Do We Care?

Do We Care?: Renewing Canada's Commitment to Health

Margaret A. Somerville Editor
John Ralston Saul
Richard Cruess
Bob Rae
Nuala Kenny
Raisa Deber
Copyright Date: 1999
Pages: 160
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  • Book Info
    Do We Care?
    Book Description:

    One of Canada's preeminent social thinkers, John Ralston Saul, begins the book with a harsh reminder that public policy can be successful only when driven by the humanistic principles which fueled its formulation. Once saving money becomes a goal in itself, rather than "something we do on the side," public policy has little chance of survival. In subsequent chapters introducing the five key areas, Dr. Richard Cruess (McGill) and Dr. Sylvia Cruess (McGill) write on the physician's role in society; the Honourable Bob Rae tackles the political challenges of health care in the consumer era; Professor Raisa Deber (Toronto) looks at the rightful place of economics in health policy; Sister Nuala Kenny (Dalhousie) examines the ethical dilemmas we face; and Professor Bernard Dickens (Toronto) describes how current health care issues are perceived by the law.

    eISBN: 978-0-7735-6794-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
    (pp. ix-x)
    (pp. xi-xvi)
    Dr. Margaret A. Somerville

    The somewhat bland title of the conference this book is based on,Directions for Canadian Health Care: a framework for sound decisions,encompasses a highly controversial area of public policy that is of profound importance to all Canadians. I had initially suggested a more dramatic title for the conference, such as “Is Health Policy Killing Canadian Health Care” or “Should We Take Canadian Health Care Off Life-Support,” but the other organizers thought that the subject was of sufficient import to not need additional hyperbole.

    The fundamental presumption that guided the structuring of the conference and the way the speakers were...

    (pp. xvii-xviii)
    Bernard Houde
  6. Health Care at the End of the Twentieth Century: Confusing Symptoms For Systems
    (pp. 3-20)
    Dr. John Ralston Saul

    When the word “vision” is evoked today, it usually refers to an apparently desperate need for new ideas and new directions to resolve society’s fundamental and destructive problems. We regularly advocate abandoning a tired, unfortunate past in order to progress to something entirely new. This tendency to consider only what are perceived to be new solutions is one of our era’s most dangerous failings, as it often serves a purpose quite different from solving problems. Over the past half-century, it has consistently served as one of the great mechanisms for taking power: you first convince people that what they have...

  7. Chapter 2 Clinical Considerations in Health Policy

    • The Impact of Health Policy on Clinical Decisions and the Doctor-Patient Relationship
      (pp. 23-35)
      Dr. Richard Cruess and Dr. Sylvia Cruess

      Before addressing the impact of health policy on clinical practice, we will begin by briefly stating our views on the issues we plan to neglect; issues that are the mainstay of current debates on the future of clinical practice. For one, we do not intend to discuss the idea of a privatized parallel sector in the health care system. We are firmly committed to a single standard of care and do not consider it possible to achieve this objective in the presence of a parallel private sector open only to those who can afford it. We also believe, however, that...

    • Creating a Sound Clinical Basis for Health Policy: Three Views
      (pp. 36-46)
      Pat Kelly, Dr. Terrence Montague and Dr. Hugh Scully

      Canada’s health care system is currently experiencing many problems. Despite the $12.5 billion in federal lunds spent annually on medicare, the standard of care is not acceptable to many Canadians, and the public is angry and frustrated that constant tensions between different levels of government, institutions, and health professionals are affecting care and patients’ relationships with their physicians. The gulf that now exists between patients and practitioners, payers and politicians reflects the public’s deepening lack of confidence in the medicare system; a crisis of confidence that mirrors an intense personal frustration among many Canadians. It is a sense of frustration...

    • Additional Thoughts on How Health Policy Can Respond to Clinical Imperatives
      (pp. 47-50)

      Hugh Scully: It is very hard to put resources into public health when the public is demanding acute care in the emergency room because that is where their point of contact is. If there was more of a margin to maneuver in the system then we would be able to accomplish more.

