Saturday, June 12, 2004

End wait chaos with guarantees

VICTORIA - Sure it's dangerous that the courts are being asked to define Canadians' right to health care - and perhaps approve a two-tier system.
But it's also inevitable given governments' failures.
Montrealer George Zeliotis waited - in pain - more than seven months for hip replacement surgery in 1999. This week his lawyers argued before the Supreme Court of Canada that his charter rights were violated. Governments must either provide timely treatment, or allow people to go to pay for surgery at private clinics, they claimed.
The federal government and several provinces - not including B.C. - intervened, rightly arguing that allowing people to pay for speedier treatment would violate the basic medicare principle of equality.
Governments must be allowed to decide how much should be spent on health care, they said. Sometimes people just have to wait.
That's a profoundly unsatisfactory position, one that suggests Canadians have no right to treatment. If a government makes health care a priority, wait lists drop. If it decides tax cuts or education are more important, you wait longer.
It's a bizarre model. I pay about $900 for car insurance, and have a clear understanding what ICBC will and won't provide in return. We pay an average $2,800 each for health care, and have a right to the same kind of clarity.
The governments' legal position would have been stronger if they had been able to tell the court the maximum times patients must wait for different procedures, and how they had decided that those waits were reasonable.
But it doesn't work that way. If budgets are tight, health authorities reduce the number of operations being done, and people wait longer. There's no medical rationale for the delay, or study of the economic costs of making people wait. Government sets the budget, and that drives the quality of care.
It's as if you crashed your car and ICBC told you that unfortunately it wasn't fixing any more front ends this fiscal year because the budget for that had been spent.
Basically the governments are saying trust us.
But people don't. An ipsos-Reid poll done for the BC Medical Association last month asked people who they believe when talk turns to managing health care. Three out of four people said the doctors' organization was believable. Only half as many were willing to believe Premier Gordon Campbell. Almost 40 per cent said he was not at all believable on health care. (That's not overly surprising. The Liberals' platform noted patients' anger that the treatment they had paid for wasn't available when they needed it, and promised better. Instead waiting times have increased. The anger remains.)
But it's not a Liberal issue, or a B.C. one. All Canadian governments take a similar approach.
There are alternatives. The BCMA is pushing for guaranteed maximum wait times, a commitment already in place in some countries and being introduced in a rudimentary form in Saskatchewan. If the government can't fulfill its guarantees, the doctors say, it should have to pay for a procedure in a private clinic or another jurisdiction
Governments could provide the guarantees. The health ministry knows, for example, that about 2,500 hip replacements will be done this year, not enough to keep up with new diagnoses, let alone reduce the 2,900-person wait list. It could calculate a reasonable guaranteed maximum wait.
Government has the right to decide that the $25 million needed to clear the backlog would be better spent elsewhere. But patients have a right to some guarantee of service. Perhaps an urgent case is promised treatment in seven days; moderate no more than five months; the rest no more than 18 months. You're assessed, and you know what the future holds. (Today many surgical patients are convinced the wait is endless.)
Governments have paid attention to their need for flexibility.
But they've ignored the need for commitments and accountability in return. That's hurt patients, and undermined an honest debate about what we can expect from our health care system.
- From The Vancouver Sun

Thursday, June 10, 2004

Liberals blowing opportunity on Harper's Iraq stance

VICTORIA - The Liberals' attack ads are a big mistake.
They're bound to alienate many voters, who associate them with ugly American political campaigns.
And they'll wreck the Liberals' credibility on those issues where Harper should be held to account, like his support for sending Canadian troops to fight alongside the Americans in Iraq.
The attack ads say Harper wanted to send Canadian forces into Iraq - true - and wants to limit abortion rights (false), wants to ally with the Bloc Québécois (irrelevant, since the Bloc won't work with any federalist party) and wants to spend heavily on military hardware (true). All this in front of scenes suggesting health care disaster and a dissolving Canadian flag and .
Scare tactics make the attacking party look both desperate and devoid of their own ideas. And their hysteria means that legitimate criticisms are written off as more of the same political smears.
In fact, there are legitimate issues the Liberals could be raising.
Harper's support for the war in Iraq, for one. He accepted claims of weapons of mass destruction and an imminent threat - claims now proved false. His statements at the time suggest that if he had been prime minister, Canadians would be fighting and dying in Iraq, and our role in the world permanently altered.
That issue leads to an examination of Harper's pledge for a massive increase in military spending. The Conservative platform calls for an immediate 10-per-cent jump, an extra $1.2 billion a year. Over time he wants to see spending increased by $8 billion a year - a 67-per-cent jump. The number of troops would increase by one-third, to 80,000.
None of the other parties propose such a massive increase.
My guess is Harper is out-of-step with most Canadians. Voters do believe that the military should be properly equipped, and that soldiers should not be sent on dangerous missions with inadequate support.
But Canada spends $12 billion a year on its armed forces - about $400 per person. Most polls suggest that health care or other quality-of-life issues rank as higher priorities with Canadians.
Both sides on defence spending find statistics to back their views. Most comparable countries do spend a significantly larger share of their GDP on their militaries. And Liberal governments did cut military spending to help balance the budget.
But Canada is still 11th out of 19 NATO countries in military spending, and in the top 10 per cent of countries around the world.
So why the need for so much more money?
The military's current mission includes three tasks - protecting Canada, defending North America in co-operation with the U.S. and contributing to peace and international security.
But the conventional military threat against Canada and North America seems remote. And there is little evidence that the best way to deal with any threats that do emerge is by adding thousands of permanent troops, or committing to more costly initiatives like the $10-billion frigate program.
And while it is fine that the military has a goal of contributing to peace and international security, it's much less clear that the best way of accomplishing that is with more soldiers and more new weapons. We have only 3,800 troops overseas now - 2,200 in Afghanistan, 200 in the Mideast, 500 in Haiti, 655 in Bosnia-Herzegovina. It's difficult, important work. But it is a small part of what Canada's military does, and one that could be handled without a massive spending increase.
In fact, Harper needs to explain why the extra $8 billion a year he wants to spend on the military couldn't be used to build peace and security more effectively in other ways. About 7,000 people a day are dying of AIDs in Africa, for example; their security could be helped more by medical and economic aid than more soldiers.
There are some real questions to be answered. Too bad the Liberals are choosing ineffective attack ads instead of asking them.
Footnote: The Liberals' attack ads have an inherent flaw. The party is in trouble in part because voters don't trust Paul Martin and company. But the attack ads will only work if voters believe them - if they trust the source. The only significant effect will be to make the Liberals looked panicky.

