Transcript: Examining Health Care Policy | May 22, 2018

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and checked blue tie.

A caption on screen reads "Examining the health care debate."

Steve says IT MIGHT NOT BE THE
ONLY TOPIC PEOPLE ARE TALKING
ABOUT THIS ELECTION, BUT HEALTH
CARE IS A TOUCHSTONE FOR MANY
VOTERS.
WE'VE HEARD FROM THE CANDIDATES.
NOW WE'RE JOINED BY DR. DOUG
MANUEL.
HE IS A PRIMARY CARE PHYSICIAN
IN OTTAWA, SENIOR SCIENTIST AT
THE OTTAWA HOSPITAL RESEARCH
INSTITUTE, AND AT THE INSTITUTE
FOR CLINICAL EVALUATIVE
SCIENCES, WHERE HE WAS THE LEAD
AUTHOR ON A RECENT STUDY ABOUT
THE COST BENEFITS OF HEALTH
PROMOTION AND DISEASE PREVENTION.
AND DR. MANUEL JOINS US NOW FOR
HIS TAKE ON THE PARTIES' PROMISES.

Doug is in his fifties, clean-shaven, with receding blond hair. He's wearing glasses, a green suit, blue shirt, and gray tie.

Steve continues GOOD TO HAVE YOU HERE.

Doug says GOOD TO BE
HERE.

Steve says GIVE US A BIT OF
BACKGROUND ON WHERE YOU'RE AT
AND WHAT YOU'RE DOING AND ALL
THAT KIND OF STUFF.

Doug says YOU STARTED OFF DESCRIBING ME
AS A FAMILY DOC AND I STARTED AS
A FAMILY DOCTOR UP NORTH IN
CHURCHILL, NORWAY HOUSE...

Steve says IN MANITOBA?

Doug says IN MANITOBA.
I SAW MYSELF WORKING THERE...
LOVING IT.
LOVED IT.
I SAW MYSELF, NOW THAT I THINK
ABOUT IT, A MICROCOSM OF THE
HEALTH CARE SYSTEM.

Steve says HOW SO?

The caption changes to "Doug Manuel. Ottawa Hospital Research Institute."
Then, it changes again to "The potential for healthy policy."

Doug says I WOULD BE THERE YEARS AND
EVERYBODY WAS SICKER AND SICKER.
WORKING IN THOSE SMALL
COMMUNITIES, YOU REALLY SEE...
YOU SEE THE WHOLE COMMUNITY.
SO I WENT BACK TO PUBLIC HEALTH
AND POPULATION HEALTH.

Steve says AND WHAT TYPE OF
MEDICINE ARE YOU PRACTISING NOW?

Doug says I DO STILL DO SOME PRIMARY
CARE WITH REFUGEES BUT MOSTLY
I'M A SCIENTIST AT THE OTTAWA
HOSPITAL.

Steve says WHY DID YOU MAKE
THAT TURN?

Doug says I FELT THAT BEING A SCIENTIST
I CAN ACTUALLY MAKE THE BIGGEST
IMPACT, SO PUBLIC HEALTH AND
SCIENTIST, I HAVE THE BIGGEST
REACH AND MAKE THE BIGGEST IMPACT.

Steve says YOU SEE HOW THE
HEALTH CARE SYSTEM OPERATES AND
EFFORTS AT DISEASE PREVENTION
AND HEALTH PROMOTION FROM A
COUPLE OF DIFFERENT PERCHES,
WHICH IS WHY YOU'RE IN THAT
CHAIR BECAUSE WE WANT TO GET
YOUR VIEW ON MOSTLY WHAT YOU'VE
JUST HEARD.
I'M NOT EVEN GOING TO ASK YOU A
QUESTION.
I'M GOING TO KEEP IT VERY
OPEN-ENDED FOR YOU.
YOU SAW WHAT THE FOUR PARTIES
HAVE ON OFFER.
WHAT DID YOU LIKE?

The caption changes to "Doug Manuel. University of Ottawa."

