(Image Credit: James St. John via flickr.com; the image is at this link. Used without modification under Creative Commons Licence)
Recent media reports about the Ford govt ‘underspending on healthcare by $21.3 billion’ show, for the umpteenth time, that our debates on policy are prisoners of paradigm; thinking beyond the narrow confines of the paradigm is verboten.
PICK & CHOOSE
On March 8th, most mainstream media carried pieces covering the recent report by the Ontario Financial Accountability Officer (FAO) titled ‘Ontario Health Sector: Spending Plan Review’ (see this link for the PDF version of this FAO report). As I have come to expect (and I suspect, many of you have as well), the media coverage of this 52-page report was limited to the parts relating to funding and staffing shortages. For example, you can read the piece at Global News here, the one by CTV here and the one by our taxpayer-funded ‘national broadcaster’ CBC here. One aspect of this coverage that stands out is:
There was absolutely no effort to process the information contained in the report and offer the result to the viewers / readers. I believe this is because the moment they saw the top-line conclusion that the Ford government would be ‘underspending’ on healthcare over the next 5 years, they could see nothing else. The belief that ‘Healthcare is underfunded’ is deeply rooted in our political arena, and once that bias appears to be confirmed in a report or study, nothing else matters and nothing else needs to be conveyed to the audience. For their part, the official opposition party, NDP, also seized on this.
The ‘underspending’ part was misunderstood by many to mean that it applies to the present, whereas the FAO report concludes that based on its analysis, the government will have underspent on healthcare to the tune of $21.3 billion BY THE YEAR 2027-28. Having cleared that up, let us now focus on the main thrust of the deeply ingrained belief that spending more money on healthcare would suffice, in and of itself, to improve the outcomes in our healthcare system.
EVIDENCE TO THE CONTRARY
It is of course, not exactly a revelation that pumping more and more money into the healthcare system has NOT resulted in improving that system. In fact, all evidence points in the opposite direction. I have written a detailed article on this (‘Canadian Healthcare Is NOT Underfunded’). In a nutshell, while our healthcare spending increased from 7.0% of GDP in 1975 to 11.6% of GDP in 2019, availability of healthcare services declined as a secular trend; average waiting time for specialist healthcare went up from 9.3 weeks in 1993 to 11.6 weeks in 2019. It is pertinent to note here that this decline took place before the disruption caused by Covid and the (ill-advised) policies to deal with it.
But that is in the past. What about the present? The FAO report itself provides us with information that should put to rest the widespread underlying assumption in our society that spending more money on healthcare is the panacea (pun intended) to bring about an improvement. Here is the relevant part from the FAO report (on Page 4 at the link cited above):
Let me emphasize this: Looking ONLY at months *not affected* by ‘elective surgery pauses’ (or lockdowns in common parlance), the number of surgeries performed in Ontario between 2020 to 2022 was LOWER than those in 2019 by anywhere between 8% to 12% – DESPITE ‘investing’ $858 million.
In a recent guest appearance in a podcast episode of Benjamin Boyce (available at this YouTube link), I had said that Canada’s healthcare system performs so poorly BECAUSE it is so well-funded. I believe that is because our supposedly universal healthcare system is in fact a tool in the hands of politicians to siphon taxpayers’ money & channel it in the direction of preferred parties; providing efficient and timely healthcare is, at best, a secondary objective. Consider the following snippet from the FAO report (also on Page 4 at the above link):
Even BEFORE the pandemic hit, Ontario had a waitlist of 200,000 surgeries, of which 38,000 patients were unlucky enough to have waited for their treatment for so long that system itself classified them as ‘long-waiters’. The rate of reduction in this number (2,280 per month), if it continues for 22 months (from September 2022 to July 2024) would bring it back down to where it was pre-pandemic, i.e., 2019. This is assuming that the volume of patients being added to the waitlist remains similar. Furthermore, the reduction is mainly in respect of the patients who are NOT classified as ‘long-waiters’, in whose case the FAO notes that ‘the Province has yet to record ANY sustained reduction in (their) numbers’ (emphasis added). While in 2019, there were 38,000 ‘long-waiters’ (I think we should call them ‘Canadians who were cheated out of their tax money’), by September 2022 their number was 107,000. After imposing policies that swelled their numbers by over 181%, we are in no hurry to get that number down to a level that was itself worrisome.