Tuesday, June 08, 2004

Harper does well in the sun, but campaign still just starting

VICTORIA - Quite a sharp contrast between the campaign visits here by Stephen Harper and Paul Martin.
Both men picked seniors' facilities. But, appropriately given the way the campaign is going, Martin came and went under a grey skies and rain while Harper hit town on one of the best days this year.
Martin took only half-a-dozen questions from reporters before climbing back on the bus, while Harper stood around for 40 minutes, long after handlers started looking edgily at their watches. Martin didn't have a whole lot specific to say, while Harper was willing - mostly - to respond directly to questions.
None of it matters that much right now. This is a strangely unformed election campaign. Talking to campaigners for all the parties, it seems the only consistent theme is that voters in B.C. feel more than usually abused by Ottawa. But they haven't yet decided what to do about it, which explains the close results in the polls and the large chunk of undecided voters.
One nice thing about that is that it means B.C. matters. The best seat projections put the Liberals slightly ahead of the Conservatives, 37 seats short of a majority. B.C.'s 34 ridings could make the difference on June 28.
The Liberals made a big push to reach out to the province this week, with the 'Dream Team' - or Parachute Club - candidates unveiling a 'made-in-B.C.' platform. it didn't really say much, waffling on offshore oil and gas, promising some unspecified action on grow ops, better roads between smaller communities and an overhaul of the DFO.
But the platform did raise some obvious questions. If these things are important, why aren't they in the main Liberal platform? And why do we have to send Ujjal Dosanjh, David Emerson and Dave Haggard to Ottawa to fight for the things that Stephen Owen and David Anderson were supposed to be looking after for the past four years?
The whole thing also created the odd sense ot the B.C. wing of the party running against their own party.
So what's your B.C. agenda, Harper was asked? British Columbians, like other Canadians, were mainly angry at an unresponsive federal government, he said. "We run on the same platform everywhere," he said.
Harper wanted to talk about programs for seniors at the Victoria stop. But much of his time was spent defending the Conservatives against Liberal claims that the party had a hidden side, one that ran contrary to Canadian traditions of respect for individual rights.
I'm not sure how successful he was. Several questioners asked him to respond to the comments of Calgary Conservative MP Cheryl Gallant, who had claimed that Canadians who exercised their right to choose an abortion and doctors who performed them were the same as the Iraqi terrorists who chopped off the head of Nicholas Berg.
I have a standing rule not to write about abortion. It does not lend itself to discussion in a 650-word column. But that was a remarkably stupid, hateful and destructive remark.
Harper only said pro-lifers tend to talk that way, and he doesn't think it's very effective. He promised not to introduce legislation changing abortion laws if the Conservatives the government. But if a private members' bill made it on to the floor of the House, he'd allow a free vote, he said.
That's highly unlikely, and it's also highly unlikely that any changes would pass even with a free vote. But Harper's easy tolerance of extreme views on what most Canadians accept as a complex, difficult matter of personal choice will scare many voters.
Not a bad start for the Conservatives. But the real tests will come over the next two weeks as voters try to figure out just what to do when they hunch over their ballots in some school gym, and all the parties try to avoid the kind of major mistakes that can change the campaign in an instant.
Footnote: Harper did come out in favour of offshore oil and gas development, noting the benefits it brought to Atlantic Canada and the provincial government's position. The Liberals are blocking economic growth in B.C., he said, singling out senior minister David Anderson. "A Liberal government, a Mr. Anderson Liberal government, would be disastrous for the economic development of this province."