Doug says WELL, FIRST, I WOULD LIKE TO
CONGRATULATE YOU FOR STARTING
THE DISCUSSION WITH PREVENTION.
I HAVEN'T REALLY SEEN... I'VE
NEVER SEEN THAT BEFORE IN AN
ELECTION.
I THOUGHT THAT WAS GREAT.
I THOUGHT THEY ALL STARTED TO
ENGAGE THAT.
I WAS CONCERNED IT WAS A LITTLE
BIT OF LIP SERVICE TO PREVENTION
AND THEN, LIKE EVERYTHING, WE
SPEND THE REST OF THE TIME
TALKING ABOUT WAITING TIMES.
I DIDN'T REALLY HEAR A LOT ABOUT
THEIR PLATFORM FOR PREVENTION.
WHAT I DID HEAR, WHICH WAS
ENCOURAGING, WAS A LOT OF THE
PEOPLE WERE TALKING ABOUT
PREVENTION IN TERMS OF BASIC
INCOME PILOT AND HOUSING.
I THOUGHT THAT WAS FANTASTIC.

Steve says THAT'S A REAL THING,
RIGHT?
THAT NEEDS REAL SOLUTIONS.

Doug says THAT'S RIGHT.
AS A RESEARCH COMMUNITY, WE'RE
REALLY EXCITED ABOUT THAT THE
BASIC INCOME PILOT IS HAPPENING
BECAUSE THESE ARE POTENTIALLY
SORT OF CHANGING EVENTS IN TERMS
OF HOW WE UNDERSTAND WHAT WE CAN
DO AT THE COMMUNITY LEVEL FOR
LONG-TERM HEALTH.

Steve says BUT THERE WAS A
COMMITMENT FROM ALL OF THE
PARTIES, I THINK, TO CONTINUE
THE BASIC INCOME PILOT, AND, YOU
KNOW, SEE WHAT HAPPENS.

Doug says I THINK THAT'S VERY
ENCOURAGING.
THAT WOULD BE A REALLY
ENCOURAGING SIGN.

Steve says ANYTHING YOU HEARD,
DR. MANUEL, THAT MADE YOU GO,
BOY, IS THAT EVER A DUMB IDEA?

Doug says WELL, YOU KNOW, I WAS
DISCOURAGED... YOU KNOW, WE PUT
A LID ON HOSPITAL CARE.
FIVE YEARS LATER, WHERE ARE WE?
IF WE PUT A LID ON HOSPITAL CARE
WITHOUT DOING ANYTHING REALLY
MEANINGFUL FOR THE REST OF THE
SYSTEM, INCLUDING PREVENTION,
THE LID IS GOING TO BOIL OVER.

Steve says JUST SO I
UNDERSTAND.
A LID ON HOSPITAL CARE...

Doug says REALLY, THE FUNDING FOR
HOSPITALS HAS BEEN PRETTY FLAT.
THIS HAS BEEN GOING ON IN CANADA
FOR 50 YEARS.
BARRETT STODDART TALKED ABOUT
THIS WITH DOCTORS.
CANADA HAS MORE DOCTORS...
REDUCE THE NUMBER OF DOCTORS.
IF YOU DO THAT, YOU NEED OTHER
COMMUNITY SERVICES.
AND SO WE REDUCED THE DOCTORS
AND WE DIDN'T BRING IN ANY OTHER
SERVICES.
I THINK THAT'S THE CYCLE THAT
WE'RE IN AND THAT'S THE CYCLE
THAT PLAYED OUT IN THE
CONVERSATION THAT YOU JUST HAD.

Steve says BUT WOULD IT BE YOUR
VIEW IF YOU WERE IN CHARGE OF
THE HEALTH CARE SYSTEM, YOU
WOULD BE SPENDING A WHOLE LOT
MORE ON HEALTH PREVENTION AND A
WHOLE LOT LESS ON SICKNESS
TREATMENT?

Doug says YOU NEED TO HAVE THE TWO
TRACKS.
YOU NEED THE LONG-TERM STRATEGIC
VIEW OF WHERE WE'RE GOING.
THAT'S WHERE YOU START.
I THINK THAT'S HOW YOU STARTED
THE CONVERSATION, WHICH WAS
GREAT.
WHEN I WALK THROUGH THE HOSPITAL
CORRIDOR, I JUST SEE ALL THESE
PATIENTS... NO ONE WANTS TO BE
IN THE HOSPITAL.
MOST PEOPLE DON'T NEED TO BE IN
HOSPITAL IF YOU STARTED... YOU
KNOW, IT STARTED BACK 20 OR 30
YEARS.
WHEN I WALK THROUGH...

