Juno News - Fixing Canada's broken healthcare system

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

00:00:06.660 This is the Andrew Lawton Show, brought to you by True North.

00:00:12.800 Coming up, a deep dive into the Canadian healthcare system.

00:00:16.600 How is it not serving patients, and more importantly, how can we make it better?

00:00:21.960 The Andrew Lawton Show starts right now.

00:00:25.460 Welcome to the Andrew Lawton Show here on True North.

00:00:31.640 Every Friday we do things a little bit differently.

00:00:34.100 We take a big issue affecting us in society, and we try to bring in a panel of experts

00:00:38.620 who can tackle it from every which way.

00:00:41.260 And today we're going to do a deep dive into healthcare,

00:00:44.220 which is not exactly an underexplored topic, certainly not in the last year and a half,

00:00:49.580 but it is one that oftentimes is scant on solutions.

00:00:53.300 We have a very narrow view of healthcare discourse,

00:00:56.480 and so many of the big changes, or even marginal changes,

00:00:59.940 that a lot of people have proposed for the system

00:01:01.840 just will not get addressed in the political realm

00:01:05.260 for reasons that I'm sure we'll tackle in the next little while.

00:01:08.700 We have a fantastic panel of guests,

00:01:11.360 all bringing very different expertise to the question of healthcare,

00:01:14.500 and specifically healthcare reform in this country,

00:01:17.720 which I think we can all agree is something that is very much needed.

00:01:20.400 Alex Hannum is the president and CEO of MedPoint,

00:01:23.920 which is a healthcare centre in my neck of the woods in London, Ontario,

00:01:27.440 that does a lot of great work and has both public and private elements.

00:01:31.480 Dr. Sean Watley, who is a family physician and author of the fantastic book

00:01:35.500 When Politics Comes Before Patients,

00:01:37.900 also the former head of the Ontario Medical Association,

00:01:41.540 and Joanna Barron, executive director of the Canadian Constitution Foundation,

00:01:45.620 which has been doing a lot of work specifically with a case in BC

00:01:49.040 that I'm certain you know of by now.

00:01:51.060 But I actually want to start there,

00:01:52.720 because I know there is this case that's been taking up several years,

00:01:56.140 Joanna, that is really getting to the heart of, I think,

00:01:58.620 where a lot of people's frustrations with the healthcare system in Canada are right now,

00:02:02.640 which is that we're told we have this universal government-guaranteed access

00:02:06.720 to a healthcare system,

00:02:07.860 but for a lot of people, that's just access to a waiting list.

00:02:10.820 Yeah, absolutely.

00:02:13.400 So that is the evidence that we let in the case,

00:02:15.940 which I don't know how much background we should provide,

00:02:17.980 but very quick story for a very long story.

00:02:20.980 It's been going on for more than 10 years.

00:02:23.180 It's brought by the Canadian Constitution Foundation

00:02:25.400 with Canby Surgery Centre,

00:02:27.460 which is a long-standing private surgical facility in Vancouver,

00:02:31.780 as well as for patient plaintiffs.

00:02:34.700 And the case is basically that, as you say,

00:02:37.300 access to healthcare is not access to a waiting list.

00:02:40.820 And that the government cannot, at the same time,

00:02:44.540 fail, just completely provenly over decades,

00:02:51.060 overwhelmingly fail to treat individuals

00:02:54.260 within maximum medically accepted wait times,

00:02:57.680 and at the same time, prevent those same patients

00:03:01.120 from taking their health into their own hands

00:03:03.080 and seeking treatment outside of the public system.

00:03:06.720 And yet, that is the detente that we're in.

00:03:08.780 Let me turn to you, Alex.

00:03:11.240 How does MedPoint fit into the delivery system we have in Canada?

00:03:15.760 And more importantly, why is it that way?

00:03:19.020 Well, we were born out of just trying to make a better system.

00:03:22.980 My wife was a physician in a medical clinic

00:03:26.580 and working in walk-in clinics

00:03:28.020 and was really quite frustrated

00:03:29.460 with a lot of patients

00:03:33.680 that were dealing with chronic health issues

00:03:35.480 that could have been prevented.

00:03:36.580 She really felt like there was no focus on prevention.

00:03:38.780 She felt like a cog in a broken wheel.

00:03:41.820 And so I built a better wheel.

00:03:43.540 And we had a lot of conversations

00:03:45.480 about what was out there in the market.

00:03:48.300 We looked at the Kopman Healthcare Centre

00:03:50.700 right around the time that Don Kopman announced

00:03:52.840 he was coming to Ontario.

00:03:53.960 And quite honestly, I've actually spoken to Don since.

00:03:57.620 And I said, you know what?

00:03:58.420 You created us,

00:03:59.760 which was an interesting conversation.

00:04:03.100 We just felt like if we could focus on prevention

00:04:06.060 and make it affordable,

00:04:08.000 we weren't, we were going to do executive healthcare,

00:04:10.500 but bring it to the general population.

00:04:14.000 We may have been a couple of years ahead

00:04:15.820 of where the market was.

00:04:17.780 So the first couple of years were a little tight.

00:04:22.160 And we did quite well with people

00:04:24.580 from outside of London and executives.

00:04:27.860 But today, in today's climate, we're packed

00:04:31.800 and we're expanding

00:04:33.520 and we're working 60, 70 hour weeks

00:04:36.820 just trying to keep up.

00:04:38.780 Now, where do you fit in the public-private discussion?

00:04:42.260 So we are a public-private hybrid.

00:04:45.520 So we have a number of medical specialists

00:04:48.240 that bill OHIP for their services.

00:04:50.380 We have a walking clinic.

00:04:52.720 We have a pediatric walking clinic.

00:04:54.400 Again, all covered by OHIP.

00:04:56.220 But when people want to focus on prevention,

00:04:58.040 we offer a three-hour medical or a five-hour medical

00:05:00.820 that focuses on disease mitigation,

00:05:04.240 lifestyle modification.

00:05:05.860 Find out, essentially, do a lot of screening,

00:05:08.480 find things that we feel the clients

00:05:11.660 and patients need to go to that next step.

00:05:14.640 And then facilitate that process.

00:05:19.520 One thing that we have found

00:05:21.120 is that with executive-level healthcare,

00:05:24.760 the client might be paying for a medical,

00:05:28.000 but they really expect a better overall experience

00:05:31.500 and a better result.

00:05:32.880 So what we learned very, very quickly

00:05:35.000 was it wasn't just, here's the medical,

00:05:37.740 let's throw you back into the OHIP system,

00:05:40.200 which isn't very efficient.

00:05:42.080 It was get me through that OHIP system consistently,

00:05:46.080 get me access to the specialists.

00:05:48.480 And what we really found was that we started to attract

00:05:52.300 a number of specialists to our clinic

00:05:53.980 to the point that we've been as high

00:05:57.260 as at one time 28 physicians working out of MedPoint,

00:06:00.660 starting with just one family doctor and growing.

00:06:03.260 So we have added gynecology, cardiology, dermatology, gastro,

00:06:09.660 and then, of course, everything just sort of escalated from there.

00:06:13.800 We now have senior care with geriatrics.

00:06:16.600 We have pediatrics.

00:06:18.900 And as you know, we have fitness facilities,

00:06:21.660 and it just keeps growing.

00:06:24.480 When you hear this, Sean,

00:06:26.780 do you think that it's a fair assertion

00:06:29.360 that the system, the traditional public universal system,

00:06:32.960 doesn't really allow for that focus on preventative healthcare?

00:06:37.420 Well, there just isn't time.

00:06:39.140 So I just think of my clinic this morning,

00:06:40.840 you know, we're squeezed in,

00:06:41.840 we're asking extra people to squeeze in,

00:06:43.780 and then we're trying to deal with the issue they came with,

00:06:46.860 the issue that they didn't tell the front staff about,

00:06:49.380 so that adds another half an hour,

00:06:51.140 plus all of the things that I'm supposed to be screening for.

00:06:54.060 Did you get your colon cancer screening done?

00:06:55.900 Oh, by the way, your cholesterol is high.

00:06:57.400 You have a 50% chance of a heart attack or stroke

00:06:59.760 over the next 10 years.

00:07:00.900 Here are the numbers.

00:07:01.740 Oh, that can't be true, Doc.

00:07:02.760 So all these things require time

00:07:05.260 to actually try to support people

00:07:08.000 and encourage them to change.

00:07:09.660 So I think the polyclinic concept,

00:07:12.860 but also, I mean,

00:07:13.840 three hours for preventative health maintenance.

00:07:16.280 Wow, that would be awesome.

00:07:18.500 And the challenge with this

00:07:21.140 is if you go to government and say,

00:07:23.180 listen, this is something that we think

00:07:24.640 would really help patients.

00:07:25.840 This is what we would like to do.

00:07:27.880 They're going to say, well, show me the KPIs.

00:07:29.880 What are the key performance indicators?

00:07:31.680 You know, how many extra quality adjusted life years

00:07:34.780 are we going to get out of this particular intervention?

00:07:38.040 And you can't do it

00:07:39.820 because how do I know

00:07:42.160 that me telling you to exercise,

00:07:44.340 stop smoking,

00:07:45.100 and maybe drink a little less alcohol

00:07:47.900 is going to make you live another 10 years.

00:07:50.240 And at what level of function

00:07:51.820 and how many extra tax dollars are you going to pay

00:07:54.140 as a result of my intervention?

00:07:56.540 And so we're dealing with a type of organization,

00:08:00.320 healthcare,

00:08:01.040 that we can't always see exactly the work

00:08:04.300 that's being done

00:08:05.220 or the result of that work.

00:08:07.360 And so it's similar to education or peacekeeping.

00:08:09.800 Go keep the peace.

00:08:11.040 Okay, how do we measure peace?

00:08:12.380 It's a metaphysical concept.

00:08:13.780 How much peace has been kept?

00:08:15.580 And so I think there's a need.

00:08:17.180 I think patients would love it.

00:08:18.740 But trying to create an evidence-based argument

00:08:21.320 to present before the funders is a challenge.

00:08:26.220 And all of us on the panel

00:08:27.540 are going to ask you a question later

00:08:28.780 so you can be low hip for this time.

00:08:30.440 We appreciate you taking it out of your schedule,

00:08:32.360 Dr. Whatley.

00:08:33.700 Let me bring this back to you, Joanna,

00:08:35.480 because what we've just heard there

00:08:36.860 are two very different perspectives,

00:08:39.740 or I guess one similar perspective,

00:08:41.240 but two different angles.

00:08:42.080 One of which is what's being done

00:08:44.180 in part outside the system.

00:08:46.080 And another one is showing

00:08:47.500 that the limitations of the system

00:08:49.320 that the government has given

00:08:50.300 to healthcare practitioners.

00:08:51.980 And a lot of this must sound very familiar to you

00:08:54.120 looking at the facts of the Canby case.

00:08:56.360 And I'm wondering why the government

00:08:58.060 is so resistant

00:08:59.480 when these solutions are being offered by people

00:09:03.300 that don't cost government any money.

00:09:05.560 I think there are a number of factors.

00:09:07.360 I think the first thing to note

00:09:09.860 is that the government

00:09:11.040 is obviously resistant

00:09:12.200 to anything that entails

00:09:13.860 going out of the public system.

00:09:16.220 And that is a question of ideology, right?

00:09:18.520 Which Sean and I have spoken about at length,

00:09:21.200 that it is just a sacred cow

00:09:23.100 in Canadian politics

00:09:24.420 to acknowledge what is already happening.

00:09:26.980 People going out of the system

00:09:28.240 by leaving the country,

00:09:29.860 people going out of the system

00:09:31.160 by frequenting these businesses

00:09:34.260 that operate in a,

00:09:36.000 to be honest,

00:09:36.740 I don't want to give Alex any legal advice,

00:09:38.560 but a little bit of a gray area.

00:09:41.100 It's not clear.

00:09:42.020 The very problem in BC

00:09:43.680 and Ontario has similar provisions

00:09:46.020 is that physicians cannot build a public system

00:09:49.800 as well as build privately,

00:09:51.760 which makes it uneconomic for them

00:09:53.900 to sort of like put all of their,

00:09:56.200 put all of their eggs in one basket,

00:09:58.600 so to speak.

00:09:59.140 And so there's a great resistance

00:10:02.000 to talking about any type of innovation

00:10:04.160 for basically ideological reasons

00:10:06.420 because it's an article of faith

00:10:08.320 and, you know,

00:10:08.740 it's a source of great pride

00:10:10.160 that Canadians have in the public system,

00:10:12.680 which I think everybody on this panel

00:10:14.420 would agree with

00:10:15.120 that we should continue

00:10:16.000 to strengthen our public system.

00:10:18.960 And so, and the second thing

00:10:20.800 is simply that all outcomes

00:10:22.540 that government allots to healthcare

00:10:24.540 is not based on the needs

00:10:26.760 of the population

00:10:27.720 or even the willingness

00:10:30.000 of the market to step up.

00:10:31.900 I think it's very clear at this point,

00:10:34.160 and Alex would know this firsthand,

00:10:35.500 that there is some portion

00:10:37.040 of the Canadian market

00:10:38.260 that is willing to pay a premium

00:10:39.720 for a three-hour, you know,

00:10:41.320 holistic health check.

00:10:42.640 But they are just thinking about,

00:10:44.240 you know, budget rationing

00:10:45.980 and budget allotments.

00:10:47.600 And there is not much time

00:10:49.300 and capacity to think beyond just,

00:10:51.480 you know, dealing with

00:10:53.440 the most acute emergencies.

00:10:55.680 Everything else gets shunted

00:10:57.220 to a waiting list

00:10:58.200 and pretty much literally

00:10:59.500 everything else from the evidence.

