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Ontario Votes 2003
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Election Day: Oct. 2, 2003   

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Critical care
by Paddy Moore

When he unveiled his Common Sense Revolution in 1994, Mike Harris promised a "fundamental" change to the way government worked in Ontario. He promised to create jobs and fire up the province's economy with massive cuts to taxes and the "unnecessary" programs they funded.

But even Harris recognized that acceptance for his "fundamental" change would have its limits. "Total [government] spending will be reduced by 20 per cent in three years," he pledged, "without touching a penny of health-care funding."




Video from Canada Now



The health policies of the three main parties are examined by Beatrice Politi (Sept. 12, runs 2:46)
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In making that promise, Harris acknowledged a political reality in Ontario: the vast majority of voters, even the most conservative ones, appreciate the guarantees that a publicly funded health-care system provides.

In the years since his election, supporters and critics have argued about whether Harris's Tory government kept his promise. To the Conservatives, the cash crunch faced by Ontario's hospitals was a direct result of cuts in federal transfer payments. Critics charge that the province would have been able to replace that federal cash if the Tories hadn't attempted to balance the budget in the midst of a tax-cutting binge.

AUDIO: Here and Now's Avril Benoit discusses a report on the parties' health policies with Dr. Brian Goldman (Sept. 19, runs 6:04):

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The reason didn't matter to patients who found themselves on waiting lists for live-saving surgery, nor for those whose ambulances were turned away from overcrowded hospital emergency rooms. Anyone who has stepped in an Ontario hospital in recent years has seen evidence of the funding crisis.

As a result, all three parties are talking in this campaign about the need for more health-care dollars. A quick survey of the PC, NDP and Liberal platforms shows many ideas lifted from a federally commissioned report by former Saskatchewan premier Roy Romanow.

They all want to recruit more nurses and doctors, give tuition breaks to medical students who agree to work under-serviced areas, reduce barriers to foreign-trained doctors, and increase the number of community health clinics providing 24-hour primary care.

Nonetheless, there are also differences in how the parties propose to spend money on the care of ailing Ontarians.

The Private Sector (Part one)

The most significant -- and the one that the opposition parties most vehemently oppose -- is the Tory preference for greater private-sector involvement in health-care delivery.

AUDIO: Three Toronto candidates with personal expertise in health care discuss that issue with Metro Morning's Andy Barrie. (Sept. 16, runs 9:51)

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The Conservatives have already opened privately run clinics in seven communities, including Ajax, Kingston, Thunder Bay and Mississauga. These facilities are owned and operated by private companies, with most services covered by the Ontario Health Insurance Plan.

The clinics operate under a system similar to the one X-ray clinics and blood labs have worked under for years. The PCs say private clinics have already resulted in shorter wait times, and will allow the government to make an additional 40 MRI machines and 50 CT scanners available to Ontario patients.

But citing Romanow ("There is no evidence that these solutions will deliver better or cheaper care"), the opposition parties have firmly opposed the creation of privately run clinics, even where such clinics reduce the time patients must wait.

The NDP calls the for-profit clinics "scans for cash," and warns that their use will lead to the creation of a two-tiered health care system in which wealthy patients will be able to pay their way to the front of the queue. The NDP promises not to allow any more private diagnostic clinics and to provide more money for the public system's diagnostic services. The Liberals make the same promises, vowing to hold the line on "creeping privatization."

AUDIO: Sandra Pupatello is the Liberal health critic from Windsor West. Morning Watch reporter Tom Aubin reports on the views of this potential cabinet minister and those of her competitors on health issues. (Sept. 16, runs 4:41)

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Unlike the Tories, neither the NDP nor the Liberals indicate how many MRI machines or CT scanners they would provide.

However, the Liberals and PCs would both set guaranteed limits to waiting times for cardiac care, cancer care, joint replacements, MRIs and CT scans. The PCs would also pay for out-of-province service if deemed necessary to meet a guaranteed wait limit.

