Lessons learned from the pandemic about health care

When we pull together, we can quickly achieve results that have escaped us in the past.

image: Hartford Healthcare

Some liken to being at war but I prefer to compare the pandemic response to what happened when we created universal health care.

Governments have been reluctant to implement the universal coverage of drugs in the past, but in short order we have vaccines freely available for all Canadians.

It’s that easy. A universal pharmacare program could happen, too. All it takes is the will to carry it out.

Canada has the dubious distinction of being the only country in the world with universal health care that doesn’t include prescription drugs.

Canada has been stuck in a time warp since the inception of health care. When Tommy Douglas envisioned a healthcare system in 1947, it included hospitals and then later, doctor’s services.

Other countries have moved on. New Zealand’s publicly funded system goes beyond hospital and physician care to include long-term care, mental health, physical therapy and prescription drugs.

While we like to boast of our healthcare system compared to our neighbours to the south, in reality ours is just good enough. Canada is stuck in “paradigm freeze” — good enough to prevent any major change or improvement.

The pandemic can shake us from our stupor and awaken us to the fact that a universal pharmacy program is cheaper for all, not just in the bargaining power of negotiating drug prices but in reduced healthcare costs resulting from a healthier population.

Another lesson learned was how rapid we can achieve, essentially, a basic universal wage. The Canada Emergency Response Benefit (CERB) was distributed virtually overnight.

CERB has been replaced with other programs but with the political will to make it happen, Canada could have a basic universal wage.

A reduction in poverty through a basic income could improve health. The connection is deep, say Drs. Nadine Caron and Danielle Martin:

“But, perhaps surprisingly, the experiment [CERB] that may have had the biggest impact on health during COVID-19 didn’t take place in the healthcare system at all.” (The Walrus, Jan/Feb, 2021)

The connection between finances and health is well studied. Between 1993 and 2014 in Ontario, for example, residents of the poorest areas were more than twice as likely to die from a preventable cause as those living in the wealthier neighbourhoods.

Another lesson learned was from the fewer diagnostics done during the pandemic.

On the negative side, cancelled tests meant that diseases went undetected. The B.C. Cancer agency estimates that 250 British Columbians unknowingly had silent cancers go undiagnosed as their screening mammograms, colonoscopies, and pap smears were cancelled in just the first six weeks of the pandemic.

On the positive side, many tests routinely done may be unnecessary. If all those tests are so important, why aren’t they done uniformly across Canada? Chris Simpson, a cardiologist and former president of the Canadian Medical Association, wonders:

“Why do patients in one region get these tests and procedures at higher rates than other regions?”

The simple answer may be that, like prescriptions, doctors like to order tests so as to be seen to be doing something towards patient care. All those tests may not be the best use of resources.

Canadians can be proud for pulling together during this crisis. Let’s not forget what we can accomplish.

Baby boomers’ long term care goes bust

The long term care of boomers is an unfunded liability. Unlike the Canadian Pension Plan and Old Age Security, the long term care of boomers is not funded at all. Our health care is not prepared to receive their numbers.

image: genx67.com

Other countries with similar long-term care pressures, such as Germany and Japan, have established various forms of public long-term care insurance. Not in Canada.

As it now stands, long-term care falls on the shoulders of family members who provide for 75 per cent of home-care for older Canadians, unpaid. Canadians typically don’t see the gaps in the current publicly-funded care programs until they or a family member falls through them.

Research from the National Institute on Ageing at Ryerson University shows that if Canada continues on its current track, the cost of publicly funded long-term care for seniors – including nursing homes and home care – is expected to more than triple in 30 years, rising from $22-billion to $71-billion, in today’s dollars. Authors of the research, Bonnie-Jeanne MacDonald and Michael Wolfson, warn:

“There is no special fund or program to cover the costs of long-term care in Canada. And it is not covered under the Canada Health Act in the same way as physician and hospital care (Globe and Mail, October 8, 2019).”

Canadians are dreaming if they think that our health care system can deal with the onslaught of boomers that will be falling into long term care. Hospitals are now struggling to place seniors in long-term care facilities and the wave of boomers hasn’t even hit yet.

Private long-term care insurance is available but expensive because of the low number of people buying it. It hasn’t worked here in Canada and is unlikely to work in the future.

Private long-term residences are having trouble staffing. In Kamloops, Berwick on the Park’s supportive living unit will close next year leaving 20 residents without round-the-clock care, despite the fact that residents pay $5,000/month for the service. The director of Berwick wrote to residents:

“There are significant challenges to retain healthcare staff in the current labor environment. An extraordinary amount of energy has been directed at recruitment and onboarding staff to meet the obligations to successfully operate our licensed care unit. The forward looking labor forecast indicates that these challenges will continue for the foreseeable future (Kamloops This Week, October 10, 2010)”

Even if private long-term care were available, many boomers couldn’t afford it. Debt among seniors is increasing according to Stats Canada. In 2016, the proportion of senior families with consumer and mortgage debt doubled since 1999.

Boomers have led privileged lives. They grew up during a period of increasing affluence due in part to widespread post-war government subsidies in housing and education. Baby boomers were more active and more physically fit than any preceding generation and were the first to grow up genuinely expecting the world to improve with time. While they have accumulated wealth, many boomers have lived beyond their means.

Boomers’ optimism for a better world is going to be severely tested as they age.

Canada needs to establish a new long-term social insurance program.  Given that health care is controlled by provinces, a patchwork system will be the likelihood as boomers totter into old age.

The current rickety long-term care system is not prepared for the wave of boomers.

 

 

Provincial health ministers should stop bickering

The provincial health ministers should resolve in the New Year to stop bickering, take the money from the feds, and use it as intended.

