Juno News - February 07, 2022Canada’s socialized healthcare system is at the center of our failed COVID policies
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Summary
In this episode, Dr. Sean Watley joins me to talk about his new book, "When Politics Comes Before Patients: Why and How Canadian Healthcare is Failing" and why our health care system is in serious need of reform.
Transcript
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COVID tested the limits and exposed the fatal flaws in Canada's centrally planned socialized
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health care system. It failed to deliver results to Canadians, and it is bankrupting our country.
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Let's talk about ways to improve the system. I'm Candice Malcolm, and this is The Candice Malcolm
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Show. Hi, everyone. Thank you so much for tuning in. Now, I know that there is a huge rally going
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on in Ottawa that the protests have moved to provincial capitals all over the world, and it
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is really exciting. We're going to continue to provide wall-to-wall coverage of that over at TNC.
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But I wanted to focus in on something else that has become so apparent and so problematic during
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the course of the pandemic, and that is the failure of our health care system. We have seen it in so
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many regards, manifest in so many ways. It is connected to the trucker protest because the
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mandates are by and large caused because of the shortages in our health care system. If we had
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a robust, thorough system that allowed for a lot more capacity for people to go into ICUs when
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necessary, we wouldn't have to lock down. We wouldn't have all of these lockdowns that have
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destroyed our society over the last two years. Just look at a place like Florida that has huge ICU
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capacity and they haven't had to have the same kind of lockdown. So our health care system is really at
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the center of this, and it is so important for us to talk about these issues, address them. And for
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people who oppose the Liberal government and want to have a better country, a better Canada, it's up to
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us to come up with ideas and solutions as to how we can improve the system to benefit all Canadians. So
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to do that today, I'm really pleased to be joined by my friend, Dr. Sean Watley. Sean is a rural family
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doctor based in Mount Albert, Ontario. He's the author of When Politics Comes Before Patients,
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Why and How Canadian Metal Care is Failing. And he's a Monk Senior Fellow over at the
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Macdonald Laurier Institute. He's spent the last 20 years serving various leadership roles on a number
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of boards and he's the past president of the Ontario Medical Association show. Sean, welcome to True
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North. Welcome to the Canada's Malcolm Show. Thank you so much for joining us today. Thanks for having me.
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So you recently wrote this great column over in the National Post. The column was titled,
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Canada's More With Less Approach to Healthcare Has Failed Us. So why don't you give us a little
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overview? What do you mean by that, the more with less approach? Yeah, so thank you. The gist of it
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is that within healthcare itself, so I served a number of years as a hospital administrator,
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and every administrator needs to know what you have to do to get ahead. What do you have to do to make
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the hospital board happy with you? What do you have to do to make the Ministry of Health happy with you?
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And one of the guaranteed paths to success is to try to provide care to more patients, better care to
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more patients, improve your level of service without spending more money. So that's always the key. How
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can we not increase hospital budgets and yet stretch out what we're doing more and more? And so we get
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thinner and thinner. In a previous book, I talked about our lack of resilience that gets baked into the
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system. But the paradox of it is that despite the fact that we're trying so desperately to provide
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more care without spending less, sort of this more with less approach, we actually end up spending more.
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So we cut beds, we decrease services, and so we end up with less care for a higher price tag. So we end up
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with less for more, despite trying to do more with less. Well, so it's interesting, I'll just pull a
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line from your column because you have this information really detailed out. So you said
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that this is talking about the province of Ontario. So in 1990, Ontario had 33,000 acute care hospital
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beds, or that's the equivalent of 3.2 per thousand population and healthcare spending represented 8.3%
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of the province's GDP. Fast forward to 2017, so 27 years later, Ontario had fallen to 18,500 beds,
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down from 33,400 down to 18,500. That's nearly, that's almost cut in half. That equates to 1.3
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beds per thousand populations, because the population is growing at the same time.
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Meanwhile, healthcare spending rose to 11.3% of the GDP. How is that possible, Sean,
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that we are getting, we're spending twice as much, and basically getting half as much?
