'It’s not about what Stephen Harper wants or what I want—85 per cent of Canadians want a wait times guarantee’
TONY CLEMENT, FEDERAL MINISTER OF HEALTH, TALKS TO KATE FILLION ABOUT BENCHMARKS, INNOVATION, AND WHAT HIS MOTHER TAUGHT HIM
Q: When you were Ontario health minister from 2001 to 2003, you called for more federal funding. Now you're the federal minister of health and you don't want to give the provinces any more money. What’s changed?
A: I am conscious of the irony. But there’s been a big change: the 2004 health accord that was agreed to by all of the provinces and the prime minister of the day, Paul Martin. It gives a lot more money to the provinces, $41 billion over 10 years. There’s a six per cent escalator per year, which takes into account health care inflation. If I had had that kind of extra cash coming in from the federal government, I wouldn’t have been complaining.
Q: So you approve of the Martin government’s handling of health care. Maybe there’s not that big a difference between Harper and Martin on this issue?
A: Stephen Harper, as Opposition leader, did endorse the accord. The main difference is that we do want to move forward with the wait times guarantee.
Q: How much will Harper need to spend to create a guarantee?
A: Is $41 billion extra not enough? I don’t think anyone in their right minds would say it’s not. We’re spending $180 billion a year on public health care right now.
Q: But in the accord, the provinces agreed only to benchmarks, not guarantees.
A: To me, they’re two sides of the same coin. A benchmark means you’ve identified a clinical time within which a patient should receive a health care service. If we have a sixweek benchmark for a particular service, we can’t then not ensure we meet it. That would be ridiculous, callous and self-defeating.
Q: Well, a benchmark is a goal, while a guarantee implies a consequence. And the provinces would say guarantees will cost more money, as will consequences, because they’ll have to keep operating rooms open longer, run additional MRI tests and so forth to deliver.
A: I would disagree. If you manage the list better you don’t have to spend more. You know, Dr. Brian Postl was appointed by the provinces to look at wait times, and he said part of the solution has to be that doctors pool their lists, so we don’t have this silo effect with each individual doctor keeping his or her list without a free flow of patients among those doctors. These are management issues. The other thing is that you’re starting to see significant investments into information technology, electronic health records and medical records, and that will help on a number of fronts. It will help track the patient better so he or she isn’t lost in the shuffle, and it will also help reduce medical error, which is rife in the system because of, let’s say, not-neat handwriting, and different types of databases not talking to one another.
Q: In the Constitution, health care is clearly a provincial jurisdiction. Why on earth would the provinces agree to create guarantees that the federal government wants, especially since they don’t share your view that $41 billion is enough?
A: It’s not about what Stephen Harper wants or what I want—85 per cent of Canadians want a wait times guarantee, so we really have to respond. And the last thing Canadians want is different jurisdictions squabbling with one another. There is a Canada Health Act, there are federal transfers to the provinces on health care, and there’s a federal minister. So let’s get beyond the who’stromping-in-whose-flower-patch issues, and actually get some work done, together, for the people we represent.
Q: Are we going to come out of this with a national guarantee or are there going to be differences between provinces?
A: I think eventually you’ve got to move to a national guarantee, so Canadians know that for specific procedures, they’re being treated the same across the country.
Q: People think wait times have dropped off the government’s agenda. The other day Chantal Hebert wrote in the Toronto Star that you’re “enjoying a life of semi-retirement.”
A: I don’t think federal politics can be called a life of semi-retirement! I said from the outset this was going to have a longer arc than the other [election] promises, because they could be delivered with a budget or a bill in Parliament, and this is going to take years. By the end of2007, we’re expecting each province to signal that they are ready to move forward on certain wait times guarantees. By the end of 2008, we expect to see the start of implementation of those guarantees. And there will be a parliamentary review in 2008, so to me that’s the time to take stock of what’s working and what isn’t working in the whole accord but also, I’m suggesting, in the wait times guarantee as well.
Q: Who’s made progress so far?
We have made progress in Quebec. Manitoba de clared wait times guaran tees in essence when it comes to cancer and car diac treatment. We're starting to see various experiments to reduce wait times, like the joint replacement project in Alberta which reduced wait times by 90 per cent. My role is to keep pushing, keep advocating, keep leveraging where I can.
