The key characteristic for any election is an open debate about the key issues at hand, one in which each side of the political spectrum is able to freely put forward its view of a particular issue. In one of its leaders this week the Economist (subscriber links only) points towards the absence of such a debate on healthcare in the Canadian federal election campaign and the reason that the real debate is absent is that it is shrouded in that stifling veil of political correctness, Canadian-style. The ruling Liberals use it to demonize the up-and-coming deregulating Conservatives and in full pre-empting damage control panic mode these very Conservatives, who know much better than to start to adhere to the pan-Canadian dogma of universal healthcare, fall in line and shy away from any bold, creative initiatives. Here’s their website:

“…to ensure adequate funding, shorter waiting lists, and more doctors and nurses. We will improve access to health care for all Canadians, regardless of ability to pay”

Any new ideas? Imaginative suggestions? Don’t think so. Indeed, universal healthcare is an article of faith in Canada and there’s no sane politician who will venture into this emotional area with some new and groundbreaking ideas, like user fees or, come to think of it, enabling private MRI clinics to do business, much as they are needed. The system is in dire need of innovation and restructuring, everyone left right and center knows it, a majority of Canadians appears to be willing to consider a parallel private healthcare option, but out of fear of being out of tune with accepted political thinking and lose votes, not one political leader dares saying it. The ideas tabled so far are often cheap ploys to buy votes; Liberal leader Paul Martin’s promise to pump more money into healthcare to reduce waiting lists is possibly the single worst idea that has hit the campaign trail so far. And not, as many think, because he as Finance Minister cut healthcare spending, no, because he should know that the last solution a broken system needs is more money. Creative restructuring where a mix of public and private resources meet to deliver an optimal solution for everyone, like in most other industrialized Western nations, is probably a sensible strategy but no one, least of all Martin, dares saying it.

The inability to break the political taboo leads to an infertile discussion, an impoverished campaign and as a result an outcome that is not all that meaningful as no one has been asked to give input on real change. A similar pattern could be discerned in The Netherlands in the late 1990s where it was out of the question to debate, question, yet even discuss issues of Muslim immigration and integration. Everyone, again left right and center, knew the issue was there but very few dared to take it on. It took the flamboyant professor Pim Fortuyn to take on the issue and put it in the open in clear terms, and be willing to take the heat for his bold electoral moves. He got a lot more than he bargained for when a deranged environmentalist shot him, but he had managed to put the issue on the political agenda in unconventional terms and was posthumously rewarded with a huge electoral success. Since then, all the main Dutch parties have adopted his ideas and the issues of immigration and integration feature in the political debate more than ever before. The policies and solutions that come out of that debate are not always that great, but there seems to be a cross-party willingness to work on it and, most importantly, break with conventional thinking.

Alas, the willingness in Canada to reform the healthcare system is mired in arguing over more cash to reduce waiting lists and access to care, any suggestions of structural reform are deemed to represent a descent in an abyss called American-style healthcare. What is needed is a bold political leader willing to take a risk and force the real issue out into the open and present Canadians with some viable options and a possible road to significant improvements in the way they have access to healthcare. But it won’t be this election, which in turn means it is unlikely that any new government - and it looks like it is going to be a minority outfit - will embark on healthcare reform, just more cash for now. A real crisis will probably have to manifest itself before any politician in Canada will take on the issue, or better still; some fresh and brave leaders will have to emerge from Canada’s underfunded pool of political talent before we can even have an inspired debate about it.