Transcript: Better Health Care through Innovation | Mar 04, 2019

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

A caption on screen reads "Better health care through innovation. @spaikin, @theagenda."

Steve says WE SPEND MORE THAN
60 BILLION DOLLARS A YEAR ON HEALTH
CARE IN ONTARIO.
YET MANY EXPERTS AGREE THAT WE
COULD SPEND TWICE THAT AMOUNT
AND NOT NECESSARILY HAVE A
HEALTHIER POPULATION OR A SYSTEM
THAT'S TWICE AS GOOD.
A DIFFERENT OPTION MAY BE, CAN
WE INNOVATE OUR WAY TO A BETTER
SYSTEM AND BETTER OUTCOMES FOR
PATIENTS?
TO THAT END, WE'VE ASSEMBLED
FOUR HEALTH CARE EXPERTS, ALL OF
WHOM HAVE SOME IDEAS WHICH IN
THEIR VIEW WOULD MAKE THINGS
BETTER.
AND SO WE WELCOME:
DR. DAVE WEBSTER, ADJUNCT
PROFESSOR IN PHYSICS AND
NEUROSCIENCES AT LAURENTIAN
UNIVERSITY IN SUDBURY...

Dave is in his sixties, clean-shaven, with short wavy blond hair. He's wearing glasses, a black blazer and a white tee.

Steve continues KATE MULLIGAN, DIRECTOR OF
POLICY AND COMMUNICATIONS AT THE
ALLIANCE FOR HEALTHIER COMMUNITIES.
SHE'S ALSO PROFESSOR OF SOCIAL
AND BEHAVIOURAL HEALTH SCIENCES
AT THE DALLA LANA SCHOOL OF
PUBLIC HEALTH AT THE UNIVERSITY OF TORONTO...

Kate is in her thirties, with short brown hair and bangs. She's wearing glasses, a black cardigan over a gray blouse, and silver earrings.

Steve continues NATALIE MEHRA IS EXECUTIVE
DIRECTOR OF THE ONTARIO HEALTH COALITION...

Natalie is in her mid-forties, with long straight chestnut hair and bangs. She's wearing a brown sweater over a black shirt, and a gray scarf.

Steve continues AND STEPHEN SKYVINGTON IS THE PRESIDENT OF POLITRAIN INC., A
PUBLIC RELATIONS CONSULTANCY.
HE'S ALSO THE AUTHOR OF THE JUST
RELEASED BOOK, "THIS MAY HURT A
BIT: REINVENTING CANADA'S HEALTH CARE SYSTEM."
THAT'S A GREAT TITLE.

Stephen is in his late fifties, clean-shaven, with short gray hair. He's wearing glasses, a gray suit, blue shirt, and spotted burgundy tie.

Steve continues THANK YOU, FIRST OF ALL, FOR COMING ALL THE WAY DOWN FROM SUDBURY, TO YOU.
AND THANK YOU FOR DRIVING IN
FROM COBOURG... YOU DROVE OR TOOK THE TRAIN?

Stephen says DROVE.

Steve says YOU DROVE.
THANK YOU FOR DOING THAT.
KATE AND NATALIE, GREAT TO HAVE
YOU HERE AS WELL.
KATE, I WANT TO START WITH YOU
AND I'M GOING TO READ SOMETHING
OFF YOUR WEBSITE, OKAY?
SHELDON, LET'S BRING THIS UP AND
EVERYBODY CAN READ ALONG.

A quote appears on screen, under the title "Medication and dancing." The quote reads "What if, along with medication, doctors and nurse practitioners were enabled to prescribe dance lessons, cooking classes, volunteer roles, caregiver supports, single-parent groups, and connections to bereavement networks?
Every point of contact you have with the health system should be a gateway to better overall wellbeing -particularly in primary care, which is most people's main point of contact with Ontario's health care system."
Quoted from the Alliance for Healthier Communities website.

Steve says KATE, YOU ARE
DESCRIBING SOMETHING CALLED
SOCIAL PRESCRIBING.
WHAT DOES THAT LOOK LIKE?

The caption changes to "Kate Mulligan. Alliance for Healthier Communities."

Kate says WELL, SOCIAL PRESCRIBING IS REALLY, YOU KNOW,
ROOTED IN AN OLD IDEA, THAT
HEALTH CARE IS IN COMMUNITY.
WHAT WE'RE FINDING IS THERE CAN
BE A ROLE FOR THE MAINSTREAM
HEALTH SYSTEM IN HELPING ADDRESS
THE GROWING BODY OF EVIDENCE
THAT PEOPLE'S, YOU KNOW, SOCIAL
AND ENVIRONMENTAL DETERMINANTS
OF HEALTH ARE REALLY KEY DRIVERS
OF THEIR OVERALL WELL-BEING.

Steve says SO YOU ARE NOW
PRESCRIBING... YOU ARE SOCIAL
PRESCRIBING AT 11 COMMUNITY
HEALTH CARE CENTRES AROUND THE
PROVINCE?

The caption changes to "Kate Mulligan, @KateMMulligan."

Kate says YES.
WE HAVE 11 CENTRES AND IN
DIFFERENT CONTEXTS.
IN THUNDER BAY, A RURAL CENTRE,
DOWNTOWN CENTRES HERE IN
TORONTO.
THEY'RE TRYING IN THEIR OWN WAYS
TO BETTER CONNECT PEOPLE WITH
SOCIAL SUPPORTS FOR THEIR HEALTH
NEEDS.

Steve says CAN YOU TELL WHETHER
PEOPLE ARE ACTUALLY HEALTHIER
BECAUSE OF THIS DIFFERENT
APPROACH?

The caption changes to "Kate Mulligan. Dalla Lana School of Public Health."
Then, it changes again to "Social Prescribing."

Kate says THAT'S OUR GOAL.
WE'RE EARLY ON IN THE EVALUATION
PROCESS RIGHT NOW.
WE ARE LEARNING AND WORKING WITH
PEOPLE FROM THE UNITED KINGDOM
WHO HAVE BEEN DOING THIS FOR A
LITTLE WHILE, AND SO WE ARE
IMPLEMENTING A VERY ROBUST
EVALUATION USING OUR SHARED
ELECTRONIC MEDICAL RECORDS AND
LOTS AND LOTS OF RESEARCH TO SEE
WHETHER THAT'S TRUE.
BUT EARLY INDICATIONS ARE THAT,
YES, PEOPLE'S HEALTH, THEY'RE
SELF-REPORTED HEALTH AND
WELL-BEING, THEY'RE SELF
REPORTED SENSE OF SOCIAL
INCLUSION AND DROP IN
LONELINESS, WE'RE ALREADY SEEING
ANECDOTALLY THAT, YEAH, PEOPLE
ARE FEELING HEALTHIER.

Steve says IS THERE AN
ACCEPTANCE IN THE BROADER HEALTH
CARE SYSTEM THAT THIS IS THE WAY
TO GO?

Kate says I THINK WE DO HAVE A WAYS TO
GO BEFORE THAT'S THE CASE, AND
THAT'S PARTLY WHY WE'RE WORKING
SO HARD TO BUILD THE EVIDENCE
BASE.
WE NEED TO HELP WORK AND
CONVINCE OTHER PEOPLE.
YOU KNOW, WE'VE BEEN APPROACHED
BY A NUMBER OF PEOPLE WITHIN
HEALTH CARE ORGANIZATIONS AS
WELL AS ARTS ORGANIZATIONS,
ECOLOGICAL ORGANIZATIONS AND
PARKS TO COME IN AND PARTNER ON
WITH THIS, INCLUDING SOME MAJOR
HOSPITALS.
SO I THINK THERE'S A REALLY,
A REAL STRONG INTEREST AND THERE
WILL BE ACCEPTANCE IF WE CAN
HELP SPEAK TO THE EVIDENCE THEY
THINK IS IMPORTANT IN
DETERMINING PEOPLE'S HEALTH AS
WELL AS THE EVIDENCE WE ALSO
KNOW IS IMPORTANT WITH RESPECT
TO HOW PEOPLE VIEW THEIR OWN
HEALTH.

