Health Care: More Thoughtfulness In Party Promises Would Be Welcome
Posted July 30, 2021
The McNeil government established an enviable track record of balanced budgets and fiscal discipline. The COVID epidemic has thrown spending caution out the window provincially and federally, not that there was much caution in Ottawa.
Big spending could be justified in the early stages but is no longer defensible. By the time the new government is sworn in, we will have achieved the highest-in-Canada threshold for full vaccinations and be ready to move to the new normal.
Health care is budgeted for $5.3 billion this year, just under half of government program spending. It should subside as COVID-related expenses diminish. Yet there is little evidence of fiscal discipline in the health care platforms of the three parties.
All take as a given the more than $2 billion investment in renewing the facilities of the QE2 and the hospitals in CBRM. Most of that money is yet to be spent.
Start with seniors’ care. Per person, home care costs an average of $15,000 per year. It is by far the most cost-efficient way of supporting seniors in need. Every effort should be made to maximize this method. The PCs suggests a $500 grant for low-income seniors to help them with things like snow plowing. The NDP wants more staff to shorten waitlists and to expand the range of services provided.
Every party wants to spend massive amounts expanding and renewing long-term care facilities. The Liberals are investing over $1 billion dollars in Long-Term Care to reduce wait times and provide more comfortable homes. The PCs and NDP want much of the same and hope to get significant federal contributions.
This is to accommodate waiting lists, especially people stuck in hospitals because they have nowhere else to go. In addition, all parties want to increase staffing ratios. The PCs estimate the first-year cost of increased staffing at $115 million.
Most of the costs of long-term facilities have to do with hoteling, not care. The funding formula charges at most one-third of the cost to the patient. That is unaddressed by any of the parties. The formula must be changed so that those who can easily afford it pay all their costs for room and board.
Mental Health features in all three platforms but the Liberals’ promises are rather modest. The NDP wants to increase that budget by $200 million because the World Health Organization says it should be 10% of the budget instead of today’s 6%.
The PCs want to provide “Universal Mental Health Care” for Nova Scotians without private insurance. That will quickly become all of them because the private sector programs will disappear, and government employees will insist on getting the robust benefits of the PC program. The cost will exceed their $102 million estimate by at least 60%.
Shortages of doctors and other health professionals is another hot topic. The Liberals have upped the number of seats they will fund at the universities and will spend more on recruiting and integration. These are useful steps but more can be done. Educating a doctor costs five times the tuition they pay. Make the other 80% an interest-free loan to be forgiven over five or ten years of the doctor remaining in the province.
After the most recent collective agreement with Doctors Nova Scotia, family physicians are the highest paid in Atlantic Canada. In addition, the prevalence of care by telephone during COVID times has been very lucrative—requiring less overhead and shorter “visits”. That has been abused by some family physicians, telling patients they should go to emergency if they want to be seen in person. The PCs promise an unnecessary further increase in physician salaries.
Virtual care is a promising way to deliver care more efficiently, but government must get the benefit of the efficiencies.
Both the NDP and the PCs complain about frequent emergency room closures in smaller hospitals. But why should there be emergency departments in North Sydney and New Waterford (NDP) when there are full-service departments less than 25 minutes away? Why should there be a 24/7 emergency department in Guysborough when an on-duty physician or nurse practitioner would be unlikely to see more than one true emergency patient in an eight-hour overnight shift (PCs)?
The NDP has a long shopping list, including the elimination of ambulance fees; free birth control, free shingles vaccines, and better access to insulin pumps; a school-based oral health program; and working with the federal government to create a national Pharmacare program.
Nova Scotia’s number of people without doctors are the same as or better than other provinces. Likewise for issues with mental health and long-term care. In a single-payer system, demand will always exceed supply.
Health Care is a top issue for voters—hence the primacy it has in party platforms. More cost-conscious proposals would be welcome.
The question taxpayers should ask is which party plans to spend health care dollars the most wisely.
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