Dosanjh, Ujjal (Interview)
UJJAL DOSANJH was standing in front of a restaurant just off Parliament Hill on the morning of July 19 when Paul Martin called him on his cellphone to offer him a job in cabinet. Making small talk, the Prime Minister began by asking his new star British Columbia MP what he was doing. When Dosanjh said he was about to buy breakfast, Martin joked, "You go tell them that if they don't give you good food you can have them condemned by the Health Department." Dosanjh's reaction: "Oh, my God, it's Health."
No wonder the former NDP premier of British Columbia, who jumped to the Liberals just before the spring election, was daunted by the prospect. Martin had made health his big policy push in the campaign. He promised historic change - even though the provinces are not eager to play ball. His health minister would have one of the most closely watched jobs in Ottawa. But Dosanjh, 56, is a tough politician. As B.C. premier in 2000, he broke with other premiers to defend national health standards - no doubt one reason Martin wanted him for the job. Dosanjh spoke with Maclean's about the task at hand:
What sort of deal with the provinces would satisfy your push for reform?
It's very clearly outlined in our platform. Wait times, home care, accountability - I believe those are three elements. And of course pharmacare, with respect to catastrophic drug costs. However, to argue that we should take over pharmacare, as [the provinces] have suggested, would be about a $12-billion-a-year venture. That's $60 billion over five years. If we do that we will not be able to do any of the reforms. Then we are into a real danger zone for the survival of our health care system.
Shortening waiting times is your government's stated top priority. But does anybody really know how to do it?
I've read comments from Ontario Premier Dalton McGuinty, saying he doesn't have the data on wait times to say how bad or good they are. I think that's true. That's why in fact we're looking for accountability, we're looking for information that's available on a comparable basis across the country in all of the jurisdictions.
How serious is the threat to public health care as costs increase?
If you look at the percentage of gross domestic product that we spend on health care, Canada is somewhere in the middle. If we're able to create efficiencies, make sure that we're accountable, have home care instead of hospital beds occupied by people who could be at home, we would save money at the end of the day. Public health care is sustainable - public health care is not expensive.
Where do you stand on for-profit services, particularly MRI clinics?
I'm not an ideologue on these things. There are private MRI clinics - I'm not running out to shut them down. There are two things I'm worried about: user fees and jumping queues. Covered services should not have fees attached to them. It's our obligation to make sure that's not done. And it's our obligation to see that people with fat wallets are not able to jump the queue by getting some procedures done in private facilities, and then being able to jump the queue for rehab and other things. If we expand public health care the need for private services might disappear.
In 1985, an extremist attacked you with an iron bar after you spoke out against militant Sikhs in Vancouver. What was your own hospital experience like?
They looked after my head very quickly, because that was the most important part - I had 84 stitches in two layers. Then they had to operate on my hand to rejoin my fingers. I waited 48 hours before they could get the operating space. It took an hour to do it, but I had to wait that 48 hours. And it's gotten worse now.
Examining health care, by the numbers
How much does health cost Canada?
$121 billion in 2003.
How fast is that cost growing?
Conference Board of Canada forecast to 2020: 2.6% a year after inflation.
How does Canada compare internationally?
Average OECD health spending in 2001: 8.4% of GDP; Canada: 9.7%; U.S.: 13.9%.
Why does the system seem underfunded?
We're still playing catch-up from the federal deficit fight: health funding from 1992 to 1996 would have had to grow 17% to keep up with inflation and population. Instead, per capita, health funding fell slightly.
How much more should Ottawa give the provinces?
To close the funding gap identified in the Roy Romanow report, about $3 billion more a year (the 2004-2005 cash transfers to provinces and territories were $35.5 billion).
What else might cost big money?
The Canadian Medical Association has called for a $1-billion federal fund to train more doctors. Liberals promised $4 billion to cut waiting times and $2 billion for home care, along with a catastrophic drug plan, and primary care reform.
See also HEALTH POLICY.
Maclean's September 6, 2004