Steve says IF THIS IS REALLY
BARE BONES BASIC ON-THE-GROUND
COMMUNITY ENGAGEMENT, I WANT TO
GO TO THE EXACT OPPOSITE END OF
THAT SPECTRUM, AND, DR. DAVE,
THAT'S WHERE I GET YOU IN.
YOU'RE A NEUROMEDICINE GUY,
YOU'RE IN LOVE WITH PET
SCANNERS. WHAT'S A PET SCANNER?

The caption changes to "David Webster. Laurentian University."
Then, it changes again to "Be a PET (scanner)."

David says WE IMAGE IN MY SPECIALTY
METABOLISM OR PHYSIOLOGY
DIRECTLY AT THE CELLULAR LEVEL.
WE INJECT LESS THAN A BILLIONTH
OF A GRAM WHICH TRACES
METABOLISM.
THE MOST COMMON WE WOULD USE IS
GLUCOSE, SIMPLE SUGAR IN A
MODIFIED FORM.
WHY THAT IS SO HELPFUL IS
BECAUSE EVERY CELL IN THE BODY
CAN USE SUGAR TO METABOLIZE.
IN CANCER CELLS CANCER CELLS CAN
ONLY USE SUGAR.

Steve says WHAT DOES IT STAND FOR?

David says POSITRON IMAGE.
IT IS A RADIOACTIVE DISPLAY.

Steve says YOU USE PET SCANNERS
BECAUSE THEY'RE BETTER THAN
OTHER KINDS OF SCANNING HOW?

David says THE PROBLEM IS THAT PEOPLE
ARE FAMILIAR WITH THINGS LIKE CT
AND MR.
THEY HAVE AN EXQUISITE ABILITY
TO LOOK AT ANATOMY AT A CERTAIN
RESOLUTION.
THEY HAVE ZERO ABILITY TO
DETERMINE WHETHER A MASS THEY
SEE IS CANCER, SCAR TISSUE, OR
INFECTION.

Steve says THAT'S FOR A CT SCAN.

The caption changes to "David Webster, @petscansontario."

David says YES.
THEY IMAGE ANATOMY OR STRUCTURE
AND WE IMAGE FUNCTION.
A GOOD EXAMPLE WOULD BE WHEN A
PATIENT HAS HAD A CANCER
TREATMENT, THEY'RE OFTEN LEFT
WITH A MASS THAT'S LEFT.
IN ONTARIO, UNIQUELY IN THE
WORLD, WE SIMPLY FOLLOW WITH CT
SCANNERS: YOU SEE IF IT'S SCAR
TISSUE, IT TAKES UP ALMOST NONE
OF THE SUGAR BUT, YOU KNOW, IF
IT'S A CANCER PERSISTING, IT
WILL.
I'VE SEEN PATIENTS AS A SIMPLE
EXAMPLE TREATED FOR LYMPHOMA.
EVERYTHING SEEMS FINE.
GO HOME AND HAVE A NICE NIGHT
WITH THE WIFE AND KIDS.
WE HAD A PET SCAN AND FOUND THAT
NOT ONLY WAS IT AN ACTIVE
CANCER, HE HAD MORE CANCER.

Steve says IN YOUR VIEW IF WE
WERE TO HAVE MUCH BETTER HEALTH
CARE IN THE PROVINCE OF ONTARIO,
WE'D HAVE MORE PET SCANNERS
AVAILABLE TO MORE PEOPLE.

David says ABSOLUTELY.
BACK IN 2004 ONE OF THE MOST
PROMINENT PEOPLE AND I TRAINED
UNDER HIM WROTE TO
MR. SMITHERMAN.

Steve says THE THEN HEALTH MINISTER.

The caption changes to "David Webster. Nuclear Medicine Doctor."

David says THE HEALTH MINISTER AND SAID
WE ARE A DECADE BEHIND THE WORLD
IN 2004.
RIGHT NOW WE ARE NOT EVEN ON THE
SAME PLANET.

Steve says HOW MANY DO WE HAVE
IN ONTARIO?

David says WE HAVE ABOUT 12 OR 14.
IT ISN'T HOW MANY WE HAVE, IT'S
HOW WE GET TO USE THEM.
IF WE LOOK NEXT DOOR IN QUEBEC,
THEY HAVE THE SAME NUMBER OF
SCANNERS, THEY HAVE HALF THE
POPULATION OF ONTARIO.
THEY SCAN ON AVERAGE 3,000
PATIENTS PER CAMERA PER YEAR.
IN ONTARIO WE'LL BE ALLOWED TO
SCAN ONLY 800 PATIENTS.
THAT'S NOT THE BAD NEWS.
THE BAD NEWS IS THAT AS A
PHYSICIAN I'M ALLOWED TO USE
THOSE IS... IF I WERE TO USE
THOSE INDICATIONS IN QUEBEC OR
FOR THAT MATTER PARAGUAY I COULD
OR SHOULD BE CHARGED WITH
INCOMPETENCE AND I SEE THE
IMPACT ON PATIENTS ON A DAILY BASIS.

Steve says HOW MUCH DO THEY COST?

David says THE PET SCANNER ITSELF IS
PROBABLY AROUND 3.2 MILLION DOLLARS,
3.3 MILLION DOLLARS.

Steve says IS THAT ONE OF THE
REASONS WE DON'T HAVE MORE OF THEM?

David says I DON'T THINK THAT'S QUITE...
INITIALLY IT WAS.
IT'S NOT NOW, I WOULD ARGUE.
THE POINT IS THAT BECAUSE PET IS
ABLE TO DO... I CAN GIVE YOU AN
EXAMPLE OF A PATIENT.
IF YOU HAVE A TEENAGER WITH
LYMPHOMA, MY ADVICE WOULD BE TO
LEAVE ONTARIO.
WHY?
BECAUSE I HAVE A PATIENT THAT'S
BEEN FOLLOWED FOR THE LYMPHOMA.
THEY'VE HAD MORE THAN 30 CT
SCANS AND COUNTING.
THAT'S MORE THAN 300 YEARS OF
EXPOSURE.
THE ONLY TIME THEY WERE EVER...
A CHANGE WAS MADE WAS WHEN THEY
HAD THREE PET SCANS, YOU SEE,
BECAUSE WE CAN IMAGE METABOLISM.
IF YOU HAVE A TEENAGE DAUGHTER
WITH LYMPHOMA, WITHIN FIVE YEARS
THEY ALREADY HAVE TO START
SCREENING HER FOR DEVELOPING
CANCERS IN HER THYROID AND
BREAST, NOT BECAUSE OF THE
CANCER OR THE TREATMENTS BUT
BECAUSE OF THE USEFUL CT
RADIATION SHE WILL BE EXPOSED TO.

Steve says THANK YOU FOR THAT.
HOLD THE FORT.
STEPHEN, YOU'RE UP NEXT.
READY TO GO?

Stephen says ABSOLUTELY.

Steve says YOU HAVE WRITTEN A
BOOK THAT'S GOING TO BE AS
CONTROVERSIAL AS HELL AND I
CAN'T WAIT UNTIL NATALIE HAS A
CHANCE TO DEBATE YOU ABOUT THIS.
YOU START BY QUOTING... I READ
THE BOOK.
YOU HAVE A QUOTE IN THERE FROM
THE LEGENDARY CBS NEWSMAN WALTER
CRONKITE WHO TALKED ABOUT
AMERICA'S HEALTH CARE SYSTEM AS
NEITHER HEALTHY NOR CARING NOR A
SYSTEM.
WOULD YOU SAY THE SAME THING
ABOUT THE PROVINCE OF ONTARIO?