00:11:01.980 When you've been crafting

00:11:03.620 your offerings, Alex,

00:11:05.320 have you found that you have been

00:11:07.040 excessively constrained

00:11:08.460 by the regulations

00:11:10.080 from what you would love to be doing?

00:11:12.360 Not at all.

00:11:14.040 And thank you, Joanne.

00:11:15.440 I do have very good legal advice.

00:11:17.500 And we are actually the concept

00:11:19.960 that we came up with 16 years ago.

00:11:22.600 Our lawyer has actually sent that

00:11:24.700 to a number of different places

00:11:26.660 saying the only place

00:11:27.540 that's actually operating

00:11:28.600 above law is MedPoint.

00:11:30.920 There's a lot of gray area

00:11:32.200 in this industry for sure.

00:11:34.220 And, you know,

00:11:35.260 you both bring up excellent points.

00:11:37.120 Sean, you know,

00:11:37.940 when you're talking,

00:11:38.840 if you have a in our system,

00:11:40.880 if you have a patient

00:11:41.600 who's having a heart attack,

00:11:42.600 you don't have time

00:11:43.400 to talk to them

00:11:44.000 about the importance

00:11:44.880 of a proper diet.

00:11:48.100 And when it comes to

00:11:50.420 and if we if we screened

00:11:54.700 everybody with an MRI

00:11:55.860 or did abdominal ultrasounds

00:11:58.120 on everybody every day,

00:11:59.500 we'd find a lot of problems

00:12:01.500 with a lot of people.

00:12:02.640 But what's the ROI on that?

00:12:04.560 And so we can't

00:12:06.720 we can't screen everybody

00:12:08.580 for everything all the time.

00:12:10.760 We have to use the

00:12:11.840 the clinical judgment

00:12:13.240 of the physicians.

00:12:14.040 And there are certain things

00:12:15.520 that we feel are going

00:12:17.880 to give us a better bang

00:12:19.680 for our buck.

00:12:21.660 Again, with executive health

00:12:23.820 has been around for 40, 50 years.

00:12:27.620 MedCan started in downtown Toronto

00:12:29.600 in the TD building.

00:12:32.040 And it's been something

00:12:34.240 that's been exclusive

00:12:35.240 for the executives.

00:12:37.700 And the concept is,

00:12:39.480 hey, we have a lot of executives.

00:12:40.680 We have to make sure

00:12:41.620 they stay healthy

00:12:43.200 so that our company

00:12:44.400 stays healthy

00:12:45.080 and we want to catch disease

00:12:46.160 early and deal with it.

00:12:47.620 Our concept was,

00:12:48.880 how do we bring this

00:12:49.760 to the general population?

00:12:51.420 How do we how do we make

00:12:52.800 this accessible, affordable?

00:12:55.500 I don't want to get

00:12:56.320 into a sales pitch,

00:12:57.080 but I'm half price

00:12:58.120 of what the Toronto clinics offer.

00:13:00.780 Our we have our five hour medical.

00:13:02.840 Actually, when we started

00:13:03.900 is almost the exact same

00:13:05.880 medical in Toronto.

00:13:06.820 We're retail at 1895.

00:13:09.580 Toronto is over $3,000 easily.

00:13:12.620 But again, they're pulling

00:13:13.920 on 5 million people

00:13:15.420 and I'm pulling on 300,000.

00:13:17.320 One thing that has really happened,

00:13:19.380 though, and I'm sure everyone

00:13:21.880 on this panel would see this

00:13:23.220 is with the age demographic

00:13:25.740 of physicians.

00:13:28.940 We've got 40 plus 40% of physicians

00:13:32.600 that were over the age of 55,

00:13:35.540 40%, 17% were over the age of 65.

00:13:38.920 That's Ontario.

00:13:39.900 In Canada, similar statistics.

00:13:42.460 The doctors themselves

00:13:43.900 are in that baby boom generation

00:13:45.960 and they are starting to retire.

00:13:48.040 When COVID hit,

00:13:49.620 a lot of those physicians

00:13:51.200 just said, okay,

00:13:52.400 well, I'm not coming back.

00:13:53.580 And so in London,

00:13:55.480 we had last year,

00:13:56.820 we had 12 family physicians retire.

00:13:59.520 This year, we've already had

00:14:00.860 eight family physicians retire.

00:14:03.320 So what we're getting

00:14:04.720 before I was getting the executives

00:14:06.600 and I was getting people saying,

00:14:08.180 hey, I just want a preventative

00:14:09.920 approach to healthcare.

00:14:10.960 I want really good screening.

00:14:12.160 I want you to help me

00:14:12.840 get through the system.

00:14:14.280 You know what I'm getting now?

00:14:15.420 I'm getting everyday people saying,

00:14:17.220 I don't have a doctor anymore

00:14:18.680 and I'm not going to get one.

00:14:20.340 And if we've had 20 doctors

00:14:25.560 retire in the last two years

00:14:27.680 and maybe a net of 16 doctors

00:14:32.260 retire less,

00:14:33.600 the biggest challenge

00:14:35.360 that I've seen in that

00:14:36.200 is the seniors.

00:14:37.620 No one is going to,

00:14:38.440 even if you have a new doctor coming in,

00:14:40.480 seniors are not going to get picked up.

00:14:42.220 So if you're in your 70s, 80s,

00:14:44.640 and you have a number of medical scripts

00:14:47.300 and ailments and chronic health conditions,

00:14:50.200 you're not getting picked up.

00:14:51.860 So we've had to shift

00:14:53.600 and we've had to create

00:14:54.880 a senior care program.

00:14:56.720 And I think what we've been able to do

00:15:00.240 and where we've been successful

00:15:01.260 is a lot of physicians have said,

00:15:03.400 hey, I've done my 20, 30 years.

00:15:06.340 I don't want to run my practice anymore.

00:15:08.580 I just want to come in,

00:15:09.560 see patients, do medicine,

00:15:10.840 and go home.

00:15:12.340 And we've become sort of a retirement home

00:15:15.560 for a lot of physicians

00:15:16.600 to end their career with us.

00:15:18.520 We also have a lot of new grads

00:15:20.480 that have recently joined us

00:15:22.940 who are just, again,

00:15:24.240 frustrated with the healthcare system

00:15:25.720 and frustrated with the mourning

00:15:27.520 that Sean's explaining

00:15:28.600 is you're trying to do too much

00:15:30.460 and you get exhausted,

00:15:32.500 you get burnout.

00:15:33.480 Physician burnout is a massive,

00:15:35.240 massive challenge

00:15:37.240 that no one's really looking at.

00:15:39.020 Well, and this is not a new problem either.

00:15:41.660 I mean, I've been hearing for years and years

00:15:43.500 the challenges of people

00:15:44.840 that can't get a family doctor.

00:15:46.600 My family was very fortunate

00:15:47.900 that I had the same doctor

00:15:49.300 from the time I was a child

00:15:50.780 until he retired,

00:15:51.660 but his daughter took over his practice.

00:15:54.100 So I was not affected by his retirement,

00:15:56.520 whereas other people I know

00:15:57.660 have had doctors retired

00:15:58.780 and they're forced to fend for themselves.

00:16:01.880 So I'm assuming these numbers

00:16:03.380 that Alex just rhymed off

00:16:04.760 are not new to you, Sean.

00:16:06.080 They're probably things

00:16:06.840 that you were dealing with

00:16:07.700 when you were at the OMA

00:16:08.660 and are still seeing now

00:16:10.040 just as a frontline practitioner here.

00:16:12.620 Why is it that we aren't seeing

00:16:15.380 an influx of doctors?

00:16:16.980 You know, it's one of the few jobs

00:16:18.740 that you're kind of guaranteed

00:16:19.720 to have a pretty stable income from.

00:16:21.560 What's stopping people from doing this

00:16:24.060 and practicing in Canada?

00:16:26.540 Great question.

00:16:27.320 So health human resources

00:16:28.240 is always a fun topic

00:16:29.540 to great committees to sit at for sure.

00:16:32.340 The short answer is

00:16:33.860 we're not pumping enough out,

00:16:35.200 but that oversimplifies a complex issue.

00:16:38.800 So we can talk about

00:16:39.620 absolute shortages of physicians

00:16:41.460 versus relative shortages of physicians.

00:16:44.520 So if I can survive

00:16:47.260 and stay sane with a roster

00:16:50.140 of a thousand patients

00:16:51.460 and that's it,

00:16:54.000 that's very different

00:16:54.920 than if I could stay sane

00:16:56.780 with a roster of 3,000 or 5,000 patients.

00:17:00.080 And so you ask,

00:17:00.760 well, how could we have

00:17:01.900 such a different relative capacity

00:17:04.780 for a fully functioning physician?

00:17:07.500 And a lot of it has to do

00:17:08.580 with what we're allowed to do.

00:17:10.660 So I don't know

00:17:11.200 if the last time you've been to a dentist

00:17:12.760 or to your accountant

00:17:13.920 or to your lawyer's office,

00:17:15.960 does your accountant

00:17:17.440 do everything in the office?

00:17:19.280 Do they just have a receptionist

00:17:21.220 and then they write the books

00:17:22.800 and go through your tax forms

00:17:24.520 and enter them all?

00:17:25.480 No, they have a horde,

00:17:27.060 an army of people helping them.

00:17:29.280 And so they leverage their own knowledge

00:17:31.200 to get other people

00:17:32.040 helping them to do work.

00:17:33.680 Same thing in the dentist's office,

00:17:35.300 same thing in any other

00:17:36.400 professional services office.

00:17:38.420 Whereas in Canada,

00:17:40.200 we have this idea

00:17:41.360 and I won't go on and on about this,

00:17:43.700 but we have this idea

00:17:44.420 that every single patient

00:17:46.620 must be seen by the doctor

00:17:48.880 before the doctor

00:17:49.660 can legally bill for that service.

00:17:52.160 Now, there are some exceptions

00:17:53.340 if I hire a nurse

00:17:54.460 and I delegate authority

00:17:55.700 to her or him, et cetera.

00:17:57.880 But essentially,

00:17:58.700 it's very, very difficult

00:17:59.920 to scale up the amount

00:18:01.520 of services I'm able to provide.

00:18:03.660 Whereas in any other

00:18:05.180 functioning situation,

00:18:06.920 you can if you maintain

00:18:09.500 responsibility for the outcomes

00:18:11.420 of the services provided

00:18:12.960 by these other providers.

00:18:14.720 And so what the government

00:18:15.420 often wants to do

00:18:16.320 is they want to get doctors

00:18:17.740 to assume responsibility

00:18:19.100 and oversight

00:18:19.800 for allied health providers,

00:18:21.320 but yet not pay them for it

00:18:22.780 or not figure out

00:18:24.900 because it's never,

00:18:26.620 Andrew's never needing

00:18:27.880 to be seen by Watley.

00:18:29.300 We can let him be seen

00:18:30.400 by a nurse all the time.

00:18:31.840 Well, it's never like that.

00:18:33.100 It's maybe 80-20 or 90-10

00:18:35.720 or you know what,

00:18:36.860 for the next six months,

00:18:38.220 Andrew has to see Watley

00:18:39.220 all the time

00:18:40.180 as the patient

00:18:40.920 and the physician.

00:18:42.140 But now Andrew's doing great

00:18:43.940 for a couple of years

00:18:44.720 and Watley can be

00:18:45.540 in the background.

00:18:46.720 And so that sort of nuance

00:18:47.820 and pivoting back and forth

00:18:49.380 is just not possible

00:18:51.060 in our rigid system

00:18:52.420 where I see you,

00:18:54.040 I bill a fee,

00:18:54.920 that's done,

00:18:55.600 or I see you,

00:18:56.540 you're on my roster

00:18:57.420 and that's done.

00:18:59.320 I'd love to circle back

00:19:00.700 to Alex's comments

00:19:01.740 about the ultrasounds

00:19:02.900 and stuff for everybody,

00:19:03.820 but I don't know

00:19:04.160 if that's getting off topic,

00:19:05.400 Andrew,

00:19:05.560 I'll leave it with you.

00:19:06.920 Well, let's go for it.

00:19:08.180 Why not?

00:19:08.520 We're having an open discussion here.

00:19:10.100 Let's hear it.

00:19:11.400 So I think it's wonderful.

00:19:13.580 Alex talks about the opportunity,

00:19:15.920 but also the appetite.

00:19:17.380 A lot of times patients say,

00:19:19.100 Doc, I just want an MRI of my knee.

00:19:20.660 And I say,

00:19:21.080 yeah, but you have anterior knee pain.

00:19:22.680 And I say,

00:19:23.100 it's not really indicated.

00:19:24.360 Yeah, but I just want to know, Doc.

00:19:26.240 And so there's certainly

00:19:27.400 an appetite within the public

00:19:29.020 to consume a lot more health care

00:19:30.960 than we currently provide

00:19:32.400 in the system.

00:19:33.580 Some of that,

00:19:34.480 I would actually disagree with.

00:19:35.920 You probably don't need an MRI

00:19:38.200 for anterior knee pain.

00:19:40.140 However, to Alex's point,

00:19:41.660 oftentimes we'll do scans

00:19:43.840 and we'll find things that,

00:19:45.480 you know,

00:19:45.640 thank God we did the scan.

00:19:47.000 We found something.

00:19:48.080 At the same time,

00:19:49.000 we often do scans

00:19:50.080 like an ultrasound

00:19:50.740 of your abdomen or whatever,

00:19:52.000 and we find something

00:19:53.380 that's benign,

00:19:54.260 but we don't know it's benign

00:19:56.060 until we do three more tests

00:19:57.740 and a surgery.

