Jordan: When voters say that Healthcare is their top priority in this election and a lot of them do what are they really saying? First of all, is it just a reflex? Because Canadians derive a big part of our national identity from universal healthcare. It is a thing that we have an America doesn’t. The father of our Healthcare System was named the greatest Canadian of all time go and pose a question about Canadians experience with their Health Care on social media and you will be flooded with anecdotes.
Most of them wonderful a few of them horrifying about people’s experiences in our hospitals and doctors offices and the easiest way to understand why we’re so passionate about our health care is to listen to Americans talk about.
News Clip: If there’s one thing that no one can agree on in Washington. It’s a health care plan. But everyone does have an opinion including those who say Canada should be our role model. You have a nation bordering on the United States two Nations that are probably as close together in so many respects as any two nations in the world a conservative prime minister and yet there is no effort to move to an American Healthcare System. I would say to my colleagues there’s not a better example.
Jordan: So yes Canadians care about this issue. It is top of mind. It’s clearly a passion, but does it matter? And a federal election and if so how much because here’s the thing while Federal elections might help shape the big picture long-term vision of Health Care in Canada.
That’s a very different thing from the healthcare. Most Canadians are talking about when you ask them what they love or hate about our system and what government should do to fix it. I’m Jordan Heath Rawlings. This is the big story and there are four days to go before Canada votes Andre Picard is a health reporter with the Globe and Mail.
Hey Andre.
Andre: Hi
Jordan: When Canadians site Health Care as their top issue and a lot of them have in this election and others. What are they typically talking about? What are they referring to?
Andre: I think when people talk about health care, they are thinking about access to healthcare. So getting the care that they need promptly and in an affordable Manner and a decent, you know being treated decently so I think it’s about access more than anything else.
Jordan: And how much of a role because what we’re trying to understand is of the promises made over the last few weeks what will actually have an impact in Canadian.
So how much of a role does the federal government actually play in providing sort of the on-the-ground access Services you mentioned.
Andre: Yeah, so they don’t play a large role for most Canadians Healthcare deliveries provincial the federal government’s responsible for delivery. But with fairly specific audiences the indigenous population the Armed Forces RCMP prisoners, so Ottawa has some delivery but it’s a very specific groups.
Jordan: So what does Ottawa do then in terms of delivering Healthcare to you know, the average voter in a province where? Their provincial government is by and large looking after their health care because they seem to care people seem to care a lot about what Ottawa can and doesn’t do.
Andre: Yeah, so what’s the people are not always clear on that division of powers, but what has two major roles for most people and one of them is the transfer of money.
So they fund Health Care to about 20 22 percent now of healthcare is funded federally so their transfer is about 40 billion dollars a year to the provinces. So that’s the main role and then the second role which is one that. The party’s debate among themselves. He’s trying to influence provincial policy with that money.
So do you target the money or do you just write a check and say the province’s do as you wish and that’s where the differences.
Jordan: With that in mind then what are some of the biggest differences between the proposals from the various parties?
Andre: I think if you look at the big issue in health care, these days is pharmacare. So we’ve been talking about this for many years. So I think the promises have come or lack of promises that revolved around that so the the NDP and the greens. Both made massive pharmacare promises are going to have a national pharmacare program funded Coast-to-Coast about 10 billion dollars a year as much as twenty seven billion dollars up front.
So you massive Investments. So that’s the big one for the the smaller. You know MVP greens parties at probably don’t have a lot of chance of governing so they can make these wild promises right? Then we go to the then we go to the liberals who actually taking a very cautious approach. They say they’re going to spend 60 billion dollars over four years on health issues with.
Pharmacare being the primary one. So they say they want to kick-start the idea of a national program and the conservatives actually want nothing to do with pharmacare their philosophical belief. Is that a provincial jurisdiction and they should stay out of it. So that’s the big one.
Jordan: What about in terms of the transfer payments to provinces this is this basically every party promising. Keep them the same or increase them.
Andre: Yeah, that’s a good example of why do we don’t have a lot of Health Care discussion in the federal election is there’s violent agreement among the parties that they’re all going to do exactly the same thing. So they’ve all promised to increase transfer payments help the health transfer by three percent a year.
So nothing to debate there among them were whether that’s a good number or not is, you know for Canadians to decide but they’ve all said a promise the same thing
Jordan: How do the parties themselves use? The fact that Canadians cite Healthcare is an issue among themselves when they’re campaigning.
Andre: Well Healthcare is federally is just sort of a rhetorical device everyone loves Medicare, you know, it’s almost our religion and you’ll hear that in passing, you know during the leaders debate. There’s actually noteworthy. There is no health section in the debates and that was telling but of course everybody got in there there mention of how they love Medicare and they’re going to protect that sorted mean fairly vague terms. The discussion takes to tends to take place.
