Canada: Voters question: How do we fix health care system's ills?

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After six years on the job, on Aug. 31, Maude Ségleski worked her last day as a nurse in Quebec.

a group of people lying in the grass: Health care workers held a © Provided by The Gazette Health care workers held a

The 26-year-old had dreamed of working in health care since childhood. But years of understaffed shifts, forced overtime and being made to feel like a number  —  employee #503036  —  instead of a person finally caught up to her.

What fuelled her decision to quit the most, though, was witnessing how the issues plaguing the health network led to what she describes as a “dehumanization” of care. A problem both exacerbated and laid bare by the pandemic.

Asked recently what needs to change to improve the state of care or stop others from leaving the profession, Ségleski listed several issues.

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“But not forgetting that we’re human beings, working for other human beings, would be a good start,” she said.

From the outset of the federal election campaign, it became clear questions surrounding the future of health care, and how to best tackle the rest of the pandemic, would be among the key issues at stake.

The pandemic has highlighted the crying needs in the network in unprecedented fashion  —  making the topic all the more critical this time around, experts say.

“One of the differences with this election is that health care is on the minds of every Canadian, as it’s never been so front and centre as it is now because of the pandemic,” said Dr. Katharine Smart, president of the Canadian Medical Association.

The pandemic “has exposed a lot of the cracks in the foundation,” Smart added, “and made it really clear that we need to reframe and reinvest in our health care system for the future if we want it to meet the needs of Canadians.”

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On the campaign trail and in debates, the leading political parties have all presented their visions for Canada’s health care system moving forward.

They’ve pledged to address some of the specific issues seen in the network, including how to retain nurses like Ségleski and remedy country-wide shortages.

And they’ve committed to improving long-term care facilities, an issue magnified by the deaths and poor conditions seen in centres across the country once the pandemic struck.

But for Daniel Béland, director of the McGill Institute for the Study of Canada, a large part of the health care debate comes down to a question of funding  —  and how much say the federal government should have in how that money is put to use.

“Because that’s what the federal government does the most in health care — transfer money to the provinces and territories,” Béland said.

a person standing in front of a computer:  A nurse in the Covid-19 unit of Verdun Hospital on Feb. 16, 2021. Quebec is facing a shortage of about 4,300 nurses, due in part to departures caused by burnout. © Allen McInnis A nurse in the Covid-19 unit of Verdun Hospital on Feb. 16, 2021. Quebec is facing a shortage of about 4,300 nurses, due in part to departures caused by burnout.

Before the election was even launched, Canadian premiers called on Ottawa to boost health care funding by at least $28 billion a year, increasing its share of health care funding from 22 per cent to 35 per cent.

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Among the most outspoken on the issue has been Quebec Premier François Legault, who has reiterated health care funding should be the “priority of all priorities” and come without conditions. Legault is facing criticism about Quebec’s nursing crisis — a shortage of about 4,300 nurses due in part to departures caused by burnout, he acknowledged Wednesday — and the lingering fallout as a coroner’s inquest examines the high death toll in Quebec nursing homes during the first wave of the pandemic.

In Béland’s view, how the parties have navigated the question of health transfers has mirrored their views on federalism.

“On the one hand, you have the NDP and to a certain extent the Liberals, who have a more centralized vision of things and think the federal government should play a more direct role in health care,” he said.

“On the other side of the debate, you have the Bloc and the Conservatives who have a much more decentralized vision and, basically, the idea is to write a bigger cheque to the provinces and territories, no questions asked.”

During the campaign, Liberal Leader Justin Trudeau has promised to give provinces more funding to improve long-term care, as well as set national standards that would need to be upheld across the country.

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He’s also pledged $6 billion to cut down waiting lists across the country and $3.2 billion to hire 7,500 new family doctors and nurses.

For the Conservatives, leader Erin O’Toole has pledged to raise the Canada Health Transfer’s annual growth rate to at least six per cent, and pledged $60 billion for more health transfers over the next decade.

Much of the debate early in the campaign also centred around O’Toole’s wish to see more “innovation” in the private health care sector, or in his words, more “public-private synergies.”

His position led the Liberal party to suggest that a Conservative government would move Canada toward a two-tiered health system, “letting the wealthiest pay to jump ahead in line.”

O’Toole has fought back, insisting he supports universal health care but at the same time would not interfere with provinces working with the private sector in health care.

The New Democratic Party, for its part, has committed to expanding health care to include pharmacare and pledged $250 million to address the nursing shortage. The party would also train and hire 2,000 nurses, leader Jagmeet Singh has said.

The Bloc Québécois, on the other hand, has said it would increase health transfers to provinces and territories until the federal government covers at least 35 per cent of health care spending.

