NEWS

Liberal musings on health care

Published at www.cmaj.ca on Oct. 18, 2006.

MAJ invited the 8 contenders for the leadership of the Lib- C eral Party—Michael Ignatieff, Bob Rae, Stéphane Dion, Gerard Kennedy, Ken Dryden, Scott Brison, Joe Volpe and Martha Hall Findlay — to sketch their views on several of the more pressing policy issues facing the health care system. Curiously, while it’s often cited as the foremost issue on the minds of s

Canadians and while the system must s e r p now resolve a raft of challenges ranging a n a from a shortage of physicians to soar- C ing drug costs, health care has received Canadians may think health care is a priority issue. But the dust-ups between leader- little, if any, attention in the run-up to ship frontrunners Bob Rae, Michael Ignatieff and Stéphane Dion have primarily been the December 2nd vote in Montréal, about foreign policy during the run-up to the Liberal party’s December 2nd vote. during which roughly 5500 delegates will stamp the party’s imprimatur on a successor to the indecisive Paul Martin. than his rivals. Candidate responses can ment. Brison argued for “customized” Hall Findlay bluntly accuses her ri- be viewed at www.cmaj.ca. solutions by provinces, while Dion vals of having deliberately shied away For the most part, the contenders called it “an advantage for Canadians to from health care issues out of fear. don’t appear adverse to some measure have many provincial health systems, “Our heads are in the sand on this,” of privatization, or other forms of sys- as each one innovates and learns from she argues. “Everybody is afraid of the temic change, although they’re still the success of others.” Ignatieff and issue. They’re terrified of talking about quick to sing from the same hymnal the Hall Findlay argued more private deliv- the problems the health care system Liberal choir has used for decades to ery could yield needed cost-efficiencies. faces…. I believe in a single-tier system, cast the party as the great defender of a As a consequence of the above- but we’re losing it real fast. Yet, there universal, single-payer medicare system. mentioned Chaoulli decision, all juris- isn’t enough political will to even talk All respondents vowed to, in some dictions have, de facto, been forced to about it.” manner, invigorate the federal role in move toward the establishment of wait That proposition is partially borne health care, although some appeared time guarantees. They are now con- out by the fact that two contenders — more vigorous in their enthusiasm than templating forms of publicly funded Kennedy and Volpe— opted not to par- others. Asked what specific role the recourse mechanisms for Canadians ticipate in the CMAJ survey, despite private sector has in the aftermath of lingering on wait lists, particularly as having had more than a month to for- the 2005 Supreme Court of Canada the first nationwide effort to compare mulate their responses. Neither the for- landmark ruling that Quebec’s ban on wait times suggests it’s all but impos- mer Ontario education minister nor the private health insurance for medically sible to ascertain whether the situation ex-federal Immigration minister mus- necessary services violated provincial is improving, even in the so-called pri- tered any form of explanation for their human rights law (CMAJ 2006;175:17- ority areas of cancer, heart, diagnostic decisions. 8), none expressed outright opposition imaging, joint replacements and sight Of the candidates who responded, to privatization except for Dryden, who restoration (CMAJ 2006;174:1246-7). Rae has clearly done the most thinking stood staunchly against “private health Asked how the determination should on health care and, as the only one who insurance coverage or private service be made as to when such a recourse has issued a health policy paper as of the delivery by physicians.” Rae essentially mechanism kicks in, most candidates CMAJ’s press deadline, appears to have ducked the issue, but others were more either ducked the issue or deferred it to more detailed and nuanced positions sympathetic to private sector involve- the relentless rubicon of Canadian poli-

