It all started with a tweet.
“Northerners are not ‘emotional’ about third world health care & infrastructure; they are tired of paying taxes for nothing,” tweeted Carolyn Hudson, a self-described retired teacher, whose Twitter header photo proclaims “I Love Public Health Care.”
Third World health care? That sounded a bit hyperbolic based on what I knew about health care services in northern Ontario.
So I followed up. There are gleaming new hospitals in Thunder Bay, Sudbury and North Bay. In fact, the hospital in Thunder Bay is considered so good, I've heard it called The Taj Mahospital . So I asked Hudson, “Why do you describe $400 million hospitals in Thunder Bay and Sudbury as ‘3rd world health care?’ I'm curious.”
Turns out, Hudson was from Kenora where she said the hospital conditions were very sub-par and needed immediate improvements.
Given that it was Twitter, our “private” conversation soon became public property and many others joined in. A Laurie Stephens wrote: “I lived in Sudbury. It has terrific health care facilities.” Then a Mike McAllister added, “North Bay has a fantastic new hospital. Too bad it’s so severely understaffed and nearly half the beds are closed.”
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Now we were getting somewhere. Someone named Onwatin Whaler tweeted “probably northerners are mad about 6-8 hour emerg. waits, beds in hallways etc.” I pointed out I’d experienced both those things in the most intensely serviced health-care neighbourhood in the entire country ̶ University Avenue in downtown Toronto ̶ at both Toronto General Hospital and the Hospital for Sick Children.
Our conversation continued to expand. Del Dhanoa, a radiologist who’s very involved in Ontario Medical Association politics, asked a great question: “What is a solution to properly fund Ontario health care long-term?”
Inevitably, discussions about health care in Ontario come down to money. The citizens of this province, through their taxes, already fund health care to the tune of more than $50 billion a year. That surely sounds like enough money to care for the needs of almost 13 million people, isn’t it? Ottawa web developer Eric Goodwin chimed in: “We’ve developed a culture where people whine about the government not doing anything for them but hate paying their taxes.”
Okay, let’s get into the money. What if we doubled taxes tomorrow and spent it all on health care? Would spending $100 billion on health make our system twice as good or our population twice as healthy? I’ve never met anyone in the health care world who believes that. The money we’re inefficiently or inappropriately spending today would simply be spent twice as badly.
In fact, we’ve already tried this experiment. Over the past decade and a half, we’ve pretty much doubled what we spend on health care. The population hasn’t doubled. Are our services twice as good? Don’t think so. In fact, some services are worse.
Nevertheless, doctors such as Del Dhanoa think the system needs more money. If we left tax rates where they are, but put more money into the system by charging patients $25 every time they visited their doctor, would that be better? It might serve as a disincentive to seek care and that might save some money. Or for low-income people, it could deter them from seeking care they truly need, thereby costing the system more once their symptoms worsen.
A user fee could put more money in doctors’ pockets, but how would that actually improve the health of our population? Again, I haven’t heard too many (any?) health system observers say that it would.
Here’s what I hear from the many experts I’ve spoken to about these issues over the years:
- We spend enough money on health care in Ontario; we just spend too much of it badly.
- We’re paying for far more bureaucracy than we need; the result is not enough money left over to spend on the personnel and services people need.
- Our system is badly managed. That’s why people who can’t get in to see a family doctor (including their own) go to emergency departments where they wait hours and hours for care that is 10 times more expensive.
In which case…
- How do we spend more intelligently?
- How do we get rid of the bureaucracy we don’t need and redirect that money to patient care?
- How do we better manage the system so more people have access to a family doctor when they need one, thereby alleviating pressure on our emergency departments and budgets?
Answer those questions, and you’ll have your answers as to how we can get by on merely $50 billion a year, while providing better care for all. And ironically, all the sturm und drang over the physician services agreement between the Ontario government and the Ontario Medical Association may have precious little to do with any of the above.
- When will Ontario’s health care system finally focus on the patient?
- The challenge of fundraising for rural Ontario’s hospitals
Clarification: The phrase "it’s nicknamed The Taj Mahospital," has been changed to "I've heard it called The Taj Mahospital."