Juno News - Canada’s socialized healthcare system is at the center of our failed COVID policies

00:00:00.320 COVID tested the limits and exposed the fatal flaws in Canada's centrally planned socialized

00:00:06.400 health care system. It failed to deliver results to Canadians, and it is bankrupting our country.

00:00:11.600 Let's talk about ways to improve the system. I'm Candice Malcolm, and this is The Candice Malcolm

00:00:15.120 Show. Hi, everyone. Thank you so much for tuning in. Now, I know that there is a huge rally going

00:00:25.200 on in Ottawa that the protests have moved to provincial capitals all over the world, and it

00:00:30.560 is really exciting. We're going to continue to provide wall-to-wall coverage of that over at TNC.

00:00:35.600 But I wanted to focus in on something else that has become so apparent and so problematic during

00:00:41.520 the course of the pandemic, and that is the failure of our health care system. We have seen it in so

00:00:46.480 many regards, manifest in so many ways. It is connected to the trucker protest because the

00:00:51.520 mandates are by and large caused because of the shortages in our health care system. If we had

00:00:56.720 a robust, thorough system that allowed for a lot more capacity for people to go into ICUs when

00:01:06.080 necessary, we wouldn't have to lock down. We wouldn't have all of these lockdowns that have

00:01:09.680 destroyed our society over the last two years. Just look at a place like Florida that has huge ICU

00:01:14.000 capacity and they haven't had to have the same kind of lockdown. So our health care system is really at

00:01:18.560 the center of this, and it is so important for us to talk about these issues, address them. And for

00:01:23.600 people who oppose the Liberal government and want to have a better country, a better Canada, it's up to

00:01:29.040 us to come up with ideas and solutions as to how we can improve the system to benefit all Canadians. So

00:01:34.800 to do that today, I'm really pleased to be joined by my friend, Dr. Sean Watley. Sean is a rural family

00:01:40.320 doctor based in Mount Albert, Ontario. He's the author of When Politics Comes Before Patients,

00:01:45.040 Why and How Canadian Metal Care is Failing. And he's a Monk Senior Fellow over at the

00:01:51.200 Macdonald Laurier Institute. He's spent the last 20 years serving various leadership roles on a number

00:01:56.560 of boards and he's the past president of the Ontario Medical Association show. Sean, welcome to True

00:02:02.400 North. Welcome to the Canada's Malcolm Show. Thank you so much for joining us today. Thanks for having me.

00:02:05.600 So you recently wrote this great column over in the National Post. The column was titled,

00:02:10.880 Canada's More With Less Approach to Healthcare Has Failed Us. So why don't you give us a little

00:02:16.320 overview? What do you mean by that, the more with less approach? Yeah, so thank you. The gist of it

00:02:22.640 is that within healthcare itself, so I served a number of years as a hospital administrator,

00:02:28.320 and every administrator needs to know what you have to do to get ahead. What do you have to do to make

00:02:33.440 the hospital board happy with you? What do you have to do to make the Ministry of Health happy with you?

00:02:36.960 And one of the guaranteed paths to success is to try to provide care to more patients, better care to

00:02:45.520 more patients, improve your level of service without spending more money. So that's always the key. How

00:02:50.880 can we not increase hospital budgets and yet stretch out what we're doing more and more? And so we get

00:02:56.400 thinner and thinner. In a previous book, I talked about our lack of resilience that gets baked into the

00:03:01.760 system. But the paradox of it is that despite the fact that we're trying so desperately to provide

00:03:09.840 more care without spending less, sort of this more with less approach, we actually end up spending more.

