Opinion

The Truth about BC Health Spending, Made Easy

It's static and under control. So why do so many, like The Globe's Jeffrey Simpson, spout the opposite?

By Will McMartin, 7 Jun 2010, TheTyee.ca

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Is it possible to explain B.C.'s health-care spending in a way that any one -- even, say, a political columnist in distant Ontario -- would understand?

Let's try to do so with a simple allegory.

A father sits at the dinner table with his family. He looks around the table with pride at his wife, teenage son and teenage daughter. He loves his family, but there is this one nagging thought...

Until recently, the evening repast had five participants. But a few weeks ago the eldest daughter left to attend university in another city. Rather than five people seated at the dinner table, there now are just four.

The meal starts to get underway when the father suddenly puts down his knife and fork, and exclaims: "Stop! We're all eating too much!"

His wife and progeny coolly look at him and keep eating. The daughter manages a one word reply between bites: "Explain."

"Well," says the father, "when there were five of us, each of us ate one-fifth of the total. But now, with just four, our individual consumption has soared to one-fourth, or one-quarter, apiece."

He continued, excitedly: "We've gone from each of us eating 20 per cent of the total food budget, to each consuming 25 per cent. This clearly is an unsustainable increase. We must be eating too much!"

Okay, the above scenario is farfetched and silly. But it also is the argument made by those -- such as B.C. Liberal politicians, certain members of the legislative press gallery and a prominent eastern journalist -- who argue that B.C.'s health-care spending is out of control.

Most Tyee readers -- sensible folk, that is -- would calculate that the family's food consumption, based on four people rather than five, probably has declined in total. Fewer people consuming less food at a lower total cost.

That there has been a percentage increase in one individual's consumption is an irrelevant consideration in comparison to that of the total meal size; that is, everybody's consumption, combined, and the total cost.

Debt, pass the potatoes to Transportation

Let us try the family dinner table again, but with a slight variation: the names of the family members correspond to those of provincial-government expenditures.

The father's name is Finance, and his wife is Social Services. Their eldest daughter (who actually hasn't gone to university, but is attending a nearby college and wants to become a mechanic) is called Interest on the Debt and their son is Transportation. The youngest daughter is Health.

Finance is convinced that all five family members are eating too much and ought to go on a diet. (In fact, he needs to cut the food budget because he wants to divert a sizeable part of the family income to an uncle, called Business. But that's a different story.)

After much discussion, he convinces Social Services, Interest on the Debt and Transportation to join him in reducing their caloric intake by one-quarter apiece. So, where each used to eat 20 per cent of the total dinner -- one-fifth for each of five people -- they now consume just 15 per cent per person.

Health, however, has refused Finance's entreaties -- she's playing girls' rugby at school and wants to keep her weight up (and, besides, she's a teenager and pretty much refuses to do anything her parents ask her to do) -- and continues to eat her typical, average dinner: no more, and no less.

This angers Finance. According to his calculations, the four family members who have cut back their consumption now eat just 60 per cent of the total dinner (four people multiplied by 15 per cent each), whereas previously it was 80 per cent (four times 20 per cent).

But Health, who used to consume 20 per cent -- one-fifth -- of the total (the same as her parents and siblings), now, because of their dieting, has seen her portion of the family meal climb to 40 per cent.

Health, of course, hasn't changed her dietary consumption at all; she's consuming no more, and no less, of the evening dinner than before. Yet, as the others' share of the meal decreased, Health's portion of the meal doubled.

It's simple. Because Finance, Social Services, Interest on the Debt and Transportation are consuming less, Health's consumption -- which is unchanged -- appears to have skyrocketed out of control, when really it hasn't changed at all.

Cutting indiscriminately

What does any of this have to do with B.C. politics and government spending on Health?

Well, consider that way back in 2002, Gordon Campbell's BC Liberals found themselves facing a gargantuan deficit. (Something to do with massive tax cuts, perhaps?) In response (or, perhaps it was their plan all along), the Campbell Liberals decided to cut government spending in all departments -- save Health and Education.

Here is what the Campbell government said in its Throne Speech on Feb. 12, 2002: "Over the next three years all ministries, not including Health and Education, will experience an average reduction of 25 per cent in their budgets."

And, this is what Gary Collins, then-finance minister, said one week later in his 2002/03 budget speech: "Total spending in ministries, except for health and education, is being reduced by an average of 25 per cent. That's a total of $1.9 billion over three years."

