Chronic Condition: Why Canada's Health Care System Needs To Be Dragged Into The 21c

by Jeffrey Simpson

Medicare is the third rail of Canadian politics. Touch it and you die. Every politician knows this truism, which is why no one wants to debate it. Privately, many of them understand that the health care system, which costs about $200 billion a year in public and private money, cannot continue as it is�increasingly ill-adapted to an aging population with public costs growing faster than government revenues.

In Chronic Condition, Jeffrey Simpson meets health care head on and explores the only four options we have to end this growing crisis: cuts in spending, tax increases, privatization, and reaping savings through increased efficiency. He examines the tenets of the Medicare system that Canadians cling to so passionately. Here, he finds that many other countries have more extensive public health systems, and Canadian health care produces only average value for money. In fact, our rigid system for some health care needs and a costly system for other needs�drugs, dentistry, and home care�is really the worst of both worlds. Chronic Condition breaks the silence about the huge changes and real choices that Canadians face.

Genres: Politics, Nonfiction, Canada, Medicine, Health, History, Health Care

418 pages, Kindle Edition

First published January 1, 2012

Reviews

[Patti · Rating 4 out of 5]

Good history lesson but shows the challenges in trying to make even small changes to a huge monster

[Kraven Moorhead · Rating 4 out of 5]

A good attempt, but could be better written.

This is a difficult subject to write about and Jeffrey does a good job of doing so. The book overviews the Canadian healthcare system, it's past, present, and suggestions for the future.

These suggestions generally make sense, expanding the role of the private sector without jeopardizing the public sector (pareto efficiency), creating a national drug plan (which is on the way), and expanding capacity outside of hospitals (the most costly area) to ensure patients are diverted into primary care/home care/the more relevant institution to ensure they are receiving the correct care at a lower cost.

My main gripe here is that the book is difficult to read. It's not engaging. It's buried underneath statistics, political commentary, and shout-outs to his partners in the healthcare system. More visualizations could help bring stats to life, and diagrams to more clearly show the complexities of the healthcare system. I think this could have been more engaging because it is an interesting topic. A new post-COVID edition should be written.

[Nathan · Rating 2 out of 5]

This book certainly contains some valuable truths about the state of the Canadian healthcare system, forcing the reader to confront some difficult questions.

Unfortunately, the truths are buried in pages and pages of statistics that simply restate other statistics that are a variant on other statistics. This book is approximately 100 pages too long, with a great deal of useless extra info jammed into the book.

After all of the extraneous content, the author only spends about 40 pages discussing solutions. Disappointing at best.

[Barry Jarvis · Rating 4 out of 5]

A bit dated statistics wise but a reasonable assessment.

[Sophie Laperrirere · Rating 4 out of 5]

A must read for all Canadians! Will undoubtedly change your perception of the Canadian health care system

[Michelle Vaughan · Rating 2 out of 5]

better that the last text book but still incredibly repetitive

[Scott · Rating 3 out of 5]

Great summary of the many health care problems in Canada

[Emily · Rating 5 out of 5]

I read this for an undergrad course and I still think about it 10 years later.

[N · Rating 2 out of 5]

Seriously disappointing. For someone who spends a lot time and effort complaining that health care system reform is hampered by politicians, providers and a public with no vision Simpson shows a real lack of it. In his world the system starts and pretty much stops at the hospital doors. His 'solutions' are simplistic, poorly thought out and limited in scope. He spends a lot of time talking about private options for joint replacement surgery; like politicians he focuses on high profile surgery. Nary a word about the 4 most common chronic conditions; Type II diabetes, COPD, CHF, hypertension, the conditions that almost half the population has by age 55, and most have two of by 70. Building shiny, private, non-union surgical facilities won't solve the problem of managing the burdens of those illnesses. Kind of an ironic failing given the title of his book. He virtually ignores chrnmic conditions and options for treating them more efficiently and effectively in Primary Health Care settings. Doing that would free up resources in his precious hospitals, the 'jewels' in our system. You can almost see his eyes getting moist when he writes that. And it's hard to believe no one told him 'bed blocker' is a pejorative term.

Like the politicians and supreme court justices he belittles (he calls them 'gifted' a true act of chutzpa) Simpson sees only short term solutions and seeks quick payoffs. Unfortunately peoples health and health care don't work that way. A better title for this book would have been 'These things have really ticked me off for years, and here's why. I don't care if fixing them my way makes sense or not'.

[Marisa · Rating 3 out of 5]

An informative read, this book will no doubt have it's avid supporters and others who feel passionately that it's on the wrong track.

The first half of the book, which outlines the birth of Medicare in Canada, was the most interesting. Born in the midst of the great Depression, health care as envisioned by the pioneers of Medicare was initially a two-tiered system - the rich paid while the poor had their costs covered. Rather ironic considering all the controversy today around private vs publicly finded models of care.

There is no doubt it is absolutely time for Canadians to have a serious talk and take real action to address a health care system that is not delivering the quality it should be given the vast amounts of government money funnelled into it. As Simpson puts it: we're paying for a Cadillac and getting a Chevrolet. The biggest challenge, says Simpson, is that many view our health care system as "iconic" and key to our self-identity - making real change difficult. He argues it is time to get beyond that, or taxpayer funding for health programs is going to crowd out financial support in other important areas, such as education.

