PM Trudeau: it's time for leadership & action on health care

[Oscar]

Prime Minister Trudeau - it is time for federal leadership and real action on health care

[ http://canadians.org/blog/prime-ministe ... ealth-care ]

January 19, 2016 - 3:46 pm

PHOTO: Council of Canadians protest the loss of the Health Accord at the Council of the Federations, 2015

This week the provincial health ministers will meet with their federal counterpart - from January 20th-21st in Vancouver - to discuss the future of public health care in Canada. The Council of Canadians will be present in Vancouver and is calling on the Liberal government to show real leadership and fulfill its election promise to reach a new Health Accord with the provinces.

While such a meeting should be regular practice, after nearly a decade of disregard by the Harper government there will no doubt be many important matters to discuss. In our letter to Minister Philpott welcoming her to the post of health minister, we outlined some of the important topics that need to be addressed.

In his mandate letter, Prime Minister Justin Trudeau tasked Ms. Philpott with, “engaging provinces and territories in the development of a new multiyear Health Accord” with “a long-term funding agreement.” While the liberal election platform had been worryingly vague in regards to health care policy (the Liberals didn’t attached any numbers beyond pledging $3 billion over four years to improve access to home care), health advocates across the country were pleased to see the importance of the Health Accord acknowledged in the mandate letter (including the call for a long-term funding agreement [the last accord was ten years], not a four year agreement that would jeopardize health policy to the whims of elections cycles).

Prior to the holidays, the tone of the discussion seemed to have changed again. Minister Philpott stated to the media that “Money isn’t necessarily where the problem is... I don’t think Canadians necessarily want us to spend more on health care.” This week that Minister Philpott was blitzing multiple major national media outlets further stressing that money isn’t the answer with statements like, “I think that most of my colleagues will agree with me that injecting more money into the system isn’t always the way to go, and isn’t always the best way to be able to drive change.” She further stated that, “My hope is that we won’t allow ourselves to be inappropriately distracted by conversations about details of the transfer at this stage of the conversation.”

The problem with statements like the ones above is they include sweeping generalizations and strawman fallacies (among others), which distract from the real discussion that needs to occur. No one is advocating we simply throw money willy-nilly at health care and call it that; nor has that been the case in the past. Additionally, there is nothing inappropriate about discussing fiscal details in relation to the Health Accord. This is like telling someone on a bike not to worry about peddling to make it move. What we need now is a robust and realistic discussion on the future of medicare.

Below are a few highlights of what we should expect from our provincial and federal governments in order to protect, strengthen and expand public health care through a Health Accord.

Funding:

The Health Accord is many things, but first and foremost it is a fiscal tool to create a funding arrange between the provinces/territories and the federal government. We’ve highlighted in the past that the loss of the Health Accord, which is due to expire in 2017, would mean a $43.5B cut (for all intents and purposes) to medicare. Currently, the federal government’s contribution to health care is only one fifth of provincial health spending, and there is a strong case to be made for, “a return to the original 50/50 funding arrangement, which is one of the key reasons the provinces signed on to medicare in the first place and has steadily been eroded in the decades since.” At the last Council of the Federations meeting, the Premiers jointly called on the federal government to cover a minimum of 25% of health care funding by 2025. This is not only fair, but also a very achievable target for the federal government to meet. In order to accomplish this, the federal government needs to provide a minimum 6 per cent annual increases. This is again both a realistic and reasonable ask if this government is truly interested in real change (if the conservative had planned a 3% increase tied to the GDP, the liberals can surely do better than 3%). What the medicare system needs is an injection of predictable, long-term, and stable funding to ensure good public health policy and quality patient outcomes.

In addition to the Health Accord and overall federal funding, another area likely to draw much discussion is regarding the Canadian Health Transfer. The previous federal government eliminated the equalization portion of the Canada Health Transfer and replaced it with a per capita transfer (meaning Alberta was the only provinces to see an increase in funding while other provinces saw billions less). This is an additional $16.5 billion less funding to health care nationally. There has already been discussion in the media from provincial health ministers in BC, Alberta and the Atlantic provinces regarding this problem, and it is one that should be addressed. Clearly, the solution is not to pit provinces and the age of their populations against each other, as the Ontario health minister recently pointed out regarding aging populations, “The evidence points to the contrary, that it does not necessarily, and is not creating a tsunami of increased health care costs.” What we do need is a return to an equalization formula which puts equity and need in the forefront.

