Ontario treasurer Greg Sorbara's collage of spending priorities last week was more a bookkeeping exercise than a budget. While it was lauded for focusing on health care and lambasted for the reintroduction of health insurance premiums, it should have been praised or paddled for neither. From the right or left, the bombast that followed it was all diversion. What those shrewd if risky shifts in medical spending actually tell us is that the province has no clue how to address the real social and economic determinants of health. Instead, the budget continues gamely reorganizing medical delivery instead of engaging the government's fiscal powers to goose the economy toward a health revolution.
If politics continue this way much longer, it will soon be easier to find someone who remembers what chickens looked like before butchered parts were plastic-wrapped than to find someone who recalls what a budget looked like before its butchered parts were plastic-wrapped.
To get some perspective on the difference between a budgeting and a bookkeeping mindset, take a glance backwards to a typical budget from the days of Tory premier Bill Davis during the 70s and 80s. The financial reckonings of the Davis era were interventionist tools that assumed an imaginative weave between government spending and market innovation.
These futuristic budgets turned a wide range of distinct problems into a set of new opportunities that government assets could breathe life into.
Problems: Tens of thousands of teens wanted promising careers but weren't thinking of university; hundreds of new skilled occupations were opening up in fields as varied as pastry baking, undertaking and cartoon animation; tens of medium-sized communities wanted ways to keep talented adults and youth from drifting away to the big city.
Davis budget solution: Create a community college system and finance it with future sales and income taxes on all the new economic activities.
Of course, the logic and formula could also fail disastrously on occasion. Take the case of nuclear power. Still, Ontario's economic diversity and well-being today are legacies of Bill Davis-style budgeting, a political art form now threatened with extinction as a result of a fixation on the needs and fiscal orderliness of any one ministry.
Though Sorbara called his budget "the plan for change," the most obedient Liberal hack couldn't find more than five of the budget's 30 pages dealing in any way with interventions to shape or stimulate positive economic change outside of cost-pruning. And those five pages are studded with yawn-inducing Sorbarifics like "the strongest societies and strongest economies are rooted in modern, efficient and affordable infrastructure."
If Sorbara had produced a budget, it would have done more than review money in and money out for education and medical care while flatlining or cutting resource, agriculture, tourism, environment and community development ministries that might create new wealth or solve health problems in the population.
To bring the Davis formula up to date on a small scale, they might problematize as follows: Skin cancer rates increase as the ozone layer thins creating the need for more trees; global warming and smog increase as fewer trees absorb air pollution; school-age youth need active jobs to pay tuition and ward off obesity. And so on.
Possible Sorbara budget solution: The province will split costs 50-50 with cities and towns that plant trees providing shade and creating healthful jobs for youth that help pay post-secondary tuition.
Packaging problems and solutions across ministries and into the market economy works. Plastic-wrapping a health strategy inside the one government department that funds medical care is never going to create a modern or cost-effective health system, no matter how many ill people are sent to 24/7 doctors' offices instead of emergency rooms or how many ill seniors are sent to long-term care institutions rather than hospitals.
The Sorbara-style medical system will continue to soak up more than 50 per cent of public dollars, starving all the government departments that deal with the social and economic determinants of health. That is the real threat to equality of access to health care, not the introduction of individual premiums that has hogged all the attention in the non-debate.
To get to a place where people produce their own health through healthy eating, living and working takes a real budget, a political tool fast disappearing from sight.