Universal health care across the country is under attack from Conservatives, like Ford and Kenney. They appear to be using the same playbook for underfunding, downsizing, and cutting health care services while ramping up privatization of those same essential services.
In a recent interview, Ron Hikel, political scientist and management consultant, stated, “It’s quite clear that, every provincial government in the country is running in fear of the demand for additional expenditures in health care that they can’t meet.”
Hikel went on to say, “It’s not too long ago the federal government was legally committed to paying 50 per cent of the province’s cost of the health care system. They’ve reduced that to only a fraction of 50 per cent. Some people say 25 per cent, some people say 30 per cent, but they are all complaining and pressing the Federal government to return to covering at least substantially more of the cost of the health care system than the are now.”
The provinces having the greatest difficulty delivering effective publicly funded health care are the same ones in which the premier is intensely unpopular. And, according to Hikel, this common problem is one that has huge political implications.
There are direct and physical political costs to the current inability for the provincial governments to meet what the system itself is demanding as additional funding.
In 2001, Hikel was deputy minister of health in Manitoba. At that time, there was a two-person committee which acted as coordinators for the Canadian health care system. The committee included a representative from the Federal government and another from the provincial level.
“Fortunately for me it was Manitoba’s time to provide one of the two people for this committee. So, David Dodge and I were the co-chairs of the Federal Provincial Council of Deputy Ministers of Health. It was a fascinating job.”
Hikel described this experience as being the most deeply satisfying experience of being a civil servant that he has ever had because as he stated, “You could see the benefits to the population of what you were doing.”
Hikel realized the health care system is enormously complicated. He sees that as both a serious and persistent problem that has profoundly complex clinical, organizational, managerial, and political dimensions. According to Hikel, this makes it, “One of the most complicated systems in existence in modern society.”
It’s extremely difficult for anyone, including people who are working full-time in it, to really understand what is going on in the health care system at any given moment.
Much of the discussion about health care concerns a problem that needs to be solved. However, finding both the parameters of that problem and the solutions that are going to work has become increasingly difficult and more complicated.
According to Hikel, “There’s been a persistent tenet within the medicare system in this country, that some people have tried to expand the scope of the private sector.”
Hikel went on to say, “There probably are some specific, fairly narrowly defined aspects of health care delivery that could be effectively handled by the private sector to an extent beyond which they are currently doing. But, the fundamental nature of the system has got to remain either dominantly public or dominantly private.”
Hikel described the United States’ system as problematic because neither the private sector nor the public sector dominate the system. That guarantees that the two diametrically opposed systems are constantly fighting. While many of the fundamental problems in the U.S. health care system have been confronted, ultimately, they have not been resolved.
Hikel believes that in Canada, “It is of enormous importance that the public sector continues to be the dominant rule maker and definer of the fundamental characteristics of this system. Because the minute that they lose that dominance, the system is going to begin to deteriorate.”
If you listen to doctors and nurses, they will tell you that the Canadian public health care system is deteriorating—a direct result of provincial austerity measures that have led to waitlists, backlogs and increased anxiety for patients.
During a trip to Wisconsin as deputy health minister, Hikel recalls, “Sitting in the reception room waiting for my meeting to start, I see a health care magazine in front of me and I pick it up. I looked at the headline on the front of this magazine and the headline was, ‘Making the Emergency Room into a Profit Center,’ and my hands started to shake. I just about got sick to my stomach. But there are people in this country today who are trying to do exactly that. We’ve all got to hope that they fail and quickly.”
Hikel acknowledges the continuing assaults on the health care system. He knows first-hand the enormity and complexity of a system that requires substantial additional incremental funding.
However, Canada’s universal health care system also requires clarification regarding authority—specifically around who is responsible for running the system and making decisions about it.
According to Hikel, “To the extent that there is confusion about who’s in charge, the system is going to suffer.”
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