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And the Green Party of Canada has focused on expanding public health care to include pharmacare, creating a national drug-reduction strategy and treating “drug addiction as a public health issue, not a felony.”

a close up of a door:  In the COVID-19 hot zone at Maimonides Geriatric Centre in Côte-St-Luc on Nov. 24, 2020. © John Mahoney In the COVID-19 hot zone at Maimonides Geriatric Centre in Côte-St-Luc on Nov. 24, 2020.

Looming over the entire health care debate is also the parties’ visions on how to best handle the rest of the pandemic and a fourth wave now threatening to overwhelm hospitals.

Questioned on why he would call an election in the middle of a health crisis, Trudeau has often said he believes it’s the right time for Canadians to decide on “how we finish the fight against COVID-19.”

In campaign stops across the country, the Liberal leader has been met by what he’s described as fringe “anti-vaxxer mobs” protesting against public health measures and vaccine mandates.

With the Liberals and Conservatives tied in the polls in recent weeks, Béland said vaccination has emerged as a wedge issue in the campaign, with Trudeau positioning himself on the side of the nearly 80 per cent of eligible Canadians who are now fully vaccinated.

“It’s not a small, angry minority that is very loud and quite scary to a lot of people that is going to start to define the country that we are,” Trudeau said this week when asked about the protests.

If re-elected, Trudeau has pledged to require travellers on interprovincial trains, commercial flights and cruise ships to be vaccinated. He would also ensure vaccination across the federal public service and set aside $1 billion to help provinces set up vaccine passport systems.

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O’Toole, for his part, has said a Conservative government would rely more heavily on rapid testing than mandatory vaccination. He’s also said he would ensure the country’s vaccination coverage climbs above 90 per cent, but at the same time has faced criticism for not demanding his own candidates be vaccinated.

For Smart, of the Canadian Medical Association, how the country decides to move forward through the pandemic is crucially important.

But it’s been frustrating to see how much the anti-vaccine movement has figured into the election campaign, taking time away from needed conversations surrounding the future of health care in the country, she said.

In a survey conducted for the association in early September, 60 per cent of respondents said the party that prioritizes health care will earn their vote. Respondents also said the health care system, more than the economy or housing, is what they believe is most in need of federal investment.

In addition to an increase in funding, what Smart hopes most to see from the next government is the will to work with health care professionals to address the persistent issues across the network.

“That’s going to take asking some hard questions,” she said. “So I really hope that from this debate comes an actual commitment. And whoever forms the government continues to prioritize health care.”

Justin Trudeau, Erin O'Toole, Jagmeet Singh, Yves-François Blanchet posing for the camera:  From left: Liberal Leader Justin Trudeau, Conservative Leader Erin O’Toole, NDP Leader Jagmeet Singh, Bloc Québécois Leader Yves-François Blanchet and Green Party Leader Annamie Paul. © Provided by The Gazette From left: Liberal Leader Justin Trudeau, Conservative Leader Erin O’Toole, NDP Leader Jagmeet Singh, Bloc Québécois Leader Yves-François Blanchet and Green Party Leader Annamie Paul.

KEY HEALTH CARE PROMISES

LIBERALS

  • Invest $6 billion to support the elimination of waitlists.
  • Provide $3.2 billion to the provinces and territories for the hiring of 7,500 new family doctors and nurses.
  • Train up to 50,000 new personal support workers and raise their minimum wages to at least $25 an hour.
  • Provide $400 million over four years to improve virtual care.
  • Invest $4.5 billion over five years in mental health services.

CONSERVATIVES

  • Increase the annual growth rate of Canada Health Transfer to six per cent, injecting nearly $60 billion into the health care system over 10 years.
  • Double the direct federal investments in palliative care.
  • Encourage employers to add mental health coverage to their employee benefit plans by offering a tax credit.
  • Create a nationwide three-digit suicide prevention hotline.
  • Invest $325 million over the next three years to create 1,000 residential drug treatment beds and build 50 recovery community centres across the country.

BLOC QUÉBÉCOIS

  • Increase health transfers to provinces and territories until the federal government covers at least 35 per cent of health care spending.
  • Address waitlists and medical procedure backlogs through increased health transfers.

NDP

  • End private, for-profit, long-term care and bring long-term care homes under the public umbrella.
  • Develop national care standards for home care and long-term care.
  • Work with the provinces and territories to tackle wait times and improve access to primary care.
  • Implement a national, universal, public pharmacare program.
  • Create a universal dental care program.

GREENS

  • Expand public health care to include pharmacare, establishing a Crown corporation to bulk purchase and dispense prescription drugs.
  • Include basic dental care in national coverage.
  • Create a national drug-reduction strategy and develop more safe injection sites.

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