Steve says HANG ON.
JUST SO I GET THAT.
MEANING THAT 20 OR 30 YEARS AGO
YOU STARTED BUILDING CAPACITY IN
THE COMMUNITY...

Doug says FOR PREVENTION.
WHEN I WALK THROUGH THE HOSPITAL
CORRIDORS, I SEE A LOT OF PEOPLE
THAT COULD HAVE BEEN PREVENTED
TO NOT BE THERE.

Steve says I SEE.

Doug says THROUGH HEALTHY LIVING.
AND I ALSO SEE, FOR INSTANCE,
PEOPLE AT END OF LIFE, YOU KNOW,
THAT WE HAVE THE HIGHEST RATES
OF IN-HOSPITAL DEATH IN
DEVELOPED COUNTRIES.
SO I SEE A LOT OF PEOPLE... AND
THAT'S HOW WE OFTEN WILL... I
TALK WITH HOSPITALS.
WE HAVE THAT DISCUSSION.
SO MANY PEOPLE WANT TO BE IN
HOSPITAL BUT WHO ARE THE ONES
THAT DON'T WANT TO BE THERE OR
DON'T NEED TO BE THERE.
SO THAT'S WHERE I WOULD HAVE
THESE TWO TRACKS AND HAVE THAT
DISCUSSION.
IN BRITISH COLUMBIA, THERE ISN'T
AS BIG A CONVERSATION ABOUT
WAITING TIMES.
WHERE THE CONVERSATION IS... AT
CABINET, WE INTERVIEWED FOLKS
FOR OUR PREVIOUS REPORT AND THE
BURNING PLATFORM AT CABINET WAS
THE INCREASING COST OF CHRONIC
DISEASE AND HOW EVERY PERSON
AROUND THAT CABINET TABLE HAD TO
ADDRESS THIS IN THEIR MINISTRY
IN SOME WAY.
IT'S A DIFFERENT DISCUSSION THAT
PLAYS OUT IN DIFFERENT
JURISDICTIONS.

Steve says BUT IN TERMS OF
POLITICIANS... WE HAD A FORMER
HEALTH MINISTER THERE, SOMEBODY
WHO HAD BEEN THE PATIENT
OMBUDSMAN FOR THE PROVINCE OF
ONTARIO, THE HEALTH CRITIC FOR
THE NDP FOR 11 YEARS, YOU HAVE
THE LEADER OF THE GREEN PARTY.
I KNOW MEDICAL PEOPLE WISH
PEOPLE WHO WERE IN POLITICS HAD
A MUCH BETTER UNDERSTANDING OF
ALL THE CHALLENGES AND OBSTACLES
AND SO ON.
WHAT WAS THE LEVEL OF CONFIDENCE
YOU HAD AMONG THAT FOUR IN TERMS
OF THEM KNOWING WHERE THINGS ARE AT?

Doug says I THOUGHT THAT THEY WERE... I THOUGHT THE DISCUSSION WAS GOOD,
AND I THOUGHT THAT THEY WERE ALL
WELL-INFORMED ABOUT THE HEALTH
CARE SYSTEM ESPECIALLY.

Steve says IN OTHER WORDS, IF
ANY ONE OF THEM WERE THE
DECISION-MAKER, YOU'D BE OKAY
WITH THAT?

Doug says WELL, I STILL AM CONCERNED
ABOUT OUR CYCLE OF, TRY TO
CONTROL HEALTH CARE COSTS, NO
STRUCTURAL CHANGES, BOIL-OVER,
KEEP ON GOING, NO LONG-RANGE
PLAN.
WE DON'T HAVE HEALTH GOALS IN
ONTARIO.
WE DON'T...

Steve says WHAT DO YOU MEAN WE
DON'T HAVE HEALTH GOALS?

