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Jordan Heath Rawlings
You can argue that it’s being streamlined and improved, or you can argue that it’s being dismantled. And this is just the beginning, but in Ontario, at least in Ontario, but the province is not alone. Universal healthcare is changing. Who will have the courage? Who will have the courage to listen to the people of Ontario and vote against Bill 60 for bringing healthcare back to the standards of a world class healthcare system, the best in the world? This week, Bill 60 received royal ascent, which allows some OHIP covered procedures to be performed at private for-profit clinics.
The Ford government thinks that this will improve access to care at no extra charge. The opposition, as well as lots of medical groups think otherwise, they’re letting private for-profit companies have unfettered access to the demand that exists in our healthcare system. So what exactly does the language of this bill allow for? How does it protect patients from having to pay for care, or does it, will it actually improve wait times and outcomes? Will we look back on this as a logical step or a massive mistake? This is not just Ontario. Elsewhere, in Canada, more private clinics are delivering care, and in Alberta, a provincial election seems poised to deliver a verdict on just how far private care in the province can go. So what can this new law tell us about the future of healthcare in this country?
I am Jordan Heath Rawlings. This is the big story. Richard Southern is the Queen’s Park reporter for City News. He’s the person we call when the Ontario government gets up to something. Hey Richard.
Richard Southern
Hello Jordan. It is good to be back with you. Hello from Queens Park.
Jordan Heath Rawlings
Yes. Well, it’s Queens Park that we want to talk about today. Because the last time we spoke to you, premier Ford had told Ontario, that he’d probably be allowing some private clinics to do some surgeries, but now it’s all codified. So is that what led to Bill 60?
Richard Southern
Absolutely. Here at Queens Park where I am, this Bill, Bill 60 passed into law this week. So this is something that can legally happen now. The government passing this health reform bill, it’s going to allow for more private clinics to offer certain publicly funded surgeries and procedures. The government says this is in an effort to cut down on big wait lists for these particular procedures. Opposition and critics, they feel differently about this, what this may do, but yeah, this bill passed into law just a few days ago, and this is something that’s going to happen now. More private surgeries. More private diagnostic imaging will be taking place here in Ontario. So more private surgeries and imaging.
Jordan Heath Rawlings
We mentioned that this had been a few months coming. What has or hasn’t changed from that kind of initial push to just do a few surgeries in private clinics? What exactly does this bill do?
Richard Southern
It’s going to allow for more cataract surgeries to be done in private clinics. They were already being done in private clinics covered by you OHIP. There’s just going to be a lot more of that. Now there’s going to be new types of diagnostic imaging being done a particular note this bill is going to put in place a new system whereby more hip and knee replacement surgeries will be done in private clinics. So more involved surgeries than just a quick in and out cataract removal will be done in these existing for-profit clinics. And the bill also allows for some more of these clinics to even be created. So I mean, again, Jordan, the government says, listen, we got 200,000 Ontarians waiting for these procedures, be they hip or knee or cataract. Now we gotta do something about it, and that’s why we need these private clinics to get on and start doing it. But there’s a big worry about the effect this is going to have on the public system. And that’s really the worry that’s taken hold here since this bill has passed.
Jordan Heath Rawlings
I wanna talk about the public system in a moment, but first, because you just mentioned, why are there 200 thousands on a wait list for these kind of surgeries? Like what has gone wrong with the system in this province that created the need for this? Whatever you think of the decision.
Richard Southern
Well, the government would point, first and foremost to the pandemic. You know, during the pandemic, non-essential surgeries were curtailed or stopped altogether. You know, if you knew if you were unable to see because of a cataract, you’d have it out. But if it was just, you know, your vision of fact a little bit, you weren’t getting that surgery done during the pandemic. So a lot of these surgeries they just built up. People were just waiting and waiting. And that led to this waitlist ballooning to an astounding 200,000 people. And to be fair, you know, that’s happened in other jurisdictions, Ontarios not immune to the effects the pandemic had on these type of surgeries. At the same time, you know, there was a sizeable waitlist, pre pandemic too, and, you know, questions about whether the system was robust enough to handle all these surgeries that people need. And you know, maybe that supports perhaps the government’s argument that maybe there is a role for the private sector to play Jordan.
Jordan Heath Rawlings
Why would the government do it this way instead of pumping up more money into the public system if the argument is that we’re just simply not equipped in the public system to handle the demand?
Richard Southern
That is an excellent question, and that’s the question the opposition parties have been asking here at Queens Park, because critics say the opposition say, why not pony up more money to have doctors perform these operations when there is space available in the operating rooms. That’s a good question. The government, when asked about that just kind of defaults to their previous talking points saying, hey, the private clinics are already doing this. They do a good job doing this, doing it more there, will help clear the backlog. But you’re right, this is the question that people have brought up. There is space in the public system to do it. Why aren’t we, what’s the concern about what moving these surgeries to private clinics. I’ll talk about the experience for the patients in a minute, but what’s the concern about what that could do to the public system aside from ease, the burden on it?
