While the Federal Government makes transfer payments, almost all health policy decisions are made by the Provincial Government. If the quality of public health care is important to you, it is vital that you vote in Provincial Elections.
While the pandemic is currently front of mind, there are other important issues in this policy area including Bill 124, the ongoing risks of for-profit long term care and the impact of insufficient social safety supports on the health care system.
This policy analysis was prepared in consultation with Michelle Cohen, a family physician in Brighton, Ontario.
PANDEMIC POLICY AND RECOVERY
The pandemic can be divided into two areas: 1) how to reduce the death and sickness caused by the virus itself and 2) dealing with the long-term strain the pandemic has placed on our healthcare system in terms of delayed surgeries and testing and a likely uptick in health issues.
Responding quickly to a surge of the virus makes it is easier to control, but Doug Ford’s instinct has been to delay or avoid public health protections like vaccine mandates, mask mandates and school and business closures as long as possible. By waiting until cases surged extremely high to enact protective measures Doug Ford condemned Ontario to move Covid cases and more deaths, but it is quite possible that these delays ALSO led to longer and more severe restrictions. Between March of 2020 and May of 2021 Ontario schools were closed for a total of 20 weeks — more than any other Canadian province or territory.
Early in the pandemic, there were also critical shortages of high-quality PPE, especially for PSWs.
After the trucker convoy protests however, Doug Ford’s disagreements with public health experts grew more pronounced and his public health decisions became increasingly political. He has refused to bring back widespread PCR testing or re-enact mask mandates in response to the 6th wave, presumably in hopes of picking up votes from fringe parties on the right. The opposition parties have all been critical of this new policy phase.
But Doug Ford’s worst public health decisions actually happened before the pandemic. In October 2018, he scrapped the two paid sick days in the Employment Standards Act. Forcing people to go to work sick spreads disease, costing the health system more and weakening the economy.
In 2018, Doug Ford also cut comprehensive safety inspections in long-term care homes — a move that proved disastrous once the pandemic hit.
Important pandemic policy issues going forward:
- better ventilation in public buildings, especially schools and congregate settings, but potentially also introducing regulation to improve ventilation in privately-owned buildings as well
- returning a proper PCR testing regime
- developing an effective contact tracing program
- paid sick days
POST-COVID HEALTHCARE RECOVERY
Ontario needs a strategy for confronting the likely surge in chronic illnesses caused by delayed testing and treatments during the pandemic, and potentially as a result of long COVID as well.
This will likely require greater investments in primary care and family health teams and expanding hospital programs. After 15 years of hospital consolidations under both Liberal and Conservative governments, it will be necessary to expand hospital services again to address the potential rise in chronic illness which will hit alongside increased demand due to an aging population. Voters should be suspicious of governments talking about further efficiencies and cost savings as it will be impossible to meet expanding demand for health services without expanding services.
Bill 124 – which Doug Ford introduced before the pandemic – limits possible wage increases for public sector workers, including nurses, to 1% which is far, far less, than inflation. As a result, even while they carried Ontario through a multi-year pandemic, nurses were actually falling further behind financially.
Any decent government would repeal Bill 124 and provide fair compensation for nurses and PSWs.
INVESTMENTS IN SOCIAL SERVICES
Ontario’s healthcare sector is often left to do a bad job mopping up issues that could be better addressed through other government programs. Using the health care system as a stop-gap comes at great cost to taxpayers. Poverty is the root cause of many of the ongoing health problems confronting both family doctors and hospitals. While the necessary services aren’t strictly part of health policy, a stronger social safety net would substantially reduce health care costs.
There are two areas of concern here: the ongoing replacement of public health services with for-profit options and challenges within the for-profit Long Term Care home system.
While privatization has already seeped into Ontario’s health care landscape, Doug Ford’s Conservatives periodically hint about further increasing private health care services in Ontario as a cost-saving measure. For example, Christine Elliot, the Conservative Minister of Health, recently suggested it might be best to address the post-COVID backlog in surgeries with privatized health care and private hospitals.
