CKNW Editorial
for December 22, 1999

I am rightly accused of being soft on Health Minister Penny Priddy ... but there are reasons.

First of all she's been, both as Minister of Children and Families and of health, a conscientious, hard working and often outspoken minister.

Secondly, I've been there and know first hand of the essential problem she faces - the Minister of Finance and Treasury Board.

The keys to a successful Health Minister are two in number - and even they will only partially handle the problem.

First, there must be serious money devoted to preventive care. Here I'm not just talking about anti smoking efforts, important though they clearly are, but much more serious efforts than that. One of the main contributors to our huge social costs in BC is the absence of good preventive mental health medicine. It's been estimated that up to 50% of all cases that reach the Provincial Court Criminal Division are because of mental illness. On top of that of course, is the enormous cost to the health and welfare systems. It's not logical to compartmentalize the problems into one ministry and say, for example, that because the money is spent in the Attorney-General's ministry or in the Social Services ministry that it's not a health cost. It is. But preventive care goes into other health areas as well, of course. At the end of the day we put peanuts into the front end of health care preferring to pay through the nose at the back end.

Second, there must be a blitz campaign, at the expense of other health programs if necessary, to build and staff long term care facilities. We have the paradox of having two many acute care beds yet not enough of them to handle the traffic. The explanation for the paradox is that acute care beds, which should be there for acute care persons, are occupied by long term care patients. This not only extends the lists for surgery it is hugely expensive.

But there are two other things the Minister should do on a priority basis.

First there must be a Commission, Royal or otherwise, into mental health care. It is inexcusable socially and hugely expensive to treat mental health patients the way they are. We de-institutionalized the patients then provided utterly inadequate help in the community. We have, through the workings of the Medical Services Plan, created disincentives to the medical profession tackling mental health problems. The prevalence of depression and related mental ailments is so widespread that it can no longer be ignored.

What's so sad is that so much of it is curable and quickly. The savings in so many other areas to be obtained with a proper program for this are enormous. But quite apart from that, why should one with a physical ailment be treated better than one with a mental one? Where's the fairness there.

Second, there must be an auditor-general just for medical expenses. We spend, literally, billions on Doctors, Hospital and other health care facilities and in running institutions yet no Minister of Health can honestly claim to have any real handle on these billions. There is no competition as there is in a private sector to apply market forces of efficiency and one has to largely depend upon those in the system itself to make sure it is fiscally responsible. No private enterprise a tenth the size of the Health Ministry would operate without a Chief Financial Officer

overseeing expenditures.

The Minister need not fear these moves. In fact if she were to implement them she would be doing that which past ministers including me ought to have done. Any system as big as this must, perforce have fat in it. It is likely, no matter how careful the hospital administrators are, to be fat that can be eliminated with no loss of service to the patient. The main point is, however, that the public is going to resist more money going into health care and even modest savings through efficiencies mandated by a financial overseer will pay off handsomely in releasing dollars for other critical needs.

There is one more thing the minister must do. She will, in fact, be compelled by events to do it ... namely look at where private money can be used. There is no sense spouting about "American" style health care when that's not the question. No one wants that nor would the public tolerate it. We can't, however, for philosophical reasons, blot out potential remedies.It's a tough job being Health Minister. There are few plaudits or thanks.

But there are ways one can make one's mark and this is especially true for Penny Priddy as she goes into the new year.