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Book: Hardcover | 235 x 159mm | 304 pages | ISBN 9780670065899 | 18 Sep 2012 | Allen Lane Canada
Jeffrey Simpson

Jeffrey Simpson has been The Globe and Mail’s national affairs columnist for more than twenty-five years. He is also an award-winning author of eight previous books—including Discipline of Power, which won a Governor General’s Award—and is an officer of the Order of Canada. He lives in Ottawa with his family.

CHRONIC CONDITION

WHY CANADA'S HEALTH CARE SYSTEM NEEDS TO BE DRAGGED INTO THE 21C

Jeffrey Simpson

Medicare is the third rail of Canadian politics. Touch it and you die. Every politician knows this truism, which is why no one wants to debate it. Privately, many of them understand that the health care system, which costs about $200 billion a year in public and private money, cannot continue as it is—increasingly ill-adapted to an aging population with public costs growing faster than government revenues.

In Chronic Condition, Jeffrey Simpson meets health care head on and explores the only four options we have to end this growing crisis: cuts in spending, tax increases, privatization, and reaping savings through increased efficiency. He examines the tenets of the Medicare system that Canadians cling to so passionately. Here, he finds that many other countries have more extensive public health systems, and Canadian health care produces only average value for money. In fact, our rigid system for some health care needs and a costly system for other needs—drugs, dentistry, and home care—is really the worst of both worlds. Chronic Condition breaks the silence about the huge changes and real choices that Canadians face.

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Chronic Condition first chapter

Letter Dr. Jeffrey Turnbull glances at the top line of the patient’s chart. He blocks with his hand the subsequent lines that describe the patient’s condition and treatment since being admitted the night before. “I know the rest,” Turnbull predicts.

The patient, R, is a ninety-four-year-old male. Turnbull’s quick assessment: “This will cost about $50,000 for the twenty to thirty days he is here.” Turnbull reads the rest of the chart. R came from a retirement home. He was given a battery of tests after being admitted to the Ottawa Hospital. The chart, all handwritten by nurses and residents, shows R’s vital signs are acceptable, but he has a urinary-tract infection, lesions (likely malignant) on his back and a form of dementia.

“That man should never have come into an acute-care hospital,” Turnbull observes. “Someone should have made arrangements a month ago for him to go somewhere, but now it’s happened.” Turnbull continues: “There are maybe 160 people in the hospital at $1100 a day waiting for long-term care. So we’re spending maybe $180,000 a day for care that is crappy, not in their best interests. In a nursing home, it would be about $200 a day. The care itself here isn’t crappy, but this man won’t have rehab. He’s not going to have his family around.

“They’ve done ten tests so far. What will happen now is that we will treat his urinary-tract infection. We’ll stabilize his condition. We’ll call the family and we’ll agree that he should be sent to a long-term care facility, and then he’ll wait for a bed. We’ll transfer him to our waiting unit, and then he’ll wait.”



Turnbull’s Monday-morning prediction introduced me, in the fall of 2011, to a week learning what goes on in the Ottawa Hospital, one of the largest teaching hospitals in Canada, with an annual budget of about $1 billion, and a template for similar institutions across Canada. The week allowed me to watch one part of Canadian health care across wards, operating rooms, the emergency department, administrative offices, inner-city outpatient care. It became evident throughout the week that at the Ottawa Hospital, as at other large acute-care hospitals across Canada, brilliant medicine is practised, caring staff offer succor and support, technologies and drugs unheard of several decades ago help patients with their ailments. Some of the very best features of the Canadian healthcare system were on display; so were some of the worst. A hospital is a...

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Jeffrey Simpson has been The Globe and Mail’s national affairs columnist for more than twenty-five years. He is also an award-winning author of eight previous books—including Discipline of Power, which won a Governor General’s Award—and is an officer of the Order of Canada. He lives in Ottawa with his family.