politics
Platform Primer: Health Care
Health care accounts for almost half of the provincial budget, and that number is only going to rise. Here's what the parties are proposing to do with all that money.
In the run-up to the provincial election on October 6, we’ll be comparing the major parties’ platforms on issues that matter to urban voters.
Health care is a portfolio that’s eventually of great interest to all Ontarians; while it’s all well and good to be transported or educated, being alive is what life’s all about. In 2010, health care spending accounted for 46 per cent of provincial spending, and that’s expected to rise to 80 per cent by 2030. Here’s a rundown on what your parties want to do with all that money.
Liberals
The Liberals don’t lack for self-esteem, and once again they get things rolling by congratulating themselves—18 hospitals built, 11,500 nurses hired, surgical wait-times reduced. It’s a nice picture, but not really an apples-to-apples comparison with non-governing parties, who might also have built hospitals if they’d had access to hundreds of billions in taxpayer cash.
The Grits then promise to do more of the same, making pointed reference to “revers(ing) the PC cuts and hospital closures by investing in new hospitals and renovating existing facilities.”
With that a given, we move on to the new stuff.
Firstly seniors, disproportionate consumers of health care, who have a powerful lobby and also have the time and the inclination to vote. The Grits commit to building on their Aging at Home strategy, designed to keep ailing elders out of expensive hospitals and in their own homes. (Note that in previous years, the strategy hasn’t seen the growth that was promised, in part because the health ministry diverted some of the funding to financially troubled hospitals.) Besides putting money into homecare for the those needing it, the plan would subsidize certain renovation costs up to $1,500 to make houses more accessible and allow seniors to defer property tax increases while they remain in their homes.
Put down that Whopper, son! Recognizing that chubby, chain-smoking kids become wheezing, heart attack–prone adults, the Liberals promise to get Ontario’s children on the health highway early. They’d put money into increasing healthy, local foods in schools and hospitals, and bump the Children’s Activity Tax Credit from $50 to $100 per child. They’d also start a Council on Childhood Obesity, which would look to reduce the childhood obesity rate by 20 per cent within five years.
As part of what they call “smoke-free Ontario,” the Liberals say they’d crack down on those who sell cigarettes to kids, whether they’re shady convenience store owners or smugglers hauling garbage bags full of smokes to playgrounds.
Finally, the Liberals promise to put more resources into mental health, an expensive and often overlooked issue, starting with kids and moving on to “prevention, early identification and services for adults” (although no money is budgeted for the latter until 2014).
All the new programs are costed at $237 million in their first year, which would buy a lot of tongue depressors but is still less than half a per cent of a health care budget of $49 billion.
Progressive Conservatives
The Tories start off with a bold statement—”It’s not about money”—and then prove that it actually is, saying that they’ll increase investment in health care by $6 billion in their first term in office. (Note: The Liberal plan commits to a similar bump; a significant portion of that funding comes from a six per cent annual increase in federal transfers that will have to be renegotiated before the current agreement expires in 2014. The feds are already suggesting that the current rate of increase is not sustainable.)
The PC health platform is couched in business jargon, full of buzzwords like “health outcomes” and “patient experience.” After sifting through tedious paragraphs of this stuff, we determined that what they’re saying is that people who run hospitals will be accountable for how well their hospitals work, which in turn will be measured by patient feedback and specific metrics like emergency room waiting times.
As part of a plan to bring down those waiting times, they would would be made available through Telehealth and online so when you get that shooting pain down your arm you can jump on the iPad and figure out which hospital is likely to get you from reception desk to defibrillator the fastest.
Like the Grits, the Tories recognize the economic, political, and social sense in expanding home care for seniors and say they’ll give seniors more choice in which home-care provider they deal with. It’s not clear what this means in practical terms, as seniors already have choices, and it may just be free-market bizspeak.
Conservative rhetoric in this campaign has leaned heavily on outrage, and the health care platform is no exception. They would scrap the Liberal-created Local Health Integration Networks (LHINs), which they deem “unelected, unaccountable, faceless bureaucracies,” and promise to take money from administrators and give it to doctors and nurses.
Tim Hudak also likes his law orderly, and vows to fight health-care fraud, in part by requiring people who use the old health card to provide government photo ID when seeing a doctor. Actually, why don’t we do this now?
NDP
Don’t tell Andrea Horwath, but NDP ambitions are pretty similar to those of their Conservative counterparts. Like the Tories, the NDP say they will reduce emergency room waiting times. However, while the former sternly invoke accountability as the solution, the New Democrats favour a kinder and gentler approach, speaking of “working closely with hospitals to address the underlying causes of backlogs and long wait times.” (Both descriptions are sufficiently general to be meaningless.)
More practically, the platform recognizes that more medical care upfront means fewer visits to the ER, and promises to invest in home care for seniors and 50 more family clinics. Specific types of support for the elderly would include chores like shovelling the walk, doing grocery shopping, and cooking meals (tasks presumably not performed by the NDP MPs themselves.) A New Democrat government would also work to spread medical expertise around more equitably by forgiving student loans for doctors willing to work in under-served communities.
Like the Liberals, the NDP propose programs to combat childhood obesity.
The NDP dislike the LHINs and would scrap them, speaking as one with their colleagues on the blue side of the House in railing against the organizations as “unelected, unaccountable bodies.”
Both Tories and NDP want to cut the fat, the case of an eHealth consultant who spent $7,800 on a trip to Japan being an example that everyone finds particularly offensive. The NDP, however, give a shout-out to their socialist roots by promising to cap hospital CEO salaries at twice what the premier makes.
Finally, the New Democrat platform is of the mind that all things health care–related should be free (to the user) and says they’ll work to eliminate fees, starting with ambulances. Next, they’d turn their efforts to increasing coverage for health care and health care–like costs such as eye exams, prescriptions, and chiropractic services.
Overall, the NDP propose about $221 million in new spending on health care.
Green Party
The Greens are on-side with some of the key ideas that everyone agrees with, notably promoting healthy living and illness prevention through exercise and diet and improving seniors’ access to home care when needed. They don’t directly call for junking the LHINs but hint at it with a call to “put communities back in charge of local health care decisions.”
More Green-specifically, they would look to create a healthier society by “paying landowners for producing healthy environmental goods and services” and “support(ing) the development of healthy, liveable, recreation-friendly communities.” (They would have their work cut out for them here, given projections that another 2 million people will cram themselves into the GTA in the next decade and a half).
Taking an easy slap at the Liberal’s eHealth woes, and proving themselves not hippie Luddites, the Greens also commit to finally deliver on electronic health records by using best practices from other places” (those places presumably do not include Japan).
Plan specifics are not costed, but their overall budgeting is similar to the other parties’.
The Upshot
Unfortunately, no party has summoned the moral courage to talk about That Which Must Not Be Named, which is to say “two-tier health care.” We’re already spending half our budget on health care; given an aging population, rising medical costs, and the fact that the economic demand for not being dead is unlimited, this is a conversation we should be having now rather than after things go off the rails.
In general, the Grits stand by their record and want to keep doing more of it, with some help for the young (lose weight! don’t smoke!) and some relief for the old (you get to live in your house instead of a crowded, spiritually toxic hospital ward!).
The Tories and NDP have much in common, except that the former use the language of the disgruntled capitalist, while the latter adopt the rhetoric of the indignant socialist. Both propose big gains from trimming waste, including LHINs, and both line up with the Liberals on senior home-care. The NDP however, are very up front about supporting the Facebook model of medical care (“It’s free, and always will be”), while the Tories—although they haven’t talked about it since 2007—may be open to a more libertarian approach.