Go big, go home

by Aaron Wherry

Brian Mulroney offers some free advice to Stephen Harper.

“We make enough mistakes in politics but it’s important that you try to get the big things right,” the 71-year-old former Conservative prime minister says in an interview from his Montreal law office. “History remembers the big-ticket items.”

… His advice to Prime Minister Harper, especially given the partisan fighting that is so much part of a minority Parliament, is to create a blue ribbon panel of non-partisan, distinguished Canadians. “Someone has to provide some unbiased, thoughtful but effective leadership in the thinking on this,” he says. “Without some new thinking and some visionary approaches, health care is going to consume 70 to 75 per cent of provincial budgets.”

Setting aside what lessons Mr. Mulroney’s premiership may provide about the wisdom of striving for big change, Mr. Harper already dismissed this specific idea in an interview with Postmedia two weeks ago.

You know, we’ve had a lot of task forces. I don’t know what we would necessarily benefit from another one. I think first and foremost everybody should understand that Canadians are strongly committed to the system of universal health insurance, to the principle that your ability to pay does not determine your access to critical medical service. That is a fundamental principle. It’s one that millions of working Canadian families, including my own, depend (on). When people say in vague terms they want to change or dismantle the system, I think people don’t know specifically what it is they’re talking about in this case. I don’t know specifically what they’re talking about. What I do know is the provinces are responsible for the management of the health care system. The single most important thing the federal government can do is make sure the provinces have the funding they’ve been promised to run the health care system … We’re obviously always open to working with the provinces in ways to improve the systems but it’s primarily their responsibility. We work co-operatively and we always work within the principle that we’re going to have the system of universal health care.




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Go big, go home

  1. Unfortunately, it seems Mr. Mulroney is still under the assumption that Mr. Harper is interested in an effective government.

  2. "That is a fundamental principle. It's one that millions of working Canadian families, including my own, depend (on). " I think that his family depends much more on (and benefits much more from) the complementary private supplemental health insurance that he has access to as a federal employee. Full disclosure, I too rely on and benefit from employer-provided supplemental health insurance, and without it, I would find healthcare costs unbearable, and the coverage of our 'universal health insurance' a bit of a joke.

  3. Harper's idea here seems sound – why, the last time it was implemented, health care was fixed for a generation!

  4. I'm rather hoping Harper doesn't turn his attention to healthcare…

  5. Couldn't we just skip the 'go big' part, and move on to the 'go home' bit?

  6. Having another committee study something to death is just the quickest way to ensure nothing gets done.

    Just look to Europe to see what works. A mixture of Private and Public Heath care services, PAID FOR from Public monies.

    Why wait 12 months for an MRI, when you can have a private clinic zip one off for you within a week. Same for minor surgeries

    Whoever performs the service, sends the bill to the province.

  7. I suspect that part of the problem is that MRI machines and minor surgeries are expensive, and the amount of money the gov't would be willing to pay for each use wouldn't be enough to cover the start-up/operating costs.

    I have no idea what the gov't pays family doctors for seeing patients, but I'd suspect that any proposal like the one you give would broadly fall within that range of remuneration.

    (not that your idea isn't without merit…this might be the first time I've ever agreed with you…I should mark the date! :)

  8. Hold up there Richard…let's do a fact check, James…

    "Why wait 12 months for an MRI"
    Day by which 9 of 10 patients have had their MRI done across Ontario? 127. But in Windsor, it can be as short as 25 days.
    Estimated MAXIMUM wait time in Manitoba right now for an MRI?
    About 20 weeks. And that's the max.
    In Halifax, at the QEW Health Centre, 9 of 10 patients are scanned in 55 days. Which you would know, if you had a working compu…oh, okay.

    Richard, the real issue is the number of BS scans people insist on. Pointless scans that doctors agree to to get people out of the office. These people are also the most likley to wait the max time, because they're not at all urgent.

  9. Whoever performs the service, sends the bill to the province.

    This is, functionally, how the system works now with the only caveat being that, if you want to bill the province, you can't accept direct payment from the "customer" for services which are covered by the province in question. The reality is that the private sector wants to be able to charge more than the Provinces are willing to pay and, in those cases where they do invest, tend to poach staff from existing public facilities to provide "their" service which does nothing to address the existing log-jam.

    The primary fixes to health care lay largely in the educational and accreditation system – we need to start graduating/certifying more health care workers to meet needs – and through the development/investment in retention, localization (in terms of getting doctors to be willing to go places they don't want to go), and adoption of advances made elsewhere where appropriate. We need to get away from this: "we can't afford it" diversion folks trot out because the reality is that, whether public or private, if you want to maintain the existing status quo or improve on it it, the money's going to be coming out of the "public's" pocket either way.