00:19:58.980 And now you're recovering

00:19:59.740 from a large cut in your abdomen

00:20:01.240 that you really didn't need

00:20:02.500 to have in the first place.

00:20:04.400 And so we have to be

00:20:05.140 a little bit cautious

00:20:06.160 because we open ourselves

00:20:08.060 up to criticism.

00:20:09.620 And this is one

00:20:10.020 of the main criticisms

00:20:11.300 people have

00:20:12.420 for any kind of services

00:20:13.640 outside the public system

00:20:14.840 is that,

00:20:15.660 oh, you're just going

00:20:16.200 to do too much.

00:20:17.020 You're going to do

00:20:17.680 a million useless tests

00:20:19.020 and a whole bunch

00:20:19.960 of useless surgeries

00:20:20.800 and people will die

00:20:21.980 because you are

00:20:22.680 evil, greedy people.

00:20:24.540 And so we have to be cautious

00:20:25.760 to that accusation.

00:20:28.340 And really,

00:20:29.140 I think the moral high ground

00:20:31.520 here is providing service,

00:20:34.100 care in a dignified way

00:20:36.160 without the wait times

00:20:37.940 that we currently experience.

00:20:40.020 And, you know,

00:20:40.920 on the one hand,

00:20:41.560 giving people what they want,

00:20:42.700 but at the same time,

00:20:44.000 being kind of

00:20:45.360 the information broker

00:20:46.320 and saying,

00:20:46.980 hey, listen,

00:20:47.520 this is what the evidence says.

00:20:48.700 We're not able to do

00:20:49.680 this evidence-based intervention

00:20:51.420 within the current

00:20:52.300 public system,

00:20:53.020 but we can do it here

00:20:54.940 in Alex's clinic

00:20:56.300 or whatever.

00:20:57.480 And so continuing

00:20:58.500 to maintain

00:20:59.140 a very high standard

00:21:01.460 with respect to evidence

00:21:02.820 and scientific thinking

00:21:04.040 and going out of our way

00:21:06.560 to avoid the commercialism

00:21:08.640 that the other

00:21:09.600 ideological opponents

00:21:11.040 will immediately attack you for.

00:21:12.720 So I just throw that out there.

00:21:14.000 I don't know

00:21:14.460 if that's provocative or not.

00:21:16.160 Well, we'll let Alex

00:21:16.820 respond to that in a moment,

00:21:17.840 but I want to go

00:21:18.700 to you, Joanna,

00:21:19.520 for a moment

00:21:20.020 and return to this idea

00:21:21.280 of the doctor shortage

00:21:22.520 because one of the chief

00:21:24.080 criticisms we hear

00:21:25.340 from anything

00:21:26.540 that moves us

00:21:27.500 in more of a private direction

00:21:29.080 or a choice direction,

00:21:30.640 especially from

00:21:31.420 the usual suspects

00:21:32.680 who want to defend

00:21:33.780 at all costs

00:21:34.480 the Medicare system

00:21:35.440 in Canada,

00:21:36.060 is that if you allow

00:21:37.200 for all of these things

00:21:38.240 to go private,

00:21:39.420 for doctors to work privately,

00:21:40.900 you're going to just

00:21:42.200 amplify this shortage

00:21:43.940 in the public system

00:21:45.100 and cause basically

00:21:46.280 an exodus

00:21:46.900 that diminishes

00:21:48.820 the universality of this.

00:21:50.660 And I know this is something

00:21:51.520 that even the B.C. government,

00:21:52.860 I believe,

00:21:53.680 has kind of argued

00:21:54.500 as well as others

00:21:55.480 seeking intervention.

00:21:56.820 Is that actually the case,

00:21:58.200 that the more you allow

00:21:59.300 for private alternatives,

00:22:00.960 the weaker

00:22:01.540 the public system gets?

00:22:02.820 So there's that proposition

00:22:05.740 does not logically follow.

00:22:07.840 And it was sort of interesting

00:22:09.240 to see,

00:22:10.020 I attended obviously

00:22:11.520 the Canby appeal hearings,

00:22:13.860 which were last June,

00:22:14.780 and there was a real vein

00:22:17.840 in the government submissions

00:22:19.240 that was essentially saying

00:22:21.000 in much fancier words,

00:22:23.080 doctors are greedy.

00:22:25.100 And if doctors are given access

00:22:26.740 to these private patients,

00:22:28.280 they will not practice

00:22:30.400 in the public care system.

00:22:32.160 And it was pretty much

00:22:34.740 unsubstantiated,

00:22:36.020 but it was sort of

00:22:36.580 just this specter

00:22:37.760 that they were very deliberately

00:22:39.240 weaving into their arguments.

00:22:41.340 And so conversely,

00:22:42.840 the evidence actually shows,

00:22:44.260 particularly with surgeons

00:22:45.260 and specialists

00:22:46.260 who are particularly affected

00:22:47.920 by these non-double-billing

00:22:50.660 regulations in B.C.

00:22:52.220 that they can't work

00:22:52.980 in the private system

00:22:53.700 as well as the public system,

00:22:54.800 is that many of these surgeons

00:22:56.280 and specialists,

00:22:57.220 for example,

00:22:57.740 one doctor

00:22:59.320 who led evidence

00:23:00.360 at the trial,

00:23:01.080 Dr. Javert

00:23:01.760 of False Creek

00:23:03.000 Surgical Center

00:23:04.060 in Vancouver,

00:23:05.280 he gave evidence

00:23:06.640 that he was allotted

00:23:07.740 so little operating time

00:23:09.960 in the public hospital system

00:23:12.200 that he wasn't even

00:23:13.420 allotted enough time

00:23:14.840 to maintain

00:23:15.680 his own medical bar license.

00:23:18.640 It was so low.

00:23:19.520 So the issue, again,

00:23:20.600 it comes down

00:23:21.540 to the fundamental mechanism,

00:23:23.640 which is government rationing

00:23:25.000 of hours

00:23:25.940 rather than, you know,

00:23:28.040 the actual ability

00:23:29.500 and presence

00:23:30.580 and willingness

00:23:31.320 of doctors.

00:23:33.140 It just comes down

00:23:34.100 to the limitations

00:23:34.900 in the budget,

00:23:35.820 which are, of course,

00:23:36.620 determined by

00:23:37.720 largely political considerations.

00:23:41.760 Is it just then

00:23:43.140 about the government

00:23:44.100 underfunding the public system

00:23:45.780 or is there something else

00:23:46.880 that's at issue then?

00:23:48.260 I don't think so.

00:23:49.760 I don't think that the issue

00:23:50.940 can be remedied

00:23:51.660 just by the government

00:23:52.600 throwing more money

00:23:53.460 at the problem

00:23:54.200 because we find

00:23:55.020 that year over year,

00:23:56.700 Canada, you know,

00:23:58.300 on average,

00:23:59.320 continues to increase funding

00:24:00.940 to the public system.

00:24:02.220 We have one of the largest,

00:24:04.720 largest share of our GDP,

00:24:06.980 which is allocated

00:24:07.720 to the public care system,

00:24:09.020 and yet the performance

00:24:10.380 indicators keep going

00:24:12.320 the other way.

00:24:13.640 So, no,

00:24:13.960 I don't think it's simply

00:24:14.880 a question of how much money

00:24:17.000 is being allotted.

00:24:17.980 It's a question of how efficiently

00:24:19.800 and how thoughtfully

00:24:20.780 we're approaching

00:24:21.500 our system design.

00:24:23.300 So, let's go back to you, Alex.

00:24:25.020 I know Sean Watley

00:24:26.720 had mentioned some concerns

00:24:28.460 that people raise

00:24:29.400 about this idea of,

00:24:30.840 if I can just put

00:24:31.520 a simple phrase on it,

00:24:32.940 just on-demand

00:24:33.900 healthcare services,

00:24:35.420 and I know this is

00:24:36.180 an accusation you faced.

00:24:38.100 I would also add, though,

00:24:39.360 that it seems like

00:24:40.160 this is coming out

00:24:41.300 in a lot of other areas now

00:24:42.920 where there's a lot more

00:24:43.760 of an emphasis

00:24:44.280 on individual empowerment,

00:24:46.560 on patient empowerment,

00:24:47.800 of going in

00:24:48.820 and not being

00:24:49.580 as deferential to doctors

00:24:51.260 as people were

00:24:52.200 perhaps a generation ago.

00:24:53.940 But is there a concern

00:24:55.260 that, you know,

00:24:55.860 if you do all of these procedures

00:24:57.100 that some people are saying

00:24:58.200 are unnecessary,

00:24:58.840 you're going to just reveal things

00:25:00.880 and open a bunch of doors

00:25:01.920 that really don't need

00:25:02.640 to be opened?

00:25:04.200 Absolutely.

00:25:05.080 And, you know,

00:25:05.960 what's fantastic

00:25:07.140 about a roundtable like this

00:25:09.360 is that we have

00:25:10.120 so many invested people

00:25:11.980 that have such amazing points.

00:25:14.060 Sean has great points,

00:25:15.100 and Joanna talks about,

00:25:16.320 you know,

00:25:16.740 in healthcare being wrapped

00:25:18.220 in the flag

00:25:18.860 and the sacred cow of healthcare

00:25:20.740 that we can't usually

00:25:21.760 have these discussions

00:25:23.220 and come up with solutions.

00:25:24.640 And that's always

00:25:25.460 the big challenge

00:25:26.060 is we just need

00:25:26.720 to have the conversation

00:25:27.880 and say, okay,

00:25:28.440 let's put the drama aside

00:25:31.740 and let's figure out

00:25:32.900 how do we move forward.

00:25:35.280 Sean, I had the same concerns

00:25:37.740 that you did.

00:25:39.540 Years ago,

00:25:40.780 all of our competitors

00:25:41.960 had the abdominal ultrasound

00:25:43.380 and we didn't have

00:25:44.420 the abdominal ultrasound.

00:25:45.860 And the reason I said

00:25:46.800 we didn't have it is,

00:25:48.300 well, there's a lot

00:25:49.900 of false positives

00:25:50.700 that come from that

00:25:51.680 and you end up

00:25:53.000 spending a lot of time

00:25:54.240 looking for chasing,

00:25:56.060 chasing shadows.

00:25:58.280 And then we,

00:25:59.340 as we,

00:26:00.140 so in our three-hour medical,

00:26:01.560 we don't have that.

00:26:02.820 In our five-hour medical,

00:26:03.960 we have a couple

00:26:04.480 of different options,

00:26:05.640 one of which is

00:26:06.180 the abdominal ultrasound,

00:26:07.400 one is an echocardiogram,

00:26:09.140 stress test,

00:26:10.080 and some more blood work.

00:26:11.280 And I'm sort of part

00:26:16.340 of the converted now

00:26:17.260 because I've seen

00:26:18.360 what we found.

00:26:19.860 And I've dealt,

00:26:21.600 and from someone

00:26:22.420 who used to off-sell that

00:26:24.020 to a surgeon and say,

00:26:24.760 well, you don't really need that.

00:26:26.040 You just need

00:26:26.460 our lesser medical.

00:26:27.640 And if we feel

00:26:28.400 you need a medical,

00:26:29.740 if we feel you need

00:26:30.600 an abdominal ultrasound,

00:26:32.000 we'll get you

00:26:32.380 the abdominal ultrasound.

00:26:33.900 And then all of a sudden,

00:26:35.280 all these kidney cancers

00:26:36.120 start coming in

00:26:36.840 and we had

00:26:37.600 a pancreatic cancer.

00:26:39.020 There's no sound on these.

00:26:40.260 There's no indication.

00:26:42.420 Now, how many kidney cancers

00:26:43.800 are found incidentally?

00:26:45.600 So, you know,

00:26:46.940 the statistic is

00:26:47.900 something ridiculous

00:26:48.960 and I don't want

00:26:49.980 to get it wrong,

00:26:50.480 so I'm not going to say it.

00:26:51.780 But we do find things

00:26:54.700 that our physicians

00:26:56.420 in all of their

00:26:57.600 clinical judgment

00:26:58.660 would not have ordered

00:27:00.740 that test in the first place.

00:27:02.360 So I sleep real well at night

00:27:04.720 knowing that we save lives.

00:27:06.500 every day

00:27:08.960 we find something

00:27:10.500 on someone.

00:27:11.460 On average,

00:27:12.060 our clients

00:27:12.820 leave with two referrals

00:27:14.840 to specialists

00:27:15.540 because we found something

00:27:17.820 and it usually pans out

00:27:19.820 into more

00:27:20.680 positive testing.

00:27:23.520 A lot of the criticism

00:27:24.700 of executive health

00:27:25.900 is you just become

00:27:26.980 a grocery,

00:27:27.800 a checklist.

00:27:29.960 Oh, you want an MRI?

00:27:30.900 Absolutely.

00:27:31.540 Let me get that for you.

00:27:32.660 We don't do that.

00:27:33.580 I know there are some places

00:27:34.820 that do to that

00:27:35.680 because they have to focus

00:27:36.960 on customer service

00:27:39.020 and the argument

00:27:40.340 that we always put forth

00:27:41.320 is, look,

00:27:41.740 we're going to do

00:27:42.360 what's best for you

00:27:43.580 whether you like it or not.

00:27:45.540 And, you know,

00:27:46.380 we have a lot of clients.

00:27:48.240 We have a very,

00:27:49.440 as I said,

00:27:50.660 we've started

00:27:51.860 with a rather high

00:27:52.900 socioeconomic clientele,

00:27:54.800 obviously,

00:27:55.600 but we also have

00:27:56.760 those general patients

00:27:57.820 and who are just coming in

00:28:00.720 and they just want to spend

00:28:01.440 their money on their health

00:28:02.960 and they should have

00:28:04.100 the opportunity

00:28:04.640 to be able to do that

00:28:05.860 and through our

00:28:07.040 public-private hybrid model,

00:28:08.920 they're allowed to do that

00:28:10.220 in an affordable way.

