Health care and Andrea Horwath’s hair – the election winds down

It’s not even election day and the media has already begun navel gazing about why voters ignored the platforms and got hung up on the minutiae of the horse race. The National Post is doing so by trying to analyse the content of Twitter posts. Do they really think this represents the views of typical Ontarians?

At the beginning of the campaign pollsters told us the number one issue was health care. Amid a tumult of bad news about the economy, attention shifted. But did either issue really resonate?

There were more pressing details, after all. Among the 10 moments the National Post lists as shaping NDP leader Andrea Horwath’s public persona: the Toronto Sun naming Horwath as having the “best hair” at Queen’s Park. Is this what voters really care about?

The parties did have health care and economic platforms that could have made for a lively exchange. During the leader’s televised debate health care was added on to the very end as if to say, “gosh, we almost forgot!” At that, it had more to do with privatization than questions of access or quality.

Some issues did get modest attention, while others stayed put in their respective platforms.

The NDP promised to look at home care delivery with the intent of creating a more stable publicly-delivered system. Not even the for-profit agencies rose to fight that proposal. Instead it got ignored and the NDP never made it a feature of their election strategy. Alternately, they talked about reducing the wait for home care by adding a million new hours of care to the 29 million hours the province presently delivers.

Long term care got more attention, but it was also about a numbers game, the Tories promising to create the greatest number of new beds:  5,000. No party spoke to the real issue that has made repeat headlines in this province – the quality of that care. Progressive groups have been arguing that Ontario needs a staffing standard for its nursing homes, something former Health Minister George Smitherman had at one point promised in the 2008 election. Staffing levels are the most direct indicator of quality of care in a nursing home. Not even layoffs at nursing homes during the election created much of a ripple on this front.

The sustainability of health care funding did get some play, but there wasn’t much to distinguish the parties. All appear to look at sustainability from the expenditure side, not from the delivery side. Not even the Auditor General of Ontario’s June warnings could get much fire going. He cautioned the base budget forecasts that later became the basis for all party platforms meant either cuts to health care services or increased debt among hospitals and other providers. No matter who gets elected, it is likely to be a very bumpy ride for health care. Some columnists picked up on this, but it generated no sustained debate.

The parties also ignored the increased crowding within our hospital system. The link between overcrowding and hospital-borne infections has been the subject of numerous studies. It has led to legislated limits on average occupancy in other international jurisdictions. While it did get some play in Niagara, where more than 30 hospital patients died this spring and summer from C. Difficile complications, it failed to gather much steam anywhere else.

During the election thousands marched on Queen’s Park to drive home the message that all parties needed to do better on the health care file. While the electronic media did provide some coverage – mostly on how the march would inconvenience traffic on University Avenue — none of the major Toronto dailies covered the event. The Toronto Star ran a photo with a column about health care. Canadian Press did file a more complete story.

Tim Hudak tried to make hay by raising the spectre of e-Health, and one or two media outlets went back to the Auditor General’s report and appropriately reminded us that the Harris (and Hudak) Tories did set the groundwork for much of the $1 billion boondoggle. However, more dominant were the stories about the need for electronic health records and its present state of implementation.

During the leader’s televised debate a question was asked about health care privatization. Andrea Horwath said that profit didn’t improve health care, and was opposed to it. The other leaders mostly ducked the question. The McGuinty government has opened the doors wide to more private delivery of public health care, including approving more than 30 privatized (P3) hospital projects. Tim Hudak would like more, indicating in his platform that public sector workers should have to compete for their existing jobs against private providers. McGuinty also began taking away community-based lab testing done by small rural hospitals despite a significant price advantage over the large private for-profit labs.

McGuinty contrasted his record of building 18 new hospitals with the Tory record of closing 28 hospitals. Few picked up on merged hospital administrations effectively closing former stand alone hospitals during McGuinty’s watch. That includes closure of the Burk’s Falls & District Health Centre (part of the Muskoka Algonquin Healthcare hospitals in Bracebridge and Huntsville), or the Shelburne Hospital, which shuttered its doors after the last of its services were packed up and relocated to Orangeville. Nor does it include the hospitals in Fort Erie and Port Colborne, both of which had their ERs closed (and are no longer technically hospitals under the Public Hospitals Act). NDP leader Andrea Horwath did pledge to re-open the two Niagara ERs as part of her campaign.

Some columnists did try and revive interest in the social determinants of health, but there wasn’t a lot of take up on the issue despite it offering the most promising return on investment. The Network for Poverty Reduction gave the NDP the best marks for committing to ending poverty, and not surprisingly, the Tories received the worst. Mike Creek, Co-Chair of the coalition, told the Toronto Star “I don’t think any of the parties are taking poverty as seriously as they should.”

The Local Health Integration Networks did get some play, the Tories exaggerating the true cost to the system by confusing the annual cost of the LHINs ($70 millon) with the total cost since 2006 ($250 million). The Tories want to eliminate the LHINs and not replace them with anything – something most analysts agree is simply not feasible. The NDP say they want to replace the LHINs with a body that is more accountable to local communities, but haven’t said how they would do that. The Liberals have defended the LHINs, but will likely bring in changes following the election. The original legislation that created the LHINs was supposed to include a review of the Act after five years. Instead the McGuinty government postponed such a review, the Premier even briefly suggesting a formal review might not be necessary.

Dalton McGuinty clearly feels he is the best to negotiate a new Health Accord with the federal government. Set to expire in 2014, the Accord includes a six per cent funding escalator each year, depositing 23 per cent of the cost of Ontario’s health system. That works out to a 1.4 per cent increase per year – nothing to sneeze at when the parties are promising to limit overall increases to around three per cent or slightly better. McGuinty would like to tie the next accord to senior’s care, while Horwath would like to push the federal government to implement public drug coverage and provide funding for more long term care beds. Both are looking for another long-term deal. Hudak only says he wants federal funding to continue. Some federal Tories have mused about the idea of simply transferring tax points to the provinces, which would take any federal role out of health care – including the enforcement of the Canada Health Act.

A year ago all parties emotionally spoke of the need for a new approach to mental health. The all-party recommendations were largely ignored in the Liberal’s three-year plan that mostly invests in mental health services for children and youth. At a campaign stop at the Centre for Addiction and Mental Health McGuinty said they would eventually reinvest in adult mental health services – but not until 2014. The amount for adults will be $30 million per year, about a third of what they are annually putting into mental health services for children and youth.

The NDP got praise for promising to create 50 new family health care centres, which would be a mix of Community Health Centres (CHCs) and Nurse Practitioner-led clinics. The Liberals said that many of their new initiatives at keeping seniors healthy in their homes would be run through the CHCs, but made no commitment to introduce more of these centres. The Liberals did almost double the number of CHCs on their watch, from 54 to 103. Despite the popularity of these centres, the Tories did not even respond to a survey by the Canadian Alliance of Community Health Centre Associations.

Unlike the Federal election where the NDP made a promise of more doctors and nurses a major campaign plank, discussion of the human resources needs of the province was much more muted at the provincial level. The NDP did promise to forgive the student debt of new doctors willing to relocate to areas of high need. Dalton McGuinty did recognized the health system is delivered by more than just doctors and nurses in the televised debate. In July and August OPSEU had run television ads promoting the fact that modern health care is team-based.

Tomorrow Ontario voters will make their decision on who to vote for. Will the party’s positions on health care matter? We can only wait and see.

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