Ready or not, a new debate about the future of health care has begun
In a year-end interview with the CBC’s Rosemary Barton last month, Prime Minister Justin Trudeau reaffirmed his view that a “long-term conversation about increasing funding to health care” should happen “when the pandemic’s over.”
But it’s not clear that date will be any time soon, and an unofficial debate about health care in Canada is already taking shape — between demands for more public funding on one side and calls for a “greater role for private health care delivery” on the other.
The strain on the Canadian system was foreseen. For example, Frances Woolley, an economist at Carleton University in Ottawa, predicted that COVID-19 would expose the fragility of the system back in March 2020. As Woolley wrote, Canada has the second-lowest number of acute care beds per capita among countries in the Organization for Economic Co-operation and Development (OECD) and nearly all of those beds tend to be filled.
While the total number of acute care beds has declined broadly across advanced economies over the last 50 years as a result of changes in technology and care, the especially low number in Canada can be traced to “a failure of funding levels to keep up with population growth,” Woolley argued.
Danyaal Raza, a family physician in Toronto and a former chair of Canadian Doctors for Medicare, made a similar case last fall. He said that when it comes to health-care costs, Canadian governments are picking up a smaller share of the bill than governments in many of our peer countries.
Greg Marchildon, executive director of the last royal commission on health care in Canada, suggests that rather than increasing the Canada Health Transfer (CHT), the primary mechanism through which the federal government funds health services at the provincial level, the government should focus on pharmacare and long-term care, which would help cover heavy costs currently being carried by the provinces.
Sean Speer, a former senior policy adviser to Stephen Harper, wrote last week that 2022 should be the year Canadians face up to the shortcomings in the health-care system and consider a greater role for private delivery. Such talk might revive a debate that played out clumsily during the last election.
In addition to that debate, expect more impassioned back-and-forth in 2022 between the provinces and Ottawa concerning the CHT.
Read the full analysis from Aaron Wherry at CBCs parliamentary bureau.
From The National
The chief of Bearskin Lake First Nation in northern Ontario is calling for more support from the Canadian government amid a COVID-19 outbreak that has affected at least half of the residents. Four Canadian Rangers are working in the community, and four more have been promised. 1:59
How the American health system is holding up compared with ours
The strain on Canadian hospitals has prompted some analysis, writes CBC’s Alex Panetta, that Canada’s more cautious attitude exhibited during the pandemic is driven by a hard practical truth that we simply can’t keep things open like the U.S. has because our health system would immediately crack.
Canada’s mostly public system has fewer hospital beds per capita than the U.S., along with many fewer nurses (though American analysts suggest a shortage existed there, too, even before the pandemic).
Given that many of Canada’s COVID-related challenges have stemmed from capacity issues, it has been tempting to consider if the country would be in a different place with bed levels seen in the U.S. that OECD data indicates are higher on average.
Michael Decter, a former deputy minister of health in Ontario and onetime chair of the Health Council of Canada, said Canadian hospitals are built to tolerate periodic overcrowding and rationing of care, with a seasonal surge that strains capacity to 110 or 120 per cent.
But Decter told CBC News that nearly two years of COVID-19 has broken the playbook because there’s been no relief. He says Canada has an overreliance on hospitals for things like day surgeries, which Decter said are handled in the U.S. at external facilities. This practice crowds hospitals, and it costs more money to do knee, hip and cataract surgeries here.
Canadian practitioners also lagged American counterparts with respect to virtual consultations, he says.
Jenna Meloche, a nurse who’s worked on both sides of the border, lamented the technology gap.
Meloche, who lives in Ontario but works at a Grand Rapids, Mich., hospital said some provincial hospitals didn’t get computerized charts until the pandemic was underway, forcing nurses to crowd around a piece of paper to read a doctor’s handwriting.
But even though OECD data shows that on average the U.S. has more bed capacity than Canada, with 50 states compared to 10 provinces and three territories, there are always exceptions to the rule.
“We are at 104 per cent [bed occupancy] right now,” said Dr. Ali Mokdad, a professor at the Institute for Health Metrics and Evaluation at the University of Washington. “We are overwhelmed by COVID patients.”
Critical care units in Massachusetts are packed and administrators have been desperately searching for beds.
The situation may get worse before it gets better. Hospitalizations have risen so far this year in most states, with 14 of them, according to one trade publication, seeing rates that have doubled to quadrupled in the past two weeks.
While it’s anecdotal, there have been fewer reports in Canada during the pandemic than the U.S. of angry patients berating hospital staff over their COVID-19 diagnosis, or demanding alternative treatments that have not been approved by government health regulators.
The American system is burdened by massive costs — related to management and litigation, time-consuming disputes between hospitals and insurance companies and the costs of frequent equipment modernization.
For all the money the U.S. spends on health care — and it’s far above other rich countries on a per capita basis — the country has unique structural and cultural challenges that converge. They include pernicious inequities in access to health care based on one’s income, concerning rates of obesity and diabetes, an opioid crisis that has been longer-lasting and more acute than in Canada and more traumatic hospital admissions as a result of gun use.
All told, it helps lead to life expectancy in the U.S. averaging four years lower than about a dozen other countries, including Canada.
For those who can’t work from home, the dangers of COVID-19 are ever present
At this point in the pandemic, B.C.-based WestJet flight attendant Crystal Hill says she no longer spends a lot of time worried about getting COVID-19 through her job that requires regular face-to-face interaction with the public
“You go to work and you understand that exposure is very likely,” she told CBC News. “Or could be very likely.
“But it has been here for two years,” said Hill. “At some point it’s almost like you have to numb yourself a little bit to it.”
Nearly two years into the pandemic, thousands of Canadian front-line workers who are unable to do their job from home continue to put themselves at greater risk of contracting COVID-19.
Toronto-based pharmacist Kyro Maseh, owner of Lawlor Pharmacy, says the stress of his job over the past couple years has him waking up multiple times a night because “there’s a million thoughts going through my head.”
He has lost weight, as well — not from dieting, but from skipping lunch. He said he simply doesn’t have the time to eat. But mostly he said he’s “livid” because he doesn’t feel the government has recognized that pharmacists are facing the same risks as other front-line health-care workers.
“We’re the ones kind of triaging, recommending, answering questions and obviously filling prescriptions,” Maseh said. “So we are the most front-line health-care professional in the Canadian health-care system. And the most accessible by far.”
In Mississauga, Ont., Canadian Tire store employee Julian Mason said for him, there’s always a concern about getting the virus and bringing it home to his family. He started a year ago and was happy to be employed, unlike many others who were losing their jobs. But he’s also a Type 1 diabetic, meaning he has a compromised immune system.
“So it’s a little scary for me to work while this is all happening,” he said.
With the increased transmissibility of Omicron, MP Brian Masse, the NDP critic for economic development, sent a letter to the heads of Canada’s biggest supermarkets last week saying workers are doing risky work and again deserve a wage premium to keep stores open and shelves stocked. Three grocery chains — Loblaws, Metro and Sobeys — ushered in a $2-an-hour pay bump in the early days of the pandemic. It was cancelled after the first wave subsided.
Back in the travel industry, Kerwin Dougan, the co-owner of Voyages G Travel in Gatineau, Que., said operators are “just trying to survive.”
Dougan and other travel agents told CBC Ottawa that, after two lean years, a combination of holiday trip cancellations, travel rules and lacklustre financial support is putting their businesses in jeopardy — just as the industry appeared to be recovering.
Most travel agents work on commission, Dougan says.
“It is going to be a devastating winter,” added Wendy Paradis, president of the Association of Canadian Travel Agencies.
Today’s graphic:
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