Ontario's Deficit-2009
Lots of talk about fiscal restraint by Ontario's Liberals. Too little, too late. When Smitherman was setting up his expensive Family Health Teams and spending oodles and oodles of cash to transform Ontario's health care system into a consultant-happy- bigger black hole than it was, people said "we can't afford not to do it!"--- A dangerous sign of things to come.
Our politicians stand before us and tell us that now is the time for difficult decisions (that time was long ago) but it is difficult to make difficult and possibly initially unpopular but necessary decisions when one's political life depends on telling people what they want to hear.
I will acknowledge that the Ontario Liberals are caught between a rock and a hard place and no matter what they do they will hear complaining from one camp or another. But at some point, it is important to do what is necessary. That doesn't look like it is coming any time soon since Dwight Duncan tells us recently that continued spending increases will occur in health care. Strange thing that comment since rapidly rising health care expenditures are what is driving spending in other necessary areas to be cut.
Alas, we are tied to the mast of the health ship that is taking every other sector down with it while politicians hold hands and will leap just as the going gets rough, just as they always do.
Definitely, I am sounding cynical today. The public is led to believe that health care is their God given right and they are soon to find out the repercussions of such thinking.
The leadership vacuum persists. There is no independent body to speak to the public with cold hard fact. Health Council of Canada does little if anything except spout the political health care dogma of the day persistently. Nope, no leadership there either. The OMA seems bound to government so tightly it can't breathe a breath of fresh air into the whole mess either. The CMA tries but will have difficult times ahead as its soon to come leadership may turn out to be regressive.
The media fails because of its largely left wing tilt and because it sees more payment and responsibility for individual health as evil--apparently better to keep us all dependent. But new media sources are coming on stream and the traditional private care hating journalists have probably had their day in the union sun.
At least in Alberta, politicians are trying to tell it like it is but the public denial may turn out to be too strong.
Perhaps the real catalyst for change will be a dose of reality, delivered to the public from non-health care related sectors.
Some facts, if you didn't already see them in the headlines today:
* Ontario deficit to hit 25 Billion-up sharply from $14.1 Billion in March
* Action plan to be revealed in 2010 (doesn't sound like action to me)
* Leaner and more efficient provider of quality public service to come (!!)
* Ontario is spending 4.8 Billion more this year than predicted
* Tax revenues falling dramatically- about 6 Billion less that predicted last spring
* Corporate tax revenue is about one third lower than predictions-2.65 Billion less (a hefty drop)
* Ontario's massive deficit is heightened by the growing size of the health care sector, expected to account for half the budget as early as 2015-Pascal Gauthier, TD Economics
*deficit budgets for years to come
* projected deficit of $21.1 Billion in 2010-2011
* projected deficit of $19.4 Billion the following year (wanna bet it will be more?)
*and how 'bout that eHealth spending, and hiding Tepper', McLeod's and Sapsford's funding deep in hospital budgets to top it all off?
The public may have to find out for themselves the hard way...just like my teenagers.
Merrilee Fullerton
189 Comments
Reader Comments (189)
http://www.healthcouncilcanada.ca/en/careers/Director%20AnalysisReporting%20HCC.pdf
The Health Council of Canada fosters accountability and transparency by assessing progress in improving the quality, effectiveness and sustainability of the health care system. Through insightful monitoring, public reporting and facilitating informed discussion, the Council shines a
light on what helps or hinders health care renewal and the well‐being of Canadians."
Really?
Ontario and Alberta have moved from high to intense category.
http://www.google.org/flutrends/ca/
A primary school teacher in Ottawa told me today a third of her class is away, but the school won't close because they will lose one day of funding?
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=didyk_profile_e
Well the plans are being draw up for cuts -we still have of course the 2 extremes - the GDPers who assure all that it is all fine and we've been through this before, and keep the spending going - and the doomsters - slash and burn now.
The middle seems to be winning this time.
Looks like cuts across the board and freezes everywhere. It's more than a 3 year run of big time deficits and we need to bring the spend down.
Biggest issue in health is that the policies put in place 3-4 years ago (which are all now suspect because they were put in play by persons now under suspicion as to their motives) are expensive to put into play. LHINs, WTAS, CCACs, etc all have big price tags. If Health and education are frozen (and take a cut in the big earners of 15%), and all other get a 5% reduction, we can pull the spend down by 6-8 billion. 25 billion over 3 years is a big amount of cash.
