Is Roger Martin having us on?
This morning the publicly funded Institute for Competitiveness & Prosperity released a working paper on policy opportunities for Ontario’s health care system during Longwood’s Breakfast With The Chiefs speaker series.
Roger Martin, the former Dean of the University of Toronto’s Rotman School of Management, was breezy in his presentation of the paper’s eight big ideas.
Some of it is the predictable low-hanging fruit, such as the need to get on with electronic medical records, reforming primary care delivery and focusing on end-of-life care (which accounts for one-third to one-half of a person’s lifetime health expenditures).
More alarming, three of the recommendations are essentially a manifesto for shifting the cost of health care away from the collective to the individual, and especially to low-income Ontarians.
In the brief question period after Martin’s presentation, his argument for co-payment on health care costs failed to get much attention despite being the most radical. Perhaps the audience felt it so far-fetched it was unlikely to get any traction from government despite coming from an advisor to the Premier.
Given the time the former Dean spent flogging the view that health care spending is outstripping the economy, there is an essential disconnect between the stated objective of building better health care versus simply shifting costs.
Co-payment — especially on the scale the paper envisions — will likely deter low-income Ontarians from accessing the care they need. That may save the Ontario treasury in the short run, but likely cost much more as the condition of these citizens deteriorate.
While Martin didn’t go into the details on the co-payment plan, the report does.
“One model proposes a 40 per cent co-payment by individuals and families for their health care services up to an annual limit of three per cent of their income,” the report suggests. Families with an income above $100,000 would be capped at $987. Those under $10,000 would be exempt — leaving many below the poverty line still having to pay more.
Given the connection between wealth and health, Martin is advocating for a massive shift in health care costs to the population that can least afford it.
“Tommy Douglas never said it (health care) would be free,” said Martin.
If that’s not enough, Martin also proposes what amounts to a mandatory CPP-type savings plan just for prescription drugs. The thought is the government would tax you in your working years so you could have could a sum to spend on drugs in your retirement. Note there is no guarantee that it would cover all drug costs. Don’t we already have something much better — the Ontario Drug Benefit Plan?
Finally Martin would slam working people; effectively making employer health plans a taxable benefit. That means you would have to pay tax on the amount the employer spends to provide you with coverage for dental, drugs and other services not covered under Medicare. That would hit up working Canadians for another $3.4 billion annually.
It’s not surprising that the business community is starting to express interest in the idea of universal drug coverage. Martin agrees that the present system is not working – noting Ontarians pay among the highest drug costs in the world while one in four are left without any coverage. Yet when asked, he failed to endorse a single-payer Pharmacare system, noting he hadn’t looked into that level of detail. The idea of introducing a made-in-Ontario Pharmacare system also contradicts his idea of a drug savings program. Why would you need such a savings plan if you already provide universal access?
Clearly he must have thought that his recommendation would ruffle the feathers of the pharmaceutical industry, noting that it contributes 9,800 jobs in the GTA compared to 263,000 in financial services. Never mind that the GTA is the financial services capital of Canada.
Martin took particular aim at Ontario’s doctors, arguing their compensation has risen much faster than other health professionals. Yet he believes that it is the doctors who need to lead the way in reforming health care, prompting Longwood’s publisher Anton Hart to ask “you don’t actually mean that?”
“We’ve invested enormously in them,” says Martin. “They have to deliver system leadership. I don’t think going to war with them is the smartest thing.”
Oddly there is no mention of mental health in the report, but Martin told the audience “we let mental health problems lead to other problems that are super costly.”
To make his argument about rising costs Martin conveniently left out the period post 2009 in most of his Powerpoint slides. That would have shown recent health care spending flat or into a slight decline. He also uses the usual trick of including all health care costs in his comparisons, not just public costs. A slide showing just the public side would present a very different picture — one where Ontario is much lower than other Canadian jurisdictions and in the middle of the pack when it comes to the OECD. Martin knows enough about marketing to understand how to manipulate the data to make such a drastic case.
Given much of the Institute’s board comes from business, we wonder if this will be the new mantra of the Bay Street elite?
While Bay Street and the U of T may control it, most of the Institute’s $936,000 annual budget comes from government sources. Are Ontarians paying for the genesis of Bay Street’s anti-Medicare campaign?
No doubt nervous about Martin’s frontal attack, the Institute was quick to point out this is just a working paper and encouraged feedback. Feel free to do so by emailing: firstname.lastname@example.org
Martin is the presently the Premier’s Chair in Productivity & Competitiveness and Academic Director of the Martin Prosperity Institute at the Rotman School of Management.
To read the full report, click here.