Canadians are delusional captives to a broken health care system. We cling to the status quo with grim complacency, comforting ourselves with the notion that it could be worse. We could wait 18 hours in a hospital emergency room and then be charged for seeing the on-call resident. We could wait nine months to see a specialist and then have to fork over a substantial co-pay. We could languish in a hospital hallway for days, waiting for a room to become available, and then have to fight with insurance for coverage for an out-of-network hospital visit.
It could be worse, we say, drearily looking south, as if anyone in Canada is actually proposing we emulate one of the worst health care systems in the world. So we settle – and wait, and suffer, and die – because at least we aren’t the United States, and at least we don’t go broke while we plead for care from a system that cannot possibly keep up.
Canada’s health care system is in crisis. In Nova Scotia, 100,000 people – the most ever – are on waiting lists for family doctors. In Ontario, patients are enduring an average wait time of 20.1 hours in emergency rooms – the longest ever recorded – before being admitted to hospital. In Newfoundland and Labrador, emergency rooms that are supposed to be open 24/7 in rural communities are closing because of staff shortages; the same thing is happening in British Columbia. In Manitoba, paramedics have been called in to help a hospital desperate for weekend staff. In Saskatchewan, overcrowding in hospitals has reached a crisis point.
These are not problems that a bump in federal funding to the provinces will fix (the premiers are asking Ottawa for a $28-billion, no-strings-attached annual increase to the Canada Health Transfer). Canada spends more proportionally than many of our peer nations on health care, yet we have poorer outcomes: fewer hospital beds per capita, longer wait times for surgeries, and fewer doctors and nurses. We are pouring money into a cumbersome, siloed, critically inefficient system, and pretending that the best solution is to continue to do so.
Professional networks have been proposing myriad remedies for years. The Ontario Medical Association, for example, released a report in February outlining how integrated ambulatory centres could be used to relieve hospital wait times. But these proposals – and government-commissioned reports on how to improve long-term care, and initiatives that challenge the limits of publicly funded health care – are no match for the awesome power of the status quo, even though the status quo is a system in crisis.
There is no one solution because the problems are multidimensional. Family doctors in Canada are overworked and underpaid, meaning fewer medical students are choosing family medicine. As a result of the shortage of family doctors, those without primary care often end up in emergency rooms, exacerbating hospital wait times. When people (usually elderly) are too sick to go home but not really sick enough to stay in hospital, they remain there, contributing to overcrowding, because we don’t have enough rehab facilities, transitory living spaces or long-term care homes to accommodate them.
The lack of integration between various elements of publicly funded health care negatively affects both the quality and cost of care. Meanwhile, archaic methods of sharing information plague the overall efficacy of the system, the result of governments of various stripes and levels neglecting it for decades. The situation will only get worse as the population ages and nurses and other professionals leave the public system in pursuit of better pay and working conditions.
What Canada needs is a top-to-bottom health care rethink. Yet we have been so conditioned to fear systemic change – so spooked by the prospect of making things worse – that we consign ourselves to the already pretty terrible. The situation is exacerbated by politicians who exploit that fear to imply that, for example, integration of private services will turn Canadian health care into something like that of the U.S. when, in practice, it will make us more like Germany or the United Kingdom. For now, only Conservative leadership candidate Jean Charest has tepidly broached the topic of scrapping some of the sacred tenets of our ineffectual health care system – but that could change, should he become leader of the Opposition, with just one well-crafted attack ad.
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