The Candice Malcolm Show - February 07, 2022


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


Episode Stats

Length

18 minutes

Words per Minute

190.06793

Word Count

3,488

Sentence Count

215


Summary


Transcript

00:00:00.360 COVID tested the limits and exposed the fatal flaws in Canada's centrally planned socialized
00:00:06.420 healthcare system. It failed to deliver results to Canadians, and it is bankrupting our country.
00:00:11.680 Let's talk about ways to improve the system. I'm Candice Malcolm, and this is The Candice
00:00:14.900 Malcolm Show.
00:00:19.940 Hi, everyone. Thank you so much for tuning in. Now, I know that there is a huge rally
00:00:24.880 going on in Ottawa that the protests have moved to provincial capitals all over the world,
00:00:30.260 and it is really exciting. We're going to continue to provide wall-to-wall coverage of that over at
00:00:34.600 TNC. But I wanted to focus in on something else that has become so apparent and so problematic
00:00:41.260 during the course of the pandemic, and that is the failure of our healthcare system. We have seen it
00:00:45.860 in so many regards, manifest in so many ways. It is connected to the trucker protest because the
00:00:51.480 mandates are by and large caused because of the shortages in our healthcare system. If we had
00:00:56.520 a robust, thorough system that allowed for a lot more capacity for people to go into ICUs when
00:01:06.180 necessary, we wouldn't have to lock down. We wouldn't have all of these lockdowns that have
00:01:09.840 destroyed our society over the last two years. Just look at a place like Florida that has huge ICU
00:01:14.000 capacity, and they haven't had to have the same kind of lockdown. So our healthcare system is really at
00:01:18.700 the center of this, and it is so important for us to talk about these issues, address them, and for
00:01:23.640 people who oppose the Liberal government and want to have a better country, a better Canada, it's up to
00:01:29.140 us to come up with ideas and solutions as to how we can improve the system to benefit all Canadians.
00:01:34.560 So to do that today, I'm really pleased to be joined by my friend, Dr. Sean Watley. Sean is a rural
00:01:40.060 family doctor based in Mount Albert, Ontario. He's the author of When Politics Comes Before Patients,
00:01:45.060 Why and How Canadian Metal Care is Failing. And he's a Monk Senior Fellow over at the
00:01:51.380 Macdonald-Laurier Institute. He's spent the last 20 years serving various leadership roles on a number
00:01:56.680 of boards, and he's the past president of the Ontario Medical Association Show. Sean, welcome to
00:02:02.340 True North. Welcome to Canada's Malcolm Show. Thank you so much for joining us today.
00:02:05.060 Thanks for having me.
00:02:06.740 So you recently wrote this great column over in the National Post. The column was titled,
00:02:10.880 Canada's More With Less Approach to Healthcare Has Failed Us. So why don't you give us a little
00:02:16.400 overview? What do you mean by that, the more with less approach?
00:02:19.500 Yeah, so thank you. The gist of it is that within healthcare itself, so I served a number of years
00:02:26.340 as a hospital administrator, and every administrator needs to know what you have to do to get ahead.
00:02:32.480 What do you have to do to make the hospital board happy with you? What do you have to do to make
00:02:35.820 the Ministry of Health happy with you? And one of the guaranteed paths to success is to try to provide
00:02:43.100 care to more patients, better care to more patients, improve your level of service without spending more
00:02:49.100 money. So that's always the key. How can we not increase hospital budgets and yet stretch out what
00:02:54.780 we're doing more and more? And so we get thinner and thinner. In a previous book, I talked about our
00:02:59.700 lack of resilience that gets baked into the system. But the paradox of it is that despite our
00:03:05.560 fact, despite the fact that we're trying so desperately to provide more care without spending
00:03:11.260 less, sort of this more with less approach, we actually end up spending more. So we cut beds,
00:03:18.220 we decrease services, and so we end up with less care for a higher price tag. So we end up with
00:03:24.780 less for more, despite trying to do more with less. Well, so it's interesting. I'll just pull a line
