A Sustainable Future for Health-Care Policy

Doug Morris, President, Morris Glass Inc. and Director, The Empire Club of Canada; The Reverend Vic Reigel, Christ Church, Brampton; Heather Ferguson, Director, Alumni Relations, Faculty of Nursing, University of Toronto and Director, The Empire Club of Canada; Dr. Kenneth Sky, Past President, Ontario Medical Association; Dr. Hugh Scully, Former President, Canadian Medical Association and Chair, World Medical Association Work Group on International Physician Migration and Work Force Issues; The Reverend Dr. John Niles, Rector, Victoria Park United Church and Director, The Empire Club of Canada; The Hon. Diane Cunningham, MPP, Minister of Training, Colleges and Universities for the Province of Ontario; and Hugh Segal, President, IRPP (Institute for Research on Public Policy).

Introduction by Ann Curran

Last week, I mentioned that one of the unique aspects of the Empire Club is that it is Canada's oldest speaking club of record. Through our yearbooks and our foundation's Web site you can read about the significant events, people and policies that have helped shape this country over the last 100 years--in essence, snap shots of what is happening in Canada and abroad. A prime example of this is the history of Canadian medicare.

In 1966, Dr. R. Jones, then President of the Canadian Medical Association, spoke about "Medicare in Canada." This was arguably the hottest issue in Canada at that time--the insurance of physician services to the people of Canada.

Since then, the club has had many experts from the medical, political. and legal communities, who have spoken about the pros and cons of Canadian health care, how it has affected Canadians and characterized our cultural identity and how it has compared to other health-care systems around the world.

In 1999, Dr. Hugh Scully, who is with us today, addressed the club on "Shaping Health Care for the Millennium."

Today, we have the pleasure of having the current President of the CMA, Dr. Henry Haddad, address the club on "A Sustainable Future for Health-Care Policy."

For those of you who may not be familiar with the CMA, it is the national voice of physicians and advocates on behalf of its members and the public for access to high-quality health care. It provides leadership and guidance to physicians. It also examines important issues in the health-care arena and their impact on the future of health in Canada.

Today. Dr. Henry Haddad will provide the details of the treatment prescribed by physicians to ensure that quality health care is available to Canadians and their families when they need it.

Dr. Haddad's remarks will form the basis of the CMA 's submission to the Romanow Commission.

Dr. Haddad is a professor of medicine and former chief of gastroenterology and vice-dean for professional and student affairs at the University of Sherbrooke, Quebec.

He was born in Sherbrooke and was educated at Bishop's University and at the University of Ottawa, where he obtained a medical degree in 1963. He completed postgraduate training in internal medicine and gastroenterology at Montreal General Hospital and the University of Pennsylvania respectively. Dr. Haddad has been on the faculty of the University of Sherbrooke since 1969 and was appointed full professor in 1982.

Please welcome Dr. Henry Haddad to The Empire Club of Canada.

Henry Haddad

Introduction and Setting the Stage

Thank you very much for that kind and generous introduction.

One of the reasons why the Empire Club is so valuable is because of the role it plays in our national life. The thing that unites us all here today is a common interest in the future of Canada. We put Canada first.

Bruce Hutchison, one of our country's finest journalists and political commentators called Canada, the "unfinished country." And in some ways we are.

Throughout our history our people and our leaders have focused on accomplishing common objectives so that our nation can move forward as one. Think of Sir John A. Macdonald and the national railway, our country's extraordinary sacrifice during times of world conflict, and the nation building of the latter part of the twentieth century. Bold leadership that created the Charter of Rights and Freedoms; bold leadership that created one of our most cherished national institutions--medicare.

Inflation is low and unemployment is on the decline. We are forecasted to have some of the strongest economic growth in the developed world. And we sit at the table of international decision making as a respected member of the global community.

But let me be uncharacteristically blunt. Despite this outlook, uncertainty over the future of health care is putting our nation's future at risk, and is holding us back from realizing the benefits that we have worked so hard, and sacrificed so much, to achieve.

To Begin, Uncertainty is Bad for Canada

Our nation depends on health care as a foundation for the strength of Canadian industry and its competitive position.

But uncertainty over the future of health care may undermine and erode the long-term health of our economy More and more frequently, ordinary people and their employers are being left to pay the bills.

And to make matters worse, our country has no roadmap for reform, no clear idea on how we will protect and afford health care in the future. Instead of working together on this genuine national priority, governments have sunken into the morass of bickering and even open political warfare.

This must not continue. So let's you and I send a message to the political leadership. Let's tell them that it ends here, today.

