Kill or Cure: How Canadians Can Remake Their Health Care System was written by Dr. Carolyn Bennett, with Rick Archbold, and released in October of 2000. All proceeds from the sale of this book (which can be purchased at most major book stores and Women's College Hospital) will be donated to the Women's College Hospital Foundation. The following is an excerpt from the preface to the book.
In 1994,when I first decided to run for public office, my patients complained, “We’re going to lose a good doctor.” But I had no trouble explaining my decision: “I think I have to go and do this in order to make sure that it continues to be possible to be a good doctor!” I told them. By then our health care system seemed ready to crumble, putting stress on both patients and health care providers. Instead of looking for ways to make our system sustainable------by spending money more efficiently and paying more attention to preventing sickness in the first place-----governments chose primarily to put a lid on costs. They began rationing medical services to save money, and succeeded mainly in eroding Canadians’ confidence in their system.
Canadians are justifiably proud of their universal, publicly funded medical care system. It is a distinctive part of our country, one of the ways we show ourselves and the world that our values include caring for one another and a fundamental sense of fairness. Reforming medicare involves much more than economic choices and policy choices. It involves making a choice about our values as a nation. I’ve made my choice. The kind of health care system I want for me and for my children is one that makes no distinctions between rich and poor, a system under which all Canadians are equal.
These days, an increasing number of politicians and others are arguing that the only way to save medicare is to sell off large chunks of it to the private sector. Many people, inside and outside the medical profession, will never be happy until patients have to pay. They believe against all the evidence that patients need deterrents in the form of user fees in order to stop them from “abusing” their system.
These proponents of what is often called a “two-tier” system argue that a parallel system of private providers will “take the load off the public system.” What’s more, they say, these private operators will inject a healthy dose of competition into the health care marketplace that will help control costs and lead to better service. I don’t buy these arguments camouflage a very different set of values from the ones on which our universal public system was founded, values that have to do with equity, social justice,and the public good.
When I first ran for public office in Ontario, I promised my patients I’d work to remake a health care system. They believed in, one that reflected their values. I believed then and I believe now that the confidence that Canadians have in the public health care system is our ultimate protection against those who want to push us down the slippery slope to a two-tier, American-style system. I am conviced that Canada’s approach to health care is fundamentally sound. But the message that the system needs fixing, not trashing, isn’t getting through. I left my wonderful practice to make sure that the message was delivered loud and clear. To the people making the decisions.
Six years later, I’m in Ottawa, and still working to bring the view from the trenches into the corridors of power. But I also now realize that the future of health care won’t be secured by one—or even seven!---physicians sitting in the House of Commons. Our system will be reformed in a sustainable way only if we reset the table where decisions are made and allow patients a permanent seat at the table. Their priorities and the way the system affects them must come first.
Last year I ran into author and globe and Mail national columnist Jeffrey Simpson at the annual “Politics and the Pen” dinner in Ottawa. Jeff had heard me ranting about health care reform and now he issued a challenge: “What makes you think that Canada can be the only industrialized nation with a universal health care system?” “Because Canadians want it to work, I replied. As I explained to him that day, I believe that Canadians want us to fix the system and keep it publicly funded and equitable. Our system of universal health care is a Canadian badge of honor. Canadians -don’t want to let it go; they want to help make it work.
Canadian health care is at a crossroads. We are in the midst of a national debate that will determine the kind of system we take into the twenty- first century. Will we fix the system that has reserved us well for many years, but that isn’t working so well any more? Or will we let slip away? Will we take collective action to cure what ails Canadian health care or will we kill it through ignorance and inaction?
I have written this book to help frame the health care debate that heated up during the winter of 1999-2000 and that will undoubtedly simmer on for years to come. I believe the debate should not be about whether we can afford a publicly funded system—evidence from around the world overwhelmingly shows that public systems are better and more efficient than private systems or two-tier systems—the debate should be over how to reform the Canadian medical system so that it delivers top-quality care to all of the people all of the time. So it provides every Canadian citizen with the level of health care he or she needs and deserves.
Michael Ignatieff once remarked that one of the real barriers to any progressive movement is a nostalgic look back to some perceived paradise in the past. Medicare past was no paradise: many of its problems were disguised because we simply threw money at them. That approach won’t work any more. Given the tools---above all, the information--- Canadians in their roles as knowledgeable patients, effective advocates, and committed citizens can and will make our system work. They have to. I promised my patients, the people of St. Paul’s, and Jeffrey Simpson.
© Carolyn Bennett 2004. All rights reserved.