Liberal health-care record withers under microscope

Thomas Walkom, National Affairs Columnist, Sewptember 15, 2007 , Toronto Star

When Dalton McGuinty's Liberals won power four years ago, polls showed health care to be the No. 1 issue on the minds of Ontarians.

Major urban cities faced physician shortages. Hospitals delayed vital operations because there weren't enough nurses. Patients waited months for relatively simple hip or eye operations. Nursing home care had deteriorated, in part because the previous Conservative government had eliminated regulations requiring minimum standards of care.

During the lead-up to that election, McGuinty savaged then-premier Ernie Eves and his Conservatives for what he called their abject failures.

"We have the fewest doctors per capita, the fewest nurses per capita," the Liberal leader charged. "We're the strongest province in the country. We should be leading. We shouldn't be dragging at the back of the pack"

Now, four years later, it is McGuinty's health-care record that is under scrutiny – not only for what he has delivered but for how he has chosen to finance it. And while hospital horror stories no longer dominate the headlines, that record is decidedly mixed.

There are still physician shortages, particularly among family doctors.

The Canadian Institute for Health Information reports that the number of doctors per capita in Ontario stayed static between 2003 and 2005, the last year for which figures are available.

There are more registered nurses working in Ontario now than when the Liberals took over. But here too, the increase has barely kept up with population growth.

As for registered practical nurses, their numbers declined not only relatively but absolutely between 2003 and 2005, according to the federally funded institute.

So while Ontario no longer brings up the rear when it comes to these indicators (that dubious honour now belongs to Prince Edward Island), this province is far from leading the Canadian pack. In terms of physicians per capita, it's fourth from the bottom.

The government has had more success with reducing some surgical wait times. But even here progress has been uneven.

According to health ministry figures, nine out of 10 Ontarians diagnosed with cancer now have to wait two months for surgery from the time their operations are formally scheduled. That's down a third since 2005 and well under the 84-day target set by the province. Similarly, cataract surgery wait times have improved dramatically (from 311 days in 2005 to 153 days now.)

But knee and hip surgery wait times are still well above the government's 182-day target for such elective operations. And for those who need magnetic resonance imaging (MRI) diagnostic scans, nine out of 10 must still wait 110 days – only a marginal improvement from the 120-day wait of two years ago.

Then there is long-term care.

Three months into their mandate, and after a Star series exposed the shocking conditions faced by elderly patients in some nursing homes, the Liberals promised what Health Minister George Smitherman called a "revolution" in long-term care.

McGuinty too chimed in, noting that his time working as an orderly in a veterans' hospital had made him "understand in a profound way the importance of that work."

But as the Star's Moira Welsh reported recently, Smitherman's revolution and McGuinty's profound understanding have yet to improve the lives of the 75,000 people who live in nursing homes. Thanks to staff shortages and lack of government funding, some incontinent residents are forced to sit all day in wet diapers.

The Liberal government is anteing up money to hire more than 5,000 new workers for long-term care facilities.

But nursing homes say the new staff numbers barely allow them to keep pace with an equivalent growth in patient load.

In spite of repeated government promises and a brand new piece of legislation, there still are no minimum standards for the hours of personal care a nursing home resident must receive. And some reforms, while marking a definite improvement over past practices, remain shockingly primitive.

For example, new rules passed this June now require nursing homes to offer their residents two baths a week – which is better than leaving them dirty all the time, but not by much.

While McGuinty's record on health-care delivery is spotty, it is his health tax that has given him most grief. To critics, the premier's so-called Ontario health premium illustrates everything that is wrong about the Liberals – their shiftiness, their casual attitude toward ironclad political promises, their willingness to temporize.

Introduced in 2004 as part of the government's first budget, the health-care premium was neither a premium nor a levy aimed primarily at health. Rather, it was a poorly designed income tax surcharge created to extricate McGuinty from a dilemma of his own making.

