CKNW Editorial
for September 10, 2001

It’s coming folks – huge changes in the healthcare system. You’ll be paying money directly, if the government deems you can afford it, and you will see services cut. Rather than extending insured services under the Medical Services Plan, they will be reduced and you will be able to insure against your need for such services. And the private sector will be invited to put more and more into the hospital business and especially into the long term care business.

First, we must remember that the political risks to the government for abandoning what we have come, comfortably, to believe as our birthright, have greatly diminished. Of course there will be the cries from the left that the government is abandoning the poor to the streets as, we’re told, is done in the United States but the left has no real political clout any more and much as they might wish it to be so, they’re not likely to have for some years to come.

Secondly, the political clout of the federal government is much reduced. They now pay only about 14% of the cost of health care and, though they will remain a noisy nuisance, their bite will be considerably less than their bark. Which is probably what is should be.

The problem faced by the provincial Liberals is not of their making. Going right back to the days of W.A.C. Bennett we have, while talking about the "baby boom", consistently ignored the impact it will have on the healthcare system. We have a gross shortage of long term care beds with the result that hugely expensive acute care beds are occupied by extended care patients. Every health minister for the last 40 years, including me, has a share of the blame for that.

Moreover, the healthcare system has been hit by a sort of industrial revolution in reverse. Instead of machines and technology coming along to reduce costs, especially of labour, we are experiencing rising costs at an uncontrollable rate. All the leftwing health economists in the country – of which we have an abundance – can trot out all the figures they want but the situation remains unaltered – the public purse can no longer meet the health care demands that increase by the day. New techniques, new diagnostic tools, new drugs, new surgeries, better personal hygiene, a fitter population have all combined to increase the costs of healthcare. (A fitter and healthier population lives long enough, ironically, to have a bigger impact on the system.) They have all given us a much better life and a longer lifespan to be sure – but we’re talking dollars and cents here.

We’ve spent 40 years passing the buck – it’s the doctors fault, it’s greedy health workers, it’s greedy corporations fighting paying their fair share of taxes and on it foes. Well, folks, we’ve run out of excuses and people to blame. The crunch is here and Gordon Campbell happens to be the premier who inherits it all. There is no one left to pass the buck too.

This government will, because it has no other choice, finally declare just what health care it is that the state will pay for. As a society, Canadians have steadfastly refused to face this question – or rather series of hard questions.

Is it every ailment, every surgical intervention that we pay for? 100 cents on the dollar? Everyone would like the answer to be yes but we are now in the boat bailing and jettisoning everything that isn’t strictly necessary to keep the boat afloat. We’re making choices.

Should there be surcharges on medical services for those who can afford it? If you simply put flat surcharges on medical services you most certainly hit the underprivileged much harder and you may discourage the needy from getting medical help which, apart from obvious and important humanitarian considerations may mean even higher costs down the way. But why shouldn’t the wealthy pay more?

We already have, by some calculations, about 25% of our care from private funds. We have, an acute shortage of capital projects, namely long term care facilities. Do we invite private capital to build these facilities? If so, what are the rules? If not, how do we pay for these projects when no government since 1989 has really been able to balance a budget and we now see nearly $3 billion going just to service the debt?

What this government can’t do is handle the problem bit by bit as each crisis arises. Having said that, the Health Services Minister, Colin Hanson, must try to save where he can but the wisest course would be to have a plan – one that can cover the whole spectrum of health cost.

The facts are all there. Our economist friends can fiddle with the figures and the available formulae but the fact remains that there is a macro economic problem here called "no more money".

Of course there are savings to be made within the present system but we’re way beyond looking at those to solve the problem and save the system.

I put no stock in the Romanow Commission though Mr Romanow is a friend of mine for whom I have enormous respect. His is a federal government mandate and we have a British Columbia problem. Our healthcare needs are unique in some respects – we are Canada’s retirement haven for one. Moreover it would be naïve, utter folly, to assume that the federal government is going to accept any recommendation Mr Romanow makes if it involves more federal funding. We have to stop making Ottawa an excuse and treat it for what it is – a largely irrelevant pain in the ass.

The options the provincial government has are few in numbers.

It can reduce the number of insured services, it can ration others, as it already does with dreadful results … in other words it can do a worse job … it can make huge capital expenditures on Long Term Care thus relieving pressure on acute care beds (this might well mean selling crown assets such as BC Hydro or ICBC) … it can invite in more private capital in building the hardware and it can ask private money to provide some of the services.

What the government cannot do is postpone, much longer, the facing up to the problems.

There is no quick fix. No one thing will make all the difference. Whatever happens will be controversial and you can be sure that all self interested groups will have something to be unhappy about.

This government may pay a high political price for what it does. But it will pay a far higher one if it doesn’t do something … and something will have to be both radical and dramatic.