Juno News - CBC's days are numbered

00:00:00.000 Welcome to Canada's Most Irreverent Talk Show.

00:00:05.140 This is The Andrew Lawton Show, brought to you by True North.

00:00:13.240 Hello and welcome to you all.

00:00:15.860 Wednesday, February 8th, just after 5 p.m. Eastern Time,

00:00:19.760 you're tuned in to The Andrew Lawton Show here on True North.

00:00:23.780 If you missed my disclaimer yesterday,

00:00:26.360 I will give you fair warning that I am coming off the tail end of what's proven to be a

00:00:33.740 weeks-long battle with pneumonia I picked up some bacterium while I was cavorting with the

00:00:39.480 globalists in Davos believe it or I I'm pretty sure that's it because I got back from Davos on

00:00:44.680 a Friday and then by Monday I just started getting a little bit ill and it just kept getting worse for

00:00:50.680 the next week and then you know three weeks later I've still got a bit of a cough but I made it

00:00:54.800 through yesterday's show with only having to go on mute and turn off my camera just once. I bet

00:01:00.560 you didn't even notice. It was so subtle. So this time we will hopefully be able to get through the

00:01:05.820 whole show without any such breakdown. But as I've said, if I keel over in the middle, just rest

00:01:10.500 assured that we'll have a guest host in place and rename the program and move on from there. But I

00:01:16.760 thank you for all of the well wishes. I actually don't know if I got any well wishes, but if you

00:01:21.000 did send a well wish yesterday i appreciate it very much i'm going to be talking about this big

00:01:26.280 40 bajillion billion zillion gazillion whatever it is dollar health care slush fund that the

00:01:33.080 liberal government is giving provinces which in true federalist fashion all of the provincial

00:01:39.320 governments are saying well you know we don't exactly like this offer from the feds no no no

00:01:44.180 we're going to take the money but we uh you know we don't exactly like the money and how it's being

00:01:48.940 spent and what terms are on it. We're going to talk about that with Sean Whatley, Dr. Sean

00:01:53.640 Whatley, the former president of the Ontario Medical Association. But I want to start off

00:01:59.480 just, I know we're a couple of days ahead of when Fake News Friday comes out, which I believe is on

00:02:03.780 Saturdays. No, wait, Fridays. Yeah, there we go. But let's talk a little bit about CBC because the

00:02:10.040 head of CBC, Catherine Tate, who lives in a multi-million dollar Brooklyn house while running

00:02:17.300 the state broadcaster of Canada inexplicably, has done an interview which, when you looked at the

00:02:22.920 headline, it seemed like a bit of a bombshell. It was in the Globe and Mail, CBC signals plans to go

00:02:30.080 full streaming, ending traditional TV and radio broadcasts. Now, for many people in this country,

00:02:36.300 this would actually come as no difference whatsoever because they live their lives as

00:02:40.820 though CBC doesn't have any traditional radio or television broadcasts because people are not

00:02:45.580 tuning into either of them but it comes across as something that was actually quite revolutionary

00:02:52.040 that CBC is going to be getting off the dial so to speak and becoming an online streaming outlet

00:02:58.720 perhaps inspired by the alternative business model of people like us at True North and then you read

00:03:04.940 through the article in the Globe and Mail you read through the interview with Catherine Tate

00:03:10.340 and you find that there's actually nothing particularly groundbreaking or revolutionary

00:03:16.480 or even new in this, I'm going to quote directly from the article.

00:03:20.540 In an interview with the Globe and Mail, Ms. Catherine Tate, president and CEO of the CBC,

00:03:26.680 said the broadcaster is eventually preparing to shift all its content to online only

00:03:32.560 in order to remain relevant.

00:03:36.140 Now, not to just play with technicalities here,

00:03:39.160 but I believe remaining relevant implies that you are relevant,

00:03:44.840 which would strike me as somewhat difficult for CBC.

00:03:48.000 Nevertheless, she said,

00:03:49.380 Canadians are moving to streaming services.

00:03:51.580 CBC is sitting there loyally broadcasting over the airwaves.

00:03:54.700 We have to be digital first if we're going to be audience first.

00:03:57.920 You say, wow, okay, what are you doing?

00:03:59.920 What are you doing to keep up with the audience?

00:04:01.520 And it's unlikely, she said, to happen in less than a decade.

00:04:06.520 So this is basically like maybe, just maybe, in 10 years,

00:04:10.820 we might consider setting up a YouTube page or something like that.

00:04:14.900 But nothing is happening.

00:04:16.600 There's nothing new.

00:04:17.580 There's been no announcement.

