Episode 14

André Picard Part2: Privatization, Cannabis, Medical Assistance in Dying, Transgender Issues & More


Guest: André Picard

Award winning health journalist at The Globe and Mail. Author of Matters of Life and Death


Key Takeaways

  • Do we really have a universal healthcare system? Yes and no, says Mr. Picard. ”We have the least universal universal healthcare system in the world,” he says.

    • Despite hospitals being covered, we only cover fractions of other things; we’re all over the place, and it’s irrational, he says. We have to widen our coverage.

  • Answering the question about what the goal of Canadian healthcare is might not be so simple.

    • It’s hard to say if our system is successful without any concrete goals, says Mr. Picard. We need to take after some European countries and introduce attainable, numbers-based goals every year.

  • In a rapid-fire ending round, Dr. K chats with André Picard about a variety of hot topics in healthcare.

    • Mr. Picard, a proponent for legalizing all drugs, says that the legalization of cannabis has been a “bust” socially, medically and economically.

  • We’ve decriminalized it, he says, only to put even more regulations on it than before.

  • National pharmacare is long overdue. As of right now, it’s done in a very haphazard way.

    • To succeed, Canada needs to first define pharmacare; what are we covering for whom?

    • We need to be smarter about what type of things we cover, and what we don’t.

  • Medical Assistance in Dying (MAiD) is meant to give patients control over their fate. It’s important to implement, but also needs proper regulation to avoid misuse.

  • Lengthy weight times are a continuing, systemic issue. The solution involves improving flows and transitions.

    • We need carrot-and-stick methods that punish hospitals for not properly managing patient flow, as well as incentivize institutions to create more long-term care facilities.

A Closer Look

Not-So-Universal healthcare and privatization

  • In Canada, despite applauding ourselves for having a universal system, our healthcare is “the least universal universal healthcare system in the world,” says Mr. Picard

    1. While we cover most care in hospitals, we cover little of everything else. 45% of drugs, 30% of homecare, 35% of long-term care and only 6% of dental care. We’re all over the place and it’s irrational.

  • Mr. Picard portrays our current system as a medical basket of services. We have a narrow and deep basket. A huge amount of things are covered in hospital, he says, perhaps even too many things, but little outside of that.

    1. We need to make this basket a bit shallower and a lot wider by covering more realms of care.

  • What about privatization? Claiming that privatizing will make use like the USA is “nonsense”, he says.

    1. In reality, no healthcare system can cover everyone completely all the time. Private healthcare will have to exist. The question is where will we have it, and how can we regulate it?

    2. The importance is making sure it is affordable and accessible.

    3. Right now, Mr. Picard says, we have a badly administered public system, and a badly regulated private system. The worst of both worlds. Taking after European countries, we should have better regulation of private care.


Evaluating the Goal of Canadian Healthcare

  • The money that we spend on healthcare is so important to us, but unless we have real goals, it’s hard to know if we’re overspending.

    • When asked about the goals of the Canadian healthcare system, many people struggle to answer. Things can get messy; we are really good at treating people who are sick, but not so good at choosing who gets that treatment.

      • Take palliative care; only 17-35% of Canadians who should be receiving palliative care actually get it.

    •  Mr. Picard gives an example. Switzerland, every year, publishes a list of it’s public health goals. Reduce child mortality by 10% over 10 years, e.g. Canada should take after them and implement this type of model.

    • We need more of a business mentality; here are our goals for the year. What can we do to achieve them?


Hot Topics in Healthcare

  • Asking a query from Twitter, Dr. K poses a very challenging question: with governments being turned over every four years, how do you break the cycle of short-sighted budget cuts to balance the books?

    • It’s a tough question, Mr. Picard says. An important consideration is that, according to him, Canadian healthcare is way too politically micromanaged.

      • Health ministers should be fire preventers, not firefighters, he says. They should be the ones setting the “goals” of healthcare mentioned in the previous topic, and allow hospital admins to administrate.

    • Another big problem is that, with respect to healthcare, there is very little difference between parties, he says.

      • Bringing up healthcare seems to be the quickest way to lose votes, because no one can agree on it.

  • Mr. Picard, a big believer in legalizing all drugs, thinks the legalization of cannabis is long overdue.

    • Unfortunately, due to asinine regulations from the Canadian government, companies are going bust. It is a failure socially, medically and economically, he says grimly.

  • National pharmacare is a necessity, and it needs to happen. But first, we must define pharmacare, and understand what we are covering for whom.

  • Medical assistance in dying is a powerful tool to give patients control over their lives. But we need to approach it slowly and cautiously, according to Mr. Picard.

    • In reality, very few people will seek this every year, but the choice is what matters.

    • We need options, but also the proper regulations to avoid misuse.

  • Increasing wait times are an ongoing and systemic issue. We need more flow.

    • A major part of this is alternative level of care (ALC) patients, or those that have been discharged but remain in the hospital with nowhere to go.

      • This is harmful for both the patients and the hospital.

    • We need more carrot-and-stick methods to get hospitals to improve their flow of care.

      • For example, punish hospitals with ALC patients, and incentivize institutions to create more long-term care homes by removing the many suffocating regulations on them, he says.

We also need to talk more about homecare. There isn’t enough investment in the chronic part of care.

Further Reading

André Picard’s profile page at The Globe and Mail

Titles by André:

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