Chronic Condition: CARRFS eNews is reviewing Jeffrey Simpson's book Chronic Condition

In 2012 Jeffrey Simpson, the Globe and Mail’s national affairs columnist, took a close look at the state of the Canadian Health Care System. In his new book Chronic Condition he outlines what is wrong with the system and how to fix it. Patrick Imlay, Senior Communications Officer, Government of Ontario reviews Simpson’s new book.

First Published, March 2013

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Canada’s preeminent national affairs columnist is not afraid to tackle today’s issues. Be it climate change, income inequality or the economy, The Globe and Mail’s Jeffrey Simpson speaks truth to power.

In Chronic Condition, Simpson takes on the “third rail of Canadian politics:” Medicare. Costing approximately $200 billion annually, and growing faster than government revenues, poll-watching politicians are reluctant to discuss health care reform. Those that do are accused of supporting a U.S.-style, two-tier system. 

Simpson wants to shake Canadians out of their comatose-like complacency. He's the Cassandra warning that health care’s challenges must be addressed now before it’s too late. To trigger this discussion, he provides a prognosis of the patient.

Through the eyes of Dr. Jeffrey Turnbull, chief of staff at the Ottawa Hospital, we’re given a front-line view. Then following a brief history of universal health care, including its origins in Tommy Douglas's Saskatchewan and the federal government's contribution, Simpson measures health care's performance.

First, how good is Medicare? Not that great value-for-money wise. Canada consistently ranks in the top five for per capita health care spending with less than satisfactory results. 

How much does Medicare cost? Currently comprising 42 - 45 per cent of provincial program spending, health care will likely consume more than half of provinces’ budget by the decade's end.

And the most controversial measure of all: Is there a role for private health care? Most Canadians would be surprised to discover that while 70 per cent of health care spending is public, the remaining 30 per cent comes from private sources.

In the book's final section, remedies are recommended. These include: measuring doctors' performance (Canada's 69,000 doctors are among the world’s highest-paid); establishing not-for-profit clinics to free up emergency wards; and aligning hospitals' communications system to reduce wait times. Simpson also showcases Sweden’s private-provider/public-payer model to reduce costs. For example, while the state controls the ordering of pharmaceuticals, private and public pharmacies openly compete. This helps reduce the cost of pharmaceuticals–which in Canada represent the second-largest health care cost after hospitals.

While well-researched, Chronic Condition neglects a key player: The patient–an odd omission considering the recent interest in patient-centred care. And the fact that one per cent of Ontario’s chronically ill patients account for almost 50 per cent of total hospital costs and 32 per cent of total health costs.

Also, with health care priority number one according to the opinion polls, Simpson doesn't offer ways to engage Canadians. Listing well-known critiques of Canada’s health care system is one thing, but suggesting ways to mobilize mass, sustained interest is quite another.

This by no means negates Chronic Condition's immense value as a health care policy primer. Already bursting at the seams, and inadequately structured to care for an aging and increasing unhealthy population, Canada's health care system faces fundamental challenges. Either we continue avoiding the issue or undertake a long overdue adult conversation. Jeffrey Simpson has done his part. Are we ready to do ours? <>