Debate on Healthcare in PEI Needs to Be Revitalized
With the recent appearance of departing Health PEI CEO, Dr. Gardam, at a standing committee for Health and the recent announcements of closures for services at the Prince County Hospital, there is an unprecedented level of worry and anxiety gripping Islanders. The trend of increasing costs and worst services for health that has been present for decades shows no signs of slowing down. It seems clear the King government does not have a realistic plan to reverse this trend any time soon.
This unfortunately is rather predictable and not a great surprise to anyone that takes a critical look at this issue.
No political party in PEI is committed to make any fundamental change in the healthcare system; by and large Islanders are not interested in changes, they just want the current system to provide them with more timely access. So debate between the political parties usually revolves around who would be a better manager or custodian of the system, which is fine if the system foundations are solid. But what if they are not? Well if that is the case then no party really has a chance to provide Islanders with adequate care.
This latter view is what I believe is the crux of the issue. A rotten tree cannot bear good fruit, so the expectation that the King government was going to fix healthcare was always unrealistic. Dr. Gardam said as much, in his testimony he stressed that his intention was not to take down the PC Party, but rather offer criticisms of the system— that also stretches back to Liberal governments.
This is a view I also share. In fact, during a budget consultation meeting to the public many years ago, I asked the then Minister of Finance, Wes Sheridan, what plans they had going forward for healthcare. I pointed out that in his last budget he had increased spending by over 7% and that was just to try to keep the system stable, not even improve it. I pointed out things were only going to get worse as more baby boomers were going to cross the critical age of 65 and such increases in spending were not sustainable. He gave me a typical political non-answer and basically kicked the can down the road for somebody else to deal with.
The one left holding the bag is Dennis King it seems.
Criticism Must Be Fair to Be Effective
While there are certainly things the King government could do to improve healthcare, I find much of the criticism coming from the media and Opposition parties to be disingenuous. Their bias is clearly showing and they are using the latest developments to score political points rather than focusing on providing a clear perspective that is sorely needed.
A clear example of this is the constant criticism that the King government should stop politicizing healthcare. Here in this message by Paul MacNeill, he explicitly states he wants King to stop politicizing healthcare. But how exactly is that to be achieved? And why would you want to anyway? If we take just a few moments to examine the statement it becomes clear just how nonsensical it is.
First, we must define what exactly it means to politicize something. To politicize an issue means to bring it into or attempt to bring it into the purview of government. Since healthcare in Canada is largely dominated by Medicare, and requires strict government regulations to be enforced, it is by it’s very nature political. To ask the King government not to politicize healthcare is like asking any trades person not to perform their trade. Since healthcare in Canada is largely regulated by the government, politicians must oversee it, there is no way out of this.
What I think MacNeill, the Green Party of PEI, and other media are trying to do, is use politicizing in a more colloquial sense. They are trying to suggest that King is not taking the long-term approach to healthcare, but rather trying to provide scapegoats to the public for short-term popularity gains that will in the long-term damage healthcare. Even if we take this different interpretation, I still do not see how this critique is anything other than absurd. It’s Dr. Gardam that keeps going to the media, not King. It’s Derek Key that resigned and made his reasons public, not King. If anything, it seems to me like the King government is trying to work quietly behind the scenes to keep the bureaucracy in PEI from exploding costs and provide quicker service. This is the very opposite of politicizing an issue in the more colloquial sense.
In the week in which Dr. Gardam gave his testimony, the media and Greens accused the King government of political interference and not letting the experts manage healthcare. Then the week after Dr. Jain also gave some testimony to the health committee, and Derek Key made some comments to the media. Based on their suggestions the new criticism was that King should hold people accountable for failed recruitment efforts in Health PEI, which is political interference. If you’re confused don’t worry, so am I. The Greens also want the government to listen to front line staff more, but when the staff say they are facing burnout and services are restricted to provide relief, then the Greens will also complain.
The message from the Greens is so disjointed they can’t even keep their story straight for more than two weeks. When you get past their criticisms you will see they have no actual solutions of their own. The only solution their latest candidate for a by election, Matt MacFarlane, can offer is a suggestion that experts like Dr. Gardam and Derek Key should be listened to. Really? That’s all you got? What about Bins, Ghiz, and MacLauchlan? Did they also not listen to the experts? I guess the suggestion from the Greens is that if you trust them to run the government then they are going to listen harder than past governments. They are political opportunists of the worst kind, they will jump on any story and provide instant criticism without a shred of any critical analysis. Their first goal is always to use any story to attack the current government regardless of whether the policy is likely to yield a good results or not.
