Is Ontario’s public health care on a slippery slope?

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Jordan Heath Rawlings So you want to make a room full of Canadians really mad? Just say something nice about private healthcare. If there is one topic guaranteed to rile up the masses in this country, it is the idea that anyone but the government should pay for anything related to our health. Of course, this already happens all the time. Canada does have universal access to healthcare, but how that is delivered varies widely. And what the government actually covers is sometimes not the best choice for you or not the ideal amount of coverage. That’s why private clinics exist like already exist. So when Ontario’s government announced last week that it would introduce legislation to expand publicly covered surgeries into these private clinics, it wasn’t much of a big deal at all. Ha right. These independent facilities, particularly if they operate in a for profit model, will have corporate and shareholder bottom lines as their priority. Ford has been scheming for years to privatize our healthcare system. His government has been following the privatization playbook to a T. The unions say for profit clinics focus their business on providing services for patients with the least complex medical needs to maximize profits, and leave public hospitals to care for patients with multiple, severe, and expensive to treat conditions, all while siphoning their staff. Ultimately, funds are returned. If it is appropriate. That’s a yes. The nut settling is allowed. Then this will be the last question. There is no question we should all be concerned about the crisis in our healthcare system. It’s not in a good place right now. We spent an entire week on this last fall. The question here, though, is how can it get better? Is this really a solution? What are the risks to opening up private clinics to publicly covered surgeries in Ontario? How is that going in other provinces where this already happens? Where is the slippery slope here? And what, if anything, is the government saying they will do to avoid going down it? I’m Jordan Heath-Rawlings. This is The Big Story. Richard Southern is the Queen’s Park reporter for City News. Richard, why do I feel like people are going to be mad no matter how we cover this topic? People are passionate about public health care in Canada and I guess don’t you think, Jordan, that’s probably that’s a good thing, right?

Richard Southern Yes. No, it’s great. I wish it was less divisive, maybe, the way we’re talking about it now, but I’m really glad people are passionate about defending it.

JHR So why don’t we start? Because here’s the thing with this issue. It’s all in the details. And if you’re not really deep into the weeds on how the healthcare system in Canada works, it can be really confusing.

Richard Southern It can be.

JHR And I actually really like this story in that there’s really good points to be made both for and against. Maybe the truth lies in the middle I don’t know. But there’s a problem in health care. The government has a plan to do something about it. Not everyone’s happy about it, but there’s good salient points to be made on both sides of this issue. Okay, so let’s start with this then, because I spoke about the details and the definitions. What exactly are we talking about when we talk about private clinics and private hospitals? And if we have universal health care, public health care in Canada, why do those exist?

Richard Southern Yeah, it’s a little bit of a misnomer. I mean, we have a law that guarantees a single payer system in that the government will pay for our health care, but it’s always been delivered in some way through private means. If you go to your doctor, jordan he or she is paying for that office, paying for any employees they have, but you don’t get a bill for that. They don’t charge you. Oh, hip pays them. That’s a private business. If you go to the dentist, it’s obviously something that’s paid for. We have private delivery of a public system in Canada. That’s always been the case. And what the government’s intending to do here is to expand that sum.

Jordan Let’s talk about exactly what they’re expanding as of now, as of last week, what are they changing about? What happens in some private healthcare clinics in Ontario, and there are some 900 of these private healthcare clinics that do diagnostic imaging and some minor surgeries. There’s ten private hospitals licensed in Ontario, and that stuff is covered by OHIP now, right?

