Universal health care? Or a food bank approach?
By Terrance Hunsley
Jane Philpott, in her recent book Health for All, proposes a radical concept – treating health care like the school system. Wherever you live, you get health care at a nearby facility, just like sending your kids to a local school.
But wait! Don’t we have universal health care? Isn’t that what medicare and the Canada Health Act (CHA) and OHIP are all about? Isn’t that what we pay for with our taxes?
For decades, whenever surveys were done on what Canadians value most about our country, universal medicare was always at or near the top of the list. The CHA was designed to ensure that all eligible residents of Canadian provinces and territories have reasonable access to medically necessary hospital and physician services on a prepaid basis. It sets out the five principles for federal financial contributions to provincial health care: universality, accessibility, comprehensiveness, portability and public administration.
But those principles are being ignored, and we have lost universal, accessible health care. A recent analysis by the C. D. Howe Institute reports that although our combined public and private spending on health care is above the OECD average, we rank last in a list of comparably rich countries in access to primary care, the gateway to health care. This, despite abundant evidence that high-quality, readily accessible primary care actually saves money for the whole health-care system and improves health outcomes. And the more vulnerable the patient (think seniors), the more important primary care is for both the patient’s health and savings to the health system.
Despite knowing that older people require more primary care to manage more complex medical conditions, governments are rationing health care. So, guess what? The number of people without primary care is increasing. The C. D. Howe study projects that nine million people will soon be without a regular primary-care provider. Seniors, the most vulnerable group, are at growing risk. More doctors are retiring than going into primary care, and older doctors have older patients. In 2019, some 23.7 per cent of the rosters of retirement-age Ontario doctors were seniors, and that proportion was increasing rapidly, according to a study carried out by Dr Kamila Premji and colleagues. So, the 7,700 seniors without a regular primary-care provider that Ontario Health counted in central Ottawa in 2022 could well be over 10,000 by now!
The C.D. Howe study reports that in the 1990’s governments actually reduced the numbers of training spaces for family practitioners. At the same time, the medical profession began requiring two years rather than one for residencies, increasing the challenge for students interested in primary care. And many hours of administrative tasks are required of physicians, making primary care even less attractive. But doctors have nonetheless guarded their monopoly on billing OHIP, keeping other health professions such as nurse practitioners from filling the gaps.
Even the more progressive people in health care – community health centres, public health agencies, health-research funding agencies – are inadvertently supporting the rationing of health care. They cite the social determinants of health which show that poor and marginalized people have worse health outcomes as a rationale for directing discretionary resources to them. But the social determinants of health are not changed by access to more health care – they would be changed by a guaranteed basic income, better low-end wages, reduced social exclusion and access to universal health services. And no surprise for a rationed system, those service agencies are woefully underfunded. That’s what happens with two-tier health care – public spending on the disadvantaged is minimal, the affluent begin to buy privileged access and those in-between resent paying taxes for no service. The CBC reports that communities are competing by offering bonuses to lure doctors from other areas. Even the Canadian Medical Association warns about the privatization of health care.
Those good souls who focus on help for the excluded are repeating a societal mistake made in Canada in the 1980s. They are taking a food-bank approach to health care and building a poverty health industry. Walk through Centretown and the Byward market any evening and ask yourself if our minimal social assistance combined with food banks, emergency shelters and special paramedics teams is working.
In a universal, accessible system as defined in the Canada Health Act, people who need more health care would easily get it. And seniors would not have to compete to show that they are desperate in order to receive something they paid taxes for. Universal health care is what Jane Philpott is also calling for, albeit in a more polite way.
In upcoming elections, I suggest that seniors ask political candidates and parties what their stance is on the universality of health care; will they commit to restoring it, when, and how? Don’t accept vague or long-term promises as a response. A key question – will every senior have a right to primary care, with access to a health-care provider who has their medical record and appointments within a week? If they don’t have a plan, or mealy mouth the answer, vote against them. If you are part of a senior’s group or community association, take on this issue. By insisting on high-quality, accessible, universal health care, you will be helping seniors, the marginalized and everyone else. And don’t believe the argument that Ontario can’t afford it.
Since it takes a long time and a lot of money to train enough doctors, let’s adopt the Alberta plan to encourage nurse practitioners to set up public practices. They are already licensed to provide primary care, and their patients love them. The Seniors Health Innovations Hub (seniorshealthinnovationshub.com) has proposed employing them in a team-based model serving seniors in central Ottawa and would appreciate your support. Talking about it can help. Perhaps you could engage your book club, your doctor if you have one or politicians, or Premier Ford’s Ottawa representative, Sean Webster?
Terrance Hunsley is a vice-chair of the Seniors Health Innovations Hub, but the opinions expressed in this article are personal.
