FEBRUARY 2008
VOLUME 5 NO. 2

POLICY & POLITICS

The Interview

Clement impatient for wait times fix

Despite his famous nickname, federal health minister 'Two-tier' Tony Clement says he has no plans to rewrite the Canada Health Act. The man who cut his teeth fighting SARS and pioneering P3s as Ontario's health minister is now on a mission to slash the country's wait times. NRM talked to the British-born politician, yes, about wait times — and then we threw him some curveball questions from you, our readers.


When's the last time you saw your family doctor? I actually had a throat infection over the holidays, so I had to get what I call my horse pills. I said, "I tried to fight it, for 12 days I was fighting this throat infection." He said, "12 days! I usually say three days." They don't usually want you to come in on the first day, so I was definitely not trying to overuse the healthcare system.

Do you have an executive health deal? No, just a regular family doctor.

Does he gripe a lot about healthcare when you see him? No, he's pretty good that way. We do talk about health policy, but he doesn't have a list of grievances, it's not a petitioning session.

Are his comments useful? Sure. He's a good guy and he's seen my political career from the start of it, and he was the family doc for all three of the births of my three children, so, you know, I've been with him a long time. We talk about hockey too. He's a big Leafs fan but I don't hold that against him.

Let me guess — you're a Senators devotee? I'm a Habs fan. When I was growing up that was the era of Scotty Bowman and Lafleur, Gainey and, dare I say, Dryden. Yeah, so I became a Habs fan.

Do you and Ken Dryden get along nowadays, being on different political teams? Not really. He's too bitter. I think he has to loosen up a little bit.

Canadian healthcare stinks, according to Canadians. A recent Commonwealth Fund survey found that 60% of us think our healthcare system needs fundamental change — more than any other country surveyed, including the US. In fact, the number of people who wanted fundamental, root-and-branch change actually declined in Canada. I think that's because all governments, including the federal government, have really focused in on wait times. The lengthening of the wait times was starting to have an impact and obviously more money has been spent. But more money is not the solution. It's how you spend it.

Wait times are high on your agenda. Yeah. I see the federal health portfolio in perhaps a fundamentally different way than some of my predecessors. We had a campaign commitment to establish, with the provinces and territories, patient wait times guarantees. That was a first year promise and we delivered it early last year.

But how do you know the guarantees will work? Well, we don't. So my approach is to try some things out. I rail against those prophets of healthcare reform who want to change the system radically overnight. That's a very high risk enterprise. What if it doesn't work? We could in fact make things worse.

When will we know if it's working? I think it's going to take a couple of years.

And how much money are we going to throw at it before we know? We've committed over $600 million from the last budget. But my point is — look, the idea is worthwhile. It's a new idea for Canada, but it's not a new idea in the world. In fact, many countries have gone past their first generation of wait times guarantees. In Sweden, for instance, they went from a flat 90-day guarantee, every procedure available within 90 days, and bumped it down to 60 days. We're still at the earlier stage, but we can learn from that.

Physicians ask the questions

Mr Clement, I'm a dedicated, proud, but not twice foolish, Canadian doctor with a family of four, who stayed and fought through the SARS epidemic and lost a close colleague and friend, Dr Nestor Yanga. What provisions has the federal government provided in the event medical people go down in the fight against the pandemic bird flu when it hits, like Dr Yanga did? Personally I don't think we, in Ontario, are anywhere near prepared and next time I plan to take a 'holiday' from my office at that time as do many other physicians I have spoken with.

— Dr Paul Stephan, family physician, Thornhill, ON

Look, the fact is whatever hits us next, there'll be some aspect of it for which we will be unprepared — that's the nature of the pandemic. If we were prepared for the pandemic, the pandemic wouldn't arrive, it would be strangled at its source. But are we better off than we were in January 2003, five years ago, a month and a half before SARS emerged? The answer is most definitely, yes, we are better off.

There's a huge disconnect between the government and medical licensing bodies on the subject of IMGs. The whole IMG licensure process is extremely lengthy, disheartening and unfair at times. Is the government finding any ways of streamlining this — for example, a federal body to assess IMGs' credentials, as the NDP proposed?

— Dr Arinder Malik, neonatal cardiologist, Brantford, ON

What we're working on is having a federal clearinghouse that would untangle some of the bureaucracy and the confusion. That's not in my bailiwick, that's the immigration minister, but something we committed to and will be rolling out.

Canada has a growing number of old people with cognitive decline and due to a dearth of longterm care beds, these patients end up 'bed-blocking' in EDs and acute hospitals. Do you have a plan to deal with this looming health issue?