Richard Southern Covered by OHIP. Absolutely. There’s some room for profit to be made, and we could talk about that in a moment. But what the government’s promised to do this week was introduce legislation whereby they’ll expand the scope of these clinics. They’re going to allow a lot more contract surgeries to be done in these private, often for profit clinics. Government’s going to perform, they say, 14,000 additional Cataract surgeries a year. And the goal here is to reduce the waitlist that we see in public hospitals for surgeries like cataracts. That’s kind of the first stage of the plan, will involve the cataract surgeries. The next stage of the plan will involve more diagnostic imaging being done in private clinics, but paid for by OHIP. So things like MRI or you need to get a Cat scan, you go to one of these private clinics or colonoscopy those, quote unquote, lucky enough to have had a colonoscopy, may have already likely gone to a private clinic to get that important procedure done. And then a year or two down the road jordan the government says they want to really ramp this up by doing some more complex things like hip and knee replacements in these for profit clinics.

Jordan I want to be clear about this, because it produced a memorable quote, and it’s a source of a lot of controversy. So, according to the Ontario government, and this legislation that they’re proposing. Will this translate into Canadians needing to pay out of their own pocket for those services you just described?

Richard Southern So the basic services know, and the Premier has used this talking point over and over again, saying, you’ll always pay with your ohip card, not with your credit card. Right. And that’s essentially true. But but yeah, that’s the big butt. Most of these clinics we’re talking about are for profit and that is their main goal, to fatten their bottom line.

Jordan How do they do that?

Richard Southern Jordan many try and Upsell patients, so we were talking about cataract surgeries. They’re going to do a lot more of those. In part of that surgery, they implant a lens in your eye, the base lens that’s covered by OHIP. But the doctor will likely say, oh, you can have that, or you can have this better quality lens where you might see a little bit better. Once it heals that lens, though, that’s going to cost you X amount out of your own pocket. And the problem, and critics say the problem, is when your doctor says you can have something better that’s going to be better for your health, it is hard to say no to that. That’s fair. I mean, that’s a reasonable feeling for a patient to have, especially because we are taught that your doctor makes the recommendation and you follow it. Absolutely. The flip side of this, and what the government tells me about this, is that this quote, unquote Upselling is happening in the public system already and has been happening. If you need to stay in the hospital, you can have a private room, right? Yeah. You want to pay extra for the private room, you can have the base wheelchair covered by OHIP, or you can have this better tricked out wheelchair for a price that’s always gone on. The government says, let’s talk right now about the climate around this.

Jordan We kind of touched on it off the top, but what’s it been like the past couple of weeks covering this?

Richard Southern I think we even used a clip in the intro of a press conference that got a little rowdy, and I think the voice shouting at the Minister of Health might have been yours. You can tell me if it’s not, but there’s definitely it’s heated down there. It is heated. And it’s been tough to get to the core of the issue with the government on this, particularly on that Upselling issue. And that’s when that news conference got a little bit rowdy. My fellow reporters and I were asking repeatedly of the Premier and the Health Minister, are you going to do anything to protect against this Upselling? Are there going to be any consumer protection measures in place? Remember, you’re a consumer. If you go into one of these profit clinics, you’re not just a patient. And Ford didn’t really answer that. He just sort of pivoted back to his talking point, saying, we got to clear the big surgical backlog. So we pressed and we pressed on that and sure enough, there are no protections in place to protect against this upselling. So that’s what critics are worried about. Yeah, I mean, it’s been tough to sort of parse through the government talking points on this issue to get to the heart of what they’re doing. And we’re also pressing them on the other big concern that critics bring up here, Jordan, and that’s where are we going to get the doctors and nurses to do all of these additional private surgeries?

Jordan Because you mentioned it. How bad is the current surgical backlog we’re dealing with? And do we know how it got this way?

Richard Southern It’s bad, Jordan. Government says 206,000 individuals are on the waiting list for surgeries. So, I mean, these are people that’s your mom, that’s your sister, that’s your daughter waiting for hip replacements, waiting for cataract surgeries. 206,000 people in the province of Ontario. Now, to be, to be fair, there’s always been a waiting list longer than it should be. Health care has been arguably troubled for some time. There’s been hallway medicine for a long time. But this situation got a lot worse during the pandemic because a lot of these surgeries that aren’t necessarily urgent were put on hold, but people still had cataracts developing in their eyes. And so the list grew and grew during the pandemic. And now it’s at a point where there’s more than 200,000 people waiting and the government says this is one way to do it. Let’s move it outside of the hospital setting, let’s let the private clinics tackle it. And in the case of the cataract surgeries, the government promises to have that weightless cleared within months. Wow, that sounds nice. If it happens. If it happens, and if people get the service they need without having to pay more for it, it’s a good thing.

