Colin Craig of Second Street on an interesting poll they did of Canadians on health care reform
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Summary
Health care reform is a hot topic in Canada right now, and with good reason. Health care costs are skyrocketing, and we need to fix it. But what if we don't have universal health care? How could we fix it? In this episode of the podcast, we talk to health care reform advocate and pollster, Dr. Ben Cohen, about the pros and cons of universal healthcare in Canada.
Transcript
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So, I mean, just to get right to it, I mean, you know, quite often, as I kind of said earlier
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in the show before you got on, there's people always say that Canadians don't want any change
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in their health system. They're afraid of change. They want the status quo. They only want to spend
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more money on it. But when you've asked Canadians directly, they sound a little more receptive to
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some reforms than some people would make you believe. Yes, for sure. It seems to be a case
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where Canadians are ahead of the politicians. And, you know, some of the polling that I've seen over
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the year suggests that Canadians have been ready for health reform for a long time now. Now, if we
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had been talking about 20 years ago, I think it was a different topic because, you know, people would
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talk about things like having private clinics outside of the public system, and it was a lot
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more taboo. Whereas I think over time, Canadians have had an opportunity to read lots of opinion
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columns, see lots of interviews, hear lots of discussions about different healthcare systems
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around the world, and understand that it's not an either or situation. We can have a universal public
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healthcare system, which is what Canadians like, this idea you can walk into a hospital and, you know,
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receive some kind of significant procedure and then walk out without facing a big bill. We can keep that
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option in place, but at the same time, allow patients the choice. So if they don't want to wait a long time
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to get their knee or hip done, maybe they could go to a private clinic and pay privately. Governments could work
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with private clinics to reduce backlogs, all kinds of different reform options. Canadians, I think, are
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understanding that these things work in other countries that are not called the United States,
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and, you know, that we could bring them here. And that's really what our poll shows is that
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Canadians are very much open to health reform, if it can help patients.
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Yeah, I mean, as you pointed out, not the United States. I mean, speaking of, you know,
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when we talk about a lot of binary, non-binary stuff, well, our healthcare isn't a binary discussion
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with systems. There's dozens of systems with a lot of innovative ideas. Some systems stink, some are very
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good. But we really have shunted our discussion and kind of closed it down for looking anywhere
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outside of North America. And that's putting us at a disadvantage.
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Oh, 100%. That's why I say not the United States, tongue-in-cheek, of course, because
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for so long, opponents of health reform, people who like this sort of pseudo-government monopoly,
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they don't want to lose any control. So they've effectively tried to position this as
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Canada's system or the US model. But as you just noted, there's tons and tons of countries around
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the world with universal healthcare systems. We could be learning from them, understanding how
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they're delivering better care. And, you know, really, I think that's what we need to do as a
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country is to start to look at, you know, what's happening in Sweden, on Australia, New Zealand,
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many other countries around the world that have that universal aspect that Canadians like,
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but ultimately deliver better results for patients.
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Well, that word's the key part, because I think that's where a lot of the fear-mongering
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misunderstanding comes. I mean, nobody's proposing to end the universal aspect of it. Nobody's saying
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we want to make it where if you don't have cash in hand, you won't get coverage. I mean,
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most people fully agree they want a system where you never have to sweat paying the bills because
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you need healthcare. So there'd be universal coverage. It's just changing how it'd be managed and
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delivered. Yeah, exactly. And, you know, even if someone did want to completely get rid of healthcare as we
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know it, it's a non-starter politically. There's not a single member of parliament in Ottawa that would
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stand up and say, let's get rid of it. There's no provincial government in the country, no major
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political party with any seats that would campaign on this. So politically, it's just not, it's pretty
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much impossible at the moment. And I would say for the foreseeable future, I don't think it's on
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anyone's radar. But yeah, like you said, I mean, we can reform the system and make sure that we keep
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that universal aspect that Canadians absolutely want and find ways to deliver care better. And we
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threw out a couple ideas in our public opinion research to ask Canadians, well, what do you think
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about these ideas? So as I mentioned, this idea of, you know, keeping the universal public healthcare
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system. But if a patient doesn't want to wait, say, a year in chronic pain for their hip operation,
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will allow them to go to a private clinic where they could pay out of pocket. And a majority of
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Canadians support that idea, about 51%. So, you know, we've seen that in the past, majority support
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that. And, you know, I think the public is there, especially when they start to understand what that
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actually means. I mean, there's ways that other countries have put safeguards in place that, you
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know, the boogeyman argument is always that, well, everyone's going to leave the public system and go and
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work at the private system. And obviously, that's not the case, because other countries successfully
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do this. And they often have some safeguards in place to say, okay, you can't work at the private
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clinic until you've done X number of hours in the public system each week or whatever.
