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Health care is the Ontario government’s biggest responsibility by far, and it was only at Wednesday night’s leadership debate that we first heard any details about what the four people who want to lead the Progressive Conservative party would do with it.
We spend $53 billion a year on health care, well over a third of the provincial budget — education is second, and its budget is only half as big. Hospitals are jammed. Rural areas are still short on health services. The Liberal government is at war with the Ontario Medical Association, which represents doctors, over unilateral fee cuts that followed failed bargaining. Waiting lists for home health care are long; in some places, they’re longer for nursing homes. The health minister just quit.
Digging into the differences among Christine Elliott, Doug Ford, Caroline Mulroney and Tanya Granic Allen is worth a bit of time, as they apply to be the person in charge of all this.
All the candidates talked about improving the province’s relationship with doctors. That’s obviously desirable, inasmuch as cooperating is inherently better than fighting, but it’s not an end in itself. The OMA’s main grievance is that the government doesn’t pay its members enough. We could solve that problem pretty simply but it’s not obvious that more money in doctors’ pockets would help with overcrowded hospitals, shortages of primary care in rural areas, or waiting lists for nursing homes.
“Though we are putting a lot of money into health care, study after international study indicates that we aren’t getting the best value for the money that we are putting in,” Elliott said. “So we are transitioning from a system of health care from one that is provider-centred to one that’s truly patient-centred.”
Ontario PC leadership candidate Christine Elliott speaks during the debate in Ottawa, Feb. 28, 2018.
Provider-centredness made sense, or at least worked acceptably well, when the basic model was that a healthy person got sick, went to a doctor, got some medicine, got better. Now that health care is an ongoing support service for more people, provider-centredness fails too often.
Patients should be on committees advising and running hospitals, Elliott said, involved in every element of care.
Job One, she said, is nursing homes. That’s where the need is greatest.
Elliott spent two years as Ontario’s patient ombudsman, the first person to hold the position. Forget the idea that this was a Liberal patronage appointment — being patient ombudsman is an actual job. But the one annual report Elliott issued is mostly about the effort involved in getting the office operational, identifying its goals, spreading the word that it existed.
Her first six months was set-up time and in the year-and-a-half that followed she filed one annual report and conducted no systemic investigations. She was, however, the Progressive Conservatives’ health critic for years when she was last an MPP, and that experience shows.
Doug Ford’s inexperience is equally obvious. He knows health care as a consumer — his mother has been in hospital recently, he said, and experienced the outrage of “hallway health care.” He’s mad about it, and he should be; we all should. We’re having a freakishly bad year for the flu, which is why hospitals like the Queensway Carleton are beyond even their surge capacities, but they run so close to the red line under normal conditions that their failing under the extra load is no surprise.
Ontario PC leadership candidate Doug Ford speaks during the debate in Ottawa.
“You’ve got to listen to the front-line people. That’s how you find savings. It’s very simple. Making sure that you listen to the front-line workers, we’ll find efficiencies and we’ll deliver better services,” Ford said.
OK, but remember that the key thing we hear from front-line doctors — who bill the government more than $11 billion a year as it is — is “pay us more money.”
Ford also said hospitals should have more people who can take patients off paramedics’ hands to get ambulances back on the roads faster. This is not a new idea, and if it just gets more people in line at emergency rooms, it wouldn’t necessarily help. What’s needed is getting patients out the other end, when they don’t need to be in hospitals any more.
Ontario PC leadership candidate Caroline Mulroney.
Caroline Mulroney’s not bad on these issues, though she doesn’t have Elliott’s depth. We should spend money on getting people out of hospitals when they don’t need to be there, she said Wednesday night, which isn’t detailed but shows the right instinct. Observers and experts have been saying for 20 years that we need better home care, more nursing-home spaces, and better physical rehabilitation and it’s no less true for being old news. Both Ford and Mulroney emphasized technological solutions to making the system work better.
Ontario PC leadership candidate Tanya Granic Allen speaks during the debate in Ottawa.
Tanya Granic Allen’s top priority for health care is respecting health workers’ personal views on things like medical assistance in dying, she said, thereby attracting more practitioners to Ontario. It’s worth noting that Elliott echoed her — doctors, nurses, and even whole institutions like Bruyère Continuing Care and its huge palliative-care unit, would have “conscience rights” under Premier Elliott.
Health care is much too big an issue to resolve in a few minutes on a debate stage but this’ll be an obvious wedge issue in the upcoming provincial election. The Tories will want a leader with the chops to stand up to Kathleen Wynne wielding more than slogans.
dreevely@postmedia.com
twitter.com/davidreevely
查看原文...
