Transcript: Can Ontario Afford Its Health Spending? | May 17, 2021

Steve sits in a room with white walls, a low slanted ceiling and several framed pictures on the walls including one of George Drew. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a blue shirt and a black tie.

A caption on screen reads "Can Ontario afford its health spending? @spaikin, @theagenda."

Steve says BENDING THE HEALTH CARE COST CURVE WAS AN ONGOING CONCERN BEFORE THE PANDEMIC HIT. NOW, WITH SO MUCH UP ENDED BY COVID-19, AS THE FINANCIAL ACCOUNTABILITY OFFICER LAID OUT, CAN THE PROVINCE FIND A WAY FORWARD? ON THAT, WE WELCOME IN FROM VANCOUVER, BRITISH COLUMBIA, ANDRE PICARD, HEALTH REPORTER AND COLUMNIST FOR THE "GLOBE and MAIL..."

André is in his fifties, balding, with a prominent white beard. He's wearing a black shirt.

Steve continues IN WATERLOO, ONTARIO, ROSALIE WYONCH, HEALTH POLICY ECONOMIST AT THE C.D. HOWE INSTITUTE...

Rosalie is in her thirties, with long straight ginger hair. She's wearing glasses and a beige blazer.

Steve continues AND FROM LITTLE ITALY IN ONTARIO'S CAPITAL CITY THERE'S SHEILA BLOCK, SENIOR ECONOMIST AT THE CANADIAN CENTRE FOR POLICY ALTERNATIVES...

Sheila is in her fifties, with short white hair. She's wearing glasses and a blue shirt.

Steve continues GREAT TO SEE YOU BACK ON OUR AIR WAVES FOR AS WE LIKE TO CALL IT A AN IMPORTANT AND TIMELY DISCUSSION IN LIGHT OF THE FAO REPORT THAT CAME OUT LAST WEEK. SHEILA TO YOU FIRST, LET'S START BROAD STROKES HERE. WHAT STORY IN YOUR VIEW IS THIS REPORT TRYING TO TELL?

The caption changes to "Sheila Block. Canadian Centre for Policy Alternatives."

Sheila says I THINK THIS REPORT IS SAYING NO MATTER HOW YOU SLICE AND DICE THE NUMBERS , THIS YEAR'S BUDGET DID NOT HAVE THE MONEY REQUIRED TO DO WHAT THE GOVERNMENT HAS PROMISED IT WOULD DO IN THE BUDGET.

Steve says ROSALIE, HOW ABOUT TO YOU?

The caption changes to "Rosalie Wyonch. C.D. Howe Institute."

Rosalie says I WOULD SAY I AGREE. IT REALLY SHOWS THE LEVEL OF THE CHALLENGE THAT WE'RE DEALING WITH IN TERMINATE OF BOTH INCREASED COSTS, DECREASED REVENUES AND A LOT OF WORK THAT NEEDS TO BE DONE IN TERMS OF FIXING SOME OF THE GAPS OR PROBLEMS WE HAD WITH THE HEALTH CARE SYSTEM ORIGINALLY. I THINK IT SHOWS QUITE THE CHALLENGE.

Steve says ANDRE WHAT'S THE STORY FOR YOU?

The caption changes to "André. The Globe and Mail."

André says SIMILAR TO THE OTHER TWO, SORT OF A CONSTANT FUDGING OF THE NUMBERS WHEN IT COMES TO HEALTH CARE AND THIS HAS REALLY UNDERSCORED IT IN A GRAPHIC FASHION. A BIG, BIG SHORTFALL OVER A LONG PERIOD OF TIME.

Steve says WELL, NO FUDGING OF THE NUMBERS COMING OUT OF THE FINANCIAL ACCOUNTABILITY OFFICER TO BE SURE. WE TOUCHED ON THIS WITH PETER WELTMAN. BUT NOW WE HAVE SOME NUMBERS TO BACK IT UP. TONY I WILL ASK YOU TO BRING UP A SHOT HERE OF THE DIAGNOSTIC TESTING BACKLOG NOW FACING ONTARIO PATIENTS. AND FOR THOSE LISTENING ON PODCAST I WILL GO INTO SOME DETAIL HERE.

A slate appears on screen, with the title "Estimated cumulative backlog of non-urgent diagnostic procedures."

A line chart shows the actual backlog of procedures from March 2020 to December 2020, just under 1500000. Then, it shows the F.A.O. forecast for 2021 up to September, when the backlog is forecasted to reach almost 2500000.

Steve reads data from the slate and says
IF WE GO BACK TO THE BEGINNING OF THE PANDEMIC THAT'S MARCH 2020. YOU CAN SEE ON THIS CHART THERE IS VERY LITTLE BACKLOG AT ALL TO SPEAK OF. BUT THEN AS THE PANDEMIC TAKES ROOT, THE NUMBERS REALLY GO UP AND UP AND UP A LOT. AND TODAY WE'RE LOOKING AT A NON-EMERGENT TYING NO, SIR PARTICULAR PROCEDURE BACKLOG OF 1.6 MILLION DOLLARS PROCEDURES AND IF THE CURRENT RATE CONTINUES, THE FAO HAS GOT THAT ESTIMATED BY SEPTEMBER TO BE NEARLY 2.5 MILLION DOLLARS BACKLOGGED PROCEDURES WHICH THE FAO ESTIMATES COULD TAKE THREE AND A HALF YEARS AT CURRENT SPENDING RATES TO CLEAR. THAT CLEARLY IS NOT ACCEPTABLE, I WOULD SAY ASSUME TO THE PEOPLE OF ONTARIO. BUT ANDRE, LET'S JUST REMIND EVERYBODY WHAT THE FAO IS TALKING ABOUT WHEN THEY'RE REFERRING TO THIS KIND OF A BACKLOG. THE SERVICES THAT THIS WOULD INCLUDE: NON-URGENT DIAGNOSTIC SERVICES MEANS WHAT?

