Social Policy in Ontario

Immediately after that press conference, I spoke with Health Minister Christine Elliott to get her response. “The one thing I can agree with is that public health is vital. I disagree with the rest of the statement,” she said to me while I was guest hosting a program on Global News Radio. And then, as she and Ford and others in her government have done all along, she went on to disagree that in fact anything really is being cut at all.

Her government, she said, is “modernizing” the health system. To make it more effective. She went on an extended rant about the continued use of fax machines. “I think it’s a bit premature to be raising this alarm when the technical working groups haven’t even been set up yet,” she said, referring to the process she proposes to improve the system and make it cheaper to run at the same time.

But here’s the thing: as she says, the working groups haven’t even been set up yet. But the budget cuts, well, they’re here already. Retroactive, in fact.

As even the most conservative city councillors have said, the money that has been cut from the city’s budget — that the municipal government would have to scramble to replace to avoid program cuts — has a dramatic impact on the immediate term. The city can’t wait for a working group — it needs to rewrite it’s already-passed budget on the fly. It can’t go into deficit. It has already mailed the tax bills for the year. There’s no time to wait for a working group to form and do its work. No time to wait for Ford’s proposed auditors to do any detailed study and make recommendations.

Elliot disagrees.

“No, with respect to most municipalities, most public health boards, the changes are not that dramatic,” Elliott said. “I think that there’s a lot of misinformation that’s been put out there. A lot of fear-mongering. This is not something that’s dramatic, this is something that’s being done in order to bring public health into line with modern reality.”

Hmm. Not dramatic. Obviously it’s a matter of interpretation.

She told me that whatever arguments people are putting forward about numbers, “The commitment is that the province is providing the city of Toronto with $114 million for public health” this year. That may be good to hear as a commitment to a dollar amount, since previously expressing it as a matching contribution to the city’s has led to reasonable speculation the province could contribute less. But let’s go with $114 million this year.

Previously, the provincial contribution, by its own numbers, was $147 million. That’s a $33 million cut.

Let’s leave aside the other cuts to this year’s budget the province has also announced that the city has to make up at the same time. How “dramatic” is $33 million?

Well, when Rob Ford was mayor with his brother (the future premier) at his side, his government spent $3.5 million to commission KPMG to find cost savings. That report — which went through months of public hearings and the whole city budget process — identified savings of $16 million. (And almost none of it, TVO’s John Michael McGrath reminded us in an opinion column recently, wasn’t efficiency savings — it was stuff like library hours and water fluoridation. It further found that 90 per cent or more of what the city spends is not really up to the city’s discretion.

“Instead of automatically running to the idea of raising taxes, they need to sit down and do the hard work in the same way that we had to do provincially to make sure we can provide the services that matter most,” Elliott told me.

It’s very hard work. The Ford brothers weren’t up to the task: as I wrote recently, when the Ford brothers needed to raise around the same amount of money per year to fund debt on the Scarborough subway, they raised taxes.

It’s not a small number.

“The people of Ontario need have no concerns about how the public health services are going to be continued. I believe that they are very, very important as well, and we are going to make sure that we work with the public health units to make sure that the system continues to be strong,” Elliott told me.

“There’s no question that the essentials will continue to be covered,” she said at another point.

But how? What the mayor and even the most conservative city councillors and now former health ministers have been saying is that you cannot “modernize” things by simply immediately slashing budgets. When you stop paying for things, they tend to go away or deteriorate, not improve. If you want to actually get better “patient-centred care” and so on, as Elliott claims this is about, you have to work towards it.

It would seem to me that if you want to ensure the essentials will continue to be covered, you simply commit to continuing to cover them. But that’s the one thing so far that Ford and Elliott won’t do. They’ll chip in for yet another external audit to hunt waste. They’ll set up working groups. They’ll scold the city for being a free-spending bastion of lefties. They’ll complain about the deficit their predecessors ran up. But they will not commit to continuing to fully fund the programs they claim to want to continue and improve.

Tory continues to fight his public opinion war — and it seems as many as 83 per cent of Ontarians are convinced he’s right. The problem for Tory and the city is they’re running out of time for public appeals. At some point taxes will have to be raised, or programs will have to be cut. Despite what Elliott says, it appears those are the choices. Not good ones. But soon necessary.

Edward Keenan is a columnist based in Toronto covering urban affairs.

https://www.thestar.com/opinion/star-columnists/2019/05/23/ontario-health-ministers-modernization-plan-cut-now-figure-out-the-details-later.html