At the same time, the provinces need to come to the table and do their part. Across Canada we have seen egregious violations to the Canadian Health Act (CHA) which put our medicare system, based on need and not the ability to pay, in peril. For too long provinces have been complicit in the privatization of our medicare into a two-tiered, US style system. From Bill 20 in Quebec, private for profit MRI services (and likely for-profit blood/plasma in the near future) in Saskatchewan, co-pays and user fees in Ontario, to the double billing in private orthopedic clinics in BC (the Dr. Day case) - just to name a few of the long list of ongoing violations - the provinces our undermining our universal public medicare. A new Health Accord must include the provision that funding is conditional with provinces strongly upholding the CHA and prosecuting those who violate it. Further, provincial data needs to be shared with their federal counterparts (it currently isn’t) in regards to CHA violations.

Where we do agree with Minister Philpott is that funding needs to be used in a more purposefully attempt to bring about positive change in our medicare. While the delivery and administration is most often the constitutional responsibility of the provinces and territories, a new Health Accord must have an accountability framework in place. Money needs to be directed to improve the quality of our public health care system and, importantly, patient outcomes in a multitude of areas. The Health Accord should not be a blank cheque for provincial finance ministers to give plump raises to the already exorbitant salaries health region and hospital CEO’s, buy quick labour peace with doctor by increasing their earnings, investing in more shoddy P3 projects, and so forth. Along with the enforcement of the CHA, conditions need to be attached to improve the quality and accessibility of care.

Unfortunately, what seems to be missing from the mandate letter and the liberal platform are any clearly articulated goals or visionary plans in this regard. We need less flowery language around ‘innovation’ (which can mean many good things but is often a code word for privatization), or ‘efficiency’ (because no one has ever worked to improve services for patients or reduce expenditures through better management?), ‘scaling up both horizontally and vertically’ (whatever that really means), and ‘health transformation’ (meaning patients and services are being offloaded from public hospitals and usually the coverage of the CHA). What is needed is clear goals and conditional funding to improve the public funding, delivery, administration of health care. If we are to scale things up, why not emulate the many successful and evidence based pilot projects which have been undertaken through public health services based on best practices, and spread them across the country to truly advance our health system.

The Council of Canadians calls for:

-A new Health Accord for an adequate period of time (a ten year period or comparable length to the 2004-2014 Accord).

-Increased funding at a minimum of a 6 per cent increase per year (as with the previous Accord)

-Reaching a minimum 25% federal share of health funding by 2025

-Conditional funding to uphold the CHA and an accountability framework to ensure funding reaches needed areas of the public health system

-Funding to support and strengthen the universal access to publicly funded and delivered medicare

Seniors Care:

As the Canadian population ages, seniors care will remain an increasingly important topic for our public health system. If anything, longer lives are a clear outcome of the success of our universal public health system and we need to support Canadian seniors in their healthy and meaningful lives. While Canada’s aging population does not represent a “crisis” of sustainability as Medicare critics suggest, it does mean that the demand for continuing care for seniors will rise. This topic will no doubt be included in the upcoming meeting and discussions surround a new Health Accord. To begin with, the Liberal government needs to join the wide range of groups and political parties who are calling for a national senior’s strategy to address the needs of aging Canadians.

Outside of a national senior’s strategy, the Prime Minister’s mandate letter included a comment on the need to, “support the delivery of more and better home-care services.” This could indeed be a positive development if done properly. We need improved standard to ensure a minimum number of direct care hours per resident per day in home care. Services should follow patients to home-care or community care settings where appropriate. Further, we need to invest in public and non-profit delivery to improve both the quality and access of services while reducing costs (widely acknowledged evidence has demonstrated that for-profit long-term care facilities are associated with lower quality of care and poorer resident health outcomes). Lastly, there are no federal standards for continuing care (home/community and residential) and it is a poorly regulated patchwork of programs. Access to continuing care currently falls outside the scope of medicare, is often two-tiered, with long waits lists, and the quality is uneven. It is evident to anyone who has a loved one in this situation that we need a national senior’s strategy that creates a national continuing care program tied to Canada Health Act standards.