The caption changes to "Stephen Skyvington. Politrain Inc."
Then, it changes again to "This may hurt a bit."

Stephen says ABSOLUTELY.
YOU KNOW, OUR PROBLEM IS THAT WE
DON'T HAVE A HEALTH CARE
SYSTEM... FIRST OF ALL, IT'S A
SICKNESS SYSTEM.
IT'S TREATING SICKNESS AND NOT
REALLY ABOUT HEALTH CARE OR
KEEPING US HEALTHY OR NUTRITION
OR WELLNESS.
THAT'S A BIG PROBLEM.
BUT THE BIGGER PROBLEM IS THAT
IT'S REALLY JUST AN INSURANCE
SCHEME.
IT'S AN INSURANCE SCHEME... I
SAY IT'S A BADLY RUN INSURANCE
SCHEME.
FOR EXAMPLE, PEOPLE KEEP ASKING
ME, WHEN YOU WROTE THIS BOOK,
DID YOU FIND ANYTHING THAT
SURPRISED YOU?
I WAS SURPRISED TO DISCOVER THAT
THE CANADA HEALTH ACT, THAT
EVERYONE IS WAVING AROUND LIKE A
GREAT FLAG OF PATRIOTISM, IS A
FINANCE BILL.
IT HAS NOTHING TO DO WITH HEALTH
CARE.
THE FIVE PRINCIPLES ARE THERE.
TOMMY DOUGLAS HAD EIGHT.
WE ONLY TOOK FIVE.
IT WAS ACTUALLY ABOUT ENDING
EXTRA BILLING AND CO-PAYMENTS
AND ALL THAT STUFF.
IT'S A FINANCE BILL THAT WE'RE
GETTING BENT OUT OF SHAPE OVER
AND TRYING TO SUGGEST THAT THAT
DEFINES US AS CANADIANS.
IT'S LUDICROUS.

Steve says LET'S GO THROUGH IT
BECAUSE NOT EVERYBODY KNOWS
ABOUT IT.
IT'S BEEN AROUND 35 YEARS, AFTER
ALL.
THE CANADA HEALTH ACT SUGGESTS
FIVE THINGS THAT OUR SYSTEM
OUGHT TO HAVE.
IT OUGHT TO BE PUBLIC, IT OUGHT
TO BE COMPREHENSIVE, IT OUGHT TO
BE UNIVERSAL, IT OUGHT TO BE
AFFORDABLE AND ACCESSIBLE.
WHAT'S MISSING ON THAT LIST?

The caption changes to "Stephen Skyvington, @Sskyvington."
Then, it changes again to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Stephen says QUALITY.
FOR EXAMPLE, WHEN I... YOU KNOW,
IT LED TO MY WRITING THIS BOOK
BECAUSE I WAS IN THE BACK OF THE
AMBULANCE HAVING DROPPED DEAD
WITH HEART TROUBLE.
THEY SAID IF I MAKE IT TO
HOSPITAL AND LIVE THROUGH THIS
I'M GOING TO WRITE THIS BOOK
FINALLY.
IF I HAD DIED, IT WOULD HAVE
BEEN THE EXACT SAME AS IF I HAD
BEEN SUCCESSFULLY TREATED
BECAUSE THE LIST WOULD HAVE
GOTTEN ONE BODY SHORTER IN OUR
SYSTEM OF BEAN COUNTING AND,
AGAIN, BECAUSE IT'S AN INSURANCE
SCHEME.
AT FORD QUALITY IS JOB ONE.
WHEN IT COMES TO MEDICARE,
QUALITY IS JOB NONE.
AND THAT'S I THINK A BIG PART OF
THE PROBLEM.
I WOULD WANT QUALITY TO BE A
SIXTH PRINCIPLE OF THE CANADA
HEALTH ACT BUT I'D ACTUALLY MAKE
A DIVERSE PRINCIPLE.

Steve says DOES IT NOT GO
WITHOUT SAYING THAT THE PEOPLE
INVOLVED IN OUR HEALTH CARE
SYSTEM WANT IT TO BE A QUALITY SYSTEM?

The caption changes to "Stephen Skyvington. Author, 'This may hurt a bit.'"

Stephen says OH, ABSOLUTELY.
AGAIN, LEANING BACK TO FORD.
BEFORE FORD DECIDED QUALITY WAS
JOB ONE, IT'S LET'S GET THE
PRODUCT OUT OF THE DOOR AS FAST
AS POSSIBLE.
THAT'S WHAT HAPPENS.
YOU KNOW, PEOPLE WHO HAVE NEVER
USED OUR HEALTH CARE SYSTEM SAY
WE HAVE THE BEST IN THE WORLD.
PEOPLE WHO HAVE HAD A PROBLEM, A
SERIOUS LIFE-THREATENING, LIKE A
HEART ATTACK OR A CAR ACCIDENT,
SAY IT'S THE GREATEST SYSTEM
EVER BECAUSE IT'S LIKE PULLING
INTO THE PITS AT THE INDY 500,
WHEN YOU HAD A HEART ATTACK OR
BEEN IN A CAR CRASH, THE PIT
CREW JUMPS IN THERE, THEY WORK
AS A TEAM, GET YOU BACK, SAVE
YOUR LIFE.
IF YOUR PROBLEM IS NOT
LIFE-THREATENING IT'S LIKE WHEN
WE HAVE A BIG SNOWSTORM IN A
CITY LIKE TORONTO AND THEY PLOW
THE MAIN ROADS AND IF YOU HAPPEN
TO LIVE ON A SIDE STREET, MAYBE
YOU'LL SEE A PLOW THREE DAYS
LATER.
THAT'S THE PROBLEM.
WE HAVE THESE LUDICROUS WAIT
LISTS WHICH ARE TOTALLY
UNNECESSARY.
WE ARE RATIONING HEALTH CARE.
IN THE STATES THEY RATION IT BY
THE SIZE OF YOUR WALLET.
HERE THEY RATION IT BY WAIT
LISTS.

Steve says YOUR SOLUTION IN THE
BOOK, YOU HAVE A TOP TEN LIST IN
THE BACK OF THE BOOK.
THE MOST CONTROVERSIAL
RECOMMENDATION YOU MAKE IS THAT
YOU THINK WE SHOULD ALLOW THE
CREATION OF A PARALLEL, PRIVATE
HEALTH CARE SYSTEM.

Stephen says YEAH.

Steve says IF WE DID THAT, WHAT
WOULD HAPPEN?

Stephen says WELL, FIRST OF ALL, PEOPLE
WILL ALWAYS SAY, WELL, WHY
SHOULD WE GIVE A SECOND TIER TO THE RICH?
THE RICH HAVE A SECOND TIER.
THEY GET ON A PLANE AND GO TO AMERICA.
THE RICH DON'T NEED IT.
THE ZOOMERS, THE BOOMERS, THE
MIDDLE CLASS, WE'RE THE ONES WHO
NEED THIS.
THERE ARE POLLS THAT SHOW
75 PERCENT OF CANADIANS ARE ON
SIDE WITH THIS.
I LAUGH ABOUT ALL THE POLITICAL
PARTIES NOT WANTING TO TOUCH THE
SO-CALLED THIRD RAIL.
FRANKLY, IF YOU DID TOUCH THE
THIRD RAIL AND EMBRACE IT, YOU'D
BE IN A LANDSLIDE IN THE NEXT
ELECTION.
THE REASON WE SHOULD DO THIS IS
IT WOULD OPEN UP SO MANY THINGS,
OPEN UP MONEY AND TIME.
ONE OF THE THINGS PEOPLE DON'T
REALIZE IS THE REASON WE HAVE
WAIT LISTS IS BECAUSE SURGEONS
ARE ONLY ALLOWED TO OPERATE ONE
DAY A WEEK.
AND SO THE OPERATING ROOM IS
EMPTY FOR THE OTHER FOUR DAYS.
THAT'S NOT BECAUSE WE DON'T HAVE
ENOUGH SURGEONS.
THAT'S BECAUSE WE DON'T HAVE THE
MONEY TO ACTUALLY RUN THE
SYSTEM, TO PAY FOR THE HYDRO,
PAY FOR THE NURSES, PAY FOR
WHATEVER IT IS THAT WOULD KEEP
IT OPEN FIVE DAYS A WEEK.

