Volume 9 Number 10

HEALTH CARE IN CANADA: TV's Diagnosis, Symptoms and Treatment

Federal Health Minister David Dingwall's repeated promise that the Liberals will preserve publicly funded health care in Canada is likely due to the frequently repeated assertion that Canada is a "better" country than the United States because all Canadians have access to quality health care. The future of health care in Canada is arguably the most emotionally charged and politically sensitive issue facing the country. All Canadians have a stake and most have an opinion.

Contrary to the Liberals' position that the only acceptable health care system is a publicly funded one, a recent Gallup poll found that 44 percent of Canadians support the introduction of privately funded services.["Public Remains Divided on Two-Tiered Health Care," The Gallup Poll, September 19, 1996.] In 1995, the Canadian Medical Association (CMA) also voted 44 percent in favour of introducing private insurers. Again this past August, the CMA vigorously debated how best to deal with increasing health care demands. President Dr. Jack Armstrong asked the doctors to hold off supporting privately funded health care because "if [the CMA] is the first out of the trenches for private funding for core medical services, we are going to get shot down in flames."

Fiscally-conservative political parties promise to save publicly funded health care by eliminating government debt and reducing the tax burden. Most recently, Preston Manning, leader of the Reform Party, called Finance Minister Martin the "Jack Kevorkian of Canadian health care" and pledged an additional $4 billion to health and education in the Reform Party's "A Fresh Start for Canadians" policy statement.

Provincial politicians also battle to be the guardians of social services. During the B.C. election campaign, Liberal leader Gordon Campbell campaigned on a platform of fiscal responsibility, promising to cut $3 billion from the provincial budget without affecting the quality of health care or education. Campbell's promise was attacked by the leaders from the New Democratic Party, the Reform Party, and the Progressive Democratic Alliance alike. The Reform Party's Jack Weisgerber said, "We all agree except the Liberals that you can't cut $3 billion." The Liberals narrowly lost the election.

In the debate on the future of Canada's social services, the media's role as moderator is quite powerful. In this issue of On Balance, we will examine how the CBC and CTV national television news reported health care issues during the first 8 months of 1996.

The diagnosis: cutbacks in health care the number one problem

Television news has emphasized funding cuts as the primary problem with Canada's health care system. As figure A shows, over 50 percent of CBC and almost 50 percent of CTV statements which commented on the problems facing the current system focused on funding cuts. For example, CTV's Larry Stout introduced an August 10, 1996 report with: "New hospital horror stories are coming out of Alberta following provincial cutbacks in health care. An Edmonton doctor has already said people have died because of cutbacks, and the head of the nurses' union is warning patients there may not be enough staff in hospitals to provide adequate care. Well, now the latest story comes from a woman who sat with her mother for months, watching her die." Similarly, CBC's Peter Mansbridge reported on April 24, 1996: "A new survey revealed grave concerns today about Canadian health care. Hundreds of doctors reported that the government cuts have gone too far, the system is sagging."

Other problems that were discussed on both CBC and CTV included Canadians abusing the system through unnecessary visits to their doctors or emergency rooms, paying doctors excessively, lack of concern by the politicians and the increasing proportion of health care expenditures used to pay for drugs. CBC's health specialist, Brenda Craig, reported a study by the Canadian Institute of Actuaries which documented how changing demographics would put an increasing burden on health services. As well, both networks criticized current medical procedures such as outdated birthing practices and the over-prescription of drugs.

Click here to view Figure A-DIAGNOSIS: What are the Problems With Health Care in Canada?

Symptoms: budget cuts hurt health services

The deterioration of Canadian health care, as documented on the national nightly newscasts, focuses on increased waiting lists, the inability to give proper care, doctors refusing new patients, and both doctors and patients opting out of the Canadian system by going to the U.S. to work or for treatment (see figure B).

CBC has focused primarily on waiting lists. On August 20, 1996, the Canadian Medical Association called for a national debate on the introduction of private medicine. The CBC's Alison [or Allison??] Smith reported: "One thing that's clear at the CMA convention is that many doctors think our health system doesn't work." CBC's Susan Bonner then filed a report in which three doctors and a heart patient criticized the growing waiting lists and the strains being put on the system because of a lack of funds. Dr. Michael Frimer stated: "So even the urgent patients, cancer patients, are having to wait, as far as I'm concerned, too long. The elective patients are a disaster and progressively getting worse."

The CTV News provided twice as much coverage as CBC on the specific results of budget cuts and tended to provide more event-driven reports focusing on dramatic, personal stories. The most frequent criticism of the CTV reports was a deterioration in the quality of care. On August 7, 1996, Dr. David Hunt was quoted on a CTV News report saying: "We had three women in labour sitting on chairs in the corridor because we had no beds to put them in. One of them started to bleed quite copiously so we had to put her in an assessment bed and then cover from there. I can think personally of two patients that I was personally involved with that I think died because of the cuts in the system."

Another of CTV's highly personal reports, aired January 10, 1996, was about an Edmonton hospital which was unable to accept a donor heart. Anchor Lloyd Robertson said, "There were a number of people for whom that heart represented a new chance at a longer, healthier life, but there was a shortage of medical staff; was it a problem of seasonal scheduling, or what many feared would happen when Alberta made deep health care cuts?"

