Health reform can’t wait. Here’s where to start

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Every Canadian should have ready access to a primary-care provider within a 30-minute drive of where they live or work. Politicians need to focus on measuring and improving health outcomes for citizens, not just increasing their health budgets. And there needs to be a recognition that failing to fix health care will compromise the country’s economy and future prosperity.

Those are some of the bold foundational commitments to reform that are imperative if we hope to pull Canada’s foundering medicare system back from the brink, according to a blue-ribbon panel.

In a new 20-page report from the Public Policy Forum (an independent think tank), entitled Taking Back Health Care: How To Accelerate People-Centred Care Now, some of the country’s top health leaders warn that widespread reform can’t wait any longer. The group of authors includes both fierce defenders of medicare and business leaders, and they all agree that we need to tone down the public-private rhetoric that so often stifles debate and reform initiatives.

They also correctly insist that health care reforms don’t have to come all at once; there’s no need to wait for a “grand bargain that all governments bless at the same time.” But change, they say, should be rooted in strong principles, and not happen willy-nilly.

The expert panel convened for the report includes Dr. Jane Philpott, a former federal health minister; Alika Lafontaine, president of the Canadian Medical Association; Danielle Martin, a health care administrator and founder of Canadian Doctors for Medicare; David MacNaughton, a former Canadian ambassador to the U.S. who now heads data software company Palantir Technologies; Vivek Goel, president of the University of Waterloo and the founding president of Public Health Ontario; Georgina Black, managing partner of government, health and life sciences at Deloitte Canada; Victoria Lee, president and chief executive officer of Fraser Health; Robert Bell, former Ontario deputy minister of health; and Jodi Butts, a senior consultant at Watson Advisors Inc.

The panel argues that fixing health care must start at the foundation, with primary care. That means that every Canadian must have access to publicly funded care, just as every child has access to a publicly funded education. That care should also be provided by interdisciplinary teams, not just solo family physicians, and there should be more choice in how patients obtain care, including nurse-led clinics and virtual-care platforms.

The expert panel also makes a strong plea for patients to have unfettered access to their health data, because it empowers them and results in better care: “It is unrealistic, even unconscionable in this day and age, to deny or limit access for people to their data if we truly believe in a health system centred on the person, not the provider.”

The report stresses that individual Canadians must take back control of the health system, and that it belongs to all of us. “Governments and policy-makers do not own the health care system; they are entrusted with its stewardship,” the committee members write, adding that health care reform must empower the system’s “true owners.” But they are vague on how citizens can flex their muscles or light a fire under politicians and lobby groups.

However, the report does zero in on two issues at the heart of negotiations around a new health accord: the better use of data to improve the delivery of care, and the national licensure of health professionals such as physicians and nurses. The panel rightly points out that politicians need to come up with a blueprint for action, a “quality plan” – not just make endless demands for more money. “Tolerance for (and indifference toward) endless discussion and disagreement has run out,” they write.

The panel also calls for a “relentless commitment to innovation spread and scale,” with particular emphasis on bolstering and sharing all the successful initiatives that are under way across the country. They also recognize that we need to clearly articulate what’s covered by medicare and what isn’t – that there is, indeed, a role for the private provision of health services, as long as it’s well-regulated and doesn’t compromise the quality of care in the public system.

Most importantly, the report also emphasizes an oft-forgotten point in this public-private debate: that health spending is an investment, not just a cost, and one that serves us well. “If we don’t address this crisis in our health system, we will compromise our economy and future prosperity,” they conclude.

And at a time when Canadians are feeling increasingly disenchanted and disenfranchised about the state of the health system, ambition, purpose and urgency are required to fix it.