The caption changes to "André Picard. The Globe and Mail."

André says WELL, MOSTLY SURGERIES. SO NOT URGENT SURGERIES BUT ELECTIVE SURGERIES. SO THERE HAVE BEEN... AS THE REPORT SAID... MILLIONS OF PROCEDURES DELAYED. PUT OFF. AND WE'RE GOING TO HAVE TO CATCH UP AT SOME POINT. AND THE QUESTION IS: HOW DO WE DO IT? WE CAN'T MAGICALLY ADD DOCTORS AND NURSES, OPERATING ROOMS ARE ALREADY FULL. WE ALREADY HAD SHORTAGES OF STAFFING. SO THIS IS A PROBLEM AND THESE NUMBERS REALLY UNDERSCORE JUST HOW SEVERE THE PROBLEM IS. BUT THE SOLUTION IS A LOT LESS OBVIOUS.

Steve says THIS CHART IS NOT EVEN ELECTIVE SURGERIES. THIS IS JUST THE DIAGNOSTIC PROCEDURES. THE BIOPSIES AND THAT KIND OF THING WHICH, I MEAN IF YOU'RE SOMEBODY WAITING FOR A DIAGNOSTIC PROCEDURE RIGHT NOW, ANDRE, THIS CAN'T GIVE YOU A LOT OF COMFORT.

André says I PRESUMES NO, THIS IS ESSENTIALLY I SHOULD HAVE STATED THAT MORE QUICKLY. THE PREP BEFORE THE SURGERY. YOU HAVE TO BE DIAGNOSED, ET CETERA. SO WAITING FOR SCANS AND THINGS IT'S A TIME WHERE PEOPLE ARE VERY WORRIED. THEY WON'T KNOW THE RESULTS. THEY DON'T KNOW WHAT'S GOING TO HAPPEN. AND THIS IS... THIS WAS A PROBLEM BEFORE COVID. WE DIDN'T HAVE A BIG BACKLOG. BUT IT WAS SORT OF AN ALL ALWAYS TRYING TO CATCH UP AND IT'S JUST BACKLOGGED TERRIBLY. AGAIN, IT'S NOT CLEAR HOW THE CATCHING UP WILL BE DONE IN ANY QUICK FASHION.

Steve says ROSALIE COULD YOU GIVE US YOUR CHARACTERIZATION OF THE SIGNIFICANCE OF THOSE NUMBERS?

The caption changes to "Rosalie Wyonch, @RosalieWyonch."

Rosalie says CERTAINLY. REALLY I THINK THAT THE NUMBER OF PEOPLE WAITING OR TESTS THAT WE HAVEN'T DONE SORT OF SPEAKS FOR ITSELF FOR THIS SIZE. BUT WHAT I AM MORE CONCERNED ABOUT AND SORT OF ECHOING ANDRE IS THAT THOSE NUMBERS DON'T INCLUDE THE CONSIDERATIONS FOR DO WE HAVE THE CAPACITY, DO WE HAVE THE STAFF TO ACTUALLY BE ABLE TO DEAL WITH THE BACKLOG IN THE TIME THAT THE FAO IS PROJECTING? BECAUSE THEY'RE ASSUMING THAT HOSPITALS CAN OPERATE ABOVE CAPACITY FOR THAT ENTIRE PERIOD. AND WE'RE THINKING ABOUT THREE YEARS. SO MY WORRY IS THAT ALL OF THAT DELAYED DIAGNOSTICS WILL ACTUALLY MEAN THAT ONCE WE DO GET THE DIAGNOSIS AND PEOPLE REACH TREATMENT, THEIR CASE MIGHT BE MORE COMPLEX, WHICH COULD COME WITH HEALTH CONSEQUENCES FOR THE PATIENTS BUT ALSO INCREASED COSTS TO THE HEALTH CARE SYSTEM. AND SO I SUPPOSE THOUGH THAT NUMBER IS SOMEWHAT ALARMING AS IT IS, MY WORRY IS THAT IT MIGHT BE TOO OPTIMISTIC IN TERMS OF HOW QUICKLY WE'LL BE ABLE TO DEAL WITH THE BACKLOG AND THAT IT MIGHT NOT INCLUDE ADDED COSTS BECAUSE WE'VE NOT FOUND SOMETHING DURING THAT BACKLOG.

Steve says THAT RAISES AN INTERESTING QUESTION. OKAY, SHEILA, PETER WELTMAN, THE FINANCIAL ACCOUNTABILITY OFFICER IN MY INTERVIEW WITH HIM, JUST BEFORE YOU GUYS CAME ON, SAID THAT ESSENTIALLY THE PROVINCE IS GOING TO HAVE TO DOUBLE THE CURRENT SPENDING IT CURRENTLY BUDGETS IN ORDER TO CLEAR THAT BACKLOG. ROSALIE RACES THE ISSUE THAT EVEN IF THEY DID THAT DO WE HAVE ENOUGH DOCTORS, DO WE HAVE ENOUGH NURSES, ENOUGH O.R. CAPACITY? DO WE HAVE ENOUGH DIAGNOSTIC TOOLS TO BE ABLE TO DO IT ANY WAY? WHAT CAN YOU TELL US ON THAT?

The caption changes to "Sheila Block, @SheilaBlockTO."

