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Missing on the campaign trail: Talk of health care

Pharmacare, a seniors strategy, home care: All relegated to passing references. Evan Solomon on the missing heart of the election campaign


 
(Chris Wattie/Reuters)

(Chris Wattie/Reuters)

Put out an alert. Send out a search party. Print a face on the side of a milk carton. Something has to happen to locate the missing campaign debate about health care. It has simply vanished.

In its place, pails of pixels are being filled trying to find out why Nigel Wright cut that $90,000 cheque to Mike Duffy. There is endless talk about a recession redux. Child care, pipelines and security issues are all eliciting Kardashian levels of political scrutiny. That’s not a bad thing. But health care has gone as silent as a Chaplin film.

“It’s a major missed opportunity for the opposition parties,” Kevin Page told me. The former parliamentary budget officer knows how fundamental this matter is to all levels of government. “Rarely do you have this much public support around an issue, and yet you don’t see it prominently displayed in any party platform,” Page says.

He’s right about public support. A recent Abacus poll found 56 per cent of voters aged 45 and over said health care is their top concern. Even 43 per cent of Millennials—those aged 18 to 29—put health care as their No. 1 issue. That’s higher than job creation, taxes, middle-class incomes and the environment. Abacus found issues such as crime and security poll no higher than 11 per cent for all ages. So why the political silence?

The answer goes back to the Lunch of 2011. In December of that year, the finance minister, Jim Flaherty, hosted his provincial and territorial counterparts in Victoria at what was supposed to be a friendly lunch. It wasn’t. Flaherty shocked the smoke out of their salmon by suddenly handing them a controversial new health care funding formula. No negotiations. No questions. A deal chipped in stone brought down from Harper’s mountaintop in Langevin Block.

The federal government promised to continue the so-called escalator—a six per cent increase in funding each year—for five years, until 2016-17. Then, reality hits. The government will tie its health care contribution to the provinces to economic growth, with a floor of three per cent. So, here we are, four years later, and, in case you haven’t noticed, economic growth is pretty hard to come by. In other words, get ready to hit the floor. Hard.

Health care spending by the provinces is almost certain to outstrip GDP growth, and the aging demographic will make it worse. “Premiers feel strapped, regarding fiscal sustainability,” Page says. For the provinces, which spend about 40 per cent of their budgets on health care, it will soon seem like a patient learning to function without a limb. This explains why Quebec Premier Philippe Couillard, a surgeon who knows an amputation when he sees one, is raising the matter of the Canadian Health Transfer payments.

Elections are as much about controlling what is not being debated as they are about what is being debated. That’s why Stephen Harper has not sent out a Franklin-style search party looking for the lost health care debate. He wants this election to be about the economy and security, not health care, which he knows plays well for the opposition. It’s not just strategy. Harper fundamentally believes health care is a provincial jurisdiction and that Ottawa should back off.

That’s not the way it’s worked historically. In the 1960s, Ottawa contributed 50 per cent of the health spend. By the end of the decade, it could drop below 20 per cent. “The federal government is dangerously close to being non-players in health care in Canada,” Dr. Chris Simpson, the president of the Canadian Medical Association, told me.

Simpson is desperate to make seniors’ care an election issue, but, so far, he’s like the kid who buys new shoes for the prom, but never gets an invitation. He believes the system is at the breaking point, but the federal government is ignoring obvious solutions. For example, why aren’t long-term-care facilities eligible to apply to the Building Canada Fund? Aren’t they basic infrastructure? “Why no one else has taken this up in this campaign is baffling,” he laments.

The NDP and Liberals insist health care is an important issue for them, and both have hinted that they might announce something soon. It’s hard to take seriously. After all their other promises, there’s just not a lot of money left for them to allocate. Is this a major political blunder, or do they know that people just don’t vote on this issue?