The fact that when you have doctors and nurses doing these things in private clinics, a lot of the time they are coming from the public system. And the worry is that this is going to be a drag on the personnel from the public system. I mean, critics point Jordan to private orthopaedic surgeries being done by a group called the Academic Orthopaedic Surgical Associates. This is up in Ottawa. It’s taking place at the Ottawa Riverside Campus Hospital, and it’s being done on Saturdays and you know, in recent months, you know, many nurses working there have come from the public hospital system and not only are they not available then in the public system when they’re doing this, they’re also being paid more. And you know, that’s another whole concern is that taxpayers will be on the hook for more money for this. But that is, I think the key concern, number one, is that staff is going to be drained from hospitals.
Number two, the worry is, these are for-profit clinics after all, many of them. Are they going to upsell you to try and get some more money out of you? You know, you can have that regular OHIP covered cataract lens. No problem, Jordan. But I’ll take a look at this one. This is a lot nicer. This is going to cost you a couple thousand bucks, and in a lot of cases, you know, you don’t want to argue with your doctor and you might pony up the money. So those are kind of the two worries. You know, that there’s going to be upselling going on and that there’s really going to be a staff drainage from the public system. So I remember when we spoke to you about this in January, we specifically talked about upselling, and you mentioned I think that it was something the Ford government had promised would not happen.
Jordan Heath Rawlings
Is there anything in this bill that protects against this? What kind of stuff is in this bill that will protect the patients?
Richard Southern
There is nothing in this bill that addresses the upselling issue. There were many amendments proposed by the opposition. You know, I talked specifically in the past few days to Dr. Adil Shamji. He’s a liberal MPP, newly elected last June former emergency room physician, and this was a big issue of his, the potential upselling that could go on. There were amendments proposed on this. The government didn’t take any of them, so there’s nothing in the bill. There’s no language that prevents this from happening. Now, the government will tell you. Hey, there’s always kind of been some upselling going on in the, in the public system even, you know, if, you know, break your ankle you’ll be offered the regular old crutches or you could get at an additional price, you know, fancier crutches or a wheelchair or a scooter or something to help you. So they contend this is something that’s always been going on, that it’s not a huge issue. They say as well that there is, a mechanism whereby you can complain to the government if you feel something untoward has happened to you on that front. But no, there’s nothing in the Bill, Jordan, that prevents this from happening.
Jordan Heath Rawlings
Can you explain the fight over this bill and all the amendments that have been proposed? This has been, and we can talk about it in the big picture because there is like an existential Canadian universal healthcare angle to this. What do the opponents of it say and what do they wish was different with this bill?
Richard Southern
Yeah, I mean, you always touch a nerve when you talk about doing more private anything in the healthcare system in Canada. We’re very proud of our public system, rightfully so. Perhaps so. I emailed just the suggestion that more of this would be going on, has really struck a nerve in Ontario and has made this a big issue. Is it a bigger issue than it ought to be? I don’t know. These are clinics that are already operating in many cases this is something that is already happening. They just want to grow with some. But yeah, there’s been a lot of opposition to it. There’s been many groups in the healthcare field, in the political field that have proposed, doing something, not doing it at all, I think is really what they wanna see because the concern is, this is a slippery slope, right? We start doing this, there’s going to be more and more surgeries done, there’s going to be more and more procedures done in the private level, and then next thing you know, are we looking at something that looks more like the United States than it does Canada. So I think, you know, when you talk about the bill, those who are against it didn’t wanna see anything like this go through. But with the massive majority, the government has here at Queens Park, it was voted into law rather quickly.
Jordan Heath Rawlings
What do the independent experts and analysts that you’ve talked to, think of this bill? First of all, do they think that this will actually alleviate the strain on the system? And second, are they worried about the precedent?
Richard Southern
Yeah, most healthcare groups are worried about it. They’re not all against it though, you know, I mean, the Ontario Nurses Association I know has come out and has said the province should invest in hospitals to perform surgeries there, rather than to set up this whole new system. Other groups though, have been a little bit more warm to it. I mean, you know, from the perspective, Jordan, of employment for those in the healthcare field could be a good thing. The fact that you could be making as a nurse or a doctor, more money working in these clinics could certainly be seen from that perspective as a good thing. But most in the healthcare field that we’ve talked to have been against this, with again, the feeling being that this could be a real slippery slope into a type of system that most Ontarians and most Canadians don’t wanna see.
Jordan Heath Rawlings
You mentioned that this has been done in a couple of other jurisdictions.What do we know from that about whether or not this works here, whether or not people do end up being upsold, et cetera, and if it actually, you know, alleviates the burden?