Simpson puts his finger on some of the key problem areas - too much emphasis on hospital care rather than community/home are, and the ridiculously high cost of drugs. That said, this is in no way a research-oriented, evidence-based examination. It's one man's view - based on decades of public policy analysis - designed to stimulate discussion and get people thinking. And in this, the book succeeds quite well.

[Kathleen McRae · Rating 3 out of 5]

There information in this book that I agree with and heartily endorse but there were some parts of the book ton which Mr Simpson missed the boat completely.I agree that our health care system is in decline because of greed,lack of centralization and overwhelmingly top heavy.one chapter was devoted to the failure of doctors and nurses in the system.Poor research or research with only one group [the Doctors] leaves you with one point of reference...The Doctors. Not did I agree that nurse practitioners could not really fit into the system at this time.I believe that a team approach in clinics where different specialists perform different functions could be very effective and this is how the countries that are succeeding are accomplishing it.We are far from proactive in Canada as we are a topdown system that is capitalist and remotely removed from an outcome based system.It is a system that can be fixed I believe but i am not sure we can change things to save universal health coverage and If Jeffrey Simpson writes a book on the subject and has a chapter on Doctors and Nurses problematic role but that chapter contains 98% info on doctors and 2% on Nurses....well

[H Wesselius · Rating 2 out of 5]

A difficult read not because of its complexity but simply because its boring and repetitive.

To give him credit, Simpson does a good job of relating the origin of medicare in Canada. However, he becomes very repetitive in discussing the "touchstone" nature of the Canada Health Act and how we need to become more flexible. He is very critical of the amount money spent yet when discussing spending and savings he refuses to acknowledge the American experience saying Canadians are far too focused on the US health care as opposed to other nations. However, the American behemoth next door is extremely relevant to the salary and drug cost in Canada, two of the most expensive elements of the system.

I'm also a bit cynical of claims of crisis and the need for change as such rhetoric has periodically appeared in the Canadian discourse since medicare first appeared. It seems its in constant crisis yet manages to deliver health care results as good if not better than most industrial nations.

[Anne Patrick · Rating 3 out of 5]

Canadians feel strongly about our healthcare system; yet many of us seem unwilling to face the reality that our healthcare costs are increasing at an unsustainable rate. Geoffrey Simpson provides a useful history of how our system developed and takes a tough look at some of the problems and challenges confronting us. I admire the strong case he makes for the potential improvement offered by publicly-funded services being provided by private health care deliverers. He argues that this possibility does not violate the spirit of the Canada Health Act and that it would introduce much-need competition into a system far too controlled by public service unions.

The downside of the book is that Simpson takes far too long to make his point and tends to repeat his argument too many times. The value of the book as a starting point for a much-needed debate on healthcare is, unfortunately, diminished as a result.

[Bruce Dayman · Rating 4 out of 5]

This book was helpful because it gave an informed critique of all aspects of Canada's medical system. For instance, universal healthcare really isn't universal. It mainly focuses on doctor's salaries and hospital administration. That's where most of the money goes. Other areas such as pharmaceuticals, dentistry, and optometry, to name some, are not covered.

Canada's healthcare system is not the best in the world. The author calls it a Chevrolet system with Cadillac prices. Wait times are not solved by throwing more money into the system because it's gobbled up by doctor's salaries and hospital administration. OECD comparisons show that systems in Sweden, Great Britain, Germany and France, not to mention Australia have better systems.

[Jennifer · Rating 3 out of 5]

This was required reading for my job and although I treated it as a book to be skimmed, I did find myself stopping and rereading some passages that really struck the chord of my experience with the health care system.

The thesis is easy, our health care system is old and it needs to modernize to meet the needs of a changing world. What is so much more difficult, is what that looks like for public policy makers. Some easy wins - doctors and nurses earn less; more focus on services delivered outside hospitals; save hospitals for only the most serious cases; team based, interdisciplinary care; diversify the delivery system to include private providers, that are publicly paid; link hospital funding to patient's treated.

[Vincent Lavallee · Rating 3 out of 5]

I found this book a little slow to get started. I realize the importance of the history of the Canadian health care system for context. But the back and forth debates for the first 150 pages was too much. After that it got into the details of the limitations and improvements that could be made which was much more interesting to me. As a whole I would recommend but may suggest skipping the first 150 if history of healthcare isn't your thing.

[Cynthia · Rating 4 out of 5]

I'm already dreading getting to the end of book 5 and having to wait :)

[Heather · Rating 4 out of 5]

Excellent overview of our healthcare system and why we need to take our heads out of the sand.

[Danielle]

A good overview, but depressing

[Linda · Rating 4 out of 5]

Great overview of the Canadian Health care system. Knowing that it has traditionally taken 30-40 years of repetition for all all major health care changes to actually take hold explains a lot.

[Lance]

Excellent book that every Cdn needs to read.

[Aaron Badgley · Rating 3 out of 5]

Well researched, but a bit of a slow read. I do not always agree with mr. Simpson, but at least he has "facts" to back up his opinion.

[Tony Nickonchuk · Rating 3 out of 5]

It seems like a well researched enough book. But any book that I get a quarter of the way into and am still not interested has failed me. Moving onto the next one.