In other words, Health and Education were allowed to keep on consuming -- tax dollars, in this case -- at a similar rate as previously, but all other departments were to see their eating trimmed by one-quarter.

Golly, do you think that the portion of the budget allocated to Health and Education might have increased as a result of that policy decision? Of course you do. If you've got as far as Grade 10 in math and don't work in the news media, that is.

As a consequence of the Campbell Liberals' deliberate decision to cut or freeze spending in all government departments save Health and Education, the portion of the budget allocated to those two specific areas increased as a percentage of the total!

Moreover, the Campbell Liberals have continued since 2002 to dampen spending in all areas of government, including Health and Education. As the chart at the top of this column illustrates, the proportion of B.C.'s annual gross domestic product (GDP) allocated to the provincial government's Consolidated Revenue Fund (CRF), actually has been in free-fall for the past two decades.

In 1991/92, CRF spending peaked at 20.9 per cent of GDP, and in 2001/02 (when Gordon Campbell and the BC Liberals were elected to government) CRF expenditures were down to 18.3 per cent.

In 2008/09, the comparable figure was a mere 15.7 per cent. (See Table A3.6 on p. 107 here.) Over the last two decades, in other words, Victoria's spending as a proportion of the provincial economy has fallen by about one quarter.

Rising inflation, more people

The issue of Health's proportion of provincial expenditures is somewhat complicated by a pair of factors: inflation and population growth.

From 2002 to 2008, for example, the B.C. Consumer Price Index rose by an annual average of about two per cent. That is, with B.C.'s base CPI calculated at 100 for 2002, it was at 112.3 by 2008. (See p. 11, here.)

Also consider that in 2001, when Gordon Campbell became premier, British Columbia's population was 4,076,264. Last year, according to BC Stats, it was 4,455,207. That's an increase of nearly 379,000 -- or 9.3 per cent.

Is it surprising that government expenditures also have grown over time? So, where CRF spending was $22.4 billion in 2001/02 (the year before the BC Liberals won power), this year's budget saw CRF outlays hit $33.8 billion.

But, again, as a proportion of the provincial economy, CRF spending actually has declined over that same time period.

Health expenditures, too, have increased in concert with inflation and population growth. In 2001/02, Health outlays from the consolidated revenue fund totaled $9.7 billion; in the latest budget, the comparable number is about $14.8 billion.

As a proportion of GDP, however, they're virtually static.

Back to the table, everyone

Let’s look briefly at the table above, which shows provincial-government expenditures (CRF) as a proportion of B.C.'s GDP over the last quarter-century. (The data are from Table A3.5 on p. 106 here.)

The top line represents CRF expenditures. As mentioned earlier, they've been falling for the better part of the last two decades. (In fact, Victoria's spending as a proportion of the provincial economy today is almost as low as it was when W.A.C. Bennett left office in 1972.)

The second or middle line is Health spending from the CRF. It is amazing -- even more so given the near-hysterical proclamations by B.C. Liberal politicians and various members of the news media -- how static it has been over the last quarter-century.

In 2001/02, when Gordon Campbell became premier in 2001/02, Health outlays were 7.3 per cent of GDP. They had fallen by 2006/07 to just 6.7 per cent -- even as the Campbell government vowed to protect Health -- and in 2008/09 were recorded at an even 7.0 per cent of GDP.

The third line combines three areas of spending from the CRF: Social Services, Transportation and Interest on the province's debt.

In 1984/85, when Bill Bennett's Social Credit party was in government, Social Services expenditures totaled 2.5 per cent of GDP, Transportation also was 2.5 per cent, and Interest, 0.9 per cent.

Combined, these outlays represented 5.9 per cent of GDP. Interestingly, that is exactly the proportion of GDP that Health spending represented that same year. Indeed, the chart above shows that Health outlays in 1984/85 were identical to the combined expenditures on Social Sevices, Transportation and Interest.

All in relation to GDP

But look at what has happened over the last quarter-century. While Health has shown little change as a proportion of GDP -- the lowest level was 5.7 per cent in 1988/89, and the highest 7.4 per cent in 2002/03 -- the other three areas of government spending have fallen dramatically.

Social Services outlays were 2.5 per cent in both 1984/85 and 2001/02. Under the BC Liberals, however, Social Services expenditures dropped to just 1.6 per cent of GDP in 2008/09.

