Rivers: Is extra billing for health care services and opening the door to two-tier health care on the way?

“The legislation is being implemented before parliamentary debate has even concluded and prior to any public hearings. The government created the Super Agency. It held its first secret meeting. The government dissolved the Boards of 20 existing agencies.

Yet the legislation has not even passed. Not only this but all public input and procedural protections that existed in previous legislation have been removed from this legislation which has been subject to no public consultation process prior to drafting.”
(March 18, 2019 – Natalie Mehra, Executive Director – Ontario Health Coalition)

Rivers 100x100By Ray Rivers

March 22, 2019

BURLINGTON, ON

 

I know what you’re thinking. If it worked for garbage why not provincial health care? Right?

Premier Ford’s younger brother Rob’s claim to his fame, besides his crazy antics which put Toronto on the front pages everywhere, was privatizing a part of Toronto’s garbage collection system to save money.

Ford waving

Bye bye local health care oversight.

So why not use the same tried and true formula with health care? Of course there is already substantial private sector involvement in Ontario’s health system, such as long term care, blood labs, and most doctors. Still, the opposition at Queen’s Park is convinced Doug’s plan is more privatization.

And that might account for why Ford and his team are busy willy-nilly disassembling and dismembering Ontario’s entire health-care apparatus. That and because those damned Liberals designed and implemented the system. Cripple the organization, create a crisis, then call in the consultants from south of the border to clean up the mess.

And they’ll tell you the other kind of privatization is the answer. That would be the kind that violates the Canada Health Act – extra billing for health care services and opening the door to two-tier health care. After all Mr. Ford seems to enjoy giving his middle finger to the feds when it comes to national programs.

The problem is we don’t know. And Ford is not telling. That might be because he doesn’t even know. Perhaps he hasn’t had time to put it all together, given it’s only half a year since the election, and re-inventing health care is not something you do in an afternoon. Then it could be the advice he’s getting from his crony, the guy with nearly a half-million dollar sole-source consulting contract, his old friend Dr Rueben Devlin.

Ford big grin

And how are we liking this government so far? Are we paying attention?

Christine Elliot - Super Health

Christine Elliott – Minister of Health

What we do know is that a super agency has been created, and everything is to be managed and controlled out of this super agency. Think of the irony, Ford the Marxist-hater building a Soviet-style centralized bureaucracy. Just about everything, including the world renowned Cancer Care Ontario has now been merged and lumped into this one oversized box.

The government has shut down the 14 local integration networks, the LHINs, which managed and allocated half of the provincial $60 billion budget among the competing demands from hospitals, long term and home care agencies. They will get their local budgets dictated from Toronto now.

There is mention of 30 or 50 voluntary regional health teams somewhere in the future to partly replace the LHINs. But it is anyone’s guess how they would work, given their limited roles. And it is hard to imagine how 30 administration units would be less costly than the 14 that have just been eliminated.

balls in the air

If the government drops a ball – who gets hurt?

No question there are a lot of balls in the air. And they’re going to stay up there for at least another three years according to Christine Elliott, the health minister. In the meantime, I guess it’s muddle through, the squeaky wheel gets the bed pan, and before you know it’ll be time to re-invent the system. That would take us to the next election and perhaps the next government.

‘Create a crisis’ was the marching song of the last PC government in Ontario. And it sure looks like create-a-crisis Mike is back in town, and back in charge, at least in spirit. Harris presided over the worst health care this province ever experienced. The longest hospital wait times in the country; cardiac patients literally dying in hospital corridors waiting for surgery; and cancer patients being bussed to Buffalo and Detroit for treatment.

According to the provincial auditor Harris’ restructuring efforts from 1996 to 2000, intended to bring common sense to the provincial health system, cost $3.9 billion mainly to lay off nurses and staff, close down local services, then rebuild them elsewhere. And his system savings amounted to only $800 million, leaving all of us in the hole.

We should be concerned and maybe even panicked at what is going on now, at how rapidly these changes are happening, at how little analysis has been undertaken, and at how little consultation has taken place. Even the official opposition seems overwhelmed, gob smacked or just sleeping. There have been no public hearings on any of these proposed changes or on the changes yet to come.