“Parties can talk about improving health care, but can’t deliver real results,” says pollster David Coletto, CEO of Abacus Data. It always gets bogged down in debates about jurisdiction and money. So, while it’s a top voter concern, he believes the public views it like protesting snow in winter. No one believes there’s anything he or she can do about it.

Still, even federal election campaigns can’t avoid reality forever. The fundamentals of the Canada Health Act are in jeopardy. Notions of universality and accessibility are becoming quaint concepts, like hand-delivered mail. Pharmacare, a seniors strategy, home care: This stuff used to be explosive political material. Today, they are passing references on a party website.

Most Canadians say they need an emergency health care cure. So far, though, the campaign is just like a visit to an overcrowded hospital: Expect a long wait.

On the web: Have a comment to share? Follow Evan Solomon on Twitter @EvanLSolomon


 

Missing on the campaign trail: Talk of health care

  1. C’mon Evan don’t be coy. You did this all the time yourself at CBC. The media always chases the shiny bauble and ignores the real issues and the parties know it’s useless to get serious on big issues with this kind of coverage. 24/7 scandals-a-day and the gotcha! are what pass for journalism these days. Why do you think your industry’s reputation is in such disrepute with consumers and is continually losing money, audience and job?. Self-inflicted wounds I’d say. Thus except for the junkies (me included) folks ignore you all and the continuous noise emanating from the ranks of the political class and their media enablers, particularly the Parliament Hill Press Gallery types.

  2. One of Harper’s tactics is to say nothing about something when he doesn’t want the public to know about what he is doing. Why the other candidates are letting this happen is disturbing.

    I am just finishing reading Brooke Jeffrey’s book, “Dismantling Canada:Stephen Harper’s New Conservative Agenda”. I have read some of Jeffrey’s thesis from other public sources, but nothing as comprehensive as his new book. I recommend it to anyone with a serious interest in this election.

    Jeffrey details Harper’s strongly right wing politics in which Harper would like to reduce the mandate of the Federal government to a minimalist presence. Harper is a fan of conservative American politics These politics are aimed at having citizens take care of themselves without any government social assistance. This includes public health care.

    Harper’s government has already dumped an arbitrary reduction in federal funding for health care out of one of his complete silences. No warning, no discussion, no compromise. I fear that his continuing silence foreshadows further cuts if he is re-elected,

    The Fraser Institute recently released a very negative report on the cost of public health care to an average Canadian family. The Fraser Institute is a highly conservative “think” tank closely associated with the Conservative Party of Canada. They share Harper and company’s distaste for social programs like medicare. I can see Harper using this report as an excuse to completely cease funding health care on the supposition that private companies can do this at lower cost due to greater efficiency. We have seen what privatization has done to other services

  3. Health care should not necessarily get more new spending than the core inflation rate. The system will spend whatever it gets, 6% or 3%, and there is much evidence it will mostly go to higher wages for the same number of health professionals, managers and support staff. Not to more care or better care…unless perhaps that new money is tied to key performance metrics. Why would anyone spend more without expecting more?

    Innovation in health seems to requires a burning platform, and a strict diet may actually be helpful. There is broad acknowledgement that more money did not make our system better. (If in doubt, look at the Commonwealth Report rankings in Health Affairs.) Health services function reasonably well in the day-to-day, but that is not enough to keep up with improvements that are happening in other OECD countries…or that occur here in isolated sparks of genius that have no channel to implement beyond a local setting.

    My vote would go to someone who can talk MUCH more knowledgeably and candidly about health services. I see no one who can do that, including most of our health ministers.

  4. (warning: possibly constructible alien blueprint)
    This is an alien blueprint with a Patent level of detail, for a strategy to prevent future pandemics. It is the tech level equivalent of 70 years in our future and it involves GE-ing ourselves into a new species that would look alien. Near has said we don’t have a bleeping clue about what to do about future pandemics. I guessed as much, in the dark, when I blundered with a bad biolab equipment pattern recognition plan a year ago, and their refutation of said plan engenders my trust of them on this file: even listening is dangerous (they don’t know about beyond light-cone, possibly Away tiled universe for sound/visual contact only), and receiving blueprints is even more dangerous; I vouch for them on this file more than any other.