    When when you accept that, and that every study has shown that the public driven systems spends that money most efficiently, the question becomes: "why do we want to waste money on paying CEO bonuses and generating shareholder dividends at the cost of care?"

  10. Yeah, I suspect you are right about that as well (unnecessary procedures). A private company charging the government for every superfluous scan would sure be wasteful…but on the other hand it likely would reduce the waiting time for legitimate scans. Whether that trade off is worthwhile? I dunno. I'm far from an expert in this field, I'm sorta just musing here :)

    Wait times are an issue, but I don't think they are quite as dire as some would have us believe. Personally speaking, whenever a relative has been in urgent need of care (Breast Cancer, Alzheimer's, MS), the lag time between appointments has been completely reasonable.

    cheers

  11. but I don't think they are quite as dire as some would have us believe
    My favourite example of this is "24 hour Emergency Room!!!" wait times which aren't a metric of how long it takes you to actually see a doctor but, instead, a metric of how long it takes them to move you from the Emergency Room to a ward if they decide your issue is worthy of admission and not something they can write a 'script for and send you home.

    While there are throughput issues that would be addressed by improving that number, it's not directly impeding care to the degree some folks would like you to think it is.

  12. Why, because clearly health care should be an investment opportunity ! All the
    cool kids know that.

  13. I don`t think Harper needs to take any advice from Mulroney concerning legacy. I say, listen to Wells—-slow incremental change will have a greater impact on long term thinking about how Canadians feel about political parties then any big box items.

    The one thing that Harper is determined to change is the myth created by Keith Davey and future Lib back room boys that the Liberal Party is the natural governing party of Canada.
    This may be difficult to hear but that bit of Liberal marketing is dying rapidly and by the time the next election is over should be finito.

    I don`t think the Conservatives will start to refer to themselves as the natural governing party ( it was rather presumptuous of the Libs ) but it looks like they are well on their way to being the first choice in 3 of the main pop. groups in the next decades—-the West, the suburbs and New Canadians. If that happens and Conservatism becomes the government most of the time, I`m sure Harper will be happy with that legacy.

  14. I believe it was the press that gave the "Natural governing party" tag.

  15. To become the "natural governing party" they would have to actually govern, and preferably to provide peace, order and good government. So when do the Conservatives plan to start doing that?

  16. When all is lost, govern not, oppose thyself? The new red tape reduction commission, peopled apparently by selected industry folks some of whom donated poliitically, received funds from government, etc etc. Just follow the money trail, whether it's diverted in some amway-style, family-owned system, or whatever, it all leads to the same thing.

  17. MostlyCivil noted:
    "the real issue is the number of BS scans people insist on"

    Yep….I agree. We need to have some prices attached to procedures or appointments. Something small, yet able to show that "free" isn't really free. I think Quebec had a good number. $25 per.

    Of course, low income people would need some help.

  18. CAPS noted:
    "I believe it was the press that gave the "Natural governing party" tag"

    I agree CAPS, however, the press did not pull this out of thin air. ?They have watched the Liberals' sense of entitlement over the years and simply put the label to the attitude.

  19. Actually, they put the label to win after win for an enormous chunk of the 20th century.

    Idiot.

  20. Mike T noted:
    "Actually, they put the label to win after win for an enormous chunk of the 20th century"

    All true,mike. Which, would tend to reinforce my comments about the Liberal attitude towards Governing. They've governed so long, they think they are entitled to do so. Remember, there was one Liberal Prime Minister' who after losing, stated, "The people of Canada have let us down"

    Yep…..that sounds like hubris to me. What say you?

  21. Well, that's good news then, because the Liberal Party has completely turned away from the idea of being the Natural Governing Party–and have done for about a year now, I'd say. Harper has accomplished his goal! He can leave now.

  22. Wow, you are being particularly reasonable today. Run out of kool-aid? (Sorry, I kid)

    Anyone feeling entitled isn't getting a pass even within the Liberal Party itself, never mind trying that attitude outside. The only one feeling entitled these days is Tony Clement, who feels he is entitled to completely misrepresent what StatsCan says to him.

    Who was the Prime Minister who said that? I'm curious, and I agree with you.

  23. Jenn noted:
    "Wow, you are being particularly reasonable today."

    We all have our moments.

    As for the LIberal PM who said it…….he was very well known and respected. Let's see if any on here know the answer……..

  24. An Elected Senate isn't big enough for Mulroney.

  25. Nope. The simple creation of an "exemption" program would cost as much in paperwork to administer as you would collect in scans. And, the really, truly ill would consder skipping scans if the exemption system had any delay or backlog. How many $25 fees do you have to collect to pay someone $30,000 to process them? And if you don't hire someone, you take someone away from other work.

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