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Shawn Whatley: Three items on Canada’s Christmas wish list to fix our health care crisis

Commentary

Conservative leaders seem loath to mention health care in equal measure to journalists’ delight in raising it. John Ivison, a columnist at the National Post, took a stab at federal Conservative leader Pierre Poilievre last week: “You simply can’t aspire to be prime minister of Canada today and claim that health care has nothing to do with you.” 

Ivison has a point. Endless headlines about health care demand a political response: for example, overcrowding in children’s hospitals, federal-provincial funding battles, and emergency department closures, to name a few.

Some leaders love to dilate on health care. Last week, Jagmeet Singh, leader of the federal NDP, threatened to withdraw support for his confidence-and-supply agreement with the Liberals. Singh demanded that the (federal) Liberals detail solutions for (provincial) health-care problems.

Ivison’s demand for details and Singh’s confidence to deliver, “When I’m prime minister,” rest on a shared assumption, a shared vision of how government should address health care. They assume health care is a factory to fix, and Singh knows just how to fix it. 

Faulty logic

Their approach contains three problems. First, health care is not a factory. It is one of the most complex sectors of our economy. One tweak by government—for example, introducing national licensure for physicians—could have vast, unforeseen effects. 

Visions of economic dials, levers, pipes, and pulleys have delighted central planners for decades. They are deceitful dreams, a feverish mirage. As Robert Heilbroner, erstwhile defender of socialism, famously admitted: the centrally planned economy was “the tragic failure of the twentieth century.”

The first problem misunderstands the nature of what we hope to fix; the second problem assumes we are smart enough to fix it. But if Singh became prime minister, his unstoppable confidence would meet the immovable fact of Hayek’s Knowledge Problem. Friedrich Hayek, the Nobel-winning economist, argued that economies cannot be controlled because there is too much to know. Especially in a service industry such as health care, individual needs, wants, and preferences determine performance. These inputs are internal to the patients themselves and the clinicians trying to care for them.

The third problem is the least obvious but most lethal. It assumes a purchaser can fix the provision of a product or service. Government pays for health care, ergo, government can fix health care. 

What is obvious nonsense for every other product or service—from coffee to construction—somehow seems reasonable for health care. Purchasers cannot fix provision. True, a purchaser can influence providers to change behaviour by demanding different products and services. But purchasers have no idea how to reorganize, retool, or redesign to deliver change itself. 

A Christmas wish list

Just as Conservative leaders are loath to talk about health care, the rest of us should be loath to offer advice. Politicians know politics; outsiders do not. 

Furthermore, Conservatives represent a vast coalition of ideas, especially on health care. Red Tories support welfare in general and Medicare in particular. Prairie populists, classical liberals, libertarians, and a dozen other flavours of Conservative form a salad of mixed feelings. It requires fancy stickhandling to get through all the policy preferences, not just the ones at “centre ice“. 

So, take this wish list in the innocence and earnestness of a child at Christmas.

  1. Show enthusiastic support for universal health insurance

Twenty-eight countries around the world have universal care. None of them have government monopolies like Canada. Universal just means everyone needs health insurance, in the same way that all cars on the road need to be insured.  

Medicare started as state-funded medical insurance but morphed into managed care. In fact, some argue we should stop thinking about “medical insurance” as insurance at all. Do not let that happen. As long as Canadians remain comfortable and familiar with medical insurance we have a tiny sliver of room for change. If insurance becomes verboten, change will be much more difficult.

  1. Fix health-care governance 

As The Hub published in April, “Medicare cannot change because it is locked in an iron triangle consisting of government, the medical profession, and public-sector unions.” And in another Hub article, it makes no sense to talk about policy, until we have fixed governance.

  1. Champion (local) innovation 

Like politics, all care is local. Care plans must be allowed to evolve based on the needs of particular patients in specific communities. Bold visions and national plans tend to deliver one-size-fits-all services, the antithesis of patient-centred care. Only government can create a regulatory environment that fosters growth, innovation, and expansion of care at the local level. 

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The crucial element is to allow hypothesis testing to happen, not do it yourself. This means you need to find a way to let clinicians fail as they struggle to innovate towards better care. Easier said than (politically) done.

In summary, all I want for Christmas is for politicians to tell us what they believe about health care, tell us what they think is the biggest problem, and show us what only they can do. Again, this is a childlike Christmas wish. But given all the other advice out there this Christmas, perhaps this offers something new.

Merry Christmas!

Jerry Amernic: Putin is this century’s Stalin

Commentary

Nothing going on in Ukraine surprises Chuck Konkel. The barbarity and tactics of the Russians. The courage and stamina of Ukraine’s military and its people. Not even missiles landing on Polish soil. A 40-year-plus veteran with the Toronto Police Service and currently a Staff Sergeant, Konkel is no ordinary cop.

He was born in Rotterdam to a Polish father and Dutch mother, both of them stateless refugees after World War II who came to Canada when Konkel was just an infant. He has a Master’s Degree in International Relations and during university spent time as an officer cadet in the Canadian army. Then he saw an ad. The Royal Hong Kong Police was recruiting Canadians to help fight corruption. Konkel replied and spent three years there, rising to Inspector. Along the way he learned Cantonese which when combined with his other languages—English, Dutch, and Polish, along with passable French—made him an officer with special skills.