At the grassroots level, there is a section of the society that believes that there is ‘administrative bloat’ in the universal healthcare system. Unfortunately, we don’t have the data to verify this (more on this point in the next segment). Over the past 15 months, I have tried to locate this data, but to no avail – the reporting on this is a maze that is at once thick and opaque. I am of the opinion that this is not by accident; no system can be so impenetrable inadvertently. I think its impenetrability is by design, so as to keep Canadians in the dark as to where and how the money is being spent. Nevertheless, from time to time, we do come across snippets of micro-level data from this or that hospital showing the extraordinarily high number of Vice Presidents (or other comparable administrative designation), along with their very high salaries. Nothing comes of these revelations because the political will to tackle this waste is nonexistent – which brings us to my next point: The oh-so-popular soundbite of ‘Finding efficiencies’ from 2018 is completely forgotten.
It is tempting to believe that this happened because of Covid, but if you care to check, after the initial period of honeymoon following the 2018 election victory of the Ontario Conservatives, everyone in government simply stopped talking about it. For a brief while, when MPP Prabmeet Sarkaria was the Associate Minister of Small Business & Red Tape Reduction (yes, that was his actual portfolio), the term ‘efficiencies’ made a brief reappearance. Thereafter, it was allowed to die a quiet but unnatural death. Or was it ‘unnatural’ really? I think not.
When a political party is in the opposition, it has to grab a headline issue in the run-up to elections (or perhaps 2 or 3 headline issues). By 2018, the 2 headline issues in Ontario were the high cost of hydro and the astronomical amount of debt that the Liberal combo government of McGuinty-Wynne had run up (around $200 billion) in 15 years of its tenure, earning Ontario the dubious distinction of being the largest sub-sovereign debtor in the entire world. Year after year, the provincial government had been running up eye-watering levels of deficit. As I showed in my July 2018 article ‘Is Ontario In a Debt-Trap?’ with the help of data, the answer to the question was an unequivocal ‘Yes’. As a side note, I must mention that this startling fact has not been reported / commented upon by any of our stalwarts in the mainstream media.
It was therefore natural for the Ontario Conservatives, sensing a near-guaranteed election win, to zero in on the high levels of government spending. ‘Finding efficiencies’ became a catchy soundbite that resonated with a lot of Ontarians. But while opposition parties may yammer on and on about the problems created by the current government and its ways of functioning, once they win the election, there are constituencies to appease. More specifically, there are promises to various vested interests to keep. These promises enjoy a sanctity that the promises made to the general population – the hoi polloi – don’t. So the latter promises are allowed to be forgotten, as much as the circumstances would permit. And so it was that the promise of ‘Finding efficiencies’ died a natural death.
THE VIEW FROM AFAR
In January 2022, Calgary Herald carried an article in which the writer Lucia Corbella quoted data from a book (‘Patients at Risk – Exposing Canada’s Health-care Crisis’ by Susan D. Martinuk). While this data confirms the belief among some Canadians about ‘administrative bloat’ that I alluded to in the previous segment, it is nonetheless shocking – Canada has 10 times as many health-care administrators as Germany (in fact, if you do the actual math based on the numbers cited in the article, i.e., Canada having one healthcare administrator for every 1,415 citizens versus Germany’s 15,545, it turn out that Canada in fact has 11 times as many healthcare administrators as Germany. Even if we make allowance for the much larger geographic area of Canada compared to that of Germany, meaning that in some regions, the need to have administrators would override the concern (of which we don’t have any) over the cost of providing this administration, a ratio of 1:11 does seem to be way too high. There is definitely room to ‘Find efficiencies’ here.
It is therefore an unpleasant surprise that no MSM outlet has done follow-up reporting on this hugely important revelation. At the time the Calgary Herald piece was published, an op-ed article or two may have been written (for example, see this piece by Jerry Agar in the Toronto Sun). Thereafter, the matter was allowed to fade away from the public sphere, and thereby from public consciousness, whereas the focus on ‘underspending’ has to be relentless; consider this chart from the FAO report that was reproduced in the CTV report:
This leads us to a disturbing question: What can we say about a media that absolutely jumps on the FAO report about the Ford government ‘underspending’ on healthcare, but lets a story – backed up by research and data – about wasteful spending of huge amounts of money in the healthcare system be ‘memory-holed’? Even if we believe that they aren’t motivated by political bias, at the very least, it would appear that they are so tightly (and, I might add, voluntarily) bound in the narrative about our health care – i.e., that it is ‘world famous’ while being simultaneously chronically and severely underfunded (a logical impossibility) – that it does not even occur to them that in the process, they have abandoned their core function, viz., to inform their audience with all the facts. If we are in an uncharitable mood, of course, we would call it ‘partisanship’ – a word that should be a curse word in relation to the media, and that brings us to our next point.
