Globe and Mail national affairs columnist Jeffrey Simpson releases Chronic Condition, a passionate call to arms to save a Canadian health-care system he believes is increasingly unsustainable in its current form BY RON CORBETT
Jeffrey Simpson walks into Mellos diner and orders tea. Which, as national affairs columnist for The Globe and Mail for nearly 30 years, is pretty much what you would expect him to drink. He looks the part too — parted hair as well defined as a national border, wire-rimmed glasses, pursed smile. At the age of 63, he still looks like the affable president of the best fraternity on campus.
And then he yells. It is a loud yell, too, nothing subtle about it, and although the diner is crowded and noisy, people turn to stare at us. Construction workers. Elderly retirees. Our waitress. You can see it in their eyes — I hope this guy isn’t going to be trouble. Simpson sees the people staring but doesn’t look at all embarrassed. In fact, dropping his voice just a notch, he leans across the table and repeats himself. “The one thing we can’t do is nothing.”
Simpson — known for his erudite discourses on Canadian politics, the man who makes self-deprecating jokes about liking provincial budgets so much that people are scared to accept his dinner invitations — is flashing some unexpected passion about his latest book.
That book is Chronic Condition, and it is Simpson’s take on the Canadian health-care system. He is not complimentary. On the back page of the uncorrected proofs of the book is a bold-type assertion: “Canadians need to have an ‘adult conversation’ about the unsustainability of our health care system.” It goes on to say, “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.”
In the book, in summary fashion, Simpson dismisses tax increases as a non-starter. He spends slightly more time — although not much — dismissing cuts in government spending so that more money can be diverted to the steadily ballooning health-care budget. Which leaves priva-tization and increased efficiency.
And with dishes clanging, bacon sizzling, a waitress coming over to refill my coffee cup and then stare at Simpson’s tea cup in wonder and confusion, Simpson makes it clear that he doesn’t think much of the last option. “I do not believe the problem can be solved by the god of efficiency,” he says. “There is no bottom-line imperative in our health-care system, no incentive to do things differently.” Which leaves privatization, the “dirty word” in Canadian health care. Much of Chronic Condition is an attempt by Simpson to make the private delivery of publicly paid for healthcare palatable to the reader — or at least something less than a capital crime. He often succeeds.
There is no disputing the success the United Kingdom has had since opening its doors to limited privatization, which goes back to the early 1980s, or the stats that show Canada is near the top of the heap on money spent on a public health-care system but closer to the bottom when you examine value for money. “We are absolutely hung up on the word private,” he says. “But unless we get the private sector involved, unless we establish some private-public partnerships in health care, we will always be playing catch-up.”
Not everyone agrees. Simpson’s book begins by describing a week he spent following Dr. Jeff Turnbull around the Ottawa Hospital. Turnbull is chief of staff at the hospital, past president of the Canadian Medical Association, and a fervent devotee of the “god of efficiency” that Simpson dismisses. “Quite frankly, we haven’t done everything we can when it comes to delivering a more efficient health-care system,” says Turnbull. “I am aware of Jeff’s arguments in favour of private-sector involvement in the delivery of health care, but until we have exhausted all other options, I have trouble supporting it.”
Turnbull gives an example of how things can be done differently in a completely public system. Every day there are scores of patients at the Ottawa Hospital who should be in long-term-care facilities or receiving home-based care. (Simpson’s book actually begins with a patient who fits this description.) It costs $1,100 a day to keep someone in the Ottawa Hospital. In a long-term care facility, the price tag would be closer to $200. Turnbull says we are “just throwing our money away” and that “every single person” working in the health-care field in Canada knows how to fix the problems.
“We need to de-hospitalize the system,” he explains. “We need to move away from an acute-care system to an integrated acute- and chronic-care system. And until we’ve actually tried to do that, I don’t think you can rule out greater efficiency as the best option.”
And there is the debate.
Simpson has won all three of Canada’s leading print journalism prizes — a Governor General’s Award for non-fiction book writing, a National Magazine Award for political writing, and a National Newspaper Award for column writing (twice) — yet he admits to being unsure, even a little nervous, about the reception Chronic Condition will get in the marketplace. His agent tells him Canadians are no longer interested in “serious books.” A look at the non-fiction bestsellers list seems to support the assertion. We apparently favour books by hockey commentators and celebrity chefs. “I don’t know if people have an interest in this debate,” says Simpson. “I certainly know politicians have little interest in it.”
Still, Simpson is convinced he is onto a good story — it is important, it affects a lot of people, conventional wisdom is challenged, all the old-school journalism requirements are met — and so he remains optimistic. “I hope the book will start a debate — and not just between me and Dr. Turnbull,” he says. “Lord knows, the country needs one.”