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A healthcare worker is shown outside a hospital in Montreal, on July 14.Graham Hughes/The Canadian Press

This Liberal government must introduce a national dental-care program before year’s end as part of its confidence-and-supply agreement with the NDP. But how can we expand the public health care system when the existing system is collapsing?

That question is vital to your well-being, which is why the time has come for a once-in-a-generation accord between the federal and provincial governments on rescuing and restoring health care.

“You see the potential for a grand bargain here,” says Steven Staples, policy director at the Canadian Health Coalition. He believes that the crisis in health care, and the coalition in all but name between the Liberals and New Democrats, offers the possibility of renewal.

“There is a real opportunity to expand health care in a way that has not been done in quite a while,” he said in an interview.

One thing should be clear to everyone by now: the status quo is not sustainable.

“The health care system is collapsing on many levels,” Katharine Smart, president of the Canadian Medical Association, told me. “I worry that the crisis in front of us is escalating, not getting better.”

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Fire alarms sound daily now, with emergency departments forced to close temporarily across the country, waiting times growing for key procedures and almost 15 per cent of Canadians without a family doctor.

But the NDP insists that expanding medicare to include dental care is both affordable and necessary.

“This is a long-standing, serious gap in our health care system,” health critic Don Davies said.

It is true that the $1.7-billion annual cost of covering the dental needs of low-income Canadians would represent only a modest increase in health care costs, which currently eat up more than $300-billion, or 13 per cent of gross domestic product. The real problem lies with primary, acute and long-term care, all of which are failing.

The premiers blame underfunding by the federal government. The federal government insists that any increase in funding must be tied to outcomes that provinces agree to meet.

This infuriates the premiers. “The federal government is not a superior order of government, it’s not a better order of government, it’s an equal order of government,” B.C. Premier John Horgan said. “We’ll take no lessons from the federal government in fiscal probity.”

But the premiers undercut their own case. Ontario Progressive Conservative Premier Doug Ford won re-election in June in part by cutting the gas tax.

Quebec Premier François Legault is promising to cut income taxes if the Coalition Avenir Québec is re-elected this fall. How can premiers demand increased federal funding while cutting provincial taxes?

We do need a dental-care program, especially for children. We need to invest in home care, which would free up hospital beds and ease the strains on emergency wards. We need to increase the supply of doctors and nurses by fast-tracking licensing for those who are internationally trained. We need physicians in group practices and digital records and stand-alone clinics for common surgical procedures, and more telehealth and, and …

“We’ve been talking about this for a long time,” Dr. Smart said, “and the issue is, none of that has happened.” But we are at a tipping point, she believes. “The status quo is failing drastically, and it’s only getting worse, not better.”

The unnecessary crisis in Canadian health care: We know what needs to be done, but not how to do it

We can patch up the system with this federal grant for that provincial program. Or we strike a new grand bargain. That doesn’t mean Ottawa dictating to the provinces. Ottawa can’t even issue passports; it shouldn’t be allowed anywhere near an emergency ward.

But all levels of government should support a provincial-federal agreement that describes exactly what the health care system should look like over the next 25 years, and how it should be funded. This writer believes the system should embrace maximum flexibility, including increased private-sector delivery of publicly funded care. Not everyone agrees.

Forget those sterile arguments over tax points and accountability mechanisms. None of that matters now. What matters is properly funding a system that delivers care in the most efficient way possible, with all levels of government doing their share.

Or we can carry on with the same old, same old. And if you suddenly need a doctor, good luck with that.

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