00:28:12.120 And as I said,

00:28:13.580 we catch so many things

00:28:17.520 that they normally

00:28:19.880 would not have had the chance

00:28:21.240 to even have access

00:28:22.780 to the doctor

00:28:23.640 and, you know,

00:28:25.080 Sean, you're mentioning

00:28:25.820 when people come in,

00:28:27.240 it's not one issue,

00:28:28.520 it's four, five, six,

00:28:30.240 seven issues.

00:28:30.880 And I wanted to circle back

00:28:32.420 on one other thing.

00:28:33.780 Nurse practitioners,

00:28:35.200 with what Sean was saying,

00:28:36.980 a nurse practitioner

00:28:37.880 can do a lot

00:28:38.900 of what a family doctor can do.

00:28:41.780 We have just,

00:28:42.440 I just hired one

00:28:43.300 and I'm actually hiring

00:28:44.620 a second one

00:28:45.280 just to keep up

00:28:45.800 with our demands.

00:28:47.000 The challenge is,

00:28:48.200 is that nurse practitioners

00:28:49.420 in some parts of London

00:28:50.980 run their own clinics.

00:28:52.060 They do almost

00:28:52.780 all the healthcare

00:28:53.660 and there's no doctor there

00:28:55.280 except for a supervising physician,

00:28:56.820 but they can't bill OHAB.

00:28:59.020 So I can't hire

00:29:00.460 a nurse practitioner

00:29:01.280 to bill OHAB to assist.

00:29:03.360 So when I hire

00:29:04.140 a nurse practitioner,

00:29:05.360 even though a family health team

00:29:06.940 gets actually paid

00:29:08.180 extra money

00:29:08.800 to have a nurse practitioner,

00:29:10.340 as a fee

00:29:11.220 for service physicians,

00:29:12.640 we can't hire

00:29:13.680 nurse practitioners

00:29:14.560 and bill OHAB.

00:29:15.560 They might make

00:29:16.300 the doctor's life

00:29:17.080 a little bit easier,

00:29:17.840 but essentially

00:29:18.440 it's a cost

00:29:20.280 to our business.

00:29:21.500 It's a cost

00:29:22.660 that I'm now willing

00:29:23.300 to pay

00:29:23.680 because of the benefits,

00:29:25.720 but there's a lot

00:29:26.840 of inconsistencies

00:29:28.180 and as Sean was saying,

00:29:29.880 a dental office

00:29:30.700 will have the hygienist

00:29:31.740 and all these other people

00:29:33.100 that are doing

00:29:33.540 a lot of the work

00:29:34.320 and they're just kind of

00:29:35.220 coming in and supervising

00:29:36.340 and then making

00:29:36.960 that final assessment.

00:29:39.100 OHIP is different

00:29:39.880 and OHIP is trickier.

00:29:42.120 Well, this is,

00:29:43.200 I think,

00:29:43.420 bringing up an important

00:29:44.340 point here

00:29:44.940 that goes to the way

00:29:46.240 that doctors are paid

00:29:47.620 and I know

00:29:48.220 that you know this

00:29:48.900 intimately well,

00:29:50.140 probably better

00:29:50.540 than you want to know it

00:29:51.360 because you've been

00:29:51.880 on the OMA side

00:29:52.900 and also in family

00:29:54.040 practice here, Sean,

00:29:54.980 but a doctor has

00:29:56.900 a very rigid set

00:29:58.880 of things

00:29:59.920 that you can bill for.

00:30:01.500 You obviously can scale

00:30:03.140 up or down

00:30:03.700 depending on the work

00:30:04.740 that you do

00:30:05.120 but at the same time

00:30:05.960 what you get paid

00:30:07.620 is set.

00:30:08.580 Anything you bring

00:30:09.640 into your practice

00:30:10.620 you're paying for

00:30:11.960 out of pocket,

00:30:12.720 you know,

00:30:12.960 from the receptionist

00:30:13.920 to all of these other things.

00:30:15.500 So where is the incentive

00:30:16.900 for a lot of doctors

00:30:18.000 to do that,

00:30:19.300 to really expand

00:30:20.160 and invest in some things

00:30:21.660 that could help

00:30:22.120 their patients

00:30:22.640 but are ultimately

00:30:23.740 just coming out

00:30:24.420 of their bottom line

00:30:25.140 as business owners?

00:30:27.060 Yeah, so great question

00:30:27.940 and to give you

00:30:28.560 a few concrete examples

00:30:29.600 just a few years ago

00:30:30.500 they decreased

00:30:31.220 the fee for phlebotomy

00:30:33.260 so that's drawing

00:30:34.380 a lab,

00:30:35.540 you know,

00:30:35.760 drawing blood

00:30:36.320 out of your arm.

00:30:37.520 Alex might know

00:30:38.120 the fee off the top

00:30:39.140 of his head

00:30:39.600 but I think it's down

00:30:40.280 around the $2.45

00:30:41.820 mark or so.

00:30:43.140 Around that.

00:30:44.120 Yeah, so I have

00:30:45.600 a hard time

00:30:46.260 to buy the elastic band

00:30:48.280 that you wrap

00:30:49.180 around your arm

00:30:50.240 and the alcohol swab

00:30:52.240 and the little containers

00:30:53.580 that you know

00:30:54.100 the needle

00:30:54.560 and the container

00:30:55.300 that we use

00:30:56.020 to actually draw the blood

00:30:57.180 never mind hiring someone

00:30:58.960 to draw your blood work.

00:31:01.600 So certainly

00:31:02.080 in little rural clinics

00:31:03.500 like the one

00:31:03.980 I work in right now

00:31:05.380 we're getting seniors

00:31:07.140 who don't drive

00:31:08.460 they have to wait

00:31:09.160 for there's actually

00:31:10.240 a bus that comes out

00:31:11.220 to our community

00:31:11.820 twice a day.

00:31:12.980 They're looking

00:31:13.420 at a round trip

00:31:14.280 event of maybe

00:31:16.280 four to six hours

00:31:17.660 to get into town

00:31:18.880 to draw labs

00:31:20.840 because the government

00:31:22.100 won't let me charge

00:31:23.320 even $8

00:31:23.900 just to cover the cost.

00:31:25.760 Now we work around it

00:31:26.960 we're part of a family

00:31:27.760 health team

00:31:28.320 and so actually

00:31:28.860 we sneak in that service

00:31:31.420 but we're not really

00:31:32.340 billing for it

00:31:33.120 so we still provide

00:31:33.880 the service

00:31:34.380 but it's all these

00:31:35.440 workarounds

00:31:36.300 that are causing

00:31:36.980 a problem.

00:31:37.540 Another concrete example

00:31:38.480 is ECGs

00:31:39.220 we have an old-fashioned

00:31:40.220 ECG cardiogram machine

00:31:41.900 in our clinic.

00:31:43.100 Well I'm not allowed

00:31:43.880 to bill for the cardiograms

00:31:46.400 that I would otherwise order.

00:31:48.280 I can only fill out

00:31:49.940 the requisition

00:31:50.840 and send them

00:31:51.840 to a person

00:31:52.560 to another lab

00:31:53.560 where it will be done

00:31:55.060 there and read there

00:31:56.020 so I could go on

00:31:56.880 and on about

00:31:57.460 the silliness

00:31:58.480 around the billing things

00:31:59.640 but I wanted to give you

00:32:00.600 a concrete answer

00:32:01.480 to your question

00:32:02.740 about will the private system

00:32:05.160 skim the cream

00:32:07.320 off the public system, right?

00:32:09.000 Will we steal doctors

00:32:10.180 and nurses

00:32:10.700 into the private system?