Sheila says WELL, YOU THINK THERE ARE A NUMBER OF THINGS THAT WE CAN START TO ADDRESS THIS. ONE OF WHICH IS WE HAVE INTERNATIONALLY EDUCATED HEALTH CARE PROVIDERS THAT WE COULD, YOU KNOW, FAST TRACK INTO SERVICE IN THIS. THIS KIND OF SITUATION. AND WE HAVE TO REALLY LOOK... TAKE A HARD LOOK AND SEE WHAT CAPITAL EXPENDITURES WOULD NEED TO BE MADE, WHAT KINDS OF INVESTMENTS DO WE NEED TO MAKE IN MORE HEALTH CARE PROVIDERS AND I THINK WE REALLY HAVE TO LOOK AT WHAT WE HAVE DONE DURING THE PANDEMIC AND STEP UP IN THE SAME KINDS OF WAYS THAT WE STEPPED UP THEN. AND I REALLY THINK THAT WE HAVE FACED DECADES OF UNDER INVESTMENT IN HEALTH CARE IN ONTARIO. AND AS A RESULT, THE CHICKENS ARE COMING HOME TO ROOST HERE AND I THINK WE REALLY HAVE TO TAKE A HARD LOOK AT WHAT WE NEED IN THE HEALTH CARE SYSTEM AND HOW WE'RE GOING TO PAY FOR IT.

Steve says LET'S DO ANOTHER CHART HERE AND THIS, AGAIN, IS FROM THE FINANCIAL ACCOUNTABILITY OFFICER'S JUST COMPLETED REPORT FROM LAST WEEK. AND ROSALIE I WILL GET YOU TO START ON THIS ONE FIRST BECAUSE THIS CHART REALLY PIQUED YOUR INTEREST AND I WILL ASK TONY BURKEHART WHO IS DIRECTING TODAY TO BRING THIS UP IF YOU WOULD. HEALTH CARE PROGRAM FUNDING AND THIS IS THE AREA... THESE ARE THE AREAS, RATHER, THAT THE FAO HAS IDENTIFIED AS FACING POTENTIALLY SIGNIFICANT FUNDING DECREASES OVER THE NEXT DECADE.

A slate appears on screen, with the title "Health care programs: Largest funding decreases."

Steve reads data from the slate and says
OPERATION OF HOSPITALS OFF ALMOST 20 percent. REGIONAL CO-ORDINATION OPERATIONS SUPPORT ALMOST 70 percent. SMALL HOSPITAL PROJECTS OFF ALMOST 90 percent. DIGITAL HEALTH DO YOU MORE THAN 40 percent. HOME CARE DOWN 3 percent. THIS IS SOMETHING THAT THEORETICALLY WE'RE SUPPOSED TO BE RELYING ON IN OUR FUTURE IN ORDER TO ENSURE OUR LONG-TERM CARE HOMES DON'T BECOME OVERRUN. 3 percent DECREASE IN FUNDING, OUTBREAKS IN DISEASES, MORE THAN 20 percent OFF. CHILD AND YOUTH MENTAL HEALTH ALMOST 15 percent OFF. ROSALIE, WHAT'S THE STORY YOU'RE SEEING IN THOSE NUMBERS?

Rosalie says WELL, REALLY, SOME OF THOSE ARE UNDERSTANDABLE. THE DECREASE IN SMALL HOSPITAL PROJECTS IS REALLY BEING REPLACED BY LARGE HOSPITAL PROJECTS. BUT REALLY SOME OF THOSE I SUPPOSE ARE PUZZLING AND POSSIBLY A LITTLE BIT WORRYING FOR ME FOR THE FUTURE. JUST BECAUSE WHEN WE'RE LOOKING AT SORT OF THE GAPS OR THE PROBLEMS THAT WE'VE IDENTIFIED, DURING THIS PANDEMIC AND BEFORE, YOUTH MENTAL HEALTH, I WOULD CONSIDER TO BE A BIT OF A CONCERN, CONSIDERING ALL THE DISRUPTION THAT CHILDREN HAVE GONE THROUGH IN THE PAST YEAR. DIGITAL HEALTH IS REALLY A TOOL TO REDUCE COSTS IN THE HEALTH CARE SYSTEM AND GET PEOPLE EASIER ACCESS. AND WE'VE MADE GREAT STRIDES IN ACTUALLY DOING THAT OVER THE LAST YEAR. AND SO THE REDUCTION... OR THESE NEGATIVE NUMBERS IN SOME OF THE AREAS THAT HAVE BEEN IDENTIFIED AS PRIORITIES SIMPLY BY THE SITUATION THAT WE'RE IN DOES SORT OF MAKE ME QUESTION IF WE ARE GOING TO REALLY LEARN THE LESSONS THAT WE SHOULD BE LEARNING FROM THIS PANDEMIC IN TERMS OF WE NEED TO THINK ABOUT HOW WE DELIVER HEALTH CARE DIFFERENTLY AND HOME AND COMMUNITY CARE, MENTAL HEALTH CARE ARE VERY MUCH PART OF THAT. AND THOUGH THE GOVERNMENT IS INVESTING IN THESE AREAS, I WONDER IF THE... WE'RE MISSING THE OPPORTUNITY TO REALLY HAVE A MAJOR PARADIGM SHIFT IN HEALTH CARE AND REALLY ADDRESS SOME OF THOSE CHRONIC ISSUES THAT WE'VE BEEN SEEING. AND WITH THAT, TO MOVE FORWARD ON THOSE ISSUES I WOULD EXPECT THAT WE NEED SOME INVESTMENT IN THOSE AREAS. AND DIGITAL HEALTH OUTBREAKS IN DISEASE, HOME CARE AND YOUTH MENTAL HEALTH, I WOULD THINK, ARE ALL AREAS OF PRIORITY. PARTICULARLY GIVEN RECENT EXPERIENCE.

Steve says ANDRE JUST BEFORE I GET YOU TO CHIME IN, I SHOULD REMIND EVERYBODY THAT THIS IS POTENTIALLY WHAT THE FUTURE LOOKS LIKE OVER THE NEXT DECADE IF, AS THE FAO SAYS, THE GOVERNMENT OF ONTARIO, DOESN'T FUND HEALTH CARE TO THE TUNE OF 60 BILLION Dollars... THAT'S THE GAP RIGHT NOW BETWEEN APPARENTLY WHAT WE NEED AND WHAT THE GOVERNMENT IS BUDGETING. IF THAT 60 BILLION DOLLARS dollar GAP PERSISTS, THOSE KINDS OF NUMBERS ARE WHAT WE'RE GOING TO BE LOOKING AT OVER THE NEXT DECADE OR SO. WHAT STORY DO YOU THINK IT TELLS?