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But, you know, one important thing about this is that right now, a lot of surgeons will tell you that
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they have time on their hands, at least certainly before COVID, when all these backlogs emerged. But
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they had all this time on their hands, because the governments wouldn't hire them to pay them
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what would be full-time work for a surgeon, they would only ration out a certain number of hip
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operations a year. So once the surgeon's done all those, he or she has time to kind of twiddle their
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thumbs, so to speak. So, you know, there's certainly a lot of capacity within existing time that surgeons
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have to be able to work in both systems. And ultimately, that would lead to more procedures being done,
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Yeah, well, that's where some of the, I mean, that's kind of the lowest you found on reforms,
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though, is the 51% talking about allowing people perhaps to pay to get in ahead in line. But, you
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know, I think with more discussion, if people realize and they frame it the right way, you know,
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they can embrace that. Like, the way I look at it is, okay, I've been told I'll get my knee surgery
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in six months. But if I let that guy pay cash and get ahead of the line, my surgery would be reduced
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to four months. So if I could just swallow the envy, yes, he got in tomorrow, but he subsidized
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my getting in two months faster. Like, I'm winning here. This is okay. And if people could kind of wrap
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it that way, rather than trying to think of somebody jumping the line, I think you'd see more people
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Yeah, it's an absolutely huge benefit if we did that, because they have patients, other patients
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would get to move ahead faster in line, it would also increase competition and innovation, you know,
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when you have two different people doing the same task, well, that increases your chances that maybe
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one of them will find a better way to do it. And then they can both learn from it. I mean, this is
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how economies work in every industry, right? You see constant innovation over the years, as new
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technologies are established and so forth. And, you know, like I said, we got 51% support, I think
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if we had to maybe rephrase the question a little bit to make it clarify that, you know, it involved
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keeping the public system, but allowing this on the side, I think that the public, if they fully
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understood what this is, I think we'd see support to be actually a lot higher. So it is, you know,
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it's something I'm thinking about the next time we pose this question is to reframe it a bit. But I
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think certainly the majority of the public is there.
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Yeah, well, and one of the areas we had a stronger showing of support, perhaps the strongest was 72%
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support copying that European Union policy that allows patients to visit facilities outside of
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their provincial borders and get reimbursed later. And I mean, that one, I guess what if a province
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has to say a specialized clinic that has extra room in it, they can bring people from next door
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and then get reimbursed from the province later and still gets to faster care, it's sort of that sort
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of concept? Yeah, it would depend how they implement it here. But I mean, you've done a pretty good job
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of explaining it. So the way it works in Europe is, let's say you're in Ireland, and you're facing a
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four month wait for your knee surgery. And when the government would provide it to you, it would cost
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them, let's say, just to pick a number 5000 euros. Well, what you could do is instead of waiting that
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four month waiting period, you could maybe go to another EU country like France and pay, let's say,
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they're charging 4000 or 5000 euros for it. Well, you go there, you pay it, you come back to Ireland,
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the Irish government reimburses you for what you paid. Now, if you found a better deal, and you paid
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less, let's say someone went to Estonia, and got their knee surgery done there. Well, then the Irish
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government would actually save money because they would pay you that that lower rate, the amount you
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actually paid. And then the opposite of that, of course, is if you went somewhere and you had to pay
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more than what your government would normally pay, well, then you would be responsible for the
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difference. But just having this funding mechanism in place for patients right now, to be able to go
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abroad and get the care they need instead of spending another year in chronic pain, off work,
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whatever. Canadians like this idea. And it's a way to get relief for patients immediately to give them
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that option, it wouldn't be forced to be completely voluntary. Patients would have that option, not
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everyone's going to take the government up on it. But you know, as we just talked about, when that
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happens, let's say the government subsidizes someone to go to wherever Tennessee to get their
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hip done. Well, then they go off of the public waiting list and whoever's behind them in line gets
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to move up a spot. So I mean, this is this policy is not perfect. But it's one I think that could help
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immediately reduce waiting lists in Canada. And at the same time, you'd help patients who are decide
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not to go abroad for surgery, they would all get to move up in a spot in line. So you know, the big
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question with this policy, Corey is, well, what's the cost? And if you think about it, over a two or
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three year period, the cost is, there's no real increase, because what you're doing is you're changing
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the timing of when expenses occur. So instead of paying, say $5,000 to, you know, fix your knee
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next year, the government would spend $5,000 this year. So over a two year period, the expenses are
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roughly neutral. Yeah, and I mean, again, you see some of the concerns that come up. And it's fair
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enough, one of our commenters, Lori Dobby saying, yes, she sees is she or he hates or tell would be
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if people with money would be able to displace others in a wait list. And we sort of addressed that
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earlier, if it's shortening the list overall, it won't displace people on the list, it would just
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mean somebody else. But the waiting list, though, at least, you know, in addressing that, that's the
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problem. That's where our system is bottlenecked. And maybe if people understand too, like as you're