00:32:12.180 And so we actually

00:32:12.780 have a concrete test case

00:32:14.580 of that right now

00:32:15.380 in Ontario

00:32:15.960 so in vitro fertilization

00:32:17.800 is covered up to

00:32:19.120 5,700 cycles of IVF

00:32:21.200 so people want

00:32:21.940 to get pregnant

00:32:22.560 this is one of the ways

00:32:23.960 that you can go ahead

00:32:24.780 and try to get that done

00:32:26.140 in Ontario

00:32:27.400 5,700 cycles of IVF

00:32:29.540 at least that's the count

00:32:30.600 I last heard

00:32:31.600 a medium to large size

00:32:34.540 or perhaps

00:32:35.160 fairly large size

00:32:36.680 fertility clinic

00:32:37.620 can do about

00:32:38.300 1,500 cycles per year

00:32:41.480 at the biggest clinics

00:32:42.600 we'll say let's

00:32:43.440 the average clinic

00:32:44.460 would be around

00:32:45.020 1,000 to 1,200

00:32:46.040 and maybe there might

00:32:47.440 be a few small clinics

00:32:48.600 but bottom line

00:32:49.580 no matter how we slice it

00:32:51.160 if we only allowed

00:32:53.000 publicly funded IVF services

00:32:55.600 and that's it

00:32:56.380 no other fertility treatments

00:32:57.900 were allowed

00:32:58.340 except that

00:32:59.300 which can be offered

00:33:00.360 in the public system

00:33:01.300 we would need

00:33:02.760 around five

00:33:03.900 perhaps

00:33:04.840 five big clinics

00:33:06.040 or maybe even

00:33:06.940 as many as seven

00:33:08.280 medium size

00:33:09.500 or maybe eight

00:33:10.840 medium to smaller size

00:33:12.380 IVF clinics

00:33:13.220 across Ontario

00:33:14.440 do you know

00:33:15.560 how many IVF clinics

00:33:16.960 do you know

00:33:17.660 how many infertility clinics

00:33:19.200 we have offering IVF

00:33:20.540 currently in Ontario

00:33:21.520 13

00:33:22.480 so the fact that

00:33:24.380 we have 13 clinics

00:33:25.580 means we have

00:33:26.220 13 separate locations

00:33:27.940 for patients

00:33:28.660 to access care

00:33:29.760 with nurses

00:33:30.580 and docs

00:33:31.400 and scanning equipment

00:33:32.680 and lab access

00:33:33.900 and and and

00:33:35.000 because

00:33:35.840 we allow

00:33:37.080 a blended approach

00:33:38.240 so although

00:33:39.960 you would think

00:33:40.760 that we've actually

00:33:41.620 poached all these

00:33:42.660 doctors away

00:33:43.360 from doing

00:33:43.860 the publicly funded

00:33:44.820 IVF services

00:33:45.820 actually we've

00:33:46.620 multiplied

00:33:47.260 the access

00:33:48.460 the convenience

00:33:49.160 the decreased

00:33:50.000 wait times

00:33:50.700 for people to get

00:33:51.800 those core

00:33:52.780 5700 services

00:33:54.660 that are offered

00:33:55.460 so I hope

00:33:56.800 that makes sense

00:33:57.640 and and I haven't

00:33:58.520 garbled the numbers

00:33:59.300 too much for you

00:34:00.160 but basically

00:34:01.060 allowing a blend

00:34:02.580 increases the

00:34:04.120 overall amount

00:34:05.360 of healthcare resources

00:34:06.540 being offered

00:34:07.200 in a community

00:34:07.900 which allows

00:34:09.000 patients option

00:34:10.220 to access care

00:34:11.540 they don't have

00:34:11.980 to travel down

00:34:12.800 from the far north

00:34:13.740 now to Toronto

00:34:14.600 to get their

00:34:15.800 infertility services

00:34:16.760 there's a robust

00:34:17.680 infertility clinic

00:34:18.620 in northern Ontario

00:34:19.940 and so on

00:34:20.720 so I just offer

00:34:21.400 that as an example

00:34:22.320 of how

00:34:23.380 offering a blended

00:34:24.620 approach

00:34:25.160 will not

00:34:26.080 poach

00:34:26.780 from the public

00:34:27.840 system

00:34:28.280 at least as far

00:34:29.180 as we can see

00:34:29.780 so far in Ontario

00:34:30.780 I want to spend

00:34:32.680 the remaining time

00:34:33.640 we have

00:34:34.120 talking about

00:34:34.760 some of the

00:34:35.340 substantive change

00:34:36.620 that we could see

00:34:37.340 either the big ideas

00:34:38.400 or even some

00:34:39.100 some very specific

00:34:40.360 ones

00:34:40.700 I mean as we heard

00:34:41.560 from Sean

00:34:41.960 right down to

00:34:42.680 being able to

00:34:43.580 charge the government

00:34:44.240 more to do a blood draw

00:34:45.360 I mean very small

00:34:46.240 things

00:34:46.640 but I'll start with

00:34:47.800 you on this Joanna

00:34:48.800 because I know

00:34:49.500 that obviously

00:34:50.000 the Canby case

00:34:50.860 which has been

00:34:51.300 going on for

00:34:51.980 a decade

00:34:52.740 and will continue

00:34:53.720 to go on

00:34:54.360 is one that's

00:34:55.180 dealing with

00:34:55.580 a lot of these

00:34:56.240 big issues

00:34:57.420 and in a very

00:34:58.220 specific application

00:34:59.360 in BC

00:35:00.080 but if we're

00:35:01.060 talking about

00:35:01.660 where the problem

00:35:02.620 is

00:35:02.860 are we talking

00:35:03.600 about the

00:35:03.980 Canada Health Act

00:35:04.880 are we talking

00:35:05.440 about ways

00:35:06.460 that provinces

00:35:07.180 are applying it

00:35:08.180 if we were to

00:35:08.780 look at

00:35:09.160 a political change

00:35:10.780 where's the

00:35:11.500 biggest thing

00:35:12.700 or the most

00:35:13.100 significant thing

00:35:13.880 that needs to

00:35:14.440 change

00:35:14.780 to start

00:35:15.660 eroding

00:35:16.500 some of these

00:35:16.980 barriers

00:35:17.360 that we've been

00:35:17.800 discussing

00:35:18.240 yeah so

00:35:19.400 it's not the

00:35:19.980 Canada Health Act

00:35:20.880 we think that

00:35:21.920 you know

00:35:22.260 public-private

00:35:23.120 partnerships

00:35:24.200 are certainly

00:35:25.480 possible within

00:35:26.260 the confines

00:35:26.840 of the Canada Health Act

00:35:27.840 it's the

00:35:28.240 provincial

00:35:28.740 regulations

00:35:29.740 in BC

00:35:30.400 it's the

00:35:30.940 Medicare Protection Act

00:35:32.240 which prevents

00:35:33.400 and I was thinking

00:35:34.060 when Alex was speaking

00:35:35.380 that what happens

00:35:36.760 when his clinic

00:35:37.620 refers a patient

00:35:38.500 to a specialist

00:35:39.340 is when the funny

00:35:40.360 stuff starts

00:35:41.000 happening

00:35:41.700 and if we could

00:35:42.660 see the same

00:35:43.240 type of hybrid

00:35:43.880 approach

00:35:44.300 that Sean

00:35:44.860 so illuminatively

00:35:46.540 described

00:35:47.300 I wasn't aware

00:35:47.920 of that

00:35:48.300 with fertility

00:35:49.320 clinics

00:35:49.940 applied

00:35:50.500 to surgeons

00:35:52.040 and specialists

00:35:52.840 so you know

00:35:53.820 so can we have

00:35:54.400 a blended approach

00:35:55.040 when you need

00:35:55.420 to get a knee

00:35:55.880 replacement

00:35:56.360 or cataract

00:35:57.200 surgery

00:35:57.660 or even

00:35:59.520 you know

00:36:00.240 a cancer

00:36:00.740 screening

00:36:01.260 or a spinal

00:36:02.360 surgery

00:36:02.960 that is where

00:36:04.320 the crackdown

00:36:05.120 at least in

00:36:05.840 British Columbia

00:36:06.520 and I'm not sure

00:36:07.540 about Ontario

00:36:08.240 maybe Alex

00:36:09.220 can tell us

00:36:10.160 about this

00:36:10.660 is the most

00:36:11.520 acute

00:36:12.020 where we have

00:36:13.320 you know

00:36:13.700 members of the

00:36:14.620 BC NDP

00:36:15.400 government

00:36:15.980 particularly

00:36:16.580 and it's kind

00:36:17.640 of ironic

00:36:18.080 that Canby

00:36:18.660 was operating

00:36:19.300 for more

00:36:20.640 than 10 years

00:36:21.520 in Vancouver

00:36:22.260 without any

00:36:23.100 deleterious

00:36:23.880 effects

00:36:24.280 to the public

00:36:25.800 system

00:36:26.300 and with the

00:36:27.280 you know

00:36:27.640 tacit support

00:36:28.680 of the government

00:36:29.380 but the government

00:36:30.760 once this litigation

00:36:31.660 started

00:36:32.200 would actually

00:36:32.720 go to clinics

00:36:33.600 and serve

00:36:34.720 physicians

00:36:35.500 and surgeons

00:36:36.320 with notices

00:36:37.380 that they would

00:36:37.940 be fined

00:36:38.800 if they took

00:36:40.460 any patients

00:36:42.160 in the private

00:36:42.860 system

00:36:43.240 even though

00:36:43.800 we started

00:36:44.580 edging up

00:36:46.260 against the

00:36:46.700 COVID pandemic

00:36:47.520 so it caused

00:36:48.440 in fact

00:36:48.980 real harm

00:36:49.560 so we should

00:36:50.620 just be very

00:36:51.580 practical

00:36:52.020 and functional

00:36:52.620 about things

00:36:53.480 even if it's

00:36:54.460 things as

00:36:55.060 serious

00:36:55.620 and as

00:36:56.160 you know

00:36:56.760 life-altering

00:36:57.620 as surgeries

00:36:58.860 Alex

00:37:00.380 I'll let you

00:37:01.020 respond to

00:37:01.800 what Joanna

00:37:02.640 said

00:37:02.940 but I'd also

00:37:03.480 add a question

00:37:04.300 to that

00:37:04.720 for you to

00:37:05.100 consider

00:37:05.420 which is

00:37:05.780 what do you

00:37:06.320 think is

00:37:06.600 the biggest

00:37:07.200 thing

00:37:07.460 or the first

00:37:07.960 thing

00:37:08.220 that could

00:37:08.680 be changed

00:37:09.300 that would

00:37:10.100 dramatically

00:37:10.680 help patients

00:37:11.800 in healthcare

00:37:12.440 such a loaded

00:37:14.840 question

00:37:15.240 I don't know

00:37:15.700 if you have

00:37:16.180 all the time

00:37:17.300 in response

00:37:18.600 to Joanna's

00:37:19.340 question

00:37:20.240 you know

00:37:20.760 we don't

00:37:21.560 we don't

00:37:22.220 set up

00:37:22.600 private payments

00:37:23.340 for any

00:37:23.680 of our

00:37:23.920 clients

00:37:24.260 we

00:37:25.060 use the

00:37:26.820 OHIP

00:37:27.220 system

00:37:27.740 to the

00:37:28.400 fullest

00:37:28.860 and

00:37:29.320 where

00:37:30.240 we

00:37:31.040 the one

00:37:32.300 thing I've

00:37:32.660 learned

00:37:32.900 in 16

00:37:33.540 years

00:37:33.820 of doing

00:37:34.240 this

00:37:34.580 is that

00:37:35.240 if

00:37:35.740 there's

00:37:36.760 a one

00:37:37.160 hour

00:37:37.720 drive

00:37:39.200 to save

00:37:40.120 two months

00:37:40.860 of a wait

00:37:41.600 time

00:37:41.900 people have

00:37:42.680 zero problem

00:37:43.540 doing that

00:37:44.040 they have

00:37:44.420 zero problem

00:37:45.140 going to the

00:37:45.640 states

00:37:45.920 if they had

00:37:46.460 to

00:37:46.700 but we

00:37:47.360 never send

00:37:47.960 anybody

00:37:48.280 to the

00:37:48.680 states

00:37:48.940 we never

00:37:49.360 send

00:37:49.660 anybody

00:37:50.120 to

00:37:50.840 for private

00:37:51.800 things

00:37:53.040 it comes

00:37:53.500 up so

00:37:53.940 rarely

00:37:54.300 there's

00:37:54.640 you know

00:37:55.360 the

00:37:55.640 just the

00:37:56.960 act of

00:37:57.540 getting

00:37:57.820 a private

00:37:58.320 MRI

00:37:58.700 in

00:37:59.320 Ontario

00:38:00.140 is not

00:38:00.740 worth it

00:38:01.240 however

00:38:01.880 I can

00:38:02.900 find an

00:38:03.360 OHEP

00:38:03.640 covered

00:38:04.020 MRI

00:38:04.380 in a

00:38:04.720 privately

00:38:05.060 run

00:38:05.360 clinic

00:38:05.680 in three

00:38:06.340 weeks

00:38:06.760 where in

00:38:07.440 London

00:38:07.740 you'll

00:38:08.060 wait

00:38:08.280 three

00:38:09.060 months

00:38:09.460 so

00:38:10.180 what we

00:38:11.360 try and

00:38:11.780 do

00:38:11.920 is navigate

00:38:12.400 the system

00:38:13.020 to find

00:38:13.480 the shorter

00:38:13.920 wait times

00:38:14.520 the best

00:38:15.460 way we do

00:38:16.000 that

00:38:16.240 is we

00:38:16.960 have a

