We want more health care, but we don’t want to pay for it

TheGlobeandMail.com – Opinions
Published: Friday, October 22, 2010.   Jeffrey Simpson

A legislative committee in Alberta recently toured the province asking citizens about health care. The committee did not ask: Do you want more health care if it means less spending on something else? Do you want more health care if it means a provincial sales tax or some other form of increased taxation? Do you want less public money spent on health care so we can lower taxes or spend more on something else.

No, predictably, the committee asked only about health care, as if it were divorced from all other government spending. And, again predictably, most Albertans said they want more health care and more locally delivered programs, but they didn’t want to pay higher taxes to achieve these objectives. And if questions exist about the system’s future financial sustainability, the answer lies in squeezing more inefficiencies from the system.

A similar committee roaming around other provinces probably would have heard the same analysis. If you put health care all by itself in front of Canadians, they generally show great attachment to the system, want more, not less, have no idea what the impact of health-care spending is on the rest of the provincial budget, think greater efficiencies will solve all sustainability challenges, and definitely don’t favour higher taxes. All of which is a recipe for trouble ahead.

Remove health care from the silo into which politicians and citizens usually place it and, instead, put it inside a provincial budget, even in a province as wealthy as Alberta. This is what you get.

According to the last Alberta budget, the spending breakdown for Alberta in 1993-1994 was: health care, 26 per cent; education (kindergarten to university), 26 per cent; social services, 11 per cent; other programs, 33 per cent. Now look at what the budget predicts for the 2012-2013 fiscal year: health care, 42 per cent; education, 23 per cent; social services, 10 per cent; other programs, 24 per cent.

Put another way, over two decades, health care as a share of the Alberta budget will have risen to 42 per cent from 26 per cent, while all other program areas will have fallen as a share of spending.

Suppose the same spending trends continue for another two decades. At that point, health care would take 58 per cent to 60 per cent of all provincial spending, education would drop to 20 per cent and social services to 9 per cent, leaving about 10 per cent for everything else: roads, justice, tourism, agriculture, environment, policing, housing, culture and municipal affairs.

Is that what Albertans want? Is that what other Canadians want, since the broad pattern of health care’s growing while everything else shrinks is happening across the country?

Maybe it is. Maybe Canadians really want more and more money to be put into health care at the expense of everything else. In Alberta, for example, total spending from 2007-2008 to 2010-2011 went up 13 per cent, but spending on health care rose 21 per cent.

Judging by the legislative committee’s report, Albertans are comfortable with more spending on health relative to everything else, perhaps because the committee didn’t situate health care in the context of other programs. The committee recommended an Alberta Health Act, an Alberta Health Charter, an Alberta Health Council and more “team-based” primary care. What it didn’t do was suggest how to pay for its recommendations.

How about restoring the health-care premiums that the Stelmach government abolished? How about imposing a special health-care tax geared to income? How about a provincial sales tax of 3 per cent or 4 per cent, with all revenue drained into health care?

So Albertans, like other Canadians, dream on that more public money can be put into health care without finding new revenue sources, without adversely affecting spending in other areas. Very few politicians, it would appear, want to spoil the dream.

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