Will Brown’s words translate into action?
PC Leader says he’ll listen to doctors’ concerns
“There’s no monopoly on a good idea … I will support great ideas if they are in the best interests of Ontario ... I think most Ontarians, regardless of political affiliation, believe in fiscal responsibility.” PC Leader Patrick Brown
Canada’s unemployment rate dropped to 5.9 per cent in November. The 0.4 per cent drop was the largest one-month decline since 2005. The OECD predicted 2.8 per cent growth during 2017 — the highest of any G7 country. Yet auditor general Bonnie Lysyk maintained that Ontario’s deficit last year was $2.44 billion with a debt of $314.1 billion. Meanwhile, Bill Morneau’s fall economic statement predicted a deficit of $19.9 billion — double that promised in the Liberal election campaign.
Patrick Brown should be aware that at the October conference of health ministers in Edmonton, overlooked was ensuring the financial sustainability of health care. There is only one taxpayer. With deficits federally and in most provinces, fiscal responsibility means that we need to be creative and look for new sources of revenue. The solution is not simply raising taxes, demanding increased federal transfer payments, hiring more hospital and OHIP administrators, laying off more nurses, cutting back physician fees, or closing more hospital beds or cancelling more days per year of elective surgery OR time. Ottawa’s flawed immigration policies and Bill Morneau’s recent tax reform proposals will also likely exacerbate the problems of health care delivery. Let me explain:
As of late September, over 32,000 asylum-seekers had entered Canada; between January and August, over 13,000 were “irregular” — mainly into Quebec. On average, $15,000 to $20,000 per person is spent by different levels of government.
Consider that 280,000 Salvadorans plus others from Central America and Africa face possible deportation from the U.S. in the next few months. If many attempt to come to Canada, what will be the cost to taxpayers?
Moreover, certain provinces may bear a disproportionate increase in their costs for supporting these migrants, leaving a lesser amount in their budgets available for health care. Morneau’s targeting of small businesses is especially counterproductive. It is they that might provide jobs for many new immigrants to Canada, so that they do not remain a permanent burden on taxpayers.
If Morneau’s initial proposals remain minimally changed, some older physicians may retire prematurely, and some younger, mobile ones may reduce the number of OHIP-covered patients seen per week or even leave for the United States. Physicians remaining in practice will be pressuring their provincial and territorial governments for additional funds to compensate them for the loss of the financial benefits of incorporation. These scenarios are particularly likely if next year the provincial government overturns by subsequent legislation any binding arbitration agreement.
Premiers of the provinces and territories reluctantly agreed to accept a cut in the annual increase in federal transfers from 6 per cent to 3.5 per cent (plus some targeted funding). Sadly, not only does Ottawa cover only 22 per cent of public health funding, but it has “doubled down” and remains inflexible on enforcing certain parts of the Canada Health Act, especially regarding extra-billing and user fees. In so doing it is precluding provinces from permitting a limited amount of privatization that could make the health-care system more financially sustainable.
All of these factors will exacerbate the health care funding shortfall for most provinces. New sources of revenue for health care must be found. Clearly, the CHA needs to be modernized and amended, beginning with permitting medical tourism, e.g. expanding operating rooms and permitting Americans and other foreign patients to undergo elective surgery such as joint replacements here. This would provide employment for recent Canadian orthopedic graduates unable to obtain OR time and hospital privileges, to nurses, and other health professionals. It would provide badly-needed extra revenue to hospitals and ministries of health.
Ottawa seems blind to the funding crisis of provinces for which it is partly responsible. Health ministers should analyze how it is that many countries in Europe — with much shorter wait times than here — have been able to successfully blend a public and private healthcare system.
In his “Peoples Guarantee,” Brown pledges to spend an additional $1.9 billion over 10 years on mental health. He promises to “reduce hospital and emergency room wait times.” This presupposes that MDs are not dissuaded from remaining in Ontario. Very importantly, he will “treat doctors with respect by consulting them on future reforms to the health care system.”
We can only hope that these fine words will be translated into concrete action.
This should include a promise to honour any future binding arbitration decision, and a pledge to work with premiers and health ministers across Canada in modernizing the CHA and provincial legislation so that health care delivery is not only financially sustainable, but provides employment and fair remuneration to physicians, nurses, and other health professionals.