Where The Parties Stand: Health Care

Jordan For the most part, and especially when talking to Americans, Canadians are quite proud of our universal health care system. Of course it has its problems. There are wait times for procedures and consultations, and in the emergency room. Dental health is not covered. We are still chasing a National Pharma care program, and mental health and therapy are almost nonexistent if you don’t have insurance through your job. But the caveat to all of that is that if you need care, you will almost always get it immediately and you won’t ever pay for it. At least that was true until the pandemic exposed some of the cracks in our health care system for the gaping holes that they probably always were…

Clip 1 During the third wave, for example, Humber River in Etobicoke went from staffing 18 operating rooms a day down to just two. Across Ontario, hundreds of thousands of surgeries were canceled, including cardiac and cancer.

Clip 2 Alberta’s Health system grapples to care for a surge in COVID-19 hospital admissions. For brain cancer patient Eric Mulder, that now means his treatment has been delayed. “The longer the waits, the bigger the chance that it progresses further to the point where it’s virtually untreatable.”

Jordan See when everything is just fine and there’s no coronavirus stacking our land, then our health care system works. Barely, but it gets the job done. But as we’ve seen over the past year and a half, we are not prepared for the level of care Canadians need during a pandemic or in a crisis, or soon, as we age. So every party naturally is promising to do more to make it better. To fix it. What will it really take to fix Canada’s healthcare system? And what are the various parties’ actual plans for getting it done?

I’m Jordan Heath-Rawlings, this is The Big Story. Dr. Katharine Smart is the President of the Canadian Medical Association. Hello, Dr. Smart.

Dr. Smart Hello.

Jordan I want to start by asking you—as we’re talking, there are protests going on outside hospitals around Canada. Did you ever imagine you’d see that happening?

Dr. Smart I certainly did not. It’s a real low point, I think right now for everybody in health care in Canada. We’ve gone from heroes and people out supporting us, chanting for us. And now we’re facing protests, harassment, bullying. It’s a really, really sad day for Canada, I think, that this is what’s happening.

Jordan What’s happened over the past six months or a year to get us here? As you said, from banging pots and pans to having to put police outside the hospitals.

Dr. Smart I think it’s a combination of things. I think there’s no question the pandemic has taken a toll on everyone in terms of their mental wellness and their state of mind. And I think unfortunately, it’s left a proportion of our society very vulnerable to misinformation. And right now, what we’re seeing is the power of misinformation and people using social media to manipulate people against truth and science. And I think that’s what’s at the root of these protests. And I think that’s at the root of the stress that a lot of these people that are being pulled in by these forces are experiencing. So I don’t have a lot of time for the people that are spewing these lies and creating the misinformation. But I certainly really have a lot of empathy for the people that are unfortunately believing it because they’re putting themselves and their families at risk. And we’ve already seen many of these people end up in hospital and some of them have lost their lives. And that’s not what any of us in health care would ever want to see.

Jordan Well, here’s where I turn this to the campaign we’re in right now, given where we are in terms of the misinformation and disinformation that’s out there. And that is by some, at least, being politicized. What do we need to see from a federal government or specifically, I guess, from the leader of whichever party forms government to shift this back in the right direction?

Dr. Smart I think there’s a few things. I think one of the most important things is really challenging some of the narratives that are out there that are encouraging this sort of anti-science protest. One of the biggest things I’ve heard people say that I think we really need to challenge is this concept that choosing to be vaccinated or not, and choosing to follow a public health guideline or not is about personal choice and personal freedom. We’re seeing people sort of take that phrase, ‘my body, my choice’, and try to use it in this context. But I think what people really aren’t thinking about, and this is where I think we need clear leadership from our federal leaders, is that when you’re in a global pandemic of an infectious disease, the decisions each of us make aren’t only about our own personal freedoms. They’re about the impact they have on our communities. So choosing whether or not to be vaccinated goes far beyond your personal views or your personal opinions or your personal freedoms. It directly impacts the freedoms of everyone around you. And right now, what we’re seeing is that those things that are being described as personal choices are having far reaching implications in terms of how they’re impacting others. Hospitals are overwhelmed. Elective procedures are being shut down. Some places are being pushed into potential collapse of their health care system. And we’re hearing from many, many people that are being impacted by excessive wait times. Over the weekend, someone died in a waiting room in an emergency Department. People are being harassed. This is not acceptable, and this goes far beyond the concept of personal freedom. So I’d really like to see our leaders shift the dialogue to one from ‘what are our rights?’ to ‘what are our responsibilities when we live in a community and we’re facing collectively an emergency of this proportion?’

