The COVID pandemic revealed many weaknesses in Canada’s health care system that had long gone unnoticed and underreported. After a fresh funding proposal from Ottawa in February but still no guarantees of systemic change, longtime political strategist and policy adviser Robin Sears has a prescription for reform, and some counsel for Jagmeet Singh on how to sell it.

Robin V. Sears

Every day in Canada, thousands of men and women struggle to offer the best patient care they can. The nurses and doctors try to stave off a health care system’s slow disintegration, working with fewer resources and fewer colleagues, over painfully long hours. 

It’s past time that we told ourselves some sad truths about the flaws at the heart of health care in Canada. As incredible as it may seem, no one is accountable for its performance, and no one manages those who work within it. By “manages” I mean the basic metrics of success or failure necessary to any system of setting goals, measuring performance, tracking outcomes and cohesively implementing change. 

In every province, we have health ministries whose thousands of bureaucrats try to pull the strings of our massive health care system, but in the end simply offer surface level administration and form filling. One hospital CEO friend told me that he must fill out 79 separate accountability documents every year.

After nearly a decade of squabbling over health care funding, in 2004, Prime Minister Paul Martin reached a deal with the provinces and territories that would see a $41.3 billion injection of new federal money into the system. It came with a series of pledges to do better on primary care, wait times and home care, among many other goals. There were no accountability mechanisms built into the new money. But it was described as a “health care solution for a generation.”

A Senate study of the outcome in 2012 concluded that there had been very little progress in the health care reforms, apart from a few “pilot programs.” Some wait times had come down for a while and then crept back up again. No one paid any price politically or financially for those failures.

On February 7, Ottawa pledged $46.2 billion in new dollars in a similar 10- year deal. (They claimed nearly $200 billion but that was the usual political padding, bundling old money commitments with new.) To bring these eye-watering stats to a more meaningful level: Martin pledged approximately $1,300 per year for every Canadian. Trudeau pledged approximately $100 less. There are six million more Canadians today than there were then. Again, there are no deadlines, no hard targets, and no accountability mechanisms built into the deal. 

Gurus of the health care policy domain, including University of Toronto’s Greg Marchildon, who served on the Romanow health care commission, say repeatedly that without rewards for success and penalties for failure we are stuck on this same carousel forever. He concedes the provinces would bellow if they were faced with actual performance commitments and financial penalties, but that it must be done. 

Similarly, provincial ministries of health try to force their hospital CEOs, their regional health organizations, and their professionals to meet better standards of performance. But without accountability mechanisms, they don’t have to listen and don’t.

Health professionals, especially specialist doctors, similarly are not accountable to anyone for their performance. The hospitals they work in, the provincial colleges of physicians they are nominally supervised by, cannot discipline them let alone fire them, unless they have clearly broken the law in their professional behaviour. 

The provincial health care bureaucracies are trained to say no, and  usually do, to any proposed change. They deny funding to innovation and refuse to elevate successful pilots into must-do best practices. Another health care veteran, a former deputy minister, says wryly, that provincial health bureaucrats really dislike only two groups: health care providers and their patients. 

We have a health care system that administers the flows of money to those who work within it, keeping the various warring tribes of doctors’ unions, hospital executives and a dozen other mutually hostile players from seizing someone else’s share of the vast health care expenditure pie. What’s missing? Management. 

There is no real management in a hopelessly change-resistant system that is costing us hundreds of billions of dollars a year. Doctors cannot be given orders. Provinces know they face little political risk for their failure to manage successfully the systems they own and have political responsibility for. 

It is therefore a fairly safe bet that there will be no noticeable improvement in our health care system by the next time Canadians go to the polls. As unfortunate as that is for voters, it presents a golden opportunity for Jagmeet Singh and the NDP. 

New Democrat strategists used to study polling numbers on health care, smile and say to each other, “That’s it then, once more to the well!”, knowing that an election fought on health care was usually a reliable vote-getter. That will be true again in the next campaign, but with a difference. 

To be believed, to defend their legacy ownership of the health care issue from Liberal poaching one more time, they will need to commit to a set of health care reforms that will be hard to digest for many in their base. Take three examples, all unanimously cited by experienced health care avdocates as urgent and essential: primary care, home care, and pharmacare. 

The only way to make a big difference in access to a doctor is to inject many dollars into new community team-based health centres, independent of the hospital empires. This will take money from hospitals, will make nurses and social workers peers of family physicians, and create hundreds of new centres of local power for provincial ministries of health to attempt to undermine.

Real advances in home care are equally threatening to the status quo power centres in health. Again, money will be siphoned from other systems, and the status and pay of personal support workers will need to be significantly improved.

A national formulary — a list and pricing for all drugs set unanimously by all governments — as opposed to the existing provincial and territorial ones, will enrage Big Pharma, a formidable enemy when challenged. When it comes as part of a national pharmacare plan — again, as many gurus in the sector say it must — it will be hard to keep insurers, giant drug store chains and doctors on board as each will have their current turfs and freedoms curbed. 

