Room for growth

All too predictably, the CMA's narrow focus on wait times has received far more media attention. But Bruce Campbell and Greg Marchildon's call to improve the existing scope of public health care in Canada deserves mention as a reminder that there's plenty to work toward beyond merely preserving the system we have now:

Claims that Medicare is fiscally and economically unsustainable are unfounded, but they are used to persuade a reluctant public that there is no choice but to accept privatized health care. According to Canada's leading health care economist, Robert Evans, the wolf at the door of the Canadian Medicare system is not an economic wolf but rather "a political wolf dressed in phony economic clothing to deceive the sheep."

Thus, the challenge is to defend Medicare against the forces seeking to dismantle it. We can best do this by completing Tommy's original vision for Medicare. Building on the proven administrative efficiencies of the single-payer systems administered by the provinces, we can expand Medicare well beyond doctors and hospitals into pharmacare, home care and dental care; to re-orient public health care around primary health care and community care, and tackle head on the social determinants of health.

In some areas change is beginning to happen. There are many examples of successful innovations, which have dramatically reduced wait times, improved access to quality care and reduced costs. Dr. Michael Rachlis, a physician and health policy advisor, has performed an important service for all Canadians by cataloging the most promising innovations in our public system. But missing is the political leadership on the part of provincial and federal governments to ensure the systematic dissemination and application of these solutions throughout the system.

Whether Medicare moves forward, or becomes progressively eroded by encroaching privatization, will depend on which vision of health care prevails. Will it be one based on the premise that health care is a commodity and that ability to pay should determine who gets what care and how? Or will it be the one actually desired by most Canadians? That is a 21st century Medicare, but one still based on the principle that every Canadian should have access to health care on the same terms and conditions.

Of course, there are far too many indications recently that we are indeed moving backward - ranging from the missed opportunity for universal prescription drug coverage in Saskatchewan to the federal Cons' determination to limit the flow of information about best practices. But it's worth keeping in mind that there's plenty of room for improvement in the system we have now, and working to push the system in the right direction rather than merely trying to hold the existing ground.