00:03:16.800 So we cut beds, we decrease services, and so we end up with less care for a higher price tag. So we end up

00:03:24.400 with less for more, despite trying to do more with less. Well, so it's interesting, I'll just pull a

00:03:32.080 line from your column because you have this information really detailed out. So you said

00:03:37.520 that this is talking about the province of Ontario. So in 1990, Ontario had 33,000 acute care hospital

00:03:43.840 beds, or that's the equivalent of 3.2 per thousand population and healthcare spending represented 8.3%

00:03:50.320 of the province's GDP. Fast forward to 2017, so 27 years later, Ontario had fallen to 18,500 beds,

00:03:58.560 down from 33,400 down to 18,500. That's nearly, that's almost cut in half. That equates to 1.3

00:04:07.760 beds per thousand populations, because the population is growing at the same time.

00:04:11.600 Meanwhile, healthcare spending rose to 11.3% of the GDP. How is that possible, Sean,

00:04:17.520 that we are getting, we're spending twice as much, and basically getting half as much?

00:04:23.280 So I always try to take the positive spin on it. And part of the story here is that perhaps we had

00:04:29.440 too many beds in 1990, right? That the beds that we had in 1990 were a reflection of what happened

00:04:34.720 in the 1970s. And before that, when we had a hospital building boom all across Canada,

00:04:40.240 and we could unpack why that happened. But we'll leave it to say we had a ton of beds in the 70s.

00:04:45.760 We didn't really build a ton more in the 80s. But then by the time the crunch hit in the 1990s,

00:04:52.160 that's when people said, whoa, we, you know, we're running out of money. And we got into the social

00:04:56.320 contract years of the decade in the 1990s. And so governments had to, A, save money, but B,

00:05:04.320 try to shift services out of the hospital. So there's a big, big movement to a lot of outpatient

00:05:09.920 care, outpatient therapy, used to, you know, have a baby and get admitted for two weeks. And then we

00:05:15.520 had trouble with people getting blood clots in their legs, because they were in hospital for so

00:05:18.880 long. And so that created its own problems. And so it was a good thing to start getting people moving

00:05:24.560 quicker, getting them at the hospital, doing more outpatient care. However, that same vision of trying

00:05:31.440 to stretch the dollar, do more with less, really was perhaps only a wise plan for the first few

00:05:38.000 years, okay, maybe it was wise to cut beds. But continually cutting beds, closing hospitals,

00:05:43.520 and thinking that that was the secret sauce, that's going to allow us to continue on forever,

00:05:49.600 that's not a vision for growth. And so whether it was just, you know, it was,

00:05:56.480 I was going to say osmosis, that's not the right word, whether it was just

00:06:01.040 inertia, inertia, that's the word I'm looking for. So you grab onto something, and you just keep doing

00:06:06.160 it over and over, and you expect different results. And unfortunately, that doesn't happen. And so what

00:06:11.120 happens is the wait times grow and grow and grow, we end up spending more and more of our GDP, and

00:06:17.600 and people are getting less service overall.

00:06:20.560 Well, it's interesting to hear you say that perhaps the 3.2 per thousand population was

00:06:25.600 too much and that we were, you know, we'd gone through this boom, and we didn't quite need it.

00:06:29.040 And yet you point out in your piece that the OECD average is 4.8 beds. So we're just wildly

00:06:36.320 underprepared in Canada in general, pre COVID. And I think that COVID just even showed that even more

00:06:44.080 how underprepared our system was. To me, Sean, this provides and creates a perfect opportunity.

00:06:50.320 And I wish that people in conservatively led provinces like Alberta, Saskatchewan, Manitoba,

00:06:55.920 and Ontario, were more prepared to step in at this point and say, look, this is an emergency.

00:07:01.280 Our ICU capacity is so small. There was an investigative report by my colleague Anthony

00:07:06.080 Fury over in the Toronto Sun, talking about how even, even with the small ICU capacity,

00:07:11.840 the capacity is even less because they don't have the nursing staff and the physician staff to,

00:07:16.560 to actually man those beds. And so, so, so that is a major problem, not so much just the pure

00:07:22.080 capacity, but you know, we're in a situation in Ontario where a couple of hundred people in the

00:07:25.360 ICU and the entire province goes into lockdown. So, so with this huge problem comes an opportunity.

