In October, Ontarians voted for the fundamental change in direction promised by the Liberal Party during the election. Over the last month, literally hundreds of our members have contacted us in shock and dismay in response to a series of government announcements. What has alarmed them is the impression that the Government’s priority appears to be the adoption of a regime of asset sales, i.e. privatization and constraint, rather than reinvestment in our social programs through a progressive tax system. Ontario’s public health care system has been severely battered in the past eight years while the previous government gave first priority to tax cuts for the wealthy, leaving the sustaining of health and social programs in a distant second place. Current priorities don’t appear much different. We are hearing almost daily that the inherited deficit has to be remedied before anything can be done to improve health care or education, even though the crying needs in both sectors remain Ontario voters’ highest priority. But our health system, and Ontarians who need it, cannot sustain more of the same.

We have learned a few key lessons from the last eight years in Ontario and from world-wide evidence that privatization and restricting services do not save money and threaten the future of the health system. From our experience, it is clear that:

1. Delisting and attacks on universality of Medicare are a false economy, replacing progressive taxation with regressive and inefficient out-of-pocket costs — another form of taxation. After the recent years of Conservative government, Ontarians now have the highest out-of-pocket expenses for healthcare of any province in the country -- an average of $1,072 per person each year. For many of the working poor, for example, this more than wipes out what they received in "tax cuts". For middle-income families it diminishes significantly any tax cut savings.
2. Privatization has increased our healthcare costs and fostered a system that is less accountable and responsive - less easy to "steer" to use the words of Mr. McGuinty and David Osbourne - not more. The public private partnerships being considered for our hospitals will cost more and will simply hide a higher debt off the province’s books. The most efficient use of society’s resources is thoughtful investment in necessary public infrastructure and restoration of public non-profit delivery of services.
3. Hospital restructuring did not yield expected savings under the Conservative government

and will not yield savings if your government follows the same path.

4. Health promotion and disease and injury prevention are cost-effective, yet governments fixated on this year’s bottom line have failed over and over again to invest now to save costs later.

It is our belief that the goal of a public Medicare system is to create the best health and health care possible for all residents. We believe that reform and revitalization of Medicare needs to stem from this premise. For too long, public policy regarding health care and the determinants of health has been based on short-term financial planning. In the meantime, closed-door negotiations have upheld old-fashioned monopolies of power and the health care reform agenda has been captured by an increasingly powerful private health care industry.

Unlike policy makers, Ontarians do not see health care as a commodity. We see it as an essential social program - an integral part of our social infrastructure. Medicare must not be seen merely as a public insurance scheme covering parts of a largely private industry. It will not be sustainable if defined this way.

The future sustainability of Medicare will depend on stable and adequate funding. It will depend on governments limiting profit-taking and resisting the commodification of health services. It will depend on the efficient utilization of resources -- with a greater percentage of health spending directed to patient care rather than advertising, profit, and excess administrative costs. Medicare’s future depends on restoring public confidence through building democratic decision-making, improved transparency, accountability, and public access to information. It depends on rebuilding and extending the application of the principles of universality, comprehensiveness, accessibility and public administration. It depends on modernization through progressive reform and the extension of the principles of the Canada Health Act to cover home care. It depends on control and coverage of drug and treatment costs. It depends on stable coverage of preventive services including homemaking, physiotherapy and other therapies, and access to timely treatment. It depends on a serious commitment to combat the social causes of ill health: poverty, lack of safe and healthy housing, barriers to the access of public services and education, and unhealthy environments and workplaces.

In the last decade, cuts and increases in pharmaceutical prices have increased the out-of-pocket burden Ontarians carry for health costs. According to the Canadian Institute for Health Information, Ontarians now pay $1,072 per person per year in out-of-pocket costs, up from $860 in 1995. OHIP de-listing, high pharmaceutical costs, shortened hospital stays, poor funding of rehabilitation therapies, inadequate home and long term care have contributed to an escalating burden of out-of-pocket health care costs for Ontarians. Forty-five procedures amounting to approximately $100,000,000 in services have been de-listed from OHIP in the last eight years. With the passage of Ontario’s Bill 26 in 1996, seniors and those on fixed incomes began to pay user fees for their drugs. The same legislation forces those waiting in hospitals for beds in long term care facilities to pay more than $40 per day for their hospital beds. Inadequate funding and cuts to homecare budgets have caused thousands of Ontarians to lose homemaking and homecare services if we cannot afford to pay for them. Almost three million Ontarians have inadequate drug coverage, according to a recent report commissioned by Health Canada.

While the temptation to delist services as a means of cost control may work to move costs off the province’s books, it does not eradicate those costs. Mr. Romanow noted in his report that these cuts were a "false economy" simply shifting the burden of payment from the progressive tax system to individuals. If we must pay either way for health services, why not pool our resources through the tax system and increase our efficiency through bulk purchasing and non-profit public services as the Medicare system is designed to do? The proposed delisting of substance abuse programs and hearing aids, and the proposed dismantling of universal drug coverage for seniors must be abandoned and a renewed commitment to universal, publicly funded services must be made.