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Ontario Health Coalition |
ANALYSIS |
First Ministers‚ Agreement:
Implications for Ontario
September 16, 2004
The worst things in this agreement are the things our Premier and the other First Ministers didn
’t do.I. PRIVATIZATION
The fact that the First Ministers dodged the question of privatization was likely the worst feature of the negotiations. It means that they did nothing to stop it. Over the two days of public negotiations Mr. McGuinty did not once mention stopping privatization or support for public delivery. There is nothing in the final agreement that will protect Ontarians from privatized P3 hospitals, private for-profit diagnostic clinics, privatized homecare and competitive bidding, or any other form of privatization. In Brampton we are already seeing that the private hospital will cost hundreds of millions more than a non-profit hospital would. The sustainability of the health system depends on definitive action to restore public non-profit hospital infrastructure and public non-profit delivery of health services.
We need to remind our Liberal MPPs that in their election campaign Mr. McGuinty clearly campaigned for a change. In fact, it was the central slogan of his campaign. He regularly rejected the privatization agenda of the Conservatives and pledged to support restored standards and public funding and delivery of healthcare. We expect improved leadership from him on this.
II. CANADA HEALTH ACT, TWO TIER SERVICES AND DELISTING
The lack of discussion about the enforcement of the Canada Health Act reinforces the federal government‚s current lack of protection for the universality, comprehensiveness, portability, and accessibility of the health system. There was no progress on prohibiting the two-tier access promoted by the for-profit clinics in Ontario & other provinces -notably B.C. This deal will not restore the services that have been taken off the OHIP list, including the audiology, physiotherapy, optometry and chiropractic services. There is a one-sentence note at the end of the deal reached by the First Ministers that formalizes a
"disputes resolution" process as per letters exchanged by the provincial and federal governments. We are waiting for details, but our initial reaction is that we are very concerned about replacing enforcement of these principles with negotiation.III. MONEY & DEMANDS ON IT
There is very little targeted money in this deal, and no enforcement mechanisms for the money that is targeted. In addition, the amount targeted to homecare and drug coverage was so little ($500 million across the country) as to be more of a public relations exercise than a real establishment of new programs.
However, there is a significant increase in the health transfer. This will increase the amount of funding available in Ontario. Note: the hospitals claim they have a $600 million shortfall and the government is currently in negotiations with the Ontario Medical Association on fees for physicians. These are two powerful demands on the increased money.
IV. HOMECARE & SHRINKING OF MEDICARE
With the closure of tens of thousands of hospital beds in Ontario over the past two decades, and the shift of care into the community, many patients have been moved out from under the umbrella of the Canada Health Act which covers hospital and physician services. (Note: many argue that the Act should be interpreted to cover the homecare services which are really
"hospitals without walls"). It is important that homecare must be covered by the CHA.In addition, seniors and others require that supportive care at home be provided publicly. Many Ontarians have lost their home support services as acute homecare patients take up the available homecare funding and Community Care Access Centres have reduced the scope of the services offered publicly. The new federal funding may help to open an opportunity to push for the restoration and extension of these services.
V. PHARMACARE
The small amount of money targeted to pharmacare across the country will make no noticeable impact in Ontario. Like other provinces, we already have a drug program - the Trillium Drug Plan - that provides coverage for listed drugs on a means-tested basis. This agreement will not improve this plan and does not cover it with the principles of the Canada Health Act that would have ensured it was universal (not means-tested) and would have stopped requirements for up-front or co-payments.
VI. WAITING TIMES
We are concerned because this issue can be used to destroy public healthcare by right-wing advocates of a two-tier health system. The crisis rhetoric regarding wait times is used by those with vested interests in privatization to push for clear
"benchmarks" for waiting times, and to pay out of pocket to jump the queue if these are not met. Their proposals, if implemented, would make the system more costly and less equitable, wait times for most people who cannot afford to jump the queue would worsen, we would lose public control and the trade agreement threats posed by privatization would worsen. A great deal can be done within the public system to improve wait times, by rationalizing and improving management of wait lists as they did with cardiac care in Ontario.
CONCLUSION
We need to ensure that the improved funding does not simply create a more expensive health system, but creates a better health system. We will need to redouble our efforts at the provincial level to stop for-profit healthcare and P3s, ensure comprehensive publicly-funded services including home support services, stop the delisting, and protect and extend the principles of the Canada Health Act. Similarly, progress on primary care reform, human resources recruitment and retention, public health, promotion and prevention, and determinants of health all remain at the provincial level.
For more information contact Ethel Meade, co chair or Natalie Mehra, coordinator at 416-441-2502.
Ontario Health Coalition
15 Gervais Drive, Suite 305
Toronto, Ontario M3C 1Y8
www.ontariohealthcoalition.ca
phone: 416-441-2502
fax: 416-441- 4073
email:ohc@sympatico.ca