Why Isn’t Health Care A Major Campaign Issue?

Canadians’ commitment to a publicly funded universally based health care system remains as strong as ever. Yet the debate over the future of health care continues to rage on. The competing narratives should be by now familiar. On the one hand, commentators incessantly remind us that our health-care system is unsustainable and that difficult choices must be made. A failure to rein in costs will result in enormous pressures on governments to curtail spending in other areas of crucial importance such as infrastructure and education. On the other hand, defenders of medicare insist that cuts in health-care spending will lead to the gradual erosion of government commitment to upholding the principles of the Canada Health Act. The pressures are exacerbated by the country’s shifting demographics. The population is aging. As people get older they are likely to require health care. How should costs be contained enough that the principles underpinning the Canada Health Act are preserved?  Should we allow the private sector assume a greater role in the delivery of health care? These are the sorts of questions ceaseless reports have attempted to answer and Canadians have pondered for the last two decades at least.

Strangely, however, health care hasn’t assumed any meaningful role in this campaign. This is due, in part, to the apparent uniformity in health-care platforms among the major parties. All federal parties commit themselves to preserving medicare, for the simple reason that failing to do so will severely compromise their election prospects. Indeed a highlight of each party’s platform this campaign is the promise to increase annual health-care spending well beyond the anticipated rate of economic growth. The conservatives especially hope to benefit by the apparent sameness in party promises: if all parties are committed to a funding increase, then the election need not be a referendum on the future of health care in Canada. More importantly, Canadians need not fear what a Harper majority would mean for the future of health care in this country. But is it really true that there is nothing to distinguish the party platforms where health care is concerned?  Is it true that Canadians have nothing to fear in a Harper majority?

The Canadian Medical Association (CMA) recently attempted to answer the first question; in doing so they perhaps unwittingly shed light on the second as well. The CMA conducted an election survey designed to encourage the main political parties (the conservatives, liberals, NDP and the Bloc; the Green Party was not part of the survey; no reason is given for their exclusion) to address the specific issues that will most shape the health care system in the coming decades. Research, home and palliative care, pharmacare and human resources recruitment strategies are the four issues singled out by the CMA. The respective party responses to their survey questions are revealing.

What is perhaps most noteworthy about the survey was the conservative party’s refusal to participate in it. Their repeated response to the CMA was to point to their election platform where, it was promised, all answers to all pertinent health care questions could be found. The response is in keeping with the arrogance demonstrated by the conservatives this election. Is it too much to ask of the party how they would address specific health care related problems and priorities? Or do they feel, as their former leader Kim Campbell once remarked, that elections are not a good time to answer difficult questions? For although the conservatives insist otherwise, their platform states little more than a promise to work “collaboratively” with provinces and territories, to reduce wait times and to address the doctors and nurses shortages in rural areas of the country.

Those promises, however, do not begin to address the precise issues raised by the CMA. For example, the survey asks if the parties in question would consider “introducing a comprehensive national pharmacrare program or a national catastrophic drug costs program?” They also ask what parties would do to ameliorate the growing crisis in home care. Both questions stem from a worrisome trend: health care costs are increasingly being transferred from medicare to individuals and families. By refusing to participate in the survey, the conservatives give no hint as to how they would address these twin challenges.

By contrast, the Liberals and NDP at least acknowledge the challenges associated with both pharmaceutical drugs and home care. In both areas, provincial standards vary, and costs are escalating at an alarming rate for many Canadians. The liberal response thus includes a promise to harmonize standards among provinces and territories. The NDP, among other things, promises to ‘bargain’ with pharmaceutical companies to reduce the costs of drugs. Both parties propose various tax breaks designed to ease the financial burden of home care and drug costs on families. The problem, according to those who study the issue, is that tax breaks are but one strand of the sort of comprehensive response that is necessary. More needs to be done. None of the parties, for example, address the need for better access among home care patients to nurses and doctors. Their reluctance is no doubt attributable to the costs of doing so. Indeed, the challenge for governments is to at once assume and contain costs associated with home care and drugs. How is this conundrum to be resolved? Parties don’t have the answers.

They should be paying closer to attention to ideas emerging from the CMA. Under Dr. Jeffrey Turnbull’s presidency, the association has more emphatically committed itself to not only defending medicare but transforming it into a more sustainable system. Medicare, according to Dr. Turnbull, isn’t characterized by wasteful spending; but it is characterized by inefficiencies. Many chronically ill patients, for example, can be treated at home at a fraction of the cost required to treat them in the hospital. Money saved in this way could then be used to improve home care. Hospital-acquired infections could be dramatically reduced through the widespread adoption of checklists reminding health-care providers to wash their hands before seeing a new patient. Housing and treatment facilities for the homeless prevent the sort of illnesses that land them in hospitals on a regular basis. Give a homeless alcoholic a drink and a place to sleep and chances are he will not acquire liver disease, tuberculosis or HIV. His life chances will also be improved. Indeed, preventative measures save money as well as restore lives. Dr. Turnbull’s work at Ottawa’s Salvation Army and Sheppards of Good Hope is a testament to this idea. If medicare is to be saved, it will be because of these sorts of innovations in our approach to treatment and human health.

The CMA was right to attempt to make its presence felt in this campaign. The survey goes a long way towards making the health care debate at once more expansive and precise. And it sheds a revealing light on where the three major parties outside of Quebec stand on the issue of health care reform. It’s too bad not many Canadians seem to have noticed.