The arithmetic of health care

There is a simple arithmetic to the rising costs of health care, just as there was to the federal deficit in the 1990s. Health care costs are increasing at a faster rate than the revenue of any government in Canada, and the scramble by governments to fund health care means that other critical priorities are being underfunded. In Ontario, for example, because health care costs have increased by an average of 8% a year for the last 5 years, their share of the government spending pie has risen from 32% to 39%; if interest costs are omitted, 46% of all Ontario spending is devoted to health care. These increases have come at the expense of funding for other priorities such as education, social programs and the environment. As Ontario Premier Dalton McGuinty explained, "there will come a time when the Ministry of Health is the only Ministry we can afford to have and we still won't be able to afford the Ministry of Health." Even if the federal government were to commit 100% of its surpluses to health care, this would not change the fact that health care costs are unsustainable. What is required is an open-minded discussion of change, devoid of the standard rhetoric that attacks new ideas as "taxing the sick" or "privatizing the system." As well as discussing equity, we must also address quality and access: outdated equipment compromises quality, and long waiting lines negate access. And the idea that centralized engineering of the system will produce equity ignores the reality that those with the means jump the queue by going elsewhere for medical care. Janice MacKinnon is a professor of public policy at the University of Saskatchewan, Saskatoon. She was Saskatchewan finance minister in the Romanow government and is the author of Minding the Public Purse: The Fiscal Crisis, Political Tradeoffs and Canada's Future. This article is based on a study published by the Institute for Research on Public Policy (www.irpp.org).