Ford staring

Rivers on Ford: “That might be because he doesn’t even know. Perhaps he hasn’t had time to put it all together, given it’s only half a year since the election…”,

There is no provincial program more important than health care. And that is particularly true for senior Ontario residents – those most in need of its services. It is the largest public expenditure item using up 40 cents of every tax dollar.

During the election campaign Ford bragged about how he was going to fix hallway healthcare by adding hospital and long term care beds. So far we haven’t heard of him doing any of that. Instead he is acting like God, creating a new universe of health care delivery out of the ruins of the one he is dismantling.

Mr. Ford may think he is inventing the wheel, but unless he is a miracle worker, he is just fixing what isn’t broken. He inherited a system with the shortest wait times and lowest costs of delivery per person in the country. He’d better not trash it.

Rivers hand to faceRay Rivers writes regularly on both federal and provincial politics, applying his more than 25 years as a federal bureaucrat to his thinking.  Rivers was once a candidate for provincial office in Burlington.  He was the founder of the Burlington citizen committee on sustainability at a time when climate warming was a hotly debated subject.   Ray has a post graduate degree in economics that he earned at the University of Ottawa.  Tweet @rayzrivers

Background links:

Ontario Health Coalition –    Elliott –    Toronto Garbage

Super Agency –     Regional Teams –      Cancer Care

A Sick Feeling –     Privatization –   Two Tier

Social Assistance –    Grifter Government –    No Consultation

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7 comments to Rivers: Is extra billing for health care services and opening the door to two-tier health care on the way?

  • Michael Hribljan

    I’m with Mr. White, allow the PC’s to get a plan in place then let’s assess the facts and details. This opinion piece uses speculation to cast fear, uncertainty and doubt. No one is arguing the health care is not important and it has be done well, however to suggest we cannot get better, suggesting it is “not broken”, is putting blinders on.

    There are thousands of stories out there, but I have witnessed first hand my father laying in emergency overnight, close to 36 hours fighting cancer because beds were not available as wards were closed.

    Nurses in the hospital were overworked and in my opinion doing one of the most difficult jobs, I have the highest admiration for people that take on this profession.

    At the same time hospital administrators are among the highest paid on the sunshine list with health care administrators occupying 9 of the top 20 salaries in Ontario.

    We have had excellent experiences with our health care system too, but that does not mean all is perfect and beyond improvement.

  • Fraser: aka D.Duck

    Ray you misguided Liberal spin doctor. You are using your political bias and hatred of anything non-liberal too cloud your perspective. Health-care is about the patient and not about frail narcissistic egos of your (or any) Political party.

    “Of course there is already substantial private sector involvement in Ontario’s health system, such as long term care, blood labs, and most doctors.”

    This article is about Ford’s changing of the Health-care LHINs. So spin doctoring that “most doctors” are private maybe somewhat truthful if we include Dentists, Chiropractics, Naturopaths, rare Psychiatrists, Osteopaths, Optometrists, Phd Physiotherapist, etc. It is not TRUTHFUL if you are just talking about Medical Physicians who are public servants paid by the Province (taxes) though self-employed and regulated by the CPSO. I find your statement sickening and inflammatory and is analogous to the vile fiction and innuendos of the former Liberal MOH Hoskins.

    “That would be the kind that violates the Canada Health Act – extra billing for health care services and opening the door to two-tier health care.”

    Again, Political fear mongering. Your two-tier health-care implies a USA-like system which ‘No One’ in their correct mind would want. BUT a ‘Mixed System’ like most top ranked OECD European countries, should be model that Canadians strive for without re-inventing the wheel. A Mixed System does not equate to a two-tier USA system.

    http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm
    – Comparison of Canada universal health-care to other high-income OECD countries. Canada is significantly behind countries that are a “Mixed Health-care System” but better than the USA in health-care quality indices.

    https://interactives.commonwealthfund.org/2017/july/mirror-mirror/
    – CDN healthcare system is third last among 11 developed countries beating out France and last place USA according to 2017 study. Perhaps universal health-care needs tweaking into a Mixed System.

    http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/
    – WHO health-care ranking places Canada at number 30 out of 190 countries with Myanmar and Central African Republic being last and second to last. USA is #37.

    https://www.fraserinstitute.org/studies/how-canadian-health-care-differs-from-other-systems
    – Worldwide, Canada has one of the most expensive Health-care systems with significantly fewer Physicians and acute-care beds and with some of the longest wait times.