The more the restructuring takes place to make government look like it is doing something, the more difficult it is too know if more money is making it to direct care...there are so many layers now that it looks like puff pastry....no filling.
thanks for the update.
at the lhin level where I live, it appears there are rather extravagant ideas about how decentralizing services out into the community (in some very nice buildings I might add) is the way to go.....Hmmm. It seems that centralizing hospitals and closing hospitals was the flavour du jour and still is and yet somehow moving services to smaller community settings is going to save money. These two actions would seem to contradict each other or is it simply a case of taking the current existing situation and creating the opposite...whether it makes sense or not it will look like change is happening.
But with all of this it is increasingly difficult to follow the money to direct patient care. Interesting.
Hospitals in a public fight with doctors over work reform
October 24, 2009
Theresa Boyle
Health Reporter
In an unusual public battle, the gloves have come off between Ontario hospitals and doctors, with one group accusing the other of protecting its turf and obstructing reform.
At issue is Bill 179, which would let non-physicians do some of the work doctors currently perform. The Ontario Medical Association, the doctors' lobby, is fighting government plans to let nurse practitioners lead local health clinics and to allow pharmacists to prescribe some medications.
The Ontario Hospital Association supports the proposed changes and charges that the OMA is more interested in turf protection than in changes that would improve access to health care while allowing doctors to focus time and talents on more complex cases.
"The (medical association), in our opinion, has a recent history of being opposed to significant health system change," Tom Closson, president of the hospital association, charged in a recent interview.
The war of words has recently erupted in the op-ed pages of the Toronto Star, with the OMA president, Dr. Suzanne Strasberg, writing that Closson's assertion that doctors aren't providing leadership is insulting.
Dr. Michael Rachlis, a private health policy consultant, observed that while the two organizations have had disagreements in the past, their differences have never spilled over so publicly before.
"It's unusual in the health policy landscape to have the OMA and the OHA go at it in public like that," he said, adding that the OMA's position isn't finding much resonance in the health sector.
"The OMA seems very offside compared to everyone else," he said.
Rachlis said the OMA section on general and family practice fanned the flames when it launched an aggressive ad campaign, warning that patient safety would be risked unless physicians reviewed the diagnosis and treatment decisions of nurse practitioners. The ads also questioned whether pharmacists have the necessary education and training to prescribe certain drugs.
Rachlis called the ads offensive: "When doctors go out and scare the public (by saying) that being a nurse or a pharmacist could be dangerous to your health, I have to check which decade I'm living in."
The campaign shows that the OMA is "very out of step with its younger members," he charged, noting that physicians coming out of medical school today are trained to work in teams with other health professionals, all of whom practise to the full scope of their expertise.
Closson also accused the OMA of being out of touch with its members.
Strasberg denied that charge, pointing out that the OMA's approval rate was almost 70 per cent last year in an annual satisfaction survey of its 26,000 active members.
She said doctors are very much in favour of the team approach to providing health care to patients and noted that she works as a family doctor at Jane and Finch with a team that includes a nurse, chiropodist, dietitian and social worker.
"What we don't want to see are silos of health care being provided such as nurse-led independent clinics," she said. "We think that all health-care providers should work together under one roof. That way we all know the patient well and we can all provide the patient with the best quality of care that's available. That's the goal of Ontario's doctors."
That wasn't always the case. Not that long ago, the OMA lobbied against the team approach to providing primary care.
"Doctors have come a long way in the last four to five years. If you ask most doctors out there today, they want to work in teams," Strasberg said.
Closson emphasized that his criticisms were directed not at front-line doctors but the OMA, which he describes as a "union."
When the province is faced with a growing deficit and health-care costs are growing at an unsustainable rate, major reform is necessary, he said.
NDP health critic France Gélinas, who supports Bill 179, credited Closson for taking on the OMA. Both nurses and pharmacists have made noise about the OMA, but because they have a vested interest in Bill 179, Closson's words have more bearing, she said.
Might be more cogent if the government sides with the OHA and defangs the OMA by revoking the legislation which provides for involuntary membership by 26,000 MDs in Ontario. One might then reasonably assess if voluntary members affiliated with the OMA permit it to speak publicly for them in this manner.