Steve says SO IF YOU ALLOWED
THOSE WITH MEANS TO PURCHASE
EXTRA CARE, IF YOU LIKE, OR
HOWEVER YOU WANT TO DESCRIBE IT,
YOU THINK THAT WOULD REDUCE THE
WAIT LIST?

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live."

Stephen says OH, ABSOLUTELY.
AND ALSO I'D ALLOW FOR MEDICAL
TOURISM FOR PEOPLE TO COME FROM
OTHER COUNTRIES TO BUY SERVICES,
FOR THAT MONEY TO GO BACK INTO
OUR PUBLIC SYSTEM.
ONE OF THE GREAT CANARDS IS THAT
MYSELF AND DR. DAY ARE PUSHING
FOR A PRIVATE SYSTEM.
GET...

Steve says DR. DAY FROM B.C.

Stephen says RIGHT.
GET RID OF THE PUBLIC SYSTEM AND
HAVE A PRIVATE SYSTEM.
WE'RE SAYING, NO, BOTH,
TOGETHER.
THAT'S THE WAY TO WORK.
REALLY, WHEN YOU THINK ABOUT IT,
TOUCHING A THIRD RAIL IS HOW THE
TRAIN OPERATES AT ITS MAXIMUM
EFFICIENCY.
WE NEED TO TOUCH THE THIRD RAIL
FOR OUR HEALTH CARE TO OPERATE
AT MAXIMUM EFFICIENCY.

Steve says HERE'S WHERE WE GO
TO THE ONTARIO HEALTH COALITION
AND WE SAY, NATALIE, WHAT DO YOU THINK?

The caption changes to "Natalie Mehra. Ontario Health Coalition."
Then, it changes again to "Single-payer Medicare, please."

Natalie says OH, I WISH I
HAD A CHANCE TO TALK ABOUT INNOVATION.
I WILL RESPOND TO THAT.
I THINK I HAVE TO.

Steve says WE'LL LET YOU
RESPOND TO THAT AND TOUCH ON THE
INNOVATION PIECE.

Natalie says UNFORTUNATELY WHAT WE'RE
TALKING ABOUT HERE IS NOT REALLY
INNOVATION TO IMPROVE THE PUBLIC
SYSTEM BUT ACTUALLY TO DISMANTLE
THE PUBLIC SYSTEM AND TO CREATE
A PRIVATE INSURANCE SYSTEM AS
WELL.
I TAKE ISSUE WITH A FEW THINGS.
ONE PREMISE THAT WE SPEND
60 BILLION DOLLARS ON HEALTH CARE IN
ONTARIO AND NOBODY REALLY KNOWS
WHAT THAT NUMBER MEANS WITHOUT
CONTEXT.
AND THE TRUTH IS THAT ONTARIO,
WE ACTUALLY SPEND AMONG THE
LEAST OF ALL THE PROVINCES.
THERE ARE SEVERAL DIFFERENT WAYS
TO MEASURE IT...

Steve says PER CAPITA, YOU MEAN?

The caption changes to "Natalie Mehra, @OntarioHealthC."

Natalie says PER CAPITA.
ON OUR HOSPITALS, WE'RE THIRD
FROM THE BOTTOM IN TERMS OF GDP,
BY EVERY MEASUREMENT WE'RE RIGHT
DOWN NEAR THE BOTTOM IN THE
COUNTRY.
NUMBER ONE, IS THERE EVIDENCE
WE'RE SPENDING TOO MUCH?
NO.
COULD WE SPEND THAT MONEY
BETTER?
BETTER?
OF COURSE.
WE HAVE THE HIGHEST EDUCATED
PROFESSIONALS, DOCTORS, NURSES,
IN THE WORLD, ACCORDING TO
INTERNATIONAL STUDIES.
AMAZING CARE.
I CAN ATTEST TO ALSO HAVING HAD
HEART PROBLEMS.
YOU KNOW, REALLY STELLAR,
STELLAR HEALTH CARE.
AND THAT MATTERS.
SO A SICKNESS SYSTEM THAT
PROVIDES FOR PEOPLE WHEN THEY'RE
SICK IS IMPORTANT, AND OUGHT NOT
TO BE TOSSED OUT IN THE NAME OF
EXPANDING CARE IN ORDER TO
PROVIDE MORE COMPREHENSIVE
PREVENTATIVE CARE.
IT'S A MISNOMER TO SAY THE
HEALTH CARE SYSTEM DOES NOT
PROVIDE HEALTH ENHANCING CARE.
A WHOLE LOT OF HOME CARE IS
PREVENTATIVE.
ALL OF LONG-TERM CARE VIRTUALLY
IS PREVENTATIVE CARE.
THE COMMUNITY HEALTH CENTRES ARE
AN INNOVATION MODEL, TEAM-BASED
APPROACH WITHIN THE PUBLIC
HEALTH CARE SYSTEM THAT PROVIDES
ALL KINDS OF PREVENTATIVE CARE
AND HEALTH SUPPORTING CARE.
THERE'S ALL KINDS OF THAT
ACTIVITY HAPPENING WITHIN THE
HEALTH CARE SYSTEM ALREADY.
SO WHEN WE HAVE THESE INNOVATORS
THAT MOVE IN AND THEY WANT TO
TAKE OVER PART OF THE MARKET
SHARE IN HEALTH CARE AND THEY
SEE IT AS A MARKET TO BREAK
INTO, OFTEN FOR PROFIT, THEY
OFTEN TRY TO CREATE A CRISIS OUT
OF THE SYSTEM, TALK IT DOWN, IN
ORDER TO RATCHET OPEN THE
ABILITY FOR THEM TO MOVE IN AND
TAKE OVER.

Steve says LET'S TAKE ONE THING
OUT OF WHAT STEPHEN SAID THERE.
HE TALKED ABOUT EMPTY OPERATING
ROOMS BECAUSE THE SYSTEM IS
MISMANAGED OR WHATEVER.
IS THAT A FACT?
ARE THERE EMPTY OPERATING ROOMS HERE?

Natalie says WE HAVE CLOSED DOWN OPERATING
ROOMS IN ALL OF THE LARGE
HOSPITALS IN ONTARIO.
AND WHAT WE WOULD SAY IS, WE
HAVE THE LOWEST HOSPITAL FUNDING
IN THE COUNTRY.
IMPROVE THE FUNDING.
OPEN UP THE OPERATING ROOMS.
AND DEAL WITH THE WAIT LIST IN
THE PUBLIC SYSTEM WITH THE
PRINCIPLE THAT ACCESS TO CARE
OUGHT TO BE BASED ON YOUR
MEDICAL NEED AND NOT HOW MUCH
MONEY YOU HAVE.
THE TRUTH IS IN B.C. WHERE
DR. DAY IS OPERATING HIS PRIVATE
HOSPITAL, PATIENTS ARE
CHARGED... THEY BILL NOT ONLY
THE PUBLIC SYSTEM BUT THEY BILL
PATIENTS ON TOP THOUSANDS OF
DOLLARS PER SURGERY FOR THEIR
MEDICAL CARE.
THAT'S ONLY AVAILABLE TO THOSE
PEOPLE WHO CAN PAY THOUSANDS OF
DOLLARS PER SURGERY.
THAT'S NOT OUT OF ALTRUISM.