00:03:32.480 from your column because you have this information really detailed out. So you said that this is
00:03:38.120 talking about the province of Ontario. So in 1990, Ontario had 33,000 acute care hospital beds,
00:03:44.640 or that's the equivalent of 3.2 per thousand population, and healthcare spending represented
00:03:49.020 8.3% of the province's GDP. Fast forward to 2017, so 27 years later, Ontario had fallen to
00:03:56.520 18,500 beds, down from 33,400 down to 18,500. That's nearly, that's almost cut in half. That equates
00:04:06.380 to 1.3 beds per thousand populations, because the population's growing at the same time.
00:04:11.620 Meanwhile, healthcare spending rose to 11.3% of the GDP. How is that possible, Sean, that we are
00:04:18.200 getting, we're spending twice as much and basically getting half as much?
00:04:22.240 So I always try to take the positive spin on it. And part of the story here is that perhaps we had
00:04:29.540 too many beds in 1990, right? The beds that we had in 1990 were a reflection of what happened in the
00:04:35.080 1970s. And before that, when we had a hospital building boom all across Canada, and we could
00:04:40.940 unpack why that happened, but we'll leave it to say we had a ton of beds in the 70s. We didn't really
00:04:46.500 build a ton more in the 80s. But then by the time the crunch hit in the 1990s, that's when people
00:04:53.040 said, whoa, we, you know, we're running out of money. And we got into the social contract years
00:04:57.360 of the decade in the 1990s. And so governments had to, A, save money, but B, try to shift services
00:05:05.840 out of the hospital. So there's a big, big movement to a lot of outpatient care, outpatient therapy,
00:05:11.360 used to, you know, have a baby and get admitted for two weeks. And then we had trouble with people
00:05:16.520 getting blood clots in their legs, because they were in hospital for so long. And so that created
00:05:20.300 its own problems. And so it was a good thing to start getting people moving quicker, getting them
00:05:25.600 out of the hospital, doing more outpatient care. However, that same vision of trying to stretch the
00:05:32.940 dollar, do more with less, really was perhaps only a wise plan for the first few years. Okay, maybe it was
00:05:39.480 wise to cut beds, but continually cutting beds, closing hospitals, and thinking that that was
00:05:44.620 the secret sauce that's going to allow us to continue on forever. That's not a vision for
00:05:50.800 growth. And so whether it was just, you know, it was, I was going to say osmosis, that's not the
00:05:58.260 right word, whether it was just inertia, inertia, that's the word I'm looking for. So you grab onto
00:06:05.000 something and you just keep doing it over and over and you expect different results. And
00:06:09.280 unfortunately, that doesn't happen. And so what happens is the wait times grow and grow and grow.
00:06:13.820 We end up spending more and more of our GDP and people are getting less service overall.
00:06:20.940 Well, it's interesting to hear you say that perhaps the 3.2 per thousand population was too
00:06:25.880 much and that we were, you know, we'd gone through this boom and we didn't quite need it. And yet you
00:06:29.740 point out in your piece that the OECD average is 4.8 beds. So we're just wildly underprepared in
00:06:37.560 Canada in general, pre-COVID. And I think that COVID just even showed that even more how
00:06:44.500 underprepared our system was. To me, Sean, this provides and creates a perfect opportunity. And I
00:06:50.640 wish that people in conservatively led provinces like Alberta, Saskatchewan, Manitoba, and Ontario
00:06:56.560 were more prepared to step in at this point and say, look, this is an emergency. Our ICU capacity is so
00:07:03.100 small. There was an investigative report by my colleague Anthony Fury over in the Toronto Sun
00:07:07.740 talking about how even with the small ICU capacity, the capacity is even less because they don't have
00:07:13.840 the nursing staff and the physician staff to actually man those beds. And so that is a major
00:07:20.380 problem, not so much just the pure capacity. But, you know, we're in a situation in Ontario where a
00:07:24.680 couple hundred people in the ICU and the entire province goes into lockdown. So with this huge
