Hard choices loom on health care

TheStar.com – Opinion – Hard choices loom on health care
November 03, 2008. Carol Goar

One of the unwritten rules of provincial budgeting is that medicare is sacrosanct.

Governments may warn that health spending is growing at an unsustainable rate. They may promise to rein it in. But they almost never do.

When the Liberals took power five years ago, they told Ontarians: “Health-care costs cannot continue to grow faster than the economy. This can only lead to the continued crowding out of available funding for other priorities.”

They vowed to curb the rate of increase in their first budget. At that time, Ontario was spending $28.1 billion a year – 38 cents out of every tax dollar – on health care. Today, the province is spending $40.5 billion a year – 42 cents out of every tax dollar – on health care.

The health budget has grown at twice the rate of the provincial economy.

The Conservatives were no better. On their eight-year watch, health spending grew at an average annual rate of 7.4 per cent.

This trend is not hard to explain. Until recently, there was no strong incentive for governments to hold the line.

* Revenues were pouring into provincial coffers faster than anticipated.
* There was no pressure from taxpayers to put the brakes on health spending. They wanted more doctors, speedier access to high-tech diagnostic equipment, shorter wait times for surgery and better – or at least newer – drugs.
* There was no advocacy group capable of competing with the powerful medical lobby.
* And the province’s population was growing and aging.

But now there is a compelling reason to exercise some discipline. Provincial revenues are declining sharply and Ontarians with pressing needs – parents raising their children in poverty, people with disabilities, citizens facing long court delays, residents of communities hard-hit by plant closings and pollution – are no longer willing to be sidelined.

Finance Minister Dwight Duncan took a couple of tentative steps to “manage expenditures” in last month’s economic statement. He delayed the hiring of 9,000 additional nurses and postponed the creation of 50 new Family Health Teams (group practices that bring together doctor, nurses, midwives, physiotherapists and other professionals).

But these measures will save just $53 million. Health spending is already $100 million over budget this year.

Moreover, there is no sign that the government has a plan to restrain the forces that are driving health costs ever upward.

Duncan’s medium-term fiscal outlook calls for a 5 per cent increase in health spending next year (to $42.4 billion) and 5.4 per cent the following year (to $44.7 billion.)

The province might have been able to afford such outlays in good times. But it is sliding into a recession.

There are four ways to handle this predicament.

The government can run up substantial deficits in the next couple of years, hoping to pay the bills when the economy strengthens.

It can raise taxes, as it did in 2004, despite Premier Dalton’s McGuinty’s public pledge not to do so.

It can cut spending in other areas – education, justice, social services – to accommodate the swelling health sector.

Or it can come to grips with the warning McGuinty delivered five years ago. “There will come a time when the Ministry of Health is the only ministry we can afford to have – and we still won’t be able to afford the Ministry of Health,” he told taxpayers.

This final approach would require more political courage than the government has ever shown. Few tasks are as difficult as rationing medical services. Few issues are as emotionally potent as health care. Few challenges are as daunting as taking on the province’s doctors, hospitals and drug providers

McGuinty wouldn’t get any thanks from voters and he’d get plenty of grief from medical lobbyists.

The safe course of action would be to trim medicare on the margins and offend as few people as possible.

The responsible approach would be to rewrite the rules of budgeting, making it clear that nothing is untouchable and hard times demand hard choices.

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