    If I want to prevent bioterror, I should consider a field that is good enough to be used as a tool for preventing all other pathogens from being researched at the moment (because it functions as a biosensor if desired) because it is actually under-rated. She is talking about the field that is about 1000x smaller than a virus: (Genetic Engineering?).
    The whole world should be able to produce a technology that is able to contact viruses and bacteria (at least) and kill them. A virus is not easy to kill unless you have a way to prevent the virus from having a way of mutating away from a vaccine.
    If you have a way of mutating a virus to a form that is not able to penetrate a human being at all, it will be unable to even have a chance to re-combine with another virus if you have a way (again human GE is considered categorically unwise by our leaders) of preventing your cells taking up a new virus that is potentially a world crippling pandemic Patient Zero. GE your immune cells in a way that enables only known pathogens to pass through a membrane that does not exist at all. The cells are able to be modified easily enough with human testing that is illegal.

    The outside should be able to be entered only once the type of microbe is known to be able to be treated, at least. If the virus is able to be analyzed in real time, it will be easy to envelope if it is a pathogen. And if it is enveloped by the artificial cell membrane it will be possible to actually bring it to our orifices; it doesn’t matter which one. It matters if you don’t dispose of it carefully or bring it to a lab that is specialized. The artificial membrane is only one natural cell membrane wide (not sure about units, I’m being tested). It is composed of mostly a substance just like our existing cells but it is suspended in the cytoplasm not as much as you would think because the volume in between the (outer) new membrane and the existing one is about 7 or 8 cell membranes (I assume) thick. The volume in between is composed of a fluid that is able to analyze a rough outline of the virus. The fluid is obviously not naturally produced by humans or any other life forms on Earth, but on her (Near) world it is a product of an animal that she eats for breakfast (of course not the real animal post-GE (fake meat?)). The substance is a lot like a red blood blood cell except it is able to image a virus or bacteria because it is able to have every permitted virus imprint on the surface of the RBC-like cellular component. The rest of the cell (this term is used nebulously) is connected all the way back to the opening of the (natural) cell as well as the opening of the artificial membrane. The connection is easily the hardest part to engineer. It is not existing on Earth at all. The connection is a little bit Oxygen, enough to carry a signal to open either door and the RBC-like object releases the pathogen one way or the other. The connection is also composed of a substance that is able to actually deactivate the pathogen’s attempt to break the membrane of its connection. The membrane also has Oxygen. It should be composed of any natural enzyme that is targeted to the pathogen that the imprint of the RBC-like object is for (I assume unknown or unresearched potentially communicalbe pathogens are automatically shown the door somehow). There are enough membranes that the free circulation of viruses or bacteria is not actually possible. Enrgy comes from cytoplasm or plasma, doesn’t matter.
    About 2030 or so this defense will be possible assuming human testing were legal. But without human testing it will be a long enough time that a pandemic is inevitable before the counter-measure is available. Even with the counter-measure a non-communicable pathogen might be able to infect humanity. Is an allusion to Transcendence delivery method and a defense against such is already possible (I assume chemical WMD Conventions).
    People will die in testing (what Geordi breathed, I’m guessing Gene got a plot at the same time I heard this, Intrepid only cared about defeating the Nazis) and it is possible testing might be outlawed even more. All cells altered except CNS ones. There is no time to undergo this procedure after a pandemic is started. I’ll write an Open Patent in years, a drawing within a year, and would appreciate a couple dozen crowd-sourced winter sales, else I’ll blog about unloading trucks.

  5. I’d like to hear more about health from the political parties for sure! I’ve written emails, letters, Facebook messages but don’t have an answer yet.

