The Only Solution for Canada's health care system
Dr. Brian Day
Canadian Medical Association
Montreal, QC, August 19, 2008
Thank you, Madam Speaker.
Ladies and gentlemen, friends and colleagues.
It's that time already. My year as your president has almost passed, and I will soon turn the over leadership of our association to the very capable hands of my friend, Doctor Robert Ouellet.
But before I do, I want to take this opportunity to share some thoughts on my year, and the current state of health care in Canada.
When I spoke to you last August, as your incoming president, I said that I was a man with a single focus.
A focus to ensure ALL Canadians receive timely access to necessary care, regardless of ability to pay.
My focus has not changed.
I believed - and I continue to believe - that putting patients first is the ONLY solution for the problems that plague Canada's health care system.
I was determined:
To provide a reality check for government, the public and the media.
I was determined:
To emphasize that we need long term planning and NOT the short term planning that 4 year electoral cycles encourage.
I was determined:
To dispel the notion that money alone could solve the problems.
I wanted governments to understand that when polls show 68% of the public want a major overhaul of our system, it is time to act. I said that change was both necessary and inevitable. I believe that message got through. The Canadian Medical Association has promoted the concept of a health system focused on patients.
We emphasized the tremendous costs of waiting for care. We raised awareness of the critical shortage of doctors. We showed that we will NOT allow health care to slip from any governments' agenda. We served notice that politicians who discount health care risk being discounted at the polls.
The CMA engaged Canadians in a positive and rewarding dialogue about achieving a viable and vibrant health care system in Canada. As many of you know, I enjoy speaking about the need for health care reform.
I also listened as I took part in about 400 media interviews, met thousands of colleagues and others, as I attended over 100 meetings, and spoke at most of them. I met with 20 editorial boards that generated 40 almost universally supportive editorials.
Throughout the year, my message - the CMA's message - was about change from patients serving the system to the system serving patients.
I met many politicians.
Individually most have a deep understanding of the plight of our health system.
Collectively, especially at the federal level, they are reluctant - even afraid - of engaging in a meaningful public policy discussion on health.
For example, in last October's throne speech I listened as the topic of health care was almost completely ignored by our Conservative government.
Not to be outdone, the Liberal Party of Canada recently sent out a questionnaire based on what they identified as today's issues of crucial significance. Of 16 questions in their poll not one question related to health care. Not one.
That poll asked questions, such as whether the changing ice formations in the Arctic are of concern; whether Canada's reputation in the world is improving; whether Canada should pursue a seat on the United Nations Security Council.
Now, don't get me wrong. These are major questions that require major decisions.
I should know because in my family, these are the sorts of decisions I get to make. Nina takes care of all the minor ones - like where we live, where the kids go to school, what kind of car we drive. You know ... minor things like that.
Why do our leading federal parties repeatedly try to sweep the topic of health care under the carpet when, at election time, health is repeatedly identified as one of the top issues that affect the way people vote?
The CMA will be there at election time. Not to lobby against or support any political party.
We will be there to advance the cause of patients. That is not a threat. It is not even a warning. It is simply a promise and a statement of intent.
In Canada, patients serve the system.
Our report card, released this week, revealed that only 10% of Canadians believe we have a patient-centred system.
Our patients - the consumers - receive poor value when governments alone dictate spending, control service delivery, and have the final word on training and employment of medical professionals.
As you know, Canada's hospitals have historically relied almost exclusively on block funding. Their allotted budgets are unrelated to performance, productivity, or efficiency.
Bad for management,
Bad for taxpayers
Bad for governments, and most importantly
Bad for patients.
Block funding blocks access.
We must generate efficiencies in acute care that can allow us to adequately fund chronic care, rural health and mental health.
A key focus of my term was the deplorable cost, both medical and economic, of Canadians waiting for care.
We showed that in just FOUR priority areas targeted in the 2004 First Ministers Health Accord, the cost to the economy in 2007 was $14.8 BILLION!
This excluded the growing costs of waiting to see a GP or specialist. And it excluded the costs as patients deteriorate and develop chronic, severe irreversible damage, addiction to painkillers, or depression.
In Canada we pay dearly to keep patients on waiting lists. This is illogical. Preventing patients from getting treatment is NOT my definition of preventative medicine.
