Category Archives: Health System

The end of March might as well as be called bash the public service day.

It’s the day the sunshine list (a list of all public sector workers earning more than $100,000) comes out and right-wing think tanks, politicians and newspapers tell us how out of control public sector spending on wages is.

This year the headline is about a jump of 11 per cent in the numbers on the sunshine list –  a number completely meaningless given the sunshine list is never adjusted for inflation.

If it were adjusted for inflation, we would be seeking the list of those who earn more than $134,000 per year, not $100,000. That would wipe out about three-quarters of the names on it. 

About 1.2 million people are employed in the public sector. There are 71,478 on the sunshine list. If the sunshine list were adjusted for inflation, that number would be reduced to less than 18,000. That is 1.5 per cent.

The sunshine list also distorts reality – that for most of us, our wages have remained relatively stagnant while the province’s elite continue to reap an ever higher percentage of economic growth. Finance Minister Dwight Duncan reported the average public sector wage went up by 1.8 per cent last year. That’s hardly the road to the high life.

Over the past 30 years Canada’s real economic output has more than doubled. Last year the Canadian Centre for Policy Alternatives released a report indicating the richest one per cent grabbed one third of all income growth since 1987. Their average income was $405,000.

The top .01 per cent saw the highest increases to their annual income, from an average of $640,000 in 1982 to $3.8 million in 2007. You won’t find any Ontario public sector workers in that category.

In the legislature the Tories were predictably on the attack. Tory MPP Christine Elliott called the McGuinty government’s spending restraint a “PR scheme.” There is no question that the Tories are looking for much tougher wage restraint in the public sector.

Earlier in the week, R. Michael Warren wrote a lengthy opinion piece in the Toronto Star claiming “over the last two decades public sector unions have used our growing dependence on their services to drive their members’ compensation to questionable heights.” Warren, who calls himself a “corporate director and public affairs commentator,” quotes a questionable study put out by the Canadian Federation of Independent Business (CFIB) that suggests public sector employees “enjoy” a compensation premium of 14.8 per cent.

To the extent that there is a wage premium in the public sector, it’s caused by two things the CFIB doesn’t ever mention: unionization and pay equity. The public sector is highly unionized and predominantly female. Because unions have been successful at enforcing pay equity laws in the public sector, women tend to receive equal pay for work of equal value. That’s not the case in the private sector, where pay equity laws are frequently flouted and women get paid less than they’re worth. The problem is women being exploited in the private sector, not overpaid in the public sector.

Clearly there is a propaganda war on our wages, and the sunshine list is the province’s annual gift to them.

Budget 2011 may be tough for much of the public sector, but there are some modest improvements in health care. These may be needed as other sectors that impact the social determinants of health continue to be significantly underfunded.

Overall health care will receive an increase of nearly $2.2 billion – about the same as 2010. That brings provincial health spending on health to $47.1 billion.

The good news is struggling Ontario Hospitals will see assistance over the next three years to deal with their accumulated debt. The government has committed $600-$800 million to restore the working capital position of the most financially distressed hospitals. This may be particularly good news for hospitals such as Peterborough Regional Health Centre, the Sault Area Hospital, and the Niagara Health System.

By addressing hospital debt, it may place communities on a more level playing field when it comes to program funding. Hospitals carrying large amounts of debt spend more servicing that debt, giving them less flexibility in providing front line care.

Hospitals will receive a similar base increase to last year – 1.5 per cent. Recently hospitals were asked to project what their situation would look like under a zero per cent funding change. Many projected deficits in the one to two per cent range. It is unclear how much pain would have been involved in reaching those deficit targets. In the South East LHIN, for example, a zero-based budget would have plunged five of seven hospitals back into debt. Seeing this, the government may have been reluctant to see hospitals slip into the red after difficult years of climbing out of it.

For home care and long term care, the government has offered up stable funding increases of three per cent per year over the next three years. While it signals a change in the right direction, it will likely not be enough to meet the expectation that significant numbers of hospital alternate level of care patients will soon find nursing home beds and home care.

The biggest winner is the children’s mental health sector, which has a commitment of $257 million over the next three years. The government says this is the beginning of its commitment to mental health, leading one to question whether adults seeking help will be left waiting. To leave the provinces psychiatric hospitals at status quo and bring community-based agencies up to the 60-40 funding split recommended by the Health Restructuring Commission, it would take an additional $1.3 billion.

