Opinion: Where's the debate on health care?

By SCOTT D. SMITH
http://www.thewhig.com

A shibboleth is a test used to verify one’s origins or allegiances. In biblical times, those who could not pronounce the word’s “sh” sound were identified as outsiders.

A shibboleth for Canadian politicians in recent election campaigns has been to profess an unwavering commitment to an exclusively public health-care system. The public-private debate, which should be the overriding political debate regarding our health-care system, remains the third rail of Canadian politics, untouched and unexplored in a meaningful way by national leaders. At the same time, in many provinces private for-profit clinics are providing elective procedures, while large elements of the health-care apparatus, such as prescription drugs and physiotherapy services, have been significantly privately funded for years.

The silence of our political leaders is unproductive. It is time to stop equating limited private health-care ventures as an embracing of the dreaded “U. S. for-profit system.” Such enterprises can help to alleviate some of the many burdens on our troubled health-care system by improving access and patient care.

The past two presidents of the Canadian Medical Association (CMA), have been strong advocates for more private-sector involvement to alleviate some of the strain on the Canadian health-care system. Dr. Robert Ouellet, a radiologist from Montreal and the 2008 CMA president, has said that it is not a matter of replacing our public system but “about improving it, by allowing the private sector to intervene in a complementary way in areas where the public sector is unable to provide services.”

Areas where the private sector is already active are orthopedic surgery clinics and diagnostic imaging clinics. Such private enterprises improve patient care for those who can afford private services, as well as for the majority who cannot, by decreasing wait times. For elective surgeries, such as knee arthroscopies, a private clinic can offer a wait time of days instead of a wait time of six months or longer in the public system. The difference can mean a summer spent in discomfort or a summer spent on a bike and at the golf course.

But this is an emotional issue for Canadians and many worry that allowing private clinics into the mix will result in a two-tier system. We clearly need a debate on the subject, but it is currently absent from this federal election campaign.

Instead, the five major political parties, driven by fears that the American economic crisis will migrate north and the politically chic topic of our day, have chosen to focus on the economy and the environment. These are important issues, but health care also needs to be on the table. For the Liberals in particular, after the poor resonance of their Green Shift policy with the public, health care presents an opportunity to attack the ruling Conservatives, whose promise to establish a comprehensive patient wait times guarantee has fallen behind schedule.

While the party leaders and media continue to ignore health care as a major issue, the Canadian public recognizes its importance. In a recent Angus Reid poll, 79% of Canadians identified health care as a very important issue for Canadian voters, a higher than for the economy, the environment, poverty or the war in Afghanistan.

Along with the public-private debate, other important health-related issues include the five million Canadians without a family physician, lengthy wait times for specialist referrals and inadequate infrastructure and home-care programs to provide care for elderly and chronically ill patients in our communities. These are not academic discussions without local relevance – all are relevant to Kingston.

Recent estimates are that up to 20,000 Kingston residents don’t have a family doctor. That means that one in six Kingston residents lacks access to primary care and must seek attention at walk-in clinics, which lack continuity of care, or at the busy emergency departments at Hotel Dieu Hospital and Kingston General Hospital. This places further strain on an overloaded system. The quality of care and patient satisfaction both suffer when patients lack a family doctor – two reasons why the College of Family Physicians of Canada states that every Canadian should have a family doctor.

In September, the Kingston Economic Development Corporation announced that it had successfully recruited six new family physicians to the Kingston area, each with the ability to roster between 1,000 and 1,500 patients. This is welcome news for the many people searching for a family doctor. Although such successful recruiting strategies are often achieved at the municipal level, we are still lacking a comprehensive plan to address the family doctor shortage in this country.

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