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Lawrie McFarlane: Health-care system needs a full reboot

The system has grown so convoluted and overstretched that it literally cannot be managed.
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Canada has 13 licensing regimes for doctors, on top of layers of credentialing for nurses, technicians and other caregivers, as well as 10 independent provincial health-care plans, each with different rules and procedures, writes Lawrie McFarlane. DARREN STONE, TIMES COLONIST

When Health Minister Adrian Dix said last month that high demand for emergency medical care may be the “new normal,” this was widely taken as an admission of failure.

And so it was. But not for the reasons many believe.

By all means, the evidence of failure is everywhere. Not enough physicians, not enough nurses, not enough operating rooms, near-criminal mismanagement of long-term care homes in Ontario and Quebec during the COVID outbreak. I could go on.

But the problem is not so much lack of funds, want of leadership, or federal indifference, though those are all factors.

Rather, the leading cause is atrophy, decrepitude, or just plain aging.

The Medical Care Act, which launched our ­universal health-care system, is nearly 60 years old. Much of the inspiration that drove this ground-breaking step ­forward has over time been dissipated.

Much of the energy that accompanied it has been swamped by red tape, petty bureaucracy and legalistic roadblocking.

Much of the path ahead is hidden from view by the very institutions set in place to guard it.

These are not symptoms of mismanagement; rather, they are symptoms of aging.

It starts with a slow wandering of the corporate mind, a loss of attention to what matters.

Thus we have Prime Minister Justin Trudeau ­verging off in pursuit of a new dental plan or a new drug plan, as evidence mounts that we can’t sustain the medical services we already have.

Some of it takes the form of unseemly middle-age sprawl.

Thus, countrywide, we have 13 different licensing regimes for doctors, on top of layers of credentialing for nurses, technicians and other caregivers.

We have 10 independent provincial health-care plans, each with different rules and procedures, none of them employing interlocking databases, none regularly ­talking to the others.

We have increasing medicalization far beyond the reach of necessity.

We’ve medicalized minor conditions like social ­anxiety.

We’ve medicalized childhood hyperactivity.

We’ve medicalized street violence.

None of these failings were foreseen when our national health service was in its formative stages. Nor would they have been tolerated had they reared their heads.

But now the system is grown so convoluted, so ­overstretched, its original promise so diluted by an immeasurable number of foot-draggers, that it literally cannot be managed.

In the private sector, the solution would be swift and conclusive; bankruptcy or a hostile takeover.

But these options aren’t on the table here. What then should be done?

We have to start by recognizing that fiddling around the edges isn’t a solution.

The entire system must be reinvented.

That must start with a rewrite of the 1984 Canada Health Act, which defined the relationship between Ottawa and the provinces.

Both a carrot and a stick will be needed.

The carrot is an offer by the federal government to restore the 50 per cent funding it promised. The stick is a threat to cancel all funding if the provinces won’t comply.

And what must the provinces do? First remove the bureaucratic obstacles to foreign-trained doctors, cancel the absurd requirement for an undergraduate degree before gaining entry to medical school, and open at least one educational facility in each province devoted to training family physicians.

Second, restore professional colleges back to their original goal — protecting the public, instead of the goal they now too often pursue — protecting their members.

Third, greatly narrow privacy legislation to prevent health-care bodies using it to hide their misdeeds and evade accountability.

Fourth, give pharmacists far wider ­authority to ­prescribe drugs. Alberta allows pharmacists to ­prescribe all drugs except narcotics and other ­medications associated with addiction.

Following that lead would greatly increase access to prescription medications.

Lastly, reinvigorate the Patented Medicine Prices Review Board, which is intended to control runaway drug prices, but which that Quisling federal Health Minister Jean-Yves Duclos gutted as a favour to the industry.

Will any of this happen? All one can say is that it had better.

Lawrie McFarlane was B.C.’s deputy minister of health in the 1990s, and before that CEO of Saskatchewan’s first regional health authority.

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