    “the guy with nearly a half-million dollar sole-source consulting contract, his old friend Dr Rueben Devlin.”
    Actually he is paid $348,000 but let’s round up to $500,000 dollars!! Assuming math was not your forte??

    “The government has shut down the 14 local integration networks, the LHINs, which managed and allocated half of the provincial $60 billion budget among the competing demands from hospitals, long term and home care agencies.

    http://www.auditor.on.ca/en/reports_en/en15/3.08en15.pdf
    http://www.auditor.on.ca/en/content/annualreports/arreports/en18/2018AR_v1_en_web.pdf
    – 2015 AG report with most recent AG report 2017.
    – 14 LHINs spend almost 50% of their operational budget on salaries and benefits in 2015 & 70% in 2017/2018.
    – Hospital administration cost should run between 4-6% of Hospital’s capital budget……..
    – After 8yrs in existence most LHINs performed below expected levels in 2015. On average, LHINs achieved 6/15 performance areas with the best at 10/15 and the worst four LHINs at 4/15. LHINs 2018 quality assessments still not available.

    “Harris presided over the worst health care this province ever experienced. The longest hospital wait times in the country; cardiac patients literally dying in hospital corridors waiting for surgery; and cancer patients being bussed to Buffalo and Detroit for treatment.”

    https://www.ctvnews.ca/health/63-000-canadians-left-the-country-for-medical-treatment-last-year-fraser-institute-1.3486635
    – 63,000 Canadians left for medical treatment in 2016.

    https://www.cbc.ca/news/canada/toronto/auditor-general-report-2017-healthcare-cancer-1.4435567
    – Dec 2017: AG finds 53 cancer patients went to USA at a cost of $35million dollars & that 15/17 types of cancer surgeries did not meet the 14day wait-time targets set by Ontario’s MOH.

    Who will ever forget the courageous Burlington Teen, Laura Hillier, who had to undergo unnecessary chemotherapy treatments because of long wait time for stem cell transplants….In July 2015, a letter was sent to Premier Kathleen Wynne and Health Minister Hoskins on behalf of Laura and every other patient subjected to the “cruel, inhumane and potentially deadly” waiting times for stem cell transplants.

    Premier Wynne cut health-care funding by 5% except in election years 2014 & her failed 2018 campaign. The term “Hallway Medicine” was born under Wynne’s reign. It was her failed voting buying 2018 election campaign that Wynne offered $3.3B for health-care investments in long term care beds, to expand OHIP+, Ontario hospitals, wait-time strategies, etc.

    June 2017: Released specific LHIN wait times:

    LHSC hip replacement surgery wait:
    • Provincial target: 182 days
    • Provincial wait time: 245 days
    • LHSC wait time: 317 days 

    • LHSC knee replacement surgery wait:
    • Provincial target: 182 days
    • Provincial wait time: 279 days
    • LHSC wait time: 389 days 

    “Mr. Ford may think he is inventing the wheel, but unless he is a miracle worker, he is just fixing what isn’t broken. He inherited a system with the shortest wait times and lowest costs of delivery per person in the country. He’d better not trash it.”

    Within a myopic spectrum you are correct. Most recent indices support that Ontario has significantly improved priority targeted surgical wait-times at the expense of other non-priority surgeries within Canada. I could not find any current studies comparing lower cost of delivery to hospital readmission rates.

    I applauded Wynne’s OHIP+ and even more so when Ford said it was only for those individuals without benefits. I applauded Wynne’s demand for long term care oversight, though it came at the expense of bed sores and elderly abuse/death. I applauded Wynne’s funding of timely cancer treatments though it cost the death of many until a very public outcry from the few.

    We need to do better! We need gov’t for the people by individuals who place Public Office over themselves or their party. Individuals who can tell the Queen/King that she/he is not wearing clothes without fearing repercussions. Ford is a bully but Wynne was no better, just vastly smarter. We need a Canadian Health-care plan that is universal with measurable quality indices across the Provinces. Not an individual Provincial plan that compares itself Provincially instead of internationally. We don’t need to re-invent the wheel. It just rolled past us as per OECD, WHO and even CIHI data.