00:07:30.560 problem comes an opportunity. And I think that conservatives need to take advantage of it by
00:07:34.420 proposing changes and telling Canadians, look, we want you to have universal coverage. What you have
00:07:39.580 right now isn't universal. When you have to go to the hospital and wait for hours and hours, or if you
00:07:43.860 need a surgery and you have to wait months and months and months, that's not universal. That's you
00:07:48.440 being put on hold. So what can we do? You spent a lot of time thinking about this. What could be done?
00:07:54.120 Yeah. So that's a huge question. So many people ask me. So first of all, there's no shortage of
00:08:00.280 ideas. There are, you know, at least we could talk about even the Romano report, which was very,
00:08:05.360 very pro Medicare, just pour more money in. But we can talk about the Mazinkowski report or the Kirby
00:08:10.360 Commission or even the Naylor report. He was the chair of the last most recent committee looking at this.
00:08:16.580 We could look at the report out of Quebec. I think it was the Claude report. So lots of good ideas out
00:08:22.620 there. We could talk about changing funding mechanism, having mechanisms, having patient
00:08:27.180 co-pay, having different insurance approaches. We can talk about public-private partnerships. We
00:08:32.720 can talk about having tests done at home, having care in the community. But all of these things are
00:08:38.500 tactics. What we need is an overall strategy. So even, you know, as supportive as I am of the
00:08:44.900 Canby surgery case, where they're really trying to say that not allowing any kind of private funding
00:08:50.640 is unconstitutional. I'm supportive of that. My worry, however, is that if we only focus on funding
00:08:56.720 and leave all the other important decisions to the state or the medical profession or the unions,
00:09:02.340 we still won't make a major change. It would be like me going to the grocery store and telling my
00:09:07.860 daughter, okay, here's 20 bucks, run in. We need 1% milk, two bags of it. It's got to be that this
00:09:13.300 particular brand and at this particular store that we're at, at this particular time of the day,
00:09:17.540 I've made all the important decisions. And she isn't, you know, maybe she doesn't have enough
00:09:22.600 money in her pocket. So she uses a visa or whatever. The payment mechanism itself is only one
00:09:28.400 feature of a much larger discussion. And part of the problem is, and I'm stealing a term,
00:09:34.760 I forget the author I got it from, but he talks about the iron triangle in corporatism. So this is
00:09:40.460 back in the 1980s and Margaret Thatcher had to break this iron triangle. And it's a term that comes
00:09:45.840 from corporatism. It talks about the government and the corporations and unions or big labor. And
00:09:52.260 we have a similar iron triangle in Canada of the government, the medical profession. So the
00:09:58.260 regulatory colleges and the educational colleges and the medical association. So doctors, the state
00:10:03.880 and the unions, and each of those entities have veto power over any substantive change. So even if we
00:10:10.740 changed funding, you still have these three self-interested parties that aren't going to allow
00:10:15.160 change to happen. So I think that's where we need to start focusing our attention. And we need to say,
00:10:21.080 is it right to have a concentration of power in the regulatory colleges? So they make the laws,
00:10:26.700 enforce the laws, oversee the laws, punish the lawbreakers if it's a doctor, rehabilitate the
00:10:32.060 lawbreakers. I mean, you would never have that in a Western approach to a free parliamentary democracy.
00:10:38.000 You separate those powers. That's just one example. We could talk about the close to 100%
00:10:43.540 unionization rate in Ontario hospitals. Does that make sense? When the broader public sector is
00:10:49.460 around in the mid-70s, you go to the private sector, you're down into the 30% range for unionization
00:10:55.260 rates. And they're even below 20% if you look at the American general overall unionization rate.
00:11:01.060 So there are a number of different ways we could look at breaking that iron triangle. But you're asking me
