5 Minutes With . . .

Piecing Together the Health Care Puzzle

André Picard
Globe and Mail journalist and
2011–12 CIBC Scholar-in-Residence

February 7, 2012

André Picard, one of Canada’s top health and public policy commentators, is assessing the policies and the politics of health care reform as the 2011–12 CIBC Scholar-in-Residence.

A journalist at The Globe and Mail since 1987, Mr. Picard has received much acclaim for his writing and for his dedication to improving health care, and is a four-time National Newspaper Awards finalist. He won a National Newspaper Award in 2007 for his contribution to a series about cancer care in Canada and was named Canada’s top newspaper columnist in 2010. Mr. Picard has received the Michener Award for Meritorious Public Service Journalism, the Canadian Policy Research Award, and the Atkinson Fellowship for Public Policy Research. He is the author of three books.

His one-year term as Scholar-in-Residence began in September 2011. In addition to undertaking research for this project, Mr. Picard will collaborate with staff at the Conference Board throughout the year. He will be the featured speaker at a public lecture in May 2012 in Ottawa. The program will culminate with the publication of the fifth book in the CIBC Scholar-in-Residence series in autumn 2012.

By financially supporting the Scholar-in-Residence program, CIBC continues its tradition of advancing research and dialogue on issues of national and global importance.

InsideEdge: Why did you agree to become the 2011–12 CIBC Scholar-in-Residence?

André Picard: First of all, being named the CIBC Scholar-in-Residence is a great honour, not least because the words “scholar” and “journalist” are rarely used in the same sentence. I’ve been writing about the Canadian health care system for a couple of decades. It’s a great job, but it has limitations. In the mainstream media, we cover a fair bit of health policy, but we do it in sporadic bursts, when a “crisis” arises or when an issue enters the political realm. As a daily journalist, you rarely have the chance to go beyond the rhetorical cut-and-thrust and provide context, historical perspective, and analysis.

The Canadian health care debate has become tediously repetitive and stagnant. We need a new approach—one that focuses on solutions, not problems. As the CIBC Scholar-in-Residence, I have an opportunity to take all these pieces of the puzzle I’ve gathered over the years and try to present a coherent picture of what I think the health care system—and medicare, in particular—should look like. That’s what I hope to do in the monograph I’m writing.

InsideEdge: When you look at the status of Canada’s health care system in 2012, what is the prognosis?

André Picard: The only thing Canadians like to complain about more than the weather is the state of health care. But this relentless whining blinds us to the fact that we do a pretty good job of providing state-of-the-art health care to a diverse population of 33 million spread over an enormous geographic area. Could we do better? Of course. But we’ve done the important stuff right. We have a universal, single-payer insurance system that’s cost efficient, excellent health care providers, and a pretty decent social safety net to complement the sickness care we provide. In other words, we have a solid foundation. What we need to do is modernize the structure that we’ve built on that foundation, to bring it into the 21st century.

The structure we have was designed principally to deliver physician and hospital care to patients with acute illness. That was great in the 1950s. But today, the majority of patients need chronic care, ideally delivered by a team of health professionals. That shift is underway but it’s been really slow. We need to accelerate the process and embrace transformation. For a variety of reasons, I think public health professionals, politicians, and the public are ready to make the leap. My belief is that we’re very close to a tipping point, and there’s going to be a lot of exciting and overdue change in the near future. In the coming years, we’re going to see the most profound change in the health system since the advent of medicare 60 years ago. So, as unusual as it is for a journalist, I’m optimistic and excited about the future of medicare, and the health care system more generally.

InsideEdge: If, as many contend, the system is neither sustainable in its current form nor providing the care that Canadians should expect, what needs to change? And where do we start?

André Picard: Like a lot of Canadians, I’m tired of hearing the health system isn’t sustainable and that health care spending is going to bankrupt us. I expect more than that from our political, business, and social leaders. A universal health system is essential if you want a country that’s healthy and productive on many levels; it’s an economic driver and it’s a tool for social justice. So the first thing we need is a change of attitude. Enough with the scare mongering; enough with the sky-is-falling rhetoric. Stop telling me medicare doesn’t work. Fix it!

The second thing we need is clear goals. The only goal we seem to have today in health care is to spend more money than we did the year before. We need to provide for the basic health needs of everyone, in a coherent fashion, from birth till death. But universal coverage does not mean medicare should cover all interventions for all people all the time. Public health insurance should cover care that is necessary, effective, and affordable. For most citizens, it should be supplemented with private insurance. That’s not a radical philosophical shift. It’s actually how our medicare system was designed to function. But we’ve lost our way; we’ve become health care wastrels.

InsideEdge: What is the role of the business sector in health care provision and reform?

André Picard: Canadian health care is a vast $200-billion-a-year enterprise that employs 1.1 million people. Everyone has a role to play in the provision of care—for-profit businesses big and small, non-profits, charitable groups, and individual providers—and everyone should have a say in reform. The distinguishing feature of medicare is that, at its core, it’s a single-payer system; that means it is publicly (and centrally) administered.

The public insurance system pays the bills, but most health services are delivered by private providers. That includes physicians (who are independent contractors), hospitals (most of which are charitable or non-profit entities), drug companies, equipment manufacturers, laboratories, and home care and nursing homes (both of which are run by a mix of private and non-profit companies). Technically, the only public sector employees in health care are those who work in provincial ministries of health and various public health services, though nurses and other unionized hospital workers are de facto civil servants because their contracts are centrally negotiated and imposed on institutions. It’s a myth that the business sector is shut out of health care in our “socialist” system. It’s also a shame that business is not a lot more vocal about the benefits of public health insurance on their bottom line.

So what can the business sector do to promote reform? It can set an example by putting forward balanced, doable proposals that benefit the whole population, not just protecting its turf, and every sector and interest group needs to do the same. For reform to happen, we need a climate for rational debate. We need everyone to put a little water in their wine.

InsideEdge: You have covered aspects of health care ranging from the tragedy of the tainted blood scandal to the inspiring work that charities and health groups do. What keeps you involved and engaged?

André Picard: There is probably nothing more precious than our health. Health care matters to people, a lot. People want the care to be there when they need it, for themselves and their loved ones. They want the care to be prompt, safe, and affordable. But they don’t necessarily understand how the system works, how policy is formulated, and how policies can impact their individual health. My job is to help them understand. I do so by exposing scandalous failures (like tainted blood), by highlighting innovation, and by cutting through the political gibberish to explain what’s really going on in health care. At least, that’s what I try to do! It’s work that’s always challenging, never boring, and, hopefully, makes a difference occasionally in improving care.