CMAJ • November 7, 2006 • 175(10) | 1189 © 2006 CMA Media Inc. or its licensors News

tics: intergovernmental consultations. ical graduates (IMGs). Rae and Hall the notion had any merit whatsoever. Dryden noted that physicians should Findlay urged measures to ease physi- They were equally tepid about the have a role to play in determining cian workloads by off-loading selective creation of a national pharmacare plan, whether a provincial system can’t pro- duties onto the shoulders of “specialty although Liberals have toyed with the vide timely care, but only Rae offered a trained health care professionals.” Dry- idea since Mr. Justice Emmett Hall’s specific mechanism, calling for the es- den and Brison urged the creation of 1964 Royal Commission on Health Ser- tablishment of a “swift response om- some form of health human resources vices recommended that medicare be budsperson for patients,” as well as the planning body or framework. Ignatieff gradually expanded to include prescrip- adoption of federal Wait Times Advisor took the ambiguous position that “any tion drugs. Such a plan was also the Dr. Brian Postl’s recommendation that reforms of the health care system can- centerpiece of the 1997 final report of regional centres of excellence be estab- not create financial disincentives for the National Forum on Health, a blue- lished to handle “backlogs and bottle- physicians to practice.” ribbon panel appointed by three-term necks.” Hall Findlay rejected the entire The respondents had conflicting Prime Minister Jean Chrétien, but the notion of guarantees as a “politically views in regard to proposed revisions Liberals deep-sixed it for a more mod- motivated, expensive band aid” that to the existing process for assessing est approach that provides assistance wastes resources. The real solution lies and licensing both Canadian-trained only for so-called “catastrophic” drug in “more trained personnel, more graduates and IMGs, although a blue- costs for families. The current crop of equipment, and the efficient allocation ribbon panel struck to resolve means of leadership contenders favours contin- of both.” Ignatieff hedged, noting that alleviating the shortage of physicians in ued incrementalism, with only Rae and while he believes in guarantees, “shut- Canada urged that a national agency be Ignatieff expressing unequivocal sup- tling patients around the country is not a established to oversee a comprehensive port for a full-scale national plan, even- viable long-term solution.” “pan-Canadian” strategy for educating, tually. Ignatieff posited that a national With delegates to the CMA general recruiting and licensing doctors (CMAJ plan would reduce costs by “allowing council in Charlottetown earlier this 2006;174:1827-8). Among measures bulk drug purchases.” He also urged year having urged governments to re- urged by Task Force Two were harmo- creation of a national drug formulary. move existing prohibitions against si- nized licensure of new graduates, stan- Although other health issues have multaneous practice in both the public dardized revalidation of existing and rarely registered on the campaign radar and private sectors (forcing physicians international physicians, and a national screen, they’ve made an occasional blip. who bill patients for necessary medical repository. Brison definitely favours a Among specific commitments were services to opt out of the public system), national approach, and even a multilat- ones by Rae, Dion and Ignatieff to bol- the candidates were asked whether they eral international regime, but Rae fears ster health and biomedical research believe such bans should be lifted. All it would step on provincial toes. Hall funding at the Canadian Institutes of but Brison were staunchly opposed, pri- Findlay and Ignatieff believed it unnec- Health Research. Canada must be “a marily on the grounds that the current essary bureaucracy. leader, not a laggard in such research,” Rae said. Rae, Dion and Ignatieff have made “Our heads are in the sand on this. some form of commitment to resurrect ParticipACTION, the now-defunct fed- eral fitness program, so as to promote Everybody is afraid of the issue. healthier lifestyles and ultimately re- duce the financial strains on the system. They’re terrified of talking about Rae and Dion have vowed to bolster spending on measures to improve Abo- riginal health, with Rae being the most the problems the health care system specific in calling for adoption of the Population Health Strategy recom- faces.” - Martha Hall Findlay mended by the Health Council of Canada, which included calls for major investments in programs to prevent shortage of physicians precludes allow- The respondents were less than en- and manage chronic diseases. ing such parallel practice without seri- amoured with the notion of establishing Dion has also advocated “a better drug ously compromising the public system. an arm’s-length national patient safety approval process, and better international Asked how the shortage should be agency that would investigate mishaps cooperation on dealing with pandemics resolved, the respondents universally and recommend regulatory or process that we must prevent in Canada. We need agreed that more entry spaces should interventions to improve safety, as rec- to strengthen our public health agency.” be created in medical schools, while ommended in a Health Canada commis- — Wayne Kondro, CMAJ there should be accelerated recognition sioned report earlier this year (CMAJ of the credentials of international med- 2006;174:1699-700). Only Rae thought DOI:10.1503/cmaj.061399

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