Headline writers may be wowed by the $41 billion announcement to fix medicare for a "generation," but really it barely amounts to a hill of beans. Spread over 10 years, the new deal adds $825 million in new money to Ontario health coffers this year, less than 3 per cent of the province's current health budget.
One way of looking at the prime minister's and the premiers' little deal is that they found a consensus on how much cash it was necessary to flash around to appease entrenched interests while giving the notion of motion.
The newly pledged federal monies to be added to provincial health budgets over the next 10 years won't restore medical service levels or reduce waiting times. Nor will it buy what former commissioner of medicare Roy Romanow called "transformative change" to steer health practices toward preventive medicine.
Listen for the sucking sound of that $825 million going to Ontario hospitals demanding $600 million to avoid drastic cutbacks, to Ontario doctors who've been stalling fee negotiations with the province until the feds coughed up and to nurses already lined up to bargain for overdue wage and shift improvements.
There's no mystery about how new funding for medical care gets spent or why new funding is chronically as good as gone the minute it's promised. The money follows entrenched groups with the power to exert what economists call "supplier-induced demand" or SID.
SID is what lawyers do when they write laws so only lawyers can understand them, what accountants do when they set up tax rules that only accountants can decipher, and what medical professions do when they control the gateway to health and we get medical financing that's just what the doctor ordered.
Licensed professionals have this knack for writing their own gold-plated full employment bills. When halls of justice dispense law, when education is about schooling, when transportation is about roads and when health is about medicine, governments and the public become dependent on licensed professionals who strong-arm the public for their now-necessary services. Nice work if you can get it.
There are virtually no economic counter-pressures to SID in the health field. Consumers lack the vital information needed to take their health dollars elsewhere and at any rate can't use medicare or drug plans to cover chiropractors, naturopaths or vitamin supplements. And the bracing winds of global free trade that ratchet down prices elsewhere don't operate well when people need neighbourhood caregivers and hospitals. Only inspired political leadership and high levels of public understanding can counter the pressures exerted by SID.
A cool look at where Canadian health care stands in the global setting (the figures are all there from a United Nations Development Program report released a few months ago) suggests that the crisis in Canadian health care that just had to be fixed for a generation in one set of meetings was either imagined or concocted.
The fact is, Canada is doing quite well. Canadians live longer than people in wealthier countries, including countries that spend more on medical care. We now enjoy 79.3 years, a nice add-on to the 73.2-year Canadian standard during the early 1970s. Infant mortality and child mortality rates are better than in wealthier countries, including countries that spend more on medicine.
And those rates have also improved since the 1970s. We did this with lower medical budgets and fewer doctors than countries that are wealthier and spend more private and public money on medical care. (It might surprise many to know that the U.S. spends exactly the same proportion of government money on medical care as Canada.) For over 30 years, we also kept public medical costs down more successfully than almost all industrialized and wealthy countries, a July survey released by The Economist showed.
We could have congratulated ourselves, then proceeded to calmly identify four trends that challenge our medical happy days. The first relates to the mass of boomers about to hit the age when chronic diseases associated (often wrongly) with old age take a severe toll, especially in an era when the right to live includes the right to live with recycled, reused, reconditioned, bypassed and transplanted basic body parts.
The second downward trend relates to the increasing toll of diseases, including many cancers, associated with environmental degradation - contaminated air, water, food and the like.
And the third relates to the decline in living standards and rise of McJobs, both linked to slow but sure declines in health status. The number of people living in poverty increased from 17 to 28 per cent of Toronto's population, for instance, in the brief time since 1981. That's a large group of people denied access to the means of health.
Then there are the economic powerhouses like the junk food industry, with vested interests in promoting behaviours that foster illness. A just-released survey from Cancer Care Ontario shows that a whopping 83 per cent of men and 75 per cent of women don't eat enough fruit and vegetables or exercise enough to avoid the three major preventable risk factors for cancer: poor diet, excess weight and lack of fitness. The trouble is doubled when it's realized that risk factors are similar for heart disease. Go figure how long $5 billion for reduced waiting lists for cancer, cardiac and other patients will last under that pressure.
Instead of keeping their wits about them by noting what's good in today's system and planning for new social trends, the pols got into a flap about waiting times, a bit like looking at the coming health crisis through the wrong end of the telescope. Waiting is traumatic and dangerous, but it's unwise to focus strategy on the issue since its an indicator, not a cause, of the under-resourcing problem.
At least five of the premier male decision-makers would've been accountable to a larger number of voters if they'd been elected mayors of bedroom suburbs on the outskirts of the GTA. Certainly, none of the premiers from Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick or Saskatchewan has the foggiest notion of what it is to manage health and social issues in multicultural cities with more than a few hundred thousand people.
These Mr. Fix-Its grabbed the money for medicare and ran, leaving the cupboard for urban social problems bare.