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So I always try to take the positive spin on it. And part of the story here is that perhaps we had
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too many beds in 1990, right? That the beds that we had in 1990 were a reflection of what happened
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in the 1970s. And before that, when we had a hospital building boom all across Canada,
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and we could unpack why that happened. But we'll leave it to say we had a ton of beds in the 70s.
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We didn't really build a ton more in the 80s. But then by the time the crunch hit in the 1990s,
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that's when people said, whoa, we, you know, we're running out of money. And we got into the social
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contract years of the decade in the 1990s. And so governments had to, A, save money, but B,
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try to shift services out of the hospital. So there's a big, big movement to a lot of outpatient
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care, outpatient therapy, used to, you know, have a baby and get admitted for two weeks. And then we
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had trouble with people getting blood clots in their legs, because they were in hospital for so
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long. And so that created its own problems. And so it was a good thing to start getting people moving
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quicker, getting them at the hospital, doing more outpatient care. However, that same vision of trying
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to stretch the dollar, do more with less, really was perhaps only a wise plan for the first few
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years, okay, maybe it was wise to cut beds. But continually cutting beds, closing hospitals,
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and thinking that that was the secret sauce, that's going to allow us to continue on forever,
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that's not a vision for growth. And so whether it was just, you know, it was,
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I was going to say osmosis, that's not the right word, whether it was just
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inertia, inertia, that's the word I'm looking for. So you grab onto something, and you just keep doing
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it over and over, and you expect different results. And unfortunately, that doesn't happen. And so what
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happens is the wait times grow and grow and grow, we end up spending more and more of our GDP, and
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Well, it's interesting to hear you say that perhaps the 3.2 per thousand population was
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too much and that we were, you know, we'd gone through this boom, and we didn't quite need it.
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And yet you point out in your piece that the OECD average is 4.8 beds. So we're just wildly
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underprepared in Canada in general, pre COVID. And I think that COVID just even showed that even more
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how underprepared our system was. To me, Sean, this provides and creates a perfect opportunity.
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And I wish that people in conservatively led provinces like Alberta, Saskatchewan, Manitoba,
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and Ontario, were more prepared to step in at this point and say, look, this is an emergency.
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Our ICU capacity is so small. There was an investigative report by my colleague Anthony
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Fury over in the Toronto Sun, talking about how even, even with the small ICU capacity,
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the capacity is even less because they don't have the nursing staff and the physician staff to,
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to actually man those beds. And so, so, so that is a major problem, not so much just the pure
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capacity, but you know, we're in a situation in Ontario where a couple of hundred people in the
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ICU and the entire province goes into lockdown. So, so with this huge problem comes an opportunity.
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And I think that conservatives need to take advantage of it by proposing changes and telling
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Canadians, look, we want you to have universal coverage. What you have right now isn't universal.
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When you have to go to the hospital and wait for hours and hours, or if you need a surgery and you have
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to wait months and months and months, that's not, that's not universal. That's, that's you being
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put on hold. So, so, so what we can do, what can we do? You spend a lot of time thinking about this.
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What could be done? Yeah. So that's a huge question. So many people ask me. So first of all,
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there's no shortage of ideas. There are, you know, at least we could talk about even the Romano
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report, which was very, very pro Medicare, just pour more money in, but we can talk about the
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Mazinkowski report or the Kirby commission, or even the Naylor report. He was the chair of the last
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most recent committee looking at this. We could look at the report out of Quebec. I think it was
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the Claude report. So lots of good ideas out there. We could talk about changing funding mechanism,
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having mechanisms, having patient co-pay, having different insurance approaches. We can talk about
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public private partnerships. We can talk about having tests done at home, having care in the community,
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but all of these things are tactics. What we need is an overall strategy. So even, you know,
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as supportive as I am of the can be surgery surgery case where they're really trying to say that not
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allowing any kind of private funding is unconstitutional. I'm supportive of that. My worry,
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however, is that if we only focus on funding and leave all the other important decisions to the state
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or the medical profession or the unions, we still won't make a major change. It would be like me going
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to the grocery store and telling my daughter, okay, here's 20 bucks, run in. We need 1% milk,
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two bags of it. It's got to be that this particular brand. And at this particular store that we're at,
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at this particular time of a day, I've made all the important decisions. And she isn't, you know,
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maybe she doesn't have enough money in her pocket. So she uses a visa or whatever. The payment
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mechanism itself is only one feature of a much larger discussion. And part of the problem is, and I'm
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stealing a term, I forget the author I got it from, but he talks about the iron triangle in corporatism.