Jordan In terms of that leadership from either a party or a leader in particular. Have you heard anything that feels right to you in terms of switching that narrative from rights to responsibilities? Is there any parties that are leading the way on this?

Dr. Smart I think we’re certainly seeing some of the parties come out more with that narrative, really calling out the misinformation, calling out the perspective that choosing to be vaccinated or not is just mostly about personal rights and liberties. So I think we are definitely hearing some of the parties speak more to that. I think we’re seeing other parties that are more along the line of kind of encouraging that type of dialogue and supporting this idea of personal freedoms, which I think in this context is not really adding to the discussion. And my worry is that it increasingly polarizes people because they feel validated in that perspective. And I just think it’s a lot more complicated than that. And we really need right now to be calling on people to really consider their roles in their communities and their responsibilities to others.

Jordan Let’s talk about the platforms now because healthcare was one of the issues our listeners selected as one of the top five that they’d be voting on. And I think a lot of that sentiment comes from the fact that the pandemic exposed a lot of problems in our health care system that we might not have known or that ordinary citizens might not have known were there before it. So first of all, before we get to what the parties are promising to do, during this pandemic, what’s gone right in terms of support from the federal government, and where have they missed opportunities in terms of raising our health care system to meet the challenge?

Dr. Smart I think we’ve absolutely seen lots of challenges throughout this pandemic, but also some wins. I think the biggest win has for sure been in terms of vaccination. Our federal government was successful in getting enough vaccine for every Canadian to have two shots earlier than anticipated. And we’ve been one of the first countries to really reach the levels of vaccination that we’re seeing globally, which is fantastic. Now we’re struggling because we’ve sort of plateaued and it’s that final 15% of people and how to encourage them that’s become really challenging. So I think that’s been the biggest win.

I think the pandemic has really shown the challenges of a healthcare system that’s so divided like ours, where you have some federal roles, but also the provincial roles. And I think the federal government has struggled to create consistency across the country because we haven’t really seen any national standards in terms of public health responses in long term care. And now going into the fourth wave of the pandemic, we’re seeing completely different approaches across the country in terms of things like vaccine certificates. So I think that’s where it’s been very challenging, is that inability to create one plan for a country that’s all facing the same infectious disease. And I think that’s where we really need to see more leadership at the federal level. Part of the Canada Health Act, is that Canadians should be able to expect reasonably similar care across the country. And when we look at what’s happening with this fourth wave, that’s clearly not what’s happening. And I think there’s a role for the federal government to step in and redirect some of these provinces towards a plan that actually makes sense based on science.

Jordan That’s what I was going to ask you about, because often when we talk about federal governments and health care, we kind of get into the jurisdiction discussion of whether or not they can or can’t do this. And I guess, is that really a guiding principle, or is that a way to kind of brush the issue off or keep it to just funding? And what can the federal government do if it wants to with regards to a standard of care across the country?

Dr. Smart Well, I think the federal government definitely does have levers it can pull. We’ve seen successful federal standards on other topics such as medical assistance in dying, cannabis legislation. So I think those are examples of where we’ve had federal leadership to create one standard across the country. And those could be models of what could happen in the future. The federal government has the ability to use some of the funding they offer the provinces in a targeted way. So asking that that funding be tied to certain outcomes. They have the opportunity to ask for data driven outcomes so that there’s actually proof that the improvements that we’re looking for are actually being made. So I think there’s more opportunity there for funding to be actually linked to what provinces then do with it. So we could see more of that.

In a pandemic. Of course, there’s opportunity to consider a federal state of emergency that would also allow the federal government to provide more leadership. And if our health care system starts collapsing, that may be something that needs to be considered. So I think there’s definitely things the federal government can be doing. I think, of course, there’s also benefits of a local perspective. I mean, there’s no question that provinces have more knowledge of what some of their populations need and some of the unique demands in different parts of the country. And I think those voices are also important. But when it comes to certain things like public health standards, standards in school, approaches to things like vaccine certificates, this is where I really think having consistent federal leadership would lead to much better outcomes than what we’re seeing right now.

