A crisis is coming, and no one cares

It is a melancholy reflection that we had to wait for the Ontario provincial election to lurch to a dismal end before we could turn to urgent questions of policy. Melancholy turns to depression at the urgency of health care reform. And tears begin to flow at the thought that the major parties’ positions on that topic contrived to be at once irrelevant and profoundly inimical to any sensible solution.

The diagnosis here is grim. On Saturday the Globe and Mail’s Jeffrey Simpson wrote, “The Liberals boast they have jacked up health-care spending by 29 per cent over four years, to $37-billion, a staggering eight per cent a year.” Strange for a government to boast of its profligacy. Especially as, Mr. Simpson went on to note, the Liberals also promised to reduce the rate of spending increases to five per cent a year, which suggests there was something wrong with their previous behaviour. The Conservatives said they’d do the same, which suggests there was nothing wrong with the Liberals’ new promise. Uh, unless you count Mr. Simpson’s pointed observation that, “No Ontario government has been able to keep annual increases to five per cent.”

Thus we may swiftly conclude that neither party had a plan for doing what they promised, and move on to the next problem. Namely, that if the party leaders did somehow keep their word it is not obvious what advantages would accrue. For one thing, increasing spending faster than revenue generally causes trouble, especially on an item that already devours nearly half of program spending. For another, laying aside the calculator for a stethoscope, how will a health care system that couldn’t cope with existing demand while gobbling down eight per cent annual increases deal with the growing needs of aging boomers on just five per cent? Sadly we were not favoured with a discussion of such alarming matters.

Alarming is not too strong a word. Mainstream politicians generally dismiss as “ideological” those of us who saw trouble coming and urged preventive action years ago. But Mr. Simpson is hardly the excitable sort of columnist prone to the print equivalent of leaping about hollering, so you might think his observations would worry the people who run the system. Apparently they don’t worry easy.

Most politicians didn’t break a sweat when Health Canada warned that Canada will be short 5,800 doctors by 2010. Nor at last week’s Citizen report of one Ottawa doctor who predicts that with middle-aged doctors working so hard they’re burning themselves out and younger doctors working less in pursuit of a more rational work-life balance, the real shortage might be as large as 10,400. Politicians also shrugged off the Canadian Nurses’ Association warning that nationally we’ll be short 78,000 nurses by 2011 and 113,000 by 2016 and this week’s Citizen story saying we’re even short of nursing school faculty to train replacements. People with weaker nerves would be especially bothered by the demographics that make these problems so hard to fix. Not only are the patients aging, so are doctors, nurses and even the remaining nursing school faculty; the Canadian Nurses’ Association says more than half of the latter were over age 50 in 2005.

The one thing I’ve noticed recently that might make politicians panic is the increasing tendency, noted in Wednesday’s National Post, for doctors to bill for various services not covered by socialized medicine, from telephone advice to faxing prescriptions, that most provided free before provincial governments got so tight-fisted with their fee schedules. Apparently, the harder the government throttles the goose that lays the golden eggs, the harder the wretched bird fights for air. But our statesmen’s fingers are as strong as their minds are weak.

I do not exaggerate either the seriousness of the crisis or the feebleness of their understanding. From time to time I may inflict upon readers obscure quotations or arcane research. But you’ll notice that all the examples in this column are from very recent newspaper stories. You don’t have to be smart to uncover this stuff. But you have to be singularly dim to ignore it. And politicians are.

Faced with such atrocious mismanagement of such a key policy issue, I occasionally fantasize about entrusting affairs of state to persons selected by citizens in a competitive process designed to oblige candidates for public office to offer detailed, practical, intelligent solutions on matters of particular import.

Wait a minute. We just did that. * Sob * Could someone please pass me a large, absorbent handkerchief?

[First published in the Ottawa Citizen]