Sunday, February 10, 2013
The Efficiences of Reform
MARGARET WENTE
Saskatchewan knows what Tommy
Douglas would do
The
Globe and Mail February 7th 2013
[Thanks to Dr. Brian Day for this item]
When Janice MacKinnon teaches her course in public policy at the
University of Saskatchewan, she likes to tell the story about the elderly
Ontario woman who fell in the lobby of a hospital and broke her hip. (The woman
had been visiting her dying husband.) Hospital staff told her that,
unfortunately, they couldn’t help her until she called an ambulance to take her
to the emergency room.
The story captures what’s wrong with health care in Canada –
bureaucratization, rigidity in attitudes and work rules, lack of common sense.
Ms. MacKinnon, a former NDP finance minister in Saskatchewan, has loads of
common sense. She also has a few ideas for improving health care. Here’s one:
Let private clinics, not hospitals, perform routine surgeries.
This idea is so controversial in Liberal-ruled Ontario that it’s
not even on the radar. Public-sector unions and academics denounce it as the
first step on the slippery slope to dismantling Medicare. Yet, it’s working
well in the cradle of Medicare itself – Saskatchewan. “They’ve kept it very low
profile,” Ms. MacKinnon tells me. “They’ve been selling it as a solution to
waiting lists.”
The Saskatchewan Surgical Initiative began in 2010 as a response
to long wait times for surgeries. Today, the province contracts out a growing
number of procedures to private clinics. The unions (and some doctors) warned
that the clinics would cost more money because the profits would be “siphoned
off.” They wanted the government to expand the public system, instead.
Here’s what happened under the new system: Wait times plunged.
Safety and quality improved. Overall costs for the contracted-out procedures
declined by 28 per cent. The cost for some procedures was cut in half.
How is this possible? “The clinics are very focused and they only
do a small number of procedures,” Ms. MacKinnon says. “They’re small and easy
to manage, and they’re not unionized.” By contrast, hospitals are large,
complex, inflexible bureaucracies with several different unions. “You need a
huge administrative capacity just to handle the union contracts and the
grievance process.”
Patients prefer the private clinics, too. They’re more convenient,
and offer better service. It’s also easier to park.
But wait. What would Tommy Douglas think?
“You know, he ran a very efficient government,” Ms. MacKinnon
says. “He believed in sound public services delivered efficiently. And that’s
what the unions are missing. Their alternative was that we would pay more for
the staffing of the facility and the public would have fewer and slower
services.”
Ms. MacKinnon, a cabinet minister in Saskatchewan during the
1990s, is in the Tommy Douglas mould. She was the first finance minister in
that period to balance the budget.
“The real problem is that health-care costs are squeezing out
education and social services, which have important influences on health,” she
says. “Tommy would not have tolerated that.”
Nor would he have tolerated the generational inequity that has
become a central feature of the system. As it’s now structured, the children
and grandchildren of the baby boomers will pay a large share of the boomers’
health-care costs. According to one study cited by Ms. MacKinnon, Canadians
born between 1958 and 1967 will consume over $4,000 more in health-care
services than they’ll pay in health-care taxes. But people born between 1998
and 2007 will pay over $18,000more in health-care taxes than they’ll take out.
And people born after 1988 will wind up paying peak taxes that are twice as
high as what the boomers paid.
That’s not fair, Ms. MacKinnon says. “You can’t have a society
built on the youngest members being stressed to the point where they lose
hope.”
Her answer: Change the income tax system, so some of the
health-care costs are borne by those who use it. She explains her reasoning in
a new report, Health Care Reform from the Cradle of Medicare, published by the
Macdonald-Laurier Institute. Some will say her ideas are heresy, but I think
they’re common sense. As she puts it, “We can best honour the spirit and legacy
of Tommy Douglas by reform.”
Posted by David Berner at 9:36 AM 2 comments
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