Tuesday, August 17, 2004

Health care summit looking like a doomed effort

VICTORIA - Things are looking rocky for Paul Martin's big televised health care summit.
Premier Gordon Campbell and the rest of the premiers are heading to Toronto for one last strategy session before they meet with Martin.
The premiers want to firm up their proposal for a federally funded, national pharmacare plan. And they need to figure out how to handle Martin's counter-proposal for a reduction in wait times for surgery.
Martin's health care summit next month has at least got everyone's attention. But it has the potential to be a weird event, as all parties jockey for political advantage under the TV lights.
Martin says he wants to leave the meeting with a new plan for health care in Canada, a ridiculous objective, no matter how much work is done behind the scenes.
The public would be much better served if this became the first of a regular series of public first ministers' meetings on health care, perhaps once a month for six months. That would allow serious work on the kind of health care Canadians want, what and how they will pay, and positive changes that can be made.
There's no fix for health care, nothing that can be cobbled together in a few days that will make a lasting difference.
A national pharmacare program makes good sense. A single buyer - and single approving agency for new drugs - could negotiate more effectively with drug suppliers, and make the best decisions about which new drugs offer enough benefits to offset higher costs.
But so far, that's not what the provinces are mainly talking about. They're concern is shifting the current costs on to the federal government. For the public, that's a bookkeeping change. The same taxpayers pay, and the system isn't improved.
Martin's focus on reducing wait times for treatment in five key areas also makes good sense. Canadians judge the system by how long they must wait for care, and have watched with dismay as wait times increased.
Other jurisdictions have provided their citizens with wait time guarantees - a promise of treatment for major ailments within a set time. If the system can't deliver, the government pays for treatment outside the country or in the private sector.
But a deal on wait time limits or guidelines is not going to be reached in a few days in Ottawa. Health care is a provincial responsibility, and premiers will be understandably nervous in committing to wait time guidelines they can't meet.
And we are a long way from agreement on what sort of wait time guidelines we are prepared to adopt. In B.C., governments have decided that people should wait longer and longer for surgery. Wait lists in most areas climbed under the NDP, and climbed even more sharply under the Liberals. The median wait for a hip replacement has climbed 25 per cent since the election, for non-emergency heart surgery by 15 per cent. Our governments have had other priorities.
In the short term, reducing wait lists is about money, as Campbell showed this week. He announced $3 million more for heart surgery this week, a 5.5-per-cent increase. That's enough to cut the median wait by 20 per cent to 12 weeks, shorter than when the Liberals were elected. And it's a reminder of how relatively small amounts of money can make a large difference in reducing the wait for treatment.
Many Canadians have lost confidence in their governments' ability to manage health care, as this week's Ipsos poll revealed. When the premiers and prime minister sit down next month, those people want to see a commitment to long-term solutions.
Instead, they will see the leaders stumbling toward a meeting with hopelessly complex objectives. One of two outcomes is likely: the meeting will either break-up in recriminations and posturing; or another short-term deal involving extra money to maintain the status quo will be cobbled together.
Neither addresses the real health care issues.
Footnote: The Ipsos survey, done for the Canadian Medical Association, asked Canadians to grade the health care system. More than one in four gave federal and provincial governments failing grades for working together to make the system more accountable. Almost 30 per cent said the federal government wasn't funding health care adequately and 22 per cent said their provincial government wasn't spending enough.

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