Martyn Brown: As B.C.’s health system death spiral revs up, the only thing sicker is governments’ feckless response

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      [Warning: this analysis is very long, only intended for those who don’t mind reading (and perhaps weeping.)]

      No news is good news, they say.

      Which might account for the ongoing deafening silence from Dr. Bonnie Henry’s fan club in the Victoria press gallery in learning that “only” 76 British Columbians died with COVID-19 in the last two weeks.

      At least that’s down from 93 deaths in the previous two weeks, which also barely spurred reporting.

      If there’s any good news related to that bad news it is that those same media apologists for B.C.’s death-defying failures in COVID management are so bored with that killer virus they are at last training their sights on other issues.

      Especially the accelerating death spiral of our public health system.

      Some 70 percent of British Columbians apparently now disapprove of the Horgan government’s performance on health care, with 56 percent of NDP supporters giving it a thumbs down.

      Even the premier recently characterized the public health system as “crumbling.”

      Then again, sometimes new news is very good news indeed: like Horgan’s terrific news on Thursday (June 23) that he is once again cancer-free for a second time, having also weathered his own recent bout with COVID.

      Or his great news on Friday that he will have more news next week about his future plans as premier in anticipation of the next provincial election.

      Will he quit while he’s still personally ahead in the polls, as I recently speculated in this forum?

      No one would blame him for making that choice, that’s for sure, bone tired as he surely must be from his 35 cancer treatments. And also, from navigating a public policy minefield from hell and from three decades of public service in elected and nonelected capacities.

      More good news was his belated mea culpa and decision on Wednesday to cancel his wildly unpopular $1-billion Royal B.C. Museum legacy project.

      He did his level best to own that debacle as his own singular mistake, thereby also clearing the decks for his potential leadership successor of that politically lethal issue.

      Run for the Colwood hills, I say, Premier, the sooner, the better for the sake of everyone’s health.

      Perhaps new leadership can right the good ship NDP on the health file that is breathing new life into Kevin Falcon’s soon-to-be formally de-Liberalized party.

      Premier John Horgan has conceded that the health-care system is "crumbling".

      A sick joke

      Each day’s news now seems to feature yet another health horror story highlighting the NDP’s appalling failures in health management.

      If it bleeds, it leads, they also say.

      And when it comes to health stories, these days more than ever, no one has more blood on their hands than our elected leaders and top health officials, federally and provincially.

      At all levels of government, their political and professional malpractice has put Canada’s health system on life support and people’s lives unconscionably at risk.

      It’s certainly not a problem unique to Canada, as recent similar news from the United Kingdom and New Zealand should remind us.

      But that should only highlight the fact that we are now in an even tougher international competition for precious health human resources that demand new funding, new responses, and world-class working conditions for all who choose to practise here.

      In B.C., that damning indictment of decades-long incompetence, neglect, intransigence and underfunding has reduced the promise of Canada’s “universal, accessible, comprehensive, portable, and publicly administered” health-care system to a sick joke.

      That sorry track record here and across Canada stands as a testament to Albert Einstein’s famous observation that the definition of insanity is doing the same thing over and over again and expecting different results.

      Especially if you only do it worse each time.

      What the hell kind of health-care system is it that has now left nearly one million British Columbians—nearly one in five of our citizens—without access to a family doctor? A figure that is growing by leaps and bounds, with only 3,200 of B.C.’s 6,800 licensed family doctors choosing to work here as family physicians or continuing to practice at all.

      Across B.C., family practices are disappearing faster than the province’s remaining old-growth forests. Entire communities like Ucluelet are barely clinging to their last family clinic, if they still have one at all.

      What kind of system is it that now distinguishes B.C. as having by far the longest wait times in Canada for walk-in clinics—a crisis that’s only gotten worse since that study was conducted?

      Those primary health-care facilities are dropping like flies, despite the Horgan government’s last-minute funding efforts, such as its one-time cash injection to save five Victoria clinics from closing as planned, at least for this year.

      It’s just nuts.

      The walk-in wait time to see a doctor in Victoria was 161 minutes in 2021—over six times higher than the Canadian average of 25 minutes.

      The average walk-in clinic wait time across B.C. was 58 minutes—nearly four times greater than Ontario’s comparable average of 15 minutes.

      And that’s assuming you can even find a walk-in clinic that isn’t fully booked for the day within hours or even minutes of opening.

      Fraser Health

      "Oopsies" fail to fill the gap

      For years we’ve known the root causes of that crisis, including a broken fee-for-service system that has marked B.C.’s family doctors as the lowest paid in all of Canada.