Steve says DOES IT REDUCE THE
WAITING LIST?

Natalie says NO.
THEY'RE AGNOSTIC AS TO WHAT THE
LEVEL OF NEEDS ARE FOR THEIR
PATIENTS.
THE PRIVATE CLINICS... FOR
EXAMPLE, THE PRIVATE HOSPITALS
IN ONTARIO, THEY DON'T HAVE
ICUs.
SO IF YOU CODE, THEY CAN'T DEAL
WITH YOU.
THEY CAN'T DEAL WITH THE PEOPLE
WITH DIABETES AND HEAVIEST CARE
NEEDS.
THEY LEAVE THOSE TO THE PUBLIC
SYSTEM.
THEY TAKE THE EASY, PROFITABLE,
FAST PATIENTS, THEY DO THOSE,
AND THEY LEAVE THE HEAVIER CARE
FOR THE PUBLIC HEALTH CARE SYSTEM.

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

Steve says LET'S GET INTO...
ONE IDEA YOU WOULD BRING FORWARD
IN TERMS OF INNOVATION THAT YOU
THINK WOULD IMPROVE THE HEALTH
CARE SYSTEM IN ONTARIO?

Natalie says I THINK WE NEED TO LOOK AT
IMPROVING ACCESS TO CARE
FUNDAMENTALLY.
AND INNOVATIONS AROUND IMPROVING
ACCESS TO CARE.

Steve says WHAT DOES THAT MEAN?

Natalie says WELL, WE HAVE LONG WAIT
LISTS, WE HAVE A LONG WAIT LIST.
SO WE SHOULD BE LOOKING AT WAYS
IN WHICH YOU GET THE SURGICAL
WAIT LISTS OUT OF YOUR ONE
SURGEON'S DRAWER AND PATIENTS
ACTUALLY HAVE THE ABILITY TO
KNOW OPENLY, NOT ON A WEBSITE
THAT NO ONE KNOWS ABOUT BUT
WHERE THEY CAN GET CARE QUICKER
AND HAVE SOME OF THOSE CHOICES
GIVEN TO THEM OPENLY BY THEIR
FAMILY DOCTORS OR BY THEIR
REFERRING DOCTORS...

Steve says A BIT OF A REGISTRY THEN.

Natalie says A REGISTRY OF SOME SORT THAT
WOULD ACTUALLY BE MUCH MORE
AVAILABLE TO PATIENTS WITH MUCH
MORE UP FRONT INFORMATION.
BUT ALSO LET'S LOOK AT THE HUGE
NEED FOR SENIORS CARE.
LIKE, WHERE SOCIAL SERVICES MEET
HEALTH CARE.
COULD WE NOT CREATE A MODEL LIKE
IN QUEBEC WHERE WE HAVE A
MEETING OF THE SOCIAL SERVICE
NEEDS OF SENIORS AND THE HOME
CARE AND THE LONG-TERM HEALTH
CARE NEED OF SENIORS WITHIN THE
PUBLIC SYSTEM ON AN EQUITABLE
BASIS TO REALLY KEEP PEOPLE AS
HEALTHY AND INDEPENDENT AS
POSSIBLE FOR AS LONG AS
POSSIBLE?
THOSE THINGS WOULD MAKE A
TREMENDOUS DIFFERENCE FOR
MILLIONS OF PEOPLE.

Steve says LET'S GET INTO SOME
DISCUSSION HERE... YOU TWO
IRONICALLY SEE THE SAME PROBLEM.
YOU ACTUALLY SEE THE SAME
SOLUTION.
YOU JUST DISAGREE, IF I
UNDERSTAND IT, ON WHAT POCKET
THE MONEY OUGHT TO COME FROM.
YOU WANT A PUBLIC... YOU WANT A
PARALLEL PRIVATE SYSTEM WITH
PRIVATE PEOPLE PAYING INTO IT...

Natalie says WHO OWNS IT...

Steve says AND YOU WANT THE TAXPAYER TO.

Natalie says WELL, WHO OWNS IT...

Steve says HANG ON A MINUTE.
LET ME GO BACK TO HIM THEN.
WHAT'S OBJECTIONABLE ABOUT WHAT
SHE JUST SAID?

The caption changes to "The big restructuring."

Stephen says LET ME GO BACK TO THE B.C.
EXAMPLE.
THEY PAID TAXPAYER DOLLARS TO
KEEP PEOPLE ON THE WAIT LIST WHO
ALSO END UP DYING ON THE WAIT
LIST.
I THINK THAT'S DISGRACEFUL.
THIS IS WHAT OUR GOVERNMENT
DOES.
AS FAR AS SOLUTIONS GO,
INNOVATIVE SOLUTIONS, I'M ALL
FOR INNOVATION, I'M ALL ABOUT
INNOVATION.
BUT HERE'S THE PROBLEM:
GOVERNMENTS ALWAYS TRY TO SOLVE
THE POLITICAL PROBLEM.
LET ME USE THE CURRENT... I'M
GOING TO TAKE A SHOT AT DOUG
FORD, DESPITE BEING
CONSERVATIVE.
THEY ARE TRYING TO END HALLWAY
MEDICINE.
WE'RE GOING TO THROW MONEY AT
THE HOSPITALS TO OPEN MORE BEDS,
OKAY?
THAT'S NOT WHAT THE PROBLEM IS.
THE POLITICAL PROBLEM IS THAT,
AND THEY CAN COOL THINGS DOWN IN
QUESTION PERIOD IF THEY DO
THAT... BUT THE PROBLEM IS THE
SO-CALLED BED BLOCKERS, WHICH I
LIKE TO REFER TO AS HUMAN
BEINGS.
THEY DID A STUDY IN HAMILTON.
40 PERCENT OF THE BED BLOCKING
IN THE HOSPITAL WAS BEING CAUSED
BY 9 PERCENT OF THE PATIENTS.
THE REASON BEING THAT THEIR
PATIENTS HAD DEMENTIA AND THE
NURSING HOMES WERE NOT PREPARED
TO DEAL WITH THAT, OR THEY WERE
OBESE.
WHAT BLOWS OUT THE BACKS AND
KNEES, THE NUMBER ONE THING FOR
PERSONAL SUPPORT WORKERS IS THEY
DON'T HAVE THE RIGHT TOOLS TO
LIFT PEOPLE, THE RIGHT
MACHINERY.
SO WHAT HAPPENS IS, WHEN YOU
THROW MONEY AT A POLITICAL
PROBLEM, LIKE WE ALWAYS DO, AND
THIS HAS BEEN GOING ON FOR YEARS
AND YEARS AND YEARS, YOU DON'T
ACTUALLY SOLVE THE REAL PROBLEM.
THE OTHER THING SOMEBODY BROUGHT
UP EARLIER ABOUT HOW GREAT OUR
DOCTORS AND NURSES ARE, AND I
TOTALLY AGREE, BUT THEY'RE TO
BLAME TOO.
FOR THE LAST 20 YEARS THEY'VE
BEEN STICKING A FINGER IN EVERY
DIKE SO IT DIDN'T COLLAPSE.
THE POLITICIANS COULDN'T HAVE
GOT AWAY WITH ALL THIS CRAP...

Steve says NOT QUITE PART OF
THE HIPPOCRATIC OATH TO LET THE
WHOLE THING FALL APART.

Stephen says I UNDERSTAND.
THEY MADE IT WORSE BECAUSE THE
POLITICIANS BECAUSE THEY LIE ALL
THE TIME HAVE MANAGED TO... HAVE
MANAGED TO PRETEND THE SYSTEM IS OKAY.

Steve says LET'S GET...

Stephen says THE 10-POINT PLAN, NUMBER
ONE, IS STOP LYING TO US.
I CAN ACCOMPLISH ONE THING, THAT
WOULD BE THE BEST OF ALL.