It is important to point out that the above paragraph does not mean we should reduce funding from acute care; as is too often the case, health funding becomes a zero-sum game which hurts patients in the long run. What we need is an adequately funding continuum of care where medically necessary services are free of charge, safe, and high quality at the point of use - whether the setting is a hospital, LTC facility, home or community agency.

The Council of Canadians Calls for:

-A national senior’s strategy.

-Focus and adequate funding on a continuum of care from the hospital to the home.

-Established through stand-alone legislation, with Canada Health Act standards, minimum staffing standards and a program to phase out for-profit delivery.

Pharmacare:

A discussion surrounding what is known as pharmacare, or a national prescription drug plan, will be on the agenda at the upcoming meeting. Already, it has been reported that, “the Premier of British Columbia and Ontario’s Health Minister say a national pharmacare plan – one that goes beyond an agreement by provinces and the federal government to buy drugs in bulk – should be a key consideration as provincial health ministers meet this week with their federal counterpart.” This echoes the public’s sentiment, as a Canada wide poll released prior to the election found that more than 90 per cent of Canadians back the concept of pharmacare.

The idea of universal public pharmacare in Canada been around since the genesis of Canadian medicare, but the script remains unfilled. Prescription drug coverage was recommended as a common sense next step by the 1964 Royal Commission on Health Services and evidence based studies to the present day continue to support the call for this needed program. The World Health Organization which has declared that all nations are obligated to ensure equitable access to necessary medicines through pharmaceutical policies. Consequently, every developed country which has a universal health insurance system provides universal coverage of prescription drugs – except for Canada. Of the 33 countries in the OECD, Canada provides a lower percentage of its citizens with a public drug plan than every other country other than the U.S. (two-thirds of the countries cover 100 per cent).

For too long the result of our fragmented and patchwork system between provinces is that many Canadians have no drug coverage at all. One in ten Canadians are not being able to afford their prescriptions (this does not include people who ration or skip taking their medication due to costs) and a new research study has estimated this could be actually be as high as 1 in 5. These medications are needed to keep people healthy and save lives; yet, every year over 3 million Canadians are unable to afford necessary medications that include everything from asthma inhalers to insulin because they cannot afford it.

This is not only unsafe, but it is fundamentally unethical that Canadians are covered for their prescription drugs based on varying factors like their socio-economic status, age, where they live, or work, rather than their medical needs. Not only are Canadian’s health needs not being met, but drug prices in Canada are among the highest in the world due to our poorly structured system. Yet, study after study shows that a universal pharmacare could save between $9 and $11 billion dollars a year depending on how the program is organized.

It is time for a universal, comprehensive pharmacare program with 1st dollar coverage that will meaningfully improve the health outcomes of Canadians. Recently, the Council of Canadians recently joined over 280 professors and health policy experts in calling for universal pharmacare in Canada. Pharmacare, would allow Canadians to access drugs more effectively, more economically and more fairly. There is no reason, other than political will, that Canadians cannot have a publicly funded and administered program to cover universal access to medically necessary drugs. Such a program would also help ensure safe and appropriate use of drugs along with improving the health outcomes of Canadians.

The time for half measure and inaction is over. Successive Liberal and Conservative governments have ignored the evidence before them while similar nations around the world have implemented pharmacare. What is needed is real federal leadership on the pharmacare file. Not only are many Canadians suffering because of our current patchwork system, without a national pharmacare plan spending on drugs will continue to increase by a remarkable 8 per cent a year above inflation (largely due to the fact that our provincial and federal leadership do not leverage their buying power together to get a better cost). This rate is not sustainable in the long term and will only increase as expensive biologics becomes more common as a treatment option. At the same time, our federal government is signing trade deals which will significantly delay the entry generic drugs into our market by granting even more intellectual property rights to big pharma (for more information on how the TPP and CETA is undermining our chances for universal pharmacare see here and here).