— Dr Pierre Laplante, neurologist, Montreal, QC

The hospital can't be everything for everybody. There has to be community-based healthcare as well and that's what a lot of provinces are doing. Obviously we're going to be facing more dementia in our society as more people age. There's some amazing scientific innovations and discoveries going on in this area, so I'm actually quite optimistic. We're down to the molecular level now, not even cellular level — that's old hat.

One of the loudest criticisms against the guarantees is that the provinces are just picking the easiest targets to meet. Yeah, the low-hanging fruit.

Do you think it's a problem? I don't think so. The provinces were saying, 'You know what, we are doing so well all we need is to shave off a week here or a few days there and we can say for every single person in the system this guarantee is there so you will get the care you need.' Whether it's in cataracts or joint replacements or cardiac, access to diagnostics, for cancer, I think that's actually the right way to approach it rather than empty, half-baked promises that don't help anyone.

But doesn't that mean we're not actually guaranteeing a reduction in wait times but rather guaranteeing to maintain the status quo? Or even making things worse — in one case, radiation oncology, the benchmark ended up being longer than the one set by the radiation oncologists themselves. You're going to get folks, specialists, that they think it should be 90 days rather than 60 or 60 rather than 90. That's a healthy clinical dialogue to have. The way other countries have approached this is entirely different. They've set a flat guarantee across the whole system. Maybe at some point we'll be ready for that — we're not right now.

Wouldn't it be easier to have one federal set of wait times guarantees? Here's the advantage and the disadvantage of the Canadian healthcare system: everybody wrings their hands because you've got 14 systems, you've got 13 provinces and territories and the federal government. 'Gosh, wouldn't it be easier, wouldn't it better if we had one system, run at the federal level?' That's like wishing the sky were purple.

Do you wish the sky were purple? No, I like to wish for things that are realistic. That isn't the way the country was put together, so stop pining over something that will never happen.

Before going federal, you served as Ontario's health minister — including during the SARS crisis. How does that experience affect the way you serve as federal health minister? When I say I look at the job of health minister differently it's because ultimately doctors and hospitals are primarily a provincial concern and I am respectful of that, I term it 'Not wishing to stomp over the flower patches of the provincial governments.' The last thing we need is another health minister being an overlord, telling the Ontario health minister or the Quebec minister, 'That's unacceptable' or 'We should be doing this.'

Did you feel that way when you were that Ontario health minister? I did, I did, I did. I did feel that way as an Ontario minister with the previous Liberal government in power. We need a federal health minister who is concentrating on things where the federal government has primacy, where we can help lever in certain areas. Like the wait times guarantees or Canada Health Infoway or the National Cancer Strategy. That's appropriate. There are areas that have been neglected by previous health ministers because they have been too busy trying to be provincial health minister.

Like what? I think food and product safety. It hadn't been touched in 40 years, and then, lo and behold, our product recalls increased by 300%. Our food recalls were a matter of great concern, spinach and whatever else. When I started digging into this, I realized Health Canada officials had been toiling in obscurity, trying to put the figurative finger in the dam. They had very arcane and archaic legislation and they didn't have the focus and the resources. So here is an area where I should have primacy, where we should be moving ahead with new legislation and we are.

Are you for more private delivery? They do call you 'Two-tier Tony' after all... I'm always pragmatic about these things. There are certain instances where that's appropriate and desirable, and others where that doesn't work as well. In the cases where it doesn't work as well you shouldn't be ideological about it, you should always strive to deliver the best healthcare you can at an affordable cost to the taxpayer.

You worked as an advisor to a private healthcare service delivery firm in Ontario called Closing the Gap the year before you were elected to federal office. In order to be sustainable for the future, as our blessed baby boomers start to retire in huge numbers and as they start to consume massive quantities of healthcare, to think you're going to keep to the status quo I think is forlorn hope. Having said that, Canadians expect that in our system we would not systematize jumping the queue and we would not create a parallel private funding system so that you could pay your way to a private doctor or pay your way to a private hospital. Canadians would not accept that. Those who are advocating for that, the two high profile advocates of that kind of change are within the Fraser Institute, Mike Harris and Ralph Klein, two former premiers who never did anything of the sort when they were premiers. So what does that tell you?

So how about that "Two-Tier Tony" nickname...? Sticks and stones, right? I never worry about kind of stuff. You're the first person to mention it in two years.

Interview conducted by Sam Solomon

 

 

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