Jordan And this is the part where I get to ask you for your professional opinion of the platforms of the three parties. As the President of the CMA, when you look at the Liberal platform on health care, what strikes you?

Dr. Smart So we’re seeing lots of things. And I think this question really also links to how do you define health? There’s lots of things that play into health: social determinants, housing, climate change and then the system itself. I think when we look at what they’re suggesting in terms of what we would sort of think more traditionally is health, the health system. They’re talking about seeking negotiated agreements with each province and territory in terms of improving access to care. There’s some dollar commitments to help eliminate waitlists. There’s talk of money to improve access to virtual care. They’re talking about Canada health transfers directed specifically at mental health, to try to improve that, some tax breaks for health care professionals to help them set up practices and encourage them to do so. Funds directed specifically at hiring more family doctors and improving access to care. And again, some directed funds specifically for wait lists.

So I think we’ve seen the Liberal government take more the tact of tying funding to specific outcomes they want to see. One of the things that’s less clear is their commitment to permanent increases and permanent sustained funding for the Canada health transfer. That’s one of the things we’ve been calling for in our election platform. It’s clear that the federal funding to the provinces is declining. And that’s one of the things that’s impacting the provincial ability to meet the needs of Canadians as they deliver health care. So we would like to see a sustained and long term commitment to increasing the Canada health transfer to allow the provinces to actually deliver care. We’re not seeing a clear commitment to that really from any of the parties.

Jordan What about the conservative platform? I have heard and this is anecdotally and through campaign messaging that they are really proposing to increase health care funding across the board.

Dr. Smart They are. They’re talking about reinstating the health escalator that we saw before, which is a 6% per year over ten years. But then the fine print is that increased funding, we’re not really going to see that for the next five years, the funding would increase much more between the fifth and 10th year of their plan. So it’s not clear how they’re planning to improve health care in the next five years, which is a bit concerning given the wait lists that are growing and clearly, I think, the impact the pandemics had on our system. So we have some questions there about what the plan is to improve things over the next five years. They’re also talking about more sustained funding for mental health, which is great to see, because that’s an area that’s really important. And I think we need to see mental health supports brought more into the universal health care system. So it’s great to see parties talking about that. That’s very encouraging. The Conservatives definitely have the perspective of providing the funding and leaving the decision making to the provinces. So we’re seeing less talk about transfers being tied to specific programs or specific outcomes.

Jordan And what about the NDP?

Dr. Smart So the NDP, I think, has made some more sweeping promises, but we don’t have perhaps the same level of detail. So they’ve talked about creating sustained, long term, predictable funding through increasing the Canada health transfer. But we’re not sure exactly how they need to do that or what dollars they’re talking about, because we don’t have those specifics. They are also talking about working with provinces and territories to tackle wait times and improve access to primary care. Again, we don’t know exactly how they intend to do that, but they have that as a priority. They’ve recognized the need to address the human health resource gap and to make a plan to recruit and retain doctors and nurses and other health care professionals. And they’re talking about a $250,000,000 fund to address shortages of nurses and health care workers as well. They also have some broader promises in terms of increasing universal health care to include Pharma care and dental care for all Canadians.

Jordan That’s the kind of thing that sounds easy to promise and tougher to deliver.

Dr. Smart Well, I think this is the challenge with everything. We’ve got all the parties absolutely identifying health as an issue, and there’s a variety of promises coming forward. But I think our concern is every election we hear a lot about things that are going to happen in healthcare, and there’s lots to talk. And up to this point, we haven’t really seen a lot of actions. What we’d really like to see is the parties having the courage to actually start addressing the healthcare system, the challenges that are in itm and actually taking action towards change rather than just talking about it. We have many commissions, many reports sitting on shelves. We know what the issues are in the system. We know they need to be addressed. And I think now really the time is for action. So it’s great to see so many Canadians wanting to see health care prioritized, and I think the challenge is going to be holding our government accountable with actual plans to see some of the changes we need in the system come to reality.

