Canadian Medicare

Canadian Medicare: We Need It and We Can Keep It

Stephen Duckett
Adrian Peetoom
Copyright Date: 2013
Pages: 184
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  • Book Info
    Canadian Medicare
    Book Description:

    Medicare has been a crucial part of Canadian identity for nearly fifty years, and it stands in marked contrast to the US health system. But these facts alone do not protect it from dismissive swipes and criticisms, claims that the system is unsustainable, and even proposals to change medicare's fundamentals. In Canadian Medicare, Stephen Duckett and Adrian Peetoom show that the shared values underpinning medicare still provide a sound basis for the system's design. While medicare remains an important pillar of Canadian policy, changes can and must be made. The authors argue for improved primary care to better address increases in chronic diseases, a comprehensive strategy to provide care for the elderly, and the introduction of pharmacare. They demonstrate how, with proper investment, the health of Canadians can be maintained and even enhanced while the nation remains financially responsible. Accessibly written and clearly presented, Canadian Medicare is a call for Canadian citizens to improve on the foundation built by Tommy Douglas and Lester B. Pearson, to become more knowledgeable about their health care, and to let their politicians know that they need to act.

    eISBN: 978-0-7735-8821-9
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. [i]-[iv])
  2. Table of Contents
    (pp. [v]-2)
  3. A Call to Action
    (pp. 3-13)

    There is no shortage of proposals for health care reform. Most take the general approach you will find in this book. Recommendations similar to many of ours may be found in older books, in newspaper and journal articles, in letters to the editor, and in conference speeches and have been raised in informal conversations among health care professionals. Here is a clear recent example, found in theGlobe and Mailon April 17, 2012, on page A₃ in an article by André Picard: “We need to fix our fundamental approach to delivering care – to put the emphasis on managing chronic...

  4. CHAPTER 1 Our Medicare Structure in Broad Strokes
    (pp. 14-28)

    Medicare is more than laws and regulations. As the Romanow report (2002) pointed out, from the beginning medicare has been an expression of our care for one another. As some other writers have said, it is as binding an element of Canadian life today as the railroads that connected East and West in the nineteenth century. Our medicare is a commitment Canadians made to one another more than half a century ago. In times of need brought on by health problems, we will continue to help each other financially. Medicare is ours. It is not the beneficence of governments, be...

  5. CHAPTER 2 Is Medicare Sustainable?
    (pp. 29-38)

    Here is what we have in mind when we contemplate the sustainability of medicare. Can Canadians continue to count on the tradition, now more than a half-century old, that their fellow citizens will help them to avoid the serious financial calamities that might result from illness and accidents? Moreover, can we enable health care professionals to help us cope well with the impact of chronic diseases and aging? Or will economic, demographic, fiscal, and financial forces overwhelm our commitments? Our answer to the first two questions is a resounding yes and to the third question a well-considered no. We tackle...

  6. CHAPTER 3 Medicare and Not Much Else?
    (pp. 39-54)

    In chapter 2 we addressed three economic challenges to the sustainability of our medicare that are regularly advanced in the media or in political speeches. We looked at the buzzwords used by those who feel that our medicare is unsustainable, in part or in whole: aging population; inadequate tax base; runaway costs. Although action is required to address all three situations, the evidence shows that Canadians can rest assured that our medicare can be sustained.

    However, sustaining medicare will require that steps be taken now to address emerging health issues. It is not particularly budget and taxation steps that are...

  7. CHAPTER 4 Let’s Get Healthier
    (pp. 55-67)

    In the remaining chapters we detail how to safeguard and improve medicare. Sprinkled throughout each chapter are clearly identified specific recommendations (in italics). You will find them also listed in appendix 1. We offer them as illustrations of how manageable the improvements to our medicare really are. They can serve as summaries that might prove useful in your conversations and correspondence with federal and provincial politicians.

    This chapter is grounded in our conviction that governments have a role to play in preventing health problems and promoting good health outcomes. Libertarians and ultra-conservatives will probably not agree. When in 2011 the...

  8. CHAPTER 5 Primary Care: The Foundation
    (pp. 68-85)

    Imagine a 50-year-old man who has a heart condition and has diabetes as well. His prospects for living a fulfilling, long life are good … provided he takes good care of himself. Taking good care of himself does not require regular acute care, lengthy stays in hospitals in the care of high-priced physician specialists and well-trained nurses. He can continue to engage in productive work, play golf, go on holidays, make love, and volunteer. However, to take care of himself he does need a support system. The first line of support is found at his home, where his partner watches...

