We don't have a health-care crisis, it's an implementation crisis, says André Picard

For four decades, André Picard immersed himself in reporting on the major health issues of our time.

He is the health columnist for the Globe and Mail and throughout his career he has seen how the health-care system has evolved in Canada, including the decline of quality health care. 

"What's wrong with Canadian health care today is we're trying to deliver 21st-century care with a 1950s model of delivery and funding. We have an Edsel, but we need a Tesla," Picard said.

He argues Canada is a country that is resistant to change.

"The principal problem we have is not the lack of solutions. It's a lack of implementation. We don't have a health-care crisis in Canada. We have an implementation crisis." 

In February, Picard delivered the 2023 Dalton Camp Lecture in Journalism — a co-production between IDEAS and St. Thomas University in Fredericton.

Here is an excerpt.

I've mentioned many hot-button issues that have arisen over the years, but a constant has been the state of the health system itself.

It has, for as long as I can remember, lurched from crisis to crisis. These days we're very close to a nadir, to a bottoming out, I hope. One in five people don't have a family doctor in Canada. The chances of getting one are slim to nil. ERs are closing with increasing frequency. When they're open, they're overflowing. People are being triaged in parking lots. It can take eight hours to get an ambulance in much of this country. Months or even years to get a referral to a specialist. Never mind the surgery. Drug shortages have become routine. Approval of new drugs takes forever. And we still haven't figured out how to pay for drugs, especially for rare disorders. We get people doing GoFundMe campaigns. That shouldn't happen in a country with medicare.

Doctors are burning out and closing their practices. Nurses are leaving in droves. Care aides are jumping at the opportunity for better work at Tim Hortons — it pays better and has better benefits. We're kicking people out of hospitals and sending them to nursing homes against their will. Long-term care homes have become killing fields. Of the 50,000 COVID deaths in Canada, 25,000 have been in nursing homes, home to one per cent of the population. It's been a massacre of neglect.

As access to care diminishes, costs continue to soar. We're not getting value for money. Oh, and we still use fax machines, 19th-century technology. So … these are all things taken from the headlines and they're pretty damn depressing. Increasingly, our experiences within the health system are frightening. So why is this happening again? We can find answers in our history.

Medicare began just after the Second World War, a heady time when nations were rebuilding and investing in public services like hospitals and social programs like pensions and medicare. People were also making babies — lots of babies. It was the beginning of the baby boom, which is now coming home to roost.

Saskatchewan created the first publicly funded hospital insurance program in 1947. Other provinces followed suit in 1957. The federal government offered to pay half of the province's escalating hospital bills, but they had a couple of conditions: access had to be universal and free. In other words, no user fees. That funding model was extended to physician care about a decade later in 1966. 

Now unfortunately, since then, not much has changed. Meanwhile the world, from medicine to demographics, has changed a lot. The needs of patients in 1957, when medicare was born, Canada was a young country. The median age was 27. Life expectancy, though, was only 67, and the health system delivered little other than hospital-based care for acute injuries and delivering babies, of course.

We built a health system for the needs of the population at that time and that was totally appropriate. Today, the median age in our country is 47. Life expectancy is 82. The vast majority of care is chronic care for older people. The baby boomers have come of age, but the health system has not. In Canada, only hospital care and physician services are 100-per-cent covered by medicare. They're the only services considered, quote, medically necessary, unquote.

We have the least universal health-care system in the world. Ponder that for a second.- André Picard

There's no rhyme or reason to the way we publicly fund health services in Canada: six per cent of dental care, 40 per cent of home care and long-term care, 50 of drugs, nothing for hearing aids or glasses or contraception. Where's the logic there?

As a result, we have the least universal health-care system in the world. Ponder that for a second. The least universal health-care system in the world. Not something to be proud of. Medicare does cover everyone, but it covers everyone inadequately. Stated simply, what's wrong with Canadian health care today is that we're trying to deliver 21st-century care with a 1950s model of delivery and funding. We have an Edsel, but we need a Tesla. And my point here is that we need modernization.

So how do we drag medicare kicking and screaming into the 21st century? Again, that's something I've been writing about for a long time, decades. And my message remains devilishly simple. The problems we have are systemic. Therefore, let's fix the system. Since the advent of medicare, there have been at least 150 high-level government-sponsored reports written about the need to reform medicare. Every one of those reports features a long list of recommendations — most of which, unfortunately, have not been acted upon.   

The principal problem we have is not the lack of solutions. It's a lack of implementation. We don't have a health-care crisis in Canada. We have an implementation crisis. We have a lack of openness to change in this country. We again don't have an absence of solutions, but a lack of courage to implement them....

So here's my pithy recipe for successful health-care reform. Let's start by scaling up our successes and stop perpetuating our failures. Every problem we have in Canadian health care is structural and administrative in nature. Not a problem of technology, not a problem of medicine, and not a lack of money. It's an attitude problem. 
 

*Transcript was edited for clarity and length. This episode was produced by Mary Lynk.