Steve says KATE, DOES SOCIAL
PRESCRIBING HAVE ANYTHING TO
TELL US ABOUT HOW TO RESOLVE THE
DIFFERENCES BETWEEN THESE TWO?

Kate says IT REALLY DOES.
THE DEBATE CAN'T CENTRE ONLY ON HOSPITALS.
HOSPITALS PLAY A REALLY
IMPORTANT ROLE.
REDUCING HALLWAY MEDICINE CAN'T
JUST HAPPEN AT THE BACK DOOR,
GETTING PEOPLE WHO ARE IN THE
HOSPITAL OUT.
WE HAVE TO KEEP PEOPLE FROM
ENTERING THE HOSPITAL.
WE HAVE TO DO SOME WORK AT THE
FRONT DOOR.
THAT'S WHERE COMMUNITY HEALTH
REALLY COMES IN.
SO SOCIAL PRESCRIBING IS A WAY
TO MOVE PEOPLE FROM HOSPITAL TO
PRIMARY CARE.
PRIMARY CARE IS WHERE PEOPLE
HAVE LONG-TERM RELATIONSHIPS
WITH THE HEALTH SYSTEM
THROUGHOUT THEIR LIVES, AND
THAT'S REALLY WHERE THE
COORDINATION OF THEIR CARE HAS
TO HAPPEN, TO DO ALL THAT
PREVENTION WORK.
SOME OF THAT IS REALLY CLINICAL.
SOME OF THAT IS LESS CLINICAL
AND MORE SOCIAL.
AND A LOT OF IT IS COOPERATIVE
AND HAPPENS AT THE COMMUNITY
LEVEL.

Steve says DOES SOCIAL
PRESCRIBING HAVE A VIEW ON
WHETHER OR NOT WE CAN IMPROVE
THE HEALTH CARE SYSTEM WITH A
PRIVATE PARALLEL SYSTEM VERSUS A
SINGLE PAYER STATUS QUO THE WAY WE ARE NOW?

Kate says WE ARE INVESTED IN THE PUBLIC SAME.
IT'S IMPORTANT THAT PEOPLE WHO
ARE FACING THE BIGGEST BARRIERS
TO HEALTH AND WELL-BEING GET THE
CARE THEY NEED.
THAT DOESN'T HAPPEN UNDER
PRIVATE CARE.
IT OFTEN DOESN'T HAPPEN UNDER
CERTAIN MODELS IN OUR PUBLIC
SYSTEM THAT ARE DISINCENTIVIZED
TO CARE FOR THE MOST SOCIALLY
COMPLEX PEOPLE, PEOPLE WHO ARE
RACIALLY, PEOPLE WHO COME FROM
LGBTQ COMMUNITIES, AND SO ON.
COMMUNITY HEALTH CENTRES HAVE A
MANDATE TO BACKSTOP THE HEALTH
SYSTEM AND TO BE THERE FOR THOSE
POPULATIONS IN PARTICULAR, AND
SO THEIR NEEDS ARE BEST MET IN A
PUBLIC SYSTEM.

Steve says DR. WEBSTER, I WANT
TO ASK YOU WHETHER OR NOT YOUR
VISION FOR INCREASED ACCESS TO
BETTER TECHNOLOGY, LIKE THE PET
SCANNERS THAT YOU CARE SO MUCH
ABOUT, WHETHER THAT IS MORE
EFFECTIVELY ENHANCED IN A
PRIVATE PARALLEL SYSTEM OR CAN
WE DO IT IN THE CURRENT SINGLE
PAYER SYSTEM?

The caption changes to "Dave Webster. Laurentian University."

Dave says I THINK MOST SYSTEMS IN THE WORLD HAVE
ALWAYS HAD PARALLEL SYSTEMS.
WE'RE ONE OF THE FEW COUNTRIES
THAT DOESN'T.
I WOULD LIKE TO STEP BACK FOR A
MOMENT BECAUSE YOU SAID LOTS OF
WONDERFUL THINGS ABOUT THE
ONTARIO HEALTH CARE SYSTEM, AND
YOU'RE WRONG.

Steve says WHO ARE YOU TALKING TO?

Dave says EVERYBODY.
WE'VE BEEN TALKING ABOUT
QUALITY... YOU'RE RIGHT THAT
CANADIAN PHYSICIANS, ONTARIO
PHYSICIANS ARE SOME OF THE BEST
TRAINED IN THE WORLD.
THE PROBLEM IS YOU'RE LED TO
BELIEVE YOU LIVE IN A
(INDISCERNIBLE).
NOTHING COULD BE FURTHER FROM
THE TRUTH.
WE ARE LAST AMONGST OECD WHEN IT
COMES TO LEVELS OF CARE.
ONTARIO DOCTORS ARE FORCED TO
PRACTISE MEDICINE AS IF WE WERE
LIVING IN THE 1990s.
WHY IS THAT?
I WILL BE CONTROVERSIAL TO MY
COLLEAGUES.
THE SYSTEM IS NOT ABOUT THE
PATIENTS.
IT IS ABOUT, IN PARTICULAR, WITH
THE FORD APPROACH IS GOING TO
BE, IS ABOUT ENSURING THAT
POLITICALLY POWERFUL MEDICAL SUB
SPECIALTY GROUPS' INCOMES ARE
NOT THREATENED BY PET.

Steve says NAME NAMES.
WHAT DO YOU MEAN?

Dave says THE STATS... TWO, FOR
EXAMPLE, SEVEN RADIOLOGISTS IN
THE PROVINCE EARN MORE THAN A
MILLION DOLLARS A YEAR.
IF PET WAS INTRODUCED PROPERLY,
AND WHAT I MEAN BY PROPERLY,
SOMETHING I'VE BEEN SAYING TO
THE GOVERNMENT SINCE I WAS
PRESIDENT OF THE ONTARIO
ASSOCIATION BACK IN 2004, WE
SHOULD ONLY BE PAYING FOR
DIAGNOSTIC IMAGING TESTS IF THEY
CAN PROVEN TO ADVANCE THE
PATIENT'S MANAGEMENT RIGHT.
BUT THEY DON'T GET PAID TO READ
PET SCANS.

Steve says SAY THAT AGAIN.

Dave says THE RADIOLOGISTS...

Steve says DON'T GET PAID TO
READ PET SCANS.
THEIR INCOME WOULD TAKE A HIT.

Dave says THEY COULD EASILY LOSE
60 PERCENT.
IN THE STATES, YOU TALK ABOUT
THE UNITED STATES MODEL, THEY
ACTUALLY ARE AHEAD OF THE SYSTEM
IN SOME WAYS.
IF YOU CAME IN WITH A CHEST
X-RAY WITH A 3-CENTIMETRE
NODULE, THEY WOULDN'T LET...
THEY KNOW THE BEST WAY TO MANAGE
THAT IS WITH A PET SCAN.
IT HAS ABOUT A 40 PERCENT CHANCE
IF YOU GET CANCER, THIS NODULE,
RIGHT?
IF YOU DO THE PET SCAN AND IT
TAKES UP AN ENORMOUS AMOUNT OF
SUGAR, WE GO TO IN EXCESS OF
90 PERCENT PROBABILITY OF IT
BEING A CANCER.
OFTEN ON THE PET SCAN WE'LL FIND
EXAMPLES WHERE IT'S ACTUALLY
ALREADY SPREAD TO A LITTLE LYMPH
NODE SITTING BEHIND YOUR HEAD.
IN ORDER TO QUALIFY YOU HAVE TO
STICK A NEEDLE IN THE LUNG
NODULE.
SHE WAS IN A TERRIBLE SITUATION.
SHE WAS IN THE ICU AND SO ON.
THE BAD NEWS WAS THE BIOPSY
WASN'T EVEN CANCER POSITIVE
BECAUSE THE C, IT CAN'T TELL HER
TO PUT THE NEEDLE.
IT GOT WORSE BECAUSE IT TURNED
OUT THE PET SCAN SHOWED NOTHING
ELSE IT CAN SHOW.