We spend $53 billion a year on health care, well over a third of the provincial budget — education is second, and its budget is only half as big. Hospitals are jammed. Rural areas are still short on health services. The Liberal government is at war with the Ontario Medical Association, which represents doctors, over unilateral fee cuts that followed failed bargaining. Waiting lists for home health care are long; in some places, they’re longer for nursing homes. The health minister just quit.
Digging into the differences among Christine Elliott, Doug Ford, Caroline Mulroney and Tanya Granic Allen is worth a bit of time, as they apply to be the person in charge of all this.
All the candidates talked about improving the province’s relationship with doctors. That’s obviously desirable, inasmuch as cooperating is inherently better than fighting, but it’s not an end in itself. The OMA’s main grievance is that the government doesn’t pay its members enough. We could solve that problem pretty simply but it’s not obvious that more money in doctors’ pockets would help with overcrowded hospitals, shortages of primary care in rural areas, or waiting lists for nursing homes.
“Though we are putting a lot of money into health care, study after international study indicates that we aren’t getting the best value for the money that we are putting in,” Elliott said. “So we are transitioning from a system of health care from one that is provider-centred to one that’s truly patient-centred.”
Ontario PC leadership candidate Christine Elliott speaks during the debate in Ottawa, Feb. 28, 2018.
Provider-centredness made sense, or at least worked acceptably well, when the basic model was that a healthy person got sick, went to a doctor, got some medicine, got better. Now that health care is an ongoing support service for more people, provider-centredness fails too often.
Patients should be on committees advising and running hospitals, Elliott said, involved in every element of care.
Job One, she said, is nursing homes. That’s where the need is greatest.
Elliott spent two years as Ontario’s patient ombudsman, the first person to hold the position. Forget the idea that this was a Liberal patronage appointment — being patient ombudsman is an actual job. But the one annual report Elliott issued is mostly about the effort involved in getting the office operational, identifying its goals, spreading the word that it existed.
Her first six months was set-up time and in the year-and-a-half that followed she filed one annual report and conducted no systemic investigations. She was, however, the Progressive Conservatives’ health critic for years when she was last an MPP, and that experience shows.
Doug Ford’s inexperience is equally obvious. He knows health care as a consumer — his mother has been in hospital recently, he said, and experienced the outrage of “hallway health care.” He’s mad about it, and he should be; we all should. We’re having a freakishly bad year for the flu, which is why hospitals like the Queensway Carleton are beyond even their surge capacities, but they run so close to the red line under normal conditions that their failing under the extra load is no surprise.
Ontario PC leadership candidate Doug Ford speaks during the debate in Ottawa.
“You’ve got to listen to the front-line people. That’s how you find savings. It’s very simple. Making sure that you listen to the front-line workers, we’ll find efficiencies and we’ll deliver better services,” Ford said.
OK, but remember that the key thing we hear from front-line doctors — who bill the government more than $11 billion a year as it is — is “pay us more money.”
Ford also said hospitals should have more people who can take patients off paramedics’ hands to get ambulances back on the roads faster. This is not a new idea, and if it just gets more people in line at emergency rooms, it wouldn’t necessarily help. What’s needed is getting patients out the other end, when they don’t need to be in hospitals any more.
Ontario PC leadership candidate Caroline Mulroney.
Caroline Mulroney’s not bad on these issues, though she doesn’t have Elliott’s depth. We should spend money on getting people out of hospitals when they don’t need to be there, she said Wednesday night, which isn’t detailed but shows the right instinct. Observers and experts have been saying for 20 years that we need better home care, more nursing-home spaces, and better physical rehabilitation and it’s no less true for being old news. Both Ford and Mulroney emphasized technological solutions to making the system work better.
Ontario PC leadership candidate Tanya Granic Allen speaks during the debate in Ottawa.
Tanya Granic Allen’s top priority for health care is respecting health workers’ personal views on things like medical assistance in dying, she said, thereby attracting more practitioners to Ontario. It’s worth noting that Elliott echoed her — doctors, nurses, and even whole institutions like Bruyère Continuing Care and its huge palliative-care unit, would have “conscience rights” under Premier Elliott.
Health care is much too big an issue to resolve in a few minutes on a debate stage but this’ll be an obvious wedge issue in the upcoming provincial election. The Tories will want a leader with the chops to stand up to Kathleen Wynne wielding more than slogans.
dreevely@postmedia.com
twitter.com/davidreevely
查看原文...