September 20, 2024

Is Doug Ford recklessly poisoning Ontario’s health-care system — or might he help fix it?

OHIP #OHIP

By selling out medicare, Doug Ford is going where no Canadian politician has ever gone. (Wrong.)

The premier is allowing private profiteers to reap the benefits at the expense of ordinary patients, who will now have to cough up their credit cards for basic care. (Wrong.)

The CEOs of Ontario’s biggest hospitals fear Ford’s Tories will destabilize the system, by draining off nurses and doctors who abandon patients in need — for greed. (Wrong.)

The worst of it is that our public system of medicare delivery is the best in the world, the envy of all Western nations. (Wrong.)

What is to be done?

We could start with a reality checkup. Each of the first four paragraphs above is demonstrably false — fear-mongering wrapped in gaslighting inside a red herring.

Monday’s long-awaited but utterly anticlimactic announcement that Ontario is expanding independent clinics — in order to reduce soaring wait times — will trigger the inevitable rhetorical ideological wars. In truth, we’re already doing it, and will now be doing more of it.

As with most medical questions, the context is complex:

  • The claim that Ontario is breaking new ground betrays a simplistic ignorance of recent innovations by other progressive provinces. By expanding the number of private clinics delivering publicly funded treatment in Ontario, Ford is following the lead of British Columbia, Quebec, and other provinces that have experimented with practical alternatives to hospital-based care.
  • The fear of for-profit operators exploiting desperate patients suggests a misunderstanding of medicare’s basic principles: It is a single-payer public system bankrolled by governments; but it is a multi-player delivery system buttressed by private colonoscopy clinics, stand-alone cataract clinics, chain pharmacies, contractor doctors and independent midwives who will deliver your baby in your own private home — far from not-for-profit hospitals. The NDP campaign slogan claiming you’ll have to pay your own way with credit cards has been repurposed by Ford into a guarantee that you’ll only need an OHIP card.
  • Critics allege new clinics will recklessly raid short-staffed hospitals for nurses and doctors. But staff shortages are cyclical, not conceptual; they raise questions of capacity, not ideology. Either way, temporary shortages are not grounds for permanent paralysis. The government says it will require personnel plans for any clinic expansions to preclude poaching. And if the threat is as overwhelming as some dissident doctors claim, why have so many (physician) leaders responsible for Ontario biggest hospitals and associations cautiously endorsed the government’s expansion plan? Perhaps they have a grasp of complexity versus simplicity in a system with so many moving parts.
  • The oft-stated and sometimes unstated premise of most critics is that Canadian medicare is so good it can’t be improved upon without imperiling patients. Yes, our universal, accessible system is free for all Ontarians, but it has descended into an unreliable free-for-all when patients discover hallway health care. Yes, Canadian medicare is fairer than America’s mess. But our system has never been the envy of the rest of the West, because universal health care across Europe has experimented with alternative delivery systems that keep patients healthy and happy, not just ideologically contented, at lower cost with better results.
  • Some critics mistakenly or misleadingly describe Monday’s reforms as unprecedented. What’s undeniable is the growing wait lists for common surgical procedures that undermine public faith in medicare.

    The last Liberal government obsessed over reorganizing the organizational structure of health-care delivery (remember LHINs?) while presiding over a critical decrease in hospital capacity. If we are short-staffed today, we were surely short-handed yesterday — thanks to an unexpected pandemic, yes, but a predictable surge in flu cases that predated COVID-19.

    The hospital overcrowding that led to hallway medicine helped bring Ford to power when patients gave up on the Liberals. Any fears that the system might now be destabilized are dwarfed by concerns that the system was already in decline — and falling behind other public, universal health-care models around the world.

    When critics fret that patients will face “upselling” from private clinics trying to extract more money, they forget that dermatologists already tempt people with cosmetic procedures that aren’t covered by OHIP — caveat emptor. Ontario already has significant private sector delivery and independent clinics, yet I don’t hear anyone demanding we shut them all down to purify our ideology.

    Under the latest plan, expanded cataract surgeries will come first; the next step will be hip and knee replacements, so that the province can walk before it runs. If these rollouts unravel, we can roll them back.

    The point is to experiment, empirically, rather than rely on a litmus test for heresy that is premised on a false history of health care in Canada. If not, the danger is that we will become so beholden to a contrived cult of medicare that we close our minds to the opportunities — and, yes, risks — of innovation and adaptation.

    We can’t afford to get bogged down in sterile debates about structure versus substance, or politics over process. Far better to figure out what works and what doesn’t, rather than fearmonger over what’s scary and what isn’t.

    I’m not brimming with confidence that the Ford government will succeed at what it tries, given its track record of failures in other areas. But I’m quite certain that doing nothing differently, given the shortcomings of the past, is not the way forward.

    Martin Regg Cohn is a Toronto-based columnist focusing on Ontario politics and international affairs for the Star. Follow him on Twitter: @reggcohn SHARE:

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