      Ever fewer family doctors are able to make ends meet at a remotely reasonable level of compensation after accounting for their overhead costs, support staff costs, unpaid and after-hour administrative burdens, and unpaid on-call responsibilities.

      If anything, that problem has been compounded by the government’s vaunted “urgent and primary care centres"—or “oopsies”, as they are now known. They are typically fully booked and closed each day to new patients within a few hours or even minutes after opening.

      Those facilities are all swamped to the max, staffed by only a tiny fraction of the numbers of doctors, nurses, and other health-providers that the NDP government promised in announcing those oxymoronic-named facilities.

      All of them are failing their central promise.

      In any event, neither those “oopsies” nor walk-in clinics are really any substitute for family practices that deliver continuity of care founded on long-term trust relationships between patients and their physicians.

      Team-based care is great and desirable, no doubt; but not at the price of breaking that crucial doctor-patient relationship that is also predicated on intimate personalized knowledge of patients’ medical history, needs, and unique circumstances.

      All of that has accelerated the death spiral of B.C.’s public health system that has so dangerously overloaded already overcrowded emergency rooms with patients desperately needing primary care and having nowhere else to turn.

      It’s not rocket science.

      The best way to reduce pressure on our acute-care system has always been to increase emphasis on preventive and early diagnostic care aimed at keeping patients healthy and out of hospitals.

      Family doctors have always been the lynchpin to the success of that strategy, along with sensible preventive health policies.

      Dr. Bonnie Henry, Premier John Horgan, and Health Minister Adrian Dix have been steadfast in denying second COVID-19 booster shots to a huge number of British Columbians.

      COVID follies

      B.C.’s “Bonnie knows best” responses to COVID have hardly helped, to put it charitably.

      With all we know about the efficacy of second COVID-19 booster shots and with some 225,000 doses of vaccine set to expire in July, one would think the government would be moving Heaven and Earth to help more people get better protected.

      On the contrary, most British Columbians literally can’t get that added preventive protection to save their lives.

      Not unless they are at least 70 years old, are living in a long-term care facility, or are Indigenous and at least age 55.

      Or, as Dr. Henry recently explained to the enraptured press gallery, without so much as a follow-up question, unless they are perhaps in their 60s and hoping to embark on a cruise.


      So, I suppose it shouldn’t come as a shock that only two percent of British Columbians had had their second booster as of May 22.

      That’s less than a third of the comparable proportion of 6.72 per cent in Ontario, let alone of Saskatchewan’s 9.32 per cent, or Quebec’s 11.89 per cent.

      In fact, B.C. has the second worst record of any reporting province in Canada for the cumulative proportion of fully vaccinated people who have also had a second booster shot.

      That, too, will surely compound B.C.’s health system death spiral, which goes like this:

      Ever worse preventive care means that ever fewer citizens can even access primary care, with fewer still being protected as they should be by the powers that be from COVID and other widely preventable afflictions.

      Which leads to more stress and higher workloads at rock-bottom pay levels for B.C.’s ever fewer remaining family doctors, causing more of them to leave their practices.

      Which is putting even more pressure on emergency rooms and hospitals and is driving even more RNs, LPNs, nurse practioners, care aides, and other health-support workers to quit their beloved professions.

      Which is thereby also leaving entire communities without any access to even basic emergency services and further aggravating the self-perpetuating crisis.

      It defies all logic and common sense.

      But then again, it’s par for the course from a government and health officer

      • that initially slammed COVID travel restrictions as unworkable and unnecessary;
      • that denied COVID is an airborne virus when it always was;
      • that still ignores the evidence that COVID is actually also a brutal vascular disease that initially presents as a respiratory illness;
      • that repeatedly dismissed the efficacy of face masks and has now stupidly decided they are altogether unnecessary in crowded venues and on ferries, buses and rapid transit;
      • that continues to deny most nurses and other hospitals workers even the basic right to wear an N95 mask as a personal choice for greater protection;
      • that for so long failed to properly protect students and teachers with proper ventilation, appropriate social distancing, or classroom mask mandates;
      • that denied British Columbians access to federally provided rapid tests that were sitting by the millions in government warehouses, even as COVID hospitalizations and deaths were skyrocketing; and
      • that has arguably been the least transparent, most secretive, and most misleading government in Canada in reporting COVID-related deaths (at least, prior to April 2022) and COVID outbreaks in schools, hospitals, and seniors’ residential, assisted-living, and independent living facilities.