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It’s a recurring bad movie says Canadian Medical Association president Granger Avery: “The Groundhog Day-type discussions where political leaders bat around percentages and figures at meetings in hotels have to stop. Our system needs better, and most important, our citizens deserve better (Globe and Mail, Dec.19, 2016).”

The provinces have had thirteen years of increases from the feds at 6 per cent a year to improve health delivery. “The transfers have been growing quite generously,” says Livio Di Matteo, a health-care economist at Lakehead University in Thunder Bay. “If you go back to about 2007, if you look at public-health spending, which is largely provincial, it’s grown about 40 per cent. The Canada Health Transfer to the provinces has grown about 70 per cent.”

We need to spend smarter. Canada spends more on health care than Australia, for example, with poorer outcomes as measured by life expectancy and infant mortality.

The provinces have not fixed the problem during times of plenty and now are faced with problems of an aging population. In addition to increased funding at 3.5 per cent a year, the feds have offered $11.5 billion for home care and mental health. I don’t know who writes the province’s absurd scripts: let’s refuse the offer, even though it’s what we want, because we want more.

Provincial health ministers don’t get it. B.C. Health Minister Terry Lake worries that if B.C. were to take the money offered, and start home-care programs, that the programs wouldn’t be sustainable when funding dries up. That would be true if hospital costs remain the same when home-care programs are added.

Home-care programs would reduce hospital costs. Hospital beds cost $1,100 per day whereas home care is one-quarter that cost according to the Canadian Institute for Health Information. Seniors take up 85 per cent of those expensive hospital beds and one-half of them remain in beds even though they are well enough to be moved because there are no long-term care facilities or home care.

Take the money spent on hospitals and spend it in the community. That would mean that four seniors would be cared for at the same cost as one in a hospital -and they would be happier.

The politics and perception of health care would have to change. Hospitals have become a measure of a politician’s success because they are highly visible monuments to health care; something that you can be sure the B.C. minister will point to often in the campaign leading up to the provincial election next May.

It’s a problem of perception, too. Home care is virtually unseen except by the few affected. It’s hard to point to the thousands of seniors happily living at home as a measure of success. British Columbians will have to change perceptions of health, from hospitals as shrines were doctors are the high priests, to a flatter hierarchy where care is diffuse and in the hands of other professionals.

 

What Liberals say, do on health care are two different things

When you get all 10 provinces agreeing on an issue, you have to think they are on to something.  Provincial governments say that Health Care in Canada is underfunded and that the federal Liberals should pay up.

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Yet, Health Minster Rock wants to study the problem further.   If  health care was Rock’s own neglected car, he’d get out  of the car during one of its frequent breakdowns, look at  the threadbare tires and stalled engine and think, “I should  get a committee together to study this problem, or maybe  redesign the car.”  Well no, Mr.  Rock, what’s needed is  immediate repair.

To premier Mike Harris, the lack of federal funding leaves few alternatives, “Either private sector is going to have to  pay more, individuals are going to have to pay more, or  somehow or other we can run this system on far fewer dollars  than we have today”.  If it’s obvious to Harris, its obvious  to all — fund public health or expect private health care.   The Liberals talk about defending public health care but I wonder.

Oh sure, Rock berates Alberta for their proposed Bill 11 that would privatize health care.  But then the Prime Minister visits Alberta and says “I’m sure all those acts  have within them absolute adherence to the Canada Health  Act.” The message may be mixed but the intent is not.  The  Liberals intend to do precisely what Rock criticises Alberta  of doing — bring private health care to Canada.

To find what the Liberals are up to, watch what they do, not  what they say.  They cut funding to health care because, they said, we have to balance the budget.  But now that there is a surplus of $100 billion in the next five years,  they are only putting $2.5 billion back.  If the budget was  the problem, then health care funding would be restored by  now.

Trade Minister Pierre Pettigrew knows the routine.  Before the talks of the World Trade Organization in Seattle, he  publicly said over and over again that education and health  care were not on the table — he would not endanger these  valuable programs.  Canada, he said, would not be trading health care and education as part of the WTO’s General  Agreement on Trade in Services (GATS).

The GATS proposes that services such as health and education  be globally traded much the way goods are traded now. The  Americans, of course, support such a deal.  The Liberals have probably already signed agreement to the deal by now.

We don’t know exactly what Pettigrew said behind the closed  door meetings on GATS.  But we do know what the reaction of others at the table was.  Through a leaked confidential memo from David Hartridge, head of the WTO services division, a  picture of compliance appears.  The memo was obtained  by  the Canadian Centre for Policy Alternatives.

It seems that in private Minister Pettigrew wasn’t so vocal  in his defence of Canada’s public health care.  In the memo, Hartridge says that the GATS agreement was the “least  controversial element” of the Seattle agenda.  Canada’s Trade Minister apparently didn’t express opposition.

Its not just me who is suspicious. A provincial health official recently said that “there’s a deliberate federal strategy afoot to talk about things other than funding”.   The Liberals know that if they stall long enough, Canada’s health care will continue to unravel to the point where the  only solution will be private health care.  And, they can say that the WTO made them do it.

As Canadians watch health care fall apart, they are getting  more desperate.  The majority want a universal, well funded public health care system and they are willing to pay for  it.  But, failing a public health care system that works,  they will spend additional money at private clinics.

It’s only human nature: when faced with the choice of keeping their health or their money, Canadians will spend  every cent they have to buy health, even if it means that  they spend the rest of their lives poverty.  A government that plays on citizen’s basic survival fears to achieve its  own political ends is unconscionable.