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i-3Tv64gz-LLast week, I hosted a Town Hall meeting in Markham on the topic of healthcare. We enjoyed hearing from a range of experts, including Dr. Andrew Boozary, Editor-in-Chief of the Harvard Public Health Review; Natalie Mehra, Executive Director of the Ontario Health Coalition; and Corey Vermey, Director of Health Care at Unifor.

During the meeting, I talked about how the Canadian healthcare system feels like a giant game of Jenga, with its tower of wooden blocks where each piece relies on a stable foundation of other pieces in order to work. If the base is unstable, or someone pulls a piece from the middle, it may hold for a while, but increases the chances that the whole thing will crumble. I’ve been a Canadian physician for more than 30 years. But in the past decade, I’ve seen significant supporting structures being removed from the public system. Our cherished Canadian healthcare system is now shaking on its foundation.

The current federal government hasn’t placed a priority on healthcare. The Prime Minister likes to emphasize that healthcare delivery falls under provincial jurisdiction. But in fact, the health of Canadians depends on strong federal leadership to set priorities, ensure cost savings and uphold the national vision for medicare.

As with the game of Jenga, some pieces are pulled from healthcare infrastructure and the instability is not immediately apparent. For example, the 2004 Health Accord that was established with the provinces ended in 2014 and was not renewed. This may seem a small matter. But the Accord had set standards for home care, team-based primary care and national pharmacare. The role of the federal government was to work with the provinces to ensure that investments in healthcare would be directed to improving the system in these areas, so that all Canadians, no matter where they live, could expect to see positive reforms. There is widespread evidence that each of these pieces could have helped Canadians enjoy better health outcomes and save costs.

Our Prime Minister pulled out another piece of the healthcare puzzle by stopping First Ministers’ meetings at which he and the Canada’s premiers could confer about how to ensure high-quality healthcare and get value for the money spent. He has not convened such a meeting since 2009. Previous First Ministers’ meetings have dealt with economic renewal, job creation and constitutional matters as well as important health topics such as disability, equality and access to primary care. For more than five years, that critical piece has been missing.

Nothing makes me more anxious about system collapse than the withdrawal of conditions on the Canada Health Transfer. This means that the federal government hands over $30 billion per year to the provinces for healthcare delivery with no comment on the principles or priorities to be upheld. As a physician, I’ve been an organizational leader in primary care for more than 10 years. I try to imagine giving a budget to my inter-professional team without agreement on how to prioritize resources, what standards should be upheld, and which principles should prevail. Transferring money with no guidelines for its use would be irresponsible.

There is considerable anxiety about the actual amount of moneythat is transferred from federal to provincial coffers and whether it will be sufficient in the years to come. The current government has prescribed a reduction in the annual increases of the Canada Health Transfer starting in 2017. I agree that the amount of money and how it is distributed are matters of utmost importance for a fair healthcare system. But more than that, our national leaders need to build in some stipulations when they hand over these massive sums. They are charged with upholding the founding principles of our healthcare system, including accessibility and universality. By failing to give direction, they have made the system frighteningly fragile. If there is no pledge that Canadians will have reasonable access to care, I’m worried about an increasingly privatized system. Health resources, especially human resources, like doctors and nurses, are not unlimited. Wealthy Canadians may not suffer the effects if private healthcare siphons resources from the public system. But most Canadians will care if they can’t get services because the providers have gone to work in private clinics.

The federal government should not dictate to the provinces about how healthcare is delivered. But the money does need to come with a clear message about priorities. Those priorities ought to include a coordinated national approach to seniors’ care, pharmacare and mental health care. Smart strategy in those areas holds the potential to harness spending and improve people’s lives.

In the game of Jenga, the tower becomes increasingly shaky for several rounds before it tumbles. If pieces continue to be withdrawn, it falls rapidly and the final player loses the game. Canadians need a federal government that cares about healthcare. If current trends continue and the system collapses, we all lose.

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