Doug says WE DON'T HAVE A GOAL OF WHERE
WE WANT TO BE IN TERMS OF LIFE
EXPECTANCY, SMOKING, OBESITY.
WE DON'T HAVE A CHRONIC DISEASE
PREVENTION PLAN.
WHEN WE DID OUR DIABETES
STRATEGY, ALMOST ALL OF IT WAS
FOR HEALTH CARE WITH, YOU KNOW,
A SMALL FRACTION FOR PREVENTION,
EVEN THOUGH WE KNOW THAT IT'S
JUST GOING TO GET WORSE IF WE
DON'T DO PREVENTION.

Steve says I WANT TO MAKE SURE
I UNDERSTAND YOU PROPERLY.
ARE YOU SAYING THAT THE
GOVERNMENT OF ONTARIO OUGHT TO
MAKE AS ONE OF ITS PRIME GOALS
THE ERADICATION OF DIABETES AND
FUND ACCORDINGLY?

Doug says I THINK WE SHOULD HAVE A PLAN
FOR CONTROLLING AND REDUCING
DIABETES.
CAN WE GET TO ZERO?
I THINK THAT'S GOING TO BE
DIFFICULT.
BUT WE NEED TO HAVE A... WE DO
NOT... WE SHOULD NOT ACCEPT THAT
DIABETES SHOULD INCREASE.

Steve says IS THAT SOMETHING
ANY SINGLE PROVINCE CAN COMMIT
TO DOING?

Doug says I THINK WE NEED TO HAVE A
DIABETES STRATEGY, CLEARLY, THAT
HAS... CORNERSTONE, AT THE
BEGINNING OF THE DISCUSSION, HOW
CAN WE REDUCE OBESITY?
HOW CAN WE PREVENT DIABETES?
NO QUESTION.

Steve says AND A PROVINCE CAN
DO THAT?

Doug says I THINK SO.
WE'RE ALREADY STARTING TO SEE
THAT BEND.
WE'RE ALREADY STARTING TO SEE
THE BEND FOR OBESITY.
THE OBESITY RATES AROUND THE
WORLD ARE DRAMATICALLY VARIED.
WE'RE GOOD SECOND PROVINCE.
WHEN YOU THINK ABOUT WHO IS
LEADING JURISDICTION FOR FOOD
POLICY, WHAT COMES TO MIND?
YOU'RE ASKING THE QUESTION, I'M
ANSWERING.
I'LL ANSWER THAT.
NEW YORK.
DENMARK.
MEXICO.
MEXICO BRINGS IN... STUDIES FOR
RAISING THE PRICE... A SUGAR
TAX.

Steve says YOU HEARD THEM.
THEY THINK IT'S A TAX ON POOR
PEOPLE.

Doug says I'M NOT A POLITICIAN OR A
ECONOMIST.
CAN YOU CHANGE TAXES IN OTHER
WAYS?
THE POLLING FOR A SUGAR TAX IS
CLEAR.
ABOUT 40 PERCENT SUPPORT FOR IT.
WHERE ONTARIO AND CANADA IS
MEDDLING ALONG, THE U.K. BRINGS
IN A SUGAR TAX AND WE'LL FOLLOW
AFTER... YOU KNOW, AFTER ALL THE
LEADING JURISDICTIONS IN
PREVENTION WE'LL ENACT THINGS
AND LEARN FROM THEM.

Steve says IN THE MEANTIME,
MORE KIDS WILL GET DIABETES.

Doug says YEAH.
WE ARE VERY GOOD ON SMOKING.
NOW, CAN WE LEVERAGE WHAT WE
LEARNED FROM HOW TO BRING IN A
REALLY SUCCESSFUL SMOKING
PROGRAM IN THESE OTHER AREAS?

Steve says I KNOW YOU'RE A
NON-PARTISAN GUY.
HAVING SAID THAT, YOU DID HEAR
THE DISCUSSION.
YOU DO KNOW WHAT THE PARTIES
HAVE ON OFFER.
IT WOULD BE REASONABLE I THINK
FOR ME TO ASK: WHO HAS THE BEST
PLAN?

The caption changes to "Doug Manuel, @doug_manuel."