If this is the level of criticism that the Opposition brings to the table then the outlook for PEI is really not good. The King government is failing, but if the criticism is not fair, then the likelihood that proper solutions can be implemented is next to zero.
On Deciding Who an Expert Really Is on Healthcare
Since this narrative that experts should be the ones running healthcare on PEI has gained the most traction, lets take a moment to dissect this argument. The Greens were some of the first to run with this narrative after Dr. Gardam made his testimony to the Health Committee. Supporters of this position have shown their disdain for King on social media and suggested that King is just some dumb hick from Georgetown, he nor his office has any right to make any decisions regarding healthcare on PEI. King might very well be some dumb hick, I don’t know, but I do know he is the one that won the last provincial election by an overwhelming margin. He has every right to get involved in healthcare. It’s what Islanders expect, otherwise there would be no need to debate healthcare during election debates. The fact that every political party on PEI comments on healthcare during an election proves that nobody buys this arms-length arrangement with Health PEI.
The other point to address is who exactly should have the power to determine how an expert in healthcare is defined. It clearly can’t be the media, the public is losing faith in media and they now require government subsidies to stay afloat so their impartiality is compromised. The next criteria might be the level of higher education attained. While this is certainly a factor to consider, it can’t be the only factor. As someone that went to a supposed top end school in Canada for a business degree, let me assure you that many not so intelligent people attain higher education. In fact, the state of higher education is collapsing at such a rate that taking on student debt in order to attend such an institution could very well be considered a poor decision.
It would seem to me the best way to decide who an expert is in healthcare would be to have an open free-market system and see who can run the most successful business in the field. Profit margin is an objective and unbiased way to determine who the most effective managers are, there is no greater accountability that I can think of. Let Dr. Gardam and Derek Key put their own capital down or convince investors to fund projects run by them and see how they perform. They may do very well, I don’t know, but neither do the Greens, the media, or other supporters of their arguments.
In the absence of a free-market, people will simply have to rely on subjective valuations to determine who an expert is in healthcare management. Democracy is the system Islanders have chosen in order to determine which expert will be in charge, and the system has chosen King. It’s commonly understood that democracy does not often put the best people in charge of government, but that is a defect that is outside the scope of this essay to explore. What is important to note is that currently that is the system which all the interested parties have decided to abide by.
If other parties feel that some other expert should be in charge then those parties should encourage the expert to run for political office so they can try out their ideas should they win.
Suggestions for Going Forward
Listening to both Dr. Gardam and Dr. Jain at the health committee it seems clear to me the bureaucracy in PEI is out of control regarding health. For the top level there is the Premier’s Office, Department of Health, Health Board PEI, and Health PEI. Simply astounding for a province of not even 200,000 people. The Fraser Institute has studies that compare Canada’s health system with other European countries and they confirm that Canada’s single payer system is far too expensive for the level of service it provides. I would start the process of cost cutting by immediately canceling the Health Board. It seems clear it has no real purpose as it’s not being used as intended and even if it was it’s just an extra layer of bureaucrats that I really see no use for. It’s cancellation would most likely save millions that could be reinvested into front line staff.
My next suggestion would be to take Dr. Gardam’s suggestion and seriously consider making fundamental changes to the system. He encouraged getting people in a room and seriously consider all options for moving forward to try and salvage this wreckage. With that in mind I’m thinking it would be a good idea to have a big conference months from now and invite all the major scholars and analysts on healthcare in North America to provide presentations. Make available publicly any consultation reports done in the last 10 years along with any relevant data collected so that everybody has a chance to present realistic solutions based on data. And yes this would include having and listening to presentations on privatization including a two-tier system, private insurance, or the use of private clinics. If everybody is serious about finding solutions then all options have to be on the table.
The biggest change though has to come from Islanders themselves. For too long they have looked at Medicare with proud hearts and touted it as one of the best healthcare systems in the world, when in truth it’s a failure by just about every single metric when compared to other Western nations. To live in truth and set things right means to sacrifice, but in healthcare Islanders have rejected the truth. For years they put their faith in politicians who promised they were going to fix healthcare but they never bothered to ask exactly how this would be achieved. They voted for what they wanted to hear, not for what was real. After years of this trend a large sacrificial debt has accrued, and it’s impossible to escape the reality.
Unless Islanders find the courage to examine the mistakes of the past and consider new courses of action then there is truly no way to set things right in my view.