Other new money includes $15 million over three years to provide about 90,000 more breast screening exams. This would expand the program to reach women between the ages of 30-39.

The pharmacists are getting a significant reward after last year’s battle over generic drug prices. $100 million is set aside to enhance pharmacy services and support to Ontarians who receive coverage through the Ontario Drug Benefit program.

The government says it is still committed to reducing annual health increases to three per cent despite this year’s overall increase, which is slightly less than five per cent.

Despite the increases, gone is the rhetoric of last year that health care was eating up an ever greater share of provincial program spending. Instead the language is more election hardened, suggesting the McGuinty government is making investments in health and education. According to the 2011 budget, health care takes up 42 per cent of program spending, down from last year’s 45 per cent.

There are some indications of where additional savings in health care are expected to come:

Existing drug reforms are expected to save $249 million per year.

$120 million annually will be saved by “curbing unnecessary testing based on medical evidence.”

By expanding bariatric surgery in province, the province expects to save a further $21 million.

Other laboratory tests and drug therapies are expected to be brought in-province to save a further $29 million.

The budget also suggests there will be further lab consolidation – likely to include public health.

In the last few years hospital funding has been a lightning rod in many communities. The threat of ER closures brought thousands out in towns such as Port Colborne and Petrolia. Mayors in towns like Shelburne and Burk’s Falls expressed frustration over the closure of hospital sites. Thousands came to a spring rally at Queen’s Park, leading to a review of rural and northern health.

For the 2011 budget, clearly the McGuinty government has made no large initiatives with regards to health care. Those will have to wait until after the election.

Who said what:

“The fact that the government has not identified which jobs will be cut says clearly that this exercise is based on political targets, not delivering quality services. The fact that the new Commission on Broader Public Service Reform has been framed as a deficit-reduction exercise is outrageous. Putting a former bank executive in charge with a mandate to privatize at will is part of an alarming and ongoing trend toward corporate influence over democratic governments everywhere.” — Warren (Smokey) Thomas, OPSEU President

“This budget provides a stable increase in hospital operating funding in 2011-12. Although some hospitals may have to make difficult decisions in order to accommodate the costs of certain collective agreements and other inflationary pressures, we believe that this level of funding will help maintain overall health system stability and protect the gains that have been made in improving patient care.” – OHA President Tom Closson

“ONA is also concerned that the budget is silent on whether there is continued funding for the two nursing initiatives that have had some success – the Nursing Graduate Guarantee and the Late-Career Nursing Initiative. It is also silent regarding whether any of the new 60,000 funded post-secondary school seats will include programs for RNs.” — Ontario Nurses Association press release

“The Canadian Cancer Society is pleased women with a family history of breast cancer and other higher-risk women will now have access to high-quality breast screening through the Ontario Breast Screening Program.” — Press Release, Canadian Cancer Society — Ontario Branch

“Given that one in five people in this province will have a mental health illness at some point in their life; this is a good first step. However, it’s imperative that the government extend funding beyond children and youth so that all Ontarians including Aboriginal people who suffer mental health challenges can receive the help they need and deserve.” — Doris Grinspun, Executive Director, Registered Nurses’ Association of Ontario.

“Rather than investing in mega-jails through private-public partnerships (P3s) that will be costly to taxpayers, nurses urge money be invested in social determinants of health such as affordable housing and that the minimum wage be increased again this year.” — David McNeil, President RNAO

“For the second consecutive year, the government has increased Ontario hospitals’ base funding by just 1.5%. This simply does not keep pace with the annual cost increases in most Ontario hospitals today. Unless such an increase is accompanied by corresponding, meaningful investments in home care and long-term care to move us toward a more sustainable health care system, we’re going to see negative impacts on the workloads of nurses and the outcomes of their patients.” — Dianne Martin, Executive Director of RPNAO.

“With wait lists growing and more than 90 per cent of home care workers living in poverty, it is vital these investments go straight to frontline care. We cannot afford to waste money on bureaucracy and CEO bonuses.” – Sharleen Stewart, head of the Service Employees International Union (SEIU).

