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Dr. Hamza Khan and OR nurses prepare for cataract eye surgery at the Royal Jubilee Hospital in Victoria on July 14, 2009. (JOHN LEHMANN/John Lehmann/The Globe and Mail)
Dr. Hamza Khan and OR nurses prepare for cataract eye surgery at the Royal Jubilee Hospital in Victoria on July 14, 2009. (JOHN LEHMANN/John Lehmann/The Globe and Mail)

Robert Silver

Where are Canada's health-care reforms? Add to ...

"It is important to remember that health costs are increasing at a rate faster than general government revenue. Should current trends continue, future health expenditures will exceed available resources by a significant and substantial amount. The historical practice of increasing health expenditures at the expense of other important public services is not a feasible, practical or advisable approach." - Roy Romanow, Commission on the Future of Healthcare

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It's been great seeing Ujjal Dosanjh on CNN the last few days extolling the virtues of the Canadian health-care system. He has come across as passionate but reasoned while explaining to a mainly U.S.-based audience the benefits of a universal, publicly funded health-care system and countering many of the myths being propagated by Republican opponents to President Barack Obama's health-care reforms.

Not to be outdone, Jack Layton is scheduled to appear on MSNBC today to talk about the Canadian system. I have no doubt the moustachioed one will be just as passionate in defending medicare.

We should take some pride that the Canadian health-care model is playing an important, if cartoon-like role in the U.S. debate over the future of their health system.

There's only one small problem, actually maybe two:

1. The status-quo of the Canadian health-care system is completely unsustainable; and

2. Rather than having a debate in Canada about how to fix our health-care system (since the "generational fix" of five-years ago didn't quite get us there), we are off bragging about the unsustainable status-quo to other countries, convincing them we have the magic answer to health care.

There is of course some reason to brag about our health-care system. It has largely served our country well. For my entire lifetime, our system, while far from perfect, has been part of our country's identity (and to be clear, there is no such thing as a perfect health-care system, every jurisdiction is struggling at all times with how to allocate scarce resources to meet insatiable demands).

So while I am a big defender of aspects of our health system, there is nothing magical about it. At least not anymore.

So why do I say the status-quo in Canada is unsustainable?

Because we are quickly hitting a point where either provinces can help educate our children, fix our roads and help our poor or they can maintain the status-quo in health-care provision.

The math is staggering; health-care has gone from about 7 per cent of program spending at the provincial level in the 1970s to an average just under 40 per cent today. It will pass 50 per cent in every province and territory within a few years.

Needless to say, this is unsustainable. The math just doesn't work at a certain point - you can't do everything other than health care that provinces are responsible for on 50 cents of every program dollar. Or at least you can't do it and provide the quality of services and infrastructure Canadians have (rightly) come to expect.

Yes, we can muddle along for another year, maybe five. Every year health-care costs will continue to grow faster than revenue. Every year, crowding out other investments that boost our productivity and prosperity.

There are lots of ways to tackle this issue; some of them are more radical than others. And no, not all of them - or even many of them - lead us to an "American-style health-care system," which for my entire life has been the slur to shut down any and all debate on health-care reform. And to be fair, almost every jurisdiction in the world is struggling with mounting health-care costs so we are far from unique in this challenge, though our rather unique system does provide some unique challenges as part of the larger issue.

I guess the question is what happens if Obama's health-care reforms succeed and an "American-style health-care system" means something very different than what we are used to? Do we then get to have a fulsome health-care debate of our own?

 

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