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speaking about, that the costs of somebody waiting, if somebody can't go to work, because they're
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injured or sick, or they're only part time, or they're not as productive. Another thing is they're
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being medicated quite often pain medication, and that can lead to addiction or long term issues,
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as well as quality of life. Like we really need to cut those weights and start to examine how we can
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do it. Yeah. And you know, I agree with your point. And Lori's I think you both made made good points
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there. Like you said, everyone could benefit because people ahead of you in line who decide
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to do this, well, they get off of the waiting list. Everyone else gets to move up a spot who's behind
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them. Lori makes a good point, though, about cost. I mean, that's true. If let's say that you need a
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whatever $30,000 hip operation somewhere, and you don't have access to being able to pay for that
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before you get reimbursed, that is the limitation, obviously, of this policy. But what this policy does
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do is if you think about it right now, who has the money to go abroad for healthcare, because we know
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hundreds of 1000s of Canadians every single year are flying to other countries, they're driving across the border to
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the US. People with access to money are able to do this right now. And it's sort of that lower income
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and lower middle income people that often don't have the funds to be able to do that. This policy
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changes that it gives them an opportunity to go abroad and get a subsidy, if not full cost coverage
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for the procedure they require. There's a patient I'll just give this quick anecdote this patient from
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Manitoba named Max Johnson, Johnson, and the CBC highlight his his story. What happened with him is he
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needed a knee replacement. And it was going to take I think something like a year or so waiting list in Manitoba,
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he ended up going to Lithuania. And after he paid for his knee surgery there, he compared that with what the
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Manitoba government would normally pay to get that procedure done for him. And he calculated that it was about
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$7,000 less in Lithuania. So if the Manitoba government had been subsidizing people to go to
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Lithuania for their knee surgeries, the government could actually save money. Patients who may not have
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whatever amount of money to go abroad, if they had this subsidy in place, they might then be able to
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start to afford it. So, you know, again, it's not a perfect solution, but it is a policy that could help right now.
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We're in a crisis, we need to think outside the box. And I think we need to pursue options
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that may not be 100% right on the money, but maybe you're 90% of the way there. And I think this is
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one of them. Well, I see you took advantage of you know, when you're doing the poll, the polls are
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expensive, especially when you get 1500 people like that through, you know, a good polling company.
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So you want to get all your questions in that you can. But this one's interesting, I think 66%
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believe that health ministers should have to hold a press conference every year and announce the number
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of patients who died the previous year due to long waiting lists. And, you know, that's kind of getting
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outside of talking about the systemic reform. But a nice way to point out like people maybe
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don't realize just how backlogged the system is. I mean, if you've been fortunate enough not to
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have health issues, not have to wait for anything in the system, nobody in your family has had a
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problem, you might not realize how bad it's getting out there. So having these health ministers get up
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and tell you, by the way, this many people would be alive today if we could have sped up the system,
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you know, it might add a little fire under some butts.
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Yeah, it's, it's, it's a real serious problem right now. And this is a you're right, this question
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is different from the others in that it's asking, it's, it's driving an accountability in the system.
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It's a sad fact that every single year, there are patients in this country that die,
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because the government made them wait too long for healthcare in Canada. Remember,
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the government has a monopoly on it, you cannot go to a private clinic and get a heart operation in this
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country because the government won't allow it. So the government has taken complete control over
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your access to healthcare. And when they essentially force a patient to die in a way because they're not
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able to get that care they need in time in Canada. Well, that's a pretty serious problem. We've been
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trying to dig into this information, we do reports every year that are called died on a waiting list
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reports. And we gather government data on on how this is happening. It's a bit difficult to get the
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numbers because governments don't track it very well. But it's a very serious problem. And so we've asked
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this question, well, you know, should health ministers should have to stand up each year and explain to
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the public how many patients died under their watch because they had to wait too long. And this option
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is overwhelmingly a popular one with the public, like you said, 66% agree with it. It's just a good
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accountability measure. I mean, obviously, politicians love to get in front of the cameras
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and attract lots of attention when they're building a new hospital, when they're hiring
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new staff, whatever. They like to get a lot of attention to the good news. This would obviously
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be an accountability problem in some cases. The public wants to know about it. That's, I think,
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what that number shows. Yeah. Now, another thing that's interesting when we're talking about
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private clinics, you know, is the pandemic crisis. I mean, that led to a lot of hospitals
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basically locking down. A lot of procedures got put off and pushed off because they were
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trying to quarantine the hospital spaces. And maybe there's a whole, you know, this is kind of going
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outside of what your poll was asking about. But still, if we had a number of specialized private
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clinics, whether it was for dialysis or orthopedic surgery or other day surgeries, those areas could have
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continued to operate while the hospitals were still locked down with vulnerable patients within them.