Doug says WHO HAS THE BEST PLAN?
I'M NOT SURE, HONESTLY, YOU
KNOW.
EVEN WHEN YOU WERE TALKING I HAD
A LITTLE BIT OF A HARD TIME
DIGESTING THEIR CLEAR PLANS.
I THINK EVERYONE IS MOSTLY
CONCERNED ABOUT HOSPITALS.
I THINK THAT, AGAIN, WE NEED TO
ADDRESS THAT.
YEAH.
I WOULD LIKE TO SEE A STRONGER
PLAN FOR OTHER PARTS OF THE
HEALTH CARE SYSTEM.
I THINK ATTENTION TO MENTAL
HEALTH WAS VERY GOOD AS WELL.

The caption changes to "Comprehensive election coverage: tvo.org/OntarioElection."

Steve says EVERYBODY SEEMS TO
HAVE... IT SEEMS TO ME ANYWAY,
THE FOUR MAJOR PARTIES HAVE ALL
FINALLY COME TO A POINT IN THEIR
COLLECTIVE HISTORIES WHERE
MENTAL HEALTH IS A THING AND
THEY'RE PREPARED TO ACTUALLY
SPEND SOME SERIOUS MONEY
TACKLING IT.
DO YOU GET THAT SENSE AS WELL?

Doug says I GET THAT SENSE.
I THINK WE'RE STARTING TO TURN
THE CORNER IN ONTARIO AND CANADA
ON MENTAL HEALTH.
I'M HOPING.
THERE ARE A LOT OF ENCOURAGING
SIGNS, YES.

Steve says WHAT DID YOU NOT
HEAR TODAY FROM ANY OF THEM THAT
YOU THOUGHT, YOU KNOW, IF YOU
WERE A REASONABLE PERSON WITH A
WELL-THOUGHT-THROUGH PLATFORM,
THIS WOULD HAVE BEEN IN THE
PLATFORM, BUT YOU DIDN'T SEE ANY
EVIDENCE OF IT?

Doug says I'M GOING BACK TO THE
PREVENTION.
YOU KNOW, IN OUR REPORT, WE
SHOWED... WE MOSTLY TALKED ABOUT
THE REDUCTION IN HEALTH CARE
COSTS FROM IMPROVING HEALTH
BEHAVIOURS.
AND THEN AFTER WE PUBLISHED IT,
PEOPLE SAID TO ME, YOU KNOW,
THAT REPORT ALL READ ABOUT
SMOKING.
IT WAS A 10-YEAR STRATEGY THAT
WAS BROUGHT IN AND IT WAS THE...

Steve says THE FORMER MEDICAL
OFFICER OF HEALTH.

Doug says SHE WAS SO POPULAR FOR
S.A.R.S. AND SHE BROUGHT IN A
NICE TOBACCO STRATEGY.
OVER THAT 10 YEARS WE CALCULATED
THERE WAS 10 BILLION DOLLARS IN HEALTH
CARE SAVINGS.
THE PROVINCE IS INVESTING
50 MILLION DOLLARS A YEAR.
EVERYONE IS KIND OF LIKE... WE
DIDN'T WANT TO GO SO FAR TO DO
HEALTH ECONOMICS BUT WE LAID
THOSE NUMBERS DOWN THERE.
THAT'S A PRETTY GOOD RETURN ON
INVESTMENT.
YOU KNOW, 50 MILLION DOLLARS A YEAR,
WE'RE SAVING 400 MILLION DOLLARS A
YEAR.
I THINK THERE'S A REALLY STRONG
ARGUMENT FOR PREVENTION.
WHY PEOPLE AREN'T PICKING THAT
UP, IT'S HARD TO UNDERSTAND.

The caption changes to "Producer: Meredith Martin, @MeredithMartin."

Steve says YOU'RE MAKING THE
CASE FOR IT HERE.
MAYBE THEY'LL MOVE THAT ALONG.
WE SHALL SEE.
WE'RE GRATEFUL, YOU FLEW IN FROM
OTTAWA. WE ARE GRATEFUL.
THAT'S DR. DOUG MANUEL, HE'S A
SENIOR SCIENTIST AT THE OTTAWA
HOSPITAL RESEARCH INSTITUTE,
PROFESSOR TO THE DEPARTMENT OF
FAMILY MEDICINE AT THE
UNIVERSITY OF OTTAWA AND WE'RE
HAPPY TO HAVE HAD HIM IN THAT
CHAIR. THANKS, DOUG.

Doug says THANK YOU.

Watch: Examining Health Care Policy