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So this is back in the 1980s and Margaret Thatcher had to break this iron triangle. And it's a term
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that comes from corporatism. It talks about the government and the corporations and unions or big
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labor. And we have a similar iron triangle in Canada of the government, the medical profession. So
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the regulatory colleges and the educational colleges and the medical associations. So
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doctors, the state and the unions, and each of those entities have veto power over any substantive
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change. So even if we changed funding, you still have these three self-interested parties that aren't
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going to allow change to happen. So I think that's where we need to start focusing our attention. And we
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need to say, is it right to have a concentration of power in the regulatory colleges? So they make the
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laws, enforce the laws, oversee the laws, punish the lawbreakers if it's a doctor, rehabilitate the
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lawbreakers. I mean, you would never have that in a Western approach to a free parliamentary democracy.
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You separate those powers. That's just one example. We could talk about the close to 100% unionization
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rate in Ontario hospitals. Does that make sense? When the broader public sector is around in the mid-70s,
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you go to the private sector, you're down into the 30% range for unionization rates. And they're even
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below 20% if you look at the American general overall unionization rate. So there are a number of
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different ways we could look at breaking that iron triangle. But you're asking me about what I'm going
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to put into the next book. And it's actually very difficult. There are so many ideas, but how do you
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package it together? And this is what I'm kind of landing on is this concept of the state doctors and big
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labor and how we're just locked and no one's going to let a change happen.
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Well, that would sort of lend an idea as to why there hasn't been
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more sweeping changes in provinces led by conservative governments, because perhaps they
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don't even have control, like they don't have the control or the power to defeat those other two
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bodies, the unions and the regulators. And we know, I mean, I've looked into the issue with sort of
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interprovincial migration or even immigrants coming to Canada and having their credentials
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not match and having a lot of problems trying to break into the labor force because these jobs are
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so guarded by the regulators that you talk about. I wanted to pull one other quote out of your column,
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because I thought it was so relevant to what we've just lived through. So you mentioned that there's a
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myopia and narrow mindedness, the bedeviled efforts to reform to healthcare reform. And we've seen this
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happen politically. So even in the last election 2021, Erin O'Toole sort of started talking about
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in a very sort of mild and reasonable way. This is a conservative legal, former conservative leader
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now, but the leader of the party at the time, just having more sort of partnerships between the private
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sector and the public sector and just leading to more healthcare spaces and a more dynamic healthcare
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system. And what did we see the liberals followed by their supporters in the legacy media,
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sort of drum it out as Erin O'Toole wants to privatize healthcare, Erin O'Toole wants to
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Americanize our healthcare, all of the exact same critiques that we've been seeing for 20 years in
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Canadian politics, they just sort of create such a shallow dumbed down attack. That's politics and
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it seems to work. Canadians seem to be very attached to the concept of our healthcare system, even though
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perhaps when they go to interact with it themselves, they have negative experiences. It's not all is
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cracked up to be, but the liberals have done a tremendous job and then the NDP as well, but of sort
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of tying our healthcare system with our national identity, that it is like the one of the biggest
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sources of pride when you see those polls about like, what do Canadians care about? They feel really
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protective over their system, regardless of how much it fails, how poorly it ranks in terms of like
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comparing it to the OECD. I'm not talking about comparing it to our American neighbors, I'm talking about
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comparing it to the UK, France, Switzerland, Sweden, Norway, all these other countries that we should
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be, Australia, that we should be looking to. And yet we have this like very rigid idea. So sort of,
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I know you think about this a lot from a political perspective, how do you think you convince Canadians
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that we need to have this change, we need to break up this, these powers, and it would be better for
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everybody if there was just more healthcare opportunities, be it public or private or or
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whatever. So great, great question. There are two issues. Number one is the negative and the risk of
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talking about the negative. So as soon as we criticize Medicare, to your point, it feels people feel like
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we're criticizing them, we're criticizing home, we're criticizing motherhood and apple pie. Jim Carrey was on
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the Bill Maher, Bill Maher show. And it ran off a major rant. This is about night to 2018. He said,
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listen, I'm from Canada, okay, and we have socialized medicine. I'm here to tell you what you hear on these
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talk shows. And he went on, gave a bunch of swear words and said why, why the Canadian system is just
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awesome. I never have to wait. I always get what I want, what I want. My mom lives in Vancouver and on and
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on and on. So that kind of approach of coming to the defense of motherhood and apple pie is a bit
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like if the Titanic is sinking, and you happen to be one of the lucky ones who got into one of the
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few rowboats. So you're safe and you're snuggled under your blanket when you're eating snacks.