The provincial government, of course, does not directly control the interest rate that it pays on its debt. But governments around the world have benefited over the last three decades from declining low interest rates -- see here for a look at the yield on U.S. treasuries -- and the B.C. government is no different.

In 1984/85, CRF spending on the provincial debt represented 0.9 per cent of GDP. It peaked in the mid-1990s at 1.6 per cent, but by 2008/09 was down to 0.6 per cent.

Combined, these three areas of expenditure have fallen from 5.9 per cent of GDP a quarter-century ago, to an even 5.0 per cent when Gordon Campbell and the BC Liberals won election to government in 2001/02. Since then, they've collapsed even further to just 2.6 per cent in 2008/09.

Remember, Health and these three combined areas of expenditures were an identical 5.9 per cent of GDP a quarter-century ago. Today, however, Health outlays are about two-and-a-half times as great as the other three. Is that because Health spending has exploded, or because expenditures on the other three have swooned?

The big cutback

Two points to note in the chart above. First, it is evident that the dramatic decline in outlays in Social Services, Transportation and Interest on the Debt mirrors the on-going drop in overall government expenditures.

It's simple: as Victoria has cut back its total spending (as a percentage of GDP), certain areas of expenditure, perforce, have experienced significant declines.

Second, because every other area of government spending has fallen in recent years, Health -- where spending has been virtually unchanged over the past several decades -- has increased in comparison.

Between 1984/85 and 2001/02, Health's share of CRF spending grew from 30.2 to 39.5 per cent. By 2008/09, it was up to 44.8 per cent.

Think again of our fictitious family eating dinner: all of the people seated around the table have gone on a diet, and the family's food bill has declined as a proportion of their total income. But one family member, Health, continues to consume an amount not dissimilar to that which she ate before the diet was adopted. Compared to the others her consumption has grown as a proportion of the total, when, in fact, it is virtually unchanged.

It should be obvious -- even to an eastern journalist -- that Health spending in B.C. is not out of control.

Did Jeffrey Simpson miss math class?

Okay, let's name names. Jeffrey Simpson, political columnist with Toronto's Globe and Mail newspaper, seems in recent years to have been on a personal crusade against health-care spending. That's okay, except when he manufactures a false picture of British Columbia's fiscal situation and disseminates that nonsense to the rest of Canada.

Here's what Simpson wrote three months ago, on March 13. "B.C., like other provinces, is desperately raiding every piggy bank to pour revenue into health care."

He went on to call Gordon Campbell "brave" for attempting to slash health outlays, but also admitted that "even he [Campbell] can't rein in the costs inherent in the existing system."

Simpson continued in a similar, nonsensical vein two weeks ago, on May 29. "While B.C.'s health-care budget jumps by over $2-billion over three years, what about other spending?"

He then listed other areas of government expenditure that are in decline -- because, he says, Health spending, in real terms, is rising. In Simpson's world, Health is a voracious monster that eats the budgets of every other area of government administration.

In fact, in B.C. reductions in spending on non-Health areas are the result of deliberate policy decisions made by the government in power. It wasn't Health that made Victoria cut CRF spending from 20.9 per cent of GDP to just 15.7 per cent; it was successive administrations that wanted a smaller government.

As a proportion of B.C.'s economy, health-care expenditures in the last several decades have been virtually static. Only in comparison to the falling budgets of other areas of spending do Health costs appear to be rising.

So, far from being out of control, Health in B.C. merely has refused to go on the same diet imposed on the rest of Victoria's annual outlays. It is a concept that a teenage, rugby-playing girl could understand, but one that evidently eludes an Eastern political columnist. [Tyee]

Tyee contributing editor Will McMartin is a veteran political advisor and analyst. Read his previous columns here.

31 Comments:

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  • BDD63

    1 year ago

    Thank you Mr. McMartin

    Excellent article. Too bad that you aren't the Finance Minister.

  • blackie

    1 year ago

    holy cow

    Will, are you out of your mind? To carry this ridiculous argument to its logical conclusion, you could posit that an elimination of all other government expenditures save health and education would mean that -- golly -- health and education spending have now become 100% of government expenditures.

    The point you, and everyone on the left, misses time and time again is that there is a finite pie called government revenue. Oh, I know, you all think it can be expanded exponentially with no affect on the economy -- but it can't. The reason all those other ministries are being cut is because of the rapidly escalating costs of medicare -- and the true effect of the baby boomer's impending assault on health care budgets has only just begun.

