Graham Steele: Liberals get theological on health authorities
Looking into the politics of district health authorities
If there is a more pointless question in Nova Scotia politics than "How many district health authorities should there be?" I don't know what it is.
The question is pointless because there is no correct answer. It's all politics and I don't mean that in a good way.
The McNeil government has already decided the nine district health authorities should be collapsed into One Unified Consolidated Health Authority (OUCH-A, for short). The IWK Health Centre will remain a self-governing entity, so we'll leave it aside.
This week in Yarmouth, Health Minister Leo Glavine launched his tour of the nine district health authorities. The tour — which is actually a carefully managed series of meetings — will take him around the province between now and the beginning of March.
The purpose of the minister's tour is to figure out how to get people to accept the transition to the OUCH-A with as little fuss as possible. Change is scary and change in health-care services has the potential to scare everyone, so the minister knows he's got a lot of soothing, consoling and cajoling to do.
Scared people vote and not for the guy who's scaring them.
But no matter how consoling the minister is — and Leo Glavine is a good guy in an impossible job — he can't win, not in the long run. To see why, let's review a bit of recent political history.
John Savage and his Liberals roared into office in 1993 with a big majority and an agenda for change. At the time, Nova Scotia was a bewildering landscape of local hospital boards.
The Liberals decided consolidation and efficiency was in order and they were right. They decided four regional health authorities was the right number.
In 1999, John Hamm and his Tories campaigned and won against a weakened Liberal government with — among other things — a promise to break up the regional health authorities into smaller units. The health boards covered too large an area and weren't responsive enough to local concerns, said Hamm.
The Tories created the nine district health authorities, but with considerable transitional expense and confusion.
By 2009, it was conventional wisdom that the nine district health authorities were top heavy with highly paid administrators. When I did my Back to Balance tour as finance minister, this was always brought up as an obvious saving.
Hamm's rationale — bringing health administration closer to communities — was rarely mentioned.
The Dexter government decided to leave the health authorities alone because we believed the savings, if there were any to be had, would be minuscule compared to the transitional expense and confusion.
Besides, we wanted the health authorites to be allies in positive change like the Collaborative Emergency Centres. They couldn't do that if they were consumed by administrative shakeups.
We all know what happened to the Dexter government. Conventional wisdom prevailed when it came to health-care administration and the McNeil Liberals were elected with — among other things — a promise to consolidate the health authorities into larger units.
Who was right? Who was wrong?
Who was right? Everybody. Who was wrong? Everybody.
In matters of administration, there will always be a tension between efficiency — especially in a province of under a million people — and local decision-making — especially in a province whose principal political cleavage is Halifax versus everything-outside-of-Halifax.
That's why there never is and never will be a correct answer.
The debate is really a substitute for debate on the real issues in publicly-funded health care, such as the cost and coverage of drugs and end-of-life care. These issues are hard and are likely to upset people, so politicians scurry for the safer harbour of administration costs.
The McNeil government, though, has taken the debate to a theological level.
They know that no matter what number they pick, it's wrong. So they've hedged their bets by saying there will be one health authority — which will inevitably be headquartered in Halifax — divided into four administrative districts.
One but Four, Four but One.
In the next election, the next John Hamm will come along and promise to break up the One-but-Four Health Authority into smaller units. Why? To get closer to the people, of course.
And the health authority dance will continue. Ouch-a.