Jordan: I feel like I’ve heard a lot of rhetoric provincially for sure with a lot of governments moving conservative provincially, but also in this campaign about how the conservatives will move towards privatization and I don’t think that any of. Conservative proposals actually do that am I right?
Andre: I right no nothing that they say explicitly and they are very careful to say that they’re not interested in that and I think that’s that’s true Canadians are to have this dislike for the notion of privatization, even though we have you know, the paradoxes we have a lot of Private health care in Canada more than most countries, but we have this notion that we don’t like it.
So no government nobody who wants to get it. Is going to come out and say yeah, we want to privatize hospitals or have doctors that you pay for the conservatives are not saying that and neither has anyone else. The closest is the People’s Party The Fairly marginal party Maxime Bernier. They are saying they want more private health care, but beyond that no one else really talking about
Jordan: When we talk about promising more private health care.
What would actually be available in Canada? Like how. How set in stone is our universal healthcare and what could governments do to get around it?
Andre: Well, what we have in Canada is a system that quite out of date. So it was created in the 60s where the where hospital and Physician Services are a hundred percent publicly funded and then everything else is in there covered under the legislation.
So there’s not really any private care in those domains is no private hospitals in Canada. There’s no very. Private delivery of Medical Care there’s some exceptions but those are almost a hundred percent private and then everything else is all over the map. So we have tons of private drug plans physiotherapy hearing aids Dental.
All this stuff is is private to varying degrees and that’s very different from other countries. So, you know when we talk about this this rhetoric about privatization, it doesn’t really mean anything unless you talk about specifics.
Jordan: In terms of specifics Beyond Pharmacare. Are there any other ways that any other things I guess that voters who would rank Healthcare is their top priority should be paying attention to when they look at the platforms.
Andre: Well, I think there’s a large absence of talk about long-term care seniors care. So that’s a big issue until we talk about. Potentially in Ontario or they use the terminology hallway medicine. There’s all this waiting in the system and know that the problem is not its Upstream. So we just don’t have a place for people who are older and frail and need care.
We don’t have places for them in the community. So they end up in hospitals and it just creates this this log jams. I think we’ve really missed out on this serious discussion and how we can fund a longer term care how we can keep people in the community and I think there’s a lot of opportunity there for the parties, but she chose not to go there.
Unfortunately–
Jordan: How dire is that situation? I mean, we’ve done a couple of podcasts about various provinces and aging population and its impact on infrastructure has come up a few times.
Andre: So it’s a massive problem just in Ontario alone. I think the last numbers I saw there’s about 35,000 people on the wait list for a long-term care beds.
So it’s not it’s a massive problem and predicts. It’s like many things it’s odd that it’s not getting discussed at any any serious way.
Jordan: Well, one of the other things that I want to ask you it’s kind of adjacent to that is as you’ve done some work and I’ve seen some stuff elsewhere about. Issues that are adjacent to healthcare that aren’t technically included in that.
So for instance, you wrote a piece recently about homelessness and how `and the role it plays in our Healthcare System.
Andre: Yeah. So the reality is most things that impact our health have nothing to do with medicine that have to do with income transfers, you know, basic income housing education and you know, we talked at the outset.
We don’t talk a lot about health during Federal campaigns. But we don’t talk at all about social services and those are what really impact the health of the population more broadly. So that’s another area. That’s really quite neglected. The only thing every song in the campaigns in the promises with the NDP made it quite a large promise of 13 billion dollars for affordable housing.
So for social housing and that that significant the Liberals have invested in this over the last few years, but. As far as I know they haven’t made any new big promises
Jordan: What happens in regard to homelessness and its impact on the healthcare system that could potentially save us a lot of money.
Andre: Well, you know, it’s very very costly to have someone living on the street. They use kind of all kinds of other social services emergency room shelters Etc. So I was just writing recently about some research that showed a homeless person. You’ll see sleeping on a great in Toronto that person will cost this the Social Services System about a hundred and sixty thousand dollars a year.
So the question becomes how can we spend that money more wisely to make their lives better and you know. Many ways and one of them the main one is this philosophy called housing first. If you give someone a home somewhere to live it’s much easier to start dealing with the the other problems. They may have a substance use disorder mental illness.
It’s hard to treat any of those things. If you don’t even have a roof over your head or anywhere anything to eat.
Jordan: How come this isn’t part of the health care debate of so much money is going to taking care of these folks and we’re also fretting about hallway medicine at the same time. This clogs the system too.
Andre: Yeah, so why isn’t it a bigger discussion? I think it’s you know, we get it caught up in minutia. A lot of that is seen as provincial issues. So as we kind of sidestep it and I think the other thing is these are very complex issues. There’s not. An easy solution, you know, I can write the solution to homelessness is housing and that’s true.