      Prevention was surely not the government’s top concern when Horgan called his opportunistic snap election with Dr. Henry’s blessing. While she ignored the pleas for urgent intervention during that entire campaign period, COVID raced out of control in B.C.

      All of that wreaked havoc on B.C.’s hospitals and compounded the mass exodus of family doctors, nurses, care aides, and other health-care providers and support workers.

      All of whom are grossly underpaid, overworked, and utterly exhausted.

      By and large, they have been treated as faceless “cogs in the machine”, despite Dr. Henry’s many laudable initiatives to keep some of them and some seniors safer in long-term care facilities.

      Those health professionals have mostly had their advice and human needs ignored by a government that has consistently put the economy first, as it also fudged its reporting of B.C.’s COVID mortality rates until it got caught.

      Let us never forget that “of the 9,496 excess deaths reported in B.C. between the start of the pandemic and October 2021, fewer than a quarter were blamed on COVID-19”, according to one peer-reviewed study published in the Canadian Medical Association Journal.

      That 4.5-fold gap between reported COVID-19 deaths and excess mortality in B.C. outstripped the comparable numbers in all other provinces. 

      And yet, Angus Reid’s latest opinion poll found that some 63 percent of British Columbians still feel that the Horgan government has done a good or somewhat good job on COVID.

      Only six percent even rate it as one of their top three concerns.

      As Jimmy Buffett once sang, “Is it ignorance or apathy? … Hey, I don’t know, and I don’t care.”

      Indeed, such is the collective weary response to the ongoing COVID calamity from so many Canadians.

      The polls suggest they are simply sick of the issue and largely inured to its human toll.

      Too many have been lulled by their blind faith in the likes of Dr. Henry and by the mostly unchallenged narratives that are amplified by the media.

      saeed karimi/Unsplash

      NDP needs to improve listening skills

      It’s telling that the public furor over Horgan’s museum project was exponentially greater than its anger and political pressure aimed at stopping the bleeding in B.C.’s public health-care system.

      That bleeding has only been intensified by the NDP’s lack of listening and meaningful consultation with health professionals.

      Time after time, we see the Horgan government continuing to attempt end-runs around B.C.’s doctors and professional organizations by unilaterally imposing its half-baked “solutions” to problems that it mostly regards as political p.r. challenges.

      Most recently, it blindsided them all with its deceivingly lucrative cash enticements for resident doctors, without any prior consultation.

      That well-meaning initiative was no less a misguided effort to pray upon the vulnerable status of debt-strapped medical graduates and coerce them into signing short-term contracts.

      It was so typical of the NDP’s Band-Aid responses to lethal conditions that demand well thought through long-term strategies developed in partnership with the health providers who are too often treated as political opponents.

      It was a classic example of how to turn an otherwise positive initiative on its head and worsen physician relations in pursuit of partisan political gains.

      Already the government has been forced to reconsider that bolt from the blue in light of the strongly critical response it received from the UBC Family Medicine Lead Residents.

      It has been stung by the even angrier response from family physicians. They rightly outed it as an ill-considered, crass public relations power play; one that epitomizes Victoria’s boneheaded, top-down approaches to “fixing” all that ails B.C.’s health system with one-off, spur-of-the-moment, time-limited investments.

      The solution to today’s health crisis surely isn’t to pretend you are consulting with doctors on how to save B.C.’s primary care system, while at the same time antagonizing them with divisive and inflammatory rhetoric and actions that also devalue their role in the process.

      Yet now as ever, we’ve seen that repeatedly from all governments of every political stripe in recent memory.

      Rather, the solution is to work honestly and collaboratively with doctors to advance their expert advice and efforts to save and enhance primary care.

      Because what the NDP has been doing sure isn’t working for anyone. Least of all patients.

      The government can brag all it wants about the record numbers of surgeries performed in B.C. over the last year and the progress it has made in reducing some posted surgical wait times.

      All good, admittedly.

      It can even legitimately point to B.C.’s comparatively favourable performance to other provinces on so many benchmarks and indicators tracked and reported by the Canadian Institute for Health Information.

      After all, every other government in recent memory has done the same in “proving” that B.C.’s health outcomes are among the best in Canada.

      But even those statistics can be deceiving.

      A case in point: surgical wait times don’t start until someone needing surgery has seen a specialist who has set that wheel in motion.

      Before that, patients first need to access a family doctor for an initial diagnosis and subsequent referral to a specialist—a process that can take eons, if those needing surgery can even access that primary care in the first place.

      With nearly a million British Columbians now not having even that access to a G.P., how many will regard the entire exercise as futile?

