The fundamental mission of Canadian medicare is to ensure no one is denied essential care, regardless of ability to pay – but it is increasingly failing to achieve that goal.
That is the blunt message from the president-elect of the Canadian Medical Association.
"There are real inequalities around the country," Anna Reid said in an interview.
The source of that inequality is two-fold, she said: 1) "Our public system is covering just part of what needs to be covered," and; 2) health services provided increasingly are varying both among and within provinces/territories.
Dr. Reid, an emergency room physician at Stanton Territorial Hospital in Yellowknife, said it is no longer sufficient for medicare to cover only physician and hospital care, because prescription drugs, home care and long-term care are often essential.
It is also troubling that there is a growing gap between the services available in urban and rural parts of Canada, and between wealthier and poorer jurisdictions, she said.
Dr. Reid said these problems have been exacerbated by Ottawa's failure to enforce the Canada Health Act, its reluctance to promote a national system, and the new way of allocating money under the Canada Health Transfer.
"Physicians, like most Canadians, would like the federal government to play a bigger role in how health care is delivered. We need them to show some leadership," she said, adding that Ottawa's role should not simply be providing money, but promoting equality.
She also stressed that doctors are realists, and recognize that there are financial limitations to funding medicare.
"We very much need to have a public debate about the things that are covered and those that are not covered," she said.
But, for the essentials, fair access is key.
"We need equitable distribution of health care resources and services so that – within reasonable restrictions such as geography and population [density] – everyone has equal access to important health-care services," Dr. Reid said.
Beyond pushing for universal access to essential medical care, she said she will use the CMA presidency to raise awareness about the role of the socio-economic determinants of health, and the need to focus on marginalized groups like aboriginal people, those with mental illness and the isolated elderly.
"That's a huge passion of mine," she said. "I see the impact of social determinants every day in my work."
A large proportion of her patients are aboriginal people, a demographic group that has rates of alcohol abuse, violence and trauma that are much higher than in the general population.
Dr. Reid completed her medical degree at the University of Ottawa, then did a family medicine residency through the University of British Columbia.
She said she got involved in advocacy – as president of the Northwest Territories Medical Association and now the Canadian Medical Association – in hopes of changing the system more fundamentally and giving voice to the voiceless.
"I want to advocate for the marginalized."
She recognizes, however, that the term is just one year, so her impact will be limited. But Dr. Reid said she is part of a continuum of medical leaders and is proud the CMA is tackling a complex issue like social determinants of health. Despite the challenges from the local to national level, she remains an optimist. "In my work, I see people who have overcome incredibly difficult circumstances – residential school survivors with terrible scars. It's inspirational.
"Their success, their hopefulness, keep me going. I wouldn't be doing this job if I was cynical."
The Canadian Medical Association represents the country's 76,000 physicians, residents and medical students. Dr. Reid is the first president from the Northwest Territories, and only the sixth woman to take the helm in the group's 145 year history. She is also the first openly gay CMA president.
"Being a woman has never stood in the way of my doing anything and neither has being lesbian," she said.