The caption changes to "André Picard, @picardonhealth."

André says I THINK VERY SIMILAR TO WHAT ROSALIE SAID. IT SEEMS TO BE A DISCONNECT BETWEEN REALITY AND WHAT'S NEEDED. THE INVESTMENT IN MENTAL HEALTH IN HOME CARE, IN DIGITAL HEALTH. THOSE SEEM LIKE OBVIOUS PRIORITIES IN THE WAKE OF COVID-19 AND THEY SEEM TO BE BEING REDUCED. SOME OF THEM MAKE SENSE, THERE IS A BIG REDUCTION IN... I FORGET THE EXACT CATEGORY... BUT ADMINISTRATION AND I THINK THAT'S A SHIFT TO THE ONTARIO HEALTH TEAM. SOME OF IT IS UNDERSTANDABLE. BUT OVERALL SOME OF IT IS VERY PUZZLING. YOU HAVE TO WORRY AND WONDER ABOUT GOVERNMENT PRIORITIES.

Steve says SHEILA, DOES IT MAKE YOU WONDER AS WELL?

Sheila says I THINK THIS GOVERNMENT'S PRIORITIES ARE PRETTY CLEAR. THEY'RE FOCUSED ON THE BOTTOM LINE. AND I THINK THEY'RE FOCUSED ON THE BOTTOM LINE TO THE DETRIMENT OF PUBLIC SERVICES. AND I THINK REALLY WHAT WE WANT TO DRIVE HOME HERE IS THIS REPORT SAYS CAN THE GOVERNMENT FUND WHAT THEY NEED THEY'RE GOING TO FUND? I THINK THERE'S A WHOLE VIEW ON WHAT THEY SAID THEY'RE GOING TO FUND IS NOT ACTUALLY SUFFICIENT. YOU CAN LOOK AT THE TIMING THAT THEY'RE GOING TO TAKE TO GET UP TO FOUR HOURS OF CARE AND LONG-TERM CARE. YOU CAN LOOK AT THE DESCALES OF LONG-TERM CARE WORKERS. CAN YOU LOOK AT WHAT WE'RE GOING TO DO WITH THE REAL CRISIS THAT NURSES ARE FACING AS A RESULT OF THIS PANDEMIC AND POLICY IN RESPONSE TO IT. AND YOU CAN SEEN THINK ABOUT THE LEGAL CHALLENGES ABOUT NURSES' REMUNERATION AND IF THE GOVERNMENT LOSES THOSE CHALLENGES THEN THEY WILL BE EVEN FURTHER HYNDMAN... FURTHER BEHIND IN THE FUNDING OF WHAT THE GOVERNMENT WANTS TO DO.

Steve says THE GOVERNMENT MIGHT SAY THEY'RE SPENDING NORTH OF 70 BILLION Dollars ON HEALTH CARE RIGHT NOW. SURELY THAT'S ENOUGH TO DEEM WITH THE PRIORITIES WE HAVE. WHAT'S THE RESPONSE TO THAT?

André says MAYBE IT'S ENOUGH BUT I THINK WE DON'T SPEND ENOUGH TIME THINKING ABOUT ARE WE SPENDING APPROPRIATE OR GETTING VALUE FOR MONEY. IT'S NOT JUST ABOUT DOING MORE OF THE SAME OLD, SAME OLD WHICH TENDS TO BE THE WAY THE GOVERNMENT OPERATES IS WE'VE SPENT "X" BILLION DOLLARS. LAST YEAR WE'RE GOING TO ADD 2.2 percent AND THAT'S THAT. IT'S NEVER BEEN AND THERE RARELY IS A FUNDAMENTAL RETHINKING OF HOW WE SPEND AND WHERE WE SPEND. AND THAT, AGAIN, I THINK IS AN OPPORTUNITY THAT COVID-19 SHOULD HAVE GIVEN US IS TO REALLY RETHINK, YOU KNOW, ARE WE INVESTING PROPERLY IN ELDERS, IN HOME CARE, IN MENTAL HEALTH. AND THIS SEEMS TO UNDER SCORE THAT WE'RE ACTUALLY NOT REALLY THINKING ABOUT THIS AT ALL. WE'RE JUST TALKING ABOUT JUST THE NUMBERS, CAN WE HOLD THE LINE. AND I THINK IT RAISES REALLY SERIOUS QUESTIONS ABOUT HOW WILL THE GOVERNMENT, IF IT FEELS IT'S SPENT ENOUGH, HOW WILL IT CONTROL SPENDING? BECAUSE IN THE PAST, HOW HAVE THEY DONE IT? YOU KNOW, THEY'VE FROZEN THE PAYMENTS TO HOSPITALS. THEY HAVE A TRIED TO CONTROL DOCTORS' SALARIES. THEY'VE CUT BACK ON NURSES AND PAY TO NURSES. ALL THESE THINGS ROB MONUMENTAL FAILURES. SO IF THE GOVERNMENT LINE IS WE HAVE TO SPEND NO MORE THAN THIS, WELL, TELL US HOW YOU'RE GOING TO DO IT IS THE MOST IMPORTANT DISCUSSION I THINK.