Waiting for care remains the number 1 health care concern on the minds of Canadians.
Other countries have had similar challenges. England has introduced reforms. They made some mistakes. Mistakes we can learn from. But, the bottom line is that wait lists have dropped dramatically, yet they spend far less on health care than we do.
Countries like Switzerland, Austria, France, Belgium, Germany and others do not ration or deny access in the Canadian manner.
It is a source of shame that we have over a million patients waiting for care and 5 million without a family doctor.
I have never advocated that we try to import any one country's particular system into Canada. But, we can - and must - look elsewhere for ideas that work
We must not deny any patient access to essential health care based on ability to pay; nor should we deny access based on a shortage of doctors, hospital beds, or operating time.
Competition, consumer choice, and market principles barely exist in our health system. Yet health care is subject to normal economic pressures and principles.
We are pleased that several provincial governments are beginning to understand the need for reform.
For example, the BC government has recognized the logic of patient focused funding. After successful pilot projects in emergency departments, they have recently provided new funding for further efforts to reward excellence and efficiency.
They have introduced the principle of "sustainability" in the publicly funded health care system, and encompassed the specific values of choice, personal responsibility, innovation, transparency and accountability in their health Act.
As we meet at the time of the Olympic Games, and as Canada looks forward to hosting the 2010 winter games, let's note that the 3 of the 6 main Olympic values; excellence, universality, sustainability - are similar to our values and aspirations for a truly great health system.
And, of course, an integral part of the Olympics is competition. Without competition we cannot expect improvement, let alone excellence.
I believe, that if we are to preserve universal health care for the next generation, we need to embrace similar principles.
Here in Quebec, the Castonguay Report was released to the predictable flurry of certain self interest groups, and other supporters of the status quo, predicting the report would lead to two-tiered American-style medical care.
But it was encouraging to hear the Quebec Finance Minister support the recommendation to replace the annual block funding of hospitals.
Other provinces are moving in the direction of positive change. The doctors of Canada deserve much credit for that.
Another accomplishment this year was the CMA's More Doctors. More Care campaign that included national advocacy efforts, many aimed directly at Parliament Hill.
We encouraged physicians and patients across the country to contact their MPs, and to let the Prime Minister know how they felt.
More than 25,000 Canadians sent a postcard to Mr. Harper.
Despite the best efforts of medical schools to expand, we have actually dropped further in the OECD rankings this year, and now rank 26th out of 28 countries in doctors per population. Twenty sixth. In the bottom 3. Adding to the pressure, 4,000 doctors are about to retire.
The reality is that too many of our young doctors are in their 50's!
So what shall we do?
It is shocking that 1,500 young, highly educated, Canadians are currently attending medical schools outside of Canada.
I hope that, at this meeting, General Council will seriously consider the benefits of the bylaw change that will allow the CMA to represent them and facilitate their repatriation.
In Ireland, tuition paid by international students underwrites the cost of educating Irish medical students.
Over 300 of those funding and supporting the free education of Irish doctors are Canadians!
If our governments are unable to fund the education of the number of doctors we need, we must consider alternatives. Public private partnerships are used in such circumstances to build infrastructure, including roads, bridges and hospitals.
Let's explore similar initiatives to develop new medical schools.
The private-public rhetoric on health care is a relic of tedious and tiresome propaganda. Those who relentlessly argue against and demonize the private sector need a reality check.
It's a strange paradox that in Canada we can universally buy private insurance for death, but not for illness.
Despite my philosophical support of a role for the private sector, and despite the fact that successful partnerships with the private sector have helped shorten wait lists in several provinces, we cannot look to private hospitals for an early solution to Canada's access problems.
Canada has no significant infrastructure of private hospitals.
Yet, reality reveals that the private sector props up our health system now. Philanthropic efforts fund many capital projects in health care in Canada.
Many of the 80,000 Canadian charities divert private capital into health care, much of which is not even tabulated when we calculate health costs.
In a recent article on Bill Gates stepping down as head of Microsoft, in order to work full time for his charitable foundation, the Economist magazine described business as a force for good in itself. The most useful contribution of business to society was, they wrote, the making of profits and products.
