The forest and the trees

The forest and the trees
Dian Cohen (Photo : Courtesy)

By Dian Cohen
“They can’t see the forest for the trees” sums up the campaigning of a lot of politicians today on the subject of what Canadians need to get and keep healthy. The politicians either don’t know our recent history, or they’re so focused on details that they can’t see the big picture.
The big picture today is that in Canada most of the $308 billion in health spending – more than $8,000 for each man, woman, non-binary and child – is spent on people living with chronic conditions. Leaving Covid-19 aside, something like two-thirds of medical admissions via emergency rooms are due to the aggravation of a chronic disease. Four out of five primary care physician-visits are related to chronic conditions. It seems self-evident that to avoid unnecessary but costly ER visits and hospital admissions, more effective management of these conditions in the community should be a goal of healthcare reform.
Other countries – Holland, Denmark, Sweden, Germany among others — made this decision decades ago, much to the betterment of their healthcare systems and their citizens. Canada wasted those decades with a plethora of studies and not a lot of effective action. Continuing the pattern of the 70s, 80s and 90s, the first six months of this century saw Saskatchewan, Alberta, and Quebec all establish provincial task forces to examine the future of Medicare.
The federal government launched two of its own — a national Commission on the Future of Health Care in Canada and a Senate Committee on the same topic. These studies, done independently,
had surprisingly similar recommendations to each other and to those done years before – chief among them a national homecare program, a catastrophic drug insurance plan,
better use of medical technology, particularly electronic medical records.
After decades lost to gripes and grievances, finally, in 2004, the
10-Year Plan to Strengthen Health Care was signed by the first ministers of every province and territory to act on a number of healthcare delivery issues that would be “a fix for a generation” (see table). The provinces insisted that Ottawa cough up more money and Ottawa agreed. This report card brings us up to 2013.
The Health Council of Canada was disbanded in 2014.
We’re now fifty years older than we were when the need for a
publicly-funded health insurance system overwhelmed all the other issues that compete for our collective attention. Canadian proclivity to
study, not act, plus the pandemic have brought us to the point where our healthcare system is visibly disintegrating. When the cost of delay and denial overwhelms our ability to live normal productive lives, logic suggests we should be on the threshold of real change.

Dian Cohen, C.M., O.M., economist
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