He joined the Toronto police in 1976 and his investigative background over the years includes the full gamut—murder, money laundering, credit card theft, you name it. But he is best known as an expert on Asian and Eastern European organized crime. Konkel’s international crimefighting assignments are right up there with James Bond.

In the 1990s he helped train the National Police of Poland on behalf of the FBI. In fact, Konkel was personal advisor to the Commissioner of that force until it was no longer deemed safe and he was urged to leave the country. Two weeks after his return to Canada the Commissioner was murdered, according to Konkel, by the Russian mob. Another time, acting under authority of the federal Department of Foreign Affairs, he hosted the Canadian visit of senior members of the Russian Police who were part of the personal security for then-President Boris Yeltsin. He also went to Moscow himself to execute a search warrant for an investigation on a site that was making illicit components for missiles. Oh yes, Konkel also does something else. He writes novels.

His third crime thriller—Who Has Buried the Dead just released by Optimum Publishing International and available on Amazon and Chapters sites and in bookstores—is full of parallels between Josef Stalin and Vladimir Putin. The novel focuses on “The Scottish Book” which involved a group of real-life mathematicians who often met at a pub in Poland. When Nazi Germany invaded that country, some of its members fled to America and wound up working on the Manhattan Project, building the atomic bomb that would ultimately end World War II.

The Soviet secret police, the NKVD, as well as Nazi Germany’s Gestapo, and the Allies were all looking for The Scottish Book which is the crux of Konkel’s novel. He calls it “one of the last great secrets” of the war. But in the process he shares what he sees as parallels between Stalin and Putin as the book provides historical insights into the mindset of the old Soviet hierarchy, its loyal but naïve base, and the threats binding them to their leader. In the old days that was Stalin, but today it’s Putin.

The historical part focuses on what happened in the spring of 1940. The Soviet NKVD conducted mass executions of over 20,000 Polish military officers, prisoners of war, and so-called intelligentsia in the forests of Katyn in Poland. It wasn’t until three years later when mass graves were discovered by the Germans, but by that time Nazi Germany and Russia were at war on the Eastern front. For decades afterward the USSR blamed the massacre on the Germans and only in 2010 did the Russian state Duma approve a declaration pointing the finger at Stalin. Three years earlier a Polish film called simply Katyn was nominated for Best Foreign Language Film at the 80th Academy Awards.

Says Konkel: “The brutal levelling of cities, the indiscriminate killing and mass murder which happened over 80 years ago in Katyn all embody Stalin’s World War II Russia and that legacy lives on today in Putin who is working straight from Stalin’s playbook.”

Konkel’s first novel The Glorious East Wind was published in 1986 by Random House Canada and McGraw Hill U.S. It was about the final years of British Hong Kong and predicted the massacre at Tiananmen Square. His next one Evil Never Sleeps was published by Harper Collins Canada in 2000 and was about corruption in Mexico.

Konkel has been working on the new novel for the past five years, a period in which he has been battling a rare form of cancer that affects one in 1.5 million people. But that hasn’t stopped him. He makes extensive use of his experience working with Interpol, the National Police Forces of Poland, the Netherlands, and Belgium, and the FBI and RCMP. Konkel is still involved with them all. Of his writing, the Canadian literary publication Quill and Quire says: “Chuck Konkel has been heralded as the second coming of late John Le Carre. His writing has been described as John Le Carre on speed.”

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Konkel says Winston Churchill was the first Western leader to recognize how bad Stalin was and that the West has some lessons to learn about how to deal with a man like Putin. “Stalin tried to reinvent this romanticism about Russia and Putin is doing the same thing,” he says. “He is using the same methodology with fear and intimidation and this fight for the Motherland. A holy war.”

But Konkel doesn’t buy the oft-repeated view that Putin is a man who lost it due to increased isolation stemming from Covid.

“Putin was this middling operative in Eastern Germany but he was an opportunist who rose through the hierarchy. He is not stupid but a very shrewd man and while Stalin was transparent but devious, Putin is more nuanced. He is charming when he chooses to be and influential. He is basically a 21st-century villain.”

Konkel says Putin remains very dangerous and that Western naivety and lack of moral fortitude work in his favour.

“Russia still gets a lot of money from Saudi Arabia, France, Germany, China, and other countries,” he says. “There is the energy card, but Russians also like to drive German cars and they drink wine. How will this war in Ukraine end? Putin can play the long game and as long as the United States is not united and countries like Germany continue to trade with Russia it will go on. I see it ending with some form of truce or maybe a buffer zone. Unfortunately, it is the people of Ukraine who suffer.”

And what of the Canadian role, if any? Konkel doesn’t pull his punches on that. “I had a lot of respect for Stephen Harper when he told Putin at a G20 meeting to get out of Ukraine. As for today, well, Canada is singing around the campfire while the world is burning.”