During the pandemic, for-profit long-term care homes proved to be significantly less safe than non-profit LTC homes. This was due to crowding and worse working conditions for PSWs in these homes — many of whom work in several different homes. Municipally-managed non-profit homes had the best outcomes. Considering that the province already funds for-profit long-term care homes with taxpayer money, it makes sense to end for-profit long term care homes in order to improve the lives of aging Ontarians.
Only the NDP have explicitly committed to phasing out for-profit LTC facilities. The Liberals have made statements critical of for-profit homes, but have yet to release their platform as of April 18th.
The Progress Conservatives are committed to continuing and expanding the for-profit system. Perhaps due to former PC Premier Mike Harris’s position as the Chairman of the Board at one of Canada’s largest for-profit LTC companies.
Hospital consolidation and urbanization of health care services has caused significant access to service problems for people in Northern Ontario and rural areas.
What are the parties saying about healthcare?
They also plan to invest $3.8 billion on mental health services over the next ten years.
During his term in office, Doug Ford:
- Capped wage increases for nurses, PSWs and other social service workers far below inflation with Bill 124, leading to additional strain on nurses
- Reduced safety inspections in long-term care homes before the start of the pandemic
- Scrapped existing paid sick day rules and refused to add paid sick days during the pandemic
- Repeatedly ignored recommendations from the Ontario Science Table and epidemiologists
- Cut $200 million from Public Health units then temporarily reinstated funding after widespread backlash
Ontario’s Financial Accountability Office (FAO) suggests that, after accounting for population growth, inflation and aging, the PCs planned health spending is not enough to keep health service levels where they are today.
- Increasing access to mental health services under OHIP
- Increasing spending on mental health from 7% of health spending to 10%
The Green Party also explicitly highlights the importance of other social services like basic income and affordable housing for addressing mental health challenges.
The Green Party have called for 10 paid sick days during the pandemic and the repeal of Bill 124.
The Green Party leader called for phasing out for-profit LTC homes during the pandemic, but there is no detailed policy on this issue in their platform.
You can read all of the Green Party’s healthcare commitments beginning on page 46 of their vision statement.
During the 5th wave, Liberals were critical of Doug Ford’s pandemic management and called for increased testing and ventilation and the withdrawal of Bill 124 among other measures.
They have pledged to grant 10 paid sick days to all workers.
On April 26, they also pledged to phase out for-profit long-term care by providing additional funding for homecare and not renewing the licenses of existing for-profit homes.
The Liberal party will reverse Ford’s cuts to mental health care and invest an additional $3 billion to hire more mental health professionals and reduce wait times.
Liberals will hire more family doctors and invest $1 Billion into clearing the surgical backlog. They also propose more nurse-led clinics in the North and rural areas and additional funding for medical students training in the North.
The NDP have committed to hiring 10,000 additional personal support workers and raising the wages of all PSWs at least $5 above pre-pandemic levels. They will eliminate Bill 124 and increase wages for healthcare workers. They also will begin hiring 30,000 additional nurses and speed the recognition of international nursing credentials. They also propose to hire 300+ doctors and 100+ specialists to work in Northern Ontario. They will increase access to midwifery services.
They also commit to increasing funding for hospital in order to expand services.
They offer a number of proposals to make healthcare more equitable and accessible for those facing racial and gender discrimination.
The NDP have announced a plan to make all long-term care public and not-for-profit as well as expanding home care services so people can age at home more easily. They will also provide financial support to people caring for their own family members.
On mental health, the NDP proposes to:
- To cover more mental health services under OHIP
- Gradually ramp up to 1.15 Billion in additional mental health funding per year
The NDP propose to fund this investment, through reduced costs in other social services, “including social services, emergency services and justice.”
Throughout the pandemic the NDP have called for 10 permanent paid sick days and 14 days during health crises like the COVID-19 pandemic.
As of April 29th, only the Greens and the NDP have released their full platforms, so it will be important to look out for future announcements. However, some clear differences have emerged between the PCs and the other three parties. The Greens, the Liberals and the NDP have all called for 10 or more paid sick days and the repeal of Bill 124. The Greens and the NDP have also released detailed proposals for expanding mental health services.
If you would like to see an increase in paid sick days for all workers, the repeal of Bill 124 and the phase-out of for-profit Long-Term Care homes, you should vote for whichever party has the best chance of beating the Conservative candidate in your riding.