00:07:31.760 And I think that conservatives need to take advantage of it by proposing changes and telling

00:07:36.320 Canadians, look, we want you to have universal coverage. What you have right now isn't universal.

00:07:40.560 When you have to go to the hospital and wait for hours and hours, or if you need a surgery and you have

00:07:44.800 to wait months and months and months, that's not, that's not universal. That's, that's you being

00:07:48.640 put on hold. So, so, so what we can do, what can we do? You spend a lot of time thinking about this.

00:07:53.280 What could be done? Yeah. So that's a huge question. So many people ask me. So first of all,

00:07:59.360 there's no shortage of ideas. There are, you know, at least we could talk about even the Romano

00:08:04.080 report, which was very, very pro Medicare, just pour more money in, but we can talk about the

00:08:08.560 Mazinkowski report or the Kirby commission, or even the Naylor report. He was the chair of the last

00:08:14.240 most recent committee looking at this. We could look at the report out of Quebec. I think it was

00:08:18.960 the Claude report. So lots of good ideas out there. We could talk about changing funding mechanism,

00:08:25.040 having mechanisms, having patient co-pay, having different insurance approaches. We can talk about

00:08:31.120 public private partnerships. We can talk about having tests done at home, having care in the community,

00:08:36.640 but all of these things are tactics. What we need is an overall strategy. So even, you know,

00:08:43.120 as supportive as I am of the can be surgery surgery case where they're really trying to say that not

00:08:48.640 allowing any kind of private funding is unconstitutional. I'm supportive of that. My worry,

00:08:53.600 however, is that if we only focus on funding and leave all the other important decisions to the state

00:09:00.240 or the medical profession or the unions, we still won't make a major change. It would be like me going

00:09:05.920 to the grocery store and telling my daughter, okay, here's 20 bucks, run in. We need 1% milk, 0.99

00:09:11.040 two bags of it. It's got to be that this particular brand. And at this particular store that we're at,

00:09:16.080 at this particular time of a day, I've made all the important decisions. And she isn't, you know,

00:09:21.440 maybe she doesn't have enough money in her pocket. So she uses a visa or whatever. The payment

00:09:26.400 mechanism itself is only one feature of a much larger discussion. And part of the problem is, and I'm

00:09:33.200 stealing a term, I forget the author I got it from, but he talks about the iron triangle in corporatism.

00:09:39.920 So this is back in the 1980s and Margaret Thatcher had to break this iron triangle. And it's a term

00:09:45.360 that comes from corporatism. It talks about the government and the corporations and unions or big

00:09:51.520 labor. And we have a similar iron triangle in Canada of the government, the medical profession. So

00:09:58.000 the regulatory colleges and the educational colleges and the medical associations. So

00:10:02.320 doctors, the state and the unions, and each of those entities have veto power over any substantive

00:10:09.600 change. So even if we changed funding, you still have these three self-interested parties that aren't

00:10:14.400 going to allow change to happen. So I think that's where we need to start focusing our attention. And we

00:10:20.480 need to say, is it right to have a concentration of power in the regulatory colleges? So they make the

00:10:26.080 laws, enforce the laws, oversee the laws, punish the lawbreakers if it's a doctor, rehabilitate the

00:10:31.920 lawbreakers. I mean, you would never have that in a Western approach to a free parliamentary democracy.

00:10:38.000 You separate those powers. That's just one example. We could talk about the close to 100% unionization

00:10:44.720 rate in Ontario hospitals. Does that make sense? When the broader public sector is around in the mid-70s,

00:10:50.960 you go to the private sector, you're down into the 30% range for unionization rates. And they're even

00:10:56.160 below 20% if you look at the American general overall unionization rate. So there are a number of

00:11:01.760 different ways we could look at breaking that iron triangle. But you're asking me about what I'm going

00:11:07.920 to put into the next book. And it's actually very difficult. There are so many ideas, but how do you

00:11:12.400 package it together? And this is what I'm kind of landing on is this concept of the state doctors and big

00:11:18.480 labor and how we're just locked and no one's going to let a change happen.

