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Canadians are losing hope in their beloved medicare system.

They see access to care, from emergency rooms to primary care to surgery, deteriorating, and have little confidence that the problems will be fixed in the years to come.

That’s the clear message that emerges from polling done by the Angus Reid Institute and presented at the Canadian Medical Association’s recent health summit.

“The system is crumbling,” said Shachi Kurl, president of the Angus Reid Institute, when bluntly summarizing how Canadians perceive the current state of affairs.

There are two key data points that deliver that message:

First, only 26 per cent of poll respondents deemed the health system to be in excellent or very good condition; that’s down sharply from 48 per cent in 2015. And second, 68 per cent of those surveyed believe health care has worsened in the past decade; again, that’s a markedly more pessimistic viewpoint than in 2015, when it was 42 per cent.

(The online survey, conducted from Aug. 1 through 8, included 5,010 adults who are members of Angus Reid Forum. The results are considered accurate within one percentage point, 19 times out of 20.)

The key concern is access or, more precisely, lack of timely access to care.

Almost half of Canadians say they can’t access a family doctor or other primary care practitioner when they need it. That includes 19 per cent who say they don’t have a doctor and another 29 per cent who say they have a doctor (in theory) but can’t get an appointment when needed.

Those without timely access to primary care turn to hospital emergency rooms for care. But many ERs are overwhelmed. They have long waits and, increasingly, are closing, temporarily or permanently, usually owing to a lack of staff.

And, of course, all these problems accessing primary care delay getting further treatment, from diagnostic tests through to surgery. The sick suffer unduly from this cruel domino effect.

Asked what their top priorities were for fixing the system, those polled said, unsurprisingly: Ensuring ERs are adequately staffed; improving how quickly patients are treated; reducing burnout and stress on health care workers; reducing the waits for family doctor appointments, and reducing surgical wait times.

But there isn’t a lot of optimism that will happen. The Angus Reid survey found that 68 per cent of Canadians are doubtful that the system will improve in the next two years, and 56 per cent carry that pessimism through to five years.

Those surveyed also reveal a fair bit of sophistication in their analysis. Generally, they aren’t convinced that more money is the solution; rather, they see the problems as systemic, and the fixes long term.

The public is also pretty clear on who is to blame for the crumbling health system: politicians.

Only 30 per cent of those surveyed are satisfied with the performance of governments, federal or provincial. That is down sharply from 45 per cent back in 2015. (Satisfaction rates vary between provinces, from a low of 18 per cent in New Brunswick to a high of 37 per cent in Quebec.)

But are politicians getting the message that people are fed up with perpetual foot-dragging and mediocrity?

Mark Holland, the new federal Health Minister, made his first major public appearance at the CMA Health Summit and, if nothing else, he said all the right things.

To wit: “Canadians are done with turf, with politics, and with excuses. They want to see results,” he told the audience of health leaders.

Mr. Holland also acknowledged that perception matters: “It’s essential that people feel improvement.”

In the new health funding deals Ottawa has negotiated with the provinces, it has placed a lot of emphasis on data collection and standardized metrics that will allow the measurement of improvements (or lack thereof).

That’s important, but more important is actually committing to structural change, especially a bolstering of primary care, from ensuring every Canadian has a family doctor or nurse practitioner overseeing their care, to ensuring that ERs are actually available to provide emergency care.

It’s essential that we restore some hope in medicare, a cornerstone public policy in this country. That requires bold action.

As the federal Health Minister said: “We need to engage in transformative change on a scale that’s never happened before.”

And it’s not enough to just say it – we have to do it.

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