Physicians, heal thy system
>> Docs, wonks and academics voice their opinions on the future of socialized medicine in Canada

by PATRICK LEJTENYI

Photos by Jason Felker

According to some, Medicare is in grave crisis, one that could eventually result in its extinction, or at least the creation of a parallel private system. But how bad is the state of our Canadian icon, really?

According to the majority of speakers at Diagnostics & Solutions: Building Consensus for Health Care Reform in Canada, a two-day conference last weekend organized by the McGill Institute for the Study of Canada, it really isn’t that bad at all.

Many speakers laid blame for Medicare’s supposed crisis on media hysteria, dogmatic right-wing ideologues and frantic cuts in budgets by provincial and federal governments desperate to balance budgets. But by tinkering with a system that works by and large well, they said, we are not only opening up our system to private sector intrusion, but also surrendering our sovereignty as a democracy to the global capitalist bugbear.

Professor Ted R. Marmor, School of Management, Yale University

“Crisis talk” would be an accurate way to describe Canadian discussion of Medicare. Looked at from the south, I would be delighted to struggle with your crisis. Looked at from afar, Canada hardly seems in crisis. I am urging the understanding that it is the media in Canada, the pressure groups in Canada and a large proportion of the politicians who have contributed collectively to the creation of a sense of crisis, even when they don’t agree on what counts as either problems to be solved or the solutions to be offered.

Roy Romanow, former premier of Saskatchewan, Royal Commission on the Future ofHealth Care in Canada.

The first of 18 public consultations begins on March 4 in Regina.
Issues of governance and leadership also figure prominently in this interim report, especially in our federal system of government in Canada. And on this point I want to mention that the corrosive and long-distance hollering that passes as federal-provincial discourse on health care (and by the way I’m not pointing fingers, I‘ve done more than my fair share of that too) is a symptom of a badly, greatly dysfunctional institutional mechanism and perhaps maybe a symptom of some more pervasive deep malaise within the body politic of Canada.

Professor Margaret Somerville, McGill Centre for Medicine, Ethics and Law, McGill University

Medicine, I believe, is one of the major value-carrying, -forming or -destroying institutions. Medicine is a replacement for religion not only as a value carrier but as a force for the creation of community and the means to experience community…
Everybody personally relates to and identifies with medicine, and it’s one of the few institutions in society where that’s true, so it’s an incredibly powerful force. The values carried with it are that we care for each other and that we’re a caring society. That’s got a correlation: if medicine doesn’t care, it means that we’re establishing a societal-level value that we’re not a caring society.

Dr. Sylvia Cruess, Department of Surgery and Centre for Medical Education, McGill University

There is a conflict in the obligations that each health professional has to the individual patient and to society as a whole. This is a conflict that has to be recognized and the policies have to allow the proper balance of patient care to take place. Our recommendation is that public policy in the health-care field has got to be evaluated not just in what it costs, but on its impact on the values of health care. And this is really what the core of the social contract is. The stakeholders are many—anybody from the public to the health-care professionals to the providers of medical supplies to interest groups to businesses and government—and they have to work together in order to develop the policy, and to look at the impact of what the policies are.

Dr. Richard Cruess, Department of Surgery and Centre for Medical Education, McGill University

It is probable that we have chosen Medicare as what defines us as Canadians in part because of the medical act itself—that the medical act is described by most objective sociologists as having some inherent value. If we’re going to have a national health scheme, we can’t totally divorce that from the value of medicine.

Sylvia and I have thought for some time that it is not morally defensible to forbid the private sector if you are unwilling to provide a functioning public sector. And an eight-week wait for an MRI is not an acceptable level of care. Now, we believe in the sustainability of our system and adequately funding and structuring it. My guess is that it’s not going to happen. I foresee an erosion, a nibbling away, a tolerance of the private sector, which is already occurring in every single province. And I think without having the debate that we’re liable to end up where we don’t want to be.

Professor Marie-Claude Prémont, Faculty of Law, McGill University

The principles of this [private-public] partnership are absolutely incompatible with the principles of our universal societal regimes. The universal public regimes, not the Quebec drug insurance one, founded on the principle of public service and financed by public taxation, represent, in my view, one of the greatest advances in our society in the 20th century, along with the adoption of the Charter of Rights and Freedoms. The present system is designed, in my opinion, to block and prevent the instituting a true universal public regime.

Professor Robert G. Evans, Centre for Health Services and Policy Research, University of British Columbia (speaking on the globalization of health care)

Economists [who support the WTO-held notion that privatization is, in and of itself, desirable and ultimately more productive] are, with confidence, willing to reach into countries, behind the borders, in order to force changes in policies, which they are quite confident, in their ignorance and arrogance, will make everybody better off. The things they are trying to achieve in the privatization of health care are absolutely nuts. But they don’t know that. And they don’t know that they don’t know that. And they carry weight in terms of coercion.
We are coming up to the fifth anniversary of the National Forum on Health’s recommendations [on the implementation of a universal pharmacare program] and can debate its merits. It is quite likely that it is no longer an option for Canadians even if 90 per cent of us think it is a good idea. It’s not an option because under NAFTA we would have to compensate the private insurance and the pharmaceutical companies for any loss of future business. Not just any fixed assets they might have to give up, but some estimate of their future business. That is a level of compensation we can’t afford, or we’re unlikely to be willing to afford. So effectively we’re foreclosed in doing something we might want to do, and we were foreclosed without anybody even thinking about it. While the forum was working and deciding this would be a good idea, this option already vanished. :