There is a very real worry that the new federal government is still not willing to fully dive in and put the health of Canadians first. Part way attempts to implement partial pharmacare won’t address the major issues we have at hand. These different approaches know as ‘bulk buying strategies’, ‘some drugs’, or only adding ‘catastrophic coverage’ to the table ignores the real health implications faced across the country. Firstly, these half measures are aimed more at containing costs (or keeping embarrassing stories out of the news) than improving the quality of life of patients; where as a full universal pharmacare program addresses both issues. These programs also pit patients against each other when they should all be getting the medically necessary support they need (it shouldn’t matter what need or disease you have). Further, covering life saving drugs and having people live more years shouldn’t simply be our end goal, as the real solution needs to include drug coverage the improves quality of life. In some schemes the federal or provincial government provides some coverage to patients if a percentage of their income is spent on drugs. This ‘top up’ doesn’t lead to the price of the drug being lowered, ignores the fiscal barriers in different population demographics (for example, 20% of your income spent on medication is very different for the rich and the poor), and disregards the fact that co-pays have been proven to discourage people from filling prescriptions (leading to negative and costly health outcomes later on). This list of issues could go on and on, but the point is we need Minister Philpott and the Trudeau Liberals to show real leadership by working to implement a full universal pharmacare system that will truly begin to address the issues at hand.

The Council of Canadians calls for:

-A comprehensive national pharmacare program that is universal and provides first dollar coverage.

-Access must be based on a patient’s need and not their ability. The program must cover the full cost of covered drugs without deductibles or co-pays.

-Public administration for the program ensuring appropriate use of drugs, public education and monitoring

-An evidence-based national formulary drawing on the best clinical and economic facts. All drugs on a national formulary must be covered under the program.

- ‘Carving out’ health care from harmful international trade deals and a creating mechanism addressing the impacts of negotiated deals.

Other Important Areas:

While the Health Accord is primarily a fiscal tool and the political moment is indicating that improved seniors care and pharmacare are possible, there are other important areas which the health ministers need to address. The Health Accord may not be the best apparatus to fully address these areas, but they are worth a quick mention and future action. Though not an exhaustive list, some topics include:

-Creating a framework, in consultation with a wide range of stakeholders, to address the health needs of Aboriginal populations in Canada.

-Strengthening access to mental health services at every age and life stage.

-Identify and improve the health outcomes for people with physical or mental disabilities.

-Invest in population health research and expand the mandate for the CIHI to publically report data on a wider range of outcomes.

-Create a health human resources strategy to meet sectoral changes and varying needs across Canada.

-Provide a plan to engage in serious deliberation regarding the social determinants of health and a health in all policies approach.

In closing, the Romanow report in 2002 stated that, “medicare is as sustainable as Canadians want it to be, we now need to take the next bold step of transforming it into a truly national, more comprehensive, responsive and accountable health care system.” We have a historic opportunity to get health care back on track when the health ministers meet this week. This takes the provinces working together and, importantly, federal leadership. The Liberal government was elected on a progressive platform; it is time to deliver.

Michael Butler's blog
Health Care Campaigner
[ http://canadians.org/blog/3657/feed ]

= = = = = =

Romanow Report - 2002

[ http://www.med.uottawa.ca/sim/data/Romanow_e.htm ]

[Oscar]

Let's take medicare down the right path

[ http://canadians.org/blog/lets-take-med ... right-path ]

January 25, 2016 - 3:31 pm

Last week, the Federal Health Mnister (Jane Philpott) met with her provincial counterparts to discuss the future of medicare. The Council of Canadians joined other health allies at the meeting and shared our priorities with the ministers at the meeting. [ http://canadians.org/blog/prime-ministe ... ealth-care ]

The Council of Canadians calls for:

• A new Health Accord for an adequate period of time (a ten year period or comparable length to the 2004-2014 Accord).
• Increased funding at a minimum of a 6 per cent increase per year (as with the previous Accord)
• Reaching a minimum 25% federal share of health funding by 2025
• Conditional funding to uphold the CHA and an accountability framework to ensure funding reaches needed areas of the public health system
• Funding to support and strengthen the universal access to publicly funded and delivered medicare
• A national senior’s strategy.
• Focus and adequate funding on a continuum of care from the hospital to the home.
• Established through stand-alone legislation, with Canada Health Act standards, minimum staffing standards and a program to phase out for-profit delivery.
• A comprehensive national pharmacare program that is universal and provides first dollar coverage.
• Access must be based on a patient’s need and not their ability. The program must cover the full cost of covered drugs without deductibles or co-pays.
• Public administration for the program ensuring appropriate use of drugs, public education and monitoring
• An evidence-based national formulary drawing on the best clinical and economic facts. All drugs on a national formulary must be covered under the program.
• ‘Carving out’ health care from harmful international trade deals and a creating mechanism addressing the impacts of negotiated deals.

This meeting was about more than federal/provincial wrangling, it was really about the future of medicare in Canada. Make no mistake, the next year is perhaps the most important period for our universal public health care system since its creation.

It is important that the provincial and territorial governments, along with their federal counterparts, start out moving in the right direction. We know that once momentum starts moving down one path with governments, it is difficult for them to change direction. It is for this reasons that the Council of Canadians will be lobbying federal MPs this week with our priorities to ensure our elected representatives act in medicare’s best interest.

Back to the Health Minister’s meeting. An announcement of shared health priorities between the provinces/territories and federal government was made at the conclusion of the meeting. [ http://news.gc.ca/web/article-en.do?&ni ... l_media_15 ]
During the talks the provinces continued to push for a minimum of 25% federal funding for health care by 2025 (which should include a 6% escalator) and while no dollar value was set at the talks the joint statement that ‘new resources’ are needed. In an interview with CBC, Minister Philpott stated that there is no timeline in regards to signing a new health accord and she wouldn’t commit to having it done by October of this year (she did not (say) there will be talks in the coming months).
[ http://www.cbc.ca/news/canada/british-c ... -1.3414317 ] The coming months will be extremely important to show if Ottawa is still committed to universal public health care.

It seems little talk occurred regarding Canadian Health Act (or at least not publicly) and tying federal funding to adherence. While the provincial ministers seemed eager to talk about scrapping the Harper governments per capital version of the Canadians Health Transfer, more talk and federal leadership will be needed to come up with a solution.

We heard a lot about ‘transformation’ in the health care system. While the meaning is vague, we demand that any such transformation be guided by patient outcomes and supporting our public system (as opposed to transformation as adoration of business management models and buzzwords as the miracle cure for our health system).

The ministers did agree to work on home care, mental health and innovation over the next several months. [ http://www.cbc.ca/news/canada/british-c ... -1.3414317 ] Much of the talk surrounding this involved expanding health care being delivered in the community and meeting the Liberal government’s $3B election promise to improve home care. The worry which we raised going into this meeting is that evidence-based studies show that we need a continuum of care. [ http://canadians.org/blog/prime-ministe ... ealth-care ] This means we need to invest in a full continuum of care, from acute care to community care, to provide for the best health outcomes; governments want to offload acute care outside the hospital so care falls outside the CHA and opens the door for privatization and lower standards.

To be fair, some things are certainly changing for the positive (although after years of the Harper government the bar has been set so low you can trip over it...). Minister Philpott began her trip by visiting Vancouver’s long-standing supervised injection site on Vancouver's Downtown Eastside and it has been reported she called the experience "incredibly moving." [ http://www.cbc.ca/news/canada/british-c ... -1.3414078 ] This is in stark contrast to the conservative party who spent huge resources fighting safe injection sites for political gain, than actually trying to support policy that saves lives.