Jordan I just want to ask you a couple more questions before I let you go. And they’re more specific things that our listeners have asked us. Does any party have a plan to address what seems like a huge and growing shortage of actual health care workers? At the beginning, we talked about how frustrating it must be for healthcare workers to have to deal with these protests, long hours, et cetera, et cetera. Are we close to a crisis? And is there anybody talking about fixing it?

Dr. Smart Yes, we absolutely are at a crisis point for sure. We have seen the NDP and the Liberals both talk about putting money into recruiting more health care professionals. The NDP has talked more specifically about funding health and human resource planning, which is one of the things we’re calling for in our election platform. Because, again, one of the challenges, we know there’s a crisis of health care workers, but we don’t have have a lot of data driven decision making in terms of exactly what health care professionals we need and where. We know we don’t have enough primary care providers. There’s 5 million Canadians without access to primary care. But what’s our specific plan to solve that? And how are we going to make those decisions?

And that’s what we would like to see from all the parties is more commitment to actually understanding this problem, taking action towards solving it. And that’s going to mean funding to recruit and retain healthcare professionals. The other piece of that is then investing in creating a system that actually allows healthcare professionals to thrive. And that’s partly what we’re seeing right now in the pandemic is how fragmented our system is, how much it does not support health care workers. And without addressing that, it’s going to be really challenging to recruit and retain healthcare workers in the future.

Jordan Considering it seems that COVID will be with us, if not as a pandemic, then endemically for some time, what needs to be done? And these are questions we got from people who either themselves or who know people who have had elective surgeries canceled amid this fourth wave, what needs to be done, and can anything be done to restructure the healthcare system so that it can handle the burden of ongoing COVID care without having to postpone elective surgeries? Which, as you know well, are not really elective for the people who need them.

Dr. Smart No, I agree. And I think that’s absolutely true. Using that word elective sort of really minimizes what people are going through. What we’re really talking about is these are not life or limb surgeries, but they’re not elective by any means.

In the short term I think it’s really challenging. There’s no real ability to massively increase the capacity of a hospital over the short term. There’s only so many beds, there’s only so many people that work there. And as long as the system is being overwhelmed with patients with COVID, that is going to push aside other forms of health care. But again, I think what’s important for people to realize is that’s not inevitable right now, we have a way to deal with that. And it’s called vaccination. Almost everyone right now utilizing the hospital, and especially ICU, are people who are unvaccinated. So if all Canadians eligible for vaccine chose to be immunized, we would not be seeing the healthcare crisis we’re seeing right now. So I think this is again why we’re really wanting more leadership and more action taken to use every lever possible to encourage and get people vaccinated, because that’s what’s really going to solve the healthcare crisis in the short term.

In the longer term, absolutely we know we need more funding. That’s one of the things that limits the amount of surgeries that can be done and the number of patients hospitals can care for. So that’s why we’re talking a lot about wanting sustained funding through the Canada Health Care Transfer to allow the provinces to upscale the resources available to deliver the healthcare locally. And then also, we do need more health care providers. Again, nurses, respiratory therapists, other healthcare professionals, physicians. They form the backbone of healthcare delivery. And if there’s not enough of those human health resources, we’ll never be able to meet the needs of our population. And we need more people. So we need a plan. We need the funding, and then we need to actually get these things moving forward so Canadians can receive the health care they need and deserve.

Jordan Dr. Smart, thank you so much for this. Last question: just in case, for someone for whom healthcare is issue number one, does the CMA have an endorsement or recommendation for any of the parties?

Dr. Smart We are not endorsing any particular party at this time, but I certainly would encourage people to speak to their MP candidates, the people running in their ridings, and ask them, ‘what action are you actually going to be taking with your party?’ Thank you, we see all the promises, but we want to know if you’re elected, what are you actually going to do? Because I think the time for just talking about health care past and we really need to see action and change.

Jordan Thank you, as always, for your wisdom on this.

Dr. Smart Thank you.

Jordan Dr. Katharine Smart, the President of the Canadian Medical Association.

That was the Big Story for more from us, including all our elections episodes, which can be found on their own special page. Head to thebigstorypodcast.ca, you can also talk to us on Twitter at @TheBigStoryFPN, and you can email us at[click here!].The Big Story can be found in any podcast player you prefer. You can also listen to us on any Smart Speaker by asking your speaker to ‘play the Big Story Podcast’.

Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.