We are honoured to feature Dr. Gregory Marchildon as our Distinguished LSE alumni in this issue of Alumni Reflections. Dr. Marchildon currently holds the Ontario research chair in health policy and system design with the Institute of Health Policy, Management and Evaluation at the University of Toronto.
He has set himself apart in the fields of health, public policy and economic history through a long and productive career, both in academia and public service.
In 2001-02, Dr. Marchildon was the executive director of the federal Royal Commission on the Future of Health Care in Canada. Chaired by the Hon. Roy Romanow, the Commission’s mandate was to provide recommendations for Canada’s publicly funded health care system. Dr. Marchildon also served as cabinet secretary and deputy minister to the Premier of Saskatchewan in the late 1990s.
He completed his PhD in economic history at LSE from 1987-1990. In 1988, he also held a one-year appointment as lecturer in American economic history at the school.
We are pleased to share Dr. Marchildon’s reflections on his time at LSE, his advice to current students, and his thoughts on the state of healthcare in Canada today.
Interview edited and condensed
By Sarah Reid
Why did you choose to study at LSE?
Well, for one main reason: It had the largest department of economic history in the English-speaking world and I wanted to specialize. I felt that it was probably the best place in the world that I could go to do that. Economic history at LSE has a very long and quite famous history. The economic historians that were at LSE were among the best. And over time they built a department that was second to none. It was large and it attracted students from all over.
What was it like being in London in the late 1980s?
It was a fairly down period, economically. And there was a kind of impatience and fatigue setting in with the government of the day. The Thatcher government was getting a little long in the tooth by that time. And there was kind of a greyness about the place. At the same time, London being London, of course, a world city, there’s always a lot happening. And you always felt like you were only scratching the surface of it. Because I was a rather impoverished PhD student, I was only able to access so much and do so much. But I was still amazed at the city and everything that was going on.
What did you do when you weren’t studying?
I went to the Three Tuns and the George IV, the local pub, on Friday nights. That was a regular sort of thing. I loved walking around London on the weekend. In the second year I lived there I was living in Maida Vale, right near Little Venice, and so I was able to walk all along the canal and I just loved that.
How did your time at LSE prepare you for your career?
I’ve had three careers – lawyer, public administrator and university professor. So it’s hard to say. It certainly prepared me for my academic career. I think I was very fortunate in ending up selecting the LSE, obviously for reasons of technical expertise, but it turned out to be so much more than that. The people that I met, in terms of the other students, were fantastic. I learned so much from them. I’ve stayed in touch with some of them for many years.
What advice would you give to recent graduates of LSE?
There’s always room at the top. In particular, if you’re scrambling for an academic position, it may seem like it’s really, really tough. And it really is tough at the bottom and in the middle. But there’s always room at the top. Don’t prevent yourself from applying for positions which you might consider to be outside your league or too much. I was very fortunate in getting my first academic position at Johns Hopkins University’s School of Advanced International Studies. As a top institution, it had room for an economic historian. And that applies to jobs outside the academy as well. I think that the experience [at LSE], both in a different country and in a world-class institution, gives you a credibility that you might underestimate. Things are competitive enough out there without discarding what could be a comparative advantage.
You served as executive director for the Romanow Commission. Have we made any progress in the recommendations that you laid out in that report?
We’ve made some progress, but I would be the first to admit that it was the easier recommendations in the report that were implemented. The harder recommendations remain un-implemented. We remain somewhat stuck in Canada, and it will probably take a crisis for us to move ahead. But that’s the nature of public policy. It’s never easy, there’s a lot at stake, there’s a lot of people that benefit from the status quo, whether they admit it or not. And it’s very hard to make major change.
The cost of healthcare continues to be a problem for many provinces. With aging populations, there’s surely going to continue to be pressures on the healthcare system. How do you think we need to manage costs going forward?
This has been a perennial problem, and I dealt with this as a deputy minister in Saskatchewan before the Commission. That was one of the largest issues facing our government. If you don’t have a timely diagnosis or a timely referral, your costs will sometimes grow exponentially. So getting these things right, in terms of how the services are actually organized, administered and delivered, is pretty critical to keeping costs down. Then on top of that, you have to ensure that you’re not encouraging perverse practices by the way in which you pay doctors. For example, forcing patients to come in, rather than giving them a quick phone call, because it’s not on the fee schedule. Those sorts of things. The cost to the system would decline if you properly structured that.
You’ve spent a lot of your career thinking about healthcare. Do we have a social responsibility to our fellow citizens to provide healthcare to everybody? Is it a right?
I feel that it’s a right for two reasons. It’s a right on moral grounds. It should be a right and a social service on the basis of the evidence as well; the positive impact that this one policy has, that universal health coverage can have on population health, and what that means for economic growth and everything else. It’s become a habit here to think of healthcare as a right. It’s not really thought through, but it’s also precarious because it is not really a fully protected right. It’s something that can be easily removed. It may be very popular, but if you have the right configuration of governments in this country it could be ended too. So people should think it through and understand what life here might be like without it.