00:11:22.640 Well, that would sort of lend an idea as to why there hasn't been

00:11:27.120 more sweeping changes in provinces led by conservative governments, because perhaps they

00:11:31.120 don't even have control, like they don't have the control or the power to defeat those other two

00:11:35.120 bodies, the unions and the regulators. And we know, I mean, I've looked into the issue with sort of

00:11:40.320 interprovincial migration or even immigrants coming to Canada and having their credentials

00:11:45.520 not match and having a lot of problems trying to break into the labor force because these jobs are

00:11:52.080 so guarded by the regulators that you talk about. I wanted to pull one other quote out of your column,

00:11:58.800 because I thought it was so relevant to what we've just lived through. So you mentioned that there's a

00:12:05.440 myopia and narrow mindedness, the bedeviled efforts to reform to healthcare reform. And we've seen this

00:12:11.520 happen politically. So even in the last election 2021, Erin O'Toole sort of started talking about 0.96

00:12:17.600 in a very sort of mild and reasonable way. This is a conservative legal, former conservative leader

00:12:22.880 now, but the leader of the party at the time, just having more sort of partnerships between the private

00:12:28.960 sector and the public sector and just leading to more healthcare spaces and a more dynamic healthcare

00:12:34.880 system. And what did we see the liberals followed by their supporters in the legacy media,

00:12:39.920 sort of drum it out as Erin O'Toole wants to privatize healthcare, Erin O'Toole wants to 1.00

00:12:43.200 Americanize our healthcare, all of the exact same critiques that we've been seeing for 20 years in

00:12:47.200 Canadian politics, they just sort of create such a shallow dumbed down attack. That's politics and

00:12:53.200 it seems to work. Canadians seem to be very attached to the concept of our healthcare system, even though

00:13:00.000 perhaps when they go to interact with it themselves, they have negative experiences. It's not all is

00:13:05.200 cracked up to be, but the liberals have done a tremendous job and then the NDP as well, but of sort

00:13:11.920 of tying our healthcare system with our national identity, that it is like the one of the biggest

00:13:18.640 sources of pride when you see those polls about like, what do Canadians care about? They feel really

00:13:22.880 protective over their system, regardless of how much it fails, how poorly it ranks in terms of like

00:13:29.360 comparing it to the OECD. I'm not talking about comparing it to our American neighbors, I'm talking about

00:13:33.600 comparing it to the UK, France, Switzerland, Sweden, Norway, all these other countries that we should

00:13:39.520 be, Australia, that we should be looking to. And yet we have this like very rigid idea. So sort of,

00:13:47.440 I know you think about this a lot from a political perspective, how do you think you convince Canadians

00:13:51.680 that we need to have this change, we need to break up this, these powers, and it would be better for

00:13:57.440 everybody if there was just more healthcare opportunities, be it public or private or or

00:14:03.200 whatever. So great, great question. There are two issues. Number one is the negative and the risk of

00:14:09.200 talking about the negative. So as soon as we criticize Medicare, to your point, it feels people feel like

00:14:15.280 we're criticizing them, we're criticizing home, we're criticizing motherhood and apple pie. Jim Carrey was on

00:14:21.200 the Bill Maher, Bill Maher show. And it ran off a major rant. This is about night to 2018. He said,

00:14:28.640 listen, I'm from Canada, okay, and we have socialized medicine. I'm here to tell you what you hear on these

00:14:33.600 talk shows. And he went on, gave a bunch of swear words and said why, why the Canadian system is just

00:14:39.520 awesome. I never have to wait. I always get what I want, what I want. My mom lives in Vancouver and on and

00:14:45.200 on and on. So that kind of approach of coming to the defense of motherhood and apple pie is a bit

00:14:52.160 like if the Titanic is sinking, and you happen to be one of the lucky ones who got into one of the

00:14:58.480 few rowboats. So you're safe and you're snuggled under your blanket when you're eating snacks.