Q: One of the ways Alberta cut their wait list was to say obese people are ineligible for certain types of surgery. Do you think that’s the model, that if you eat too much or, say, drink too much, you shouldn’t be eligible?
A: It was a first-time look at this thing, and the moral of the story is that they did nothing that was contrary to the Canada Health Act. They managed the list differently, and they cut the wait times significantly. Is it perfect? No. I think you find out what worked and what didn’t work, and you do better the next time around.
Q: How much responsibility do individual Canadians have to look after their own health?
A: A lot. There’s a libertarian argument that it’s none of the state’s business, but when a lot of tax money goes to health care, it is everyone’s business. Look, I’m not perfect, I have a bit of a sweet tooth myself, for chocolate. But most Canadians know what’s good for them. It’s not rocket science.
Q: What kind of recourse will patients have if a wait times guarantee isn’t met?
A: I’m of the “let a hundred flowers bloom” philosophy because we’re moving into a new frontier and I don’t want to be dogmatic. It could be that a patient navigator of some sort kicks in, who says, “Look, I know you expected to have your procedure done in six weeks, but you’d have to wait eight weeks at your local hospital, so we’re going to look around the province or region to find you a better turnaround time.” It could be some sort of appeal process, similar to but more robust than the one that’s already available in several provinces. Recourse, to me, means that you’re not left stranded in a system that doesn’t care whether you get the services in a timely manner or not. I just don’t think that’s acceptable, and the Supreme Court of Canada is saying the same thing. The Chaoulli decision really did change the complexion of the health care debate in Canada.
Q: But the decision, which essentially said that if the province isn’t providing services quickly enough the patient can get them elsewhere and the province has to pay, is more than a year old. And it’s not really being enforced, is it?
A: It’s a precedent. And there’s now a new court case in Alberta where a patient wants Chaoulli-type rights. We’re going to see more of this type of advocacy if we simply do nothing.
Q: When you were running for the Conservative leadership federally, you talked a lot about innovation in health care, and there were mutterings that “innovation” was a code word for privatization. But isn’t it really code for “unions are obstacles to delivering more patientcentred care”?
A: Innovation is in the eye of the beholder. In order for health care to be available in the future in a sustainable manner, we are going to have to look at scopes of practice, making sure that each medical professional can practise to the fullest extent of his or her training. That isn’t happening. When you say, “Gee, maybe that registered practical nurse should be doing a little bit more,” the registered nurses get upset.
And when you say, “Gee, maybe this nurse practitioner should be doing a little bit more,” the family physicians get upset. So the toughest thing when it comes to innovation is not money, it’s getting everybody to play in the sandbox. And the tough message is that the health care system ultimately cannot be about the providers. It has to be about the patients. I mean no disrespect to any provider, but for goodness sake, if we’re worried more about what the providers will think of something versus what the patients will think, we’re a long way from a better health care system. At the same time, you have to move forward on innovation in a way that providers feel included. That’s a difficult balancing act.
Q: Speaking of balancing acts, in hindsight, do you wish you’d thrown your support in the Ontario Co?iservative leadership race to Jim Flaherty, now federal minister of finance, rather than Ernie Eves?
A: As my mother taught me, “If ifs and buts were candy and nuts, every day would be Christmas.” Jim and I don’t dwell on that. We have an extraordinarily strong working relationship.
Q: He made very personal attacks, on your wife even, during that race. How did mend the fences?
A: Life is too short to hold grudges. When you look at Jim Flaherty and me, how passionate we are about politics, and quite frankly the common sacrifices we’ve made for it, we have a lot more in common than we do apart. Don’t forget, Jim and I had a reconciliation two years ago, because he was one of my national co-chairs when I ran for the leadership of the federal party.
Q: You lost four elections in a row and won the fifth by just 28 votes. Why are elections so tough for you?
A: I just don’t think we can assume we have a God-given right to be in politics. Voters make decisions for all sorts of reasons, or they may make a decision for no reason at all, and all of it is valid. If you start to take it personally, you should get out, very quickly, because you’re going to be miserable. The good news, for me, is that if we were having this conversation a year ago, the question would be: what makes you think you can possibly be resurrected in politics? A year ago, most people would’ve laughed if you’d told them I’d be health minister. As Keith Richards says, “It’s great to be here. It’s great to be anywhere!”
'I have a bit of a sweet tooth. But most Canadians know what's good for them. It’s not rocket science.’
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