Health care is the biggest issue of the election, according to polls — so why haven't the parties been talking about it?
It's the top concern in this year's federal campaign, according to a recent Ipsos-Reid poll, and is a platform plank for each of the major political parties.
But party leaders have said very little of substance about it, says Darryl LaBuick, a St. Albert doctor and board member with the Canadian Medical Association. "Nobody has really addressed the obvious problem that basically the principles of medicare are not being met today."
It's probably for strategic reasons, says John Church, a political scientist with the University of Alberta's School of Public Health and former St. Albert resident — if the parties had talked about health earlier, it would have crowded out the issue of trust.
Canadians spend about $3,500 per person on health care each year, notes the Frontier Centre for Public Policy — more than all but three of the 34 nations in its Euro-Canadian Health Consumer Index — yet comes in 25th place in that index when it comes to value for money.
Wait times for MRI and CT scans are far greater than those in European nations, which generally spend less on health per person, the group found, while public support for drug programs is far less. "Canadians are paying for a world-class health care system," the group writes, "but for a variety of reasons they are not getting one."
Accords and doctors
One place to start is the federal-provincial health accord, which is up for renewal in 2014. The Liberals, Conservatives, NDP and Greens all say they will renew the accord, with the Liberals promising to call a first ministers' summit within 60 days of taking office.
That accord, established in 2004, saw the provinces promise the federal government to fix problems such as wait times in exchange for more health dollars, says Louis Francescutti, an emergency room doctor and professor of public health at the University of Alberta.
"The system is no more fixed [now] than it was back then," he says — Canadians now wait about 96 per cent longer for elective treatments than they did in 1993, according to a 2010 study by the Fraser Institute. Federal leaders should make future health dollars contingent on meeting performance targets, he says — reducing wait times or smoking rates, for example.
The next health accord also has to address many obvious gaps in our health care system, LaBuick says. Diabetes medication is vital for survival, for example, but isn't covered by public health plans. A national drug program would be part of the solution.
Another place for reform is rural doctors. All four parties have promised to get more doctors into rural areas, with most proposing to do so by forgiving some of their student loans.
The amount of relief offered is "meaningless" to most students, Francescutti says — most doctors graduate with $250,000 in debt, and the Liberals and Conservatives would forgive up to $40,000 of it. The NDP has proposed to train up to 1,200 new doctors, he notes, but med schools don't have the capacity to train that many new students. "The proposals that they're floating are not based on the realities of today."
The problem is one of distribution, not number, he argues — we have a glut of neurosurgeons, for example, but they're all in the cities.
Doctors avoid rural areas because they're paid per patient, says Donna Wilson, a professor of nursing at the University of Alberta, and there aren't many patients in the country. "If a doctor moved out to many of the small rural areas now, they would starve." Saskatchewan and Ontario have solved this problem by using nurse practitioners instead — they're paid a salary and have many of the same skills as family doctors.
“I'm a doctor, not an octopus”
Canadians need to rethink how they approach health care, according to Church. "Their family doctor is not an octopus," and can only do so much. Canadians will have to do more to care for themselves and their family members as our population ages.
One alternative is home care. The Liberals and NDP have respectively proposed yearly tax credits of $1,350 and $1,500 for people caring for old or ill family members, and would allow people to get six months of Employment Insurance benefits — up from the current six weeks — when caring for a gravely ill relative. The Conservatives have proposed a $2,000 credit for those caring for ill relatives.
Canada should strike a national panel to see how other nations support home care, Francescutti says. France, for example, has groups of "doctors on wheels" that do regular house calls to treat patients at home instead of in a more expensive hospital.
Church and Francescutti also called for more investment in health promotion and injury prevention. Injuries cost Canada $19.8 billion a year, notes the SMARTRISK Foundation, and most of them are preventable.
Health care reform is a huge issue, LaBuick says, and leaders need to find the courage to address it. "If they wait another 10 years, the system will probably implode."
