John Lawrence Reynolds - Prognosis

PENGUIN CANADA

PROGNOSIS

JOHN LAWRENCE REYNOLDS is the author of twenty fiction and non-fiction works, including When All You Have Is Hope, co-authored with Frank ODea. His book Free Rider: How a Bay Street Whiz Kid Stole and Spent $20 Million won the National Business Book Award and was optioned as a motion picture. Shadow People, his study of secret societies throughout history, was published in more than a dozen countries. A two-time winner of Arthur Ellis Awards for Best Mystery Novel and winner of a National Magazine Award, Reynolds lives in Burlington, Ontario.

Also by John Lawrence Reynolds

Non-Fiction

When All You Have Is Hope (with Frank ODea)

The Naked Investor:

Why Almost Everybody But You Gets Rich on Your RRSP

Shadow People: Inside Historys Most Notorious Secret Societies

Straight from the Top (with Robert Milton)

All in Good Time (with Brian Tobin)

Money Management for Canadians (contributor)

Free Rider: How a Bay Street Whiz Kid Stole and Spent $20 Million

Mad Notions

RRSPs and RRIFs for Dummies

Ballroom Dancing: The Romance, Rhythm and Style

Fiction

Haunted Hearts

Solitary Dancer

Gypsy Sins

Whisper Death

And Leave Her Lay Dying

The Man Who Murdered God

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First published 2008

1 2 3 4 5 6 7 8 9 10 (RRD)

Copyright John Lawrence Reynolds, 2008

Author representation: Westwood Creative Artists

94 Harbord Street, Toronto, Ontario M5S 1G6

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book.

Manufactured in the U.S.A.

ISBN-13: 978-0-14-305093-3

ISBN-10: 0-14-305093-1

Library and Archives Canada Cataloguing in Publication data available upon request.

Visit the authors website at www.wryter.ca

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For Nan and Gord Roeder
and to the memory of Lisa

Healing is a matter of time,

but it is sometimes also

a matter of opportunity.

HIPPOCRATES

INTRODUCTION
HOCKEY, MARK TWAIN, AND McLUHAN

Hockey may be Canadas national passion, but analyzing the countrys health care system is its national pastime. We discuss it everywhere in the newspapers, at the water cooler, in Tim Hortons, over lunches and dinners, and on the internet. Our obsession with the topic recalls Mark Twains comment about the weather: Everybody talks about it but nobody does anything about it.

People elsewhere in the world might question our endless complaints. Canadians, statistics tell us, enjoy among the highest life expectancies and lowest infant mortality rate of all industrialized nations, including the United States, yet we spend far less per capita on caring for our citizens than our wealthier neighbour. We value our health care system above almost every other national concern, and the overwhelming majority of us like to believe it reflects two quintessentially Canadian values: fairness and pragmatism. But the criticism continues, often punctuated with raised voices and fists.

Few Canadians talked and wrote more about the health care system in recent years than former Saskatchewan premier Roy Romanow. His Royal Commission report on health care, issued with great fanfare on November 28, 2002, was greeted with huzzahs for the authors hard work and wisdom, and was praised for its comprehensive approach and firm recommendations. Public health care, Romanow trumpeted, was a right of citizenship, and Canadians viewed health care as a moral enterprise, not a business venture.

Four years later, a review of the report and its impact revealed the following:

The proposal by the Royal Commission on Health Care to include home care among five specific areas of special funding, as recommended by Romanow, was later deleted in direct contradiction to the Romanow Reports recommendations.

No changes had been made to the Canada Health Act.

The Health Council of Canada, yet another government-funded body, had been established with a mandate and budget so confusing in their articulation that it is difficult to define either its goals or its cost to taxpayers.

Federal and provincial governments continued to skirmish over who decides what to do, and for whom, and how much to pay for it.

Canadas most widely circulated English-language magazine devoted virtually an entire issue to attacking the concept of Canadas publicly funded health care system, praising the merits of private enterprise and, in a manner worthy of any small-town chamber-of-commerce effort to promote local industry, printing a Complete Users Guide to Private Medical Care in Canada.

As dedicated, comprehensive, and detailed as the Romanow Report may have been, it suffered from the same problem all government reports encounter: it wasnt read by the people most affected by its findings. Those employed within the health care system digested its contents and debated its findings. Those outside the systemthe consumers of health care services in Canadarelied for the most part on media reports that treated the Romanow Report as though it were any other news story, meaning it was crowded off the pages and television screens by urgent headlines dealing with wars, murders, assaults, and the weekend antics of movie stars. Meanwhile, horror stories of extended wait times and the health care systems escalating costs remained a hot topic among columnists and the hosts of radio call-in programs, whose lamentations continued to drown out the Romanow highlights.

At times, it appears that the only subject of any dialogue concerning our health care system is the public-versus-private-funding debate, an exchange that remains as polarized and vehement as any evenly matched Stanley Cup playoff game. The funding question dominates the discussion not because it is fundamental but because the choices are easily defined (even if the relative benefits remain vague), and the proponents tend to divide along political left-right lines, producing an innate resistance to compromise and rapprochement.

Challenges to the health care system extend beyond the manner of funding. Whats more, while the public-versus-private barrage gives no hint of an early ceasefire, no matter how many targets are demolished (and quickly restored) by both sides, everything else continues apace. In fact, at times the flurry of exchanges between funding competitors risks being left behind by the engines of change and the hard hammers of reality, until both sides appear like medieval scholars duelling over the number of angels pirouetting on the heads of pins. For, no matter how the funding question may be posed, other challenges and opportunities loom. Five to ten years from now, the funding debate will likely be continuing but the challenges and promises will be at our feetor, in many cases, at our bedside. They include these: