Amid all the pre-election mudslinging,
Ottawa politicos seem to be forgetting one of the key
issues that gave us such a fractious parliament in the
first place: healthcare. The parties floundered on this
one last time round, which is in part responsible for
the current winter election. Will they again? Most probably,
but this time there's a chance we'll face ineffective
healthcare policies from a majority government. Tory
leader Stephen Harper has been droning on about Liberal
corruption (even the ill-timed Brian Mulroney tapes
haven't dampened his enthusiasm for this) and stopping
gay people from getting married. Jack Layton's failed
power grab last month has tarnished the NDP's image.
The Bloc Quebecois' Gilles Duceppe is coasting on the
Gomery report. All the while Paul Martin is sitting
pretty, taking the relatively high road much preferred
by the docile Canadian electorate.
For physicians, the possibility
we'll be facing down a flu pandemic this winter is even
more wearying than the looming snow-covered election.
Everyone in Ottawa is more worried about votes than
vaccines — for more than one reason, winter isn't
a great time to go to the polls.
The parties' platforms on health,
as on most things, are vague at best. The NDP is likely
to carry on its private war against private healthcare.
The Conservatives are going to be "tough" on healthcare,
and not touch the public-private debate with a 10-foot
pole. The Bloc wants Quebec to have its own national
hockey team (that's pretty much their platform right
now). The Liberals will throw more money at the problem,
if we'll just give them another chance.
If Paul Martin is re-elected and
gets a majority, the biggest policy that will affect
healthcare is not really a policy at all. It's more
like a slow-moving continental drift, one that will
have Pierre Trudeau turning in his grave: decentralization.
Paul Martin has already ceded unprecedented control
over spending to the provinces, and he's likely to continue
on this path — not least to appease restless provinces
like Quebec and Alberta.
What this will mean for Canadian
physicians is that healthcare disparities among the
provinces are likely to widen. If a powerful healthcare
lobby has the ear of, say, the BC premier and conditions
for both physicians and patients are improved there,
doctors from other parts of the country are likely to
flock west. This trend is already in evidence. A report
released in late November by the Health Council of Canada
showed that inter-provincial doctor poaching is rampant,
with the richest provinces actively recruiting physicians
from "have-not" provinces. Between 1999 and 2003, BC
gained 466 doctors from other provinces; Alberta nabbed
345 and Ontario 241. On the losing side were: Newfoundland,
which lost 269 doctors, Quebec and Saskatchewan which
lost 263 each, Manitoba (185) and Nova Scotia (95).
So, this is good news if you live
in balmy BC, but it could be time for the Newfoundland
Medical Association to think about moving to smaller
digs. On the surface, Paul Martin's decentralizing frenzy
sounds good for healthcare — no more edicts from
Ottawa that are far-removed from local realities. But
the hidden consequences of pandering to regional demands
is the level of care will become even more unequal.
Is it fair that one patient should have to wait far
longer for knee surgery than another just because they
happen to live in Saskatchewan instead of BC? And is
it reasonable for a physician who sets a broken arm
to bill much more if they live in Alberta than if they
lived in Quebec?
Of course, everyone's worst fear
about a national pay strategy (with obvious adjustments
for local cost of living) is that the feds would put
on their Scrooge cap. But one of the valued tenets of
the medical profession, and one that's increasingly
under siege, is your right to work wherever you want
in this country. If you hold dear your freedom of movement
it's worth considering equalized healthcare that lives
up to Canada's motto, A Mari usque ad Mare (From sea
to sea). — Gillian Woodford, news/editor
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