The Politics of Health Care … How Ottawa Governs

1. The Politics of Health Care… How Ottawa Governs Association of Canadian Academic Healthcare Organizations 4th Annual Fall Invitational Conference Ottawa November 4, 2005

2. Four Questions • What do we think about the funding and delivery of health care in a post-Chaoulli world? • How does the politics of health care mesh with the “productivity agenda”, federal-provincial relations and how Ottawa governs? • How do wait times, patient safety initiatives and the future of Academic Health Sciences Centres impact on the mission and mandate of members of ACAHO? • What is the role of research, innovation, and commercialization in relation to technology assessment?

3. Advancing the Cause: • Health Care: Anatomy of an Issue • Diagnosis: Epidemic of Expectations • Prognosis: Prospects for a “Cure” • Prescription: Treatment Program

4. Health Care: Anatomy of an Issue • personal and universal • visceral, ideological, now even class-driven • compelling though simplistic narratives, especially in media and in politics • the ultimate “wedge issue” especially in minority-government environment • politically, administratively and legally complex and interjurisdictional

5. Diagnosis: An Epidemic of Expectations • intensely rivalrous competition for priority attention and resources: • among regions, provinces and cities • among causes, institutions, interest groups and personalities • surfeit of “good ideas” – limitless demand for resources • similar economic and social challenges of health care are common in other developed nations • many groups / organizations share similar pathology of failed advocacy • “Six Reasons Organizations Fail in their Attempts to Influence Government” or “Why Bad Things Happen to Good Ideas”

6. Six Reasons Organizations Fail in their Attempts to Influence Government • They Ask for the Wrong Thing • They Get Active Too Late • They Ignore the Realities of Government Decision-Making • They Don’t Help the Government Think It Through • They Don’t Have a Champion in Government • They Stick with the “Same Old, Same Old”

7. Incestuous Amplification: A condition in warfare when one only listens to those who are already in lock-step agreement, reinforcing set beliefs and creating a situation ripe for miscalculation" Janes Magazine

8. Prognosis – Prospects for a “Cure” • forecast calls for continuing national denial and self-delusion about the economics, politics and allocative realities of modern health care • anything other than traditional publicly-funded and managed approaches continue to be “third rail” of Canadian politics at federal and provincial levels • search for made-in-Canada solutions will continue to be handicapped by the burden of the US metaphor • crisis-driven system causes occasional periodic lurches in priority setting; those prepared to be opportunistic will often be rewarded - usually to those that can show early results / progress • …. however, things can be done to improve prospects for advance

9. “The definition of insanity is doing the same thing over and over again, but expecting a different result.” Albert Einstein

10. “To have the results you’ve never had, you must do what you’ve never done.” Pierre Ducasse

11. Prescription – Treatment Program • Emphasis on both “process” and “substance” and “expectations management” • Process: • recruit, commit and support key sponsors / champions • be opportunistic - prepared to quickly exploit situations • committed to “do-it-yourself-public-policy” • Substance • New Narrative • based on responsive political and public-policy insight • includes a picture of Canadian health care in 12 months, 3-years • Expectations Management • some early, easy “wins” with demonstrable results

12. Sean Moore Partner / Public Policy Advisor Gowling Lafleur Henderson LLP 613-786-0216sean.moore@gowlings.com www.gowlings.com www.seanmoore.ca