Steve says SHEILA LET ME PICK UP ON ONE ASPECT OF ANDRE'S DISCUSSION AND ANDRE WROTE ABOUT THIS IN HIS MOST RECENT BOOK AS WELL. OLDER PEOPLE WANT TO AGE IN THEIR HOMES AS OPPOSED TO HOOKED UP TO TUBES AND LINES IN A HOSPITAL BED. AND THE WAY TO MAKE THAT HAPPEN IS TO INCREASE FUNDING FOR HOME CARE PERHAPS BUT NOT NECESSARILY AT THE EXPENSE OF MORE MONEY TO HOSPITAL CARE. OR LONG-TERM CARE. THE EXPRESSION WE HEAR ALL THE TIME IS WE DON'T WANT A WAREHOUSE SENIORS WE WANT THEM TO AGE APPROPRIATELY IN THEIR HOMES. WHEN YOU LOOK AT THAT CHART AND THE PRIORITIES THE ONTARIO GOVERNMENT HAS ENUNCIATED SO FAR, DO YOU SEE THAT APPROACH BEING PUT INTO EFFECT?

Sheila says I DON'T SEE THAT APPROACH BEING PUT INTO EFFECT. AND I THINK WE HAVE TO NOT ONLY LOOK AT THAT APPROACH AS A WAY TO REDUCE HEALTH CARE COSTS. BUT I THINK WE HAVE TO LOOK AT IT AS HOW DO WE ENHANCE THE QUALITY OF LIFE? AND I DON'T THINK THAT, YOU KNOW, AN IMMEDIATE KIND OF REMOVAL OF MONEY FROM HOSPITALS OR REDUCTION IN LONG-TERM CARE AND REINVESTMENT INTO HOME CARE IS REALLY THE WAY TO DO THIS. I THINK WHAT WE NEED TO DO IS INCREASE INVESTMENT IN ALL OF THESE SECTORS. AND THEN WE CAN KIND OF TAKE A LOOK AT IT AND SEE HOW ARE WE INCREASING THE QUALITY OF LIFE. AND THEN WE'LL ABSOLUTELY BE SOME POSITIVE OUTCOMES. WE KNOW THAT MANY SENIORS ARE IN HOSPITAL WAITING FOR EITHER HOME CARE OR LONG-TERM CARE. BUT I THINK THE OBJECTIVE REALLY SHOULD BE QUALITY OF CARE AND QUALITY OF LIFE.

Steve says ROSALIE, DO THE NUMBERS WE JUST PUT FORWARD SUGGEST TO YOU THAT THE GOVERNMENT SEEMS COMMITTED TO IMPROVING THE HOME CARE BUDGETS, IMPROVING LONG-TERM CARE BUDGETS AND SO ON?

Rosalie says WELL, I THINK THAT THEY'VE MADE COMMITMENTS ESPECIALLY BECAUSE OF THE REALLY THE RESULTS WE'VE SEEN IN THE PUBLIC DEMANDS THAT WE REALLY DO SOMETHING ABOUT THE SITUATION THAT OCCURRED IN LONG-TERM CARE HOMES. BUT REALLY WHAT I THINK WHEN WE'RE TALKING ABOUT ALL OF THIS INVESTMENT AND I AGREE THAT THERE ARE ISSUES THAT ALL OF THESE ISSUES NEED TO BE DEALT WITH. BUT AT THE END OF THE DAY WE ALREADY HAVE A GAP IN WHAT'S PROMISED. YOU KNOW, WHAT WE ALREADY SORT OF HAVE ON THE TABLE ALREADY LOOKS SOMEWHAT UNAFFORDABLE. AND THEN WHAT THE FAO PROJECTIONS LOOKING OUT TEN YEARS, THE GAP BETWEEN WHAT THE GOVERNMENT PROJECTS AND WHAT THE FAO PROJECTS IS EQUIVALENT TO ALMOST THE ENTIRE POST-SECONDARY BUDGET. SO WE CAN'T INVEST EVERYWHERE IN HEALTH CARE. WE CAN'T JUST KEEP SPENDING MORE THERE. WHAT WE NEED TO DO IS BE INCREDIBLY STRATEGIC ABOUT WHERE AND HOW WE SPEND THAT MONEY. AND OTHERWISE, HEALTH CARE SERIOUSLY RUNS THE RISK OVER THE LONG TERM OF CROWDING OUT OTHER PROGRAM SPENDING OR QUITE SIGNIFICANTLY INCREASING TAXES. AND SO THOUGH WE CAN TALK ABOUT WHAT WE WOULD LIKE TO DO IN AN IDEAL WORLD WITH ALL THE RESOURCES AVAILABLE, THERE REALLY IS AN UNFORTUNATE FACT THAT GOVERNMENT REVENUES HAVE ALSO TAKEN A HIT. AND THAT INVESTING IN ONE PLACE MEANS THAT YOU CAN'T INVEST SOMEWHERE ELSE. AND THOUGH WE DO NEED TO INVEST IN OUR HEALTH CARE SYSTEM, I WORRY THAT IF WE FOCUS TOO MUCH IN ONE AREA, WE WILL NEGLECT ALL THE OTHER AREAS OF PROGRAM SPENDING, PUBLIC SERVICES THAT, REALLY, IT'S THE COLLECTION OF ALL OF THESE PROGRAMS THAT CONTRIBUTE TO PEOPLE'S HEALTH AND QUALITY OF LIFE. AND, YOU KNOW, KEEP THEM WELL. AND SO I THINK WE DON'T WANT TO INVEST IN SICK CARE AT THE EXPENSE OF CROWDING OUT, YOU KNOW, PREVENTIVE... PREVENTIVE CARE AND HIGH QUALITY, SOCIAL DETERMINANTS OF HEALTH. SO THINKING ABOUT WELFARE, EDUCATION, AND REALLY THERE ISN'T AN INFINITE AMOUNT OF MONEY. AND SO WE DO NEED TO BE STRATEGIC. BUT AT THE SAME TIME, WE HAVE QUITE A LARGE PRIORITIES THAT WILL BE EXPENSIVE. SO I'M SYMPATHETIC TO THE IDEA THAT THIS IS AN INCREDIBLY DIFFICULT CHALLENGE. BUT THAT JUST CHOOSING WHERE TO SPEND THE MONEY WON'T BE ENOUGH. WE NEED TO THINK DIFFERENTLY ABOUT HOW WE'RE GOING TO SPEND THE MONEY. SO THAT WE CAN ACTUALLY AFFORD HIGH QUALITY CARE FOR EVERYONE.

