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The Globe and Mail

When even Dr. Optimism is losing faith in medicare, it's time to fix it

"We have seen a slow and steady decline in what we would all now agree is a deeply troubled health-care system. To be clear, this pillar of Canadian society is eroding. … We are losing something of great value. It's slipping away slowly, incrementally."

This kind of rhetoric is so commonplace that we have become largely inured to it. At first blush, it's another medicare-is-doomed pronouncement like we've heard seemingly every day for the past half-century or so.

But pay attention.

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Those mournful words were spoken by Dr. Jeff Turnbull, the outgoing president of the Canadian Medical Association, in his valedictory address on Tuesday.

Dr. Turnbull is one of the most unwaveringly hopeful and positive people in medicine. He knows the health system inside out, and from the bottom up. He cheerfully treats poor, homeless addicts as part of Ottawa's Inner City Health project. He is equally upbeat as chief of staff at the Ottawa Hospital, a thankless position. He affably heads the CMA, which speaks and lobbies on behalf of the single most powerful and prickly group in the health system, physicians.

If Dr. Turnbull is losing faith in medicare, we need to prick up our ears – and roll up our sleeves and fix it. When he expresses his frustration, it is not rhetoric. He backs his feelings with cold, hard facts and incisive anecdotes.

"I've always been immensely proud of our health-care system – one that was once considered to be one of the best in the world," he told CMA delegates. "But times have changed and Canada now ranks below Slovenia in terms of effectiveness and last or second last in terms of value for money."


Equally scathing is his summary of the frustrations he has heard expressed by patients in his travels coast to coast. "They've told us they're suffering because of a lack of access to timely, effective care, confused by a system that is limited in the services it provides, that is cumbersome and almost too complex to navigate, and angered by a system that fails to put their needs first or even engage them about their health issues."

That takes care of the international comparisons and shortcomings in care delivery. What about administration of the $192-billion-a-year health system?

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"I've been struck by the lack of leadership, co-ordinated management, accountability and responsibility and, yes, needless waste. … Worse, we allow staggering inefficiency, ineffective management processes, incoherent decision-making and practice variations that undermine quality and safety," Dr. Turnbull said.

Despite it all, he remains optimistic. "I do believe this can be changed ... that we can create a better health-care system in the future."

Dr. Turnbull has a diagnosis and a prescription.

It begins with getting back to basics. Medicare – and other social programs – were created to address social inequities, to make good health achievable and affordable for all. Yet, today in Canada there is "devastating and epidemic health inequity" – and it has become a major driver of health costs.

One way to address inequality in health-care delivery is to ensure all Canadians have access to a basic level of prescription-drug coverage, a "glaring failure" of medicare, Dr. Turnbull said. Similarly, there needs to be a massive shift in approach (and resources): From the 1950s-style illness-care system we have now to a 21st-century health system that emphasizes chronic care and prevention.

Dr. Turnbull, in his time as CMA president, has championed this transformation. The blueprint is a document entitled "Health Care Transformation in Canada: Change that Works, Care that Lasts." It's by no means perfect, but it's a start.

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It does not merely advocate shoring up the system that is eroding but rebuilding it from the ground up – all the while keeping the foundation, the public insurance model.

As Dr. Turnbull told his CMA colleagues: "Leadership demands vision to see the path before us, the courage to take it and the strength to follow it."

Not just hope, not just words, but purposeful actions.

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