      How many will just pray that they’re not already sicker than they think, or not in more dire need of surgery than they might suppose?

      The longer those patients wait to access primary care, the worse off their conditions will become and the more it will cost our health system in the long run to address their pressing needs.

      How many more British Columbians already died or might yet die because they don’t even have access to a family doctor?

      How many cancer victims or other seriously ill patients went—or will go—undiagnosed, because they don’t have ready access to a doctor to even give them a basic physical exam?

      How many more patients will not even seek rudimentary medical attention through “virtual visits”—if they even have access to high-speed Internet?

      Artur Tumasjan/Unsplash

      Physicians, where art thou?

      Is preventive primary care bound to become the privileged domain of those rich or lucky enough to have access to costly for-profit providers like Telus Health, which is now under review by the Medical Services Commission?

      Its LifePlus program charges its patient/clients $4,600 in the first year, and more than $3,000 annually. More about that here.

      And that’s only one issue.

      The ongoing failure by our provincial and federal governments to appropriately address the worsening systemic challenges in health human resources, aging and inadequate infrastructure and technology, and operational renewal is literally killing our still widely beloved public health system.

      Index Mundi reports that Canada now ranks 76th in the world on so-called “physician density”, with only 2.31 physicians per 1,000 population.

      It also reports that Canada ranks 89th in the number of hospital beds per 1,000 population, with about half or less the comparable number from most other developed countries.

      The Organisation for Economic Co-operation and Development also finds Canada’s performance of those measures lacking, with a particularly pathetic ranking on its relative numbers of medical school graduates and nursing graduates.

      The NDP government can’t be too smug about its recent welcome initiative to expedite credentialing of the thousands of foreign-trained nurses who want to practise in B.C.

      After all, CBC informs us that accord to the Canadian Institute of Health Information, British Columbia has the second lowest number of RNs employed in direct care per 100,000 population in Canada. A much worse record than most provinces.

      We need Herculean efforts and unprecedented investments to seriously address those basic human capital problems that previous Canadian Health Human Resource "strategies" and frameworks for Collaborative Pan-Canadian Health Human Resources Planning failed so miserably to solve.

      Almost five years on and counting, we’re still waiting for the NDP’s updated health human resource strategy that was long ago promised as a vast improvement over the former government’s 2015 “strategy.”

      Next month, Canada’s premiers will be meeting in Victoria to once again put pressure on Ottawa to increase its share of health funding, further to Horgan’s latest missive as chair of the Council of the Federation.

      Funny. It reminded me of the 2002 premiers’ meeting in Victoria, which I attended and witnessed as the designated staffer in the room.

      Can you guess where the evening reception for those first ministers was held? 

      In the now permanently closed Old Town on the 3rd floor of the Royal B.C. Museum.

      Guess that option’s off the table for this go-round.

      Though with Horgan putting his museum rebuild project on hold, I suppose that empty floor could be quickly repurposed.

      Ideally, with electronic exhibits and perhaps colonial relics from Victoria’s long-defunct wax museum, highlighting the collective failures by Canada’s living, lost, and forgotten “nation builders” in protecting and improving Canada’s health system.

      In those days, nearly two decades ago, Canada’s premiers were demanding that the federal government immediately increase and maintain its share of health funding from 22 percent of national health expenditures to 25 percent.

      They pointed out that ask represented only half of Ottawa’s original 50 percent health funding commitment from the '60s.

      Now their successor premiers want Trudeau to commit to raising the federal government’s share of total health funding from 22 percent to 35 percent of all health expenditures.

      Which begs the question, why not 50 percent?

      The Trans Mountain Pipeline Expansion is far more expensive today than initially estimated by the Trudeau government when it bought the system from Kinder Morgan.
      Trans Mountain

      Pipeline project gobbles up cash

      Surely that would be a more worthy investment than Trudeau’s publicly owned Trans Mountain Pipeline Expansion money pit.

      Which the parliamentary budget officer just reported has a net present value of negative $600 million—about $1.2 billion less than the PBO's December 2020 estimate.

      That boondoggle will now cost at least $21.4 billion to complete, up 70 percent from the federal Liberals’ initial estimate of $12.6 billion—a cost that is sure to further escalate with inflation.

      Imagine if that money had instead been invested in improving Canada’s health system?

      It should be getting massive new cash injections just to offset the added escalating costs of caring for its rapidly aging population—a dynamic that is wildly out of synch with Canada’s growth in GDP that has for too long dictated increases in federal health transfers.