00:38:17.440 number

00:38:17.620 of

00:38:17.800 specialists

00:38:18.180 that

00:38:18.600 come

00:38:18.980 on

00:38:19.320 and work

00:38:19.880 at

00:38:20.180 MedPoint

00:38:20.560 and those

00:38:21.320 specialists

00:38:21.760 are accessible

00:38:22.520 to the

00:38:23.000 general

00:38:23.240 public

00:38:23.720 other

00:38:24.300 doctors

00:38:24.740 can send

00:38:25.200 to our

00:38:25.580 doctors

00:38:25.980 and we

00:38:27.240 just have

00:38:27.840 we have

00:38:28.940 them right

00:38:29.260 on site

00:38:29.740 and that

00:38:30.080 makes a

00:38:30.440 big

00:38:30.580 difference

00:38:31.020 and to

00:38:33.100 be honest

00:38:33.500 we've

00:38:34.140 actually

00:38:34.380 just added

00:38:34.980 psychiatry

00:38:35.880 and I

00:38:36.660 you know

00:38:37.120 psychiatry

00:38:37.760 is very

00:38:38.260 very hard

00:38:38.820 to find

00:38:39.280 it can

00:38:39.820 be a

00:38:40.120 year

00:38:40.380 year and

00:38:40.740 a half

00:38:41.100 wait

00:38:41.460 and we

00:38:42.740 have brought

00:38:43.240 one

00:38:43.600 directly

00:38:44.320 onto

00:38:44.700 our

00:38:45.060 staff

00:38:46.860 and all

00:38:47.600 she does

00:38:48.000 is

00:38:48.160 bill

00:38:48.360 OHEP

00:38:48.640 so

00:38:49.500 I

00:38:52.200 think

00:38:52.400 we're

00:38:52.760 missing

00:38:53.160 I

00:38:53.480 you know

00:38:53.780 I don't

00:38:54.160 have

00:38:54.420 the

00:38:54.620 solutions

00:38:55.060 to

00:38:55.780 you know

00:38:56.320 years ago

00:38:57.080 if you

00:38:57.280 asked me

00:38:57.520 that

00:38:57.680 question

00:38:58.000 I

00:38:58.160 would

00:38:58.280 say

00:38:58.520 we

00:38:59.000 gotta

00:38:59.120 have

00:38:59.300 public

00:38:59.620 private

00:39:00.060 hybrids

00:39:00.540 you know

00:39:01.120 have

00:39:01.620 something

00:39:01.980 that's

00:39:02.820 OHEP

00:39:03.240 and

00:39:03.760 privately

00:39:04.380 run

00:39:04.760 I

00:39:05.560 would

00:39:05.760 say

00:39:06.000 that

00:39:06.180 the

00:39:06.320 government

00:39:06.600 should

00:39:06.900 be

00:39:07.040 in

00:39:07.160 the

00:39:07.260 private

00:39:07.540 healthcare

00:39:07.880 business

00:39:08.360 you

00:39:08.620 know

00:39:08.740 it

00:39:09.000 shouldn't

00:39:09.500 be

00:39:09.920 independent

00:39:10.920 people

00:39:11.380 it

00:39:11.560 should

00:39:11.760 be

00:39:12.160 out

00:39:13.040 in

00:39:13.200 the

00:39:13.320 open

00:39:13.640 and

00:39:13.860 say

00:39:14.140 here's

00:39:15.040 your

00:39:15.140 private

00:39:15.420 MRI

00:39:15.740 machine

00:39:16.160 it's

00:39:17.120 gonna

00:39:17.260 cost

00:39:17.540 you

00:39:17.660 this

00:39:17.860 much

00:39:18.120 to

00:39:18.340 do

00:39:18.520 it

00:39:18.740 and

00:39:19.320 if

00:39:19.500 you

00:39:19.600 want

00:39:19.760 to

00:39:19.880 jump

00:39:20.060 the

00:39:20.240 line

00:39:20.540 you

00:39:21.080 know

00:39:21.260 the

00:39:21.660 money

00:39:21.880 is

00:39:22.000 going

00:39:22.100 to

00:39:22.160 go

00:39:22.420 into

00:39:23.220 that

00:39:23.480 place

00:39:23.840 and

00:39:24.060 it's

00:39:24.200 going

00:39:24.300 to

00:39:24.340 be

00:39:24.500 funded

00:39:24.820 back

00:39:25.240 into

00:39:25.800 the

00:39:26.320 healthcare

00:39:26.580 system

00:39:27.080 so

00:39:27.760 and

00:39:28.500 how

00:39:28.640 much

00:39:28.820 money

00:39:29.000 can

00:39:29.160 we

00:39:29.300 save

00:39:29.540 there

00:39:29.740 and

00:39:29.920 again

00:39:30.220 I

00:39:30.460 think

00:39:30.660 there's

00:39:30.880 so

00:39:31.040 much

00:39:31.240 rhetoric

00:39:31.800 and

00:39:32.240 so

00:39:32.480 much

00:39:32.780 of

00:39:33.100 the

00:39:33.560 boogie

00:39:33.820 man

00:39:34.140 of

00:39:34.380 the

00:39:35.180 private

00:39:35.480 healthcare

00:39:35.820 system

00:39:36.360 we

00:39:37.380 don't

00:39:37.540 have

00:39:37.720 two

00:39:37.920 tier

00:39:38.140 healthcare

00:39:38.480 system

00:39:38.880 we've

00:39:39.180 got

00:39:39.340 nine

00:39:39.780 tiers

00:39:40.220 and

00:39:40.820 the

00:39:40.980 number

00:39:41.180 one

00:39:41.480 tier

00:39:41.820 is

00:39:42.400 who

00:39:42.740 do

00:39:42.860 you

00:39:42.900 know

00:39:43.200 you

00:39:43.680 know

00:39:43.860 I

00:39:44.100 remember

00:39:44.460 years

00:39:44.860 ago

00:39:45.220 this

00:39:45.800 hour

00:39:46.000 is

00:39:46.180 22

00:39:46.560 minutes

00:39:46.960 you

00:39:47.300 had

00:39:47.520 a joke

00:39:47.900 saying

00:39:48.160 oh

00:39:48.320 I

00:39:48.420 got

00:39:48.580 to

00:39:48.660 get

00:39:48.780 in

00:39:48.940 it's

00:39:49.220 six

00:39:49.860 months

00:39:50.140 to

00:39:50.240 get

00:39:50.340 in

00:39:50.480 oh

00:39:50.740 you

00:39:50.900 know

00:39:51.060 Wanda

00:39:51.440 okay

00:39:52.100 I'll

00:39:52.520 get

00:39:52.680 you

00:39:52.840 in

00:39:53.020 you

00:39:53.660 know

00:39:53.860 it's

00:39:54.500 that

00:39:54.860 happens

00:39:55.380 and

00:39:55.700 we

00:39:55.860 all

00:39:56.020 know

00:39:56.200 it

00:39:56.360 happens

00:39:56.800 and

00:39:57.680 so

00:39:58.660 it

00:40:00.260 needs

00:40:00.440 to

00:40:00.540 be

00:40:00.660 out

00:40:00.880 the

00:40:07.920 who

00:40:08.060 got

00:40:08.200 knee

00:40:08.440 surgeries

00:40:08.840 because

00:40:09.340 they

00:40:09.460 sent

00:40:09.700 a

00:40:09.860 bottle

00:40:10.140 of

00:40:10.380 johnny

00:40:10.720 walker

00:40:11.060 blue

00:40:11.420 to

00:40:12.140 through

00:40:12.800 a

00:40:12.960 lawyer

00:40:13.260 to

00:40:13.700 a

00:40:13.840 doctor

00:40:14.160 who

00:40:14.620 bumped

00:40:14.880 them

00:40:15.040 up

00:40:15.220 on

00:40:15.320 the

00:40:15.420 list

00:40:15.680 it

00:40:16.020 happens

00:40:16.480 the

00:40:18.480 bigger

00:40:19.640 issue

00:40:20.100 that

00:40:20.680 no

00:40:20.920 one

00:40:21.120 is

00:40:21.300 facing

00:40:21.720 yet

00:40:22.120 is

00:40:22.900 what's

00:40:23.540 coming

00:40:23.900 and

00:40:24.800 what's

00:40:25.440 coming

00:40:25.740 is

00:40:26.020 we

00:40:26.320 have

00:40:26.720 wait

00:40:27.000 times

00:40:27.340 that

00:40:27.560 have

00:40:27.740 gone

00:40:28.020 up

00:40:28.420 and

00:40:28.680 up

00:40:29.000 and

00:40:29.280 up

00:40:29.600 we've

00:40:30.080 had

00:40:30.240 surgeries

00:40:30.760 that

00:40:31.040 have

00:40:31.140 been

00:40:31.300 delayed

00:40:31.820 because

00:40:32.340 of

00:40:32.500 COVID

00:40:32.800 it

00:40:33.580 has

00:40:33.940 we

00:40:34.860 were

00:40:35.080 in

00:40:35.180 a

00:40:35.320 bad

00:40:35.620 situation

00:40:36.360 pre

00:40:37.040 COVID

00:40:37.420 now

00:40:38.600 we've

00:40:39.480 got

00:40:39.740 these

00:40:40.160 massive

00:40:40.600 wait

00:40:40.920 lines

00:40:41.240 and

00:40:42.000 we're

00:40:42.580 at

00:40:42.700 the

00:40:42.840 tip

00:40:43.040 of

00:40:43.140 the

00:40:43.260 iceberg

00:40:43.600 because

00:40:44.380 many

00:40:44.980 patients

00:40:45.780 aren't

00:40:47.580 going

00:40:47.860 in

00:40:48.080 to

00:40:48.180 see

00:40:48.340 their

00:40:48.540 doctors

00:40:48.940 with

00:40:49.520 the

00:40:49.660 exception

00:40:50.000 of

00:40:50.540 Sean

00:40:50.920 and

00:40:51.080 some

00:40:51.240 other

00:40:51.440 fantastic

00:40:52.000 physicians

00:40:52.500 that

00:40:52.720 are

00:40:52.800 out

00:40:52.960 there

00:40:53.140 a

00:40:53.760 lot

00:40:53.980 of

00:40:54.100 doctors

00:40:54.500 especially

00:40:55.040 in

00:40:55.280 family

00:40:55.540 health

00:40:55.820 teams

00:40:56.160 have

00:40:56.520 been

00:40:56.640 sitting

00:40:56.880 at

00:40:57.040 home

00:40:57.300 and

00:40:57.960 they're

00:40:58.080 not

00:40:58.380 seeing

00:40:58.640 patients

00:40:59.080 in

00:40:59.280 person

00:40:59.640 the

00:41:00.360 CPSO

00:41:03.120 and

00:41:03.380 the

00:41:03.520 Ministry

00:41:03.800 of

00:41:03.940 Health

00:41:05.180 send

00:41:05.500 out

00:41:05.700 a

00:41:05.840 letter

00:41:06.060 list

00:41:06.460 in

00:41:06.860 the

00:41:06.960 last

00:41:07.180 two

00:41:07.360 weeks

00:41:07.620 saying

00:41:07.860 hey

00:41:08.520 guys

00:41:08.860 time

00:41:09.420 to

00:41:09.540 come

00:41:09.680 back

00:41:09.880 to

00:41:10.040 work

00:41:10.320 we've

00:41:11.320 been

00:41:11.460 working

00:41:11.880 unbelievable

00:41:12.980 hours

00:41:13.440 just

00:41:13.780 trying to

00:41:14.240 get

00:41:14.440 through

00:41:14.660 our

00:41:14.780 clients

00:41:15.080 now

00:41:15.280 I've

00:41:15.480 got

00:41:15.620 an

00:41:15.760 advantage

00:41:16.140 of

00:41:16.340 doing

00:41:16.520 that

00:41:16.760 or

00:41:16.880 I've

00:41:17.000 got

00:41:17.100 a

00:41:17.240 reason

00:41:17.540 to

00:41:17.740 do

00:41:17.880 that

00:41:18.180 financially

00:41:19.500 for

00:41:19.820 sure

00:41:20.140 but

00:41:20.740 there

00:41:20.960 is

00:41:21.080 a

00:41:21.240 massive

00:41:21.620 demand

00:41:22.140 and

00:41:22.820 the

00:41:23.160 people

00:41:23.480 that

00:41:23.660 are

00:41:23.760 coming

00:41:24.000 in

00:41:24.300 are

00:41:24.520 saying

00:41:24.920 I've

00:41:25.600 got

00:41:25.740 this

00:41:26.000 I've

00:41:26.160 got

00:41:26.300 this

00:41:26.540 I've

00:41:26.680 I've

00:41:28.460 been

00:41:28.580 sitting

00:41:28.840 there

00:41:29.040 with

00:41:29.240 knee

00:41:29.480 pain

00:41:29.780 I'm

00:41:30.240 waiting

00:41:30.440 for

00:41:30.640 my

00:41:30.800 doctor

00:41:31.100 to

00:41:31.260 come

00:41:31.440 back

00:41:31.660 to

00:41:31.840 work

00:41:32.120 they're

00:41:32.620 not

00:41:32.860 doing

00:41:33.160 it

00:41:33.400 I

00:41:33.980 need

00:41:34.200 someone

00:41:34.420 to

00:41:34.560 help

00:41:34.720 me

00:41:34.880 get

00:41:35.060 through

00:41:35.260 this

00:41:35.520 system

00:41:35.880 so

00:41:36.460 when

00:41:37.000 those

00:41:37.860 patients

00:41:38.420 who

00:41:38.900 are

00:41:39.120 still

00:41:39.660 afraid

00:41:40.000 to

00:41:40.200 leave

00:41:40.380 their

00:41:40.560 house

00:41:40.960 finally

00:41:41.720 poke

00:41:42.060 their

00:41:42.240 head

00:41:42.420 out

00:41:42.700 by

00:41:42.900 ground

00:41:43.180 ground

00:41:44.000 bay

00:41:44.420 look

00:41:45.000 out

00:41:45.180 and

00:41:45.300 say

00:41:45.460 okay

00:41:45.840 it's

00:41:46.080 safe

00:41:46.340 I'm

00:41:46.880 going

00:41:46.960 to

00:41:47.020 go

00:41:47.140 see

00:41:47.320 my

00:41:47.500 doctor

00:41:47.860 those

00:41:48.940 doctors

00:41:49.380 are

00:41:49.660 going

00:41:49.780 to

00:41:49.820 be

00:41:49.960 writing

00:41:50.320 referrals

00:41:50.920 for

00:41:51.180 orthopedics

00:41:52.060 for

00:41:52.520 hearing

00:41:53.020 for

00:41:53.800 audiology

00:41:54.720 for

00:41:54.980 dermatology

00:41:56.520 those

00:41:57.440 referrals

00:41:57.960 are

00:41:58.300 going

00:41:58.500 to

00:41:58.600 go

00:41:58.760 through

00:41:59.020 the

00:41:59.220 roof

00:41:59.640 and

00:42:00.180 we're

00:42:00.360 going

00:42:00.460 to

00:42:00.540 go

00:42:00.720 from

00:42:01.020 two

00:42:01.540 year

00:42:01.800 wait

00:42:02.040 times

00:42:02.340 in

00:42:02.500 some

00:42:02.700 places

00:42:03.040 to

00:42:03.520 five

00:42:03.960 year

00:42:04.140 wait

00:42:04.360 times

00:42:04.700 and

00:42:05.380 at

00:42:05.780 that

00:42:06.060 point

00:42:06.340 so

00:42:06.560 your

00:42:06.760 question

00:42:07.100 is

00:42:07.360 how

00:42:07.740 do

00:42:07.860 you

00:42:07.960 fix

