6/1/11

Hudak PCs on health care: mysterious reforms and bigger shovels

The Ontario Progressive Conservative policy manual released on the weekend repeats their earlier promise to increase health care funding over four years. As noted earlier, this is actually a much harsher position on funding than has been the case and will mean more cuts in services, especially in the hospital sector.

But the PCs also raise some other points about healthcare. As on other issues, the promises are usually kept vague (but menacing).  Here are four not discussed earlier.

[1] "Patient centred reforms"

"We are committed to publicly funded health care for Ontario families. Everyone knows some change will be required to provide modern, sustainable care. The size and scope of our health system obscures the most important person: the patient. Care in Ontario is structured around forms, processes, long lines, and bureaucracy, when it should be built from the patient out. This is true when it comes to emergencies. It’s true when it comes to chronic diseases like cancer or diabetes. It’s especially true for people who have a mental illness who too often get lost in the system. We will introduce a series of patient centred reforms that make the patient – not bureaucracies, not administrators – the focus of our health care system."

Whatever on earth they have in mind in this 'series' of reforms, they are not saying -- at least not in their policy book.  But another round of health care restructuring is certainly in the wind. 

It's worth remembering that the last round of major health care restructuring (under the Mike Harris PCs) led to the  merger and closure of hospitals.  For all the Harris government's rhetoric, this did not lead to reduced spending on hospitals and health care – instead, there was a very significant increase in spending.

[2] Cuts in healthcare

"Whether in the Ministry of Health, hospitals, or Community Care Access Centres, there are savings to be found at multiple levels – savings that can go towards helping patients. We will reduce administration and reinvest that money in nurses, doctors, health care technology, and other frontline care."
Here, they make clear that they will find cuts in healthcare, but try to make nice by saying that the money will be reinvested in frontline care.  While the plan is kept very vague, it seems that the target is support services.

This is pretty much what hospitals have been doing for many decades: there has been a huge cut in the proportion of Canadian hospital budgets spent on hospital support services since the 1970s.  This has meant that CUPE members (who provide much of the support services in healthcare) are often the target of the cuts. And, it appears, they would be especially under attack with a Hudak PC government.      

Its worth adding again that such cuts have, oftentimes, proven disastrous for patients -- witness the cuts to hospital housekeeping services and the rise in hospital acquired infections, or the replacement of real food in hospitals by factory produced substitutes.


[3] Anti-immigrant sentiment

"To reduce health care fraud, we will require people who have the old red and white health cards to identify themselves and present another form of government-issued identification, such as a driver’s licence or passport."

Well they don't seem to want to actually say it, but like other parts of the PC program, this sounds like it is directed at immigrants. Who else could they be targeting?

Given that this is one of the few specific promises the PCs actually make on health care, you might think that they would at least claim that this is a major cost problem, or that  their plan will save a lot of money.  But they don't.  

I feel sorry for all the older people with the red and white OHIP cards who will have to frig about and remember to bring their passports when they go to the doctor.  

[4] Competition

"We will give home care users more dignity, more flexibility and more say in determining where they acquire these important services. They will be able to choose to stay with the provider they have now, or pick a new government funded home care provider who better meets their individual needs."
This will perhaps divert some from the main problems with home care -- a lack of resources and a privatized system.   But it won't resolve them.  Far from it.  


Implicit in this promise is the idea of competition between provider organizations for patients.  Instead of cooperation, integration, and the sharing of best practices, we get competition, secrecy and commercial confidentiality.   A cooperative, integrated system does not fit with a privatized corporate model, where the profit motive forces corporations to resort to competition, secrecy and commercial confidentiality.


In fact, we have already had quite a bit of competition through compulsory contracting out for home care services (the model is actually referred to as "competitive bidding").  The results have been very poor: huge turnover in staff, very bad working conditions, a lack of continuity of care, etc.   This model is so bad it that has been suspended for the last six years.  


Usually, if you dig yourself into a hole, the first thing to do is to stop digging.  The PCs want a bigger shovel.  



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