So now we'll really see a test of Mr. McGuinty's governing skills. He's got a mess. Does he have the fortitude to make the public sector share the burden of recession?"
http://www.theglobeandmail.com/report-on-business/public-sector-must-share-the-pain-of-deficit/article1336227/
The pronouncements of the OHA must now be taken in context of their member instututions(including Mr. Clossen himself) actively having broken the intent of the salary guidelines.
The OHAs goal with NPs and the like, of course, in to assure their funding comes through their budgetary lines.
"The OHAs goal with NPs and the like, of course, in to assure their funding comes through their budgetary lines."
and Canary, McGuinty and fortitude in the same sentence.......not likely.
http://medicinesocialjustice.blogspot.com/2009/10/uncomplicated-primary-care.html
http://www.nationalledger.com/artman/publish/article_272628667.shtml
Government simply cannot spend and spend and borrow and borrow without somebody taking the hit and that would be us. We must learn to live within our means and that means taking more responsibility for your own health, including paying for medical services in some part beyond taxation.
http://www.theglobeandmail.com/news/national/ontario-deficit-hits-24-billion-but-no-exit-plan/article1335097/
DBRS's move followed the warning by Premier Dalton McGuinty's government to Ontarians to brace themselves for a new era of restraint as a growing gap between revenue and expenses pushes the province deeper into the red. But it does not plan to begin cutting overall spending on provincial programs for another two years."
Two years! Perhaps too many legal challenges to avoid.
and iPhone app for H1N1 tracking too!
http://www.iphonesavior.com/2009/04/swine-flu-tracker-app-for-iphone-awaits-approval.html
http://blog.michaelrachlis.com/
Finding alternate ways to fund medical care through tax free savings accounts or direct payments in some cases would allow more public resources to be spent on the homeless...other than medical care...ie social care, affordable housing, adapted education programs etc.
Has it occurred to Doctors for Medicare that with more spending on health care as Dwight Duncan and McGuinty suggest, that less resources will be available for very dependent individuals and more spending will be frittered away in bureaucratic black holes...
What did happen to the spending at Infoway...
from October 16 but still worth a read if only for noting that Dr. Rachlis identifies CHCs as providing superior care.....but he fails to note that they cost almost twice as much as a traditional practice and that the cost of many kinds of preventative care will quickly outpace our ability to pay for it.
http://www.drbarrydworkin.com/2009/10/25/examining-claims-of-vaccine-harm/
In the meanwhile, we posted a slate of flu clinics and assessment centre hours (as has PH itself) for the six practices. So now, we wait...gives a new twist to "waiting times"...
The line ups may be shorter than anticipated.
Only problem is that the second wave is likely going to peak this weekend (Halloween) in most urban areas and then slowly decline over several months. The vaccine needed to have been fully administered a month ago in order to have any impact on hospitalization rates.
http://www.pharmanews.eu/gsk/361-experience-of-gsks-h1n1-adjuvanted-vaccine-pandemrix-and-preliminary-paediatric-results
anybody heard of mixing it with chocolate syrup...I am about to contact public health to see what they say....
Big uptick in sick people at the office-clinic today....perhaps we`d better get the flu assessment clinics up and running next week.
Seeing plenty of people with respiratory symptoms mainly viral but with secondary infections after 10 days or so.
Dalton Days may not be as obvious a solution for the province as it was for Bob rae in 1993. The union deals that establish remunerationand other working conditions are now protected by the constitution of this country in ways they were not in 1993 according to Supreme Court rulings since then.
This means the public sector unions would have to agree to negotiate some version of Dalton Days or the government is left with option of laying off massive numbers of employees across the million strong public service sector. The province has direct agreements with only baout 60-63K of this million so complexity is compounded.
The other option theoretically open to government for a 'quick fix' approach on payroll side would be to move toward massive private sector take up of current public service roles. That option would pretty much guarantee very poor Liberal election prospects in Ontario for many elections to come given the wrath the entire union sector would have to exorcise.
One way the government might be able to convince the union sector to adopt something like a Dalton Day scheme would be for them to agree to up-front to union demands that:
a) specific 'leaders' be shown the gang plank.
b)In addition, a certain % of mandarins would have to navigate the plank as well.
c) a severe reduction (permanent) in number and kind of 'consultants hired for core government tasks
Only then would the union members be asked to donate a single day to the cause.