00:42:08.200 the

00:42:08.360 system

00:42:08.720 the

00:42:10.460 system

00:42:10.740 can

00:42:10.940 be

00:42:11.120 fixed

00:42:11.680 but

00:42:12.440 you've

00:42:12.900 got

00:42:13.060 to

00:42:13.200 look

00:42:13.380 at

00:42:13.680 someone

00:42:14.180 who

00:42:14.800 can

00:42:15.020 run

00:42:17.860 the

00:42:19.140 Cleveland

00:42:19.800 Clinic

00:42:20.200 is

00:42:20.920 a

00:42:21.360 28

00:42:21.860 minute

00:42:22.280 air

00:42:22.920 flight

00:42:25.200 from

00:42:26.060 Toronto

00:42:26.560 to

00:42:26.900 Cleveland

00:42:27.220 they

00:42:27.720 have

00:42:27.860 a

00:42:28.040 50

00:42:28.460 hectare

00:42:29.260 facility

00:42:30.160 there

00:42:30.540 they

00:42:31.060 could

00:42:31.240 probably

00:42:31.720 fix

00:42:32.100 Ontario's

00:42:33.460 orthopedic

00:42:34.380 knee

00:42:34.620 surgery

00:42:34.940 problem

00:42:35.380 within

00:42:36.040 a week

00:42:36.500 or

00:42:37.160 within

00:42:37.580 a couple

00:42:37.920 of

00:42:38.060 months

00:42:38.260 maybe

00:42:38.520 but

00:42:39.300 it's

00:42:39.780 going

00:42:39.880 to

00:42:39.960 cost

00:42:40.160 money

00:42:40.420 so

00:42:41.060 we

00:42:41.540 have

00:42:41.820 to

00:42:41.960 look

00:42:42.140 at

00:42:42.300 other

00:42:42.580 partners

00:42:43.000 who

00:42:43.200 can

00:42:43.360 run

00:42:43.580 things

00:42:43.860 efficiently

00:42:44.320 and

00:42:44.780 we

00:42:44.920 might

00:42:45.120 have

00:42:45.280 to

00:42:45.380 start

00:42:45.600 sending

00:42:45.920 Ontarians

00:42:46.480 directly

00:42:47.240 to

00:42:47.520 a

00:42:47.660 partner

00:42:47.960 in

00:42:48.220 the

00:42:48.360 US

00:42:48.780 who

00:42:49.220 have

00:42:49.380 their

00:42:49.560 act

00:42:49.760 together

00:42:50.080 who

00:42:50.260 can

00:42:50.420 run

00:42:50.620 things

00:42:50.880 properly

00:42:51.280 or

00:42:51.960 allow

00:42:52.700 them

00:42:52.880 to

00:42:53.020 come

00:42:53.200 up

00:42:53.400 here

00:42:53.840 and

00:42:54.220 set

00:42:54.420 up

00:42:54.560 shop

00:42:54.860 there's

00:42:55.540 got

00:42:55.800 to

00:42:55.960 be

00:42:56.240 other

00:42:56.700 solutions

00:42:57.160 because

00:42:57.580 those

00:42:58.680 politicians

00:42:59.260 that

00:42:59.560 have

00:42:59.640 been

00:42:59.760 wrapping

00:43:00.040 themselves

00:43:00.480 in

00:43:00.720 the

00:43:00.820 flag

00:43:01.140 and

00:43:01.340 saying

00:43:01.640 oh

00:43:02.100 no

00:43:02.260 no

00:43:02.460 no

00:43:02.760 and

00:43:03.140 the

00:43:03.520 challenges

00:43:03.900 that

00:43:04.240 Joanna

00:43:04.860 is

00:43:05.020 dealing

00:43:05.200 with

00:43:05.380 out

00:43:05.580 there

00:43:05.740 they

00:43:06.860 are

00:43:07.100 going

00:43:07.380 to

00:43:07.500 suddenly

00:43:07.860 be

00:43:08.100 looking

00:43:08.380 at

00:43:08.580 people

00:43:08.860 marching

00:43:09.260 in

00:43:09.420 the

00:43:09.540 streets

00:43:09.860 if

00:43:10.180 they

00:43:10.340 could

00:43:10.520 walk

00:43:10.900 saying

00:43:12.200 I

00:43:12.600 need

00:43:12.840 these

00:43:13.640 surgeries

00:43:14.000 and

00:43:14.260 you

00:43:14.360 got

00:43:14.520 to

00:43:14.600 come

00:43:14.740 up

00:43:14.860 with

00:43:14.960 a

00:43:15.100 solution

00:43:15.460 and

00:43:16.000 you

00:43:16.140 can't

00:43:16.540 deny

00:43:17.060 me

00:43:17.480 access

00:43:18.700 to

00:43:19.040 the

00:43:19.200 healthcare

00:43:19.500 system

00:43:19.980 that

00:43:20.140 I'm

00:43:20.280 paying

00:43:20.440 my

00:43:20.640 taxes

00:43:20.980 for

00:43:21.240 thank

00:43:22.780 you

00:43:23.000 Alex

00:43:23.360 we'll

00:43:23.700 give

00:43:23.880 you

00:43:24.000 the

00:43:24.160 final

00:43:24.400 word

00:43:24.660 on

00:43:24.840 this

00:43:25.020 Sean

00:43:25.280 and

00:43:25.460 I

00:43:25.860 always

00:43:26.140 try

00:43:26.400 to

00:43:26.540 end

00:43:26.680 these

00:43:26.860 things

00:43:27.060 on

00:43:27.200 a

00:43:27.260 bit

00:43:27.380 more

00:43:27.540 of

00:43:27.640 a

00:43:27.740 cheery

00:43:27.980 note

00:43:28.240 although

00:43:28.660 Alex

00:43:29.060 has

00:43:29.280 shattered

00:43:30.040 that

00:43:30.320 idea

00:43:30.680 in

00:43:30.960 some

00:43:31.200 ways

00:43:31.480 but

00:43:31.700 still

00:43:32.100 are

00:43:32.260 there

00:43:32.560 individual

00:43:33.040 fixes

00:43:33.520 either

00:43:33.860 on

00:43:34.060 the

00:43:34.220 big

00:43:34.880 scale

00:43:35.280 or

00:43:35.460 even

00:43:35.620 the

00:43:35.760 micro

00:43:36.040 scale

00:43:36.380 that

00:43:36.540 you

00:43:36.620 think

00:43:36.780 could

00:43:36.880 be

00:43:36.980 put

00:43:37.200 in

00:43:37.380 that

00:43:37.500 would

00:43:37.660 move

00:43:38.140 us

00:43:38.340 in

00:43:38.440 that

00:43:38.580 direction

00:43:38.960 we

00:43:39.120 need

00:43:39.260 to

00:43:39.360 be

00:43:39.480 headed

00:43:39.720 yeah

00:43:40.600 so

00:43:40.820 such

00:43:41.100 an

00:43:41.380 important

00:43:41.860 and

00:43:42.140 huge

00:43:42.580 question

00:43:43.060 Andrew

00:43:43.420 and

00:43:43.600 I

00:43:43.740 appreciate

00:43:44.080 I

00:43:44.280 had

00:43:44.380 a few

00:43:44.620 extra

00:43:44.880 minutes

00:43:45.180 to

00:43:45.340 think

00:43:45.520 about

00:43:45.740 things

00:43:46.040 but

00:43:46.240 I

00:43:46.700 guess

00:43:46.960 I

00:43:47.080 would

00:43:47.240 simplify

00:43:47.940 it

00:43:48.160 down

00:43:48.280 to

00:43:48.420 two

00:43:48.680 words

00:43:49.140 number

00:43:49.420 one

00:43:49.740 we

00:43:49.900 have

00:43:50.060 to

00:43:50.180 define

00:43:50.540 what

00:43:50.700 we

00:43:50.780 trying

00:43:51.020 to

00:43:51.160 fix

00:43:51.520 and

00:43:52.220 number

00:43:52.420 two

00:43:52.900 we

00:43:53.540 have

00:43:53.820 to

00:43:54.000 let

00:43:54.240 it

00:43:54.380 happen

00:43:54.840 so

00:43:55.600 you

00:43:55.760 could

00:43:55.880 talk

00:43:56.100 about

00:43:56.400 innovation

00:43:56.900 with

00:43:57.120 public

00:43:57.420 private

00:43:57.740 partnerships

00:43:58.300 you

00:43:58.540 could

00:43:58.660 talk

00:43:58.880 about

00:43:59.100 innovative

00:43:59.480 ways

00:43:59.820 to

00:44:00.000 manage

00:44:00.300 the

00:44:00.460 system

00:44:00.720 you

00:44:00.880 could

00:44:01.000 talk

00:44:01.220 about

00:44:01.420 innovation

00:44:01.920 with respect

00:44:02.480 to

00:44:02.680 incentives

00:44:03.320 innovation

00:44:04.160 with respect

00:44:04.680 to

00:44:04.880 regulation

00:44:05.480 decreasing

00:44:06.180 regulation

00:44:06.780 right

00:44:07.080 touch

00:44:07.340 regulation

00:44:07.780 there's

00:44:08.060 so

00:44:08.200 many

00:44:08.380 different

00:44:08.720 opportunities

00:44:09.380 to

00:44:09.840 create

00:44:10.300 change

00:44:10.800 we

00:44:11.300 don't

00:44:11.460 have

00:44:11.640 to

00:44:11.760 reinvent

00:44:12.080 the

00:44:12.360 wheel

00:44:12.620 there

00:44:12.840 are

00:44:12.960 many

00:44:13.220 other

00:44:13.720 quite

00:44:14.480 high

00:44:15.080 functioning

00:44:15.680 wheels

00:44:16.160 out

00:44:16.380 there

00:44:16.600 not

00:44:17.100 just

00:44:17.460 south

00:44:17.880 of

00:44:18.000 the

00:44:18.120 border

00:44:18.380 and

00:44:18.980 god

00:44:19.280 forbid

00:44:19.580 we

00:44:19.760 talk

00:44:20.000 about

00:44:20.200 American

00:44:20.600 anything

00:44:21.040 right

00:44:21.420 not

00:44:21.720 withstanding

00:44:22.340 Alex's

00:44:22.880 comments

00:44:23.260 I

00:44:23.440 actually

00:44:23.660 agree

00:44:23.960 with

00:44:24.180 them

00:44:24.400 but

00:44:25.220 you

00:44:25.540 can

00:44:25.720 look

00:44:25.860 to

00:44:26.020 Europe

00:44:26.280 or

00:44:26.520 anywhere

00:44:26.700 else

00:44:27.000 in

00:44:27.240 the

00:44:27.640 world

00:44:27.900 that

00:44:28.160 is

00:44:28.300 doing

00:44:28.600 better

00:44:29.000 than

00:44:29.240 we

00:44:29.500 are

00:44:29.800 that

00:44:30.140 Commonwealth

00:44:30.660 Fund

00:44:31.040 study

00:44:31.340 mirror

00:44:31.580 mirror

00:44:31.800 just

00:44:32.060 updated

00:44:33.260 their

00:44:33.620 data

00:44:34.240 in

00:44:34.460 2020

00:44:34.880 on

00:44:35.200 this

00:44:35.400 and

00:44:35.520 once

00:44:35.720 again

00:44:36.020 we're

00:44:36.300 second

00:44:36.960 from

00:44:37.220 the

00:44:37.380 bottom

00:44:37.600 of

00:44:37.760 the

00:44:37.900 pack

00:44:38.240 in

00:44:38.400 OECD

00:44:39.000 countries

00:44:39.420 so

00:44:40.160 I

00:44:40.380 think

00:44:40.640 the

00:44:40.840 challenge

00:44:41.300 is

00:44:41.900 that

00:44:42.240 it's

00:44:43.020 kind

00:44:43.200 of

00:44:43.260 like

00:44:43.460 saying

00:44:43.820 okay

00:44:44.520 Sean

00:44:44.820 give

00:44:45.960 me

00:44:46.080 your

00:44:46.300 top

00:44:46.680 three

00:44:46.960 fixes

00:44:47.360 on

00:44:47.600 how

00:44:47.760 to

00:44:47.880 improve

00:44:48.220 parenting

00:44:48.640 in

00:44:48.900 Canada

00:44:49.220 well

00:44:50.120 it's

00:44:50.640 it's

00:44:50.960 huge

00:44:51.440 right

00:44:51.700 how

00:44:51.880 do

00:44:52.020 you

00:44:52.160 make

00:44:52.460 better

00:44:52.800 parents

00:44:53.420 and

00:44:53.680 so

00:44:53.940 on

00:44:54.680 the

00:44:55.020 one

00:44:55.240 hand

00:44:55.500 we

00:44:55.680 have

00:44:55.900 to

00:44:56.140 allow

00:44:56.540 the

00:44:56.740 professionals

00:44:57.300 who've

00:44:57.820 committed

00:44:58.060 their

00:44:58.340 lives

00:44:58.760 to

00:44:59.140 doing

00:44:59.460 this

00:44:59.720 kind

00:44:59.980 of

00:45:00.080 thing

00:45:00.380 to

00:45:00.760 let

00:45:01.040 them

00:45:01.260 do

00:45:01.480 what

00:45:01.720 they

00:45:01.860 know

00:45:02.220 the

00:45:02.940 patients

00:45:03.320 need

00:45:03.720 so

00:45:04.160 that's

00:45:04.360 part

00:45:04.620 of

00:45:04.740 it

00:45:04.920 but

00:45:05.140 it's

00:45:05.340 not

00:45:05.580 that

00:45:05.840 simple

00:45:06.220 so

00:45:06.420 I

00:45:06.540 think

00:45:06.660 we

00:45:06.800 need

00:45:07.060 the

00:45:07.300 legislative

00:45:07.800 work

00:45:08.260 that

00:45:08.960 and

00:45:09.220 the

00:45:09.380 legal

00:45:10.380 work

00:45:10.760 that

00:45:11.020 Joanna

00:45:11.380 and her

00:45:11.880 team

00:45:12.140 is

00:45:12.280 doing

00:45:12.520 we

00:45:12.720 need

00:45:13.060 the

00:45:13.280 public

00:45:13.520 private

00:45:13.820 partnerships

00:45:14.400 that

00:45:14.740 Alex

00:45:15.120 and

00:45:15.280 his

00:45:15.460 team

00:45:15.700 is

00:45:15.840 doing

00:45:16.100 but

00:45:16.780 we

00:45:16.980 also

00:45:17.260 have

00:45:17.500 great

00:45:18.080 opportunities

00:45:18.720 within

00:45:19.100 hospitals

00:45:19.640 themselves

00:45:20.200 to

00:45:20.480 look

00:45:20.680 at

00:45:20.800 how

00:45:20.980 managers

00:45:21.480 think

00:45:21.940 how

00:45:22.340 does

00:45:22.520 the

00:45:22.800 professional

00:45:23.560 managerial

00:45:24.240 class

00:45:24.640 get

00:45:24.900 trained

00:45:25.520 and

00:45:25.920 taught

00:45:26.340 and

00:45:26.920 what

00:45:27.100 sort

00:45:27.360 of

00:45:27.500 key

00:45:27.680 performance

00:45:28.140 indicators

00:45:28.680 are they

00:45:29.140 driving

00:45:29.540 towards

00:45:30.100 how

00:45:31.160 are

00:45:31.440 the

00:45:31.740 KPIs

00:45:32.540 themselves

00:45:33.240 creating

00:45:34.240 untoward

00:45:36.460 outcomes

00:45:37.040 I'm

00:45:37.840 missing

00:45:38.100 the adjective