  • Perry Bowker

    This is another example of the Wreck-it-Ralph style of the current government – break something totally, then reassemble the pieces according to whatever bias or grudge may appeal to the leader, and do it in stealth if possible. What many may have hoped for — some adult supervision from the cabinet — seems to be lacking. Instead we have formerly respected ministers announcing, with a straight face, that the brown muffins in the road after the horse has passed by are really chocolate fudge. And backbenchers deliriously applauding every burp and fart emitted by the leader. Sad state of affairs indeed.

  • Stephen White

    If the Liberals under Kathleen Wynne did such a splendid job improving the quality of health care in Ontario: a) why are the wait times in emergency rooms so long; (b) why do we still have patients waiting days in hospital hallways waiting to get rooms; and (c) given the amount of money funnelled into health care during the Liberals’ tenure, why didn’t they get re-elected? Maybe illusion doesn’t equal reality after all.

    Shovelling money at a problem doesn’t automatically fix it. Paying ever increasing amounts of money and bonuses to hospital CEO’s doesn’t guarantee health care improvement. What is needed are strategic and targeted investments. Having worked in the sector I can tell you the amount of waste, profligacy and duplication is beyond ridiculous. Truly, the only sensible health care improvement idea in the last thirty years was the formation of the CCACs, an initiative that came about under the Harris regime.

    The formation of the LHINs was ridiculous, and should never have occurred. All the Liberals did was take a function previously managed at Queen’s Park and created 14 duplicated structures across the province, all in the name of local control. Let’s also not forget the $2 billion George Smitherman squandered on the wonderful e-Health system, or the $1.2 billion that got blown on e-ORNGE.

    Before crying “Wolf” can we at least please see what Ford and Elliott come up with in the way of concrete plans or initiatives to improve health care delivery and administration, and then pass judgement accordingly? Admittedly, I’m no great fan of the Premier, and he has made some bone-headed decisions, but in fairness he at least deserves a chance to put forward proposals and to be evaluated on the basis of their merits.

  • Mike

    Given the cost of healthcare in Ontario (and it is only projected to grow faster than the economy), something has to give. Anyone who has worked in any of the organizations targeted can tell you of all the “red tape”, “turf management” and politic’ing by the various groups to keep and expand their domain of responsibilities and therefore budgets. This is what bureaucracies do. We need some bureaucracy to govern but ON’s has been in need of an overhaul for a long time. And yes, Cancer Care is one too. They do not deliver care – they set guidelines/best practices and fund some services.

    Remember the vast majority of our healthcare is already privately delivered (Hospitals and Doctors) but it is publicly funded. How we oversee that delivery and decide on what can be covered and what cannot, needs to be simplified and more focus put on delivery from the patient.

    If he they get us 2-3 steps in that direction it will be a great accomplishment. The McQuinty/Wynn governments made little progress in 15+ years and just tried to solve the problem by large financial increases to the health budget (2004 – 29.7B, 2018 61.3B). But as you note, things are no better.

    • Perry Bowker

      Let’s admit that the Liberals did make some progress, OK. Some elements of our system are world class, like Cancer Care, despite your remark. On the other hand, the LHINs were really just a firewall to ration out whatever money the gov’t was willing to provide. But what they did show was that local input is essential to deal with local problems – I lived quite a while in the North, where the LHIN was a major obstacle to dealing with the issues on the ground, and our MPPs just shrug because the LHIN was doing what it was supposed to: mash square pegs into round holes, or maybe just throw away the peg. So a sound strategy would be to get some facts on what is working well and preserve it, and redirect what is not. This means independent, non-political evaluators who will take some time to do the hard work. And then be respected.
      I also worked in IT for a long time, and I can tell you that solutions to some of today’s problems have been well known for decades, but getting them in place is impossible because of intersecting interference from all sides, especially politicians and bureaucracies of all stripes. Same reason Phoenix is all over the floor. That is when you do need to consider carefully, choose a path, and demand that everyone drop their favourite sacred cow and get on board. But there is no politician anywhere with the guts to follow through on that.

  • Phillip Wooster

    Sorry to disappoint you Ray but the socialist myth that Ontario has one-tier health care is exactly that–a myth! The wealthy can afford to go to the United States for care and treatment that for many conditions is the finest in the world and even if they choose to remain in Ontario, the wealthy and well-connected are easily able to “jump the queue”.

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