It had all the trappings of an election. There were lawn signs, TV commercials, and door-to-door campaigners. The local media solicited the views of both politicians and citizens as everyone scrambled to become informed before the vote.
Saturday Kingston residents got the opportunity to express their preference on whether a proposed new hospital facility in their community was going to be entirely public or be under a 30-year finance and maintenance contract with a private for-profit consortium.
While this election wasn’t conducted by Elections Ontario or Elections Canada, it had the feeling of being the real deal. Citizens were given the opportunity by the Ontario Health Coalition to consider a private or public option even if the result will be non-binding.
After five weeks of public debate, the answer was clear. 96% of the 9,885 votes cast at more than 50 polling stations said yes to keep the new hospital entirely public.
We have had one “official” election on this issue before. In the 2003 provincial election Dalton McGuinty opposed privatizing public infrastructure, campaigning against two “public-private partnership” (P3) hospital deals set up by then Premier Ernie Eves.
Like the results in Kingston, in 2003 the public instinctively bridled against the idea of privatizing key elements of Ontario’s public infrastructure. It helped give McGuinty the first of his two back-to-back majorities. Ontarians were already aware of what a bad deal the province got from privatizing Highway 407. They were worried about the impact of deregulation and privatization of electric power, particularly after a devastating outage in August of that year that took out much of the continental northeast.
Like the Kingston ballot, the 2003 election was non-binding when it came to McGuinty’s promises.
Despite warnings from a Deloitte report around the higher costs of the public-private partnership, McGuinty signed the deals for the William Osler and Royal Ottawa hospitals claiming it was too expensive to cancel – something later discovered not to be true.
He did make one change – technically the ownership of the hospitals remained with the public even if the control of the facilities were given over to the private sector for three decades. Most recognized that change to be largely cosmetic.
But McGuinty also went much further. Ontario embraced the idea of privatizing public infrastructure like no other government in Canada. Today about half of all Canadian P3s are in Ontario. In the hospital sector more than 30 such infrastructure projects went this route, including expensive new hospitals in St. Catharines and North Bay.
What’s strange about this proposed new hospital in Kingston is that it comes at a time when the government is implementing an austerity agenda and hundreds, if not thousands, of jobs are being lost this year in the hospital sector.
Local Kingston MPP and Cabinet Minister John Gerretsen has admitted that developing a new hospital this way is more expensive. This is not an issue that is in dispute. Most reports that have looked at this, including by the pro-P3 Conference Board of Canada, are willing to concede on the issue of cost. The argument for P3s is that this gives the government price security, even if that price security comes at a significant premium.
No government builds a hospital with public workers. The design and build is always contracted to the private sector. Traditional design-build projects can deliver price security – it just has to be written into the contract. Peterborough Regional Health Centre was built this way and came in on time and on budget and at about half the cost of the William Osler P3.
Where public projects often go off the rails is in the cost of changes made after construction starts. In the hospital world change orders are not unusual as new technology can dramatically alter how health care is delivered. Costs related to change order are as much a part of the P3 experience as they are with a more traditional infrastructure project.
This issue is a complicated one, and for five weeks Kingston residents actually debated it. The municipal politicians we spoke with admitted that the campaign was a great educational tool. It proved the public could look at sophisticated issues like P3s and come to a decision.
Even Infrastructure Ontario was compelled to come before Kingston City Council and answer questions. Council members were surprised to learn the government thought it was okay that the private consortium would get an estimated annual return of 12 per cent on their investment – money that would be paid from only one source: the Province of Ontario and its citizen taxpayers. Municipalities also are asked to make a direct contribution to large public infrastructure projects. The thought that Kingston City Council would be asked to pitch in millions towards a project that a private company is deriving profit stuck in the craw of some representatives.
It’s not like the vote was conducted without arguments from the other side. Kingston’s Mayor Mark Gerretsen voted against a City Council motion to send a letter to the province asking them to strip out the 30-year private provisions in the P3 proposal. The Mayor’s vote narrowly tipped the balance against the motion. More than 200 people did vote for the privatization option on the OHC plebiscite ballot. Those operating the polls made sure that citizens understood they had a choice.
Despite the cold weather, more than 180 volunteers fanned out throughout the region encouraging people to vote. Several polling stations were outdoors, exposed to the wind and at time a cold rain, including one in the market adjacent to City Hall. At other locations the poll operators were encouraged to set up inside businesses, including a gas station and Tim Horton’s we visited out towards the 401. At one grocery store where the poll was set up inside the entrance, activists were pleased at how supportive staff and management were.
At the polls residents were asked to sign a form acknowledging they would only vote once. Voters had to be at least 14-years of age and live in the immediate region.
This is not the first citizen-organized plebiscite campaign on the issue, but clearly the Ontario Health Coalition is getting better at conducting them.
The question is, given the results of both this plebiscite and the 2003 election, where does the government feel it has a mandate to make such a fundamental change to the way it develops public infrastructure?
For five weeks in Kingston the Ontario Health Coalition made the issue rise above the noise. The question is, come the next election , can they do the same and give Ontarians a more binding choice in the matter?
Watch for our documentary video coming soon!
Expensive Systems — privatization in other public sectors should be a warning for health care.