The time has run out for a real debate on health care in the Ontario election. All three major parties have attempted to address this issue but all have failed miserably. Instead of offering voters clear, compelling and differing visions of health care in Ontario, all three campaigns have settled for peddling myths. There are three favourites:

• more spending equals better healthcare;
  
• unenforceable patient charters are the answer;
  
• our system is the best because it's not American.
  

We tried this approach for every other pressing public policy problem for the past 30 years and it didn't work, so why should healthcare be any different? From job creation to youth crime to First Nations poverty to regional development, we ran up a 28 years of deficits and a $580 billion debt trying to buy our way out of our problems. But these problems are still with us. Merely committing more money for more nurses, more MRI machines, better medical records systems, or alternative-level-of-care (ALC) beds will not in and of itself make our healthcare system better.

Instead, the Canadian Taxpayers Federation prescription is to focus on outcomes. What is the strategy for reducing waiting lists for MRIs and CT scans? Yes, more equipment may be one response but it surely is not the sole solution. The same is true when it comes to nurses. Simply hiring and training more will not ensure that patient care is improved unless there is a strategy which takes into account demographic shifts and epidemiological studies. We must ensure that nurses and other allied health professionals are trained to give the appropriate professional care and encouraged to practise (or are placed) in communities where they will be needed.

In future, we should demand that our politicians talk about outcomes and results.




Each party has promoted some form of patient charter to buy our votes. Element of these charters include: a guarantee that patients in hospitals will be seen by a triage nurse within 15 minutes; hospital beds will be available for those that need them; and so on.

But what if a bus crashes right outside the local emergency ward next September. Or what if a major flu virus strikes in a major Ontario urban centre next November? Will people with minor sports injuries be seen in 15 minutes when the bus crash passengers and streams of flu patients are lined up in front of them? Hardly. In light of these possibilities how can our politicians possibly guarantee 15-minute triage assessments? And who will enforce these timelines? What recourse and legal remedies do patients have if their "patient rights" are violated?

Instead of unenforceable, unrealistic and absolutely stupid ideas of patient charters, our politicians should face reality. Admit the waiting lines exist. Admit that rationing will continue in an era of spiraling technological costs and unprecedented utilization pressures.

In a universal access system in which people perceive healthcare as a "free public good", overconsumption will continue to exist and will definitely get worse before it gets better. Public provincial benchmarks should be established as to the appropriate waiting times for MRI and CT scans or the number of weeks someone will have to wait for a hip and knee replacement. Such an honest approach is probably too much to ask for from our vote-buying politicians, now or in the future, but it is a necessary prescription to treat this ailment.




When it comes to almost every public policy problem, those who wish to defend the Canadian status quo always wrap themselves in the flag and say "well, at least we're not employing the American approach." From gun control to healthcare to environmental assessment, our flag-adorned friends would have you believe that everything south of the border is ‘evil' and must be rejected at all costs.

We can not forget that 31% of our health care spending in Canada is already private. From dentists to chiropractors to cosmetic surgery, the for-profit system is already providing care.

As voters, taxpayers and healthcare consumers we should demand an automatic 10% payroll deduction for medical research from each politician who tries to frame our healthcare dilemma as a simple binary choice: Canadian vs. American. There are at least 75 major industrial and post-industrial economies that successfully employ a blend of public and private medicine to serve the needs of the population.

The aging of the baby boom generation will increase pressure on health care, meaning that we must find a smarter way of providing service.

Our prescription seems straightforward enough: we should ask politicians to scan the globe to ascertain which countries are most adept at coming to grips with these demographic and funding realities and adapt their solutions to Canada's problems.

It is too late now to put some of these real health care issues onto the agenda for debate before voting day tomorrow. And the Ontario election experience will probably be repeated in future campaigns (provincial and federal) until we as voters say no to this "superficial symptoms" approach to the health care debate. We must educate ourselves and search for real answers and solutions. This election will serve, we hope, as a self-awareness checkup for voters. It had better - our future health depends on it.