Canada's health-care system is not financially sustainable. We face a crisis if efforts are not made to avert disaster.
Health-care costs are exploding, increasing by 5 per cent to 7 per cent annually. Yet, GDP and tax revenue - which finance health care - are growing much more slowly.
At this rate, health care will make up 80 per cent of total program spending in Ontario by 2030, leaving all other programs to be funded from the remaining 20 per cent. That is clearly not feasible. This same trend can be seen across all the provinces and territories.
The need for a frank discussion on our health-care future must no longer be avoided.
What are some of the ideas we could be discussing? Here are a few: We need to deliver more services outside hospitals in specialty clinics, whether these are publicly or privately operated. We must accelerate the rate of primary care reform. We need to create more long-term care beds to stop tying up acute care beds with people who do not need acute care services.
Provinces should be encouraged to experiment and not be shackled by outdated principles. For instance, with an increasingly aging population, we need incentives for families to provide home care for elderly relatives, easing the burden on long-care institutions.
Adoption of electronic communications services, including electronic health records, needs to be drastically accelerated. Our health-care system lags two decades behind other sectors in use of digital technology.
And our licensing procedure and rules around scope of practice need to become more flexible and reflect modern reality.
These are important ideas that must be implemented; even then, we will not have solved health care's financial crisis.
We believe Canadians can accept the fact that either health-care services must be reduced or revenues to the system must be increased. There are no other ways to close the gap.
Canadians will not want to reduce services. Indeed, there is a compelling argument that services should be increased to at least include prescription drugs. So the question is: How do we get new money into the health-care system?
Either Canadians can pay increased income or sales taxes to the government, which would then put the money into health care, or they could contribute an income-based tax or levy directly to the health-care system.
For example, Canada could return to the days when users co-paid the premium for their insurance coverage, again subject to an income test. Even Tommy Douglas argued that "there is [a psychological]value in having every individual make some individual contribution [to health-care costs]rdquo; and that "even if we could finance [medicare]without a per capita tax, I personally would advise against it."
Whatever change is made, it must meet the two key principles of health care that Canadians cherish: that everyone is covered, and that no one will suffer undue financial hardship as a result of becoming sick. Canadians treasure their health-care insurance, which ensures that no one will have to cough up cash at the point of service.
Every developed Western European country has a health-care system that preserves these fundamental principles, yet each funds its system in a slightly different way.
Unfortunately, intelligent debate about what should be done has basically ground to a halt by incendiary claims that any attempt to update the system amounts to treason - a repudiation of sacred Canadian values. Critics have been able to score cheap and easy points by accusing governments of intending to destroy universal health care should any change to the system be discussed.
We must move beyond this impasse and have a national adult discussion that will allow us to arrive at a common goal: finding new ways to increase funding to our system while preserving the fundamental principles Canadians cherish.
In 2014, Canada's current accord with the provinces will expire. In designing a new agreement, we have an opportunity to create an improved, yet financially sustainable, health-care system to serve the next generation. We need to engage in serious debate now.
We both have had some experience with the challenges and complexities of negotiating national agreements with the provinces that affect all Canadians. We feel that, because the politics of leading change will be virtually impossible for any government (partisanship being what it is), Ottawa needs to recruit a task force of experienced public- and private-sector people to develop a plan for putting health care on a stable, long-term, financial footing.
Canada has the resources required to update its system for the 21st century; all that is required is the will of the nation to do so.
Michael Kirby, a former Liberal senator, is chair of the Mental Health Commission of Canada. Brian Mulroney, Canada's 18th prime minister, is a senior partner at Ogilvy Renault LLP.