00:11:07.580 about what I'm going to put into the next book. And it's actually very difficult. There are so many ideas,
00:11:11.780 but how do you package it together? And this is what I'm kind of landing on is this concept of the
00:11:16.740 state doctors and big labor and how we're just locked and no one's going to let a change happen.
00:11:22.580 Well, that would sort of lend an idea as to why there hasn't been more sweeping changes in provinces
00:11:29.020 led by conservative governments, because perhaps they don't even have control, like they don't have
00:11:33.020 the control or the power to defeat those other two bodies, the unions and the regulators. And we know,
00:11:37.340 I mean, I've looked into the issue with sort of interprovincial migration, or even immigrants
00:11:43.420 coming to Canada and having their credentials not match and having a lot of problems trying to break
00:11:48.600 into the labor force, because these jobs are so guarded by the regulators that you talk about.
00:11:55.180 I wanted to pull one other quote out of your column, because I thought it was so relevant to
00:12:02.280 what we've just lived through. So you mentioned that there's a myopia and narrow mindedness that
00:12:07.620 bedeviled efforts to reform to healthcare reform. And we've seen this happen politically. So even in
00:12:13.440 the last election 2021, Erno Toole sort of started talking about in a very sort of mild and reasonable
00:12:19.800 way. This is a conservative legal former conservative leader now, but the leader of the party at the time,
00:12:25.360 just having more sort of partnerships between the private sector, and the public sector and just
00:12:31.200 leading to more healthcare spaces and a more dynamic healthcare system. And what did we see the
00:12:36.540 liberals followed by their supporters in the legacy media, sort of drum it out as Erno Toole wants to
00:12:41.980 privatize healthcare, Erno Toole wants to Americanize our healthcare, all of the exact same critiques that
00:12:46.160 we've been seeing for 20 years in Canadian politics, it just sort of creates such a shallow dumbed down
00:12:51.440 attack. That's politics. And it seems to work. Canadians seem to be very attached to the concept
00:12:57.620 of our healthcare system, even though perhaps when they go to interact with it themselves,
00:13:02.240 they have negative experiences. It's not all it's cracked up to be. But the liberals have done a
00:13:08.180 tremendous job and then the NDP as well, but of sort of tying our healthcare system with our national
00:13:14.760 identity that it is like the one of the biggest sources of pride when you see those polls about like,
00:13:21.140 what do Canadians care about? They feel really protective over their system, regardless of how much it
00:13:26.460 fails, how poorly it ranks in terms of like comparing it to the OECD. I'm not talking about
00:13:31.180 comparing it to our American neighbors. I'm talking about comparing it to the UK, France, Switzerland,
00:13:37.420 Sweden, Norway, all these other countries that we should be, Australia, that we should be looking to.
00:13:43.440 And yet we have this like very rigid idea. So sort of, I know you think about this a lot from a
00:13:49.280 political perspective. How do you think you convince Canadians that we need to have this change? We need
00:13:54.080 to break up this, these powers and it would be better for everybody if there was just more
00:13:59.620 healthcare opportunities, be it public or private or, or whatever.
00:14:04.420 So great, great question. There are two issues. Number one is the negative and the risk of talking
00:14:09.640 about the negative. So as soon as we criticize Medicare, to your point, it feels, people feel like
00:14:15.420 we're criticizing them. We're criticizing home. We're criticizing motherhood and apple pie.
00:14:19.680 Jim Carrey was on the Bill Maher, Bill Maher show. And it ran off a major rant. This is about
00:14:27.060 night to 2018. He said, listen, I'm from Canada. Okay. And we have socialized medicine. I'm here to
00:14:32.480 tell you what you hear on these talk shows. And he went on, gave a bunch of swear words and said, why,
00:14:37.560 why the Canadian system is just awesome. I never have to wait. I always get what I want, what I want.
00:14:43.200 My mom lives in Vancouver and on and on and on. So that kind of approach of coming to the defense
