On Tuesday, 13 premiers and one Prime Minister met in a boardroom somewhere in Ottawa, and the Prime Minister plunked a metaphorical bag of money in the centre of the table. Once the sack of cash and any half-hearted strings dangling from it were laid out, the political leaders all swanned off to the microphones to thump their chests about fighting the good fight for their citizens.
Much will be said and written about who will try to extract what from whom, and what it means for the various turf wars that would have been packed invisibly into that meeting room around the 14 of them.
And then on Wednesday, an ordinary person will spend the entire day sitting in a walk-in clinic waiting room, sharing their germs and their misery with all the other people sardined into the cheap vinyl chairs around them, because none of them have a family doctor either.
On Thursday, someone else will peer down the basement stairs and decide it’s not worth the risk to go put the laundry in, so they’ll limp back to the couch on their bad hip and wonder when the hospital might call.
Yet another person will spend all of Friday night in the emergency department because there is only one doctor on duty, and the queue will get longer and longer with children sicker than their own, until finally the sun comes up and the day shift starts.
On and on it will go for the rest of the week and beyond: A million little vignettes of frustration, pain and desperation, an entirely predictable and predicted parade of failure.
The health care debate often ends up centring on naked politics and the incomprehensible amounts of money at play, somehow making the whole issue seem both technocratic and vaguely greasy. But health care is as personal and high-stakes as public policy can possibly get. It long ago rocketed past being a top-of-mind polling concern to reach full crisis status, for both the country at large and in the lives of individual Canadians.
Some people believe you have to hit rock bottom before you can truly commit to difficult change. When the federal Health Minister, Jean-Yves Duclos, says flatly that the system “doesn’t work any more” in the very same week that 3,000 people bombard a strip-mall medical clinic with e-mails and calls after it says it’s accepting new patients, surely Canada has burrowed down to bedrock.
British Columbia Premier David Eby’s wife, Cailey Lynch, is a family doctor. It’s a fact that’s widely known in his province, and often he can sense people blowing past the pleasantries of meeting the Premier to ask for what they really want.
“Everywhere we go: ‘Is your wife taking new patients?’” Mr. Eby said. “Wherever I go: ‘Nice to meet you. Is your wife taking new patients?’”
Speaking to The Globe’s editorial board a few days before he and his counterparts met with Prime Minister Justin Trudeau in Ottawa, the NDP Premier waved off the idea that anyone back home would care even a little bit about federal-provincial wrangling.
“Fix the hospital!” he said, by way of summing up the extent of what the public cares about. “Work with the federal government, fix the hospital.”
Canadians have earned the right to adopt exactly that sort of blinkered toddler obstinance with their leaders. It’s the only way the political will for true reform can rouse and sustain itself.
The money the federal government put on the table on Tuesday – $46.2-billion in new funding over 10 years – is significantly less than the premiers had demanded, and is conditional on the provinces and territories improving how health care information is collected, shared and reported.
Alika Lafontaine, president of the Canadian Medical Association and an anesthesiologist in Grande Prairie, Alta., believes most Canadians would be surprised by how little information is available to shape patient care.
“It’s amazing that Facebook can send me an advertisement for what my eight-year-old wants for his birthday, and be fairly close,” Dr. Lafontaine says. “But the health care system doesn’t know the type of anesthetic that I can provide.”
One of the big changes Dr. Lafontaine advocates is pan-Canadian licensure of physicians. That would mean that when he travels to visit his mom in Regina, for example, he could pick up a few shifts without having to go to the hassle and expense of being licensed in a different province.
But the specific bottlenecks vary across the country, and without better data, it would be difficult to move personnel and resources around effectively, he says. “That’s the only way for you to get more production out of a limited human resource while we try to train and recruit more folks,” he says.
Sarah McMullen is an internist and intensivist at Dalhousie University, and she practises critical care with the Nova Scotia Health Authority. The single biggest issue from her vantage point is a shortage of nurses. That causes a cascade of other problems: Hospitals close ICU beds if they don’t have the staff, which forces them to care for critically ill patients in other departments, and that leads to cancelled surgeries if the post-op beds are full of people who should be in the ICU.
“In a dream world, I would say we’d have enough nurses and front-line health care workers to staff the beds that we need to staff, we’d have a national licensing system for physicians, and we’d have a national electronic health record,” Dr. McMullen says.
It’s worth backing up a step to consider that such a modest list of requests constitutes a fantasy scenario on the front lines of our health care system at the moment.
The only way it gets better is if Canadians keep reminding those 14 people in that boardroom – loudly – of the millions outside it, slumped in cheap vinyl chairs for endless hours, hobbling back to their couches, waiting for something better.