00:04:18.600 And by the way, whatever you think of Catherine Tate and CBC's management,

00:04:24.080 this is a crown corporation.

00:04:26.920 So ideally, something really fundamental about the future of CBC

00:04:31.040 should not be announced by this unelected bureaucrat,

00:04:34.600 but should be announced by, I don't know,

00:04:36.040 the minister who's responsible for CBC.

00:04:38.500 Not that I've got a lot of time

00:04:39.760 for the heritage minister and the Trudeau government,

00:04:42.400 but ideally it would be an elected government

00:04:44.040 making the decision about the future of CBC.

00:04:46.920 But then you get further into the article

00:04:48.700 and I find the real noteworthy stuff

00:04:50.520 has nothing to do with the future

00:04:53.040 of whether CBC is making a play

00:04:55.520 for Netflix's market share,

00:04:57.300 but it's actually about the way

00:04:59.020 that she views Pierre Polyev who is the leader of the conservatives who has pledged to defund

00:05:05.440 CBC and by the way even after becoming leader of the conservatives he has not gone back on this and

00:05:12.840 I was very keenly aware of this possibility because it's what Aaron O'Toole did when he

00:05:18.160 became the leader of the conservatives all of a sudden his pledge to defund the CBC became

00:05:22.640 unrecognizable. It was like, we need to maybe strike a committee to possibly consider talking

00:05:28.960 about perhaps, you know, changing the ad model of CBC or something. There was nothing resembling

00:05:35.020 what he pledged in the leadership, which was defunding once he had become the leader. Pierre

00:05:39.820 Polyev, to his credit, has been consistent since becoming the leader of His Majesty's loyal opposition.

00:05:46.740 But Catherine Tate doesn't like that because he is now threatening her job effectively. So she

00:05:52.580 said, oh yeah, this opposition leader is doing CBC bashing, which, okay, probably an accurate

00:05:59.660 representation of it. She said this though, I think they feel that CBC is a mouthpiece for

00:06:07.740 the liberal government. Now, Pierre Polly have tweeted out, I think I refreshed the screen or

00:06:13.640 moved this. Oh, here it is. Pierre Polly have tweeted out that Catherine Tate is proving that

00:06:18.520 she is, in fact, a mouthpiece for Justin Trudeau. So I guess in that sense, Catherine Tate is kind

00:06:23.300 of accurate in her depiction of Pierre Follieva's believing she's a mouthpiece for the Liberals,

00:06:28.440 but she's conveniently getting into the political fray here. And instead of telling Canadians why

00:06:33.780 CBC deserves to exist and deserves to get over $1.2 billion of Canadian taxpayer money every

00:06:40.260 year to exist, all she's doing is firing these potshots at the Conservatives saying they're the

00:06:45.960 big, evil, scary guys because they want to go after CBC. Now, look, CBC has produced, my issue

00:06:53.600 with CBC has, believe it or not, not been entirely about its content. Sure, they've produced some

00:06:58.660 absolutely terrible shows, like being a little mosque on the prairie was probably one of the 1.00

00:07:03.680 most embarrassing, humiliating excuses for programming. But you look on the contrary, 1.00

00:07:08.960 Schitt's Creek, I admit I've never seen an episode of it, but it's managed to be tremendously popular,

00:07:14.580 not just in Canada, but even in the coveted U.S. market. Shows like Heartland, my old classmate

00:07:21.140 from school actually, Amber Marshall, the star of that show, that seems to have a very loyal

00:07:26.560 audience. It was going for several years. It might even still be on the air, I must confess. I don't

00:07:31.400 know. And you have other shows that ZBC has had that occasionally have been winners. But if you're

00:07:38.380 producing a winning show, you don't need a government subsidy. And if they produced more

00:07:45.360 good quality shows, I don't think there would be this antipathy by Canadians to CBC to the extent

00:07:51.920 that there is. And I think BBC in the UK is a great example of this. Now, look, fundamentally,

00:07:57.080 I don't believe that in this day and age, you need public broadcasters that are getting billions of

00:08:03.000 of state money and going after competing with private sector media companies. And it's just

00:08:09.500 not necessary. The fact that CBC is bidding on the Olympics as though there's no private business

00:08:15.560 case for someone to air the Olympics is laughable and shameful. But that aside, BBC is almost more

00:08:25.800 forgiveness worthy because BBC produces like great shows and they have produced historically

00:08:32.580 great British program. So if CBC had the batting average of BBC, they wouldn't be struggling to

00:08:40.500 stay relevant and trying to make these half-baked claims about, oh, well, yes, we need to move our

00:08:45.400 content online. You can move crap content online and it doesn't make it less crap content. The 0.97

00:08:52.520 problem is not that Canadians have to watch Rosemary Barton's proclamations about politics 0.79

00:08:58.360 on a conventional television set.