    Simpson is right on the money. Your analogy about a 5-person family's food budget at 20% per member suddenly becoming a 4-person at 25% is valid only if the budget stays the same. The health care budget isn't staying the same -- never has, and unless some radical action is taken soon, never will.

    Don't lecture people about math when your own simplistic analogy is so transparently bogus. A teen-age rugby playing girl would laugh at this ridiculous attempt to deny that health care costs are going up.

  • Loofasuitsu

    1 year ago

    "Finite" Pie

    Blackie, this so-called "finite pie" of government revenue you refer to more accurately resembles a single serve tart under the Campbell government, largely due to it's continued purposeful shrinking of available revenues (that's ill-conceived tax-cuts in case you're wondering.) No one, let alone McMartin has suggested that government revenues can expand exponentially. The point is the pie has been shrunk to a tart on purpose and the villains have been made out to be the two Ministries which did not have budget cuts when the others did. Blame has been conveniently laid at the doorstep of the very two buraucracies that Campbell has been looking for ways to privatize since he came into this job. Simpson fails to grasp this, as do you apparently, and to pretend that that is not part of the long term game plan is disingenous. Yes, health care costs are rising, as is everything - except our ability to fund the system due to government`s continued efforts to choke available revenues off. These are more properly seen as political calculations first, then financial.

  • RickW

    1 year ago

    Monsieur Blackie

    You didn't make it to grade 10, did you?

    Quote:
    Health expenditures, too, have increased in concert with inflation and population growth. In 2001/02, Health outlays from the consolidated revenue fund totaled $9.7 billion; in the latest budget, the comparable number is about $14.8 billion.
    As a proportion of GDP, however, they're virtually static.

    Figures don't lie - but liars can figure.

  • Skywalker

    1 year ago

    Way to go Will.

    Another excellent article. It amazes me how often right-wing governments manipulate a situation to justify their policy. They give resources away for peanuts and then come back to the average consumer with all kinds of fee and tax increases. Once the "finite pie" is determined by short-sighted policy then everything else is suppose to follow logically? Sure and with the media supporting this nonsense it seems to work...and many of them got past Grade 10.

  • Illahie

    1 year ago

    Good Article Will

    I think that health care projections worry the government. I believe that they are projecting that health care costs will increase by 70% in the next 5 years, as the population ages, and many working people retire, which reduces the income tax base.

    I think that the government also hates government (so why are they running the government?). They would dearly like to destroy (privatize) our health care system.

  • Amelia Bellamy-Royds

    1 year ago

    Great metaphor

    It may oversimplify, but it is important to hammer home the difference between relative and absolute budgets when the government (and others) insists on using the percentage of budget as evidence that health spending is soaring.

    However, I disagree with your choice to use spending as a percentage of GDP as a measure of "absolute" spending. Doing so implies that you think government spending in general and health spending in particular should go up when the economy is good -- and down when it is bad. Although GDP is a good rough estimate of the tax base available, there are both political and practical reasons for avoiding a analytical framework that suggests spending should always be an even percentage of the economy. Imagine the strange jump in your graph if it was extended for last year, when GDP dropped and spending increased.

    A more meaningful graph would have shown per capita spending in inflation-adjusted dollars. That would cancel out the two "complicating" factors you mention while avoiding adding the extra complication of GDP. And it would provide a more forceful argument against those like "blackie" who can only see "the rapidly escalating costs of medicare".

    Without digging up the numbers this morning, I am fairly confident that you would find that, by this measure, (inflation-adjusted per-capita) provincial health spending has increased slowly but definitely since the mid-90s era of budget slashing. Economy-wide health spending -- including private insurance and out-of-pocket spending on pharmaceuticals -- would have increased at a higher rate. The real question is whether quality of life and health outcomes have increased correspondingly. And that's a much more difficult number to put into a graph.

  • KWD

    1 year ago

    more GDP problems

    Presenting health care costs only as a proportion of GDP is misleading. While it may be true that health care costs, as a proportion of BC’s economy (GDP), are remaining static, the fact is BC’s GDP has increased substantially … approx. $158 million in 2004 to $198 million in 2008.

    So, for what it’s worth, if we believe the figures, one can only conclude that there are more dollars available for health care.

