Person A: Knock, knock
Person B: Who's there?
Person A: John...er...Don
Person B: John...er...Don, who?
Person A: Don Drummond, it's my turn to create a crisis!
Whew, what a ride this whole Drummond frenzy has been! Starting months ago speculation began on what the report would contain. Groups gathered from all sides of the table to discuss the possibilities, fear set in when trial balloons were floated with severe austerity measures and huge cut backs, and now here I sit after a night of reading, tweeting, debating and trying to follow all the media at once with a desire for reassurance. Is Ontario really drowning in debt?
Thank goodness for the clear-headed CCPA and friends and colleagues who are able to put everything in perspective for me. No Adrienne, Ontario is not drowning in debt "the current accentuated sense of "crisis" over provincial debt is misplaced, and is being used manipulatively to justify unnecessary austerity".
Drummond recognises that his austerity measures come on top of already reduced spending:
Spending growth has slowed in recent years. In 2010-11, the latest fiscal year, health spending expanded by only 3.7 per cent, its lowest annual rate of growth in a decade.
What Drummond fails to point out is that the lack of spending has hit Ontario particularly hard. Ontario now falls second to last on hospital beds per person and on per capita spending (see my blog here for more details on the state of ON's health care), 36,000 people are on waiting lists for long term care beds and many will be forced to live apart from loved ones due to bed shortages.
However, Drummond starts of his health care recommendations outlining the need for a dramatic cut in expenditures. One that would take us from an already low budget of 4.9 per cent to an even lower 2.5 per cent!
Drummond at length talks about how expensive the system is getting (citing numbers from private sector care) and yet, doesn't separate publicly delivered health care expenditure from privately delivered health care expenditure. Those of you who have read my blogs before will be all too familiar with these numbers but again, public health care has remained stable at 5-7% of GDP for over three decades! Private health care is the major driver of health care prices and is increasing rapidly at 7.5-12% per year! Drummond points out the cost of drugs (private), eye care (private), dental care (private) are all major cost drivers, but then he actually recommends that we increase private delivery of services....(insert rewind sound here) what?!
He recommends deep privatization that expands across home care, long term care (although he wants that eliminated, but more on that in a minute), for-profit stand-alone clinics (the example given is the Kensington Eye Institute), to name a few. Drummond tries to calm us by suggesting that these privately delivered services will continue to be paid for by government...meaning you:
"As long as government remains the payer for all covered services, it should allow for a role to be played by both the public and private sectors" and "services could be provided by private, for-profit entities, but operated within the public payer system."
But as we've shown time and again, these services are more expense and offer less quality. You might not be paying for them out-of-pocket, but you are paying for them through your taxes, so really, who's winning here?
If you add the profit incentive to health care delivery something has to be cut to make a profit. Often it's quality of care, but sometimes it's also refusing service to patients, especially chronic care patients, who aren't making you any money (this is often referred to as cherry-picking).
Cherry-picking or "activity based funding" is something that Drummond has no problem with. In fact, he encourages hospitals to cherry-pick by incentivizing some surgeries over others. In urban areas this is upsetting enough, but in rural areas where there is only one hospital, who do you think will get priority status, the $2000 surgery or the $20,000 surgery?
The recommendation to scrap long-term care facilities and only focus on home care is one that concerns me. Drummond does not provide a lot of detail except that home care services should be delivered on a for-profit basis and should rely on community services (also likely private, for-profit). Without any more detail it's hard to tell exactly what home care would look like. If there aren't any more long-term care facilities are families and communities expected to take on looking after a loved one when no home care services can be provided? In the current system people are allotted a certain amount of hours of home care per week, if there meets cannot be met within that amount of hours, then people are often asked to discuss alternative arrangements such as LTC. If LTC isn't an option, what will the impact be on Ontarian families?
Drummond spends several recommendations on hiring practices and setting up advisory and stakeholder panels. But in many of these recommendations he forgets to include citizens and patients...I guess like how he forgot to include civil society in consultations before this report was published... It needs to be recognised by Drummond and the McGuinty government that those who pay for the services (us) deserve to play a meaningful role in their planning.
Prescription drugs are also the subject of several recommendations. Drummond recommends not covering drugs for people over ages 65 instead tying drug coverage to income. He also recommends the McGuinty government conduct drug to drug comparisons or push the Federal government to do this. Yet, Pharamacare, a solution that has been proposed since universal medicare debates first began would not only save Canada $10.7billion a year, but it would cover many of these recommendations on drug-to-drug comparisons, bulk purchasing savings (with much more bargaining power than the province of ON alone could have), and there would be no need to cut off those over the age of 65 because it would provide universal coverage!
Overall this report is what we expected. It starts by scaring people into believing the health care is unsustainable because it doesn't break-down the public and private costs to show that public health care is truly very sustainable. Then it recommends deep privatisation of services only to "reassure" you that it's coming out of your taxes and not your pocket. Lastly, it offloads a lot of patient care and responsibility onto families and communities.
Capping the health care budget at 2.5 per cent means severe cuts to health care. To-date there has been no discussion with civil society prior to writing this report. There is little in the way of long-term impact assessments for many of these recommendations and even the cost-analysis (the justification for this report) is often vague or missing. What did Ontario spend $1500 a day for?! The solutions to health care have already been prescribed by many academics, health care professionals, and research institutes and they are backed by evidence. Drummond can keep on drummin' but not with our tax dollars.
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