Meddling, thin-skinned and secretive are not traits you would normally look for in people entrusted with caring for a national treasure. But those are the characteristics we see expressed, over and over again, by politicians and governments overseeing medicare, Canada's publicly funded health system.
The most recent example is the firing of Eilish Cleary, New Brunswick's chief medical officer. We don't know exactly why she was sacked, but we do know Dr. Cleary didn't shy away from studying controversial issues, such as the health effects of the herbicide glyphosate and of fracking (a way of extracting shale gas).
For now, the provincial government is hiding behind the well-worn "personnel matters are private" excuse while, at the same time, insisting the firing was "not politically motivated" and not related to Dr. Cleary's "medical and scientific work" – which, naturally enough, has everyone convinced it was politically motivated.
Canada, sadly, has a long tradition of muzzling public-health officials, from the 2002 firing of Alberta medical officer of health David Swann for expressing concern about the health effects of burning fossil fuels, through to former Toronto mayor Rob Ford berating David McKeown, the city's chief medical officer of health, for suggesting the speed limit in the city should be reduced to lower the risks of injury and death among pedestrians.
One of the essential roles of public-health officials is to speak health-care truths to people in power. They should not be there to do the bidding of business, or pay any heed to the partisan views of the governing party.
Any government that does not see the value of an independent watchdog, and an independent civil service more broadly, is foolishly self-centred and shortsighted.
Muzzling public employees – something that Stephen Harper's government raised to an art form, but is current practice in many provinces – is only part of the problem. Equally concerning is the tendency of governments to micromanage, particularly in the administration of the health system.
The most glaring example of meddlesome interference comes from Alberta, where the province has been fiddling non-stop with the structure of the system for almost a decade, moving from a policy of centralization to regionalization and back again.
In the process, Alberta Health Services, the supposedly independent agency that oversees the provincial health system, has seen seven chief executive officers come and go in seven years. The most recent AHS boss, Vickie Kaminski, left for "personal reasons," but there is no doubt she was irked by the lack of independence. During her tenure, the AHS signed a $3-billion contract to centralize lab services and one of the first acts of the new NDP government was to cancel that contract.
No business – or government-funded program – can flourish in a circus-like atmosphere such as that one, where every decision is second-guessed. These machinations leave employees dispirited; they also distract resources and energy from where it belongs – on the quality of care.
All told, Ottawa, the provinces and territories spend about $6.5-billion a year on the administration of the health system – and that is just the cost of running ministries of health and regional health authorities, not the administration within hospitals and other programs.
The role of government and ministers of health should be to establish a vision, a philosophy. Big-picture stuff.
The actual administration of the health system should be left to skilled managers, with clear lines of authority, goals and expectations. They should be encouraged to innovate and feel free to fail – just like managers in the private sector.
What we have instead in Canadian health care is a system where managers ultimately have little or no authority and, as a result, there is no real accountability.
What dominates, then, is a don't-rock-the-boat bunker mentality, where the status quo reigns, and political operatives from the premiers' and prime minister's offices are constantly poking their sticky little fingers into the gears of daily operations to partisan ends.
Not exactly a model of good governance. It is no surprise, then, that we get the results we do: long waits, mediocre outcomes and high costs. One of the distinguishing features of the European and Nordic countries that do much better than Canada is they have strong, respected bureaucracies.
For an efficient, cost-effective health system, you need to begin with the basics: transparent, accountable administration, with independent watchdogs keeping it honest.