The key for good leadership, according to the experts, is a balance between abstract thinking and empathetic engagement. The problem with power is that it tips the scale toward abstract thinking and less towards empathetic engagement. Those in power, most often, feel very little towards those most impacted by their decisions.

Updating medicare is complex, the ability utilises abstract reasoning. The healthcare system problem has elements of a wicked problem. That is not easily resolved because of the trade offs involved.

The first step in the process is to understand the many aspects of the problem. It is obvious that medicare is not working. The plan was developed in the 1960’s and 1970’s for a very different world.

The system is in chaos. There are big capacity constraints. The system is not sustainable. There are a lot of very unhappy consumers of healthcare. Many Canadians are leaving the country for care. 

The objectives of updating medicare have to be clearly understood. One way to approach what might be acceptable today might be to look at the structure of two new programmes Canadian pharmacare and the Canadian dental care plan. 

The Canadian Dental Care Plan could eventually provide dental insurance for about 9,000,000+ Canadians.

Under the Canadian Dental Care Plan , medically necessary dental services will not be 100-per-cent covered. 

There will not only be means testing (wherein eligibility depends on family income) and a co-pay of 40 percent to 60 percent, which is again income-dependent. 

Furthermore, the 50 per cent of Canadians who already have employer-sponsored dental insurance will not be eligible. 

Finally, the administration of the plan has been contracted out to a private insurance company, Sun Life.

With these two programmes, Canada could see a big shift in spending from private insurers to public insurers, at a substantial cost.

The Pharmacare Act will almost certainly have a means test and copays and other limits on who is eligible, which will almost certainly not include the more than 70 per cent of Canadians who already have private drug insurance. Unless employers cancel their private drug plans.

What these new programs do, with their means tests, mixed payment models and limits on who is covered, is raise important questions that relate to how medicare could be updated. 

If it’s acceptable to expect a good portion of Canadians to pay for prescription drugs and dental care privately, then why isn’t it acceptable for them to also do so for hospital and physician care? 

That is the wicked problem confronting those who are leading or should be leading in the updating of medicare.  It is about time.