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Rob Leone: The future of Canadian health care is private

Commentary

When NDP Leader, Jagmeet Singh, says that he wants to take the profit out of health care, he’s not talking about your family doctor being a private actor in a single-payer health-care system. He’s talking about rich CEOs and corporate profits siphoning money that might otherwise go to the public system and into the pockets of shareholders.

It sounds good. I mean, by the very nature of having a profit going to a corporation, we can very cogently see that the money isn’t going to hire a nurse or more doctors.

Here’s the problem though: the government—by itself—is incapable of solving the world’s wicked problems. The government actually needs the private sector to help.

If we stop to think about how we got out of the pandemic, could we have done it without the private sector? Could vaccines have been as effective, and developed as quickly, if we left government scientists to do the work? Could we have done as many diagnostic tests for COVID-19 if we didn’t have private community laboratories running millions of COVID tests? Could we have built enough supply for PPE and hand sanitizer if the private sector didn’t adjust its production to focus on these items? 

Even where governments should have had a solid grasp on operations, say procuring vaccines or the logistics of getting vaccines in arms, they were woefully slow. One could legitimately argue that a patchwork network of for-profit pharmacists, armed with the online savvy Vaccine Hunters sourcing available vaccines, aided what otherwise was a catastrophically slow rollout of the vaccines. 

That was one case study of the past, but if we look to the future, we are confronted with major problems with our frail health-care system. Under the current and outdated thinking, we now have insufficient infrastructure (e.g. not enough ICU beds), a health human resource shortage exacerbated by funding caps in publicly assisted higher education, and a health-care system that is currently facing unreasonable wait times for most medical procedures. 

To illustrate the point, most readers would not believe that the only industry that is still primarily relying on the fax machine to function is the Canadian health-care system. The fax machine is used for referrals, booking appointments, and more. A medical office administration takes a form from a doctor, faxes that form to a specialist, and it will sit on that fax machine until another medical office administrator picks it up and sits next to a computer to figure out when the appointments will be made.  This causes unnecessary delay, and it is happening across Canada every minute of every day. Not only is there excess delay, but there are also excess costs associated with this waste.

It’s not that the technology does not exist to get rid of the mess. It does exist. It exists because there are enterprising companies that have figured out ways to make health care more efficient. You see, many for-profit companies are popping up to innovate and sell their innovation to make system improvements. These system improvements will solve the wicked problems of the future in health care and beyond.

We are at the precipice of understanding that the root cause of our health-care system crisis is founded on an antiquated system, built in the 1960s, reaffirmed in the 1980s, and is severely strained today. The old design has also led to antiquated thinking. When it came to building electronic medical records, for example, many provinces decided to build their own beast. Today, we’re faced with massive interoperability problems for no other reason than governments thought they were better at designing their electronic medical records than leaving them to private entities that could have provided off-the-shelf solutions cheaper and quicker.

What will happen over the next 10 years is entirely predictable if we take a few moments to think about it. All of these smaller for-profit entities will be consolidated into massive health conglomerates. As these conglomerates grow, they will become more skilled at defining health-care problems and developing health-care solutions than governments will. They will do so much quicker and of a higher quality than governments can ever imagine. Think of how Microsoft or Google have now become technology giants. In the same way, the future of Canadian health care, and health care around the world, frankly, will be about the private sector becoming super proficient at solving health-care problems. 

This is inevitable because governments are simply not capable of doing the job. Governments have long ceased to have the in-house technical skills to create these solutions to massive problems that are ailing the health-care system. And, if they did for some reason have the technical skills to do it, they are prone to taking historical, antiquated approaches to fixing future problems, as exemplified with eHealth across the country.   

The future of health care is private. Delaying the inevitable will only make our present system worse. Sorry, Jagmeet. 

Malcolm Jolley: An ode to the third place

Commentary

A large café closed around the corner from where I live in mid-town Toronto. It took up two storefronts and was fronted by large floor-to-ceiling windows facing the street. I would walk by it several times a week because it was housed underneath my gym, and I would often see friends and neighbours through the windows, working on laptops by themselves or having a coffee and a chat for some kind of meeting.

