Canada’s health care system has been called many things including a “jewel” and “the very essence of what Canada is all about”. It has also been called “sclerotic”, “archaic” and for politicians it has become “a sacred cow”. For many Canadians, our health care system has become a mirage. Aside from the illusory notion that our health care is “free”, many cannot explain how it works and how it is financially sustained. Many cannot access the care they need.
However, this mirage is going to be drawn into clear focus in the weeks and months ahead as the B.C. Court is hearing a case put forward by surgeons and patients that accuse the B.C. government of denying them their rights to timely medical care.
Perhaps the B.C. case will allow Canadians to begin the necessary discussions about how our health care must change to address the serious systemic shortfalls within it. We have a strained health care system due to an increasingly aging population, more pharmaceutical options, more medical technology with associated potential interventions, and emerging science that requires more medical research and money.
For people waiting for care, or denied care, or whose disease is treatable elsewhere but not here, the limitations of our current system have become numbingly clear. We should walk a mile in patients’ shoes to understand the importance of the B.C. Charter Challenge for those who have been denied timely care. While the outcome of the case is important at an individual level, it will also resonate at a societal level – throughout our country.
Some people choose to frame the case as a “private vs public” health care battle and foresee the destruction of Medicare if B.C.’s provincial health care service loses the case. However, at a foundational level, the case is a challenge about the rights of Canadian patients in a system that denies timely care. What rights does a patient have? What recourse should a patient have? What suffering can the government health insurance plan fairly impose on an individual patient, if any? (In a country that has recently witnessed the Supreme Court of Canada rule in favour of an individual’s right to die, one might expect that it would also rule in favour of an individual’s right to live.)
Now is the time to ask the difficult questions about what we want from our health care system that was designed for another era and which, despite transformation, is a laggard in the developed world. Many of us who have been part of the on-going debate about patients’ rights and the short-comings of the system recognize that we can and must preserve what is fair and equitable about Canada’s health care system and move forward to improve what is not.
There are some important questions that must be fully discussed.
Must we pit patient against the system? What is more important, the patient or the system? Can we not all agree the system must exist for patients? So, the question then becomes “How to provide more care to more patients?” In that context, how is it ethical to preserve a system that cannot meet patient demand despite almost fifty years of trying?
How comprehensive a system can we afford? Do Canadians want modern health care that keeps up with change, or do they want an archaic system designed for fifty years ago? As pharmaceuticals become more and more prominent in treatment options, many Canadians want to include pharmacare in our country. However, the cost of Canada’s government funded system makes it difficult to move forward in publicly funding other areas of care such as eye care, dental care, and newer pharmaceuticals for cancer and other previously untreatable diseases. How can a better balance of services be achieved that will meet our expectations for an advanced health care system?
There’s the important issue of “Universality”. Do Canadians want universal health care coverage in theory or in reality? The term “universal” does not mean “government funded”. It simply means coverage for everyone. There are many ways to provide coverage for everyone in a truly universal system that creates access instead of imposed rationing. Many other countries have hybrid systems for medically necessary care and manage to achieve universality at lower cost and with better outcomes. Why aren’t we looking at and learning from other better performing systems? And, what of portability of care in Canada? Do Canadians want a system that provides similar services across the country, or do they want the system to be determined simply by the degree of rationing required in each province?
What is to be done about the under-utilized infrastructure and medical workforce? What do Canadians want, more government rationing of care or more ways for more patients to access care? Canada has less than the average number of physicians per capita compared to many developed countries yet we cannot fully employ our medical workforce due to costs associated with utilization of government funded services. Operating rooms and surgeons sit idle, hospital beds may exist but are “unfunded”. Hybrid systems of other developed countries have more providers, more hospital beds, and better access to medically necessary care at lower cost than Canada’s health care system.
Canadians must have this honest and difficult discussion about our health care system if we are to create a truly universal system with quality health care that addresses patient need. I believe the B.C. Charter Challenge will help in this dialogue. Contrary to rhetoric about the case being an attack on Medicare, it is not. Given the history of our country, Medicare will continue, but we must acknowledge its faults. A more robust health care system is needed, one that is truly universal, comprehensive, and accessible and not so negatively impacted by government short comings both in funding and in vision.
The B.C. case will bring our health care system into much clearer focus. It will drill to the core of the debate. If we are to give patients the dignity and respect they deserve, then we must acknowledge that they are part of the solution and give them the necessary freedoms that are currently lacking.