00:15:03.760 And someone says, hey, there's someone else drowning in the water. And you say,

00:15:07.280 stop that. Look, we're nice and warm. We're safe. How dare you criticize the work of these hardworking

00:15:12.880 sailors too? You know, it just doesn't make sense. So we have to shift the narrative to say,

00:15:18.160 listen, we're not criticizing everything. We're just saying that people are really suffering and

00:15:22.320 actually dying. So that's the negative side. And how do we respond to the negative? But I think it

00:15:27.680 has to go beyond that. We have to talk about the positive. What kind of vision can we offer people?

00:15:34.640 And this is a challenge. Part of it, you know, we could create this gigantic vision and no one would

00:15:39.760 listen to you because it would take too long to tell them. Or we can just get really nitty gritty

00:15:44.080 and say, what do you want? You want great care when you need it close to home without having to travel.

00:15:50.480 You want to be able to change docs if you and your doc really butt heads. We could look at the Canada

00:15:56.000 Health Act. I mean, everybody loves comprehensive care, universal care, portable care. We could unpack

00:16:01.760 those three principles and say, yeah, we love those three principles. But the first principle,

00:16:07.280 publicly administered, okay, wait a second, why do we have to be so rigid on that?

00:16:11.520 We all love comprehensiveness and universality and portability, even though you don't have

00:16:15.920 portability to Quebec because it doesn't really reciprocate, but we'll leave that to the side.

00:16:20.480 But why do we have to be so rigid on publicly administered? And then the final part of the

00:16:26.400 Canada Health Act is accessibility. Why are we so rigid on saying, okay, no hospital user fees,

00:16:32.480 but yet hospitals charge outrageous parking rates and they charge overpriced for coffee in the hospital

00:16:37.920 and overpriced at their gift shops. So they're still doing a pseudo hospital user fee, at least

00:16:43.920 with the parking fees, but yet that's okay. So we need to sort of take the heat down in the room.

00:16:52.000 Stop letting people say, we just want an American system. There are many other countries in the world.

00:16:57.280 Stop talking about the whole business and profit thing. Every single person working in healthcare,

00:17:02.640 at least as far as I know, gets an income. Everybody profits from the work they do. You

00:17:07.920 don't see a bunch of people going around taking vows of poverty and working for free as a nurse or a

00:17:13.600 doctor or anything. So we need to start unpacking that and really make sense of it. If it wasn't for

00:17:18.560 businesses, this is Taylor. He's a journalist in the UK. He said, if it wasn't for businesses,

00:17:24.160 all we would have is doctors and nurses standing in a field in their underwear.

00:17:29.600 So because of businesses, we have hospital beds and drugs and procedural instruments,

00:17:37.280 and we have buildings and light. And so there are a bunch of ways where we could really unpack this,

00:17:42.880 but it needs to be in little snippets that people want to consume when they're thinking about politics.

00:17:47.280 Well, that's so helpful, Sean. And I'm really excited. I didn't know you had a new book coming

00:17:52.800 out. So we'll have to keep an eye on that and have you back on the program when that book comes out. I

00:17:58.720 feel like this is just the start of a conversation. I would love to have you on again so we could jump

00:18:03.360 into other issues and go into more depth. I really appreciate you being out there having these

00:18:08.480 conversations and getting the ball rolling and getting people thinking about it. I think it's

00:18:11.680 so important for the country. So I really appreciate it. Thank you so much for joining the show today.

00:18:15.440 My pleasure. Thank you. All right. Thank you for tuning in. I'm Candice Malcolm,

00:18:19.760 and this is The Candice Malcolm Show.

Juno News - February 07, 2022

Canada’s socialized healthcare system is at the center of our failed COVID policies

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