A Fraser Institute Report, published in November, has alarming implications for several Provinces in Canada, most especially Ontario and New Brunswick.
In 2014, Ontario and New Brunswick’s health care system will consume half of the Provincial revenues of these two jurisdictions. By 2034, an additional four of the ten Provinces in Canada will be in the same position – Prince Edward Island, Nova Scotia, Manitoba and Quebec will join Ontario and New Brunswick as “fifty percenters”.
The implications of reaching this position are complex. Attempts to reduce health care costs, to pass costs onto consumers or to privatize services are met with angry responses from a public used to its “free” health care. Attempts to use stealth to cut costs - reducing the supply of physicians and nurses, allowing hospital infrastructure to deteriorate, delisting services (e.g. chiropractic) and refusing to cover new medical technologies or license the use of new drugs or procedures – create longer waiting lists and also cause public anger. As a result, no jurisdiction is seriously looking at reinventing our health care system – something that has to happen if it is to be affordable and accessible.
The alternatives are also equally unattractive politically. So as to pay for health care, there will be a need to increase taxation significantly. This at the same time that energy prices will be rapidly increasing as carbon taxes and climate change mitigation starts to bite and inflation follows the recession. Increasing health care premiums – something Alberta just abolished, to its cost – and guaranteeing that these funds will go directly to front line health care services may be a route some wish to follow, but at a political cost.
If taxes are not increased, the other option will be start to reduce or close other services so that the money expended on them can be transferred to health. Cutting cultural and social programs, closing a few Universities and Colleges, accelerating the closure of rural schools are all options that need to be on the table, but it is difficult to imagine any of these being acceptable.
Roger Martin, long time Dean at the Rottman School of Business at the University of Toronto, observes that health care spending is largely about consuming wealth now (though he recognizes that some health spending is focused on ensuring people can work, such as preventive health care and medical rehabilitation) but investment in education is largely about building capacities for future prosperity. By not dealing with the challenge of health care spending and sacrificing education to pay for health, which is what has been occurring, we are reducing our future prosperity so as to permit current consumption.
In the absence of the political courage to say that the health care funding system emperor “has no clothes”, it will take an independent and respected voice to encourage the public to do so. This voice is urgently needed. The time to deal with health care in a fundamental way is now. The Fraser Institute analysis is a starting point for this conversation – what we need is leadership to ensure that the conversation actually gets somewhere.