His family’s inability to pay for hospitalization and treatment of his father’s respiratory ailment anchored Saskatchewan’s Tommy Douglas’ determination to initiate publicly financed hospital and, later, medical insurance, the combination Canadians know as Medicare. Here we are more than a half-century later. We have a growing population of elderly Moms and Dads getting acute care repeatedly for their chronic conditions, many of them languishing in hospital beds, all for lack of the supportive services they need to remain healthy, happy, and safe in their own homes and communities. The pendulum has swung too far. Where are the political leaders now with the determination to make it right?

What should they do?

First they should expand the definition of what is publicly insured under Medicare; include prescription drugs, assisted living, and rehabilitation for a start. Let’s make real the “comprehensive” principle of the Canada Health Act! It doesn’t make sense to provide first dollar coverage only for in-hospital and physicians’ services while retaining co-pays and other financial barriers to the range of home, assisted living, community-based services elderly people need to stay in their own homes. Can we afford it? The total cost, measured as a share of the Gross Domestic product, would be the same or less, as is demonstrated clearly possible by other countries like the United Kingdom and the Netherlands with far more comprehensive coverage than in Canada. But the distribution of publicly supported services would be much fairer, especially between acute care and the kinds of care frail, poor, and elderly people need to continue living safely in their communities.

Second, all Canadian provinces should take a close look at how multi-professional primary care teams in European countries care for their elderly citizens; Denmark is a particularly good example. Canada’s thin population and vast geography do present particular challenges but European and Canadian cities are not dissimilar when it comes to the organization and provision of home and community care. Let’s do what they do.

Third, it is (over)time for our governments, federal, provincial, and territorial, to get real with respect to health information management. We need governments to lead/govern, a role they are entitled to play given that 70% of the total cost of healthcare comes from the public purse. It’s time to come into the 21^st century and lay down the kind of standards that the myriad, competing commercial ‘packages’ out there have to meet to contribute to a genuinely comprehensive, inter-communicating, country-wide health/healthcare information system, one that also gives every citizen a health record, shareable with all his or her service providers, from home care nurse through to tertiary care hospital.

Finally, healthcare is but one of the many factors that determine peoples’ health. Fully 75% is determined by social factors of which, for elderly people, appropriate and assisted housing, a supportive community, income and personal security, exercise, and a nutritious diet are particularly important. Optimizing the health of the population requires a ‘whole of government’ approach. For starters, the fourth action governments should take is to amalgamate their Ministries of Health and Social Services. Not only would this eliminate many current inter-Ministerial obstacles for service providers and citizens alike, it would make more direct the accountability central government needs and taxpayers demand for better health outcomes than Canada now produces. Surely for the money spent we can do better than come second to last relative to other OECD countries!

These things can be done! All we need is leadership and the determination to get on with it.

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