Although two of the candidates to lead the BC Liberal Party were recently ministers of health and another practiced medicine for 32 years, talk about radically reforming the system for delivering medical care in the province is so far being left to outsider Ed Mayne.
Asked for his best suggestion to improve the public health care system, the former Parksville mayor and Tim Horton's donut store chain executive said he would "blow it up."
Considering the health services ministry spends roughly 44 cents of every dollar that passes through the provincial government, managing the system will be a large part of the new premier's job. While it's unlikely others will advocate blowing the system up, none have said much about what they would do.
The Liberals' most recent health minister was Kevin Falcon. His leadership campaign has focussed more on the economy and transportation than it has on health, though he has dedicated a page of his website to the topic.
On it he describes his own family's experience with the health care system and stresses that he understands the need for a strong, sustainable public system.
He suggests better health promotion and disease prevention as ways to keep people out of hospitals, and says, "I believe the key is to be more creative and more innovative on how we get as much patient care as possible out of those billions of dollars."
The website doesn't offer examples of how he would do that, and Falcon didn't respond to several requests for an interview.
Falcon talked reform
As health minister, Falcon made sometimes controversial forays into reforming the system. There was a plan -- made public thanks to Saskatechewan's premier -- to promote "surgical tourism" and bring patients from across Canada and from outside the country to B.C. for surgery.
He also earmarked a small portion of the health care budget for patient-focussed funding so that hospitals or other providers would be encouraged to compete against each other for patients. Critics said Falcon's change would likely increase costs.
Falcon also hiked the amount 20,000 seniors living in residential care would have to pay.
Moira Stilwell's biography on her leadership website highlights her three decades as a doctor, her work at B.C. Women's Hospital in Vancouver and her desire to create "positive change."
Her campaign announcements since she entered the race in November, however, have been about student loan interest rates, infrastructure funding for post-secondary institutions and raising the minimum wage. While there were indications she would unveil a health care platform Jan. 25, she did not respond to requests for an interview.
'Hell on wheels': Abbott
George Abbott, who was health minister before Falcon, acknowledged the size of the issue in a recent appearance at the Truck Loggers Association conference in Victoria.
As baby boomers pass their 65th birthdays, it will make a big difference by both reducing the number of taxpayers and increasing the demand on services, he said. A decade ago, eight per cent of the provincial population was over 65 years old. Today it's 15 per cent and in another decade it will be over 25 per cent.
"That's going to have a dramatic impact on our ability to deliver health and education services and other important services of government," Abbott told the conference. "I used to tongue-in-cheek say as the health minister, 'I'm glad I got to do this job when the job was easy.' It is going to be hell on wheels for a health minister 10, 15, 20 years from now with the demand and the cost of the system."
The province's changing demographics are the greatest challenge to the health care system, Abbott said in an interview. "There will undoubtedly be much pressure on the health care system," he said. It will need additional resources put into it as well as finding ways to do things better, he said.
In particular, he advocated expanding primary care, where health care professionals work as part of teams and family doctors are no longer necessarily the gatekeepers into the system. "It is a way of moving away from what has been the dominant paradigm in health care," Abbott said.
Focussing on primary care has had good results in the Northern Health Authority, where the large distances between population centres have necessitated doing things differently, he said.
Abbott said health care questions have come up occasionally but have not been dominant on the campaign trail, where he's been to more than 100 meetings in 50 communities.
'Blow it up': Mayne
Asked for his best idea to improve the health care system, Parksville mayor Ed Mayne said he would "blow it up and start all over again."
When medicare started in the 1960s, all it paid for was doctors and hospitals, and in those days hospital stays were rare, said Mayne. "If we still had just that parameter, medicare would be very, very sustainable," he said. "But medicare has grown in multitudes over that period of time."
People tend to blame the "damn" unions, doctors and management, he said. "Medicine is death by a thousand cuts. It's all of those things. They all need to be looked at... Do we need six different health authorities with all the management staff that they have?"
Mayne said that he is taking lipitor, a prescription drug used for lowering blood cholesterol. Every two or three months when it is time to renew the prescription, his doctor asks him to come in for a visit, which costs the system, he said. "You do that every day, 100 doctors, how much does that add up to?"
Fixing how health care is delivered is too much of a political hot potato for the politicians to deal with, and the civil servants have too much vested in their current empires, he said. The government needs someone to come in from the outside with a fresh perspective who can make the hard decisions, he said.
A job for a business exec
Mayne said someone like his friend Paul House, the executive chairman at Tim Horton's could do the job. "He's the fellow who took Tim Horton's from where it was to where it is," said Mayne, who was a Tim Horton's vice president in Ontario before moving west.
Mayne said he offered House a dollar a year to come reinvent B.C.'s health care system. "That's really what you need to have. It was tongue-in-cheek to him, but you need to have a person who has that ability and that integrity and that honesty to say, 'This is what it's going to take to change it.'"
A stripped-down system would cover doctors, nurses and hospitals, but nothing else, he said. Things like residential care for seniors, addictions counselling and prescription drugs would all fall outside the system, he said.
"I'm not saying you don't pay for it, you just have a true accounting of what is what," he said. "I'm not saying they're wrong, but they're over and above. That's another budget."
The BC Liberals will pick a new leader on Feb. 26 to replace Premier Gordon Campbell, who in 2006 launched a Conversation on Health with the public that resulted in no obvious changes to the system.
Former attorney general Mike de Jong and former cabinet minister and on-leave radio talk show host Christy Clark are also seeking the job. Neither responded to The Tyee's requests for interviews.
"We haven't heard any significant statements from the Liberal candidates," said Lew MacDonald, co-ordinator of the B.C. Health Coalition. The BCHC will release an open letter later this week that it is sending to the candidates in both Liberal and NDP races, he said. The letter asks them to commit to blocking the proliferation of for-profit private clinics, investing in home and community care and stopping the charging of hospital user fees.