Justin Trudeau has decided — at least for now — to see Ontario’s moves toward for-profit medical care as “innovation” by Doug Ford’s government to resolve the health-care crisis gripping the country.
Trudeau has been conspicuously quiet about the Ford government’s announcement to allow more medical procedures to be done by for-profit health-care providers. Too quiet, New Democratic Party Leader Jagmeet Singh charged on Thursday, the same day Ford was out on the road in Windsor, talking up his health-care fix.
In a half-hour interview with me this week, also in Windsor, Trudeau was remarkably upbeat about the prospects of federal-provincial co-operation on major repairs to the health-care system, and made clear he had no intention of wading into a fight with Ford over what Ontario is doing.
“I have been saying for years that delivery of health care is the business — is the responsibility — of the provinces,” Trudeau said when I asked why he’s been so quiet in the wake of Ontario’s recently announced measures — which some have said is a door opening to two-tier health care in Canada.
“I have penalized provinces that have strayed too far from the Canada Health Act and gone too far into private delivery.”
However, Trudeau added, “I recognize we’re in a moment of crisis right now, but we need to build a stronger system for the future, and that’s where my focus is. I’m not going to comment on what Doug’s trying to do on this one … We’re supposed to say a certain amount of innovation should be good as long as they’re abiding by the Canada Health Act.”
The prime minister says he doesn’t mind if the health-care system looks different from province to province — and says, in fact, that this loose federation may be a bonus.
“The upside of having 13 different health systems in this country is you get to draw on best practice,” he said, “and then that’s one of the things we’re really trying to push.”
The Trudeau government has said it is willing, even eager, to pour more money into provincial health-care budgets, but that injection of cash comes with an important string attached — better data-collection and reporting on outcomes by the provinces.
In a way, that’s not surprising coming from this federal Liberal government. Trudeau has been a big fan of the data revolution in politics and 21st-century campaigning, and the Liberal party has been highly immersed in fighting the data war in the political trenches. Where Conservatives once were the leaders in that data war, the Liberals are widely seen to have overtaken them in the past few elections, with sophisticated microtargeting techniques at the grassroots level.
Fixing health care is a far different challenge than winning an election riding by riding, but it’s clear Trudeau is placing a lot of similar faith in data to revolutionize Canada’s creaking health-care system.
I asked him what that would look like: what can better data do that a major cash infusion wouldn’t solve on its own?
“If people can actually see what’s happening across the country and see what the outcomes are, that’ll drive improvements,” he said.
“First of all, it means collecting data the same way: making sure that there are comparable indicators across the country, making sure that there are things that actually matter to Canadians, like the percentage of citizens in your province that have access to a primary-care physician.”
Even though this prime minister doesn’t see competition between different systems as a bad thing in a modern national medicare system, he also said “it doesn’t have to be about comparing across the country. It can be just comparing within a single jurisdiction, knowing that some sectors or some hospitals are doing better than others. That understanding of data actually allows you to deliver better health outcomes to all citizens, by knowing what’s working and being clear-eyed about what maybe needs tweaking.”
It was the pandemic, the prime minister said, that underlined the need for better data and measuring across the entire medicare system. In the early weeks after COVID-19 hit in March 2020, his government was struck by all the health-care information it didn’t have — and worse, couldn’t get.
The typical conversation around that time went something like this, he said: “‘What do you mean we can’t get numbers from this province?’ ‘Well, they have a (different) way of collecting that’ … And we actually worked in those first few weeks of the pandemic on top of everything else to try and make sure that all the provinces were at least collecting and reporting on a similar basis so we could have that national picture.
“But that sort of got us all thinking, well, how many other areas are we not comparing?”
This data disconnect wasn’t just limited to COVID-19, he said. It also surfaced before Christmas about flu data for children, when provinces were continuing to collect the information in different ways and no one national picture emerged about the state of the illness sweeping through Canada.
“So, yes, the pandemic was a piece of that — not just because it satisfies data geeks like me, but because it actually tangibly means more doctors for people, better services, better care, better quality of care, better understanding of where you’re going to get that care.”
Trudeau didn’t confirm recent reports about a first ministers’ meeting in the works, but he hinted strongly that things are on track for some kind of agreement (or perhaps 13 different agreements) with the provinces and territories.
“We’re coming down on the values and the principles,” the prime minister said. Exactly what those values are may become clearer next week, when his cabinet meets in Hamilton for its annual January retreat.
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