SEPTEMBER 30, 2007



Canada's largest province heads to
the polls

Healthcare issues omnipresent as Ontario election date approaches

Some have said the October 10 Ontario election is in large part a referendum on the current Liberal government's record managing the province's giant healthcare budget. With its large population, huge territory to administer and its ever-rising healthcare expenses, Ontario's campaign debate has thus far proven them right. Many of the most important battles between the three major parties have been waged over the sustainability of healthcare spending.

Ontario's $2.4 billion health premium - introduced in 2004 despite the Liberals' promise during the 2003 election campaign not to raise taxes — has become the main rallying point for the opposition Progressive Conservatives and third-place NDP.

"The so-called health tax is nothing more than a huge tax increase and one of the biggest broken promises in political history," PC leader John Tory stated in a release. Mr Tory has pledged to eliminate the tax entirely within four years, but insists he will be able to increase healthcare spending by $8.5 billion, in part by making the system more efficient. NDP leader Howard Hampton has also proposed phasing out the health tax and promises a $450 refund per person next year if he is elected. To offset the loss of tax revenue, Mr Hampton says he would raise income taxes for the wealthy.

In response to critics of the health premium, Liberal deputy premier and health minister George Smitherman has warned that cuts would threaten healthcare services. "All of the progress we've made to reduce wait times and boost the number of doctors and nurses is at risk," he said in a release.

Premier Dalton McGuinty has said he had no choice but to introduce the tax after inheriting a $5.6 billion deficit from the former Conservative government. He pledges no further tax hikes, but insists it's necessary to maintain the health premium. However, for the 2006-07 fiscal year the McGuinty government posted its second consecutive balanced budget and a $2.3 billion surplus.

Livio Di Matteo, PhD, a professor of Health Economics and Policy at Lakehead University, is doubtful of Mr McGuinty's claims. "Is the health tax absolutely essential? Probably not," he says. "Revenues have been healthy over the past few years and the economy has been relatively stable. Unless there is a major turn, you could probably phase out the tax by first reducing it by one quarter, see how that affects things, and then progressively phase it out."

The province is currently short 2,000 doctors and 8,000 nurses by the Ontario Medical Association's count. If those who are 65 and older decide to retire, it may lose 2,500 more doctors. The Liberals recently announced an IMG fast-track program targeting healthcare workers, but the Tories say the Liberals recruitment strategies have failed: the number of doctors accepting new patients has fallen since they took office.

Ontario's progress on e-health records (EHR) is well behind that of Alberta, BC and PEI, but the Liberals are still aiming for universal EHR coverage by 2014. The Conservatives make similar promises and say they will immediately take advantage of the federal funding for e-health programs the Liberals have missed out on.

The news isn't all bad for the Liberals when it comes to healthcare, however. They've had some success in reducing wait lists. Wait times for diagnostic scans, cancer treatment, cardiac operations, cataract surgeries, and hip and knee replacements have all decreased since 2005.

There's one healthcare spending issue that's received precious little discussion from party leaders so far, says Eduardo Sousa, a member of the Ontario Health Coalition's board of directors. "We're not getting a sense of how committed some leaders are to single-tier health care," he says.

The Conservative platform vaguely commits to public-private partnerships "provided that services are paid for by OHIP, meet provincial standards and do not allow queue jumping or patients paying from their own pockets." That policy has come under attack from Minister Smitherman who called John Tory the "dance partner" of new Canadian Medical Association president Dr Brian Day, whose prescription for Canada's healthcare system, Minister Smitherman alleged, is motivated by profit.

With a new lawsuit filed in the provincial Superior Court challenging the province's ban on private care (for more on this case, see "New lawsuit threatens Ontario private care ban" on page 21), Mr Sousa says the parties must be clear on where they stand. "We want to know how seriously the provincial government would fight this challenge," Mr Sousa says.



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