Like The Hub?
Join our community.
Join

Rudyard Griffiths: Time to face the unpleasant truth: Reforming our health system is an urgent necessity

Commentary

What is the plan?

This is the question we should be asking ourselves morning, noon, and night.

Ontario and Quebec, the economic engines of the nation, cannot endure another COVID shutdown. Shaky public finances will buckle. Public confidence will collapse. Talent will flee. An already acute physical and mental health crisis will metastasize into a tragedy of unimaginable suffering. It is by no means hyperbole to posit that the risk of another prolonged shutdown is existential. 

Yet here we find ourselves again…slowly and painfully emerging from the fourth round of mass closures in twenty months with not only no plan in sight but the absence of even a discussion of what we could do to prevent future shutdowns.

Who is to blame for the void of ideas and action on the single most important issue we face? It’s too easy to call out hyperreactive politicians and governments. Both are in survival mode caught up in case counts, hospitalizations, and polling numbers. The media sadly has shown itself to be largely uninterested in examining the hard choices required to pandemic proof our institutions. Instead, clickbait COVID headlines and “hot takes” from the country’s self-appointed COVID expert class clog our social feeds and desktops. The result is we are two years into this crisis and have yet to have any kind of coherent conversation about the steps and actions we need to take to avoid a fifth, sixth, or seventh lockdown.    

The real culprit of our collective inaction and paralysis is us. It’s the broad public who are deeply uncomfortable with the difficult truths COVID-19 has revealed about our single most important and cherished public institution: health care. 

Public health care systems were in trouble before the pandemic. We knew we were rationing care through the silent suffering of lengthy wait times. We knew the opioid epidemic was, in part, a reflection of systems that lacked the resources to address chronic illness and debilitating pain. We knew that the delivery of health care had become overly bureaucratized. But despite all these failings we clung to our single-payer system because it represented one of the last vestiges of an older civic compact based on an ethos of mutual care and solidarity. 

Graphic credit: Janice Nelson

The pandemic has done something more pernicious to public health care than just flooding our hospitals with sick and dying, canceling lifesaving surgeries, and burning out legions of frontline workers. It has turned a touchstone of common identity into the foil for our collective immiseration through shutdowns, closures, restrictions on basic civil liberties, and divisive debates about vaccines.

With fewer intensive care units per 100,000 people than Mongolia and total bed capacity near the bottom of the OECD, our public health systems have become choke points that strangle any effective, long-term strategy to manage COVID-19. 

How else do you explain a province like Ontario with almost 15,000,000 residents repeatedly shutting down when its COVID-related critical care admissions top four hundred, or a paltry one I.C.U. COVID patient for every 40,000 residents?

This we know: there will be more variants. Some will be milder than Omicron. Some less infectious. Others may not. With billions of people around the world unvaccinated and immunocompromised, COVID will mutate relentlessly looking for new ways to evade both vaccines and naturally acquired immunity. The comforting prediction that COVID will soon become endemic and mostly harmless is an assumption based on past pandemics shaped by different pathogens, different public health responses, and different therapeutic technologies (e.g. there weren’t tens of millions of people on retroviral drugs in 1918-19). The risk of future shutdowns in a significantly health care-constrained country such as Canada isn’t some hazy hypothetical, it’s a highly probable event in our near-term future. 

We are at the breaking point. The debilitating effects of another shutdown cannot be overstated. As painful and disorienting as it will be for our collective sense of self, we have to rethink health care delivery. Everything needs to be on the table, from the private funding of the medically necessary hospital and physician costs, to public/private partnerships to build more hospitals, to opening up professional credentialization, to user fees, to the holy of holies: a rethink of universality itself. 

Fortunately, we can learn from countries that are much farther down the road of health care innovation and reform and who have efficient and high-performing health care systems such as Norway, the Netherlands, and Israel, to name a few. Systems that proved themselves better able to cope with the surges in infection that have swept the world repeatedly and will do so for the foreseeable future. We need to follow their tracks and move fast. The virus isn’t waiting. It’s mutating. 

Graphic credit: Janice Nelson

The rejoinder to such a clarion call is to increase government funding and build more hospitals, hire more doctors and nurses, expand not contract universality to pharma care, dental care, etc., etc., etc. We are in an emergency. The clock on the next shutdown is ticking. With most provincial budgets already allocating 40 percent or more of revenues to health care, there aren’t the resources to do what needs to be done at the speed with which a transformation has to happen. Ottawa is similarly financially constrained as our debt-addled federal government falls ever deeper into deficit spending in the tens of billions annually for years to come.

If we want to be honest with ourselves the traditional response of injecting more government funding into health care wasn’t working before COVID. Wait times were increasing. Bureaucratization was growing. Patient outcomes were worsening. Health care costs were growing faster than inflation and population. 