00:09:00.780 The problem is that Canadians don't want to see

00:09:03.060 what Rosie Barton has to say.

00:09:05.220 And that's not a slight at Rosie Barton.

00:09:07.040 I've had a number of chats with her over the years.

00:09:09.680 She's a lovely person,

00:09:10.960 but she is not connecting with Canadians.

00:09:15.000 And most of the CBC anchors,

00:09:16.720 remember when they got rid of Peter Mansbridge,

00:09:18.520 who was basically the greatest illusion

00:09:22.460 that's ever been portrayed to Canadians,

00:09:25.060 that this was this anchor, this mainstay of Canada

00:09:28.120 that Canadians look to and trusted, like Walter Cronkite.

00:09:31.220 And then he goes and no one has really realized he's gone.

00:09:35.660 And they replace him with four other people

00:09:37.900 because he was such a giant of a man

00:09:39.560 that you need four rotating anchors to do it.

00:09:43.000 And the problem was not that this was

00:09:44.480 on a traditional broadcasting set.

00:09:46.960 The problem was that no one cared.

00:09:49.620 No one cared.

00:09:50.640 So CBC is galvanizing private sector media.

00:09:54.820 and they're doing this in a way that is costing Canadians again 1.2 plus billion dollars a year

00:10:02.300 cannibalizing private sector media and we're all supposed to accept that this is the natural order

00:10:09.800 or the natural order of things and and there are different models for public broadcasters and there

00:10:14.900 actually is believe it or not and I should do some further investigation on this there's an

00:10:19.600 international consortium of public broadcasters. And they all get together, the Norway public

00:10:25.740 broadcaster, the Canadian public broadcaster, the British public broadcaster, they all get together

00:10:30.660 and basically talk about how they can ensure they remain funded. Because that's their goal. It's not

00:10:37.040 relevance. Their goal is funding. Their goal is that they don't want a Pierre Polly F type or a

00:10:41.420 Maxime Bernier type coming in and saying, why is this something that we have to pay for?

00:10:46.220 and I remember I was in England a couple of years ago I was at the Global Conference for Media

00:10:52.340 Freedom and I was interviewing the woman whose name escapes me right now unfortunately who was

00:10:58.680 the head of this consortium of public broadcasters and I was asking her a bunch of questions about

00:11:04.380 this and I asked about the gap filling model which is what she called it where you say that

00:11:09.720 you know the public broadcaster should only exist where there are gaps that the private sector won't

00:11:15.860 fill for example you know it might not have the strongest business case to broadcast in a very

00:11:22.500 small indigenous language that's not spoken all that much or to broadcast in a rural remote

00:11:28.320 northern community there might not be a business case so that's where we should have a public

00:11:32.380 broadcaster and she said oh no no that's we we don't need to do that we need robust public

00:11:38.040 broadcasters we need them in every space imaginable they should have the olympics they should have all

00:11:42.840 of this and that to me is insane and these entities are just these giant one story about

00:11:51.420 CBC I've interrupted my own sentence there but one story I'll tell before we move on from this

00:11:56.500 for the time being I covered in it was a very big story and I ended up being one of the ones who

00:12:01.260 broke it nationally in 2017 there was a thwarted terrorist attack in Strathroy Ontario the guy's

00:12:09.140 name was Aaron Driver. He was shot by police. It was very dramatic. And there was, inconveniently,

00:12:14.780 very little information that came out about it after the fact. But I broke this story. I was in

00:12:19.800 Strathroy the night this whole thing happened. The next day, all the national media came from,

00:12:25.660 you know, all of the places around Ontario to cover it the next day, because they have to be

00:12:30.980 there the day after the news has happened for some reason. And, oh, CP24 has a van with a camera

00:12:38.040 a person and a reporter. Oh, the Globe and Mail sent down a guy. Canadian Press hired a photographer

00:12:44.340 who was local. And who else was there? City News sent a van. CTV London sent a van. CBC,

00:12:51.200 I want to count this out to just tell you how many crews they had. CBC Windsor was there.

00:13:01.100 London or Strathroy is like halfway between Windsor and Toronto. So CBC Windsor was there.

00:13:05.920 CBC Toronto was there. CBC National from Toronto was there. CBC The National, the show that was at

00:13:15.880 the time Peter Mansbridge, The National sent their own person. So I think we're at five now. And then

00:13:22.020 CBC Radio Canada sent someone from Toronto to do the same thing in French. So you basically had

00:13:28.340 six separate CBC crews all coming and doing their own versions of the same story, which by that

00:13:35.560 point wasn't really a story because the story had happened 24 hours earlier so this is CBC so when

00:13:41.640 they get that 1.2 billion dollars they're actually spending more money than private sector media is

00:13:47.960 now I don't support government bailouts of media I've been against the 600 media bailout I hope it

00:13:54.040 gets absolutely destroyed and ripped up but there is a thing like if the government is going to spend

00:13:59.320 1.2 billion dollars. Imagine how much more journalism, if that's the goal, you could produce

00:14:04.760 by spending that money on more efficient private sector media. Again, I'm not lining up to say we

00:14:11.540 need to expand the bailout to triple its size, but I'm saying that even if we want to say that

00:14:16.520 public broadcasting is an important function, CBC is the least efficient model for that, and there

00:14:23.160 is no business case for it. The fact that Canadians are tuning out and not paying attention to this

00:14:28.360 is an example of this they would never make this money from selling ads because they don't have the

00:14:33.080 audience space to support it and when Catherine Tate from her million dollar multi-million dollar

00:14:38.520 Brooklyn home says well we need to stay relevant we'll try becoming relevant first your issue is

00:14:44.420 not where you're broadcasting your issue is what you are broadcasting so CBC is like the federal

00:14:51.240 government selling something for which there are no buyers I'm going to talk about health care in

00:14:56.580 just a moment here. But first, I want to do something which we tried to do yesterday,

00:15:02.040 had a little technical glitch here. So our absolute sincere apologies. But our friends

00:15:06.920 at SecondStreet.org have a very novel idea on how Canada can help cut Vladimir Putin's military

00:15:15.620 budget. This is a plan they've laid out in a new documentary called Defund Putin, which goes in

00:15:21.720 extensively to that very topic you can watch it for free at defundputin.ca and there's a little

00:15:27.640 bit of a taste of it in this trailer here in order to stop vladimir putin's war machine we

00:15:34.360 need to reflect on the old expression follow the money it's not a thriving expanding growing

00:15:43.140 economy russia today is essentially a gas station vladimir putin has been working behind the scenes

00:15:49.740 to sabotage his competitors.

00:15:52.480 Putin and his cronies helped fund the anti-shale gas propaganda

00:15:55.800 that led seven European countries to ban fracking.

00:15:59.620 Do we stand up and help the world wean itself off of Russian oil and natural gas? 0.91

00:16:05.620 Or do we keep our resources in the ground

00:16:07.680 and let the world stay dependent on tyrants like Vladimir Putin?

00:16:19.740 that is thanks to our friends over at secondstreet.org you can watch that at defundputin.ca

00:16:28.040 and by the way i mean that is not even a commentary on the russia ukraine war that's a commentary i

00:16:33.680 think by and large on energy policy in this country and when you look at what's happened

00:16:38.780 to places like germany places like hungary they've been entirely dependent on sucking at the teat of

00:16:46.200 the russian state and they're enriching the oligarchs they're impoverishing their own citizens

00:16:51.040 and in canada we have energy that we can make available to the world and we have our own

00:16:56.160 ideologues in government that don't want to make that happen so i'm glad over at second street

00:17:00.740 they're shining a light on that let's turn to health care though as you would have heard

00:17:05.920 yesterday perhaps justin trudeau has decided to go to the provinces and offer up 46.2 billion

00:17:11.860 dollars in new health care funding now it sounds really big this is over the next 10 years

00:17:18.080 and it is not condition free and what's happening now is provincial premiers are saying

00:17:24.180 yeah we're going to take the money but uh you know i don't like it but it was basically

00:17:28.700 an ultimatum it was a one-size-fits-all offer and now the federal government is wanting to

00:17:35.160 put more conditions on this money which again the premier is not loving but uh let's face it no one's

00:17:41.320 going to turn down the cash when there is a healthcare crisis across this country. It's an

00:17:46.700 issue Dr. Sean Watley knows very well. He literally wrote the book on ways that the government could

00:17:51.820 fix this, and the fact that he hasn't been made a health minister is a great shame here, and he's

00:17:57.220 the former president of the Ontario Medical Association. Sean, it's good to talk to you as

00:18:02.480 always here. We talk about the system, and oftentimes people can point to a number of things

00:18:08.080 that need more funding and need more money.

00:18:10.420 But there's an efficiency problem here

00:18:12.780 in that you can't just write a check

00:18:14.980 without reevaluating, in my view,

00:18:16.880 how the money is spent.

00:18:18.820 Oh, absolutely.

