The slippery slope

There's no denying that the taxpayer-funded health care system in Ontario, in common with much of the world, is under strain at the moment. The impact of years of under-funding has been greatly exacerbated by the COVID pandemic, resulting in delayed surgeries and even occasional, short-lived closures of emergency rooms in rural areas.  

There's also no denying that Ontario Premier Doug Ford thinks the private sector does just about everything better than the public sector, so it's no surprise that his solution to the health care crisis is to start farming more of it out to the private sector. This morning the Premier announced a three-part plan to do just that, starting with cataract surgeries, then moving on to diagnostic tests such as colonoscopies, and then to knee and hip replacement. This is all controversial, to put it mildly. Here are a few preliminary thoughts. 

The first point that needs to be made is that there is already a lot of private money involved in the Ontario health care system. As the linked article notes, there are already 900 private diagnostic and surgical offices in the Province. Moreover, dental and routine ophthalmic care is basically fully private already, and most people do not get any public funding for prescription drugs. Insurance companies enthusiastically fill the airwaves with ads to help with the cost of services the public system does not cover. 

Premier Ford is adamant that the steps being introduced today will not require Ontarians to reach for their credit card when they visit a private clinic. Your health card (known as an OHIP card) will still have you covered.  He is equally adamant that the new clinics will not in any way cannibalize the public system, particularly as regards staffing.  That can surely only be true if there are squadrons of ophthalmic surgeons (and later, orthopedic surgeons) currently sitting around twiddling their thumbs outside the public system, just waiting for the opportunity to open a clinic of their own. 

It can be fairly confidently stated that that's not the case. Staffing for the new clinics will exacerbate the existing shortage of medical professionals in Ontario. A much better solution already exists for that shortage: speed up the process of certifying fully-qualified immigrants to work in the Province's health-care system. 

Cataract surgery and diagnostic testing is one thing, but joint replacement, even relatively routine procedures like knee and hip replacements, is surely another thing altogether.  How many private sector clinics will invest in the premises and equipment needed to carry out these surgeries quickly and safely? Will they really be able to do this at a lower cost than the public sector does?  Then there is the issue of surgical complications. In the UK, which has a fully-fledged private system alongside the NHS, the private sector only takes on routine operations: anything that looks likely to run the risk of complications is quickly punted back into the public system. As in most areas of "public-private partnership", it quickly becomes apparent that the private sector has much more appetite for reward than it does for risk. 

There may well be a case for small stand-alone clinics to cover routine procedures and take the pressure off full-service hospitals. It's much less clear that the private sector will operate such clinics more efficiently and economically than the public sector can. And the really big fear here has to be that,  having whetted his appetite with the relatively minor steps announced today,  Doug Ford will sooner or later press ahead with much wider privatization of health care.  

Given Ontario's proximity to the United States, this recent warning from the excellent UK blogger Chris Dillow about health care problems in that country's National Health Service surely goes double here: In this world, we must guard against the (high) risk that the task of reforming the NHS will be undertaken by vicious incompetents in hock to US insurance companies. There would be very little support for that in any part of Canada, but that doesn't mean Ford isn't thinking about it. Ontario's healthcare system may just have been placed on a very slippery slope.