One of the most important challenges facing the progressive health community is how to try to frame the debate in ways that will win public support and shift the way health reform is understood. Public opinion data clearly shows solid support for the values of universal access and Medicare, but there are also widespread worries about waiting lists, finding family doctors, long-term sustainability of the system, etc.
If the system is seen to be in crisis — if the issue can be defined as unreasonable waiting lists or bureaucratic ineptitude, as conservative proponents attempt to do – then this can open the way for simplistic privatization arguments. Why not let some people get their hip replacements at a private clinic if it would ease the burden on the over-stretched public system? There is solid and consistent evidence for ‘why not’: private funding and provision of health care services is far more costly, access is inequitable and quality poorer. But that is another story.
My point here is how important it is for progressives to not be seen as solely defensive:
- Medicare can’t be defended simply as some kind of defining icon or immutable value;
- the existing system has great strengths that need to be defended – especially universal access – and the inequitable impact of privatization does need to be highlighted;
- but we also have to recognize that there are significant problems in access and delivery that must be fixed;
- recognizing these problems is also strategically very important because it is on system inefficiencies and access bottlenecks that privatization proponents are making their pitch.
We need to couple a vigorous defence of universal access and the basic values of Medicare with a plan to address the health system’s current problems and mobilize around a positive vision of the future.
Tremendous work in fleshing out this vision of the future is being done by the Association of Ontario Health Centres and the Canadian Alliance of Community Health Centre Associations in advocating for completing the second stage of Medicare. They remind us that Tommy Douglas and the original founders of Medicare always saw the crucial goals of universal health insurance and access to hospital and medical care as just the vital first steps to a system that would keep people well and not just treat them when sick.
The Second Stage would:
- increase the emphasis on preventing illness and promoting good health;
- develop cross-sectoral approaches to addressing the underlying social determinants of health;
- prioritize reducing health disparities;
- reorganize services to provide them in more flexible and integrated ways such as multi-disciplinary teams, comprehensive clinics, better local and regional coordination, and so on;
- through such changes – and through more democratic governance of health care planning — ensure more timely, equitable and effective care.