Richard Southern
Yeah. City News had some reporting just a few days ago about this happening in Quebec and how they expanded the private system for healthcare in Quebec, and what ended up happening was that it costs the government a lot more money. As we were just saying, you know, in many cases you are paying these doctors and these nurses a premium and these clinics, they’re trying to make a profit. So they’re trying to charge top dollar to the government, right? So what had happened in Quebec was the government ended up being on the hook for a lot more money. This was not a cost effective way of doing things. We’ll have to see if that, ends up being the case here in Ontario. But again, I mean, I imagine you’d have the government saying, listen, whatever the cost, we might need to do this to clear this massive backlog. But there is big concerns and there is evidence from other provinces that this costs taxpayers a pretty penny
Jordan Heath Rawlings
In the bigger picture, there’s also a huge fight in Alberta right now in the middle of their election. About potential private healthcare services, potentially selling public hospitals, or whether or not you should have to pay for a routine visit to your doctor, all that kind of stuff. Whether or not it’s going into law now, it’s definitely on the table for discussion.Why are we hearing more of this? Not just in Queens Park, but all around Canada right now?
Richard Southern
I mean, I think it’s become a lot more difficult to deliver healthcare through covid and post covid and, it’s always been tricky. I mean, you look at the so-called hallway medicine situation that has existed so long in Ontario. The system has always, or at least in recent memory, been kind of bursting at the seams. I mean, you know, if we get the treatment we need, hopefully when we need it, but a lot of the times we do have to wait a quite a while for it. And you hear these terrible stories of people waiting in hallways or in unloading docks for it. You don’t want to hear that. That has been the case for a long time. So I think there are governments in Alberta, in Ontario, in Quebec and BC where this is also happening, that are looking at ways of doing it differently. And oftentimes that means a more of a private influence. I mean, you hear the talking point from the Ford government for a long time on this has been, the status quo isn’t working in healthcare. That’s kind of the justification that they use for doing this. And you know, maybe the status quo hasn’t been working and I think that’s why a lot of governments are kinda looking to this as, maybe a way to fix it, Jordan.
Jordan Heath Rawlings
we talk about this as a test case for Ontario, and we’ve seen it elsewhere in Quebec. I’m not going to get into right now cause it could be its own episode about whether this is really a slippery slope or will help make the system work or the beginning of the end of public healthcare in Canada. But, I mean, is it safe to say from what you are hearing at Queen’s Park and what we’re seeing elsewhere, that one way or another, the way Canada approaches universal healthcare is going to shift?
Richard Southern
Absolutely. I think it is and it has been for a long time. Right. I mean, these are clinics as we’ve said that have been operating and that have been growing for some time. There is a change. But you’ve also heard, you know, at least here at Queens Park, the government has always been adamant about, you know, using this line, you will always use your health card, your OHIP card, not your credit card. So I think the real worry will come when or if you are forced to pay out of pocket. That is not the case for these type of surgeries right now. Certainly we’re seeing a shift, but up until now it’s a shift that still involves OHIP taking care of the costs, Jordan.
Jordan Heath Rawlings
So this bill is becoming law right now. I just received Royal Ascent, which means these surgeries will start happening. What are you, yourself and your colleagues at City News going to be watching for in the next few weeks and months? You know, how are we going to determine whether or not this is working?
Richard Southern
First and foremost, we’re going to keep a close eye on that surgical wait list, which as we say stands at 200,000. Is this actually going to do what the government says it will do and reduce that in shorter order? We’re looking at, we’ll look at that number one, we’ll also look, and this will come out in the budget in the spring and in the fall, economic update that comes out usually in October and November about what is this costing Ontarians? Is this costing more, are we being forced to spend more to expand these private clinics? That’s what we’ll be watching. We’ll be watching is and listening to Ontarians as well about this whole upselling business. And certainly we’ll be looking for people who have gone to these private clinics and talking to them about, Hey, were you pressured to buy something you didn’t think you needed to buy? And there’s a lot to keep an eye on to see how this. Rollout goes, Jordan.
Jordan Heath Rawlings
It’s one thing to pass a bill, it’s another thing to make the bill work on the ground in practice.
Richard Southern
Oh, it sure is. The government’s been under pressure on the healthcare file for a long time, right. And they’re under pressure to draw down this wait list. And I think they looked at this as an immediate way to be able to do it. Will it be successful? We’ll have to see.
Jordan Heath Rawlings
Richard, thank you as always.
Richard Southern
Jordan, appreciate it.
Jordan Heath Rawlings
Richard Southern reporting from Queens Park for City News. That was The Big Story. For more, you can head to thebigstorypodcast.ca. You can also find us on Twitter @thebigstoryfpn. If you have, in the next several weeks, any stories about being upsold at a private clinic or even just want to share your experience getting public care in a private space with us and our colleagues at City News, you can always get in touch with us by emailing hello@thebigstorypodcast.ca, or by calling us up and leaving a voicemail 416-935-5935.
Joseph Fish is the lead producer of The Big Story. Robyn Simon and Ebyan Abdigir are our producers. Ryan Clark leads our sound designers. Saman Dara is our researcher, and I am Jordan Heath Rawlings. Thanks for listening. Have a great weekend. Get some Sun. We’ll talk on Monday.
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