Why the NDP’s bombshell about the Tories’ health-care plan didn’t go boom

OPINION: It’s good that the official Opposition leaked a draft of the government’s massive health-care reform bill, writes John Michael McGrath. But there’s no cause to cry “privatization” just yet
By John Michael McGrath - Published on February 1, 2019
Ontario NDP Leader Andrea Horwath
Andrea Horwath has charged that Premier Doug Ford is preparing to introduce a bill “with a specific mandate to privatize health services such as hospitals in Ontario.” (Frank Gunn/CP)

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Ontario NDP leader Andrea Horwath made an explosive allegation Thursday at Queen’s Park — namely, that Premier Doug Ford and Minister of Health and Long-term Care Christine Elliott were preparing to introduce a bill “with a specific mandate to privatize health services such as hospitals in Ontario.” As proof, the NDP supplied the leaked text of draft legislation that outlined major structural changes the government is apparently planning for the health-care sector.

But the text of the bill doesn’t back up the NDP’s claims — and some parts actually contradict them.

Elliott did confirm the authenticity of the draft Thursday afternoon, but it’s unclear how much of it will remain when something is formally tabled at Queen’s Park later this month. In theory, it could also change substantially during debates at the legislature, although that rarely happens in the case of important government bills. And this one is important: it contains wide-ranging changes to Ontario’s health-care bureaucracy — Local Health Integration Networks created by the Liberals would be scrapped and replaced by a so-called super-agency (almost certainly a placeholder name for the early drafts of the legislation) that would reorganize hospitals, clinics, and care homes.

The official Opposition’s claim is a specific one: the government is creating a major new health-care agency with a mandate to privatize health services. But (as we’ve had occasion to note in other contexts recently) words are supposed to mean things. When the government gives an agency a “specific mandate,” it’s spelled out clearly in law. When the Liberals gave Metrolinx the mandate to plan and build a transit network for the Greater Toronto Area, they explicitly included, in the Metrolinx Act, that “the objects of the Corporation are … development of an integrated, multi-modal transportation network.”

There’s nothing remotely like that in the text of the bill the NDP released this week. When reporters challenged Horwath on this, the NDP pointed instead to a section of the law that would allow the minister of health to “designate” certain hospitals or other health-care providers as an “integrated care delivery system.” The terminology isn’t as important as the New Democrats’ assertion that, because this section doesn’t include an explicit prohibition on private or for-profit care, the government must be plotting to privatize health care.

But watch the slipperiness here: initially, they pointed to a “specific mandate” for privatization; now, they’re concerned by the lack of an explicit prohibition. The strongest argument they have relates to the absence of evidence: If the Tories weren’t planning to privatize health care, why wouldn’t they include an explicit prohibition?

Well, how about because many of the province’s health-care services are already formally private? There are privately run, long-term care homes, clinics, and even some privately run hospitals that predate the era of OHIP and public health care. The NDP may object to their existence to varying degrees, but they are part of Ontario’s health-care system, and any government that is taking a hard look at making major changes to it can’t pretend they don’t exist. Asking for the government to explicitly prohibit private health care in these structural changes would be asking it to make a plan without actually considering the reality of Ontario’s current system.

The bill also says that the government cannot “designate” a health-care provider if doing so would lead to a patient’s being forced to pay for care, and includes a clause that specifically limits the government’s powers to share personal health information while it reorganizes health networks – a task that will, necessarily, involve the moving around of many many bytes of data. For the most part, this is exactly the kind of bill we should have been expecting from the Tories: a root-and-branch reorganization of the health-care bureaucracy in this province, with precious little evidence of anything more nefarious.

This sort of thing  — the NDP claiming to have uncovered the nefarious machinations of other parties — has happened repeatedly under Horwath. At the beginning of the 2014 election campaign, for example, the party charged that the Liberals were planning to privatize Toronto’s transit system; in 2016, it raised alarms about the prospect that the Liberals were poised to privatize Ontario Place — all because the then-government put some boilerplate legalese in a bill intended to reduce regulations. The Liberals (spoiler alert) never privatized Ontario Place, and the text of the bill the NDP pointed to back then didn’t do what the party claimed it did.

The NDP isn’t obligated to take the government at its word. It doesn’t have to believe the repeated assertions Elliott made yesterday that the Tories are committed to the public health-care system. Indeed, as the official Opposition, the NDP’s role is to challenge the government on its policies and propose alternatives when possible. Releasing the draft legislation was worthwhile in itself.

And there’s definitely stuff in the government’s proposed legislation to be concerned about: it would give the government broad powers to reorganize a health-care system that the Tories believe is a rat’s nest of agencies working at cross-purposes, when they’re working at all. Those expansive powers could be misused. A former deputy minister of health, Bob Bell, warned on Twitter that “the biggest worry about this process is the chaotic development and description of our new health care system.”

The changes that the Tories are proposing would be big, and it’s important that we scrutinize them. We should be vigilant when it comes to anything that could exacerbate the unequal health outcomes Ontarians already face as a result of poverty or other factors. But trying to scare voters by doing the political equivalent of pulling the fire alarm won’t help anyone.

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