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  • Chronic Condition: Why Canada’s Health-Care System Needs to Be Dragged into the 21st Century by Jeffrey Simpson
  • David Verbeeten
Chronic Condition: Why Canada’s Health-Care System Needs to Be Dragged into the 21st Century by Jeffrey Simpson. Toronto: Allen Lane, 2012. 304 pp. Cloth $32.00.

Jeffrey Simpson, the well-known political pundit and national affairs columnist at the Globe and Mail, has produced a book that treads into territory that he himself recognizes as the preserve of intense emotion, inertia, and vested interests more often than common sense, adaptation, and openness. Canada’s health-care system is not just the top public priority of its citizens, but also, according to surveys, a definitive part of their national identity and self-conception. Notwithstanding their attachment to the system, Simpson avers that most Canadians lack an understanding of its operation, are incorrect in their opinion of its world-class quality, and have been misled by politicians who prefer to push off rather than address mounting pressures.

As the author asserts at the start of his disquisition, the fiscal situation for Canada’s health-care system is unsustainable. In the past 35 years, health-care has tended to grow faster than gross domestic product and state revenue, such that this sector “is devouring budgets, taking an increasing share of spending each year” (p. 2), even as overall economic growth is slowing and the general population aging. Despite having one of the most expensive public health-care systems in the developed world, Canada produces “only average value for money” (p. 7). Canada “ranks in the top five countries for per capita spending on health care” (p. 157), yet provides full coverage only for physicians and hospitals; “has the longest wait times among Western industrialized countries” (p. 40); “stands dead last among leading Western countries in the use of electronic records” (p. 44); finishes “at the bottom for outcomes and satisfaction” (p. 158); has “fewer MRI exams and CT scans” than the Western average (p. 161); and pays too much for its unionized medical workforce and its prescription pharmaceuticals.

Despite these facts, which are reported in numerous surveys by leading domestic and global organizations, Canadians are loath to accept and learn from them. They prefer to compare their health-care system to the unfair and disliked arrangement in the United States, whereby they “derive their misplaced moral superiority” (p. 156), for the American model is neither the only nor the best index. Sweden, Australia, and Britain, among others, are countries to which Simpson refers, noting that they provide more public coverage of more medical services, more efficiently and less expensively than Canada. He provides data to this [End Page 187] effect as well as the views of leading civil servants whom he has interviewed. These states have engaged in comprehensive and pragmatic reform, whereas “Canadians are stuck with their principles, while being too fearful of new methods” (p. 310). Notably, these other countries have split purchasers from providers, allowing public funds to follow patients, who may choose to go to private servers. This public coverage of private provision has injected competition, allowed for maximal use of otherwise idle infrastructure, and encouraged innovation. What is more, minor user fees have been applied to “deter frivolous use of the health-care system” (p. 298), without detriment to the indigent, who are exempted.

Simpson advocates these reforms in particular, but notes that they remain anathema to most pundits and policy-makers in Canada, who insist on the current monopoly. He traces the source of the reigning confusion to the Canada Health Act, which was passed unanimously by the federal Parliament in 1984 in order to defend medicare from growing tendencies, like private billing, which threatened at the time to undermine its five principles of “public administration, comprehensiveness, universality, portability [and] accessibility.” The Canada Health Act, Simpson maintains, says “that health care has to be administered and paid for publicly, on a nonprofit basis, but delivery by whom and how remains flexible” (p. 148). Simpson devotes a good and very interesting chunk of his text to the historical origins of medicare among left-wing Prairie intellectuals, observing pointedly the irony that “what the...

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