Denley: Ontario’s current health-care spending plan is a pile of horsefeathers

By this September, the surgical backlog will have reached 420,000 procedures and there will be a backlog of 2.5 million diagnostic tests. It will take more than three years to eliminate the queues. What realistic solution does government propose?

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The COVID-19 pandemic has certainly underlined the deficiencies in Ontario’s under-resourced health care system. According to a new report Monday from the province’s Financial Accountability Office (FAO), fixing those deficiencies is going to cost far more than the Doug Ford government has let on.

Ontario’s projected health-care spending plan is a pile of horsefeathers, or markedly unrealistic if you want to be polite. Although the government projects increased health spending every year, it won’t be nearly enough to cover inflation, increased demand, the COVID-related surgery and diagnostic backlog and the cost of the government’s announced health-care improvements. The gap between projected base spending and real costs creeps up every year and will reach $12.4 billion by 2029-30, the report says.

By the end of the decade, the provincial government thinks the annual health-care bill will be $82 billion, up from $63.7 billion back in 2019-20. The FAO puts the number at $94.4 billion. There is no easy way to eliminate that gap.


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The pandemic has certainly dealt Ontario health care a serious blow, requiring $16 billion over three years for onetime costs but at least that money is budgeted. Unfortunately, it’s still short of what is required to eliminate the massive surgical and diagnostic hangover the pandemic created.

The FAO estimates that by this September, the surgical backlog will have reached 420,000 procedures and there will be a backlog of 2.5 million diagnostic tests. Clearing that up will cost just over $1.5 billion, but it’s not so much the money as the time. It will take 3.5 years to eliminate the surgery queue and the testing will take three years to get up to date. It amounts to a colossal denial of timely service unlike anything Ontarians have seen before.

The provincial government has promised to add more hospital beds, increase mental health spending, boost home care and dramatically expand and upgrade the beleaguered long-term-care sector. Those changes are needed and overdue but they need to be backed with a realistic spending plan.

Between 2010-11 and 2019-20, health-care spending increased at an average rate of 3.2 per cent. To keep costs down, the former Liberal government froze hospital budgets for four years, cut physician payments twice and approved almost no new long-term-care beds. That hardly seems like a recipe for future success.

By contrast, the Progressive Conservatives imagine they can restrain heath care costs to an average annual increase of just 2.6 per cent a year for a decade, while spending big to improve health care. This is the fiscal equivalent of hoping for a miracle cure.


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To meet rising costs, the provincial government can increase taxes, narrow the scope of health-care service or implement efficiencies that have been promised but not yet specified. Some combination of all three would likely be required.

The alternative is increased federal health-care money. Federal transfers are expected to cover about 25 per cent of overall health spending over this decade. Doug Ford and the other premiers have asked for that to be increased to 35 per cent. That would provide Ontario with an extra $9.5 billion a year by 2029-30, not enough to close the entire gap, but it would make it manageable.

Prime Minister Justin Trudeau has told the premiers that he won’t increase health funding now, but maybe later. Somehow, spending more on Canadians’ health is less important than any of the vast list of spending promises contained in the federal government’s latest budget. The Trudeau government, like its predecessors, is a champion of public, universal health care. Splendid, but someone has to pay the bill.

Whatever the solution is, it needs to be put in place now. The FAO report lays out the familiar story of how a decade of health-care underspending dug Ontario into a deep hole. It’s a mistake we can’t afford to repeat.

Randall Denley is an Ottawa political commentator and author. Contact him at randalldenley1@gmail.com


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