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Lerer: Toward Pragmatic Health Care Reform

November 9, 2011

The 2011 Ontario provincial election came and went seemingly without a word on this century’s most important topic. During Ontario’s 2011 Leaders’ Debate, Bilal Vakani asked party chiefs whether they would consider increased privatization in Ontario’s health care system. Andrea Horwath responded with evasive rhetoric about “putting patients first”; Tim Hudak took the opportunity to slam McGuinty on the decade old E-Health Scandal; Dalton McGuinty was the only leader to speak to the future of the health care system, stressing the new health care accords in 2014. Still, he did not speak to specific issues and ideas about how to make Ontario’s health care system sustainable, only saying that “exciting innovations [exist] inside [Ontario’s] public health care [system].”

Unfortunately, there has been reticence on behalf of politicians to engage the public on the issue of health care. Provincial politicians are racked by tremendous political fear concerning our health care system. One reason for their reservation is the complexity and enormity of our system – it is a difficult issue on which to address the public, and reform is a tough sell. More importantly however, health care has become iconic to our identity as Canadians. This is described best by Jeffrey Simpson, who argues that Canadians have come to define themselves politically by their healthcare system. As a consequence, any intentions to reform or adapt Canada’s health care system are akin to a direct assault on the Canadian political identity. In many ways, heath care has become the third rail of Canadian politics.

At the same time, a recent Nanos poll showed that the issue most salient to Ontarians is the future of Health Care. Ironically, however, we Canadians are woefully in the dark concerning how much the system costs, and what the consequences of increasing health care costs are for its consumers (us) and on other government services. What is worse, avoiding the political issue means allowing the dire consequences of increasing health care costs to be swept under the rug. In his upcoming book, Jeffrey Simpson explains how cost increases in health care are forcing provincial governments to cut costs in other departments. In Ontario in particular, these consequences are having drastic impacts on various government portfolios. Ontario’s lotteries and gaming establishment was originally intended to provide revenue streams for programs related to culture and recreation. However, through no fault of the provincial government, these revenues now must contribute almost entirely to the province’s increasingly costly health care system. Put simply, the largest issue facing Canadian provinces in the 21st century is the question of how provinces can manage their increasingly costly health care systems.

When Dalton McGuinty rose to power in 2003, strong intervention in health care was needed. The Ontario health care system was in shambles, with some of the longest wait times in Canada, low quality services, and millions of Ontarians without family doctors. Soon thereafter, Premier McGuinty negotiated a landmark Health Accord with Paul Martin in 2004. This accord set systemic targets and mandated the creation of the Canada Health Transfer (a transfer payment from the federal government to the provinces in the form of a lump sum) which has increased at 6% per year. Over the past 8 years, under consistent federal financing, the McGuinty government has achieved great results. Ontario now has the shortest wait times in the country; 1.3 million more Ontarians now have family doctors than in 2003; tens of thousands of new nurses have been hired over the past 8 years. However, this accord expires in 2014. Moreover, health care costs have been rising at over 6% themselves – leaving no room for growth. Indeed, the time to renegotiate the health accord is drawing near, at a time when a new set of health care issues are threatening to tear down our entire system.

Certain cost-cutting measures, widely touted as a solution to Canada’s rising health care costs are prevention of disease and promotion of healthy living. McGuinty was one of the first Premiers to create a Ministry dedicated to this ideal: The Ministry of Health Promotion and Sport. Formed in 2005, this ministry implemented programs like “EatRight Ontario”, which provided residents of Ontario with access to advice regarding healthy eating by registered dieticians. In fact, the Ontario Liberals have published a 20 page platform regarding their vision for a healthier Ontario, entitled “Ontario’s Action Plan for Healthy Eating and Active Living.” Although this portfolio has now been brought back under the Ministry of Health, these programs are still running, and are working first hand to keep Ontario’s health system manageable. At the same time, McGuinty has also instituted the first family health teams and nurse practitioner-led clinics in the country. His plan to enhance senior care by keeping them in their homes and out of intensive and long-term care facilities will both keep costs down and take significant pressure off of hospitals. These cost-saving techniques are exactly what the province needs if it intends to maintain its public health care system.

In addition to cost-cutting measures, Canada must simply spend more on its health care system. Today, Canada spends about 12% of its national economic output on health care; most of this bill is footed by the provincial governments. Even compared to the United States at 18%, Canada lags behind. In Ontario, Dalton McGuinty and the Liberals must provide a bulwark against a Conservative federal government which lists health care low on its list of priorities. The federal government must be urged to utilize its spending power to ensure that health care costs stay manageable. In this spirit, McGuinty must push hard for a new ten year accord which acquires increased, not sustained, funding. It is surely fortuitous that Tim Hudak was not elected to office, who, when pressed for an answer by the press, said that he was content with current funding and would not push for another 10 year accord.

If McGuinty truly wants to ensure long-term sustainability of Ontario’s health care system, he must push for an accord which operates on a cost-sharing basis, and hanker back to the days when the federal government paid their fair share of Canada’s health care system. Until 1977, this was how it worked – and the federal government footed the bill for 40-50% of provincial health care costs. Today, the Conservative government in Ottawa pays 23%. If Ontarians don’t want to see their public services being continually cut over the next decade, the ballooning costs of health care must become a shared cost in Canadian federalism.
Canada, and by extension Ontario, seem to pride themselves on their equity of access to their health care systems. It is about time we addressed the question of inter-generational equity.

The provinces are in need of a new health accord: one that will take some of the financial burden off of the provinces in the long term, and one that will be a stable and dependable facet of the federal experience. At the same time, the current system of health care is in need of a significant overhaul. The current machinery is unsustainable over the long term, no matter the funding. A 10 year agreement ensuring basic health care costs are met will allow provinces like Ontario to engage in said reform. Premier McGuinty has committed himself to this new 10 year accord, and has started the province down the right path toward health care innovation. However, much more must be done if we expect Canada’s public health care system to last well into the 21st century.

One Comment leave one →
  1. Junior permalink
    November 21, 2011 1:21 pm

    Good to see you guys producing new content daily like you promised. Oh wait…

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