There are few things more on the mind of people than their health and their access to hospitals, doctors and other health service providers when they need them. It is not surprising, therefore, that when politicians sally forth to woo voters, promises to provide more publicly-funded healthcare and make it more quickly available feature prominently in their platforms. And so it is with the Parties now vying for favour in Ontario.
The Liberals, of course, are defending their now long record in government, touting their recent expansion of subsidies for out-of-hospital prescription drugs for young people, complementing those long in place for the elderly. The 2018 budget had an additional $822 million for hospitals and the Throne speech committed additional funding to reduce hospital wait times by expanding home care and community mental health services. Their campaign commitments to date include expanding pharmacare and dental care, an overhaul of mental health services, and 30,000 additional hospital beds over the next 10 years, including $2.4 billion to rebuild Toronto’s Hospital for Sick Children.
The New Democratic Party, now leading in the polls, promises universal coverage for prescription drugs and dental care, a 5% boost in hospital funding, 2200 new mental health workers, 15,000 long-term care beds, new hospitals in Brampton and Peel, creation of a First Nations health plan, and establishment of a new Ministry for Mental Health and Addictions.
The Conservatives have yet to release a platform but have publicly rejected ‘two-tier’ medicine, declaring their commitment to Ontario’s publicly funded Medicare. They have pledged to cut wait times, provide more funding for mental health, dental care for seniors, and the creation of 15000 more long-term care beds in 5 years, and 30,000 in 10.
On healthcare, the Green Party has been much more modest, pledging only substantially increased mental health coverage under Medicare. The Trillium Party’s innovation would tie government funding directly to health services through the use of a new “Smart OHIP” card to eliminate much administrative expense.
A little more of this, a little more of that, eliminate inefficiencies and waste – nothing of what we are hearing in this campaign is new. Ontarions have heard many times before how their new government would solve healthcare’s problems by spending more money on one or another or several elements of the so-called ‘system’. Yet the same problems persist, unabated and sometimes worse, election after election. It brings to mind the definition of insanity often attributed to Einstein, ‘doing the same thing over and over again while expecting a different result’.
It is well over 50 years since Medicare was adopted in Ontario to provide publicly-funded insurance for in-hospital and physicians’ services. Since then we have come to realize that many other services, out-of-hospital pharmaceuticals, dental, mental health/addiction, rehabilitation, home and community care, etc., are also important, even vital contributors to effective healthcare. And there is also compelling evidence showing that population health is 75% or more attributable to its social determinants, education, income and physical security, housing, nutrition, supportive communities, and so on.
What we need is a government seized by the fact that time has marched on and what’s needed is a fundamental re-think of how best to re-deploy our financial resources and re-organize our providers of health and of social services to optimise the health and well-being of Ontarions. It is (over)time to create a real health and healthcare system. It is time to create a system responsive to the leadership of strong governance whether in Toronto, in the fourteen Local Health Integration Networks, or with the newest wrinkle, the still vaguely defined sub-regional LHIN networks; some Party seeking to be our government has to grasp the nettle of identifying the locus of system leadership. That system must connect our often excellent but separate health service providers one with another. It’s time to get those providers out of their silos, to enable them to serve to the full extent of their scopes of practice, and forge them into accountable teams capable of discharging the responsibility of providing cost-effectively the full range of healthcare and other health services needed to enhance the health of the populations they serve.