When we turn to management systems and goals, and the granular data systems needed to support them, there will also be winners and losers. Cardiac surgeons who consistently take twice as long to operate as their peers — a reality in every big hospital — will need to watch the clock more closely. Hospitals that consistently have hundreds of hours of empty operating theatres — again, the norm in many big city hospitals — could face provincial supervision. 

The federal leader who irrefutably meets the character and authenticity requirements of reforming health care is Jagmeet Singh. Like Tommy Douglas, who was a tough but affable, well-loved party leader, Singh overcame great obstacles on his way to success.

In other words, if we manage the health care system based on the same norms that govern business, the academy or a corner convenience store, the changes internally will be wrenching for some set in their unaccountable ways, but we will get faster and better care.

The lack of accountability in health care and the concomitant absence of trust by patients, will require of anyone seeking to be believed as the saviour of the system a life experience and authenticity that are unimpeachable. 

That person will be more credible coming from an underprivileged background, and to have, through character and determination, achieved personal and career success. If you have never had to fear what would happen to you or your family because you had no access to health care, it is hard to appreciate the panic in the minds of too many parents today. 

The federal leader who irrefutably meets the character and authenticity requirements of reforming health care is Jagmeet Singh. Like Tommy Douglas, who was a tough but affable, well-loved party leader, Singh overcame great obstacles on his way to success. Like Douglas, Singh had a bruising childhood including abuse and alcoholism leading to family break-up. Douglas’s guts, and his indomitable crusade for fairness in access to health care grew out of what we today would call equally painful “lived experience.” Singh’s focus on the challenges faced by those on society’s margins has similar roots. 

But does Singh have the will and the skill to face down a larger and more powerful enemy? In Douglas’s case, it was the potentially disastrous doctors’ strike of 1962, in Saskatchewan, he helped break it by encouraging his successor, Woodrow Lloyd, to bring in doctors from the UK. But the NDP had to make costly concessions whose damage still afflicts our system today. Deeply reforming health care today could well precipitate a similar showdown with doctors and drug companies.

Canadians have responded with incomparable resilience to the nightmares they have faced since the Great Recession. For many of us, this last decade — from Britain’s Brexit debacle, to the presidency of Donald Trump, to the deadly mobbing of the US Capitol, to the siege of downtown Ottawa by blockaders, to the apparently endless pandemic — has forced us to become more self-sufficient, more committed to family and community as a survival strategy. The suffering has reinforced many social bonds and solidarity. 

Like citizens of a nation in wartime, many people have gone out of their way to help those most afflicted by fire, flood and COVID. They are proud of their community work but they want better government-run programs, especially in health, which may be the one big policy question on the next ballot. 

The near-collapse of our health care system during the pandemic opened everyone’s eyes to its failures, and as even the prime minister has admitted, more money alone won’t solve this crisis. Neither will Doug Ford’s open door to the private sector. It will merely add another 20 percent in profit margin to our spiralling health care costs — and the unpreventable poaching of the best staff from the public system. This crisis is not a public vs. private failure, nor a funding failure, it is not even a medical failure. It is entirely a political failure. 

Children die waiting years for life-saving surgery because politicians have never forced hospitals to deliver and governments have never dared to try hands-on management. Voters are beginning to understand that, and they are very angry about it.

Three to four out of every 10 dollars Canadian governments spend is on health care and we get among the worst medical outcomes in the developed world. In its 2021 report on how US health care compared to 10 other high-income countries, the Commonwealth Fund ranked Canada 10th, just ahead of America. That is a definition of political failure. 

No one else has New Democrats’ credentials as creators, guardians and champions of a medical system built on social justice. But their urgent health care reform solutions need to be precise in their prescriptions, serious about deadlines and performance measurement, and able to be launched now. 

Most experts in the field agree that we need to do detailed real-time data collection, primary care, home care, and pharmacare as the most urgent reforms in the system. To be successful, Singh and the New Democrats will need to make credible offers on each.

Tommy Douglas spent years fighting the drug companies and the doctors’ multimillion-dollar campaigns against him, trying to demonstrate the fairness and efficiency of a well-run public health care system. He gave hundreds of speeches in his crusade. He would often end his speech with a passionately delivered, heart-breaking tale of another family crushed by their lack of access to treatment.

His stories would rise to a crescendo denouncing a shameful system where young children and beloved grandparents die, deaths suffered only because they were poor. As a child polio sufferer 

from a genteelly poor family himself, he felt these injustices personally. He would often close in a quieter somber voice, pleading with the audience to help him end these appalling cruelties. 

When he slowed finally to silence, the audience would sit frozen for a few seconds, then leap to their feet, clapping and cheering, many in tears. The unnecessary suffering we have allowed to creep into the system Tommy Douglas devoted his life to building has discredited that system. It is beginning to be seen as a national shame.

The best policy package always needs to be wrapped in a compelling human story passionately delivered. Jagmeet Singh can put his empathy and insight, and the stories of today’s health care tragedies to work in the service of launching a second Canadian health care revolution.

Contributing Writer Robin V. Sears, a former national director of the NDP during the Broadbent years, is an independent crisis communications consultant based in Ottawa.