Wednesday, March 30, 2011

Canada's Jack Layton & NDP on Healthcare

Tommy Douglas, architect of Saskatchewan's Medicare and first leader of the federal NDP.
Saskatchewan's Medicare was the precursor of the federal system in place today
A recent poll found that for Canadians healthcare is the top priority issue {at 18%}, as the election season gets out of the stating gate. Jack Layton's NDP goes after Conservatives' health policy with this ad::

The ad focuses on three issues:
  1. Inadequate emergent care capacity
  2. A shortage of physicians
  3. Woefully inadequate responses by the Harper government
In the Globe & Mail article the ad refers to, the BC NDP pointed to how the longterm impact of cuts affect provincial healthcare in the trenches. Sue Hammell, a BC NDP MLA responded to the issue::
“I think it is outrageous. What are we coming to when we are serving up our health care in a fast food restaurant?...The problems do not show up overnight...The problems of delay and cutbacks have shown up a number of years later.”
The upwards of 5M Canadians without a doctor and the physician shortage are problems that are likely to get worse without near-term action.

As an aside, the spectre of foreign physicians as a short-term solution to taking up the slack regarding the physician shortage is likely to be a future hot topic of discussion. In response to Saskatchewan's implementation of Medicare in 1962 {the Saskatchewan programme was the precursor for today's federal Medicare}, physicians organized a  doctors strike with public protests and one of the targets were foreign doctors deemed a certain peril and instrumental for Medicare's success::

click to see deep link at 5m36s of "Saskatchewan Doctor's Strike 1962 Part 1"
in a new window
It would be interesting to see how today's Conservative Party of Canada plays the issue of the possibility of an influx of foreign physicians to address shortages, given how they're trying to appeal to new Canadians in the GTA and older constituents with anti-immigration sentiments.

While Harper may be pleased to announce his $9M rural health initiative aimed at enticing 110 new doctors to leave the city, a drop in the bucket given systemic physician shortages, what happened to his 2005 promise to reduce wait times? His 2007 "Taming of the Queue" resulted in a patchwork of provincial initiatives that threw $612M at the problem with spotty results and now the money's gone. How's that for sound fiscal management? Meanwhile, although Harper's been careful to be in support of Medicare, he has gone on record as being in favour of market-based reforms and his policies reflect a self-fufilling prophesy. Conservative policy, like the "Taming of the Queue", is bad policy—exhibiting poor health planning, with expected results. One can only wonder if by not improving things, it paves the way for the market-based reforms he wants. Like I said in this blog on taxation, if there are problems with the efficiencies of government, well, fix the damn government.

Let's get back to the NDP's platform. The crux of the matter is access and affordability of health care for all Canadians. It's worth revisiting Tommy Douglas' take on Medicare in a CBC interview that aired a day before the Saskatchewan doctors' strike ended::

CBC Close-Up Interview of Tommy Douglas, NDP Leader, 22 July 1962,
click on image to play in a new window
Douglas' approach is to treat healthcare as a social infrastructure that's available regardless of one's ability to pay and provide access to healthcare to those who might be excluded because they aren't profitable patients.

Finally, it's worth addressing where Canada stands with respect to other nations. According to the OECD's 2009 "Health at a Glance" report::
  1. Canada’s spending on health per person is also higher than the OECD average, with spending of 3895 USD in 2007 (adjusted for purchasing power parity), compared with an OECD average of 2984 USD. Per capita health spending over 1997-2007 grew in real terms by 3.8% in Canada, slightly less than the OECD average of 4.1%.
  2. The public sector continues to be the main source of health funding in all OECD countries, except Mexico and the United States. In Canada, 70% of health spending was funded by public sources in 2007, less than the average of 73% for OECD countries.
Regarding the first issue, Canada is on par with a expenditure/GDP trendline with other OECD nations, from a 2009 report using 2007 data [pdf]::

A breakdown of the costs show complex and systematic problems, notably out-patient and pharmaceutical costs::

The costs per capita and the rise in costs speak to the NDP's concerns about the state of healthcare in Canada, given issues of access.

The second point from the OECD report is another issue that is in alignment with NDP policy. Canada's public expenditure on healthcare was 74.5% in 1990, but dipped to 70.2% in 2008. One implication of this is a rising per capita out-of-pocket cost for Canadians [xls-OECD 2010 data]::

It will be interesting to see how the Liberals address the health folder and I would surmise that the Conservatives will be laying low on this one. The NDP platform addressing improving front-line health services and their focus on making life affordable is a smart move in this political and economic climate. It defines a defensible positioning space on a key issue that the other parties have to respond to, combining the tactic of being first-mover with a relatively strong position. Moreover, I feel that this is a message that can resonate in Ontario, Atlantic Canada, and BC.

Twitterversion:: [blog] post using @jacklayton's #NDP ad on Harper's 'Tim Horton's healthcare' to elaborate on stakes for Canadian health @Prof_K

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