      Margaret Somerville: But it seems that the relationship with high tech is really what is driving expenditures at this time.

      Richard Cruess: Dr. Scully is a high-tech doctor. I was an orthopedic surgeon, a high-tech doctor. The biggest waits are for total hip replacement and cardiac surgery. This...

  8. Chapter 3 Economic Considerations in Health Care

    • The Use and Misuse of Economics
      (pp. 53-68)
      Dr. Raisa Deber

      Many discussions about health care justify universal, comprehensive coverage on grounds of “equity” and “Canadian values,” but assume that hard-nosed economic considerations would instead justify a more U.S.-style “two-tier” model. Similarly, policy makers often tend to assume that Canadian spending for health care is somehow out of control, at least as measured against other industrialized countries. Closer examination reveals that both of these statements are myths, based on a misinterpretation of both the available data, and of economic theory.

      Economics is called upon in discussions at all levels of health care, from the macro level of examining overall systems, to...

    • Where Does Economics Belong in Health Policy: Three Views
      (pp. 69-81)
      Nathalie St-Pierre, Dr. Devidas Menon and Dr. John Wade

      Mixing economics and public health policy can form a dangerous cocktail. Quebec’s new universal drug insurance plan, brought in two years ago, highlights the difficulties of reconciling economic imperatives with health policy. I will examine Quebec’s drug plan in this light, and look at where the economic burden of the plan now falls.

      The idea of a drug insurance plan was first suggested by the Hall Commission in 1964, and was proposed again by the Castonguay-Neveu Commission in 1970. After 30 years of pressure from various public interest groups, the government finally agreed to consider a plan in 1996, although...

    • Additional Thoughts on the Assumptions Behind the Numbers
      (pp. 81-86)

      Rachel Miller: Several years ago I wrote a publication on the economic burden of illness in Canada, which basically took the national health expenditure and attempted to break it down by disease category. I found it very frightening that we are still largely unable to answer basic questions about what different health problems are costing us. Fortunately we are now starting to include this cost of illness data when planning for the allocation of limited resources. Obviously the “What is he paid?” approach is imperfect, but at the same time, putting some sort of value on life is better than...

  9. Chapter 4 Political Considerations in Health Care

    • Health Policy in the Consumer Era
      (pp. 89-94)
      The Honourable Bob Rae

      Politicians are always the villains of the piece. There is a populist rhetoric that creates two different species: human beings and politicians. It is easy to blame others for our problems, but the issues politicians face are public issues that all of society has to confront. Public opinion, however, is often contradictory. Public opinion surveys uninformed by the larger world outside health care won’t tell you much about the nature of public choice and political options. Governing is inevitably about choice, and choice requires that we do some things and not others. We can’t, for instance, talk of spending more...

    • Reconciling Political and Health Care Agendas: Three Views
      (pp. 95-103)
      The Honourable Monique Begin, Dr. Mark Wainberg and Senator Lois M. Wilson

      To discuss the future of health care in Canada most often means discussing this country’s ability to continue funding “medicare” as it is presently formulated, and about its financial burden, rather than discussing the type of system and services Canadians are willing to support.

      Although I have yet to hear a satisfactory answer as to what the optimum funding level for health care should be, in Canada or anywhere else, the fact that we have now returned to a level of total health expenditures which places us in the medium range of OECD countries provides us with a standard of...

    • Additional Thoughts on Citizens, Choice and Good Governance
      (pp. 103-106)

      Linda Haverstock: Given that public policy objectives need to be met within a government’s legislated lifespan of four years, and that fewer and fewer Canadians even bother to vote, how can we truly hope to engage Canadians in their health care system?

      Bob Rae: The public has a great deal of difficulty becoming engaged in areas where they don’t see choices, and we have to find more and more places where Canadians can discuss what the choices actually are. This is not just a matter of people demanding more of their special interests, it involves looking at the tradeoffs and...

