Last spring the media was filled with panic stories about the financial sustainability of public health care spending. The most extreme was TD Bank Financial, who issued a report suggesting that health care would take up to 80 per cent of Ontario’s budget by 2030 if corrective action wasn’t taken. Now that the barbeque season is winding down, the onslaught appears to be starting up again.
Global Public Affairs, a private “government affairs” company, has organized a September 22nd Bay Street panel entitled “Ontario Health Spending: The Pacman of Provincial Budgets.” Aside from a title that doesn’t quite make sense, the breakfast forum is another chance for the TD Bank Financial Group to make its case that health care is unsustainable unless we increase private sector participation.
Last week Montreal Gazette columnist Janet Bagnall called efforts to brand health care as unsustainable a “masterful propaganda operation.” She also said that according to recent polls, Canadians were not buying the message.
Bagnall quotes internationally respected health economist Robert Evans (see https://opseudiablogue.wordpress.com/2010/06/17/evans-debunks-myths-about-health-care-unsustainability-at-ottawa-news-conference-today/) who says public Medicare spending is about the same as it was 20 years ago. Evans makes the point that the problem is “uncontrolled private health spending combined with a drop in provincial revenues created by large tax cuts over the years.”
From 1997 to 2004 tax cuts amounted to $170.8 billion taken from the public sector, representing about $35 billion per year at the provincial level. Private care – mostly drugs and dental care – account for 12.7 per cent of health spending by Canadians.
Bagnall makes the distinction between this panic mongering and our ability to run a more efficient ship.
She points to a 2003 study published in the Lancet medical journal in which 40 per cent of illness and 53 per cent of deaths in developed countries can be attributed to risk factors associated with smoking, excessive alcohol consumption, bad diet and obesity.
Bagnall writes that according to the Institute for Clinical Evaluative Services, the jurisdictions with the best health behaviours were British Columbia and Quebec. These two provinces spend far more money to encourage healthy behaviour than Ontario. BC spends $21 per capita on health prevention, Quebec spends $16.80. Ontario, which didn’t even have a Ministry of Health Promotion until 2005, only spends $7.40 per capita. Not surprisingly, BC has the highest life expectancy in Canada.
When Arnold Relman visited Ontario a few years ago, the former editor of the New England Journal of Medicine said that if privatization were the answer, the United States would have the most efficient health system in the world.
Despite the evidence, the TD Bank economists seem to think the private sector will bring innovations to solve our problems. If that were the case, then with an unfettered private system in the U.S., why are their health costs so high and their outcomes so low?
On top of that, the Ontario government continues to cut taxes. According to this spring’s Ontario budget, almost $5 billion in corporate tax cuts are expected within the next three years. That’s $5 billion less that can be spent on health, education, social services, infrastructure and the other key government functions.
Evans frequently says health care is as sustainable as we want it to be. As we march to the next provincial election we may need to ask ourselves, do we want more tax cuts, or do we want health care?
The only Pacman on the screen is the one labeled “corporate tax cuts” ingesting and digesting social spending through tax cuts to ever increase husky corporate profits.