Policy Monday: The Subtle Art of Keeping Folks Alive
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Policy Monday: The Subtle Art of Keeping Folks Alive

Policy Monday is a weekly feature during the lead-up to the provincial election where Torontoist will dive into the mean and gritty world of public policy, turning a critical eye at a specific area of the policies and machinations of the four major provincial parties.
Photo by Jay Morrison from the Torontoist Flickr Pool.
Saskatchewan may have given us Tommy Douglas, the father of Canadian medicare, but we in Ontario are a bit obsessed with our own health care—and no less so in our fine city. We live in a place where OHIP cards are as treasured as driver’s licenses and credit cards and where people love to laugh at Americans for their health care system, yet we also tell horror stories of excruciating wait times or poor service.
Health care is always a top-ranking issue during election campaigns. So what are our politicos going to promise about it?

McGuinty and the Gang

The Liberals have done a decent job with the health care portfolio so far. They’ve increased the amount of people with a family doctor, increased the number of nurses throughout the province, and have slightly decreased wait times. Of course, they’ve done this by instituting the very controversial Ontario Health Premium.
The Health Premium was introduced in 2004 while the McGuinty government was dealing with the post-Harris/Eves deficit. In order to make all of their health care-related (and other) campaign promises, they had to break their “no new taxes” promise and essentially tax everyone in the province with an annual income of over $20,000, all of it (supposedly) going toward health care. The premium has given the province a significant amount of cash, which has helped maintain and improve the system. Now that we’re in a surplus, however, some people are wondering why their paychecks are still being reduced. The Liberals have enjoyed having the excess money, and have said that they won’t be ridding us of the premium.
2007_09_23dualambulances.jpgMcGuinty has made the typical health care promises—pledging to decrease wait times for surgery and in the emergency room, to help more Ontarians get family doctors, and to increase the number of nurses in our hospitals. They want to make it so that 70% of our province’s nurses are working full time. Nurses are the backbone of our hospitals, and are some of the most valuable people in health care—making nursing a more viable career is pretty spiffy.
McGuinty also wants to create a provincial electronic health record by 2015. We’re a little concerned about the privacy of this sort of a record. Any electronic data is vulnerable to both hacking from the outside and improper use on the inside. A province-wide electronic record would make it easier for doctors to swap patient information, but we’re not sure how much we want the nerd we used to pick on in high school to be able to find out that we’re deathly allergic to powdered yams.
Prevention is worth an ounce of cliché, so the Liberals have also worked on a prevention strategy in the hopes that by urging people to lose their unhealthy habits, our hospitals won’t be so crowded. They’ve committed to cancer and diabetes prevention programs, but haven’t released many details about them—though we already know that they want to pay for HPV vaccines and prostate exams.
Obesity is under siege as well. The Liberals say they are going to start a campaign against child obesity, which will include legislation that will force school cafeterias to serve healthy food, tax breaks for parents with kids in athletic extracurriculars, and a PST break on bikes. This is a start, but the Liberals aren’t looking at all into revamping the sorry excuse for physical education we have in our schools. If anything would help kids stay fit, it would be fun, inclusive, and diverse gym programs.

Johnny and the Tories

The Tories really don’t trust the Liberals. In opposition, they wanted to make sure that the Liberals are spending health care money as efficiently as possible, and now they want the public to know that you can do more with less money if you spend it right. They’re so concerned about this that they even want to create university courses in cost-effective medicine. Their financial plan is to take advantage of our current surplus and gradually phase out the Health Premium (or as they like call it, the health tax) to show that our health care system can operate well without it. At the same time, they want to increase spending on health care by $8.5 billion over the next four years. No one really knows how this will work.
Tory does have a few interesting ideas. He wants to partner with the private sector to reduce wait times for OHIP-funded treatment, which would help alleviate the issue of queue-jumping. While not two-tier, this could creating an interesting (and possibly cost-effective) mix of public and private health care that (hopefully) wouldn’t exclude people based on income.
A lot of the Tory promises for health care are the same as the Liberals’. Like the Liberals, they also want more doctors, a 70% full-time rate for nurses, and a universal electronic health record. The Tories will allow people to opt out of the record, however, which could help alleviate some privacy fears.
The PC plan to fight child obesity contains a vague promise of “supporting daily exercise for school-aged children.” Hopefully this means daily exercise in a school setting, but it’s not quite clear. They also want to make sure that schools and community centres are able to have programs in the evenings and on weekends. This is a start, but a greater variety of after-school physical activities would also be a great help. What kid wouldn’t want to stay fit by going to a weekend Taiko class or by going to her after-school WarioWare league?

Howard Hampton and the New Democratic Super Friends

If you make under $80,000 a year, the NDP plan for the Health Premium isn’t too bad. They plan to reduce the Health Premium for middle-income earners, refunding $450 of it over four years. For low-income earners, it’ll be gone completely—though this isn’t much of a change. For people who earn over $150,000 a year, it’ll be raised by 2%. Corporate taxes will go up as well to make up for the lost income that used to come from low- and middle-earning families. This is a better plan for lessening the burden of the premium than the Conservatives’, yet it’s not likely to garner financial support from the influential or from corporate donations. Like it or loath it, both are needed to win elections.
Unlike the Liberals and Conservatives, whose plans for improving long-term care are lacking much detail, the NDP have promised to institute a minimum of 3.5 hours of hands-on care for seniors living in long-term care facilities. The amount of care time that many seniors get now is appalling, so a plan with strict goals is desperately needed.
Like other parties, the NDP has goals of helping speed along the accreditation of foreign-trained doctors and increasing the total number of doctors in this province. The NDP, however, wants our health care system to be 100% public—no private sector interaction at all. It might not be as cost-effective, but it’s more principled.
Finally, the NDP have also promised free dental care for low-income families, a policy that the Liberals have co-opted. Poor Howard.

De Jong’s Green Lanterns

2007_09_23ambucopter.jpgThe Green Party is all about prevention. A healthy environment or a healthy community, they say, is the key to good public health. They want to double the budget of the Ministry of Health Promotion, which is supposed to promote healthier choices and lifestyles among citizens. Like telling people to ride bikes and not eat fast food and stuff. Poster campaigns are nice, but more substantial powers or policy would be needed to get people to make healthier choices.
Like the Progressive Conservatives, the Greens are in favour of looking into private-public partnerships, provided that they are done with full disclosure to the public. They’re all about being cost-effective with our health care system. That being said, they also realize that people with lower incomes can’t quite afford the non-government-covered aspects of health care, and have pledged to provide the lowest 75th percentile of earners with $1000 to spend on prescription drugs, as well as procedures and treatments from any regulated health professional—including naturopaths.
Some of their more interesting ideas include bribing new family doctors to go to rural and suburban areas by offering them a refund of one year’s tuition for every year they pledge to work in an under-serviced area of the province and a promise to mandate that at least 50% of hospital board members must be health care professionals. These would be pretty amazing, actually. Health care workers know what it’s like as a grunt in a hospital and can run it accordingly. New doctors have a lot of debt and are needed outside of urban centres. Kudos to the Greens.
Finally, this week’s kind-of-out-there-but-kind-of-intriguing Green Party promise is a commitment to increase the funding of midwifery training by $10 million over four years, increasing the amount of midwives in the province. Midwifery’s coming back, and it’s not just for tertiary biblical characters anymore!
Top photo by DimsumDarren. Middle photo by Mr Kevino. Bottom photo by News46. All from the Torontoist Flickr Pool.