There was also some promising movement on the pharmacare file. The federal government will join the provinces in their bulk-purchasing initiative through the pan-Canadian Pharmaceutical Alliance, which negotiates lower drug prices on behalf of public drug plans. This is a baby step in the right direction, but as we pointed out earlier, it only partially contains costs while not addressing accessibility and health outcomes for patients. [ http://canadians.org/blog/prime-ministe ... ealth-care ]

While no concrete plan for universal pharmacare with first dollar coverage came out of the meetings, a working group was set up to address "accessibility, affordability and appropriate use" of pharmaceutical medications. Minister Philpott highlighted the formation of a working group to discuss a national pharmaceutical strategy, saying she had "considerable" discussions with her colleagues about a potential shared approach. [ http://www.ctvnews.ca/health/health-min ... -1.2747562 ]

While questions remain on who would establish the national formulary (there are murmurs private industry being involved, which creates significant pitfalls to the equity and access of medications), we still don’t know what direction the federal government and the provinces/territories will go. Will they stop at catastrophic coverage in the working group which will not address access issues and may create many more problems? [ http://www.ctvnews.ca/health/health-min ... -1.2747562 ] Will they cover only some drugs and not others? Will harmful trade deals that hurt the chance of pharmacare be addressed? These and many question still remain.

On a positive note, Ontario Health Minister Ed Hoskins says he’d like to see a national drug plan in place by 2017 as a fitting achievement for Canada’s 150th birthday and the 50th anniversary of medicare. [ http://thechronicleherald.ca/editorials ... ative-care ] In another interview (on CBC Toronto Metro Morning which is worth a listen to for those who aren’t up early), [ http://www.cbc.ca/player/play/2682377116/ ] Minister Hoskins outlined how the issues of fairness, equity and access need to be addressed through the working group which every health minister agreed to form. He also goes on to mention that it is not just cost elements we need to look (at), but we need to move beyond a patchwork approach and finally provide fairness and equity to Canadians through pharmacare.

There is a lot of work to be done in the near future to push the governments to put patients and our universal public health care system first. The Council of Canadians will be in Ottawa this ( - - ? - - ) reminding MPs that we need a robust health accord, a strengthened continuum of seniors care, and a universal comprehensive pharmacare program.


Michael Butler's blog
Health Care Campaigner
[ http://canadians.org/blog/3657/feed ]

[Oscar]

Council of Canadians bring a medicare message to new MPs

[ http://canadians.org/blog/council-canad ... ge-new-mps ]

January 28, 2016 - 1:01 am

This week Council of Canadians representatives joined over 140 health care advocates from across Canada meeting with MPs new and old. Incredibly, over 130 MPs on parliament hill we met with during the lobby to protect, strengthen and expand our universal public health care.

After nearly a decade of neglect under the Harper government, now is the time for leadership and action in health care. Canada is desperately in need of a new Health Accord, lacking a national seniors strategy, facing increased privatization of our medicare, and lacking is lacking a universal pharmacare system (among many other issues). We took our voice to Ottawa and spoke with MPs about the above issues and asked them to #stand4medicare with us.

The coming year will be the most important period in recent memory for our public health system. The Council of Canadians is proud to be a part of this important conversation across the country and on all levels of government. As a long standing and respected voice for equity and social justice (over 30 years!) we will continue to fight for Canada's most cherished social program, medicare.

The MPs we met with joined us for a photo to show they #stand4medicare and we asked them where they stand on a variety of issues. Overall, as would be expected the tone in Ottawa has changed. MPs were generally receptive to the issues we brought forward and we will continue to pressure them to support strengthening medicare. Later this year we will be taking the lobby to their local constituencies with our members to ensure they are putting people's health before profit.

It is a time for vision, leadership and courage to make the health care we deserve a reality.

Michael Butler's blog
Health Care Campaigner
[ http://canadians.org/blog/3657/feed ]

[Oscar]

LISTEN: Pharmacare - 7:43 min.

[ http://www.cbc.ca/player/play/2682377116/ ]

CBC Radio - Metro Morning Season 2016, Episode 300236743 January 22, 2016

Canada has been a world leader in providing universal health care, but with universal access to drugs, not so much. Matt Galloway spoke with Ontario's Health Minister, Dr. Eric Hoskins.