Human Cost of Uncertainty

I hear about it in my travels in community after community, when people tell me how worried they are that they can't find a family physician willing to take on new patients. But as a doctor and a parent I also live it.

I see it in the faces of my patients who after a six-month wait are told to get in line for three more months for a simple barium meal or ultrasound.

The human cost hits home when a patient with cancer, a patient who may have had to wait months for life-saving surgery, finally arrives at the hospital on the morning of his procedure. He may have steeled himself mentally and gone without food or water. And then suddenly the operation is cancelled because the operating room has to be shut down because there aren't enough health professionals (nurses).

The human cost of uncertainty includes telling this patient that even after this ordeal, you may not know when his surgery--his cancer surgery--can be rescheduled. Think about that for a moment. If it happened to someone you love...

Keeping it Simple

I originally got into medicine because I had a desire to help people and serve my community by trying to make things better. I've never been one to sit back and let

things just fall where they may. As a doctor and a teacher, I've always wanted to do what I can do to help people.

As President of the CMA and coming from Sherbrooke, I sometimes feel a little out-of-place in our nation's capital. That's because I have a simple, straightforward view about how best to end this uncertainty over health care and make a real difference in the lives of Canadians.

Here is what I believe:

I believe in putting patients and people first.

I believe in putting someone's health ahead of his or her ability to pay.

I believe in making health care genuinely more accountable to Canadians and their families.

I believe in opening the locked doors and windows of decision making, making it more transparent and inclusive.

And I believe in making changes based on what we know--using evidence--not what we simply think. These principles are what guided us in our efforts to improve health care for Canadian families.

Today, we released the results of this hard work when we delivered our prescription for sustainability to the Commission on the Future of Health Care. While we have some 30 recommendations that touch on all major aspects of our health system, they rest on three main pillars: a Canadian Health Charter; a Canadian Health Commission; and a modernization of the Canada Health Act, with locked-in long-term federal funding and federal tax reform from Ottawa.

As you will hear, these ideas must go together, because it is only together that these ideas can provide genuine certainty in health care and improve the day-to-day lives of the Canadian people.

In delivering our ideas to Commissioner Romanow, we emphasized one other thing. Canadians want action on health care. The time for talk is over. There is a lot of work to be done.

Canadian Health Charter

Canada's doctors believe that Canadians have the right to know exactly what to expect when they need health care. So at the heart of our prescription package is the Canadian Health Charter.

A health charter will spell out everyone's rights and responsibilities in providing and receiving health care--patients, health providers and even government. Crucially, it will also establish and entrench clear minimum national standards of access for different types of health care. Canadians should not have to face uncertainty when they are faced with a life-threatening disease.

These health-care access standards--guarantees if you will--will be very clear statements about the maximum time any patient in any province or territory should ever have to wait for care. If patients face a wait longer than the acceptable standard, they will be able to get the potentially life-saving care they need, even if it means going to another province, or another country. And they can take some comfort in the peace of mind that comes with knowing that the government will cover the cost.

I like to think of the health charter as shatterproof glass that protects our basic health-care rights from the uncertainty of economic or political shocks. Shocks will happen. We just think that they can't be allowed to harm the health-care rights of Canadians.

Canadian Health Commission

For the health charter to mean anything, someone needs to keep a watchful eye and protect these rights. That's where the Canadian Health Commission comes in.

Now, the last thing Canada needs is more bureaucracy, especially when it comes to health care. The health commission is very different. It will be a watchdog, an auditor general of health if you will, that protects Canadian families and fights to bring certainty to health care.

The health commission could have between 12 and 18 people drawn from across Canada as members--ordinary people and health professionals removed from the world of politics--and will represent the national interest. It would be headed up by a commissioner, operating at arms length from all levels of government.

Think about it. It would mean transparency. It would mean accountability. It would mean an end to the back-room decision making on health care that typified the '90s. The commission will hold our collective feet to the fire using one of society's most powerful enforcement tools. It will use the power of public persuasion to get real results. The commissioner will shed light on the black box of bureaucracy by reporting to the Canadian people and telling them straight up--like a report card--whether our national health standards are being met.

Reforming the Canada Health Act

To give the health charter and health commission the teeth they really need, as a nation we will have to make a difficult decision and modernize the Canada Health Act. It's served Canadians well but health care has changed dramatically since it was first drafted some 18 years ago.

At a minimum, we have to modernize the act so that the charter, commission and health-care guarantee are officially recognized.

We strongly believe that the act must be amended to incorporate the health-care guarantee--the assurance that if a person has to wait too long for care, they can go where they need to to receive that care, as well as have the right to prospectively purchase supplementary insurance to cover additional costs.

