PoliticsSenator Michael Kirby Begs to Differ

Senator Michael Kirby Begs to Differ

Senator Michael Kirby Begs to Differ

Editor’s note: Senator Michael Kirby and the Senate's Committee on Social Affairs, Science and Technology have prepared their own report on Canada's troubled health care system, one that takes issue with some of the findings and recommendations of the Romanow report. Senator Kirby spoke to Ottawa Life reporter Peter Gill in November.

Ottawa Life Magazine: Some cynics call your committee's report "ambitious" and "unaffordable."

Michael Kirby: I don't regard the "ambitious" label as bad. If we are not ambitious in terms of changing the system, it won't be possible to solve the problem. As for it being unaffordable, we have actually costed our program in some detail. My belief is that if we don't put in money of that order of magnitude, which is less than all the provinces are asking for, the system will be unstable.

OLM: Is there room for private health care in Canada? Also, would equity in our health care system be destroyed?

MK: It depends whether you mean private funding or private delivery. We have said categorically that we believe the system ought to continue to be publicly funded and therefore there is no room for private funding at all. This means that there is no room for any kind of health care delivery institution that takes both public and private pay patients, because we said there shouldn't be private pay patients. We had said that we're neutral on the issue of whether or not certain specialized clinics are privately owned. We don't mind one way or the other, but we've also pointed out that there is no way one could ever make any money in the health delivery business in terms of running major hospitals. In the most generous scenario, 90% or more of the business will always be in public or private not-for-profit hands.

OLM: Is there a problem with the federal government when it comes to accountability and the funding of health care?

MK: I guess it depends how you define "accountability." There is obviously no problem with respect to funds transferred under the Canada Health and Social Transfer, because that program is entirely a block-funding program. There is no obligation that the money be spent on health care or on any of the other programs. There has been a bit of a problem, although I think it has been exaggerated, with respect to whether the money went where it was supposed to. That is a problem, but it's a relatively minor problem. Our view is that the way we structured our recommendation, this problem is avoided, because in certain situations, the federal government pays 100% of a capital program for teaching hospitals, and therefore the accountability is easy to manage, because the federal government is handling the entire program.

OLM: Is there a lack of cooperation between federal and provincial politicians when it comes to delivery of health care?

MK: I think that there has been a considerable amount of shifting the blame. The reality is that any time there is real pressure from the public to improve something that has become a joint responsibility, there will always be arguing among the two sides about who ought to pay how much and to try to make the public believe that the problem rests entirely with one side, when it actually rests with both.

OLM: How relevant is the Canada Health Act? Does it need to be reformed in any way to suit present-day circumstances?

MK: No. It is highly relevant, in the sense that it is an icon to Canadians and therefore it should be preserved, but we have said explicitly that all our recommendations require absolutely no change to the Canada Health Act and we have in fact recommended that it not be reopened, because that would set off a debate and would encourage people to try to tack on all kinds of other new conditions. That's why our proposals were that new legislation should be enacted outside the Canada Health Act.

OLM: In your opinion, what is the single biggest problem with Canadian health care today?

MK: I think there are three, so it is hard to single one out. From the public's point of view, the single biggest problem is the perception that they have to wait an undue length of time for certain essential services. And I say "perception," because the lack of waiting line data means it's hard to know how big a reality that is. But it has often been said that public perception is reality and everyone we've talked to knows enough anecdotal evidence to suggest that it is a very serious problem. Indeed, it's a problem that has to be addressed, if you're going to get the public to support other changes.

The second issue is the need to introduce greater efficiencies into the hospital system by moving to what we've called service-based funding, which would enable regional health authorities or provincial governments to know which hospitals are efficient and which aren't and thereby encourage efficiencies and deal with inefficiencies. In order to do the service-based funding, you have to do some of our other things, which include management information systems and so on.

And the third case is the need to put a significant infusion in both equipment and capital facilities and teaching hospitals, because the biggest cutback in terms of not keeping up with the latest developments have all occurred with the teaching hospitals. That's where all the most complicated cases in the country are dealt with. Therefore, a program for funding the infrastructure of teaching hospitals is critical.

OLM: Roy Romanow told the media that your committee's $5-billion tax plan is "regressive." Any comment?

MK: He also said in the media, as I understand it, that he is not going to propose any method of raising funds. Let's understand that he said it would be irresponsible not to deal with the issue of how health care should be funded, that we were not going to do the traditional thing, which was to completely duck the question of where the money should come from. This is often the toughest political question and so we were prepared to tackle it head on. Mr. Romanow indicated that he wasn't going to do that. I don't know why he ducked the question, but that's his choice.

We don't think our funding formula is regressive at all. It has a progressive element to it, in the sense that it begins at 50 cents per day and goes up to $4 a day, depending on income tax brackets — which is obviously progressive. So I have no idea why he called it "regressive". It doesn't make sense to me.

By: Peter Gill

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