  10. Chapter 5 Ethical Considerations in Health Care

    • Ethical Dilemmas in the Current Health Care Environment
      (pp. 109-117)
      Dr. Nuala Patricia Kenny

      The images that spring to mind when we think about ethical dilemmas in health care are those of drama and conflict: new reproductive technologies, cloning, end-of-life care, unequal access to technology, and inadequate resources. More recently, images of patients suffering because of inadequate care, families burdened by increasing demands for care, and patients dying because of unavailable care have dominated the media and public discussion. These are not simply individual issues. Economic, political and social forces all shape this health care environment. Each of these forces contains assumptions about what values should count in decision-making. Some are explicitly acknowledged in...

    • Creating a Sound Ethical Basis for Health Care Decisions: Three Views
      (pp. 118-129)
      Timothy A. Caulfield, Dr. Maurice McGregor and Dr. Lesley Degner

      It is becoming increasingly difficult to incorporate ethical concerns into decision-making processes and policy. This difficulty stems, in part, from the encroachment of consumer culture into the health care domain. The impact of this trend can be seen in the growing involvement of the private sector in health care. Determining the appropriate role of market forces in directing health policy remains a key debate. However, it is also one that is essentially redundant, given the post-Keynesian embrace of market forces by all Western governments over the past few decades, and the resultant movement towards debt reduction, consumer empowerment and globalization...

    • Additional Thoughts on Maintaining Ethical Practice in a Rationed Environment
      (pp. 129-134)

      Henry Dynsdale: With the advent of an evidence-based system, what the physician says to the patient about the appropriateness of certain treatments may well depend on the physician’s awareness of the resources available. In my area of neurology, there is fairly good evidence suggesting that administering a particular kind of expensive treatment within the first three hours of a stroke will markedly decrease long term damage to the brain. And yet many of my neurological colleagues seem to be backing away from this sort of intervention because they are not sure that the resources required to administer the treatment are...

  11. Chapter 6 Legal Considerations in Health Care

    • The Law’s Contribution to Sound Health Policy
      (pp. 137-143)
      Dr. Bernard Dickens

      Law is essentially parasitic. It depends on other people doing other things, and it reacts to them. It is therefore fitting for me, in this final chapter, to revisit issues raised in previous chapters and look at how the law confronts these issues, how some of them challenge the law, and what problems the law itself presents in creating sound health policy and ensuring sound health practices. But before getting into specifics, let me first look briefly at what law is. The law is an instrument, a tool, used by politicians through their legislative powers and declared by the courts....

    • Appropriate Uses of Law in Health Policy: Three Views
      (pp. 144-152)
      Dr. Marcia Rioux, Dr. Jamie Cameron and Dr. Margaret A. Somerville

      In many ways, health care has become a kind of barometer that indicates the state of the fundamental social contract of our society. The medico-legal cases with which we struggle today are not so much about medicine as they are about clarifying collective social values. Issues such as consent, confidentiality and access arise in many professional contexts, but when lives are at stake there can be no room for the expediency and compromise that characterise other types of lawsuits. Weighty moral questions must be confronted and decisions reached in the knowledge that each case sets a precedent, and each judgement...

    • Additional Thoughts on Where the Law Belongs in Health Care
      (pp. 152-158)

      Richard Cruess: I was the only physician member of the Federal/Provincial/Territorial Review on Liability and Compensation Issues in Health Care, chaired by Robert S. Prichard in 1990, and one question we did not address was whether society uses the malpractice system as a means of winning compensation for indivduals who have been harmed or as a part of the profession’s accountability system.

      Jamie Cameron: Most plaintiffs who sue for compensation want acknowledgment of a mistake, some vindication of their instinct that the physician must be accountable for his or her effect on individuals’ lives. It can range from a desire...

    (pp. 159-166)