Steve says THE QUESTION IS HOW
DO WE GET MORE OF THESE THINGS...

Dave says YOU HAVE POLITICALLY POWERFUL
MEDICAL GROUPS THAT DON'T WANT ACCESS.

Steve says NATALIE, I'M GOING
TO BRING YOU IN THERE.
DO YOU BELIEVE IT IS THE CASE
THAT WE HAVE, YOU KNOW, THERE'S
A DISCUSSION THAT THE LIONS LOOK
AT EACH OTHER DIFFERENTLY WHEN
THE WELL RUNS DRY.
DO WE HAVE THE SAME SITUATION IN
ONTARIO WHERE EVERYONE IS OUT
FOR THEMSELVES AND THEY'RE NOT
SEEING THE BIG PICTURE HERE?

Natalie says THERE CERTAINLY IS... THAT'S
A TOUGH QUESTION.
YOU CAN EVEN SEE IT HERE.
EVERYONE WHO IS SITTING HERE
WANTS MORE OF THE MONEY AND MORE
OF THE RESOURCES THAT ARE
AVAILABLE EITHER IN THE SYSTEM
OR BY MAKING PEOPLE DIG INTO
THEIR POCKETS AND HANDING THEM
MORE MONEY.

Steve says HE WOULD SAY
ALLOWING PEOPLE.

Natalie says RIGHT.
WELL, THEY WOULD HAVE TO AT THAT
POINT, RIGHT?
HE WANTS IT FOR HIS, YOU KNOW,
SURGICAL CENTRES.
YOU WANT IT FOR THE COMMUNITY
HEALTH CENTRES.
YOU WANT IT FOR THE PET SCANS.
SOMEONE HAS TO ACTUALLY MANAGE
HOW WE PROVIDE HEALTH CARE, THE
BEST HEALTH CARE, FOR THE MOST
PEOPLE POSITIVE GIVEN OUR
POPULATION DEMOGRAPHICS AND SO
ON, AND, YEAH, I DO THINK THAT
THERE ARE LOTS OF VESTED
INTERESTS IN THE SYSTEM THAT
PUSH VERY HARD FOR THAT MONEY TO
GO TO THEMSELVES.
I THINK THAT HAPPENS WITHOUT
QUESTION.

Steve says DAVE?

Dave says I TAKE STRONG EXCEPTION TO
THAT.
THE POINT IS WE HAVE WAY TOO
MANY PET SCANNERS... SORRY, WAY
TOO MANY CT SCANNERS AND MRs.
THEY'VE HANDLED THIS IN QUEBEC,
IF YOU'D LIKE ME TO DETAIL THAT.
THE POINT IS WE DON'T KNOW THE
CT SCANNERS AND MRs.
WE KEEP REPLACING THEM AND WE
DON'T NEED THEM.
AS I SAID, THE PATIENT WITH 30
CT SCANS, THEY ONLY NEEDED THREE
PET SCANS.

Steve says WE SHOULD BE GOING
TO THE NEXT...

Dave says THE POINT IS WE DON'T NEED
THE CTs.
WE COULD DO IT WITH A LOT LESS.
BY THE WAY I'VE INTRODUCED THIS
TO EVERYBODY INCLUDING DOUG
FORD.
THE WAY PET IS DONE IN THE U.S.
IS NOW MORE THAN 50 PERCENT
ACTUALLY COMES FROM A MOBILE PET
CT.
THE POINT IS IN SUDBURY, I'VE
BEEN TRYING TO GET THIS FOR THE
PAST SEVEN YEARS.
I HAVE THE FIRST MOBILE PET IN
CANADA.
THE ONLY COST TO THE HOSPITAL TO
HAVE THAT THING PHYSICALLY THERE
NEXT YEAR IS A 220-VOLT LINE TO
PLUG IT INTO.
HOSKINS WAS ON THE RADIO...

Steve says THE FORMER HEALTH MINISTER.

Dave says THE POINT IS THAT I'VE MADE
IT VERY CLEAR, WE ACTUALLY COULD
HAVE A MUCH CHEAPER HEALTH CARE
SYSTEM WITH A LOT LESS
DIAGNOSTIC IMAGES TESTS.
YOU HAVE TO UNDERSTAND THAT WHEN
YOU'RE SCREENING KIDS FOR
RADIATION EXPOSURE, THEY
WOULDN'T BE DONE.

Steve says KATE IS TRYING TO
GET IN HERE.

Kate says I WANTED TO
SPEAK TO THAT IDEA THAT
EVERYBODY IS OUT FOR THEMSELVES
UNDER THIS SYSTEM AND THAT THERE
ARE SOME POWERFUL INTERESTS.
I WANT TO GIVE A POWERFUL
INNOVATION THAT IS UNDERGOING
RIGHT NOW THAT INCLUDES SOCIAL
PRESCRIBING BUT IS A LITTLE
BROADER.
RIGHT NOW WE'RE WORKING WITH
MANY PARTNERS ACROSS THE HEALTH
CARE SYSTEM TO LINK THOSE WITH A
SOLO PHYSICIAN WITH THE
TEAM-BASED CARE THEY NEED.
WE KNOW PEOPLE NEED A BROAD
RANGE OF DIFFERENT TYPES OF
SUPPORTS EITHER WITHIN THE
COMMUNITY OR HEALTH CARE SYSTEM
OR TO SPECIALISTS BUT
INDIVIDUALLY PRACTISING
PHYSICIANS JUST CAN'T HANDLE
THAT LOAD ALONE, PARTICULARLY
FOR THEIR CLIENTS WHO ARE
MEDICALLY OR SOCIALLY COMPLEX.
WE'RE LINKING THOSE SOLO
PRACTITIONERS WITH TEAMS THAT
AREN'T JUST COMMUNITY HEALTH
CENTRES BUT MENTAL HEALTH
AGENCIES, SOCIAL SUPPORT
AGENCIES AND SO ON WITHOUT
HAVING TO CHANGE GOVERNANCE,
JUST BY WORKING TOGETHER,
WITHOUT HAVING TO CHANGE BILLING
CODES.
DOCTORS WANT TO PARTICIPATE
BECAUSE IT FREES UP THEIR TIME
TO WORK ON OTHER CASES THAT ARE
MORE RELEVANT TO WHAT THEY'RE
DOING AND THEY GET... EXCUSE ME.
THEY GET THE SUPPORT THEY NEED
TO DO THAT OTHER WORK.

Steve says STEPHEN, LET ME ASK
YOU ABOUT... WE HAD CHRISTINE
ELLIOTT, THE HEALTH MINISTER, ON
THE PROGRAM LAST WEEK, TALKING
ABOUT THE SIGNIFICANT
RESTRUCTURING THAT SHE HAS
UNVEILED.
DO YOU THINK THAT'S A STEP IN
THE RIGHT DIRECTION?