But we really need to do much more. Right now only hospital and physician services are considered "core services." As a country, it is imperative that we have a discussion about which other core services should or should not be available to the people of Canada and covered by the health-care guarantee. This discussion needs to be open and honest. It needs to be conducted in public, in the open, and it needs to be based on facts, not opinions.

Few decisions we make as a nation will be as important as this one. But we've proven before--countless times--that we can come together as a country and make decisions about our national priorities. We have the courage. And we must act now for our children's sake and for the millions of Canadians who want an end to the uncertainty. We must move forward and build public health care for the future.

Federal Government Must Pay Its Fair Share

Now, it goes without saying that ending uncertainty in health care will take time and a lot of energy.

It also means a financial investment in the future and the federal government paying its fair share of health-care costs.

The 1990s delivered a near fatal blow. Cumulatively, Ottawa withdrew over $30 billion from health care with cuts at the provincial level having an impact too. These cuts, while defensible from a fiscal policy point of view, took a terrible toll on the health-care system.

Now think of the incredible scientific and technological advances--like MRI scanners or gamma knife neuro-surgery--that have emerged in recent years. These advances mean longer, healthier lives for people, but they are also very expensive. So we need to find ways to pay for them too.

So with the deficit dragon now slain and health-care needs rising every day, there could be no better time for Ottawa to invest in the future of health care. And end the uncertainty. The federal government can't continue to lump all the different transfer payments together and, with the wave of a wand, call it health-care funding. And it cannot keep pretending that the tax points it transferred

to the provinces decades ago are actually federal funding for health care.

Our nation can afford to invest in the future of health care. Did you know that for the fiscal year just ended, the experts are forecasting a $10-billion budget surplus in Ottawa? And as best as anyone can tell, there won't be any new investment in health care. This is on the heels of the last budget--with no new investment in health care either. The politicians need to get off this merry-go-round--now.

Federal funding must keep pace with GDP growth and should be locked into the target of 50 per cent of provincial per-capita health spending for core services. Canadians need this investment so they can count on minimum national standards of access actually being met.

And to modernize health-care information technology and take action to deal with the underlying problems associated with the national shortage of health professionals an additional $2.5 billion is needed.

An investment of this scale obviously means working in genuine partnership with the provinces and territories. And on this point, I want to make one thing quite clear. When I say our politicians need to get off the merry-go-round, I mean the provinces too.

All of us should ask ourselves, what happened to the money our country set aside several years ago so the provinces could invest in health-care technology? No one really knows. This is unacceptable. And that's why the Canadian Health Commissioner will report on whether the provinces are holding up their end of the health-care bargain too.

Modernizing the Tax System

There is one more thing we can do to end the uncertainty over the rising costs of health care. Ottawa should reform the tax system so that it better supports the health priorities of Canadian families.

Why is it that if we choose to take care of our elderly parent in our own homes we are left out in the cold, but if our parent goes into an institution we can get financial help? Why aren't Canadians who care for a family member or friend who is very sick receiving a tax credit for their hard work and sacrifice? This example, and others like it, point the way to reform.

Are there tax incentives that might help families afford the cost of noninsured health care? We don't have all the answers, but I believe that tax reform has great potential to make immediate change for the better. And that is why a Blue Ribbon panel of Parliament should immediately be established to investigate and make concrete recommendations on reforming the federal tax system.

Conclusion

Before I leave you, let me say this. I read an article in the National Post a few weeks ago about a recent report on health reform. It said meaningful health reform is unlikely in Canada because ideas are not specific enough, there isn't likely to be funding and that health professionals are unwilling to compromise.

I was saddened to hear someone say yet again that we can't do it.

That there is no will... That there is no money... That there is no commitment to real change...

Can you imagine if this was the attitude of Canadians who built the railway.

Or how about the Canadians who fought in World Wars I and 11.

Or the Canadians who built our modern dynamic nation with hard work and determination.

A Canadian Health Charter, a Canadian Health Commission and the other ideas I've talked about here today can help end the uncertainty that is keeping our country from taking its rightful role in this new century.

It's simple. A nation that cannot provide solutions to the problem its own citizens say is their biggest worry, is not the nation that Laurier envisioned or the nation that I want to leave to my children.

I'm not a politician; I'm just a doctor from Sherbrooke. But I've also seen the incredible and the impossible happen every day in my practice when we all work together.

Let's not settle for anything less than the very best. Let's build on the many strengths of what we have, and restore Canada's place among nations as the envy of the world when it comes to health care.

Thank you.

The appreciation of the meeting was expressed by The Reverend Dr. John Niles, Rector, Victoria Park United Church and Director, The Empire Club of Canada.