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But because we have everything packed into a few giant hospitals, it made us a heck of a lot more
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vulnerable when a pandemic came around. I'm just saying that there's benefits we could see from,
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you know, spreading our system out a little more rather than having it packed into one central
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location like that as well. Yeah, you're 100% bang on. This is a very serious problem, I think,
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in Canada is that so often, when you need to get your your knee or your hip done, or maybe you're
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an expectant mother, and you're giving birth, you're going into that hospital building, often it's
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the same building and complex where you've got people going in because they've got COVID or the flu
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or some kind of other disease or something that can spread. And sometimes those infections happen,
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right. And when you keep the healthy people, if you're pregnant, you're healthy, if you need
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your knee done, you're healthy, you just you have this other problem, right? You're not contagious.
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So if you had those procedures taking place in private clinics, at least if you had that option,
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then I think you help could you could help spread some of those viruses and that from being transmitted.
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Yeah, well, we're kind of, you know, going, I guess, a different route rather than
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lobbying the politicians, you're talking to the public, because as you said, the public's kind of ahead of
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the politicians on this one, if they can realize there's an appetite for this among the electorate,
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maybe they'll be ready to take it on. But I mean, there's clashes that could come with the Canada
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Health Act. Would it be time to start calling for maybe reforming that act a little to allow
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I think so. Yeah. And I mean, you talked earlier about the funding of health care in this country
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and how it used to be sort of 50-50. Now it's down to 20 some percent that the federal government's
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contributing. The vast majority is coming provincially. The great hindrance is that when provincial
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governments try to experiment a bit, you know, we talked earlier about innovation,
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when they try to innovate and try things, try doing things differently to try and improve services.
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Well, if Ottawa doesn't like it, they can come in with the hammer and say, well, we're going to cut
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your funding. Now, it's only 20 percent, but that's 20 percent that provincial governments need.
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So, you know, if you did reform the Canada Health Act, I think you could make sure some of the language is
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clear so that provincial governments have the opportunity to innovate while keeping that
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universal aspect that, you know, Canadians overwhelmingly like. So, you know, I think
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there's an opportunity to reform the Health Act. And if you did, you could ultimately improve
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Well, and we have to start with somewhere, as I said, that the politicians will move when their own
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electoral butts get on the line. So, you know, you guys are doing good work and getting the public
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working up on it and, you know, and realizing that we've got to examine new things. You've been
00:18:27.340
doing other things with Second Street before I let you go to, you know, your Survivors of Socialism
00:18:31.660
series and a number of other things. Do you want to let us know a little bit about the work you do
00:18:35.660
before you go? Sure. Yeah. Like you said, we did a series called Survivors of Socialism, where we
00:18:40.540
talked to Canadians who came from socialist and communist countries. We heard their stories and we also
00:18:46.060
surveyed them to say, you know, are there any policies in Canada that concern you because they remind you of
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the countries that you fled. And so, yeah, we've got some interesting responses there. People can
00:18:54.700
check that out. We've been doing public opinion research on the oil and gas sector and what
00:19:00.140
Canadians think about developing and exporting more of our resources so that the world can buy from us
00:19:07.420
instead of Russia. And obviously the huge benefit of that is if the world doesn't have to keep money,
00:19:12.700
giving money to Putin for energy, well, then he has fewer dollars to buy tanks and rockets and
00:19:18.620
invade countries like Ukraine and whoever, what other, what other countries that may be on his list
00:19:24.860
to invade next. So we've been doing projects like that. We've got lots of stuff on our website and
00:19:29.820
obviously people can find it at secondstreet.org. Excellent. Well, I always appreciate you coming
00:19:34.940
in. I really liked the poll you did, you know, and getting some of that good information directly
00:19:38.140
from Canadians. So thanks for coming on to talk to us today about it and keep up the good work.
00:19:42.780
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