      To say nothing of the added costs posed by inflation and by Canada’s increased immigration levels that will add early half-a-million residents each year.

      Meanwhile, after all these years, foreign-trained doctors continue to be shut out of offering their professional services by our do-nothing governments.

      It’s as if we’ve learned nothing in the last three decades since B.C.’s 1992 report from the Seaton Royal Commission on Health Care and Costs, which offered lots of great advice but also stupidly urged the government to “ State clearly that immigrant physicians do not have a right to practice medicine in BC.”

      It also suggested the government should “Require visa trainees to agree not to stay in Canada when they complete their training” and “Develop a program to limit the number of physicians practising in BC,” on the basis that our province had 50 percent more doctors than the Canadian average.

      Even by the time Campbell’s B.C. Liberals came to power in 2001, it was clear that advice was deeply flawed, which in part explains why his government doubled the number of UBC medical graduates. A drop in the bucket as compared to B.C.’s growing needs.

      In light of recent history, it’s hard to be optimistic about what will flow from the upcoming premiers’ conference, notwithstanding the urgent appeals from Canadian Medical Association.

      Its president, Dr. Katharine Smart rightly warns our system is “on the verge of collapse” and that it’s time to accept some of the CMA’s recommended remedies.

      Video: CMA president Dr. Katharine Smart says Canada's health-care system is on the verge of collapse.

      B.C. cuts health spending as portion of GDP

      Ignoring that advice and other expert suggestions will only consign us to repeat the mistakes of the past.

      There was the failed “fix” in 2000 that was replaced by the failed 2003 accord, followed by the premiers’ 2004 “action plan”, and the subsequent failed 2004 “fix for a generation.

      That was subsequently abandoned and replaced with the Harper and Trudeau governments’ failed health-transfer funding arrangements.

      Yet even with B.C.’s whopping $7-billion increase in total health funding under the NDP, Horgan is hardly in any position to point fingers at Ottawa for its relative cuts in proportional health funding.

      The federal government also substantially increased health spending in absolute dollars, if not nearly by its fair share, which desperately needs to be addressed.

      Still, would it surprise you to learn that the NDP’s 2022 budget actually projects a 0.5 percent annualized cut in health expenditures (pg. 175) as a percent of nominal GDP? From 7.7 percent in 2015, to 7.6 percent last year, to 7.3 percent by 2024.

      With inflation now running at 8.1 per cent in B.C, is it not surprising that the growth rate of Horgan’s total health budget is projected to drop from an estimated 5.4 percent this year to 2.8 percent in the following two years?

      Meanwhile, would you be shocked to learn that total health spending has dropped almost every year in B.C. as proportion of total government operating expenses? From 42.5 percent in 2013, to 40.5 percent in 2017 when the NDP formed government, to 37.7 percent last year—in the midst of the pandemic.

      Those who argue that a lack of health funding isn’t the problem are dreaming in technicolour.

      Yes, the system can and should be more efficiently managed to get more bang for each health buck. And a first ministers’ meeting with the prime minister that invites expert input into addressing that need should be at the top of Trudeau’s priorities.

      Sure, we can and should do better in gathering and tracking standardized national health data, as part and parcel of any new federal/provincial funding arrangement.

      But don’t kid yourself.

      If we are really serious about dramatically increasing our domestic supply of physicians, nurses, and other health professionals through increased training, recruitment, retention, and also new utilization of the untold thousands of foreign-trained professionals living in Canada who want to practise in their fields—it will take much, much more money.

      So will Canada’s desperately needed investments in building new hospitals and upgrading the ancient ones. They weren’t built for today’s technology and equipment—much of which competes for space with patients lying in hospital hallways.

      It will take massive new investments from both levels of government to properly address the problems in primary and preventive care, mental health and addictions, long-term care, home care, access to drugs, and other priorities.

      Anyone who tells you otherwise is either ignorant or lying—and we shouldn’t let ignorance or apathy reign supreme.

      Nor should we be launching costly new national health programs as the federal Liberals and NDP are pushing for denticare and pharmacare, unless or until those myriad other existing health system needs are properly funded and met.

      And with that, I’ll end this long diatribe and leave with you this hopeful tweet from BC Family Doctors.

      Martyn Brown was former B.C. premier Gordon Campbell’s long-serving chief of staff, the top strategic adviser to three provincial party leaders, and a former deputy minister of tourism, trade, and investment. He also served as the B.C. Liberals' public campaign director in 2001, 2005, and 2009, and in addition to his other extensive campaign experience, he was the principal author of four election platforms. Contact him via email at