Month: January 2023

A crumbling health care system cracks at the very foundation of not only this country but who we are as a people.

Saints, it has been said, are the sinners who kept on trying.

For first ministers across Canada, their road to redemption may well run through Feb. 7. That’s when Prime Minister Justin Trudeau and premiers will gather to start negotiating a new deal on the federal government’s funding for health services.

Hope, for this reason, is in the air as a sense that previously insurmountable differences will — at last — be cast aside for the greater good. And yet, many can only muster the most cautious sense of optimism. Because, let’s face it, Canadians have been let down on this issue countless times before. Politics has interfered; talking points have prevailed.

As a result, our health care system is now beyond the breaking point. Patients are suffering. Doctors and nurses are exhausted and burnt-out. Wait-lists are surging. Innovation is stalling and investment is falling to dangerous levels.

What most of us feel, at best, is hope of a kind: like the branch you cling to before the current carries you over the falls. The reality is this: none of the significant problems in our health care system will fully get fixed until the federal government returns to its role and pays its share. Point finale.

While there are few reference points for the kind of selfless political leadership required to solve the health care crisis, one does come to mind: the efforts to patriate the Constitution and entrench the Charter of Rights and Freedoms in the early 1980s.

Memorably, Bill Davis played a leading role in negotiations between the provinces and federal government, helping to bring his fellow premiers into the fold through skilful diplomacy and good old fashioned Canadian compromise. This struggle would cost Davis politically. His support for Pierre Trudeau’s ambitions upset not only his federal cousins but his own caucus. And yet, today, his contributions are universally celebrated. Why? Because he put the good of his country ahead of partisanship.

In negotiating the future of health care in Canada, Davis’s successors should replicate his example. And there are signs this just might happen. When The Star’s Susan Delacourt recently asked the prime minister about Premier Doug Ford’s plans to clear Ontario’s surgery backlog by delivering more operations through private clinics, he chose to call it “innovation.”

Make no mistake, Trudeau’s answer was a momentous break with decades of orthodoxy. But the cliché that politics makes strange bedfellows is a cliché for a reason. The PM well understands that there is no deal if the lines of distinction are drawn too sharply before formal negotiations even begin. Crucially, he recognizes that Ford will be a vital partner in this upcoming negotiation and, that with Ontario’s support, he has a powerful ally in bringing other provinces along.

Some opposition parties will, predictably, try to upset progress. NDP leader Jagmeet Singh, desperate for oxygen, has said he’ll consider pulling support for the Liberals if they do not insist on no-privatization conditions for health care funding. While that might be in his narrow political interests, this is not the time for such considerations.

All of which is not to deny that getting this right will be a win for those who do, which raises the question of legacy, specifically the prime minister’s. Achieving this deal will produce very close to immediate results.

A crumbling health care system cracks at the very foundation of not only this country but who we are as a people. So the point is this: It won’t matter if Trudeau puts a Canadian on the moon. His accomplishments will count for nothing if he misses this once-in-his-premiership shot to repair our national foundation. If he does miss, his legacy is in deep trouble. But if he makes this crucial fix, his legacy will have a new cornerstone.

Make no mistake, Trudeau’s answer was a momentous break with decades of orthodoxy. But the cliché that politics makes strange bedfellows is a cliché for a reason. The PM well understands that there is no deal if the lines of distinction are drawn too sharply before formal negotiations even begin. Crucially, he recognizes that Ford will be a vital partner in this upcoming negotiation and, that with Ontario’s support, he has a powerful ally in bringing other provinces along.

Some opposition parties will, predictably, try to upset progress. NDP leader Jagmeet Singh, desperate for oxygen, has said he’ll consider pulling support for the Liberals if they do not insist on no-privatization conditions for health care funding. While that might be in his narrow political interests, this is not the time for such considerations.

All of which is not to deny that getting this right will be a win for those who do, which raises the question of legacy, specifically the prime minister’s. Achieving this deal will produce very close to immediate results.

A crumbling health care system cracks at the very foundation of not only this country but who we are as a people. So the point is this: It won’t matter if Trudeau puts a Canadian on the moon. His accomplishments will count for nothing if he misses this once-in-his-premiership shot to repair our national foundation. If he does miss, his legacy is in deep trouble. But if he makes this crucial fix, his legacy will have a new cornerstone.

This article first appeared in the Toronto Star on January 30, 2023.

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Politicians and other policymakers have figured out that private participation in a public health care system is no longer the bogeyman.

A fearlessly pragmatic intervention or a desecration of our national fabric and everything we hold dear?

A slippery slope certain to trigger a mass exodus of public health care workers or an innovative plan to boost collaboration and ease the burden across a strained-to-the-breaking point sector?

Or, finally, rerouting water away from the dam (to steal Premier Doug Ford’s metaphor), or a short-sighted stopgap that will only delay a greater flood? The spin lines are drawn in predictably binary and deeply unenlightening ways.

The truth is that, however you slice it, last week’s announcement by the Ford government of a multi-phased plan to fund for-profit clinics will fundamentally reshape Ontario’s health care landscape.

We are now firmly on the road toward significantly greater private participation in our health care system. The questions are: will it work and will Ontarians and Canadians support it? The Ford government is banking that the answers will be yes and yes.

Facing an avalanche of criticism, the government has decided the best way to reduce wait times is to expand the role of private clinics to provide a series of diagnostic and surgical procedures paid for by OHIP.

Ontario is not alone in taking this approach. Confronting its own dire challenges, Quebec, too, has started to make this pivot. In September, the Coalition Avenir Québec announced plans to open one-stop-shop medical facilities in Montreal and Quebec City, privately owned and built, but publicly funded. Meanwhile, British Columbia, Alberta and Saskatchewan have made progress in reducing their surgical backlogs by implementing community-based models for procedures.

Some will say that this turn to privatization carries with it significant risk. These critics imagine the Ford government’s plan might lead to labour shortages in the public sector. Of course, introducing substantial change into a bureaucratic system as dense and complex as health care will be no easy challenge. But the risk of being perceived to do nothing — that is, to accept the status quo — is much, much greater.

On this front, Navigator’s most recent research on the views Canadians hold about the health care landscape is extremely revealing. For decades, conventional wisdom has held that changing the status quo in health care has been the third rail of Canadian politics.

But our data indicates this is simply no longer true. Indeed, more than half of Canadians (58 per cent) believe that the sector’s backlog is so urgent that change is necessary, even if this means allowing the private sector to play a more significant role.

Politicians and other policymakers are finally figuring out that private participation in a public health care system is no longer the great bogeyman it was once held to be; rather, many Canadians now see it as a vital tool in the delivery of services that will meet their needs.

It speaks volumes that, to this day, many politicians still run for their lives from this subject. Or worse, still think that airing blanket criticisms will fare better than proposing concrete solutions. But, as the events of recent months have shown, governments are waking up to the crucial and increasingly unavoidable point that many Canadians see privatization measures as realistic and even promising.

So here’s how I see it: Health care in Canada is at a tipping point and an expanded role for private health care providers, universally covered, has been the logical solution staring us in the face for the better part of a generation.

(While my opinions are my own, readers should know my colleagues have lobbied on behalf of organizations in the health care sector including medical professionals, hospitals and companies).

With more people suffering as a result of our overburdened system each passing day, with delays piled on delays as a result of COVID, governments can no longer afford to simply avoid or ignore this solution.

The reverse of what was so long held as unthinkable in Canadian political life is now true: embracing private health-care delivery, paid for by the public purse, is not only politically necessary but has become politically advantageous.

This article first appeared in the Toronto Star on January 25, 2023.

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