During the 2003 election campaign, the Liberal leader had been determined to please everyone. To those on the left, he promised to restore public services cut by the Conservatives. To those on the right, he promised no new taxes, going so far as to sign a pledge for the Canadian Federation of Taxpayers (which, like many such organizations, is neither a federation nor representative of taxpayers). For Bay Street, he promised to eliminate the provincial deficit.

Put together, the three promises were arithmetically impossible to meet. The province's $5.6 billion deficit simply couldn't be eliminated without either raising taxes or cutting spending.

It's not clear who was more foolhardy: McGuinty for making these impossible promises or the voters for believing him. But the reality he faced on winning power was stark. He had to choose which solemn pledges to break.

In the end, he broke two of the three. He didn't balance the books and he did raise taxes. In a vain attempt to pretend that the most important of these increases – a $2.6 billion annual boost in personal income taxes – was not a tax hike, he and Finance Minister Greg Sorbara called their new creation a health premium.

The new tax satisfied no one. Unlike former medicare premiums, it was not a fixed per capita charge. Rather, it increased with income so that – up to a point – those who made more paid more. But because the maximum levy was set at $900, those earning well over $200,000 annually paid proportionally less than those with more moderate incomes.

In effect, it was an income tax surcharge on middle-class earners. Yet while clumsy, not particularly fair and all too visible, Liberal strategists saw it as politically preferable to the alternatives. To garner the same revenue, the government would have had to raise personal income tax rates by 11 per cent, corporate taxes by 25 per cent or the provincial sales tax from eight to nine per cent.

The "health premium" – for all its faults – seemed more saleable.

Indeed, in the broadest sense, the new McGuinty tax represented business as usual in Ontario.

Governments often dress up new taxes in order to soothe the voters. Who can forget the tire recycling tax (introduced in 1989 by David Peterson's Liberals as an environmental measure and cancelled by the Bob Rae New Democrats four years later), or the so-called fair share health-care levy brought in by the Mike Harris Conservatives in 1995 to help fund medicare? In the world of politics and taxes, fancy monikers are not unknown.

But in the end, all of the money raised through all these taxes goes into the same pot to pay the province's bills.

Most of the tire tax money wasn't spent recycling old tires. Similarly, health-care tax revenues aren't necessarily spent on the province's roughly $38 billion annual bill for doctors, hospitals and drugs.

That has been the case with the McGuinty tax. Finance ministry figures show that the Liberal government raised $9.3 billion from their new tax between 2003 and 2007. But during the same period, health spending rose by only $8.5 billion.

The remaining $800 million went to pay bills incurred by the roughly $88 billion the government spends each year.

Curiously, health spending has increased at a slower rate under the Liberals than it did during the last years of the Tory regime. Between 1999 and 2003, the Tories increased the amount they devoted to health care by $8.7 billion, or 43 per cent. Between 2003 and 2007, and in spite of their new tax, the Liberals boosted health spending by just 30 per cent.

McGuinty says that if re-elected, he will keep his health tax because it's needed. That too is business as usual in Ontario. The Mike Harris fair share health-care tax is still being levied, albeit under a different name. Since 2000, it has been called simply the Ontario surtax.

DID THEY DELIVER ON THEIR PROMISES?
In 2003, the Liberals campaigned heavily on health care and promised, early in their mandate, a "revolution" in long-term health care.

Today there are still no minimum standards for the hours of care a nursing home resident must receive. New rules passed in June offer some improvement, but homes are required to give their residents only two baths a week.

In other areas, the province still has a shortage of doctors and nurses. And while wait times have improved for cancer and cataract surgeries, waits for some other operations have remained static.

WAIT TIMES
Cancer: Most cancer patients now wait two months for surgery, down a third since 2005.
Cataracts: Down dramatically, from 311 days in 2005 to 153.
Knee and hip: Remain well above the government's 182-day target.
MRIs: Most must wait 110 days, only marginally better.