The Private Sector (Part 2)

Ernie Eves' government wants more hospitals, but it doesn't want to build them or run them.

In the Tory plan, new facilities would be leased by hospital boards from the companies that build an operate them. The Conservatives are already employing these private-public partnerships with four hospital projects, including the Royal Ottawa and Peterborough Regional hospitals.

They say the partnerships enable the province to quickly build more hospitals, and argue that such an approach is needed to service the province's growing and ageing population.

But private interests are profit-driven, says the NDP. As a result, Howard Hampton contends that privately built hospitals will cost more to build and run, and the taxpayer will be on the hook if there's a problem. The NDP commits itself to publicly built hospitals (although they don't say how many) and the cancellation of the four projects already underway.

The Liberals make no mention of building hospitals, but promise to open 1,600 beds as a way to reduce pressures on the province's emergency rooms. They also put down the Tories for "opening the door to private … hospitals." Their platform does not say how they would approach private-public partnerships to build hospitals. However, they are proposing the "Commitment to Medicare Act."

Home care

Taking another page from Romanow, the New Democrats and Liberals are both committed to extending home-care coverage, which they consider a humane and cost-effective way of taking pressure off the province's hospitals. The NDP says it would extend the principle of universality to the home-care sector; the Liberals are more modest, proposing to take the first steps toward making it an essential part of medicare.

The Tories make no mention of home care in their health-policy paper.

Accountability

As for making sure that taxpayers get good value for their health-care dollar (another Romanow imperative), all the parties are proposing some kind of oversight body.

The Liberals propose giving the provincial auditor the power to look at health-care agencies and hospitals. They also want to set up an independent agency called the Health Standards Council to track the effectiveness of the services getting delivered.

The NDP wants a Health Care Standards Commissioner who reports to the legislature on a proposed Patients' Bill of Rights. That person would investigate complaints and work with the health-care sector to set standards of care, such as maximum wait times and patient safety.

The Tories want to appoint an Ontario Health Quality Auditor (similar to their Education Quality Auditor) to ensure money is being used for its designated purpose and services are providing the expected result.

The fundamental shift

The differences in how each party would spend the money are incidental, however, compared to the big ideological question: How high up the list of priorities should health-care spending rank?

Harris considered it important enough that he promised to make his tax and program reductions "without touching a penny of health-care funding." But when Ottawa cut back, he wasn't willing to change his political agenda (in other words, to postpone tax cuts that ate into provincial revenue) so that his government could guarantee funding levels for the Ontario's hospitals.

In this campaign, Ernie Eves raised the bar for his party - and the opposition - by making that promise, guaranteeing base funding for three years. No matter how you read it, Eves appears to have committed himself to paying hospitals the same amount every year, whether Ottawa keeps the money flowing or not.

As a result, no matter who wins this election, health-care spending is destined to be the next government's number-one priority.

 

 

Education Highlights

PC Health Platform               more
Create Ontario Health Quality Auditor to ensure funding is being spent wisely and tracking waiting times
Build more hospitals through public-private partnerships
Set guaranteed wait limits for general surgery, cataract surgery, cancer treatment, MRIs, and hip and knee replacement. Would provide out-of-province care if necessary to meet time limit
Provide 40 MRI machines and 50 CT scanners over five years


NDP Health Platform            more
Full and immediate implementation of Romanow recommendations
Create Patients' Bill of Rights and Health Care Standards Commissioner, ensuring health money "goes to patients, not tax cuts"
Stop expansion of private MRI and CT clinics, diverting funds to public system
Stop private-public partnerships the Tories are using to build hospitals
Extend universality to long-term and home-care sectors


Liberal Health Platform        more
Create independent agency to track delivery of medical services
Give provincial auditor the authority to audit all health-care agencies
Set limits for waiting times, starting with cardiac care, cancer care, joint replacements and MRI/CT scans
Invest in home care, taking first steps to follow recommendations of Romanow to make it an essential part of medicare



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