Jordan Why is the government doing it this way and pushing towards private clinics instead of putting more staff, as we always talk to healthcare providers, about more hours, more money into the hospitals that are already set up and already performing these procedures?

Richard Southern It’s a very good question. And we asked the premier that question, and his answer was, we’re doing both. We’re giving more money than ever, he says, to health care. And in a way, that is true when you look at the budget. It’s also true, though, that the government has underspent what it planned to spend on health care when you go back the past couple of fiscal quarters. So the government says, we’re doing both. But it is a good point to be made.

Jordan Could more money be inputted into the public system?

Richard Southern We’ve seen a lot of staff leave the public system, and some nurses point towards one Ford government measure as the reason they’re leaving. And it’s something called Bill 124 was introduced three years ago. It’s a law that restricts the nurses wage increases every year to just 1%. Of course, with inflation going the way it is, that’s a big pay cut. And many nurses say we’ve left the public system, many going to these private facilities because of that. So the critics say the government has helped create this problem with laws like that and not treating workers with respect. And maybe, I mean, we’ve heard from the NDP, I think it’s kind of a conspiracy theory. They say the government intentionally hurt the public health care system in order to bring in more private care. That’s what the leader of the opposition has essentially been saying. I don’t know if that’s true or not. Jordan well, I did want to get around to the rhetoric about this on both sides. I understand why people in the NDP or other opposition parties would be concerned. I really understand if you’re a person who looks at care that if it’s private, you can’t afford it would be concerned.

Jordan I understand the passion around Canadian healthcare in general. I guess my question is, how do we know if this is going to play out the way the government says it will and what could go wrong?

Richard Southern The staffing issue is what could go wrong? And I think this is really the big concern we need to look at with this plan. How are we going to protect against these private clinics, head hunting nurses and doctors and other professionals away from the public system with better salaries, with better working hours? What the government said is they’re going to require these for profit clinics to submit staffing plans to ensure that they’re not poaching staff away from the public system. But it’s not clear, and they haven’t really detailed how that’s going to work. I mean, you can’t really stop someone from leaving one job and getting another if that’s their choice to do. So the Premier has said, hey, 60,000 nurses have been hired since 2018, and that’s true, but a lot of those have already gone to the private system. So staffing is the one thing that really could go wrong here. On the flip side, though, ontario is kind of lagging behind other provinces who are already doing a lot of these private surgeries. Only about 3% of surgeries in Ontario, Jordan are done outside of hospitals. You look at a province like British Columbia, it’s like 20% and growing. And there has been reporting that it costs the taxpayers money, more money in those other provinces to do this. There was a 2017 investigation by the Globe and Mail that found significant unlawful extra billing by Canadian doctors through private clinics in places like BC. So that’s a concern too. But Ontario is lagging behind other provinces who, with some success, have been doing this for a while. But there is that concern that this move is going to just put a further staffing drag on an already understaffed Ontario healthcare system. Why is the fight over this so heated and so pronounced if, as you say, Ontario is lagging behind the rest of Canada in doing this. I totally understand, given the passion that we’ve already discussed for public health care, if this was a groundbreaking move, if this was a huge step outside of what is already happening. I don’t like this move, I’ll be frank. But I also don’t understand why this is seen as a step too far when we already sort of do this in this province. Other provinces are already doing it.

Jordan Why is this the hill to die on?