00:14:49.220 of motherhood and apple pie is a bit like if the Titanic is sinking and you happen to be one of the
00:14:56.940 lucky ones who got into one of the few rowboats. So you're safe and you're snuggled under your
00:15:01.920 blanket when you're eating snacks and someone says, Hey, there's someone else drowning in the water.
00:15:06.500 And you say, stop that. Look, we're nice and warm. We're safe. How dare you criticize the work of
00:15:12.000 these hardworking sailors to, you know, it just doesn't make sense. So we have to shift the
00:15:17.420 narrative to say, listen, we're not criticizing everything. We're just saying that people are
00:15:21.220 really suffering and actually dying. So that's the negative side. And how do we respond to the
00:15:27.020 negative? But I think it has to go beyond that. We have to talk about the positive. What kind of
00:15:32.380 vision can we offer people? And this is a challenge. Part of it, you know, we could create this gigantic
00:15:38.840 vision and no one would listen to you because it would take too long to tell them. Or we can just
00:15:43.000 get really nitty gritty and say, what do you want? You want great care when you need it close to home
00:15:49.040 without having to travel. You want to be able to change docs. If you and your doc really butt heads,
00:15:54.920 we could look at the Canada health act. I mean, everybody loves comprehensive care, universal care,
00:16:00.040 portable care. We could unpack those three principles and say, yeah, we love those three
00:16:04.560 principles. But the first principle publicly administered, okay, wait a second. Why do we
00:16:09.960 have to be so rigid on that? We all love comprehensiveness and universality and portability,
00:16:15.140 even though you don't have portability to Quebec because it doesn't really reciprocate,
00:16:19.040 but we'll leave that to the side. But why do we have to be so rigid on publicly administered?
00:16:24.820 And then the final part of the Canada health act is accessibility. Why are we so rigid on saying,
00:16:31.020 okay, no hospital user fees, but yet hospitals charge outrageous parking rates and they charge
00:16:35.980 overpriced for coffee in the hospital and overpriced at their gift shops. So they're still
00:16:40.620 doing a pseudo hospital user fee, at least with the parking fees, but yet that's okay. So we need to
00:16:48.460 sort of take the heat down in the room. Stop letting people say, we just want an American system.
00:16:55.280 There are many other countries in the world. Stop talking about the whole business and profit thing.
00:17:00.240 Every single person working in healthcare, at least as far as I know, gets an income. Everybody
00:17:05.900 profits from the work they do. You don't see a bunch of people going around taking vows of poverty
00:17:11.760 and working for free as a nurse or a doctor or anything. So we need to start unpacking that and
00:17:16.780 really make sense of it. If it wasn't for businesses, this is a Taylor. He's a journalist in
00:17:22.220 the UK. He said, if it wasn't for businesses, all we would have is doctors and nurses standing in a
00:17:28.220 field in their underwear. So because of businesses, we have hospital beds and drugs and procedural
00:17:35.880 instruments, and we have buildings and light. And so there are a bunch of ways where we could
00:17:41.680 really unpack this, but it needs to be in little snippets that people want to consume when they're
00:17:46.360 thinking about politics.
00:17:47.320 Well, that's so helpful, Sean. And I'm really excited. I didn't know you had a new book coming
00:17:52.840 out. So we'll have to keep an eye on that and have you back on the program when that book comes
00:17:58.520 out. I feel like this is just the start of a conversation. I would love to have you on again
00:18:02.440 so we can jump into other issues and go into more depth. I really appreciate you being out there,
00:18:07.980 having these conversations and getting the ball rolling and getting people thinking about it.
00:18:11.320 I think it's so important for the country. So I really appreciate it. Thank you so much for
00:18:14.620 joining the show today. My pleasure. Thank you.
00:18:17.860 All right. Thank you for tuning in. I'm Candice Malcolm, and this is The Candice Malcolm Show.