The Daily Exchange: What ever happened to health care as an election issue?

Health care is a topic that politicians fear. It has consumed over half of the provincial budget, and Ontarians continue to rank it as a top priority.

In the next decade, our population of seniors will grow by 43%. Chronic diseases, such as asthma, diabetes and cancer are growing. There is a whole segment of the population – the “sandwich generation” – who are caring for their parents as well as their own children.

Yet, it is remarkable that in this campaign there has not been a serious discussion on the future of our health care system. I conclude it hasn't been a serious topic because nobody's talking seriously about it.

The Ontario Liberal party has arguably tried the hardest of the three parties. The Liberals' plan on investing in a healthy renovation tax credit ($1,500 annually) and homecare at least begins to address our aging population. However, when Ontario Liberals talk about health care, they focus on statistics and their past accomplishments - they clearly haven't put health in front window.

We hear Premier McGuinty talk about the Federal health accord. And yes, as an Ontarian, I want him at the table when re-negotiating health funding with the federal government. But there is a lack of a serious discussion about the projections of our health budget reaching 55 per cent, 65 per cent, or 80 per cent of the provincial budget in the next decade.

The Ontario Liberals have been able to co-opt most of the historic centres of opposition on health care (specifically, the nurses' union) by having a solid record in the past eight years. But having a solid record doesn’t address what you are going to do in the future – it just buys you trust in the short term.

Worse, when the PC Party of Ontario talks about health care, it only talks about it from the perspective of waste (elimination of Local Health Integration Networks, eHealth). The party's messaging is focused on what the system is doing wrong, and in no way does it address how it will “fix” it. Further, the waste the PCs talk about is a fraction of the overall health budget. Their failure to do appropriate level of staff work during past two years at Queens Park is now costing them in their level of health care policy and debate.

The Ontario NDP platform just makes no sense. In a nutshell, the NDP would basically nationalize the home care/long term care sectors and associates no cost to it. Further, the party's reckless plan would build very expensive beds (remember it takes years to build new facilities) which patients will no longer want to go to in ten years – seniors do not want to age in “facilities," they want to age at home. They clearly know it makes no sense, which is why they're focusing on a poorly-defined executive salaries cap, which sounds good until you realize it will also apply to doctors and cancer researchers.

Ontarians deserve better on the health care debate. We are facing huge challenges in the years ahead on health care, particularly in terms of cost control, but there has been a surprising reluctance on the part of all three parties to engage on it.

In some ways, this is great from a campaign tactic perspective, but may be something the winner will regret down the road.

- Erika Mozes, former senior adviser to George Smitherman and Gerard Kennedy

 

Response from Guy Giorno, former chief of staff to Mike Harris and Stephen Harper:

When Erika said she was going to write about health care, I anticipated a rhetorical duel over the parties’ respective pronouncements and promises.

Instead, I agree with her thesis which (in my own words) I understand to be as follows: In this campaign we are not having a serious discussion about health funding, nor will we, as no politician is willing to confront the serious challenges facing our system.

By happy coincidence, the University of Toronto School of Public Policy & Governance, where I am a Fellow, is today co-sponsoring a roundtable discussion on the very topic of what will happen when the tax-transfer agreement expires in 2014. I believe there might still be a few tickets (they are free). In 1996, heath care consumed 31 per cent of the Ontario Government budget. The upward trend was obvious and many (including Mike Harris) warned that soon health spending would consume half the budget.

Despite politicians’ pious expressions of concern, nothing was done, until now  just as predicted  health spending consumes almost half the provincial budget (46 per cent). Economist Don Drummond projects that health spending will eventually consume 80 per cent of Ontario Government spending, crowding out other priorities such as education and law enforcement. Why would anyone believe that politicians (of all parties) who presided over the rapid rise from 31 per cent to 46 per cent will do anything to prevent an increase to 60 per cent, let alone 70 or 80?

One reason is that nobody is willing to pay the political price for fixing the system. The last PC government increased health care funding dramatically: from $17.8 billion to $26.1 billion. PC health spending went up and up and up ... And in an effort to spend those billions more effectively  that is, not to cut spending but to use the increased spending better  the PC government restructured the hospital system. This hospital restructuring now figures prominently in a massive union-funded ad campaign against Tim Hudak. (As I have previously noted, Mr. Hudak’s ability to respond is capped by spending limits, while unions running the attack ads can spend unlimited amounts.)