Richard Southern I think there’s two things to point out on this. I mean, again, people are so passionate. Canadians love their health care system, and all you have to do is look at the United States where someone can go bankrupt for delivering a baby or hurting their back. So people are passionate about this. And I think the concern here is that this is a slippery slope. Sure, we’re going to do some more cataract surgeries that we already do. We’re going to do some more hernia surgeries in private clinics that we already do.

Richard Southern But then what? Is this just the beginning? And sure enough, I actually asked the premier, I said, okay, so once you clear the public hospital backlog, is this plan going to go out the window? You’re going to do away with no, he said. This is permanent, ford said. And what’s more, the Health minister left the door open to doing more further complex procedures, as yet unnamed procedures in these clinics down the road.

Richard Southern So I think a lot of the concern among individuals out there is that this is just a slow drip, drip into a more private healthcare system. That’s a big worry. But you said you don’t like this.

Richard Southern What don’t you like about this, Jordan, I’m curious.

Richard Southern I shouldn’t have phrased it like that. You know, I don’t like the optics. I am on the side of public health care. I am on the side of publicly funded medicine and care being available for free to all Canadians the highest quality whenever they need it. So the optics of this ring hollow to me. And I probably shouldn’t be going to this place because I’m not supposed to be opinionated on the show. But I feel really bad for doctors and nurses in our hospitals right now who have suffered for the last two and a half years and carried all of us through a pandemic only to be told that the private clinics won’t be subject to the same pay freezes that they are. It feels unfair to me. Richard. It’s been a long slog and it is not fair. And this wage restraint legislation, it affected nurses and other public sector employees, but it didn’t affect police officers. The government kind of picked and choosed with that. So it’s not great. Yeah, I don’t know. To be fair, I don’t know whether this plan will work or not. And actually, the last question I was going to ask you is how will we or won’t we know when the plan is working? I can’t sit here and say I don’t like this because I think it will go badly, because I simply don’t know enough. Listen, I hope it works, but it does kind of feel like a big hand in the face of the people who we were ringing pots and pans for two and a half years ago. It does. But we also do need to deal with these 206,000 ontarians. You need to get a surgery or a procedure done. I don’t want to wait to get a Cat scan done if my doctor needs to see what’s going on with me, I don’t necessarily want to get up at three in the morning like some people do to get a Cat scan. This could be a way for more people to get the health care they need in a more expedient way. But it also could be a slippery slope. It could lead to me having to pay a bit more if my doctor tries to sell me something. And it could cause a lot of concern with staffing. The Premier has just announced that the government is going to allow nurses and doctors accredited in other Canadian provinces to work in Ontario immediately without any new accreditation. So the government’s already, it seems, trying to do something to tackle what could be a staffing drain brought on by this plan. How do we know it works, though? I mean, I don’t know. We’ll have to keep an eye on that big surgical backlog. Hopefully this gets that clear, Jordan.

Jordan Richard, thank you so much for explaining this and I’m glad we had this conversation. And you know what? Much like the subject, I’m glad that it was passionate. It’s a good thing to be involved in these important issues and that’s why we’re asking the tough questions of the Premier and we’ll continue to do so. Jordan and I love it when I hear your voice shouting after him as he walks away from the podium. I just have to say that. So thank you. You’re welcome.

Richard Southern Thanks, Jordan, for having me on.

Jordan Richard Southern reporting from Queens Park for City News. That was The Big Story, and this is where I usually ask, plead, for feedback from the listeners. I don’t have to do that this time because some of you are already pissed, I guarantee it. But we’d love to know what you thought of this discussion because it’s a hard one to handle and as Richard said, it’s pretty nuanced. So, feedback. Welcome as always. You can send it to us on Twitter at the Big Story. FPN. You can write to us via email hello at The Big Storypodcast CA and you can call us and leave us a voicemail 416-935-5935. The Big Story is available in every podcast player. If you feel like spending a little money and not hearing commercials. You can subscribe to TBS Plus on Apple Podcasts. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.