Steve says IN FACT, I'VE BEEN HEARING HEALTH MINISTERS ACROSS THE COUNTRY TALK THAT WAY FOR THE LAST THREE AND A HALF OR FOUR DECADES AND ANDRE MAYBE I WILL GET YOU TO WEIGH IN ONTHIS, WE'VE ALL HEARD OVER AND OVER AGAIN THAT THE HEALTH CARE SYSTEM REALLY HAS TO STOP SINGULARLY FOCUSING ON BEING A SICKNESS STREET SYSTEM AND HAS TO START ENCOMPASSING IDEAS OF HEALTH PROMOTION AND WELLNESS PROMOTION. ARE WE DOING THAT YET ADEQUATELY IN YOUR VIEW?

André says WELL, THE SHORT ANSWER IS NO. WE'RE NOT ANYWHERE CLOSE TO DOING THAT. AND I THINK WHAT ROSALIE SAID IS REALLY IMPORTANT. WE HAVE TO BE CAREFUL TO NOT JUST SAY WE'RE GOING TO KEEP SPENDING ON SICKNESS CARE OVER AND OVER. WE'VE SEEN THIS, PARTICULARLY IN ONTARIO, IN THE PAST. WHAT THEY'VE DONE IS SLASH WELFARE BUDGETS, HOUSING PUBLIC HOUSING SUPPORT, ET CETERA. THINGS THAT KEEP PEOPLE HEALTHY IN THE FIRST PLACE AND THAT IS A LOSING PROPOSITION IN THE LONG RUN. SO WE HAVE TO BE CAREFUL TO FIND THAT BALANCE. IT'S TRUE THAT MONEY ISN'T UNLIMITED. SO WE HAVE TO MAKE CHOICES AND I THINK ONE OF THE MOST IMPORTANT POLICY DISCUSSIONS WE NEED TO HAVE IN CANADA AND WE'VE BEEN PUTTING IT OFF FOR DECADES IS WHAT DO WE COVER PUBLICLY AND WHAT DO WE COVER, WHAT MUST BE COVERED PRIVATELY. AND PEOPLE DON'T LIKE TO HEAR THAT WORD. BUT WE HAVE A LOT OF PRIVATE FUNDING IN CANADA NOW. WE JUST DON'T NECESSARILY DO IT IN ANY COHERENT FASHION. IT'S NOT CLEAR WHAT'S COVERED OR WHY. AND WE HAVE TO HAVE THOSE DISCUSSIONS MORE BROADLY AND OPENLY.

Steve says WELL, AND DIFFERENT PROVINCES SHEILA COVER DIFFERENT THINGS AND THAT KICKS OFF A LITTLE CONVERSATION I WOULD LIKE TO HAVE ABOUT COMPARING AND CONTRASTING ONTARIO WITH SOME OF THE OTHER PROVINCES AND LET'S START FOR ARGUMENT'S SAKE WITH QUEBEC. WE NOTICE THAT QUEBEC RAMPED UP SPENDING AND TRAINING TO CREATE MORE PERSONAL SUPPORT WORKERS AFTER THE FIRST WAVE. AND ONTARIO EVENTUALLY BROUGHT OUT A SIMILAR POLICY IN WHICH THEY OFFER TO SUBSIDIZE THE EDUCATION TO CREATE A WHOLE NEW GENERATION OF PERSONAL SUPPORT WORKERS IN THE THIRD WAVE. WHY WERE WE APPARENTLY SO LATE TO GET ON THAT TRAIN?

Sheila says WELL, THAT IS A DEVASTATING QUESTION. AND I THINK THERE'S A REAL QUESTION WHEN GOVERNMENTS REALIZE THEY'VE MADE AN ERROR AND MOVE TO CORRECT IT AND GOVERNMENTS WHO DON'T. AND I THINK THE CLEAR POLICY THAT THE GOVERNMENT HAS HAD THROUGH THIS... THROUGH THE PANDEMIC AND PARTICULARLY IN LONG-TERM CARE IS THEIR RESPONSE WAS TO KIND OF LOOSEN REGULATIONS AND TO LEAVE WIDE ROOM FOR PROVIDERS TO MOVE THROUGH THEM. AND, FOR EXAMPLE, B.C. VERY EARLY ON SAID YOU CAN'T MOVE FROM ONE HOME TO THE OTHER. ONTARIO SAID THE SAME THING. EXCEPT THEY SAID IF YOU'RE A TEMPORARY WORKER YOU CAN MOVE FROM ONE HOME TO ANOTHER.

Steve says YOU'RE TALKING ABOUT PSWs IN ONE HOME ONLY.

Sheila says IN ONE HOME ONLY. THOSE KIND OF POLICY RESPONSES FROM THE FORD GOVERNMENT HAVE VERY MUCH COST LIVES. AND I CANNOT GIVE YOU A POLICY REASON WHY THEY DID THAT. IT'S TRULY DISTRESSING. AND I THINK THE LONG-TERM CARE CLINICIAN LAID THAT OUT VERY CLEARLY.

Steve says ANDRE, MAYBE I'LL GET YOU TO MAKE ANOTHER COMPARISON BETWEEN ONTARIO AND THE PROVINCE OF QUEBEC. QUEBEC HAS THE MINISTRY OF HEALTH AND SOCIAL SERVICES. WE DON'T. WE ARE ONLY THE MINISTRY OF HEALTH IN ONTARIO. MAYBE THAT'S IMPORTANT AND MAYBE IT'S NOT. YOU TELL ME.