00:18:19.640 And that's what I think the feds are using

00:18:23.300 as a springboard to say,

00:18:25.120 this is why we need more control

00:18:26.480 because we need a whole bunch more accountability.

00:18:29.040 Having said that,

00:18:30.160 no purchaser of services or products

00:18:34.020 has ever been able to renovate the delivery of those services or products. If you walk into

00:18:40.340 Tim Hortons right now and tell everybody in your Tim Hortons, hey, I'm going to pay for all your

00:18:44.520 coffee and donuts. And then you walk up to management and say, all right, I want you to

00:18:48.640 change the way you make your donuts. And I want hotter coffee and a little more cream in my double

00:18:53.480 double. Management is going to look at you and say, you don't, you don't know how to run a Tim

00:18:57.920 Hortons. What are you talking about? Yes, you've just paid for all the services, but you can't

00:19:02.320 change the management so i think that's what you're getting at right there it's very very

00:19:06.220 difficult for provinces and the federal government to change the way services are delivered and we

00:19:12.800 can't improve care without changing it at that fundamental level that you're talking about

00:19:17.360 yeah i mean anyone who's ever looked at government spending reports which i suppose is not as amusing

00:19:23.500 an activity as i'm making it sound but you'll know that there's this thing called march madness where

00:19:28.660 every March you have these government departments that just blow money on new chairs, new desks,

00:19:34.060 new computers because they had this room in the budget and they don't want it to be taken away

00:19:37.880 the next year. So you have people that are spending up to their cap and it's not a question

00:19:43.100 of what's the best use of this money, how do we best improve our performance and our output

00:19:47.700 and I fear that's what's happening here now. I mean the federal government has not proven,

00:19:52.900 certainly not this government, that it has an ability to do any level of central planning. So

00:19:57.580 even putting this money to provinces and saying here's how you need to spend it

00:20:01.860 like i'm not seeing the roadmap on how health care will be improved with this

00:20:06.940 yeah so two points you raised there i'm glad you use the word central planning and that needs to

00:20:13.380 be more a part of our dialogue so understandably 200 billion dollars captures the headlines and

00:20:20.360 that's what we want to talk about and i'm glad you highlighted that actually this is only 46 billion

00:20:25.300 in new dollars. The rest of that money was going to flow anyways, and it spread out over 10 years.

00:20:31.940 Having said that, people still love to talk about the money. But really, what we should be talking

00:20:37.020 about is the control that's at issue. So you look at their long list of things they want changed,

00:20:42.780 even going back to March. I'm looking at a list by Health Minister Duclos. He said, well, these are

00:20:48.140 our five priorities. But if you look at them, they're actually more like 10 or 15 priorities.

00:20:53.020 So essentially, they're setting the marching orders, and I can't understand why they want

00:21:00.280 control. It's like a dog chasing the car. What are you going to do when you catch the car?

00:21:04.300 Furthermore, how do you even know you can control health care better than the provinces? And so

00:21:09.820 it's a mixture of ignorance and arrogance. And to hear our prime minister almost fold his arms and 0.72

00:21:16.720 say, we need better performance, and you're not going to get money until you show me performance,

00:21:21.880 it's it's like saying that the beatings will continue until morale improves i just

00:21:26.440 i can't figure it out and you also made a comment though about march madness and funding

00:21:31.480 what we see in the hospital sector especially is that the worst performers often get the most

00:21:38.360 funding now governments tweaked into this a few years back and they realize now that if you really

00:21:44.200 come you know you really go over budget and maybe you need to be replaced as a board but never come

00:21:50.360 in at budget i never come in below budget because it means your budget will get cut next year and

00:21:55.400 so there's this bizarre political game going on when really patients want care and they want to

00:22:02.280 know who to hold accountable for delivering that care how much latitude do premiers have

00:22:09.640 to be innovative about delivery and and i i'm not talking about privatization here i am talking

00:22:15.800 about private alternatives you can have universal coverage and private delivery there's nothing as i

00:22:21.480 understand it that precludes that but but how trapped are premiers in this system so fantastic

00:22:28.760 question you're asking like someone who i think ran for political party perhaps basically they

00:22:35.000 have almost zero latitude so if you speak to these ministers of health or a minister of long-term

00:22:39.960 care they say listen john the money's all tied up it's all tied up in salaries it's tied up in

00:22:45.800 in contract negotiations and collective bargaining agreements. That's the wording I was looking for.

00:22:51.160 And so there's very little wiggle room as far as injecting some creativity in how our system

00:22:57.120 functions by tweaking the way funding flows. Having said that, Premier Ford's recent announcement

00:23:03.840 where he says, you know, we're just going to shift more services outside of hospitals. We've had this

00:23:09.300 shift going on for 40 years. It's a little bit absurd that people are saying, oh, this is terrible.

00:23:15.040 this is the end of the world no we're just going to increase mris and ct scans in the community

00:23:20.720 like we've been doing for the last 20 or 30 years doing that though leapfrogs all of the management

00:23:27.920 and the regulatory system that is attached to hospitals and so for a short time you'll be able

00:23:34.640 to see innovation on the management side in these non-hospital facilities so ministers of health can

00:23:41.280 do those sorts of things but it's very difficult to actually use dollars and be creative like we

00:23:46.540 would hope they could be. One thing I know and I've been very fortunate I've had a family doctor

00:23:52.840 my entire life when my doctor from childhood retired his daughter took over his practice and

00:23:58.940 I mentioned at the top of the show that I was just coming off a bout of pneumonia and I mean

00:24:03.500 when I called my family doctor I had an appointment a few hours later and I know that a lot of people

00:24:08.060 do not have anywhere close to that level of access here. And you are right, because if someone can't

00:24:14.860 get in to see a family doctor, what is it they want to do? They want to go to a hospital, they

00:24:18.300 want to go to an urgent care system. You've got a lot of people in hospital that don't need to be

00:24:22.800 there. And this seems to be this catch-all that no one has really come up with an answer to.

00:24:28.720 Yeah, I'm glad you mentioned privileged access, because you're a prime example of someone who

00:24:35.000 has connections and someone who um the person at the other end of the line will definitely pick up

00:24:41.160 the phone and and the reason i i when i was a nobody they still picked up the phone though

00:24:45.880 so i don't attribute it to privilege i just think it's a really good doctor but carry on

00:24:49.880 it's all privilege man it's all privilege no uh one of the core fundamentals of our system is care

00:24:56.240 regardless of the your ability to pay and it's sort of this beautiful um uh truth that we we

00:25:03.340 design our whole system around but really the reality is that people who have some sort of

00:25:08.460 access or they know somebody inside the system get better they are able to get better care for

00:25:13.640 themselves and their family so the issue of privileged access is key you also ask though

00:25:18.480 about accessing care in different ways you know should the hospital really be the place that we

00:25:24.640 go as a default and canada has always had a hospital based or a hospital centric system

00:25:30.320 And this flows, you know, 1957, the Hospital Insurance and Diagnostic Services Act.

00:25:35.240 That was the first time we saw this dollar for dollar cost sharing where the government, federal government said, listen, provinces, we'll pay 50 percent of whatever you spend in hospitals.

00:25:44.780 And they repeated the same deal with the Medical Care Act 1966.

00:25:48.760 And those are the two pillars of Medicare as we know it.

00:25:52.500 as you know, the first Trudeau government turned off that blank check approach of the 50-50 deal

00:25:57.780 in 1977 with the established program as a financing act. And then provinces and the

00:26:03.280 feds have been fighting about funding ever since. And that's what we're seeing right now.

00:26:07.720 Well, I mean, on mental health care specifically, I mean, I've been very open about my own

00:26:11.740 experiences with mental health challenges, but just looking at it from the system perspective

00:26:16.260 here, I think one of the worst things you can do for a patient who is not in any acute medical

00:26:20.960 situation is to have police pick them up on a mental health call and bring them into a hospital

00:26:26.260 where the resources are already tied up and already stretched thin. And again, I would imagine there's

00:26:33.020 probably a much less costly and better quality alternative out there, but it requires a complete

00:26:40.700 rethink of the system. Well, part of what you're getting at with mental health care and many other

00:26:46.160 services fall into this as well is that they are intangible it's easy to say we have a wait time

00:26:51.540 for hip replacements we know your hip is worn out and we can measure it and we can you know pay

00:26:56.600 then for the number of hips being done mental health care is very difficult because um it's

00:27:02.140 you know james q wilson harvard professor talks about it being more a representative of a coping

00:27:07.720 organization it's more like education or like peacekeeping when a police officer is out keeping

00:27:13.480 the peace, how can you tell how much peace they're keeping? Can you pay them more if they keep more

00:27:18.340 peace or punish them if they don't keep peace? Well, peace is a metaphysical concept. And you're

00:27:23.380 getting at that with healthcare as well. How do we know that my advice to you to change your diet

00:27:31.300 or whatever is going to do anything for you 20 years from now or 40 or 50 years from now? Will

00:27:36.740 it make you live one year longer? How do we know that my advice was perhaps ignored and maybe you

00:27:42.380 listen to someone else in your house or your friend or your mom or whatever and so what you're

