As attentive listeners will know, there has been a persistent murmur in the background of national life in Canada for some time now as people across the country have carried on a thousand separate conversations about the future of healthcare.

Now, that rumbling noise is building steadily into the unmistakable sound of a full public debate about how to make our health system more sustainable.

Spurred by projections of an aging citizenry that will see seniors outnumber children by 2021, demand is growing by the day for ideas about ways to keep costs under control while increasing quality of care.

This debate is timely, necessary, and will likely in time come to define the next decade.

The demographic pressures are undeniable. Population forecasts show that we will grow to a nation of 39 million by 2031, with a sharp increase in the number of people living with chronic disease predicted.

The challenge is to find ways to absorb these pressures while maintaining a healthcare system that is a source of enormous national pride and international envy.

Despite the heckling from the cheap seats, the pride Canadians take in their healthcare system is well founded. The Canadian system has a proven track record of providing good care at reasonable cost.

Compared to Americans, Canadians tend to lead longer, healthier lives on average. A 19-year-old in Canada could expect to enjoy 2.7 more years of perfect health than a 19-year-old in the U.S.¹ A US study of the gap between the two countries pointed to universal health care as a critical factor in the higher quality of life in Canada. Importantly, this top-flight performance is coming at reasonable cost. When compared to other industrial countries, Canada’s total health care expenditure as a percentage of its Gross Domestic Product (GDP) measures up favourably.

Indeed, Canada’s public healthcare spending is at par or significantly less than most industrial countries. Healthcare spending in this country in 2007 in US$ per capita was less than that of the US, France, Germany, Austria, Denmark, Ireland and Norway.

Impervious to the rantings of free-market fundamentalists, a steady stream of data has relentlessly shown there is no more efficient or effective health system than the public health system.

The failings of the private model are most glaring when Canada is compared to its closest neighbour. US per capita spending on healthcare is almost 1.5 times that of Canada. Yet Canadians score higher on health and quality of life. Meanwhile, an American is forced to file for bankruptcy every 30 seconds following a serious health problem.³

After a tortuous century of debate in the US, Americans have finally accepted their experiment with private medical care has been a failure, and embraced change.

As Canadians, the evidence leaves us with no choice but to apply ourselves to improving on what we have to get the most value for patients out of every healthcare dollar.

How? A starting point would be the creation of a national program to purchase drugs in bulk, allowing provincial governments to negotiate lower prices and get a better deal for Canadians.

As our population ages, we should also make more use of home care to deliver improved healthcare performance while constraining expenditure growth in the costly acute and long-term care sectors. Home care allows people to remain independent for longer. A survey conducted in Ontario found that homecare is the preferred option for 88% of Ontarians. Seniors with chronic conditions and physical disabilities are at imminent risk of institutionalization. Providing supportive care enables them to remain in their homes, maintaining their independence while saving the system the high cost of emergency rooms or acute care beds.

Informal caregivers such as families and friends also make an enormous contribution to the sustainability of our health system through caring for their elders. A targeted benefit for family caregivers so they can continue juggling earning at work and caring at home would be a fiscally shrewd investment.

But we must remember that while many point to aging as the main cause of an increase in chronic disease, that’s not the whole story. It is also a function of our changing lifestyles (OECD, 2009). In 2006, only a quarter of Canadian 15-year-olds had daily physical exercise, and 15 per cent of Canadians were obese in 2007. Unhealthy choices may lead to chronic illnesses – like diabetes, cardiovascular disease and some types of cancer – that are the main cause of extra demands on our health system.

In addition to pulling on leotards and buying workout DVDs, one way to rein in chronic disease costs is to improve the overall well being of Canadians. Studies have linked higher obesity and related chronic diseases to poverty levels. Indeed, Canada’s high scores in healthcare indicators compared to the US correlate with substantial differences in access to care as well as substantial differences in social and economic inequality.⁴ Canada has done better because the gap between the haves and have-nots has been smaller. The widening of that gap is worsening health and should be halted and reversed as part of a holistic and proactive approach to reducing chronic diseases.

Finally, we should remember that while baby boomers were raised to believe they were the centre of the universe, their era will pass. The spike in our aging population will peak in 2031 and then fall. In 20 years, demographic trends will start to reverse as our falling birth rate catches up with us.

In the meantime, we must not become distracted by the din from the chattering classes or allow ourselves to be stampeded by shrill voices in the crowd into dismantling what we have or repeating failed experiments.

Canada has one of the best healthcare systems in the world. Let’s pass it on to the next generation in stronger and healthier shape than we found it.

¹http://www.cbc.ca/health/story/2010/04/28/health-life-expectancy-canada-us.html
²Commission on the Future of Health Care in Canada, 2002, Final Report: Building on Values: The Future of Health Care in Canada
³National Coalition on Health Care, 2008
⁴David H Feeny, Mark S. Kaplan, Nathalie Huguet and Bentson H McFarland, 2010, Comparing population health in the United States and Canada, Population Health Metrics 2010, 8:8, Published: 29 April 2010, (retrieved from http://www.pophealthmetrics.com/content/8/1/8 on April 29, 2010)