André says I THINK IT'S SYMBOLICALLY IMPORTANT. I THINK IN QUEBEC THE MINISTRY OF HEALTH IS DOMINANT MUCH MORE SO THAN THE SOCIAL SERVICES. BUT I THINK THEY UNDERSTAND BETTER THAT THESE THINGS ARE LINKED. THAT, YOU KNOW, MAKING SURE COMMUNITY CLINICS OFFER WELFARE SERVICES, A GOOD EXAMPLE I LIKE TO USE IN QUEBEC, THEY HAVE A PROGRAM WHERE IF YOU GO TO YOUR LOCAL COMMUNITY HEALTH CENTRE CALLED CLSCs IN QUEBEC, A PREGNANT WOMAN WILL BE PRESCRIBED ORANGE JUICE AND MILK AND PRENATAL VITAMINS SO THIS IS AN INTEGRATION OF LET'S KEEP PEOPLE HEALTHY SO THEY DON'T HAVE LOW BIRTH WEIGHT BABIES. THAT'S AN EXAMPLE. IF YOU HAVE MORE INTEGRATION YOU HAVE SMARTER POLICIES. BUT QUEBEC ISN'T MAGICALLY BETTER. BUT ON THAT COUNT I THINK THEY'RE A LITTLE MORE THOUGHTFUL AND THEY REALIZE THAT THIS IS A WHOLE CONTINUUM THAT'S NOT JUST ABOUT SICKNESS CARE IT'S ABOUT ENSURING PEOPLE ARE HEALTHY IN THE FIRST PLACE.

Steve says ROSALIE LET'S DO ANOTHER LITTLE BIT OF COMPARING AND CONTRASTING HERE. HOW ABOUT THE HOSPITAL BEDS IN? THE NUMBER OF HOSPITAL BEDS IN ONTARIO COMPARED TO THE OTHER NINE PROVINCES OR IF YOU WANT TO INCLUDE THE TERRITORIES, TOO, HOW ARE WE DOING?

Rosalie says WELL, ONTARIO IS A LITTLE BIT BELOW THE CANADIAN AVERAGE. AND UNFORTUNATELY CANADA IS NOT... DOESN'T FARE THAT WELL ON AN INTERNATIONAL COMPARISON, EITHER. AND SO I WOULD SAY THERE ARE RELATIVE TO THE SIZE OF THE POPULATION, THERE ARE GENERALLY A SHORTAGE OF HOSPITAL BEDS EVERYWHERE IN THE COUNTRY. BUT AS WELL ONTARIO IS A LITTLE BIT BELOW THAT AVERAGE. AND SO THERE IS SORT OF... IT JUST SHOWS THE SITUATION THAT WE WERE IN GOING INTO THIS PANDEMIC THAT THERE WERE POTENTIALLY NOT ENOUGH HOSPITAL BEDS FOR THE SIZE OF POPULATION. THERE WAS A LARGE WAIT LIST FOR LONG-TERM CARE. AND SO I THINK JUST REALLY AS SHEILA SAID EARLIER, THE UNDER UNDERINVESTMENT AND THE CHICKENS COMING HOME TO ROOST, IT'S SIMPLY THAT YOU CAN'T CREATE THAT CAST AT THIS OVERNIGHT. AND AS A RESULT YOU END UP WITH A LOWER CAPACITY, LESS ABILITY TO MAINTAIN ELECTIVE SURGERIES. AND SO REALLY IT JUST RESULTS IN A SITUATION THAT WE'RE IN NOW WHICH IS THAT TOUGH PROBLEM OF WE NEED MORE BEDS. WE NEED INVESTMENT IN HOME CARE. WE NEED TO ADDRESS THE SITUATION IN LONG-TERM CARE. AND MEANWHILE, THERE STILL IS... WE'VE BEEN SPENDING AT AN ALMOST PHYSICALLY UNSUSTAINABLE RATE YET WE STILL HAVE THESE ISSUES. WE'VE JUST REALLY BEEN DIGGING A HOLE. AND COVID JUST REALLY SPED UP OUR... THE DOWNWARD TRAJECTORY. AND NOW THAT'S WHERE WE ARE. AND WE NEED TO FIGURE A WAY OUT OF IT.

Steve says SHEILA, YOU WANTED TO ADD SOMETHING?

Sheila says I JUST WANT TO LEAP IN THAT ABSOLUTELY WE DON'T WANT TO INVEST IN HEALTH CARE AT THE EXPENSE OF OTHER SERVICES. AND IN PARTICULAR IN THE SOCIAL DETERMINANTS OF HEALTH. BUT I THINK WE REALLY HAVE TO BE CLEAR THAT THERE ARE FISCAL OPTIONS AVAILABLE. AND THAT INCLUDES INCREASING TAXES, THAT INCLUDES SUMMARY NEGOTIATION WITH THE FEDERAL GOVERNMENT IF WE'RE WILLING TO MEET SOME OF THOSE LONG-TERM CARE STANDARDS THAT HAVE BEEN SPOKEN ABOUT. AND SO I THINK, REALLY, THE LESSON FROM THIS PANDEMIC IS WE NEED A SHIFT TO A GREATER AMOUNT OF ECONOMIC ACTIVITY IN THE PUBLIC SECTOR AND, IN PARTICULAR, IN THE CARING ECONOMY. AND IT'S NOT AN INFINITE AMOUNT OF NEED AND THERE ARE RESOURCES IN THE RICHEST PROVINCE THAT WE CAN ACTUALLY PUT TOWARDS THEM.

