Democracy Gone Astray

Democracy, being a human construct, needs to be thought of as directionality rather than an object. As such, to understand it requires not so much a description of existing structures and/or other related phenomena but a declaration of intentionality.
This blog aims at creating labeled lists of published infringements of such intentionality, of points in time where democracy strays from its intended directionality. In addition to outright infringements, this blog also collects important contemporary information and/or discussions that impact our socio-political landscape.

All the posts here were published in the electronic media – main-stream as well as fringe, and maintain links to the original texts.

[NOTE: Due to changes I haven't caught on time in the blogging software, all of the 'Original Article' links were nullified between September 11, 2012 and December 11, 2012. My apologies.]

Thursday, October 25, 2012

For Canada’s “Chronic Condition” no end in sight

Under the Conservatives, the federal government, as we know, is retreating from the field of health care oversight. While the funding is still doled out, it now comes with no strings attached. Such an approach is in contrast to previous governments who tried to get something in return.

The new Conservative approach is a good fit for party ideology, much in keeping with Stephen Harper’s preference for keeping his paws out of provincial jurisdiction. Politically it’s not bad either. One less thorny problem for the prime minister. Notice how, despite the concerns that the current system may be unsustainable, that health care is far from the top of the national discussion.
Jeffrey Simpson’s new book – “Chronic Condition; Why Canada’s Health-Care System Needs to be Dragged Into the 21st Century” – will hopefully help bring the debate to the forefront. The book is a perceptive and penetrating synopsis of the medicare story – where we’ve been, where we are and where we might be going.

The diagnosis isn’t pretty. While the problems pile up, we muddle along. The system, as Simpson notes, isn’t in crisis but if we continue the laissez-faire approach, look out.

The provinces like their new autonomy. They get to take the money and run. Some of the provinces are introducing worthwhile reforms. But with them going off in varying directions, the national system risks becoming less and less national. If it’s a patchwork quilt, medicare will wilt.

Roy Romanow, who headed up a royal commission on health care a decade ago warned earlier this year that without the direct involvement of Ottawa, “it will mean more privatization in more provinces, or some combination of private and public. It will be a very much weakened fabric of national unity.”

Meeting in July without the feds present – Harper has ended annual conferences with first ministers – the premiers made clear their intentions. “We decided, as provinces, that we don’t need the federal government “ said Prince Edward Island’s Robert Ghiz. “We run the health care system.”

The premiers were critical of Ottawa for not negotiating a new health care accord, but said they could fill the leadership void. Hopefully they’ll maintain national benchmarks, but it’s difficult for them to act in concert when different govenrments with different premiers come along so often.

As Simpson’s book makes clear, medicare is an extremely complex system that gives way to no easy solutions. His study leaves little hope that necessary reforms can be put in place in the next few years. More federal involvement is welcome but only if Ottawa gets it right – and often it doesn’t. The Romanow Commission and later Paul Martin’s pact with the provinces failed to provide remedies necessary to modernize the system. Lots of money, as Simpson says, but money that didn’t buy the necessary change.

Simpson sees three urgent health-care objectives; improving quality outcomes for patients, hastening access and lowering the long-term increase in health-care outlays. Sounds straightforward enough until you look deeper. Simpson spent time in an Ottawa hospital with its chief of staff, Dr. Jeffrey Turnbull, a former president of the Canadian Medical Association. A chapter on that experience with Turnbull’s running analysis of the problems is an eye-opener.

“Let’s make the system as efficient as it can possibly be,” says Turnbull, “and then look for money if we need it. If someone came to me with more dollars for the existing system, I’d say not a penny more – and I’m in the system.”

Needed change, writes Simpson, will require political leadership of the highest order. But look around. Where is it going to come from? A new Ottawa funding formula from Finance Minister Jim Flaherty is already in place and set for years to come. A change of government in Ottawa, if at all, is three years away. Another royal commission to chart a new course for medicare is out of the question.

At the provincial level, two of our heavyweight premiers, Quebec’s Jean Charest and Ontario’s Dalton McGuinty, have recently stepped down. At the same time the system is not doing badly enough to generate the kind of public outcry that is necessary to bring about an overhaul.

The upshot is that it will be left to the provinces to go about addressing questions of reform in an ad hoc way. For those wishing for a modernization of the system while maintaining uniform national standards, the outlook is anything but rosy.

Original Article
Source: ipolitics
Author: Lawrence Martin

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