    We are Canadian citizens and taxpayers, and contribute to the B.C. Medical Services Plan, and we support public funding of in vitro fertilization (IVF). 76 percent of Albertans, 73 percent of British Columbians and 73 percent of Ontarians also believe IVF treatment should be publicly funded.

    In fact, public funding for IVF is one of the most important issues for my family in this federal election, and it is for many of the one in six Canadians that suffer from infertility. Infertility isn’t simply a matter of ‘oh we couldn’t get pregnant, let’s get the doctors to help’. Most discussions I see people have gloss over the fact that infertility is caused by an underlying medical condition – infertility is the outcome, much like AIDS is an outcome of HIV. The undertone is that these women simply ‘forgot’ to have children, and are now going around blaming everyone but themselves and asking society to pay for their ‘oversight’.

    This simply isn’t true. Infertility is a serious medical condition that the World Health Organization (WHO) recognizes as a disease. Infertility can affect anybody, at any age, and has many causes. People may be undergoing lifesaving chemotherapy to preserve their fertility. Women may be suffering the results of lifelong endometriosis, which affects 10 percent of women and often takes more than 9 years to diagnose. 30-40 percent of women suffering from endometriosis will subsequently suffer from infertility. Many women may experience tubal obstructions, or polycystic ovarian syndrome (PCOS) – PCOS affects 5-10% of childbearing age women and is the leading cause of female infertility. Do you start to get the picture?
    
    I haven’t even begun to list the causes of male infertility. Men can experience blockages in the ducts that carry sperm, or may have suffered from mumps as a child that can cause male sterility later in life. Infertility is due to purely female factor in 30% of cases and purely male factor in 30% of cases. In some cases, both partners may have issues, or be faced with the diagnoses that they have genetic material that is in conflict.

    The Canada Health Act requires the Provinces to provide public health care insurance that is ‘comprehensive’. The Federal government is able to direct Provinces to require public funding for IVF in order to meet this requirement. Currently the process to determine what is and what is not required to be covered is neither an open nor a transparent process.

    I would like to see the party that wins this election bring forward a bill instructing the Provincial health ministries to have an open process and bring in coverage for the costs of IVF in keeping with the requirement for ‘comprehensiveness’ of health services as stipulated by the Canada Health Act. This important measure would give all Canadians, regardless of income or geography, the opportunity to build their families safely, while saving provincial health care systems millions of dollars per year.

    In 1993, the Canadian Royal Commission on New Reproductive and Genetic Technologies recommended full public funding for fertility treatments such as IVF. Twenty-eight out of thirty-four OECD member countries (more than 80 percent) publicly fund IVF, including Australia, New Zealand, Japan and most of the EU.2 Belgium, France, Israel, Slovenia and Sweden offer multiple, fully funded IVF cycles. 15 states in the United States require private insurers to cover the costs of IVF. In Canada, only the governments of Manitoba, New Brunswick, Ontario and Quebec have shown the leadership required on this very important family issue.
    
    Some people criticize IVF as a ‘lifestyle choice’. As mentioned above, many different medical diagnosis underlie infertility. Women have had children into their forties for millennia. This is not a ‘lifestyle choice’ but the result of an actual medical condition. Unfortunately, we never get to really discuss public policy around women’s fertility, because people still associate fertility with some sort of magic voodoo.

    Because we keep this topic taboo, we don’t develop good practices. Women’s hormone levels are not checked on a regular basis (when we go in for our pap tests, for example) even though it is very inexpensive to do so. Regular hormone test could easily become regular practice, giving women more information about her medical condition and a timeframe in which to prepare. Hormone testing needs to become the norm but we can’t even have the discussion when people prefer to perpetuate a myth that women suffering from infertility brought it upon themselves and have no right to medical treatment.

    A lifestyle choice is when you go skiing and break your arm. Our public health systems pay for your broken limbs to be repaired despite that fact that you engaged in a risky behaviour.

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