Steve says YOU ANTICIPATED EXACTLY WHERE I WANTED TO GO NEXT IN OUR REMAINING MOMENTS. THAT'S PERFECT. THIS IS THE QUESTION I WAS GOING TO SAY FOR THOSE OF US OLD ENOUGH TO REMEMBER THE OLD GAME SHOW THIS IS THE 64000 dollar QUESTION. BUT APROPOS OF WHAT THE FAO HAS SAID, NO, THIS IS THE 61 BILLION DOLLAR QUESTION. WHICH IS THAT IF WE'RE GOING TO DEAL WITH THAT GAP IN WHAT THE GOVERNMENT WANTS TO DO AND WHAT IT APPARENTLY HAS BEEN PREPARED TO FUND, WE'VE GOT TO FIGURE OUT EITHER HOW TO FIND 60 BILLION DOLLARS OR REDUCE OTHER PROGRAMS BY THAT AMOUNT OR BORROW MORE OR TAX MORE OR WHAT. AND I WANT SOME ADVICE FROM ALL OF YOU ON THAT ALL RIGHT. ANDRE, WE KNOW WHAT THE OPTIONS ARE. WHAT'S THE WAY TO GO?

André says WELL, THE WAY TO GO IS WE HAVE TO RECOGNIZE THAT WE WANT A CERTAIN LEVEL OF SERVICES, A CERTAIN QUALITY OF LIFE. AND WE'RE GOING TO PAY FOR IT. SO WE HAVE TO FIGURE OUT THE WAY TO PAY FOR IT MOST EFFICIENTLY. AND THE WAY TO DO THAT IS WITH COLLECTIVE PROGRAMS. LET'S FIND THE PUBLIC PROGRAM THAT IS ARE MOST EFFICIENT, THAT GIVE US THE BIGGEST BANG FOR THE BUCK AND INVEST WELL THERE AND THEN THERE HAS TO BE A PORTION FOR PEOPLE INVESTING PRIVATELY EITHER PRIVATELY OR OUT OF POCKET. EITHER WE PAY FROM THE LEFT POCKET PRIVATELY OR THE RIGHT POCKET PUBLICLY. BUT WE HAVE TO FIND THE PERFECT BLEND TO GET VALUE FOR MONEY AND TO GIVE PEOPLE GOOD QUALITY OF LIFE.

Steve says NOW, ROSALIE, I CANNOT IMAGINE THAT A REPRESENTATIVE OF THE C.D. HOWE INSTITUTE WHICH IS A BUSINESS-FRIENDLY THINK TANK, I THINK WE CAN SAY THAT. I CAN'T IMAGINE YOU ARE GOING TO AGREE TO 60 BILLION DOLLARS IN CORPORATE TAX INCREASES IN ORDER TO FUND THIS GAP OR ARE YOU GOING TO SURPRISE ME TODAY AND SAY YES YOU ARE?

Rosalie says WELL, I WOULD POINT OUT THAT THE CORPORATE INCOME TAX TAKE IN ONTARIO WAS A LITTLE UNDER 12 BILLION DOLLARS LAST YEAR, SO IT WOULD NEED TO BE NOT A SMALL INCREASE TO COVER THE GAP BETWEEN THE PROJECTIONS OR THE TOTAL AMOUNT. AND SO I THINK THAT IT WOULD BE SHALL WE SAY, OPTIMISTICALLY, IT WOULD BE VERY DISTORTIONARY LIKELY IF WE WERE TO JUST FULLY FUND THAT AMOUNT WITH TAXES. AND I WOULD SAY EVEN IF WE WERE TO DO THAT, IT WOULD STILL BE THE CONCERN ABOUT HEALTH CARE SPENDING GROWING FASTER THAN THE REVENUE BASE OR GDP. AND THAT AT THE END OF THE DAY, WHATEVER THE LEVEL OF SPENDING WE HAVE ON OUR HEALTH CARE SYSTEM, WE HAVE TO ENSURE THAT IT IS PHYSICALLY SUSTAINABLE. OR WE'LL JUST FIND OURSELVES IN ANOTHER TOUGH SITUATION DOWN THE ROAD.

Steve says FORGIVE ME. LET ME JUMP IN. FORGIVE ME ROSALIE I HAVE A MINUTE LEFT AND I WANT TO MAKE SURE SHEILA GETS A CHANCE TO RESPOND TO WHAT YOU SAID AND I WILL PUT THE OPPOSITE QUESTION TO YOU, SHEILA. ARE YOU REALLY PREPARED TO STICK BUSINESS WITH 60 BILLION DOLLARS IN NEW TAXES TO PAY FOR THIS AT A TIME WHEN SO MANY BUSINESSES... NOT AMAZON, BUT OTHERS... NOT WALMART, NOT COSTCO, BUT OTHERS... ARE HAVING SUCH A DIFFICULT TIME STAYING AFLOAT?

Sheila says I THINK IT'S A FALSE... IT'S KIND OF A FALSE EQUIVALENT. I THINK WHAT WE CAN ABSOLUTELY SAY IS WE WOULD PHASE-IN THESE TAX INCREASES. WE HAVE TO REMEMBER THAT RIGHT NOW THE COST OF GOVERNMENT BORROWING IS AT HISTORIC LOWS. WE DO NOT HAVE TO PAY ALL OF THIS UP FRONT IMMEDIATELY. A PHASED INCREASE IN TAXES ABSOLUTELY NOT ALL OF IT IS WILL BE ON CORPORATE INCOME TAXES IS THE WAY TO DO IT. AND WE WOULD WANT TO BALANCE THAT WITH ECONOMIC RECOVERY. AND ABSOLUTELY IT'S DO-ABLE.

The caption changes to "Producer: Liane Kotler, @LianeKotler; Producer: Steve Paikin, @spaikin. Student Intern: Simone Gavros."

Steve says I WANT TO THANK OUR THREE FINANCE MINISTERS FOR COMING ON THE SHOW TONIGHT EXPLAINING HOW THIS IS ALL GOING TO GET DONE. ANDRE PICARD, ROSALIE WYONICH, SHEILA BLOCK. IT'S GREAT OF YOU TO SPEND SO MUCH TIME WITH US TONIGHT ON TVO. THANKS SO MUCH.

All the guests say THANK YOU.

Watch: Can Ontario Afford Its Health Spending?