Michael Rachlis MD

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At the University of Toronto with the Globe's Jeffrey Simpson

9 February 2013, 3:50 PM

I was on a panel at Hart House University of Toronto on Thursday February 7th with the Globe and Mail’s National Columnist Jeffrey Simpson — the topic was the sustainability of the Ontario health care system. My slide presentation available at the Publications page, concludes that health care spending is not “wildly out of control” and we need very little new money to ensure we hardly wait at all for needed health care. You can also find a picture at the publications page.

Mr. Simpson’s new book Condition Critical outlines the problems with our health system — long waits, mediocre quality, relatively high costs. His main recommendation is more for profit competition within our public financed system.

In general, Simpson toes pretty close to the conventional centre/right line:

      *     Health Care costs are wildly out of control

      *     The baby boomers will really deep six Medicare
      *     The only alternatives are to either cut real services or use more private care and finance
      *     We need an “adult conversation” to reduce our expectations and make us see the need for private involvement

Even when confronted with examples of how we could eliminate waits for care — patient co-production, high functioning teams, shared care with specialized services — Mr. Simpson doesn’t believe these really could be the norm. He doesn’t think providers, especially doctors will change the way they do their work.

I understand Mr. Simpson’s skepticism. We’ve known about these innovations for a long time. Change is hard anywhere at anytime. But, it’s been really hard to change Canada’s health care delivery system. But, I like to think that Canada could have a world class health care system if we wanted one.

I found Mr. Simpson reminded me of John Ralston Saul’s descriptions of Canada’s elite in his 2008 book “The Fair Country”. Saul refers to the “Colonial Mind” — that the Canadian elites tend to have a colonial view of insignificance within the Empire (British originally, US now) and to be focussed on the outside world for validation. I find folks like Jeffrey Simpson to have a cynical view of the Canadian potential. He can’t or doesn’t want to clarify whether he is saying we can’t do something — like eliminating wait lists with process improvement — or rather that up until recently there has been little effective implementation of these innovations.

Perhaps he is correct. But I don’t like the way he dismisses the notion that we should aspire to health care excellence with a quick knowing shrug, “tried that, too hard, let’s move on (to private care).” Let’s all prove him wrong.

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