Canadian medicare is suffering from long-standing problems that can only be fixed through long-term reforms. It’s also facing an immediate crisis – been to an emergency room lately? – that has to be tackled immediately.
This pair of challenges eating away at our health care system are distinct, yet linked. To have a tomorrow, medicare needs breathing room now.
The birth of medicare – 60 years ago this summer – happened under similar circumstances. The NDP government of Saskatchewan had a long-term plan to overhaul health care, starting with the introduction of the country’s first system of universal health insurance.
But before Saskatchewan could get started, it had to overcome an immediate obstacle: On July 1, 1962, the day the Saskatchewan Medical Care Insurance Act came into force, the province was suffering from an acute shortage of doctors.
Many of the province’s physicians had greeted the arrival of medicare by going on strike. It was unprecedented – and Saskatchewan responded by also doing the unprecedented. It brought in doctors from Britain, the United States and across Canada. Before the month was out, the strike was over, leaving the road open for those long-term plans for universal health insurance to go into effect.
The situation today is not exactly the same, but there are echoes.
In the long run, medicare has to be redesigned – to get better results and deliver better service – without ending universality, or creating a two-tier system where the size of your wallet determines your place in the queue. We largely know what to do. The blueprints have been around for decades.
But before we can get to reimagining the future, the present crisis has to be overcome. It’s a crisis of staffing, and much of it has to do with a shortage of nurses.
Last weekend, 25 hospitals in Ontario temporarily closed parts of their operations – things like ERs, or intensive-care bed or even entire units – owing to staff shortages, according to the Ontario Nurses Association.
Two weeks ago, Toronto’s University Health Network – a multicampus operation with nearly 18,000 employees – had to call on nursing students and medical residents to keep one of its two ERs running.
UHN’s largest hospital, Toronto General – Newsweek recently ranked it the 4th best hospital on the planet – said this week that its ICUs are “at capacity.” Next door, the Hospital for Sick Children issued a notice that, owing to a lack of personnel, staff from other areas might have to be reassigned to the pediatric ICU.
Health care is like a car engine: every part depends on every other part. If one piece goes missing, the whole machine can come to a halt. So even if operating theatres and surgeons and beds are available, without enough trained nurses, surgeries aren’t happening.
The Ontario Hospital Association said in March that 9 per cent of positions at hospitals are unfilled, including 13 per cent of registered nurse positions.
The more understaffed the system becomes, the more it burns people out; the greater the burnout, the greater the staffing shortages – leading in turn to escalating demands on those who remain, and more burnout. It’s a vicious circle, made all the worse by more than two years of hospitals overtaxed by COVID-19, and by the fact that a future of continuing COVID means that the small but meaningful share of staff calling in sick could, for some time, be consistently higher than in the pre-pandemic era.
To stabilize things, so we can move on to tackling those big, system-wide reforms, governments have to start acting like today’s crisis is a Code Blue – the hospital term for a patient critically ill with something like a heart attack, necessitating immediate deployment of a rapid-response team to prevent death.
Provinces need to find thousands of fully trained nurses, and not in 2024. Now. There’s a world of nurses out there, not to mention foreign-educated nurses in Canada awaiting accreditation. We need to blow up the rules so people who are fully trained and experienced can come to Canada, quickly, and start working, immediately.
Ottawa and the provinces have to use some common sense, and cut through the paperwork. It’s a crisis. Stop responding at the speed of bureaucracy.
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