Health is the first wealth
By Mr. Bernard Lord and Dr. Arthur Porter
Our health care debate is becoming increasingly emotional, confusing and polarizing. We all know we face health care challenges and we all know we need to find solutions. If we can begin at a place where we all agree, then just maybe we can find common ground in our search for those solutions. And so we thought there was no better place to begin than with Ralph Waldo Emerson’s famous words: “health is the first wealth”.
Universally accessible health care was an idea that arrived in Canada essentially in the 1960s, and though other countries have also put that idea into practice, no country has more profoundly embraced it than ours. There is little, with the possible exception of hockey, that so marks the identity of Canadians and the values we hold than the deeply held notion that need, rather than wealth, should dictate access to care.
Forty years into our common project, commitment to accessible health care remains strong. However, we are beginning to appreciate that while values can be passed on, the world in which these are expressed is rapidly changing. Those who framed our modern health care system knew nothing of CAT scans. Even if they had heard of an MRI, they could hardly have predicted that use of this type of imaging would become routine in the diagnosis of many of the diseases that afflict us. From heart and lung transplants to angioplasty and stents to the advent of personalized medicine, the recent pace of medical and technological evolution has been truly remarkable. The future of health care is clearly a promising one.
At the same time, new technologies, drugs and surgical techniques have put tremendous financial stress on our public health care system. Over the next twenty years, the number of Canadians over the age of 65 will double, creating more fiscal pressure on an already strained system.
Increased demand will mean increased supply. How many more beds will be needed? How many more doctors? Nurses? Surgeries? How will we pay for the added services? Answering these questions will require sober assessments of the costs of senior care and the extent to which it is fair to ask the youngest generations to carry the financial burden by our increasing the debt or cutting into other vital public interests such as education.
Do we need a complete overhaul of our system? Of course not. We have a health care system that is envied by many, and for good reason. One of the highest life expectancies and one of the lowest infant mortality rates in the world has helped maintain Canada's continued lofty ranking on the United Nations Human Development Index as one of the world’s “most liveable” countries. There is so much our health care providers do well.
But we do need to focus our attention on today’s realities and the very real challenges they pose. As Canadians, we have chosen to organize much of our health care in a way that obliges the collective to respond to the needs of the individual. Now, as concerned individuals frustrated by long wait times and as responsible citizens worried about rising costs, we know that the collective system is in trouble.
And so we find ourselves on the doorsteps of change. There is a health care model that responds to the demographic needs, technological advances and fiscal realities of the 21st century, and we need to find it. If collectively we do not find it, then individually we will. More angry citizens will push for health care reform through litigation. More private clinics will pop up randomly across the country. More Canadians will search for solutions elsewhere. In turn, governments will be scrambling to react. That is one way for public policy to change.
There is a better way. That is for all of us to contribute to this public dialogue and, together, forge a plan that guides public policy in the direction that we believe is best and that most reflects the priorities we set and the values we hold.
We are not the only country taking a hard look at its health care policy. Our neighbours to the south are poised to embark on just such a journey. Many Americans look to us, see the time it takes to get treated and say, “we can do better”. Many Canadians look at the U.S. system, see the striking lack of accessibility and say the very same thing. Let’s put national pride aside for a moment. What if we are both right?
We have important decisions ahead of us. We have tough choices to make. At every critical point in our history, Canadians have risen to the challenge. Health care will be no different. Together, we will find our way and protect that wealth we so cherish.
*Dr. Arthur Porter is the CEO of the McGill University Health Centre (MUHC) in Montreal. Bernard Lord is a former premier of New Brunswick and currently with the Montreal office of McCarthy Tetrault. They recently founded the MUHC Institute of Strategic Analysis and Innovation as a vehicle for promoting debate about health care policy. *
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