But beyond that there’s a lot of stuff that has to be done. We have to figure out why are people on the streets? How do we treat their mental illnesses? These are very complex issues. They don’t lend themselves well to sound bites during an election campaign.
Jordan: If there was one issue in particular related to healthcare and the work in reporting you’ve done that you wish Canadians understood better when they’re trying to decide who to vote for what would it be?
Andre: Oh boy. Well, I guess I wish that they understood the system better that they just didn’t fall for this bland rhetoric about you know, Private is bad public is good. We all love Medicare because it’s you know, it’s a mixed system. It’s very complex mixture in this campaign in particular. I think the the other issue that we didn’t talk about that’s really been neglected is the opioid crisis. So the worst Public Health disaster in Canada in many decades thousands of people dying a year and you know, each party has made some minor promises to spend more money, but. Pretty no discussion. I didn’t hear the word opioids come up during any of the leaders debates.
And this is a severe public health problem that we haven’t seen for forever. And it’s unfortunate. They’re just saying that we’re going to spend a little bit more money to do what we’re doing now, which is not working tremendously.
Jordan: Well that was on my list to ask you about because we’ve talked to people across the country and the impact in neighborhoods has been tremendous and yet I can’t remember a single, you know new policy proposal through this entire campaign.
Andre: Yes, I think as far as I what I looked up each of the parties has promised to spend some money on dealing with the opioid issue the Liberals again have done a fair bit in the last few years if they come a long way, but.
You know we still this is not being treated as the crisis that it is the greens that said they want to decriminalize all drugs. So that’s the most radical policy. I’ve proposal I’ve seen but it’s one that many academics a is ultimately the solution, you know, as long as until we have safe drugs on the streets people are going to keep dying and.
Good conservatives at the other end of the spectrum feel that that’s enabling people with drug use if they’re elected people fear. They may try and shut down some of the supervised injection sites Etc. So again, there should be fodder for debate there because there are major differences, but we just don’t seem to get to that in the campaign.
Jordan: We talked to Mike Eppel who’s a business reporter yesterday about affordability is an issue. And one of the things he was kind of grappling with is the idea of things like Pharmacare which would potentially help. A lot of people save money in the long run would not necessarily help balance any budget whatsoever in the short-term and the policies you’re talking about with regards to homelessness and kind of preventative care seem. Very similar in that we’re trying to we’re trying to talk to people about long-term impact of something that they’re feeling right now. And I wonder how do you broaden the health care discussion so that it becomes more than wait times or the service? I’m getting on the ground when I go to the doctor.
Andre: Yeah, I think that we have to have the discussion of on a couple of levels one is were paying for this. You know, we’re paying for homelessness. We’re paying for lack of affordable housing and the question is do we want to pay it from? Our left pocket to the public treasury or do we want to pay it from the right pocket privately.
So we’re going to pay for these issues one way or another so we have to figure out how to do it. What’s most effective what will give us the best bang for the buck other countries when I look at European countries, they invest more in you know, the collectivity spend more on social programs and less on on sickness care so in Canada.
Tend to let people degenerated and get sick and then we treat them really well, but you know, we have too many of them to treat so they fill our hallways. So how do we invest in that prevention? And then I think the larger philosophical issue is the one I mentioned in passing we do we believe in the collectivities first started.
We believe in individual. The individuality first and sort of and Canada’s kind of smudge between that us, you know, the individual reign supreme and the European or Nordic view of the collectivities important and we’re we kind of are on the fence and we we do need their well, so that’s I think our Challenger as a country philosophically is where we have to figure out where we sit on the Spectrum
Jordan: Right and how do we currently stack up against other countries with universal medicine?
Andre: Well, we spend far less than most countries on public health care. So we have as I mentioned in passing before we spend a lot on private care, although we seek we don’t so we don’t spend our tax dollars as wisely as other countries.
I don’t think and then the big difference is not so much health care, but it’s social services. So I take a country like. Denmark 27 percent of their GDP is simply spent on social services. So social housing Etc and in candidates only thirteen percent. So not surprisingly Denmark has better health outcomes.
They have lower Health spending because they make sure people are healthy and and taken care of in the in the first place. But again, it it all comes down to a philosophical view that people feel a responsibility for those around them more than we do here, you know the notion of someone sleeping on a grate. I can’t imagine ever seen that in Copenhagen to be honest.
Jordan: Thanks Andre. Andre Picard, Health reporter at the Globe and Mail. That was the Big Story. You want more they are all at thebigstorypodcast.ca Including countless election episodes. You can also talk to us about all things election. And please got other things to at @thebigstoryfpn. We’d love to hear from you and you can rate and review Us in the Apple Store.
You can also find us absolutely everywhere. Your favourite podcasts are distributed. That’s Apple and Google and Stitcher and Spotify and pod-catcher. Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk more politics tomorrow.
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