Click here to view Figure B-SYMPTOMS: What are the Results of These Problems?

Treatment: increased government funding preferred solution on CBC

The fundamental difference between the CBC and CTV networks was how proposed solutions were presented. As demonstrated at the recent CMA convention and in public opinion polls, both doctors and the public are fairly evenly divided as to whether or not the introduction of a parallel user-pay system is a viable option for Canada. The CTV News reflected these divided sentiments in its coverage, with 19 statements supporting the continuation of a fully public system and 15 statements calling for privately funded alternatives. In contrast, CBC reports contained 64 statements advocating the public system, and just 25 statements supporting some form of private health services (see figure C). The doctors, academics, and politicians who CBC chose to interview in their reports account for this imbalance.

For example, on August 20, 1996, CBC dedicated a full-edition National Magazine to health care issues. Host Laurie Brown first interviewed two doctors on either side of the privatization debate--BCMA President Dr. Derryck Smith and Dr. Mimi Divinsky. Dr. Smith stated: "We unanimously supported Medicare, but we think that Medicare is seriously underfunded and the federal government is going to be spending less money on health care rather than more. So, if the waiting lists get too long, we think we need to look at giving Canadians the opportunity to purchase insurance services privately if they so wish. If the waiting lines in the public system are too long, there needs to be a safety valve."

Dr. Divinsky argued that "there are lots of research and good arguments to support the concerns that when you bring in two-tiered medicine, you transform health care from a right that all Canadians have access to on a fair basis, to a commodity in the marketplace. And when you do that, it means that people who have financial means can access it and have it available to them, and people without money to pay will get slower and second-rate care."

In the next two interviews, first with Professor Hugh Armstrong and then Ontario Health Minister Jim Wilson, both men were opposed to private options and supported maintaining or expanding publicly funded care. Dr. Armstrong commented that "private eye clinics [are] using the Medicare funds from the public purse but then tacking on an administrative fee or a user fee . . . that would enable you, as a rich Albertan, to jump the queue. The principle of Medicare is that you get service on the basis of need, not on the basis of how fat your wallet is."

Following these interviews, CBC's Ann MacMillan profiled "the British example of two-tier medicine." In contrast to CBC's coverage of Canadian health care reform, all but one of the people from the British system who were interviewed were supportive of the private insurers, saying that it was necessary to take pressure off the public system. Incentives for doctors were also examined. MacMillan reported that many British doctors work in the public system for relatively low wages but are able to supplement that income in the public sector. Dr. Steven Brearly commented that: "An increasing number of people are thinking that there must be easier ways of earning a decent income than being an NHS hospital doctor. Clearly if one is also earning a substantial amount from medical practice in the private sector, it makes you think twice about throwing out a medical career and going off to be a merchant banker."

Dr. Jonathan Berry, the only critic of Britain's private health insurance quoted in MacMillan's report, warned that increasing demands and decreasing funds would result in a system whereby "life-threatening illnesses are funded by the state, all other procedures, which may be very painful procedures, are funded by the private sector."

The debate on the introduction of private medicine in Canada focused on the "two-tiered system" and the inequity of better care for the rich. For example, on August 20, 1996, the top story of the day on CBC was Health Minister David Dingwall's reaffirmation of a publicly funded system. Reporter Kas Roussy stated: "Dingwall made it clear that Ottawa will not support a two-tier system--that is, one for those who can afford to pay and another for those who can't." On the next day's "National Magazine" Laurie Brown said to Dr. Derryck Smith: "I'm having trouble with some of the words. At first I hear `two-tier,' and now I'm hearing `parallel system.' But when you boil it right down, isn't it really a class system? One type of health care for people who can afford to pay more and another type for people who can't afford it?"

CBC presented the introduction of private medicine as inevitably leading to a dual system, rather than, as exists in Britain and New Zealand, a system in which all citizens are insured for basic services, but the option exists of paying for faster and/or better care out of private funds.

Click here to view Figure C-TREATMENT: Proposed Solutions for Health Care

CBC cameras focus on Ontario; CTV on Alberta

Another significant difference between the CBC and CTV national news reports was their attention to provincial health issues. As figure D shows, Albertans received the greatest reduction in health care funding between 1991 and 1995, followed by Saskatchewan and Ontario. But, as table 1 illustrates, even after budget cuts, Ontario had the most funding per capita of any of the provinces other than British Columbia.

Click here to view Figure D-Attention to Provincial Health Care

Click here to view Table 1

On the other hand, of the CBC reports that focused attention on the provinces, almost one-half of that coverage centred on Ontario; CTV, meanwhile, focused the greatest proportion of its reports on Alberta. Neither CBC nor CTV focused their reports on Saskatchewan, even though that province bore the second highest per capita funding cuts between 1991 and 1995, and now has a per capita funding level lower than all other provinces with the exception of PEI. In addition, Saskatchewan has the greatest number of senior citizens in Canada, and caring for the elderly takes the biggest portion of health dollars.

