Defend Public Healthcare

Martin Cohn added some more today from his interview with Bay Street one-percenter Don Drummond who is developing  recommendations for government on public sector reform. And the news is not good. On interest arbitration (which hospital workers are forced by law to use to settle collective bargaining disputes) here is Cohn's report: Drummond discounts public-sector pay freezes because unions inevitably earn catchup increases down the road. But he is mindful of criticism by Hudak’s Tories that a broken arbitration system needs reform: “Broken might be a bit strong, but I will definitely be making some recommendations for change.”  Arbitrators should reflect private-sector wage trends. But they are wrong to think government can easily meet pay demands merely by raising taxes: with labour costs ranging from 50 to 80 per cent in some sectors, arbitrators must take account of deficit constraints and the lack of additional tax room. Private sector union wage settlements have been

Don Drummond says his Commission on public services in Ontario is spending 40% of its time on  health care “structural redesign”, Martin Cohn at the Toronto Star reports.    Drummond adds,  “We do not even have an integrated health care system”.    "Structural redesign" and more "integration" could mean a lot of things, but it sure sounds like he is contemplating more restructuring of health care employers.  Proposals to move money out of hospitals are also  possible (and perhaps even privatization  -- although Drummond was told not go there).  Drummond claims his reforms will be more 'strategic' than past system redesigns that failed.  But the Mike Harris government also tried 'structural redesign' of the health care system.  Ultimately the costs of the Harris redesign went through the roof, many of the the plans to shutdown or merge hospitals were abandoned, and the Harris government began providing funding increases to hospitals again.

The austerity sweeping the developed world is now hitting the elderly in nursing homes: Cuts to US Medicare will lead to 20,000 layoffs in nursing homes according to a new survey of home operators. Another 20,000 jobs will be lost to foregone expansion plans. A new regulation cuts Medicare payments for therapy received in nursing homes by an average of 11.1%, reportedly .  Alliance for Quality Nursing Home Care President Alan G. Rosenbloom warned that further funding cuts on the table could spell disaster for nursing homes. Catalonia, one of the richest regions of Spain, simply ceased payments to care homes for the elderly and mental health clinics last week due to 'cash flow' problems. The government says it is a temporary measure, but a union representative says "We don't understand how the Catalan government, at a time of funding difficulties, can have concentrated these measures on one of the most vulnerable sectors in Catalan society."  These steps &q

A report from the Canadian government suggests  that union density (of non-agricultural, paid workers) went up over 30% again, hitting 30.8% in 2010, up from 29.9% in 2009.  As well, union membership hit a new high of 4.645 million, almost 600,000 more than in 2000.  That's the good news.   The bad news is that the increase in union density is a one year break in a long decline from 32.2% density in 2000.  Moreover, the increased density in 2010 mostly reflects a shrinking workforce, occasioned by the poor economy.  If the workforce had even stayed the same in 2010 as in 2009, the density would be only 30.2%.    Union Membership in Canada, 2000–2010 Year Union Membership (000s) Civilian Labour Force* (000s) Non-Agricultural Paid Workers* (000s) Union Membership as a Percentage of Civilian Labour Force % Union Membership as a Percentage of Non-Agricultural Paid Worker % * Statistics Canada, The Labour Force Survey, Labour Statistics Division 2000 4,058 15,

Last week, the government announced that it would renege on its election funding promises. Now Dwight Duncan is making more noises about what this may mean. Here's some of his comments to the Toronto Star : The Ontario government faces "very difficult choices" as it moves to limit spending increases to just 1 per cent, warns Finance Minister Dwight Duncan. ... Duncan said his fall economic statement the week after next would signal the belt-tightening that looms ahead as the Liberals strive to eliminate the deficit. "Traditionally, fall economic statements are about updating the numbers for the last budget. We're going to do that, but more importantly we're going to start to lay the path towards the next budget and the sorts of decisions that we are going to need to take in order to stay on target for our balanced budget (in 2017-18)," he said."Those inevitably will involve some very difficult choices."  Duncan told a busines

The Ontario Hospital Association has released  a report entitled,  OHA Position Statement on Funding and Capacity Planning for Ontario’s Health System and Hospital s.  After discussing various reforms in health care delivery, the seventh and final point deals with "options for addressing labour costs". The OHA argues that there "are limited options available for meeting very ambitious expenditure reduction targets in a compressed period of time".  To maintain service levels "consideration will have to be given to finding ways to restrain the growth in the prices paid for labour". The OHA argues that this area "will need to be explored particularly if there is little choice in making rapid and substantial funding cuts".  To their credit, the OHA recognizes that such changes "may not create long term or lasting savings" but states that other changes may not solve immediate funding pressures.  "Given the very high level of effici

The new  National Health Expenditures Trends   notes that the administrative costs arising from private sector funding are now more than three times the administrative costs associated with public sector funding (p. 31): In 1975, administration accounted for 2.9% of total public-sector expenditure and 2.5% of total private-sector expenditure. The public- and private-sector trends differ over time. While the share gradually declined in the public sector to 2.0%  in 2009, the private-sector share has risen to 6.2%. The increase in private sector administrative costs appears to coincide with the increased role of private health insurance  discussed earlier .  That makes sense.  Private insurance incurs administrative costs while the other main form of private payment, 'out of pocket' payment, incurs very little. The more private insurance, the more administrative costs. Just like the USA.