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.
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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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