Doug Ford hasn’t revealed a plan to dismantle public health care — or one to fix it

Posted on August 20, 2022 in Health Delivery System

Source: — Authors: – Politics/Opinion
Aug. 19, 2022.   By Martin Regg Cohn, Political Columnist

There’s no need to contrive a crisis in health care when the system seems constantly in distress, Martin Regg Cohn writes

They say a crisis can be an opportunity.

So is Doug Ford deliberately creating a crisis in hallway medicine merely to conjure up an opportunity for privatized health care?

Recall that a previous Progressive Conservative government, headed by Mike Harris, stoked a crisis in education that triggered strikes by teachers. Those tactics — caught on tape — helped the Harris Tories implement their controversial “Common Sense Revolution” decades ago.

Today, there is no secret tape showing the current premier repurposing the Harris playbook. Then again, there’s no need to contrive a crisis in health care when the system seems constantly in distress no matter which party is in power.

Cries of hallway medicine echoed through Ontario’s hospitals during the last two election campaigns, with much finger-pointing but no politician truly pointing the way forward. During their first four years in power, Ford’s Tories sent mixed messages about downsizing, upsizing, rightsizing and privatizing.

This week, they unveiled the broad outlines of a new strategy to restore stability, grandly if embarrassingly entitled “Plan to Stay Open.”

Little wonder the premier and his new health minister, Sylvia Jones, inspired a mixed reaction. On Ford’s watch, hospital hallways are increasingly overflowing, wait-lists are longer, emergency rooms are closing, nurses are quitting, COVID is coming back and flu season is looming.

Now the focus is on freeing up hospital resources by reducing backlogs andblockages.

That means moving more scheduled surgeries outside of public hospitals, including to private clinics — raising suspicions of stealth privatization.

It also means moving out patients with chronic (or complex) ailments more rapidly into long-term care where they belong — even with temporary placements until landing in their preferred choice. The idea is to reduce the burden of so-called “bed blockers” who often linger for long periods in overcrowded acute care hospitals, waiting for spots in a highly sought nursing home or specialized facility.

Critics fretted that the elderly would be railroaded into unwanted facilities away from friends and families, even if only in the short term. Others feared that for-profit clinics would undermine public health care.

Yet leading voices in the hospital sector — some of whom have criticized past PC government decisions — saw the beginnings of a pragmatic response to a system that needs to try something untried, rather than doing more of what has always been done in the past.

So is this government determined to dismantle the edifice of medicare in order to rebuild it around the pillar of for-profit medicine?

On the early evidence, there is not so much a master plan as there is a lack of planning by this government.

Jones was initially invisible and now seems inscrutable. She failed to persuade the public or reassure the sector that she has serious solutions mere weeks after taking the job in June.

Ontario spends a staggering $70 billion a year on health care, a sprawling sector that has a life and death impact on 15 million Ontarians. Past governments of every stripe have long feared creeping costs would soon soak up half of the provincial budget, and so they constrained spending — until panicking and resuming unrestrained growth.

The province’s politicians have closed hospitals only to reopen them. They have let nurses go only to hire them back. They have reduced medical enrolments only to expand them again.

When Dalton McGuinty defeated the previous PC government in 2003, he promptly delisted numerous OHIP procedures as medically unnecessary — diverting many patients into private clinics. His Liberals also targeted surgery backlogs and made significant headway — thanks in part to privately runoperations that provide publicly funded OHIP services.

The latest crisis predates the pandemic, thanks to an especially virulent flu season just before the 2018 election. The resulting overcrowding caught the governing Liberals off guard, forcing them to reopen a hospital they had just shuttered.

The reality is that health-care delivery is a dauntingly complex operation that is hard to scale up while keeping up to date. The only certainty is that sticking to the status quo, merely because that’s the way we’ve always done things, won’t get us unstuck.

Cutting money arbitrarily — as Ford first planned in 2018, before backing down under pressure — would only make matters worse. Constraining future spending stealthily — as the Ford government seems intent on doing down the road by failing to keep pace with inflationary pressures — would only muddy the waters.

But throwing more money at medicare won’t fix the pressure points as our universal system falls further behind its foreign counterparts. Clamouring for cash from Ottawa is a Queen’s Park perennial that is entirely beside the point, because Ontario has enough tax points to raise any revenues it needs.

It’s too easy to get bogged down on jurisdictional and ideological debates. Federal transfer payments are a chimera, just as privatization is a panacea if not done judiciously.

As we grapple with OHIP’s growing pains, we must be guided by first principles. Medicare never proscribed the private delivery of services — whether by doctors, pharmacies or clinics — it merely prescribed the public accessibility of medically necessary services without extra billing.

Rather than fixate over privatization, let’s focus on innovation. And seek inspiration from health-care leaders who must point the way for politicians who keep pointing fingers.

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