Stephen says IT'S A
STEP IN THE RIGHT DIRECTION BUT
IT DIDN'T GO FAR ENOUGH.
I'M EXTREMELY DISAPPOINTED.
ONCE AGAIN IT'S REARRANGING THE
DECK CHAIRS ON THE TITANIC.
IT'S FUNNY, THEY EVEN USED THE
SAME LANGUAGE THAT THE LIBERALS
DID FOR 15 YEARS, THE
TRANSFORMATION, TRANSFORMATION
AGENDA WAS THE LIBERALS AND
THEY'RE TALKING ABOUT WE'RE
GOING TO TRANSFORM... YOU'RE NOT
GOING TO TRANSFORM ANYTHING.
WHAT YOU'RE DOING IS YOU'RE
BRINGING A BUNCH OF DECK CHAIRS
INTO ONE SUPER AGENCY, WHICH IS
FINE.
BUT YOU'VE GOT TO FIRE PEOPLE.
YOU'VE GOT TO REALLOCATE
RESOURCES.
SIMPLY TAKING THE 14 LHINS FULL
OF LIBERAL HACKS AND OTHER
PEOPLE THAT GOT APPOINTED AND
NOT FRONT LINE CARE PEOPLE AND
PUTTING THEM INTO ONE SUPER
AGENCY AND ALLOWING THEM TO
CONTINUE DOING THEIR THING BUT
IN A DIFFERENT BUILDING, QUOTE,
UNQUOTE, VIRTUAL BUILDING,
THAT'S LUDICROUS.

Steve says I'M NOT SURE THAT'S
GOING TO HAPPEN.

Stephen says THAT SEEMS TO BE WHAT I'M READING.

Steve says THE MINISTER DIDN'T
WANT TO SAY BUT THE REALITY IS
THERE ARE SOME BUREAUCRATS THAT
ARE GOING TO LOSE THEIR JOBS...

Stephen says THERE HAVE TO BE A LOT.
LET ME SCARE THE HELL OUT OF
MILLENNIALS WHO DON'T THINK THEY
HAVE TO WORRY ABOUT THIS STUFF.
AN ACCOUNTING PROBLEM, THAT'S
WHY WE NEED TO BE WORKING ON
THAT PROBLEM NOT JUST
REARRANGING THE DECK CHAIRS.
MY GENERATION, THE BOOMERS, WILL
RECEIVE... AND THIS WAS A STUDY
I TALK ABOUT IN THE BOOK... WILL
RECEIVE 4,000 MORE HEALTH CARE
IN THEIR LIFE THAN WE PAY FOR IN
TAXES BECAUSE AGAIN YOU'RE
ALWAYS PAYING FOR THE GENERATION
AHEAD OF YOU.
THE MILLENNIALS WILL PAY 18,000
MORE IN TAXES THAN HEALTH CARE
RECEIVED, AND THE IGENS WILL PAY
27,000 MORE IN TAXES THAN
HEALTH CARE RECEIVED.
THAT IS A HUGE PROBLEM.
THERE'S TOO MANY OF US, WE'RE
TOO EXPENSIVE, WE'RE NOT DYING
QUICKLY ENOUGH, THERE'S NOT
ENOUGH OF THEM.
THEY OFTEN DON'T HAVE FULL-TIME
JOBS OR THEY'RE IN HUGE DEBT,
GRADUATING UNIVERSITY.
THERE'S A VARIETY OF ISSUES.
UNTIL WE GET REAL AND HAVE WHAT
I CALL THAT ADULT CONVERSATION,
WHICH IS WHY WHEN THE BOOK CAME
OUT I WAS HOPING THAT THIS YEAR
AND THIS RAMP-UP TO THE FEDERAL
ELECTION WE'D FINALLY HAVE THAT
ADULT CONVERSATION AND MAKE
HEALTH CARE THE NUMBER ONE ISSUE
OF THIS ELECTION BECAUSE
POLITICIANS WILL ALWAYS SAY,
WELL, I'M FOR THE CANADA HEALTH
ACT, I'M AGAINST TWO-TIERED
HEALTH CARE, AND THAT'S GREAT.
BUT HERE'S THE PROBLEM: IF YOU
ARE FOR THE CANADA HEALTH ACT
AND THE STATUS QUO AND THE
CANADA HEALTH ACT AND ALL THAT
SORT OF STUFF AND YOU'RE GOING
TO PUSH FOR THAT, YOU'RE GOING
TO END UP WITH THE THING YOU'RE
AFRAID OF WHICH IS A U.S.-STYLE
TWO-TIERED HEALTH CARE SYSTEM.
BY 2030 MUCH OF THE BUDGET WILL
BE SPENT ON HEALTH CARE.
DALTON McGUINTY HAD THE GREAT
LINE, THERE WILL COME A TIME
WHERE THE ONLY MINISTRY WE'LL BE
ABLE TO AFFORD IS THE MINISTRY
OF HEALTH AND WE WON'T BE ABLE
TO AFFORD THE MINISTRY OF
HEALTH.
UNLESS YOU'RE WILLING TO
PRIVATIZE EVERY SCHOOL AND HAVE
NO MONEY FOR INFRASTRUCTURE
BECAUSE IT'S ALL GOING TO HEALTH
CARE BY 2030, THAT'S WHAT YOU'RE
DOING BY TELLING PEOPLE THE
SYSTEM IS SUSTAINABLE.
IT SIMPLY ISN'T.

Steve says I'M DOWN TO MY LAST
MINUTE.
NATALIE?

Natalie says THEY WANT TO
CREATE A CRISIS AND PRIVATIZE.
THAT'S THE LANGUAGE HERE.
AND THE TRUTH IS THAT HEALTH
CARE REALLY IS ABOUT PEOPLE, AND
WHAT WE HEAR FROM ARE THOUSANDS
OF... LITERALLY THOUSANDS OF
SENIORS WHO ARE BEING PUSHED OUT
OF HOSPITAL WITH NOWHERE TO GO,
WITHOUT PROPER LONG-TERM CARE.
PEOPLE WHO ARE LYING ON
STRETCHERS IN HALLWAYS, YES, FOR
WEEKS SOMETIMES WAITING FOR
CARE.
COMMUNITIES WHERE THEY SEE THEIR
LOCAL HOSPITAL UNDER THREAT OF
CLOSURE.
WE ACTUALLY DO NEED MORE
RESOURCES.
WE ARE FAR BELOW THE AVERAGE OF
THE REST OF THE COUNTRY.
THERE IS ROOM FOR THAT TO
IMPROVE ACCESS.
AND ANY INNOVATIONS THAT WE
ACTUALLY BRING INTO THE SYSTEM,
WE SHOULD GUARD VERY CAREFULLY
THAT THEY'RE IN THE PUBLIC
INTEREST, THAT THEY CERTAIN
PATIENTS AND NOT PRIVATE
INTERESTS.

David says I HAD A SIMPLE SOLUTION I
PROPOSED LONG AGO.
THE AMERICAN INSURANCE SYSTEM
ACTUALLY WORKS PROPERLY IN SOME
WAYS.
WE SHOULD ONLY BE ALLOWED TO LET
DOCTORS ORDER TESTS THAT THERE'S
A REASON TO ORDER IT.
RIGHT NOW FOR EXAMPLE IN
RADIOLOGY REPORTS IT'S NOT
UNCOMMON FOR 70 PERCENT OF THOSE
REPORTS TO RECOMMEND YET ANOTHER
RADIOLOGICAL INVESTIGATION.
QUEBEC HAS HANDLED THIS.
THE POINT IS THAT THERE'S WAY,
WAY, WAY TOO MANY DIAGNOSTIC
TESTS DONE BECAUSE PEOPLE GET
PAID TO READ THEM, AND AS I
SAID, 70 PERCENT OF THE TIME
THEY RECOMMEND ANOTHER TEST.

The caption changes to "Producer: Mark Brosens, @MarkBrosens; Producer: Steve Paikin, @spaikin."

Steve says DR. DAVE, WE NEED
ANOTHER SHOW.
WE BARELY SCRATCHED THE SURFACE
AND WE'VE GONE ON FOR MORE THAN
A HALF AN HOUR.
THANKS EVERYBODY FOR COMING IN
FROM NEAR AND FAR TO JOIN US
TONIGHT ON TVO.
WE'RE GRATEFUL YOU SHARED YOUR
VIEWS WITH US TONIGHT.
THANK YOU SO MUCH.

Watch: Better Health Care through Innovation