Also noteworthy is the fact that only 12 percent of CBC's total coverage of health care focused on provincial issues, in contrast to 54 percent of CTV's coverage. One explanation is that the CBC, due to its reliance on federal funding and its mandate to unify the country, places greater emphasis on the debate at the national level even though the provinces have control over how health care is delivered. The Globe and Mail's Edward Greenspan argues that health is the "last of the great universal programs" which justifies federal government [intervention??], while the headline declared "If health care founders, then the federal system will be in peril." [Edward Greenspan, "The 68¢ Government," The Globe and Mail, September 28, 1996, p. D1.] Perhaps CBC's concern with its own survival has inhibited its ability to report fairly on matters of federal/provincial powers.

CBC looks at French social benefits

In addition to examining Britain's National Health Service, CBC also looked at the publicly funded health services in France. In a documentary that examined how France is restructuring and reducing social programs to meet requirements for the common European currency, the CBC's Paul Workman reported: "You can still have a pretty nice life in France, even without a lot of money, much of it due to the benefits provided by the state--free schools, free health care, free pensions. So how generous is French medicare? Well, imagine a week in the seaside town of St. Jean de Luz. Twenty percent of the people who come to this spa are here for treatment, mostly for arthritis or rheumatism. There are places like this all over France. And depending where you go, the state will pay anywhere from 20 percent to 98 percent of your treatment. Muscle massage, water therapy, mud baths--you can see why the French are reluctant to give it up."

Doctors are top source on CBC and CTV

Similar to the National Media Archive's findings in its examination of health care in 1989, doctors were the most quoted source on both networks, accounting for almost 30 percent of CTV's and 20 percent of CBC's total attention to Canadian health care (see figure E). In addition, representatives of medical associations across the country accounted for approximately 10 percent of CBC's and 5 percent of CTV's sources' statements. Politicians and academics were CBC's second and third choices for sources on health care, while on CTV patients were widely quoted.

Click here to view Figure E-Sources on Health Care

CBC talks more about ideals

In the analysis of the networks' coverage, all commentary was divided into one of five areas: acts of governance, systems operations, research and academic studies, anecdotes or individual experiences, and perceptions or statements of ideology (see figure F).

Click here to view Figure F-Coverage of Health Care

Discussions of government comprised the greatest proportion of coverage on both networks, accounting for almost one-half of CTV's coverage and over one-third of CBC's coverage. CBC dedicated a greater proportion to systems operations, at 18 percent, than CTV, at 14 percent. For example, the National Magazine examined how Toronto's Wellesley Hospital is implementing cuts to its operating budget. CTV provided proportionately more attention to anecdotes and individual experiences, accounting for 18 percent of total coverage compared to CBC at 11 percent. On both networks, scientific research and academic studies comprised the least coverage, constituting 9 percent of CBC and 7 percent of CTV total attention.

The greatest difference between the networks was in discussions of perceptions or ideas. CBC dedicated 26 percent of total coverage to these debates whereas on CTV ideas comprised just 15 percent. For example, on the August 20, 1996 National Magazine interview with Dr. Derryck Smith and Dr. Mimi Divinsky, the following exchange took place:

Laurie Brown: How will creating a whole, complete, new, tier of a system help if we can't afford one?

Derryck Smith: The government can't afford it. What we're saying to Canadians is: the quality of health care is eroding; the waiting lists across the country are getting longer; and we need to have a serious look at other alternatives, including the possibility that people should be able to purchase health care if they think the waiting list is too long for them or their family.

Mimi Divinsky: I think it's been unrealistic to think that a majority of Canadians have money to spend extra on health care insurance policies. I really don't see how any but the wealthy will be able to take advantage of the system that you propose.

Derryck Smith: Well, I think that's nonsense. We're not talking here about a system here for the wealthy. We're talking about the average working man and woman in Canada who may not wish to spend a year waiting to have their cataracts repaired. They may have the $2,000 that it takes to have that done next week. Now why should we insist that they must wait an entire year simply because that's the length of the waiting list in the public system?

Summary of health care

Television news emphasized funding cuts as the primary problem with Canada's health care system. Over 50 percent of CBC and almost 50 percent of CTV statements identified funding cuts as the problem facing the current system.

The deterioration of Canadian health care, as documented on the national nightly newscasts, focuses on increased waiting lists, the inability to give proper care, doctors refusing new patients, and both doctors and patients opting out of the Canadian system by going to the U.S. to work or for treatment.

The fundamental difference between the CBC and CTV coverage of health care is how proposed solutions are presented. On CTV, 19 statements supported the continuation of a fully public system and 15 statements called for privately funded alternatives. In contrast, CBC reports contained 64 statements advocating the public system, and just 25 statements supporting some form of private health services.

Methodology

Results are based on 31 CBC "The National," 6 CBC "Sunday Report," 13 CBC "The National Magazine," and 30 "CTV News" stories which contained the words "health care" from January 1, 1996 to August 31, 1996. Further information or details on the coding design and methods may be obtained by contacting the National Media Archive.

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Last Modified: Wednesday, October 20, 1999.