The problems with the current system are structural. We can only change the system and start down the road of pandemic proofing our hospitals, economy, schools, and day-to-day lives if the change itself is structural. Anything short is a copout that will set the country up for another round of debilitating shutdowns. 

None of this is pleasant. No one is contemplating wrenching changes to an institution like health care that is integral to our national way of life with glee. This isn’t about ideology. It’s about facing up to reality. It’s about living with this novel virus and the threat it represents for years and possibly decades to come. 

To fail in this singular task is to condemn ourselves to Einstein’s definition of insanity, doing the same thing over and over and expecting a different result. 

Yet, nothing about this crisis is inevitable including future shutdowns. It’s past time to reform health care delivery in Canada and reclaim our agency in the era of COVID that will impact our way of life, like it or not, for years to come. 

Ray Pennings: Inside the trucker convoy is a tale of two protests

Commentary

Possibly the largest protest in Canadian history overwhelmed the national capital on the weekend, not to mention mainstream and social media.

Thousands of trucks, tens of thousands of people, and (if we inclutrde the solidarity protests in other cities and those who lined up to cheer on the convoy at overpasses and rallies), hundreds of thousands of sympathizers braved the frigid Canadian winter to raise their voices. As of Monday morning, 113,000 Canadians combined to contribute over $9.1 million in support of the Freedom Convoy’s 2022 GoFundMe campaign

But what exactly was the protest’s message?

The official request framed by the convoy organizers was an irrational childish tantrum and did not reflect mature politics. Asking the Governor General and Senate to take over the government to end vaccine mandates isn’t how our constitution and system of government works. However, the official website and original organizers of the convoy seemed to be quite irrelevant in the actual event. I spent 90 minutes wandering through the crowd on Saturday afternoon. While there were a few megaphones with what appear to be self-appointed (noisy but incomprehensible) spokespeople, the event (based on what I saw and found in coverage) seemed simply to be a gathering of folks in protest without any official stage or spokespeople.

That vacuum was filled in two very different ways. The Prime Minister and almost all establishment spokespeople denigrated the convoy in advance of its arrival. The headlines on National Newswatch, a news aggregator site that is a default tab for many of those connected in the political and business world, illustrate the point. Seven of the top eight stories on Friday morning dealt with the convoy. Here are the headlines: 

  • “Large number of donations to protest convoy came from aliases, unnamed donors.”
  • “’Embarrassment for the industry.’ Not all truckers support the freedom convoy.” 
  • “Trucker convoy expected to cause disruption throughout Ottawa.” 
  • “MPs warned about security risks related to convoy, O’Toole plans to meet truckers.” 
  • “Canadian truckers rule – Elon Musk joins Donald Trump Jr. cheering on vaccine protest barreling toward Trudeau.”
  • “MPs worry anti-vaxxer convoy has taken a turn for the worse.” 
  • “FluTruxKlan trends on Twitter as trucker convoy passes through Toronto.” 

Not too hard to discern the establishment take on the effort.

So, it would not be a surprise that anyone relying only on this coverage of the event would expect Saturday’s events to be an embarrassment to all things right and decent. The protestors certainly provided enough visual and verbal fodder for such a take. There is no defence for protesters dancing on the tomb of the unknown soldier at the National Memorial; for waving Confederate and Swastika flags; and for defacing the statue of Terry Fox, turning his courageous fight against cancer into a partisan protest against vaccines.

As Liberal pundit Scott Reid ironically tweeted, “So…swastikas aren’t representative. The whack MOU to dissolve all govt isn’t representative. The organizers aren’t representative. The media hate isn’t representative. The bigoted/homophobic slurs aren’t representative. The anti-vaxx shit isn’t representative. Got it. Crystal.”  (Notably, in response to these events, some protestors took it upon themselves to maintain guard over the tomb, restore the Terry Fox monument, and clean up garbage from downtown Ottawa.)

When there is such a vacuum it is incumbent on those who are protesting with different motives to denounce (and do everything you can to stop) all violence that comes with mobs and to articulate your own responsible requests clearly.

During 90 minutes mid-Saturday afternoon in the midst of the rally, I did not observe much hate first-hand, save a Confederate flag on a vehicle driving on Elgin Street. I did see plenty of signs that I found offensive (typical protest stuff on profanity steroids), probably one in five or so that included the prime minister’s name alongside cusses and expletives. I also saw highly dubious theology (“I trust God, not vaccines” to which I respond “OK, but what if God uses vaccines?”); ill-informed political theory (“Citizens demand that Trudeau quit” to which I respond “We just had an election, which like him or hate him, he legitimately won. A protest doesn’t undo that.”); but mostly patriotism (“God save this land, glorious and free”) and frustration at mandates (with hundreds of variations on freedom and ending lockdowns or vaccine mandates.)

