Drummond recommends “structural redesign” of health care, but is he qualified to deliver?

“We have probably spent 40 per cent of our time on health care.” – Don Drummond, Toronto Star, November 10, 2011

There is no question that health care will figure predominantly in the Drummond Commission’s report expected in January.

The Commission was struck last march to look at “reforming” Ontario’s public services. The Commission has chosen who to meet with — it has not been an open process. There have been no public hearings.

Whether the former senior banker will have any more weight than the long list of health reformers before him is an open question. Drummond is not a health economist. How familiar he is with the changes that have already been tested – and in some cases failed – is an open question. Certainly his recent predictions of skyrocketing health care costs have not been borne out by reality. Neither did reality smile on him after the Martin federal government slashed the corporate tax rate upon his advice. Drummond later admitted the tax cuts had no effect on the economy.

As Dr. Michael Rachlis pointed out in a November 11 Toronto Star Op/Ed, health care costs are dropping relative to both provincial government spending and the size of our economy (GDP). The Canadian Institute for Health Information (CIHI) recently reported that provincial health care spending has dropped across Canada as a share of GDP from 7.8 per cent to 7.5 per cent. The decrease in Ontario spending has been more dramatic – health care has dropped from 45 per cent of provincial program spending to 40 per cent. Didn’t Don Drummond predict that it would quickly shoot up in a straight line to 80 per cent?

There is definitely a credibility issue here.

What Drummond is specifically recommending is hard to figure out. We do know that he wants to cap health care increases to 3 per cent per year for much of the rest of the decade. McGuinty’s recent comments suggest support for that plan. Last year Ontario increased health spending by 5 per cent.

Last week he told Star columnist Martin Regg Cohn that he didn’t believe in wage freezes, but opened the door to tinkering with the fairness of the arbitration system – “I will definitely be making some recommendations for change,” he told Cohn.

Drummond is calling for a “structural redesign” of health care, but he told Cohn he was skeptical of Tim Hudak’s plan to eliminate the Local Health Integration Networks (LHINs), instead calling for greater integration around primary care doctors, community care, and long term care. Primary care doctors are presently outside of the LHIN jurisdiction.

Bringing primary care doctors under the LHINs would likely raise opposition from the Ontario Medical Association, but it is hardly major structural redesign. Nor would it save the kind of money Drummond has been openly musing about.

Drummond told Cohn “what would need to unfold in Ontario is in many ways more severe than what government did in the 1990s.”

Yet Drummond calls the Harris era cuts a “fairly brutal exercise.”

The question is: what’s more severe than “fairly brutal?”

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