I don’t know the intimacies of the café’s business or its troubles, other than an eviction notice on the door said the owners owed a couple hundred thousand in back rent. On the Summerhill stretch of Yonge Street, that might not take too long to accumulate. What the closure made me think of was the idea of the “third place” and that the regulars who populated it, especially in this era of remote work, would miss it.

The idea of the third place, where people can gather that’s neither home nor work, was developed formally by the American sociologist Ray Oldenburg in the late 1980s and ’90s. But the concept of the third place was popularized in physical manifestation by Howard Schultz, the president of Starbucks who led the chain to its explosive growth in the final decade and a half of the 20th century.

Schultz positioned Starbucks as an American version of the Italian espresso bar (or just “bar”, since most serve alcohol too), and serve as a meeting place for all sorts of occasions in a village or city neighbourhood. In Anglo-Celtic Europe, the traditional third place is the “public house”; or the “local”, which performs the same function. It’s where you go to hang out.

Churches, of course, are also third places. And gyms or sports clubs allow for that function too. In warmer climates, a town square is also a natural place for people to habitually cognate outside of the pressures and obligations of family and work life.

Back in Toronto, despite our recent loss, my neighbourhood still has lots of coffee shops. Some are closer to in-and-out Italian bars selling mostly take-out, others more inviting of laptop workers. It also has a few pubs, and I am a regular at one, where I meet people or take some reading to do over a casual lunch or a beer in the late afternoon once or twice a week.

Part of the charm of going to a place where everybody knows your name is that things mostly stay the same there, so change, when it comes, is noted. Not long ago I spotted a new red tap behind the bar and was pleased to see it read in white lettering “Oast House” and ordered a pint of the clean drinking Pap’s Pilsner.

An oast house was the building in damp British breweries where hops were dried in kilns. The Niagara Oast House Brewers is a brewery just outside of Niagara-on-the-Lake that was established by three employees of the Inniskillin winery in 2012. At first, it was a kind of local secret and a treat to try their artisan beers on trips to wine country. Trying the Oast pilsner brought back memories of wine trips and the maybe not-so-well-known relationship between wine-making and beer.

I fear many outsiders to the wine trade think it’s full of snobs. It may have more wine snobs than other groups, but it’s the same trade that makes, sells, and writes about all the wines, so in my experience the true snobs are mostly consumers who can afford to buy only expensive wines. As I have written before, if all you drink is fancy wine, then you’ll miss out on some simple pleasures, and most of us in the thick of it try and keep our minds open.

But even if you spend a day tasting through beautifully made wines, or especially if you have spent a day tasting through any kind of wine, few things taste as good at the end of it as a beer. Wine is high in acid, which is why it almost always benefits from being served with food.

With some sour exceptions, beer is generally low in acid and slakes thirst while camping the palate. They say it takes a case of beer to make a case of wine, and I can see why after a day of constantly tasting the product and physical labour in the vineyard or cellar, many if not most winemakers and crew would welcome a cold one after a long day. 

The wine press, by and large, likes beer too. Some writers also cover beer and are aficionados in their own right. Others, like me, just like a break and enjoy the product without thinking too much about it, especially after a long day of tasting. On my last trip to Alba, to taste the newly released Barolo, Barbaresco and other Langhe wines, a few of my colleagues and I discovered a bar devoted to birre artigianale near our hotel.

The bar, which does not seem to have survived the pandemic, soon became an unofficial canteen for the foreign press. Cold glasses of IPA were bought between colleagues who’d spent the day swilling and spitting young, highly tannic wines. Sure enough, we discovered a few winemakers in there too one night, and I was able to arrange a winery visit on my free day based on the meeting.

It was our own impromptu third place between work and home; a place to drink a beer and talk about wine after the busy events of the day, during that time when small conversations happen and life is mostly lived.