Essays

Essays June 2011

The End of Healthcare Infotainment

Neil Seeman

Three cheers for ending the debate over two-tiered healthcare! With a Harper majority, serious dialogue over the one issue that is crippling our healthcare budget – chronic illness – will be addressed in the next Parliament. I know this because (a) Stephen Harper is an economist who understands the return-on-investment of a preventive healthcare model and (b) in the NDP we have a party that has embraced prevention. On this issue, we will see a happy marriage.

Most important: the people – on either side of the political fence – who blather on about tinkering with the funding formula (“Save Medicare!”; “Embrace the free market!) don’t matter much anymore. Debate over moving to a ‘private model of healthcare’ – even though much of our healthcare is already paid out of our own pockets; hospitals are private; and doctors are independent contractors – was public policy entertainment fodder for pundits who were cajoled by advocacy groups whose primary agenda was to get media attention.

The erstwhile ‘influencers’ in Canadian healthcare – the major media, advocacy groups, a handful of strident activists – now have limited capacity to sink the debate over healthcare back into infotainment. This was what the debate over Canada’s ‘creeping privatization’ always has been. The new influencers in healthcare are post-partisan: they want to talk about the prevention of chronic illness, which is an issue driving roughly 70 percent of our health costs.

We now have a policy window of opportunity to return Canada to where it once was – an international thought leader in preventive care, thanks to the 1974 Lalonde Report. Most who work in the front lines of clinical care, in hospital administration, and in any area of health system design, know that new ideas to combat chronic illness of an aging population are what matters if we want to bring costs to heel and improve human health. This is a position shared by economic models proposed by left-wing economists; right wing economists; and everyone in between.

Yes, this requires investment in the short term. But the self-styled libertarians who dominate talk-radio and wince at any expansion of the state forget that prevention used to be a policy idea supported by conservatives. To constrain the power of the state, and give back power to individuals to take care of their own health needs, we need to take prevention seriously.

We also need to measure the impact of prevention activities on an individual level as opposed to investing in failed top-down government approaches to curtailing the costs of obesity (‘eat-your-fruits-and-veggies’; ‘get moving!’; banning vending machines in schools), obesity being the primary driver of most chronic illness. The direct costs of overweight and obesity are $6 billion – 4.1 % of Canada's health budget. Productivity costs (e.g., absenteeism) are $30 billion annually.

Ultimately, the cure to chronic illness will not come from government dollars alone – and I have every confidence that this ‘government investment’ frame will not be the one that dominates the federal renewal of the Health Accord in 2014 – but from a climate of deregulation that enables the private marketplace to offer goods and services that attack chronic illness.

Public infotainment over healthcare has sidelined the critical role of entrepreneurs and private business in the improved delivery of healthcare solutions. These include implantable devices, glucose self-monitoring apps, and employer-based portals to help staff navigate the health system to get better access to mental health or cancer services. Companies invest in preventive care because they want to retain and recruit healthy workers; and because their investors demand it. If government ‘innovation funds’ got out of the way, and stopped picking winners for taxpayer-funded subsidies – green technology comes to mind – then the prevention market would thrive.

With a majority, stable government in power in Ottawa, the federal government will now be free – not to rip and replace the Canada Health Act, which it has pledged not to do – but to move the dial on serious dialogue over chronic illness. Thank heavens, real entrepreneurs and private business will play a bigger role in this debate; advocacy groups will be less and less relevant. This is something for which we, and the next generation, will be thankful.

About the Author

Neil Seeman, a Senior Resident at Massey College, is CEO of the Health Strategy Innovation Cell.

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