One extension of the ‘Conservatives are underspending on healthcare’ is that ‘Ford wants to crash the healthcare system deliberately so he can privatize it’. Over the past 15 months, as I dug deeper and deeper into the mess that our healthcare system is, I realized that the deterioration had been going on for some 50 years. Therefore, all the 3 main political parties (Liberal, Conservative & NDP) that had been in government in Ontario over that period were equally culpable for the decline of the healthcare system. As well, at the federal level, both the Liberal and Conservative parties had been similarly responsible. I have lost count of how many times I have made this point on social media and elsewhere – but it always fails to resonate with the people who want to cling to the ‘Ford wants to crash healthcare deliberately’ belief.
Over in the media, barring rare instances like Lorrie Goldstein of the Toronto Sun and Robyn Urback of the Globe & Mail, I haven’t come across anyone making this point. Listening to them, one might get the impression that all the problems in our healthcare system are due to the current Conservative government, or failing that, due to the previous Conservative government. For this purpose, it suffices if the previous Conservative government was federal, while the current Conservative government is provincial; both are supposed to have the same malicious effectiveness on the state of affairs in healthcare, a personal defect that the Liberals are supposed to be naturally immune to. This can be illustrated with the help of a chart in the FAO report that was not quoted in any MSM coverage of that report. Here it is:
Let us focus on the bars on the left (in dark blue) relating to the number of hospital beds in Ontario and crunch some numbers. The population of Ontario in 2005 was 12.53 million (see this link), while that in 2019 was 14.57 million (see this link). However, since we are talking about partisanship here, let us look at the year 2018, when the government changed hands from Liberal to Conservative. In 2018, the population of Ontario was 14.32 million (see this link). Let us be generous and consider that ALL the addition to the hospital beds was done by the Liberals over their 12.5 years of tenure, and none by the Conservatives for the 18 months that they had been in power.
The population of Ontario increased from 12.53 million in 2005 to 14.32 million in 2018 – or 14.29%. In comparison, the increase in the number of hospital beds was a paltry 2.6%, meaning that increase in hospital beds capacity lagged population growth by a factor of 4.5. I think this bears repetition: Under Liberal rule in the province, while the population of Ontario increased by 14.29%, they increased the hospital beds capacity by only 2.6%, which was less than a FIFTH of the growth in population. And it wasn’t like we had excess capacity in hospital beds at the start in 2005 that was later put to use with the increase in population; 31,865 hospital beds for a population of 12.53 million yields an average of 2.54 beds per 1,000 of population, which is basically the average in OECD countries.
The FAO’s focus is on the population of seniors, on grounds that their need for hospital beds is higher than younger people. By that metric, while the population of seniors went up by 56%, increase in hospital beds was 2.6%, meaning that there was one new hospital bed for every 21.54 additional seniors. All this numbers crunching brings me to the crux of this argument: Failing to make the required additions to capacity is nothing other than a different way of ‘crashing healthcare’, but you will never find anyone making that accusation against the Liberals. Probably because before ‘Ford is underspending on healthcare’ became available, ‘Harper underfunded healthcare’ still got the clicks.
On one hand, we have a constituency (much larger in comparison to the other one) that considers it an article of faith that the only possible remedy to any shortcoming of the universal healthcare system is more funding, no matter how unwisely the existing funding may be getting spent. On the other hand, we have the other, smaller constituency that, at the top level, has given up even the pretense of ‘Finding efficiencies’. Instead, Premier Ford is pushing the federal government to increase its share of funding, thereby indirectly supporting the patently false argument that ‘healthcare is underfunded’. The ONLY entity that can access the required information and opine on the matter in an authoritative manner, the FAO, hasn’t considered it necessary to explore the issue. Lastly, the mainstream media doesn’t seem to have an iota of interest in a proper examination of what ails our healthcare system.
Given this harsh and unpleasant reality on all fronts, the only likely scenario over the next few years is that we will be pouring ever-increasing amounts of money in the system when more money is demonstrably not the remedy; healthcare spending was 7.0% of our GDP in 1975, and the increases over the years and decades brought it to 11.6% of GDP in 2019. The subsequent increases on account of Covid have brought it to 13% of GDP now, and as the FAO report and its media coverage demonstrates, there is no appetite for ‘Finding efficiencies’. At some point, the expense will become too high to be sustainable, and drastic measures will be the only recourse available, including ushering in private healthcare. A very large section of the Canadian population will take satisfaction in the argument that their stance that ‘Conservatives want(ed) to crash the healthcare system so they can privatize it to benefit their cronies’ was vindicated. And life in Canada will continue – on a downward trajectory.
(Stay tuned for Part-2 of this article, hopefully later this week)
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