Too often we forget that taxation of successful and profitable businesses helps fund our social programs and support the less privileged in society.
I have said in every speech, I believe the Canada Health Act of 1984 needs to be updated.
Put in an historical perspective, 1984 was the last year that a Grand Slam tennis final was won with a wooden racquet.
In its current form, the Act impedes progress and change. Most change will come at the provincial level, but that does not mean the feds are off the hook.
As physicians we want to care for patients. Spending to achieve timely care for patients is a true investment that will generate financial returns.
We have shown that rationing care is truly irrational, increases costs dramatically, and threatens sustainability.
I liken past efforts to improve our health system to using an expensive placebo that lacks any beneficial placebo effect. Canadians need focused action. I am pleased that change and progress, stimulated by the doctors of Canada is happening.
Patient focused transformations will break the vicious circle, whereby rationing of services leads to limited access, reductions in workforce, limited investment in technology, long wait lists that negatively impact the economy, resulting in funding pressures that force rationing. That circle must be broken.
I am especially proud of some of the new initiatives being discussed at this GC.
Delivering a baby or fixing a fracture, whether in Newfoundland or BC, are similar. It is nonsense to block the mobility of fully trained and accredited doctors across provinces. The barrier to physician mobility in Canada must be eliminated.
General Council will also debate facilitate the creation of a Canadian Patients' Alliance to represent the health care policies and preferences of Canadians.
It is bordering on fraud to suggest that union funded and housed special interest groups, such as the Canadian Health Coalition, represent the public or patients.
A new independent body will fill that role, and ensure that governments and others are responsive and accountable.
When I reflect on the past 12 months, I recall some unforgettable times.
A trip to St. John NB when, after the second attempt at landing in a storm, the pilot came on to say we'd be returning to Montreal. Then he came back on to say we didn't have enough fuel for the return trip, and would be giving the landing one more try. A little scary.
Even scarier was Bill Tholl chauffeuring me from Winnipeg to Regina, through many hundreds of miles of prairie terrain, with Bill thinking the speedometer on his rental car was reading 110 kilometers per hour, when in fact it was in miles per hour.
I had to fake amusement, as the outgoing SMA President introduced me with remarks like, "What's the difference between an orthopaedic surgeon and a carpenter?" Answer: "A carpenter can name 2 antibiotics", and then, "What's an orthopaedic surgeon's definition of the heart?" Answer: "An organ for pumping Ancef around the body".
I saw the north and had a great visit to Yellowknife, where the minus 53 degree weather was more than compensated for by the warmth of the people we met.
And the trip to the Yukon, where doctors maintain broad skills, and some still fly their own planes to visit patients. I gained a whole new understanding of the term, "access to care."
Most rewarding, was the level of support I received from my colleagues across the country, in all provinces and territories.
I particularly appreciated the support of the CMA Board and the talented CMA staff led by our Secretary General Bill Tholl.
I am grateful for your friendship, and the many kindnesses and above all, your help in fulfilling my responsibilities.
I also want to acknowledge the support and guidance of our past president, Dr. Colin McMillan.
As I said at the outset, I've given literally hundreds of interviews and speeches in the past year, and traveled from coast to coast and back again.
None of this would have been possible without the steadfast support of my wife, Dr. Nina Bland, and my children.
There were many trips Nina would have wanted to take with me, but instead she stayed at home in Vancouver looking after our many commitments at home, and most importantly our young children, Alexander, twins Jamie and Stephanie, and Andrew.
As a husband and a father, I am very proud of them and grateful for what they gave up for the CMA and for me. My second oldest son Jonathan and his older brother Christopher are my IT and website gurus.
During my year as your president I have come to appreciate that, if ever there was an organization whose whole was greater than the sum of its parts, it is the Canadian Medical Association.
There is a real and committed leadership within the Association that will ensure continuity.
As I hand over the CMA Presidency to Dr. Robert Ouellet, I know he will carry forward the momentum for change.
We will continue to hold governments accountable and press for investment in quality care.
Let me summarize with this final thought. The Canadian health system should be - and can be - the best in the world. To be the best, we need change. Change that matters. Change that will see patients truly put ahead of politics and the so called system.
I am more than optimistic - I am absolutely confident - that the momentum for change has not only begun, but is unstoppable.