Recent MPP graduate Dr Jesse Kancir reflects on his time in Cambridge and what the MPP has given him as he develops his career in medicine and health policy
I’ve been asked more than once over the past year why I moved to Cambridge in 2014 to study for an MPP. Before arriving, I had graduate training in health policy and economics, had worked on the frontlines of healthcare as a medical trainee, and served in leadership positions with Canada’s national medical organizations. Many questioned the additional value of a year in Cambridge.
However, I had been feeling a growing sense of cynicism and frustration with Canadian public policy. My personal health policy prescriptions, I hope informed more by evidence than ideology, never aligned with those of any Canadian government. Sometimes individual positions may have been shared but I found the provincial/territorial/federal collection of priorities to be wanting. And there were deeper questions: Why had our country failed to implement a set of wide-ranging health reforms that might fix healthcare for a generation? Why were current attempts at reform so timid in their ambition? Before moving to Vancouver to begin my specialty training in public health and preventive medicine, I left for Cambridge with these questions in mind and the hope to find some answers to help move along health policy in Canada.
My MPP studies transformed the way that I understand the policy cycle and my own potential role in the process. I’ve come to realize that I tended to understand policy as a collection of individual decisions rather than as a coherent portfolio of decisions. More importantly, I had no appreciation for the full policy cycle. I understood static policy decisions but did not wholly understand dynamic public policymaking. As simple as that sounds, becoming more holistic in my comprehension of policy became the most important outcome of the year.
An example best illustrates this point.
There are three important ‘H’s to being Canadian: hockey, Hortons[i], and healthcare. A passion for winter sports and hot beverages is equaled by our love for healthcare. The father of Canadian Medicare, Tommy Douglas, was chosen as being the most historically important Canadian, above any of our ice-skating legends. In a way, publicly financed healthcare embodies our core values in a relatively young country that has struggled with national identity.
It is no wonder, then, that the legal, financial, and political challenges within healthcare elicit strong opinions. Further complicating the situation is a powerful professional medical community, a constitution interpreted to largely assign health policy to provincial and territorial governments, and a massive fiscal transfer from the federal government that is key to financial sustainability. It’s a complex, wicked, and fascinating policy area.
Recently there has been a strong focus by the health policy community on the prospect of an expansion of our universal health coverage to include pharmaceutical coverage. The arguments are solid: we are one of the only high-resource countries without universal pharmaceutical coverage, the impacts on health outcomes and social equality are negative, and cost-benefit analyses are favourable. As a problem in health economics and health policy, the argument for expansion (referred to as pharmacare) appears clear cut.
The problem with pharmacare is not whether it is a ‘good’ or ‘bad’ idea. The problem is how this issue compares to a host of other ‘good’ ideas. When I entered the MPP, I was convinced that the expansion of universal health coverage should be an election topic in our Canadian General Election in October 2015 and perhaps even form a central plank of an electoral platform. Pharmacare, I would have argued, should become a proposed vision for the people of Canada as our next nation-building project.
Now, I’ve become convinced that pharmacare in Canada is a ‘good’ idea, but that it’s not the right choice for right now. MPP classes in macroeconomics have helped me understand fiscal policy options and the reduced GDP effects of welfare programs compared to that of other programs like infrastructure investments. Pharmacare would relieve some financial burden to patients and governments but would not be as effective as a general increase in GDP growth and job creation in our floundering economy. Further, our classes in political and legal institutions encouraged me to look at the complicated history of medicare in Canada and to realize the enormous political capital that it would take to institute such a difficult expansion of a program. Finally, several case studies undertaken during the MPP have sharpened my comparative analysis and helped me realize the gaping lack of other options explored for health system reform. There has been no clear case made why pharmacare matters as a top priority among all other potential health policy reforms.
All in all, my time at Cambridge has made me more competent. I questioned at one point in the year if becoming more aware of the struggles of good policymaking would lead me to doubt that I could advance policy. These thoughts were always short-lived as I now begin to better understand the complexity of the tradeoffs between the panoply of other policy directions a government may pursue. Awareness has made me less frustrated with democratic dialogues and more appreciative of the hard choices made on a daily basis in the public sphere. That has motivated me to become more personally engaged and to expect rigour from others in their approach to public policy.
One final reflection on the year at Cambridge is the unexpected development of national pride. Our institutional or policy arrangements are not better than those of my classmates from the UK, Australia, the Netherlands, or Colombia. Rather they are a unique reflection of something distinctively Canadian. I didn’t expect to become a better citizen by leaving the country for a year; however, in addition to the analytical capacity and the polishing of professional skills, Cambridge has helped this Canadian more deeply desire to serve the land that loves its percolated coffee, ice skates, and healthcare. And so, when questioned now, my answer is immediate: my MPP year wasn’t an interlude but rather an important step forward in helping me to serve my profession, my patients, and the Canadian public in the years to come.
[i] Tim Horton’s is a well-known coffee shop known for its trademark ‘double-double’ addition of cream and sugar to coffee.