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It’s time we talked about health care this election

The 2015 election campaign is well underway and the airwaves are fully saturated with political messages. Yet, of particular concern there seems to be a conspicuous absence of any talk regarding Canadian health care and the devastation caused to the system over the past 9 years of Conservative rule. In the only debate so far with all the national leaders, healthcare was given a passing mention only 3 times. At the same time, a recent poll highlighted that 73% of Canadian voters feel ‘fixing healthcare’ is an absolutely crucial policy plank for parties to address to win their vote. Another poll showed that close to two thirds of Canadians would support a political party committed to negotiating a new health agreement between Ottawa and the provinces and committed to annual funding increases for health care. A recent Abacus poll found, “56% of voters aged 45 and over said health care is their top concern. Even 43% of Millennials—those aged 18 to 29—put health care as their No. 1 issue. That’s higher than job creation, taxes, middle-class incomes and the environment.” While everyone has their pet issues they want to hear discussed, it seems a vacuum has been created where the national narrative only focuses on the economy and foreign policy. Public health care is a ‘key issue’ for Canadians, so why aren’t our leaders talking about it?

A Macleans article this week highlighted that, “Elections are as much about controlling what is not being debated as they are about what is being debated. That’s why Stephen Harper has not sent out a Franklin-style search party looking for the lost health care debate. He wants this election to be about the economy and security, not health care.” It is clear why the Harper government does not want to talk about healthcare: they have walked away from the health accord (resulting in $43.5 billion cuts in health care transfers over the coming years and loss of national standards); reduced the Canadian health transfer to provinces (for all provinces except Alberta); implemented cruel and unusual cuts to the Interim Federal Health Program for refugee claimant; demolished the Health Council of Canada; increased privatization promoting in our public health system through wasteful p3s (five provincial auditor generals have discovered that P3s end up costing much more while providing less service); and, failed to show any leadership on a national seniors strategy or universal pharmacare. This list is by no means exhaustive but it highlights the structural dismantling of medicare occurring in Canada and further opening the door to two-tier health care.

(Council of Canadians activists action to stop the sun from setting on medicare at the 2015 Council of the Federations meeting)

Even the Canadian Medical Association, not normally known for moving off the fence and issuing bold statements, has grown vociferous about the lack of attention health care is getting.  CMA president Chris Simpson recently stated, “We’ve got a $220 billion health care system and nobody’s in charge. It’s crazy…” In an excellent editorial in the Canadian Medical Association Journal (a prominent medical journal for peer-reviewed clinical research and health policy), Dr. Matthew Stanbrook, the journal’s deputy editor, outlined why it is so crucial that health care be discussed seriously this election.  He stated:

“Too often, at election time, we neglect our health care concerns and let economic fears dominate how we vote. This must change, immediately…  By all appearances, the federal government seems to be trying to get itself out of the health care business. It cannot. Without such leadership, Canadians will continue to suffer… Recent years have seen Canada’s health care system race to the bottom of quality rankings compared with peer nations that have prudently invested in maintaining a strong social safety net… Of great concern is the change in the federal philosophy behind funding — areas that are more aligned with business interests are increasingly favoured. No matter how fruitful such partnerships might prove, science and health must never be relegated to being secondary means to an economic end.”

The last 20 years have seen successive federal governments unwilling to act beyond superficial nods to the evidence before them. As a result, Canada is now ranked 17th among OECD nations in life expectancy while we were ranked 8th in 1980. For their part, Canadian Premiers finally addressed the elephant in the room when they recently asked the federal government to step up to the plate and cover at least 25 per cent of all health care spending by the provinces and territories.  ( Originally, Medicare was a shared responsibility with each level of government contributing 50 per cent of the funding. Last week, Quebec Premier Philippe Couillard wrote to the leaders of all federal parties, “renewing calls for them to take into account aging populations when calculating the $32-billion Canada Health Transfer.”  The Premiers also realize that within the next 25 years, the number of Canadians aged 65 and older will double, reaching 10 million nationally, correlating in increased health care costs.  These issues are by no means insurmountable, but the issue remains a lack of real leadership at the federal level. So why are our national leaders so silent?

(Council of Canadians activists force the Premiers to acknowledge the elephant in the room -the health accord – at the 2015 Council of the Federations meeting)

The silence is deafening.  At best Canadians get a passing remark about health, but no in depth discussion from the party leaders.  Sure NDP leader Tom Mulcair recently stated, “I’m more than willing to sit down with the provinces and territories and come up with a new health accord,” and Liberal leader Justin Trudeau said that he is, “willing to work with the provinces,” (though he didn’t specifically address the issue of health transfer payments or substantial details). But, any robust discussion on health remains nonexistent. Former parliamentary budget officer, Kevin Page, recently echoed this position saying, “It’s a major missed opportunity for the opposition parties… Rarely do you have this much public support around an issue, and yet you don’t see it prominently displayed in any party platform.”

The problem is not a failure to understand the problems, but the will to make health policy that is guided by creating the conditions for all people to enjoy true health.  To put it another way, there are evidence based answers to improve our public medicare, but there are no magic bullets or simple solutions to the complex challenges. Both ‘upstream’ and ‘downstream’ proposals to protect, strengthen and expand our public health care system take thorough research, imagination and time before the benefits become apparent. Sadly, the parties are underestimating the ability of Canadians to understand the current situation and that they realize there are no quick overnight repairs in medicare. Election campaigns have become the territory of sound bites, exercises in rhetoric and branding political parties as capable of leading the country; they are no longer about providing ideas that are visionary in scope and revolutionary in their effect on our health. However, it only takes one party leader to put forward a show of clear leadership on health care to make the others respond. 

Canadians know what ails us, and it is avoidable. They also know that our public healthcare requires leadership and that anything is possible if we come together and demand an equitable, healthy and caring nation.  Hopefully, when we head to the polls on October 19th, the election narrative will have shifted to include what remains a foremost priority for Canadians, universal public health care.