Cuts, make that squeezes, to Ontario’s health care spending were an inevitable part to this week’s provincial budget – it’s the single – largest cost center. Don Drummond’s report called for it. Cabinet ministers hinted at it, especially in reference to wage restraint. The outcry, particularly from public sector unions, was equally predictable. There are no cuts, however, only a reduction in the pace of spending increases. Last year, health care costs were up 6.5 per cent. This year, the goal is 2.1 per cent. Spending will still go up, to $48.7 billion in 2012-2013. Exactly how the reductions will be made is still up in the air. Physicians will certainly be asked for wage freezes, at the very least. The budget contains some of the usual vague language about efficiencies and new funding models, but few details. However the savings – if savings they can be called given that costs are still going up – come about, they’re long overdue. Health care spending has been outstripping inflation and economic growth for years, an unsustainable situation.
Whatever Premier Dalton McGuinty’s government comes up with, however, will only be tinkering at the margins. He, like all other politicians, has no stomach for the conversation that’s really needed, namely the huge amounts of money spent on what could be deemed marginal cases: extending end-of-life dates of the seriously ill by weeks or months, often with the elderly and those with terminal diseases. Also on that list, with some crossover, are expensive drug therapies that provide little extra benefit and the payment structure for doctors that tends to reward interventions, no matter how useful, over preventative medicine.
Some of those points easily lead to the death panel hysteria seen with Obamacare debates in the U.S.
Even without that kind of hyperbole, some will argue that the system shouldn’t be rationing services like that, perhaps deciding who lives and who dies. Fact is, however, that we already do that. There are waiting lists, it can take ages to see specialists and patients are prioritized based on their conditions.
Then there’s the issue of prevention versus emergency care, somewhat touched on in the budget. Advocates of reform have argued for years that we’re better off spending money upfront to prevent illness – promoting healthier lifestyles, smoking-cessation, obesity-avoidance – than to essentially bail people out of the poor health choices they’ve made all along by pumping much more cash into acute care at the end of their lives.
Unable to make basic cuts, or even compensate for the billions wasted on the likes of eHealth and ORNGE, the government is certainly not going to consider, let alone make the tough decisions. Much easier to keep on spending, putting off the issue until the crunch comes … ideally long after someone else is in office. But just like pension reform, changes must be made now to avoid crises later.
And the fewer crises the better, as they are invariably used by anti-government organizations, typically on the right-wing, as an excuse for changes that benefit the few at the expense of the rest of us. Every boondoggle and every mismanaged situation serves to undermine the legitimacy of government, in turn opening it up to the threat of would-be reformers. Ontarians suffering from tax fatigue and becoming fed up with the exorbitant cost of public sector wages, benefits and pensions, could easily reach the breaking point, becoming willing to cut off their noses to spite their faces.
With that in mind, public sector unions already moaning and complaining about the budget would be wise to shut their mouths, duck their heads and prepare to give back after years of overly-generous contracts from the McGuinty government. Many of the jobs could see wages cut in half and still have a long line of people waiting to take them: remember, inclusion on the sunshine list puts someone in the top five per cent of wage earners, and represents more than twice the average income.
Given that wages make up more than half of government costs, serious rollbacks would be an enticing way to deal with deficits. The public appears poised to go along with that line of thinking.
And the sentiment isn’t contained just to the province. The federal government plans employment cuts to its civil service, with no public outcry. Municipalities, too, are ripe for an overhaul. As a recent piece in the Waterloo Region Record notes, spending driven by wage increases has fueled huge property tax increases locally even as real-world incomes have declined in the last few years.
Local politicians interviewed trot out the old chestnut about everybody wants services to continue not face cuts. Costs increases because they don’t contain them. They also have no appetite for making tough decisions: it’s much easier to say yes. In reality, there are supporters for every program where money is spent, no matter how few people are served – see the extension of bus service to Woolwich, for instance.
Politicians must learn to say no, learn to sell the benefits of not spreading resources so thin such that many things are done but done poorly. The current cast of characters at all levels can learn to do that, or be prepared to make room for those who can.