“This is really a good news budget for long term care home residents. We are very aware of the unprecedented fiscal challenges this government continues to face. This level of investment in the current environment clearly demonstrates the McGuinty government’s commitment to improving the lives of Ontario’s seniors.” — Debbie Humphreys, Acting CEO of the Ontario Association of Non-Profit Homes and Services for Seniors.

The British binman rapper MC NxtGen has put together a rap video about a white paper that proposes massive privatization of the UK’s National Health System.

The track singles out UK Health Minister Andrew Lansley, who is the subject of the refrain “Andrew Lansley, greedy! Andrew Lansley, tosser.”

NxtGen raps “we’ll become more like the US / and care will be farmed out to private companies, / who will sell their service to the NHS via the GPs / who will have more to do with service purchase arrangements / than anything to do with seeing their patients.”

While well researched, the rap video is not subtle. At one point the camera focuses on a turd atop the white paper “Equity and Excellence: Liberating the NHS.”

Check out the rap video at

The provincial election may be slightly less than eight months away, but the hyperbole is already building.

At a nursing lobby day earlier this month, Health Minister Deb Matthews slammed the Tories for not explaining how they will find $3 billion to replace the health tax. Matthews suggested that a $3 billion shortfall would mean either closing every hospital in the north or ending drug coverage for seniors.

Tory leader Tim Hudak initially responded that the Tories had no plan to do away with the much complained-about tax. A statement from his office said: “Ontario PC Leader Tim Hudak has been very clear. If elected premier, he would not cut the health tax or Ontario’s health care budget.” PC MPP Sylvia Jones went further, saying Matthews “was clearly lying.”

A few days later Hudak was less clear about his support for the health tax. “We are considering all tax options and how to give families a break,” he told the media.

Hudak told the lobbying nurses that they would increase health care spending, “but it doesn’t mean we will spend every penny in the same way.”

The Tories have repeatedly said they would scrap the Local Health Integration Networks, which would save about $80 million on a $46 billion health budget.

However, Hudak has not said what his government would replace the LHINs with.

Matthews said eliminating the LHINs would see all local health care decisions made in Toronto.

Matthews also resurrected the spectre of former Premier Mike Harris, reminding the nurses that Harris had suggested they were no more than a fad, comparing them to the Hula Hoop.

In fact, Harris was talking about all workers impacted by hospital closures. In 1997 he said “just as Hula-Hoops went out and those workers had to have a factory and a company that would manufacture something else that’s in, it’s the same in government, and you know, governments have put off these decisions for so many years that restructuring sometimes is painful.”

While the health minister talks about dire consequences of having $3 billion taken out of the government’s revenue stream, the irony is the McGuinty Liberals are sticking by their plan to reduce corporate taxes by $2.4 billion per year. They are also substantially reducing the rate of funding increases for health care despite the fact that Ontario already has among the lowest per capita funding in Canada. It would take $3.5 billion just to bring Ontario hospitals up to the Canadian average in funding.

Maclean’s Magazine and the Canadian Medical Association – representing more than 57,000 doctors across Canada – are hosting a series of town hall forums to engage the public on the issue of rebuilding Medicare.

The alliance should raise more than few eyebrows given Maclean’s continual advocacy for more private for-profit health care. In the on-line backgrounder, Maclean’s quotes the Frontier Institute, an extreme conservative think tank for which free market ideology is the answer to almost all questions. It also highlights the OECD’s call for more user fees, a clear violation of the Canada Health Act.

And, of course, they quote Brian Mulroney’s call for an adult conversation.

The reality is we have been having an adult conversation. The problem is, Mulroney, Maclean’s and the Frontier Institute are not getting the ear of Canadians for a good reason: there is no evidence to suggest that private for-profit delivery of health care works. If so, the United States would be the most efficient health system in the world. Instead, they’re dead last among modern industrialized countries in most key measurable categories. Canadians get that.

Maclean’s also raises the Frontier Institute’s nonsense argument that we could be more like the Europeans if we allowed two-tier private health care. The reality is a greater share of health care is publicly paid for in Europe than it is in Canada. Among the G7, Canada is second to the United States in per capita spending on private health care. It represents a little over 30 per cent of our total health spending. If we were to be more like the Europeans, we would make more of that 30 per cent public, not create even more private health care.

The CMA/Maclean’s tour comes to Toronto’s St. Lawrence Hall on March 1st from 7 to 9 pm. To attend the televised event you need to register by e-mailing events@mcleans.ca