OTTAWA - Heavy hitters involved in rethinking health care financing say Canadians can't rely on government to figure out how to preserve and pay for health care in the future.
Noted economists Don Drummond and David Dodge as well as several other high-profile experts say health care costs are not sustainable for governments, but any useful proposals to fix the system would be politically "toxic."
They say no government will act until enough concerned people speak up about rising costs, value for their money, and the lack of coverage for drugs and other health services.
"It's going to have to come from us. It's not going to come from governments," Dodge, the former governor of the Bank of Canada, told an audience of government officials, lobbyists and policy experts.
That's because solutions could involve dicey ideas such as covering costs through co-payments from patients, private insurance, and means testing.
"Sorry, there is no free lunch," said Michael Kirby, the chair of the Mental Health Commission of Canada, and a former Liberal senator who led a major inquiry into the health care system in 2002 that recommended more private sector involvement.
These payment methods are used in other countries that offer universal health care, and those countries are able to offer more extensive, more cohesive coverage of health care services than Canada, he said.
"I think Canadians are way ahead of the government in recognizing there is a problem that needs to be solved. Unfortunately they think it can be solved painlessly."
Drummond, Dodge and Kirby were joined Wednesday by the head of the Canadian Medical Association Jeff Turnbull and health care policy expert Michael Decter, to discuss how to create a sustainable health care system once the current federal-provincial funding agreement expires in 2014.
Their panel was part of a growing discussion being led by think-tanks and health groups across the country, as concern about the quality and cost of Canada's system mounts. Already, the CMA, the Conference Board of Canada and the C.D. Howe Institute have set up task forces to push federal and provincial governments into action.
Federal and provincial officials started low-level talks earlier this year about how funding should be renewed. The negotiations were overtaken by promises during the election campaign.
Prompted by a vow from the Liberals to maintain increases of six per cent a year to the provinces after 2014, the Conservatives matched the commitment.
But the Conservatives have yet to explain how long the funding commitment will last, and what strings will be attached, if any. It remains unclear how the funding commitment will affect the next health accord.
The official Opposition, now the NDP, talks frequently about the future of healthcare. Like many of the experts and economists, the party wants to see a national pharmacare program and more efficient use of government money.
But public administration, and a ban on private health care, are paramount for the NDP, said critic Megan Leslie.
Regardless, costs are rising for both governments and individuals, the experts said, and demand for health care services is also on the rise. So spending on healthcare is growing at about 6.5 per cent a year.
They said governments need to reconsider what medicare covers -- especially since drugs are a growing part of keeping healthy, but are not covered by a national pharmacare plan.
They pointed out that primary care is completely paid for by government funds, but other key areas of health care are barely covered or not covered at all. And that leads to a distorted use of the health care system by doctors and patients alike.
Kirby is particularly incensed that medicare doesn't cover mental health care for children, saying that a family trying to watch over a suicidal child typically waits six months before receiving public services.
But the sustainability of the health care system is not just about having an open mind about how to pay for it, several panellists said.
Much of the reason Canada does not perform well in international scoring on health care is because of extremely poor health conditions among aboriginal people and on reserves, said Decter.
The answer on reserves has less to do with throwing health care funding at aboriginal communities, and more to do with financing an improvement in basic living conditions, he said, pointing to housing, education and child services.
"If we didn't have this shameful health status among our First Nations peoples then we would rank near the top in international comparisons," he said.