00:27:46.860 getting at is the intangible you're getting into an intangible thing where you know you hear not

00:27:53.460 everything that can be measured matters and not everything that matters can be measured and so

00:27:58.740 now you're talking about something that is very difficult to measure but it matters a great deal

00:28:04.200 and so it tends to fall off the budgets and spreadsheets and all these beautiful charts that

00:28:09.640 you see from our health system planners but we end up in the crisis that we're in right now because

00:28:15.360 of it so suppose you are the health minister of a province it doesn't really matter which one

00:28:22.580 and the government has given you whatever your province's share is of this 46 billion dollars

00:28:28.700 over the next 10 years which when you break it down over 10 years plus over 10 provinces and

00:28:33.120 three territories it's not even as huge it's even less significant an amount but let's say you're

00:28:38.920 given this what is the most in your view tangible change you could put in place with that money

00:28:46.600 so you've limited me to just talking about money usually i try to answer that question

00:28:51.080 by saying i want to talk about governance first let's do both i mean let's do okay how how can

00:28:56.120 you most efficiently spend that money pretending that the current governance restrictions are not

00:29:01.480 there okay so it's usually three things i talk about number one we know we have to figure out

00:29:05.960 governance who's in charge right now canadians don't know who to hold accountable do we hold

00:29:11.160 the feds accountable do we hold the provinces accountable do we hold our local hospital

00:29:14.760 accountable who do we hold accountable for access to care so that has to be clear number one number

00:29:20.120 two we need to expand core services so when i talk about core services i'm talking about life or limb

00:29:28.040 and that's sort of the fundamental that's the moral high ground in medicine whatever you do

00:29:32.440 when someone comes in you have to save life or limb first mental health falls in there it is a

00:29:38.200 life or limb issue so we need to expand services around life and limb issues the second thing

00:29:45.640 the third thing actually or the second thing with with concrete things that i would change

00:29:50.440 with respect to funding is to constrict and this is the part people don't like to constrict

00:29:56.680 things that are inappropriate so we have to have a discussion first about appropriateness are all

00:30:03.720 the services that we spend money on actually appropriate for the current environment we live

00:30:10.600 in right now medicine can offer far more than anyone ever dreamed it could offer in the 1960s

00:30:16.520 when we were coming up with this public health insurance approach in canada and so we've massively

00:30:23.240 expanded what we can do and what we can offer. And then provinces are pressured to keep at

00:30:28.580 offering, you know, PET scans or MRIs for anterior knee pain, or you could go on and on with the

00:30:34.480 things that we probably shouldn't be doing. The obviously wrong things are fall under the

00:30:40.920 choosing wisely campaign where they encourage doctors to stop ordering useless tests, but

00:30:46.280 that's only a fraction. We need to have a robust discussion to say, what do we have Medicare for?

00:30:52.200 Is it simply a redistribution program, like Roy Romano calls it?

00:30:56.460 He calls it our great redistributive program in Canada.

00:30:59.580 Or is it to provide a safety net for core life and limb issues?

00:31:04.220 So that's where I would focus on, expanding those services, contracting the more useless ones.

00:31:08.980 But number one, we have to get governance fixed up.

00:31:12.360 Yeah, and again, we all get stuck, and you and I have spoken about this in the past,

00:31:16.780 in this very false dichotomy between a Canadian health care system and an American health care

00:31:22.340 system. I was just listening to a show my friend Mark Stein did, and he just was talking about the

00:31:27.120 difference between the UK system and the French system. They're both completely government funded,

00:31:31.780 but one is vastly superior to the other. So there are degrees of quality within every system,

00:31:37.260 within every permutation and combination here. And, you know, there are things that I think

00:31:41.840 shouldn't be third rail issues one of them and again i'm not even advising that the government

00:31:46.800 does this but i i certainly think there should be a permitted discussion is having a co-pay when you

00:31:51.920 go to a clinic or when you go to a family doctor perhaps everyone gets you know three free visits

00:31:56.780 a year and if you go over that you have to pay some nominal fee or something like that like but

00:32:02.080 the fact is there are what i think are ideological uh people that are resistant to any change

00:32:08.740 whatsoever and they'd prioritize uh equality of care over quality of care yeah great comments and

00:32:16.060 you've really opened a wide up door wide wide door for a whole bunch of discussions which is great as

00:32:21.300 we're winding down just to like throw the bomb of copay in there but anyway carry on so we have

00:32:26.100 the 28 universal health care systems around the world and i think we can be strong in saying

00:32:31.120 universal care just means everybody in your country gets care there are many different ways

00:32:35.520 to achieve that end 28 different countries around the world have universal health care 23 of the

00:32:40.880 28 have some form of cost sharing now when you get into patient cost sharing one of the mistakes

00:32:46.880 people make and i just wrote a large paper on this actually for mcdonald laurier institute

00:32:51.120 is that they think they'll get cost sharing to increase revenue in fact that doesn't work

00:32:57.200 the countries that use cost sharing they always have robust exemptions for the very old the very

00:33:04.320 young the chronically ill and that sort of thing so once you narrow who you're going to focus the

00:33:10.560 cost sharing onto you do have a measurable change in in how many times people will go to the doctor

00:33:17.600 for the same problem for their anterior knee pain which is the bane of an orthopod's existence

00:33:22.720 and so there there is some role for it to play however however it actually may cost the system

00:33:28.880 more if you imagine a long lineup at tim hortons and everybody in that lineup wants you know one

00:33:35.760 tim bit and there are two or three people in there with a large order the average cost for that long

00:33:43.200 tim hortons lineup will be very low whereas if every single person in that lineup wants a dozen

00:33:48.880 donuts and 15 coffees the average cost per customer is very high it's the same with health

00:33:54.880 care if you use user fees to get some of those low value people out of that line you may drive up

00:34:01.920 and most studies suggest you will drive up the average cost per patient but that's the right

00:34:07.120 thing to do so we should do it to improve efficiency and improve horizontal equity so

00:34:13.760 that you and i if we're earning the same amount of money and we have similar genetics and you go to

00:34:18.640 the doctor every two weeks and i go to the doctor once a year why do i have to play the same health

00:34:23.920 premiums so there's an argument to be made for them but it's not the magic solution that some

00:34:28.860 people think it is well i appreciate it very much and just on the note of ideology i have to share

00:34:34.600 this comment there was a service that started up in canada a few years ago called maple which lets

00:34:38.960 people for a nominal fee whatever it is see a doctor virtually and and get a prescription if

00:34:44.880 they need or anything like that and in my as to my understanding all of the doctors on maple are

00:34:50.800 employed within the public system, but in their off time, they sign up and they take, you know,

00:34:55.820 however many patients a day or a week. And it's a net increase in the amount of care available in

00:35:02.460 this country. It costs the public system nothing. It costs taxpayers nothing. Jagmeet Singh last

00:35:08.200 week was saying we need to prohibit it. We need to close what he's calling the maple loophole.

00:35:13.360 Yeah. So I've been on a number of interviews actually debating what he's been saying. He's

00:35:20.240 been saying things like in BC they're buying up all the private clinics and so I don't know we

00:35:24.340 can have another you know Air Canada or whatever but to your point about increasing access that's

00:35:29.500 a key point that I think the public really needs to know about and I'll use a concrete example so

00:35:34.460 in Ontario we have a certain number of IVF cycles so people who can't get pregnant they

00:35:41.140 want to get pregnant they go to fertility service and they can get something called IVF

00:35:45.240 in vitro fertilization. Ontario funds 5,500 of those a year. That number of procedures could

00:35:55.660 support, you know, five clinics. A large clinic will do around 1,000 procedures a year. Because

00:36:01.820 Ontario allows private billing for IVF services, infertility services, we actually currently have

00:36:10.060 13 clinics in Ontario. That's this 2020 data. So in other words, people who want their publicly

00:36:17.180 funded IVF services now have clinics much closer to home. We have them far up in the north,

00:36:23.540 all across southern Ontario. So 13 instead of five or six, because we've allowed a greater

00:36:30.340 number of or a blend of public and private billing for IVF. And you have to realize that each one of

00:36:37.280 those clinics hire staff and they have rent space and they have equipment and so not only is it

00:36:43.540 better for patients it's better for the economy it's better for the health care workforce so it's

00:36:48.340 better overall so this book this uh fear-mongering about um any any blending at all is just not borne

00:36:56.700 out by the data dr sean whatley author of the book when politics comes before patients why and how

00:37:03.000 canadian medicare is failing but he doesn't just come with doom he comes with a bit of hope and

00:37:07.280 with suggestions and i think leaders in government should very much heed those sean always a pleasure

00:37:12.920 thanks for coming on today my pleasure thank you thank you that was dr sean whatley we have to end

00:37:19.820 things there my thanks to all of you for tuning into this edition of canada's most irreverent

00:37:24.960 talk show back on friday with fake news friday and then next week with more of this program thank

00:37:30.380 you god bless and have a great day

00:37:33.000 Thanks for listening to The Andrew Lawton Show.

00:37:35.940 Support the program by donating to True North at www.tnc.news.

Juno News - February 08, 2023

CBC's days are numbered

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