00:45:38.660 right now

00:45:39.200 but

00:45:39.500 they're

00:45:41.000 creating

00:45:41.380 outcomes

00:45:41.840 that are

00:45:42.140 often

00:45:42.540 exactly

00:45:43.140 the

00:45:43.380 opposite

00:45:43.720 so

00:45:43.960 you

00:45:44.060 think

00:45:44.260 of

00:45:44.400 a

00:45:44.540 wait

00:45:44.740 time

00:45:45.020 strategy

00:45:45.560 for

00:45:46.200 our

00:45:46.500 limit

00:45:46.900 that's

00:45:47.280 it

00:45:47.420 well

00:45:47.680 maybe

00:45:48.360 if

00:45:48.500 we

00:45:48.600 just

00:45:48.800 punt

00:45:49.040 people

00:45:49.320 home

00:45:49.620 faster

00:45:50.020 we'll

00:45:50.260 be

00:45:50.400 able

00:45:50.560 to

00:45:50.740 meet

00:45:51.000 perverse

00:45:52.780 that's

00:45:53.000 what

00:45:53.060 I'm

00:45:53.140 looking

00:45:53.360 perverse

00:45:53.860 incentives

00:45:54.300 so

00:45:54.560 we

00:45:54.700 have

00:45:54.940 to

00:45:55.140 there

00:45:56.100 are

00:45:56.260 so

00:45:56.620 many

00:45:56.900 opportunities

00:45:57.700 but

00:45:58.140 we

00:45:58.220 have

00:45:58.420 to

00:45:58.620 first

00:45:59.120 define

00:45:59.740 what

00:46:00.080 we

00:46:00.260 want

00:46:00.460 to

00:46:00.560 look

00:46:00.740 at

00:46:00.980 and

00:46:01.200 too

00:46:01.440 often

00:46:01.700 what

00:46:01.880 we

00:46:02.000 do

00:46:02.160 in

00:46:02.300 Canada

00:46:02.620 is

00:46:02.940 we

00:46:03.160 start

00:46:03.840 with

00:46:04.040 waits

00:46:04.380 I

00:46:04.860 agree

00:46:05.160 wait

00:46:05.460 times

00:46:05.740 are

00:46:05.900 terrible

00:46:06.320 we

00:46:06.640 need

00:46:06.900 to

00:46:07.100 fix

00:46:07.460 them

00:46:07.740 but

00:46:08.260 the

00:46:08.420 simple

00:46:08.680 way

00:46:08.840 to

00:46:08.960 fix

00:46:09.200 them

00:46:09.400 is

00:46:09.500 just

00:46:09.680 to

00:46:09.820 pour

00:46:10.160 a

00:46:10.320 whole

00:46:10.440 bunch

00:46:10.680 more

00:46:11.400 money

00:46:11.700 in

00:46:11.920 and

00:46:12.020 we

00:46:12.160 keep

00:46:12.400 seeing

00:46:12.680 this

00:46:12.900 every

00:46:13.100 10

00:46:13.380 years

00:46:13.680 or

00:46:13.820 so

00:46:14.020 you

00:46:14.180 know

00:46:14.320 in

00:46:14.520 2004

00:46:15.080 a

00:46:15.320 fix

00:46:15.580 for

00:46:15.760 a

00:46:15.900 generation

00:46:16.440 where

00:46:17.100 we

00:46:17.240 talk

00:46:28.140 Medicare

00:46:28.560 Act

00:46:29.000 where

00:46:29.200 there's

00:46:29.360 a

00:46:29.480 $25,000

00:46:30.220 fine

00:46:30.840 for

00:46:31.100 anyone

00:46:31.380 caught

00:46:31.780 jumping

00:46:32.280 the

00:46:32.500 queue

00:46:32.740 as

00:46:33.440 far

00:46:33.660 as

00:46:33.760 I

00:46:33.860 know

00:46:34.000 no

00:46:34.200 one's

00:46:34.460 been

00:46:34.620 fined

00:46:35.080 yet

00:46:35.300 and

00:46:35.520 we

00:46:35.980 continue

00:46:36.600 to

00:46:37.040 know

00:46:37.340 that

00:46:37.660 privileged

00:46:38.540 access

00:46:39.060 is a

00:46:39.600 fact

00:46:39.940 of

00:46:40.100 life

00:46:40.480 the

00:46:41.680 CEO

00:46:42.380 of

00:46:42.540 the

00:46:42.660 Dallas

00:46:43.120 professional

00:46:44.640 sports

00:46:45.180 team

00:46:45.480 was

00:46:46.060 on

00:46:46.260 Twitter

00:46:46.680 and

00:46:47.020 then

00:46:47.280 blew

00:46:47.780 up

00:46:48.000 on

00:46:48.960 media

00:46:49.240 just

00:46:49.520 recently

00:46:49.960 a few

00:46:50.300 years

00:46:50.500 ago

00:46:50.780 and

00:46:51.480 he

00:46:51.620 was

00:46:51.760 describing

00:46:52.260 how

00:46:52.620 he

00:46:52.880 got

00:46:53.320 better

00:46:53.740 care

00:46:54.140 in

00:46:54.340 a

00:46:54.480 large

00:46:54.880 Toronto

00:46:55.240 hospital

00:46:55.660 because

00:46:55.980 someone

00:46:56.340 recognized

00:46:56.900 him

00:46:57.160 as

00:46:57.340 someone

00:46:57.640 famous

00:46:58.160 and

00:46:58.780 he

00:46:58.920 described

00:46:59.360 it

00:46:59.540 he

00:46:59.620 said

00:46:59.800 I

00:46:59.920 know

00:47:00.160 I

00:47:00.380 wasn't

00:47:00.760 in

00:47:00.920 as

00:47:01.080 much

00:47:01.340 pain

00:47:01.780 and

00:47:02.200 I

00:47:02.400 hadn't

00:47:02.880 been

00:47:03.080 there

00:47:03.280 as

00:47:03.440 long

00:47:03.720 as

00:47:04.000 a

00:47:04.120 whole

00:47:04.280 bunch

00:47:04.500 of

00:47:04.620 other

00:47:04.780 people

00:47:05.100 who

00:47:05.260 were

00:47:05.400 in

00:47:05.540 worse

00:47:05.780 conditions

00:47:06.280 so

00:47:07.040 it

00:47:07.220 really

00:47:07.580 behooves

00:47:08.320 us

00:47:08.480 to

00:47:08.660 start

00:47:09.040 at

00:47:09.240 where

00:47:09.560 do

00:47:10.820 we

00:47:10.940 want

00:47:11.160 to

00:47:11.260 start

00:47:11.540 fixing

00:47:11.940 the

00:47:12.200 system

00:47:12.540 personally

00:47:13.640 I

00:47:13.960 think

00:47:14.120 we

00:47:14.220 need

00:47:14.360 to

00:47:14.460 start

00:47:14.620 with

00:47:14.780 dignity

00:47:15.160 how

00:47:15.660 are

00:47:15.920 people

00:47:16.240 being

00:47:16.500 treated

00:47:16.880 in

00:47:17.120 the

00:47:17.260 system

00:47:17.560 itself

00:47:17.980 what

00:47:18.260 is

00:47:18.420 it

00:47:18.560 like

00:47:18.800 for

00:47:19.000 them

00:47:19.280 when

00:47:19.480 they

00:47:19.640 actually

00:47:20.080 access

00:47:20.540 care

00:47:21.080 and

00:47:21.640 if

00:47:21.760 we

00:47:21.900 start

00:47:22.300 from

00:47:22.640 that

00:47:22.980 point

00:47:23.380 and

00:47:23.740 build

00:47:24.120 from

00:47:24.380 there

00:47:24.620 I

00:47:24.780 think

00:47:24.900 we

00:47:25.020 have

00:47:25.140 a

00:47:25.260 great

00:47:25.520 opportunity

00:47:25.980 to

00:47:26.220 just

00:47:26.400 start

00:47:26.660 knocking

00:47:27.100 dominoes

00:47:27.720 over

00:47:27.980 and

00:47:28.200 saying

00:47:28.400 oh

00:47:28.680 this

00:47:29.340 gives

00:47:30.520 an

00:47:30.680 undignified

00:47:31.300 experience

00:47:31.880 why

00:47:32.260 are

00:47:32.380 you

00:47:32.500 doing

00:47:32.760 that

00:47:33.100 why

00:47:33.620 can't

00:47:33.880 we

00:47:34.000 change

00:47:34.300 that

00:47:34.580 could

00:47:34.900 we

00:47:35.060 maybe

00:47:35.300 change

00:47:35.780 that

00:47:36.000 what

00:47:36.320 about

00:47:36.620 and

00:47:37.360 when

00:47:37.480 we

00:47:37.620 ask

00:47:37.920 these

00:47:38.380 courageous

00:47:39.580 questions

00:47:40.220 I

00:47:40.580 think

00:47:40.920 the

00:47:41.140 only

00:47:41.480 way

00:47:41.700 we

00:47:41.900 can

00:47:42.120 go

00:47:42.400 is

00:47:42.700 up

00:47:42.980 from

00:47:43.240 here

00:47:43.500 so

00:47:44.140 it's

00:47:44.300 a

00:47:44.380 huge

00:47:44.540 opportunity

00:47:45.020 hopefully

00:47:45.420 that's

00:47:45.660 a more

00:47:45.880 positive

00:47:46.280 note

00:47:46.560 to

00:47:46.740 end

00:47:46.940 on

00:47:47.220 it's

00:47:47.760 pretty

00:47:47.980 hard

00:47:48.220 to

00:47:48.320 go

00:47:48.420 down

00:47:48.780 when

00:47:48.980 we

00:47:49.140 are

00:47:49.300 where

00:47:49.480 we're

00:47:49.660 at

00:47:49.900 well

00:47:51.160 that's

00:47:51.420 yeah

00:47:51.940 it's

00:47:52.180 so

00:47:52.500 bad

00:47:52.880 it

00:47:53.020 could

00:47:53.140 only

00:47:53.360 get

00:47:53.600 better

00:47:53.920 I

00:47:54.100 guess

00:47:54.320 is

00:47:54.500 one

00:47:54.820 way

00:47:55.040 to

00:47:55.160 instill

00:47:55.660 some

00:47:55.880 optimism

00:47:56.360 I

00:47:56.880 know

00:47:57.020 I

00:47:57.180 think

00:47:57.440 that's

00:47:57.600 very

00:47:57.760 well

00:47:57.940 said

00:47:58.120 and

00:47:58.260 you

00:47:58.520 reminded

00:47:58.920 me

00:47:59.180 Sean

00:47:59.380 I

00:47:59.520 didn't

00:47:59.740 do

00:47:59.880 my

00:48:00.080 obligatory

00:48:00.620 disclaimer

00:48:01.160 that

00:48:01.380 you

00:48:01.480 have

00:48:01.700 to

00:48:01.820 do

00:48:01.940 any

00:48:02.120 time

00:48:02.320 you

00:48:02.460 talk

00:48:02.680 about

00:48:02.880 health

00:48:03.120 care

00:48:03.280 in

00:48:03.420 Canada

00:48:03.700 which

00:48:03.940 is

00:48:04.080 that

00:48:04.280 private

00:48:04.920 does

00:48:05.160 not

00:48:05.360 mean

00:48:05.520 American

00:48:05.960 this

00:48:06.260 is

00:48:06.380 not

00:48:06.600 a

00:48:06.840 dichotomy

00:48:07.380 it's

00:48:07.600 not

00:48:07.740 a

00:48:07.860 binary

00:48:08.180 we're

00:48:08.420 not

00:48:08.580 talking

00:48:08.940 about

00:48:09.260 choosing

00:48:09.860 between

00:48:10.240 Canadian

00:48:10.620 health

00:48:10.900 care

00:48:11.080 or

00:48:11.240 American

00:48:11.560 health

00:48:11.860 care

00:48:12.060 but

00:48:12.220 perhaps

00:48:12.520 building

00:48:12.840 a

00:48:13.000 system

00:48:13.240 that's

00:48:13.740 better

00:48:14.100 than

00:48:14.300 either

00:48:14.500 one

00:48:14.740 right

00:48:14.960 now

00:48:15.220 so

00:48:15.800 thanks

00:48:16.040 for

00:48:16.260 inadvertently

00:48:16.960 prompting

00:48:17.500 that

00:48:17.760 Dr.

00:48:18.160 Sean

00:48:18.440 Whatley

00:48:18.780 Family

00:48:19.080 physician

00:48:19.520 former

00:48:19.960 head

00:48:20.280 of

00:48:20.520 the

00:48:20.640 OMA

00:48:20.980 and

00:48:21.580 author

00:48:21.840 of

00:48:22.000 the

00:48:22.080 great

00:48:22.280 book

00:48:22.440 when

00:48:22.620 politics

00:48:23.080 comes

00:48:23.520 before

00:48:23.980 patients

00:48:24.500 Alex

00:48:25.120 Hannum

00:48:25.420 president

00:48:25.760 and

00:48:26.140 CEO

00:48:26.480 of

00:48:26.840 Medpoint

00:48:27.380 and

00:48:28.020 Joanna

00:48:28.460 Barron

00:48:28.800 executive

00:48:29.160 director

00:48:29.580 of

00:48:29.880 the

00:48:30.040 Canadian

00:48:30.420 Constitution

00:48:31.020 Foundation

00:48:31.540 this

00:48:31.880 was a

00:48:32.280 fascinating

00:48:32.780 discussion

00:48:33.280 and

00:48:33.940 thanks

00:48:34.260 to

00:48:34.380 all

00:48:34.500 three

00:48:34.680 of

00:48:34.820 you

00:48:34.880 for

00:48:35.020 joining

00:48:35.240 me

00:48:35.400 for

00:48:35.600 it

00:48:35.880 thank

00:48:37.080 you

00:48:37.200 thank

00:48:37.900 you

00:48:38.120 well

00:48:39.020 that

00:48:39.200 was

00:48:39.340 fantastic

00:48:39.900 my

00:48:40.160 thanks

00:48:40.460 again

00:48:40.880 to

00:48:41.220 Joanna

00:48:41.700 and

00:48:41.980 Alex

00:48:42.380 and

00:48:42.760 Sean

00:48:43.240 Dr.

00:48:43.540 Sean

00:48:43.860 Whatley

00:48:44.160 for

00:48:44.360 coming

00:48:44.580 on

00:48:44.740 the

00:48:44.840 show

00:48:45.020 it

00:48:45.600 was

00:48:45.880 a

00:48:46.140 pleasure

00:48:46.400 I

00:48:46.560 always

00:48:46.740 learn

00:48:46.920 so much

00:48:47.320 from

00:48:47.460 doing

00:48:47.680 these

00:48:47.960 Friday

00:48:48.340 shows

00:48:48.680 so I

00:48:48.960 thank

00:48:49.200 you

00:48:49.560 for

00:48:50.140 all

00:48:50.460 of

00:48:50.620 those

00:48:50.860 of

00:48:51.000 you

00:48:51.100 who

00:48:51.260 have

00:48:51.400 tuned

00:48:51.660 in

00:48:51.900 and

00:48:52.200 also

00:48:52.460 those

00:48:52.720 of

00:48:52.840 you

00:48:52.920 who

00:48:53.040 have

00:48:53.140 sent

00:48:53.300 topic

00:48:53.660 ideas

00:48:54.020 we've

00:48:54.280 had

00:48:54.460 some

00:48:55.080 suggestions

00:48:55.540 of

00:48:56.120 things

00:48:56.540 that

00:48:56.660 we

00:48:56.780 should

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Juno News - November 12, 2021

Fixing Canada's broken healthcare system

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