What’s the lesson of the Working Families Coalition ads? Spend more while restructuring the health care system and you will pay a huge political price. Little wonder that politicians just promise to spend more, period.

During the recent federal election campaign, the Conservatives promised to increase federal health transfers by 6 per cent annually. In fact, all parties jumped on the 6 per cent bandwagon. Never mind that during the last five years the average rate of increase in federal revenues has been less than one per cent per year, and revenue has recently been in decline.

In this campaign, the PCs are promising to increase health spending to record levels. They will certainly keep that promise if elected, just as Mike Harris easily kept his word after winning re-election in 1999 on a promise to spend record amounts on health care.

Keeping the promise to spend more on health care is easy. As evidence consider the last 25 Ontario Government budgets.

The Liberals promise to increase health spending by 3 per cent per year, leading to two questions: First, if he increases health spending by 3 per cent, and federal transfers increase by 6 per cent, what will Mr. McGuinty do with the rest of the money? Second, what’s the likelihood that the provincial government will actually limit health spending growth to half the increase in federal funding?

All parties pay lip service to reforming the system, but the claims are not credible. Take the NDP promise to reduce costs by extending government funding of prescription drugs. Right now the government pays about 40 per cent of drug costs (mostly for seniors and social assistance recipients), employer plans cover another 50 per cent, and the cash market covers the remainder. Does anyone believe that by assuming 100 per cent of the prescription drug market, the government will manage to reduce costs? That hasn’t happened in the parts of the health system that the government already funds at 100 per cent  nor in pretty much any other service under government control.

Spending more and more on health care: it’s the one promise that every political party can be trusted to keep.

Restructuring health care to make it more effective? Not in the sense of real restructuring. In health care, no good deed goes unpunished. Why would any politician take the risk?

 

Response from Jeffrey Ferrier, former communications director for the Ontario NDP:

Unlike my two colleagues, I actually believe there has been a good debate about health care in this campaign.

It hasn't been so much about health care delivery. This is because, despite Erika's attempts at spin, apart from the NDP's proposed clampdown on executive salaries, the policy differences between the three major parties' health care plans are, shall we say, less than dramatic.  

All promise new investment in health care, more doctors and nurses, and a focus on meeting the health care needs of an ageing population. All promise to focus on reforming the system and finding efficiencies to improve patient care and find savings. And no one is musing about turning things over to the private sector (though that is what Dalton McGuinty has already done with home care).

Where he have seen a good debate is on how we fund health care.

Voters in this election have two choices. 

The first, put forward by Dalton McGuinty and Tim Hudak, is that we should go ahead and give away $9 billion in no-strings-attached corporate tax cuts.

These are tax cuts that overwhelmingly benefit the people at the top, the corporate CEOs and executives who make more in three days than the rest of us make in a year.

We are told that these tax cuts will mean improved economic growth, greater prosperity and more money for the public services we need like health care.

What's the reality?

Corporations have used the billions in corporate tax cuts they've been handed in recent years to pad their already generous pay, not to create jobs and grow the economy. That's no help to sustaining health care.

And in big cities like Toronto, the gap between the rich and poor is growing, thanks in large part to corporate tax policy. The Toronto Community Foundation's Vital Signs report is out today. It finds that child poverty rates are up 40 per cent in one year. Middle-income neighbourhoods are projected to completely disappear by 2025. This growing gap has far-reaching impacts, including more pressure on health care. Again, this is not a good way to sustain health care.

Fortunately in this election, voters have another choice.

Andrea Horwath will roll back the blank cheques to businesses and replace them with targeted tax cuts to businesses that create jobs, plus investments that everyday families need, like better health care. I know there have been some hysterical arguments made in the last couple days by voices of the establishment, but it's worth noting to those who think the sky is falling that the NDP will keep Ontario's combined corporate tax rate below that of our closest competitor, to maintain our competitiveness.

Bottom line - Tax giveaways simply haven't worked. They aren't fair. They aren't smart. They don’t help us sustain services like health care. It's time to try something new.