My own broader social network (especially as represented on my social media feeds) included dozens who either attended the rally in Ottawa or showed their support as the convoy passed locally. Most of these people are not the sort I’d describe as big-time political activists. But I was struck by the emotion reflected in the posts that followed the rally: 

  • “Today was a goosebumps kind of day” wrote one of my elementary school peers who it seemed attended the rally with her kids, grandkids, and other members of her church community. “It’s the first time in more than a year that I felt proud to be Canadian again—and for the first time in a long time, I feel cautiously optimistic about the future of Canada. There were literally thousands of people standing united, gathered on overpasses and roadsides today sending a message to our government that ENOUGH IS ENOUGH.” 
  • A lawyer friend, who attended the Ottawa protests, wrote, “It really felt like this is a movement to reclaim Canada, not destroy it…. There was frustration with our Prime Minister, but out of love for our country.” 
  • A trucker after driving through Thunder Bay wrote, “This is what freedom feels like. I felt normal for once and not alone like the last two years.”

While in the crowds on Saturday afternoon, I approached over a dozen people randomly, asking them where they were from and what they hoped the rally would achieve. Everyone was unfailingly polite. While about a third were very negative and cynical about the prime minister, all expressed sentiments on how good it felt not to be alone and frustration at one or other aspect of the current state of affairs. I was struck by how many in the crowd were young families (many with kids in strollers). While the crowd was certainly more caucasian than the general population, I’d guess no more than 10 percent of protestors were BIPOC, they were not the uniformly white crowd critiqued by many.

So, was the gathering hate or patriotism? Did it reflect genuine democratic participation for an unheard group or simply a platform for the worst impulses that divide, disrespect, and denigrate? The evidence is clear, uncomfortable as the truth might be. Both were present. While we cannot measure these things tit for tat, the good deeds of care and concern are counterbalanced by incidents in which protestors abused hotel clerks or misused food banks.

It isn’t fair or honest for the media to provide a one-sided portrayal based on what would appear to be a minority of participants. Neither is it fair or honest for well-meaning protestors simply to wash their hands of the ugly side, especially since some of the organizers and leaders of the protest seem to be less than innocent. When the organizers of the protest have the dubious resumes that this crew does, it’s too simplistic just to blame the media for reporting on the expression of organizers’ ugly beliefs.

This doesn’t let the media off of the hook.

No fair-minded person could walk through these crowds and only see hate and ugliness. There was grassroots, home-spun patriotism. There was relief of frustration, not in debt to any political organizer or movement, but evidence of something far deeper and personal. Most conversations directly with those had gathered, as well as conversations overheard, make it hard to come to any other conclusion.

What will come of it? Protests are a symptom; a consequence of people not being heard by their leadership. Rather than sanctimony from our political and media elites, the more appropriate response would be listening and empathy. It is clear there are many in this country who feel our leadership disrespects them and doesn’t listen to their concerns. Leaders don’t need to agree with all of those they are called to lead. In fact, they are responsible to take clear positions and explain the reasons for them in an attempt to bring people along with them. 

Louder than either the angry hate or the frustrated patriotism and nostalgia for a different time was the vacuum of leadership. The ever-moving COVID-19 goalposts, the failure to even acknowledge nuance or the legitimacy of other perspectives than the official one, and the polarizing rhetoric that marginalizes those who disagree—this leadership approach eventually will reap what it sows. (To be fair, some of the media coverage on Saturday was fairer than the coverage leading up to the rally. Some journalists genuinely tried to listen and give voice to the actual protestors on-site. By my count, this remained the minority mainstream media coverage.) I could not help bringing to mind American journalists who thought the election of Donald Trump was impossible. After the fact, they reflected on how they had not listened to the grassroots frustration of the ordinarily non-political populace. What I saw on Saturday was similar venting going heard.

Analysts are divided in measuring what the protest says about Canadians and their views. I wonder whether they’ve missed the real question. Protests are the bubbling over of a boiling populist sentiment. The necessity and extremes of protests are, I humbly suggest, as much a failure of leadership to listen, treat dissent with dignity, and respectfully try to make the case for the policies they have put in place over the past few years, as it is the opinions expressed in the -20 degree Celsius cold before Parliament on Saturday.

Yes, we must hold the hundreds of thousands of Canadians responsible for their actions and for the messages they sent (or failed to condemn) this past week. Even more culpable, I would suggest, is the leadership of this country.

Suppressing dissent and failing to acknowledge the dignity of those with whom you disagree is itself an expression of disunity that has consequences. Historic protests that attract global attention say something about the protestors. They also say something about the leaders. Before the critics become too sanctimonious about the undermining of their inclusive and tolerant Canada, they may do well to look in a mirror. Even if their policies and perspectives are all correct, could their implementation not be at least part of the story of the weekend protest?