Yes I jest. Dreaming is healthy.
Correct me if I'm mistaken. Since the province can not print it, the government's options are - borrow more money, sell assets, increase taxes or reduce spending.
And as the gipper said, "We don't have a trillion-dollar debt because we haven't taxed enough; we have a trillion-dollar debt because we spend too much." - R Reagan
It appears those over 50 years old believe, those under 50, who earn income, are sweating.
How does government figure it is going to cope over the next 10-20 years with health care alone..
It cannot..not with the transformation it is describing (which is actually more expensive)
The "home first" strategy off loads the last phase of life to "home". Institutional care facilities will require an actual active ministry of "Long term care". When will they be "restructured" a la Duncan?
We have heard from the Ontario Hospital Association, how about the long term care association?
must mean prednisone....
http://www.cp24.com/servlet/an/local/CTVNews/20091026/091026_woman/20091026/?hub=CP24Home
Will try again tomorrow but not after I see another days worth of patients with various ILI symptoms.
After reviewing who was at the meeting, it was recognized that all present had been shpown to have conflicts of interest which have be found by the opposition (renovations of offices, salaries existing recommended guidelines, salaries being paid through hospitals, etc) - all food for the oppositions as proposed cuts are being discusssed.
Solution was obvious - no documentation of meetings where these decisons are made.
In moments of great state urgency secret meetings were held to discuss and act with grimness and determination. They protected the people from the insolence and arbitrariness of despots, became the censors of morals and authors of public treachery of in 1355 in Venice.
Have we succumbed to the same temptation in 2009 in Ontario?
We had 50 cases of H1N1 come through the clinic yesterday.
http://www.cdc.gov/h1n1flu/EUA/pdf/tamiflu-hcp.pdf
http://www.healthzone.ca/health/newsfeatures/swineflu/article/716657--teen-died-of-h1n1-health-officials-say?bn=1
Thanks for the info on the chocolate syrup Canary. Now the pharmacists are saying they cannot get hold of the 30 and 45gm tablets so they are stymied as what to do. First the sugar free Ora Sweet in short supply now the Tamiflu in pediatric dosage.
Also, no release of the provincial stockpile of the antivirals yet.
Wonder why not.
Definitely rising numbers of H1N1 in the clinic today.
Frustrations from providers that they are not able to get their shots in a timely way.
Frustrations from patients and parents that they cannot get access to vaccination in a timely way.
Many patients asking many questions about H1N1 and vaccine while other patients wait.
Difficult time today.
Such is a flu pandemic.
Debt is, we all agree, a bad thing. It arises from deficits;also bad things.
The real issue is how bad a thing and what the plan is to deal with it. There is a plan in place that may prove to fall short but that remains to be seen at the moment. There was, likewise, a plan in the dire days of 1993 and each budegt thereafter.
I recently mentioned that the size of the 1992/93 Ontario deficit relative to GDP is the same as for current year. It took then,and will take now, many years to discharge it.
Some indeed believe, contrary to most mainstrean economists, that Ontario will not grow and adjust to world market conditions such that the means to retire debt is lost. Why be so comfortable with the negative on this question?
Not only was the 1992/93 deficit relative to GDP the same as today; total government revenue relative to GDP is also the same. This means that the current government is not taking more from the GDP pie to deal with borrowing load than was the case in the early 90's. Again, why the big Chicken Little show?
As for:
'The Province, as needed, can enact any legisation needed to control spending' -mfo
I stand by my previous post here mfo.
Since 1993, collective bargaining has been recognized as a protected right under the Canadian Charter of Rights and Freedoms based on a BC provincial government case before the Supreme Court.
Ontario cannot pass legislation that is unconstitutional unless it can use the 'not withstanding clause'...which it won't.
It, Ontario, can certainly take other actions. It just can't pull this particular stunt. Said other actions it can adopt have, as I indicated, serious political downside to contend with.
I suspect Mr. Duncan and Mr. McGuinty well understand the relationship of today's crisis to the 1992/93 version and will gave action to be taken accordingly all the while keeping an eye on the electoral calculations. It's what they do.