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And someone says, hey, there's someone else drowning in the water. And you say,
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stop that. Look, we're nice and warm. We're safe. How dare you criticize the work of these hardworking
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sailors too? You know, it just doesn't make sense. So we have to shift the narrative to say,
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listen, we're not criticizing everything. We're just saying that people are really suffering and
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actually dying. So that's the negative side. And how do we respond to the negative? But I think it
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has to go beyond that. We have to talk about the positive. What kind of vision can we offer people?
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And this is a challenge. Part of it, you know, we could create this gigantic vision and no one would
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listen to you because it would take too long to tell them. Or we can just get really nitty gritty
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and say, what do you want? You want great care when you need it close to home without having to travel.
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You want to be able to change docs if you and your doc really butt heads. We could look at the Canada
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Health Act. I mean, everybody loves comprehensive care, universal care, portable care. We could unpack
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those three principles and say, yeah, we love those three principles. But the first principle,
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publicly administered, okay, wait a second, why do we have to be so rigid on that?
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We all love comprehensiveness and universality and portability, even though you don't have
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portability to Quebec because it doesn't really reciprocate, but we'll leave that to the side.
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But why do we have to be so rigid on publicly administered? And then the final part of the
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Canada Health Act is accessibility. Why are we so rigid on saying, okay, no hospital user fees,
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but yet hospitals charge outrageous parking rates and they charge overpriced for coffee in the hospital
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and overpriced at their gift shops. So they're still doing a pseudo hospital user fee, at least
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with the parking fees, but yet that's okay. So we need to sort of take the heat down in the room.
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Stop letting people say, we just want an American system. There are many other countries in the world.
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Stop talking about the whole business and profit thing. Every single person working in healthcare,
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at least as far as I know, gets an income. Everybody profits from the work they do. You
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don't see a bunch of people going around taking vows of poverty and working for free as a nurse or a
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doctor or anything. So we need to start unpacking that and really make sense of it. If it wasn't for
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businesses, this is Taylor. He's a journalist in the UK. He said, if it wasn't for businesses,
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all we would have is doctors and nurses standing in a field in their underwear.
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So because of businesses, we have hospital beds and drugs and procedural instruments,
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and we have buildings and light. And so there are a bunch of ways where we could really unpack this,
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but it needs to be in little snippets that people want to consume when they're thinking about politics.
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Well, that's so helpful, Sean. And I'm really excited. I didn't know you had a new book coming
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out. So we'll have to keep an eye on that and have you back on the program when that book comes out. I
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feel like this is just the start of a conversation. I would love to have you on again so we could jump
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into other issues and go into more depth. I really appreciate you being out there having these
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conversations and getting the ball rolling and getting people thinking about it. I think it's
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so important for the country. So I really appreciate it. Thank you so much for joining the show today.
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My pleasure. Thank you. All right. Thank you for tuning in. I'm Candice Malcolm,