    One can speculate on the reasons for cutbacks …perhaps it's the desire to downsize government … but it’s likely not that simple.

    If we believe money represents a fiat form of energy … it takes energy to keep the wheels of society turning … then it may make more sense to measure and compare spending on social services against changes in energy costs.

    As cheap energy supplies dwindle the justification for cutbacks in social services will stray further and further into ideological fantasy and further and further from reality.

    When you consider that Canada exports 60% of the energy it produces the justification for cutbacks becomes even more confusing.

  • biscotti

    1 year ago

    Simpson, Mulroney and "Free Trade"

    Ah yes, the Jeffery Simpson who supported the Mulroney FTA with the US in 1989.

  • Glenda J Petersen

    1 year ago

    Thank you.

    Beautifully done.

  • xbie

    1 year ago

    Great Mental Fliparound

    This is an excellently formulated, provocative article. At the very least, it forces people to actually think for once about the statistical boondoggle being thrown at the public about health spending in BC.

    As near as I can tell, Blackie didn't understand the actual argument being made, and tried to compensate for this misunderstanding with ideological bluster.

    But Amelia, aren't you extrapolating too far? I didn't see anywhere where Will suggested or even implied that we should make decisions about health care spending based on whether the GDP goes up or down. And in any case, that doesn't undermine in any way the actual logic of the argument Will is focusing on, does it? Looking at per capita spending could also be useful, yes, but that doesn't prove that looking at it as a percentage of GDP is useless. And in your scenario, there would also be "complicating" factors to consider, e.g. per capita spending would have to be measured against per capita earnings and per capita gov't tax income etc.

  • Frank

    1 year ago

    Wow blackie, wow

    I think you should excuse yourself from all future discussions involving math.

  • Ron Strand

    1 year ago

    obvious

    To me the article is so obvious so the question is,why all the orchestrated panic about health care costs? Could it be there are some interests that want the panic and might benefit from it--like, duh, the promoters of private health care?

  • Name

    1 year ago

    Could you do one of these for Education?

    Great piece - the graph says it all, and was pleased to see inflation and population growth factored in and explained too.

    Now could do please do one of these for BC's Education budget too????

    The BC Liberals have just done a real hack job on the Vancouver School Board as part of their mission to convince everyone that Education spending is out of control, so that they can kill locally elected School Boards and replace them with less feisty bureaucrats who will enforce their cuts without complaining.

    Health spending has been protected by the simply fact that failing to do so means people die and that makes for nasty headlines. But it's all too easy to turn your back on children and leave students behind, as long as it doesn't kill them outright.

  • MikeS

    1 year ago

    Health spending

    Bravo, Will! Nice job on revealing the Emperor's lack of clothing. Of course the massive cuts to other public services are going to make it look like our health care costs are rising, if all one looks at is raw percentages. It's all just Lieberal smoke and mirrors in the cause of trashing, then corporatising (the real term for the phony "privatising") our medicare system.
    The ignoring of the facts you eloquently spell out by our so-called media is almost as criminal as the game plan of the corporatisers, themselves. Any fool can see through the simplistic games being played by these neo-cons (con artists?), so why do our media types fail to do so? Lack of education as you ask? No, lack or morals and principles - they have all sold out to Uncle Business. 21st Century journalism = corporate propaganda, no more, no less.
    Keep up the good work - it's nuce to see the truth for a change.

  • morechatter

    1 year ago

    Why Not?

    Whats stopping the Liberals under Campbell's rule from doing what ever the premier wishes? The criminal justice system, the law, the watchdogs,the media, the NDP, the taxpayer as clearly Campbell has an agenda of his own and the people of this fine province are not part of the agenda in the new era under the Liberals nor does he care about the systems in place. Thanks to Campbell's Liberals British Columbians are going to find themselves going through Stagflation.
    And its not about downsizing Government not in the least its just about downsizing taxpayers money that ends up in the pockets of taxpayers because if it isn't where is all the money?

  • myworld2

    1 year ago

    Increasing cost

    I've always heard that health spending is fairly constant in relation to GDP, mostly from my NDP friends, but the mainstream media never challenges Lib assertions. The media has let us down many times over in that regard.
    I guess that if health care is deteriorating then we are paying about the same for less. Thus, good quality healthcare might cost quite a bit more than we are accustomed to. I have no problem with paying more. I don't understand how people can be opposed to healthcare. There are complexities and dilemnas and a need for efficiency etc, but who is it that does not want healthcare services when they become ill or injured?
    I am also bewildered when people seem to resent their neighbours earning a decent salary, as in 'big union' employees of the healthcare system, and how people fail to realize that the public service is a contributor to our economy. Healthcare dollars are going into the pockets of our community members.
    The economy is the by-product of human activity, not a system that human activity has to fit in to. Perhaps Liberals think that we have a surplus of humans in our system.

