Taking the Pulse of Canada’s Health Care System

Venerable journalist Jeffrey Simpson’s new book, Chronic Condition, examines and challenges why debating health care issues has become endemic rather than a healthy exercise. In this, his eighth book, Simpson challenges the populist understanding of the history of health care by exposing common myths, and he debunks some ideas about the future of health care. In response, UVic’s Department of Human and Social Development invited the author to discuss his book at an event called “Taking the Pulse of Canada’s Health Care System” on Oct. 1. Simpson eagerly took part in the debate over his findings, and afterwards he sat down to talk about it with the Martlet.

Host Mary Ellen Purkis (dean of the Department of Human and Social Development) introduced Simpson’s co-panelists: Ken Fyke, a health-care expert who led the Fyke Commission on Medicare; Georgina MacDonald, Vancouver Island Health Authority’s (VIHA) Vice President of Planning and Improvement; and moderator Dr. Evert Lindquist, Director of UVic’s School of Public Administration.

Simpson gave a short synopsis of Chronic Condition, which examines redesigning medicare to suit shifting demographics, and Fyke expressed his appreciation for the amount of research that went into the book. MacDonald concurred with the concepts in the book, adding that we need to go further. “Population aging, worker attrition and a shrinking economy suggest we are heading for the perfect storm,” she said.

Members of the audience challenged some precepts in the book. In response, Simpson stressed his own frustration, citing Marc Lalonde’s 1974 landmark work, New Perspectives on the Health of Canadians, and the 2010 report Creating a Healthier Canada: Making Prevention A Priority as being entrenched in the same pitfalls. Simpson said these famous “ringing declarations” on social determinants of health are just “a reinvention of the wheel” that don’t progress towards the unpopular but necessary choices.  Nonetheless, in the spirit of progressive problem-solving, Fyke suggested that restricting salt content in low-budget foods could prevent 25,000 strokes a year.

Early in Simpson’s book, past Canadian Medical Association President Dr. Jeffrey Turnbull is quoted suggesting that indices for Hepatitis C Virus (HCV) are as bad in some parts of Canada as in sub-Saharan Africa. Simpson was reluctant to discuss such particulars at first. “I know nothing about Hepatitis C. Next question.”  Since there are major economic implications behind the current HCV epidemic — which often leads to an undiagnosed, frightfully slow and expensive death — why do Dr. Turnbull’s concerns not sway Simpson’s argument?

“Social determinants of health are important but they are difficult to deal with,” he said. “They are more difficult than straight-up conversations about elements of delivering public health. Social inequalities, income inequalities, are much more difficult to deal with than some of these particular current health care issues. Social inequalities take a long time to deal with.”

Simpson responded to a question about why the federal government is looking to build prisons instead of senior care facilities. He corrected the question by saying, “No, actually they announced, perversely, that they are [now] cutting the correctional services, and the irony of that is that the tough-on-crime legislation will mean that there will be more prisoners and probably more incidents of health-care costs as a result.”

Subsequently, Simpson talked about a book review last month in the Winnipeg Free Press in which Alan Katz accused Simpson of advocating privatization of the health care as kind of a “silver bullet solution.” Simpson strongly disagrees with the Katz analysis. “Yeah, that is complete bullshit,” Simpson said. “As was explained [in the forum] by Ken Fyke, and as was explained in this book, we’ve had private delivery since the day Tommy Douglas signed the deal with the doctors. What I am saying is [that], as the population ages and governments are constrained and hospitals are jammed, we are going to have to have more private delivery of publicly funded services, which has been extremely common in Sweden and elsewhere [for care of the aging]. That does not mean that I favour wholesale privatization of the system.”

Chronic Condition by Jeffrey Simpson is an intriguing work that navigates through difficult issues. If you don’t have time to read the entire book, make sure to review chapter 12, which covers the why and how of consensus building.  We need to ask ourselves questions as we ride in what Simpson calls “Chevrolet services at Cadillac prices.”

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