  9. CHAPTER 6 Pharmacare: The Time Is Right
    (pp. 86-91)

    We have already argued that greater efficiency will guarantee the survival of medicare. When economists talk about efficiency, they mean more than producing something at the lowest possible cost. Their concept of efficiency includes social efficiency, which involves the reaching of desirable ends. For instance, it is not socially efficient for people to frequent hospitals, which provide expensive care, simply because they don’t have access to the right services in the community (which are much cheaper for governments and more beneficial for patients). Hospital care is simply not the best health care for certain conditions.

    With social efficiency in mind,...

  10. CHAPTER 7 Innovations in Health Care: Who Benefits?
    (pp. 92-97)

    We live in an age of unprecedented innovation in many areas of our lives. Health care is no exception. There is a steady flow of new drugs, new tools, new equipment, and new procedures. The first answer to the question in this chapter’s title is that untold millions have already benefited from innovations in health care.

    Adrian and his wife Johanna have personally experienced the blessings of innovations. Adrian had to have his appendix removed about one month after he landed in Canada in 1954. His belly was cut open, and he had to stay in the hospital for one...

  11. CHAPTER 8 Those Seniors Once More
    (pp. 98-112)

    We began chapter 5 with a dream for primary care. In it we pictured the ongoing care for a middle-aged man with chronic conditions. If we can realize that dream by developing primary care clinics for everyone, then life for all seniors will become easier and more pleasant, at least with respect to the health care they will need. However, more needs to be done for seniors. This chapter tackles the gap between the care received by seniors still living at home with or without some kind of support and that received by seniors in total-care nursing homes. To fill...

  12. CHAPTER 9 Hospitals: Quality, Access, and Efficiency
    (pp. 113-133)

    Hospitals are complex institutions staffed by highly educated and trained caregivers. They also have a long tradition of strong hierarchies. In this chapter we will touch on only some of their complexities. In the end, hospital care will be improved only if there is what we will call a just and trusting culture within each hospital. As in other areas of health care, we remain convinced that genuine progress will not be made until health care workers are given room to tackle their problems themselves. Only then will administrative prodding toward efficiency (including social efficiency) and provincial government policies (e.g.,...

  13. CHAPTER 10 Nurturing and Obtaining the Right Skills
    (pp. 134-148)

    Here is the heart of this chapter: health care professionals are bright, they have received many years of education and apprenticeship, and they naturally want to use their competence to the full.

    Sometimes a health professional is called to be a lone Good Samaritan, for instance in caring for a sick fellow passenger in an airplane or caring at the roadside for someone hurt in a collision. But such individual care is rare these days. Contemporary health care involves professionals and support staff working together. Perhaps our health care goal (see chapter 3) needs to read:The right member of...

  14. CHAPTER 11 Medicare Voices
    (pp. 149-166)

    Right from the first page we have maintained that Canada has a good medicare and that it can be sustained without crippling cutbacks or exorbitant taxes, but that it needs fine-tuning. Fine-tuning means making it more efficient, which entails both being cost conscious and providing (or enabling) the proper care.

    Not all Canadians are convinced (yet) that medicare can be sustained even if we fine-tune it. Some are not convinced for ideological reasons: anarchists think that we should have no governments at all; libertarians want to dramatically shrink governments and government systems of care for those who need care. It...

  15. CHAPTER 12 The Road Ahead
    (pp. 167-176)

    In chapters 2 and 3 we argued that Canadian medicare is sustainable. We looked at what’s been happening and what needs to happen. The moment has come to point the way to a secure future for medicare. Of course we cannot guarantee that our “prescription” will be implemented or even that it will be followed. All we can do is put up signposts to point politicians, health care providers, and managers in the right direction. They are the ones who will make the required changes. Our hope is that this book will help many more Canadians to prod them effectively....

  16. APPENDIX 1: Recommendations
    (pp. 177-181)
  17. APPENDIX 2: Key Canadian Health Organizations
    (pp. 182-184)
  18. Bibliography
    (pp. 185-186)
  19. Index
    (pp. 187-189)