Health care rhetoric making me sick

Dalton McGuinty has solved our health care problems again. How many times is that?

This time the idea is to replace global budgets for hospitals with a "Health Based Allocation Model" (H-BAM) that will apparently send money to hospitals serving growing and aging populations and also, as the Globe and Mail reports, give hospitals "additional money based on how cost-effectively they treat patients." Hey, efficiency. Why didn't I think of that?

This is a definite case of "If I could walk like that, I wouldn't have to work for a living." If the Ontario government knew how to direct funds to hospitals that treat patients cost-effectively, do you not think they would have done it before now?

Actually it's "If I could stagger like that" because when Ontario health minister Deb Matthews tried to explain the throne speech proposal that "for more and more services -- money will follow the patient," it went badly.

"We know," she told reporters, "that rural hospitals, hospitals in smaller communities will (still) need the global budget because of the nature of the care they provide, but in some of the larger hospital budgets, as we transition to more patient-based payments, we're going to be able to drive those efficiencies." You go, girl. Drive those efficiencies. Uh, where's the steering wheel?

Don't ask George Smitherman, who's now threatening to do for Toronto what he did for health care in Ontario as minister from 2003-2008 (earning the moniker "Furious George" not "Effective George," you'll note).

And don't ask Matthews, whose muddled interview with Steve Madely on CFRA can be found at

In fact, don't ask anyone in the political health business. I am astounded to find it's now 11 years since I responded to a federal minister's glassy-eyed declaration that, gosh, he'd like some way to measure health-care outcomes.

I reminded him of the Soviet experience. "Without prices," I wrote on February 19, 1999 "planners are reduced to setting two basic kinds of targets: quantitative and qualitative. In the first, they tell the factory 'Make as many nails as possible' or 'Make at least this many nails' and it does, but the nails are feeble pins. In the second, they say 'Make the sturdiest nails you can' or 'Make nails at least this big' and the factory makes one 60-foot-long nail. When they set window quotas by weight, they got panes of glass too thick to see through. When they switched to quotas in square feet, they got windows so thin they shattered if lifted."

Any questions?

Well, how about: Did they ever find a way to measure outcomes? (No.) Are they about to? (No.) Does anyone remember or care about that initiative? (No.) If you can't measure outcomes, how are you going to direct money to cost-efficient hospitals? (Um duh dawk.) Say, aren't you currently trying to switch doctors from fee-for-service to global budgeting? (What? Are we?)

There is no reason to believe any of these questions were ever raised in the inner councils of the Ontario government, where the solution to major difficulties is to ignore them or, when cornered, make patently untrue statements in a tone of sober responsibility. Consider the throne speech claim that "In Ontario, no one who gets sick is turned away." Then what's a waiting list? Or what about being stashed in a hospital corridor and turned away from treatment happening elsewhere in the building?

It is impossible to tell whether McGuinty knows such soothing sentiments to be false or even recalls what that term means. But the style is mentally poisonous.

Consider his post-throne speech comment to reporters about the gaping $24.7-billion deficit: "We don't want to compromise our future by moving to balance the budget too quickly." Who on Earth, or beyond the asteroid belt, worried that the Premier might balance the budget too quickly, or believed he had any clue how to do so if that malevolent impulse somehow seized him? What honour, or value, is there left in pouring out oily reassurances on false issues, while dodging the crucial question whether he knows his arm from a tree branch about managing large, complex, ruinously expensive government programs?

When George Smitherman was health minister, I got to tell him the old Soviet joke about what would happen if the Soviet Union invaded the Sahara ("For 25 years, nothing; then a sand shortage"). He was not amused. I'm finding it less funny since the throne speech confessed "20 years ago, 32 cents of every dollar spent on government programs were spent on health care. Today, it is 46 cents. In 12 years, it could be 70 cents."

It will be even less funny in 12 years when some slick politician announces with obtuse delight that efficiency is the 70-cent solution. And gets re-elected.

[First published in the Ottawa Citizen]

ColumnsJohn Robson