  • RickW

    1 year ago

    KWD

    Quote:
    One can speculate on the reasons for cutbacks …perhaps it's the desire to downsize government … but it’s likely not that simple

    "Total spending in ministries, except for health and education, is being reduced by an average of 25 per cent....." I think it actually IS 'that simple'. The Libs, by this statement, are demonstrating their fiscal responsibility to the voters by cutting back. At the same time, by NOT cutting health and education, they demonstrated a responsibility to the voters to provide the basic necessities of modern living. At least, that's how they promoted this policy.

    In reality, as the article demonstrates, the Libs have deliberately created a set of figures that can be manipulated (as was done by a 'prominent eastern journalist') to show that healthcare and educuation costs are escalating in double digit increases. IMHO, this was the REAL reason for the Libs budget - setting the stage for massive reductions in health and ed, and setting the stage for privatization.

    Figures don't lie - but Liars can figure. And the Libs are good at figuring.

  • KWD

    1 year ago

    RickW

    I hope you're right. That would mean that a change of government would solve all our health care problems.

    Somehow I doubt it.

  • RickW

    1 year ago

    Our Health Care Problems Stem From More Than Just Cash......

    But removing the (implied) threat of privatization would go a long ways toward improving morale.

    De-politicizing healthcare and education might be one tact. That would mean two things: a] creating an arm's length administration, and b] de-unionization.

  • cloak

    1 year ago

    A Good Change of Focus leading to another

    The article does a good job of changing the way that health costs should be measured from the portion of expenditures to the portion of the provincial GDP. This a valuable insight.

    However, there should be some acknowledgement that the GDP is not fixed and there is some role for the government to sustain the GDP. This may be by taxing more or less and spending and incentivising in different ways.

    So the insight of the article moves the debate to the bigger question of how can the provincial GDP be maintained in proportion to the demands of the growing and aging population so that government spending, including health spending, can be fairly provided. No political party or ideology is always right or wrong about this. There is a tough balance that has to be achieved.

  • KWD

    1 year ago

    getting beyond budget manipulation

    It’s not surprising that the Liberal goal is to shift more and more health care to the private sector. Private health care has become ubiquitous; it’s a capitalist parasite. And it’s not unique to BC’s Liberals.

    But there’s a reason why these private sector parasites are infecting the body of social services. I suspect it has much to do with the fact the financial health of the working poor and what’s left of the middle class … which requires a steady diet of cheap energy in order to keep it’s resistance level in fighting form … has become more and more compromised.

    There’s an inverse relationship between the provisioning of social services and energy costs. As the energy return on energy invested decreases, the cost of social services increases.

    Canada is awash in energy but thanks to NAFTA we can’t make it work to reduce per capita costs of social service provisioning. We are forced to energize the life support systems of the U$.

  • zalm

    1 year ago

    Mo' money?

    In contrast to the majority of you, I think Amelia is on the right track. I appreciate Will's analogy as far as it goes, but it ultimately fails, as all do, to explain all aspects of the problem.

    I note the brains trust that advised the Preem even thought along similar lines a few years ago when they evaluated health care at http://tinyurl.com/2dneocc . Some of the calculations Amelia suggested are right there.

    When Gordo says he's increased health spending 3% in each of the last few years, I tend to believe him. I'm not seeing the carnage in my workplaces that I saw in his early days when he hadn't a clue how to run a popsicle stand, never mind a province with a bunch of huge ministries that he had no idea how they worked or what value they added to the economy.

    We've paid a huge cost for a mighty expensive education for our Preem....

    But just so you'all know, health care is hostage to a lot of special interests:
    - some business wants to cut it to promote pivatization or profit-making activities
    - some business (particularly small business) wants to retain it as a lower cost (read business subsidy) to their workers, not to mention the owners themselves.
    - some big health institutions have taken on a self-replicating life of their own and think they know better than anybody else where scarce dollars need to be allocated, such as VGH, Children's, and CCA
    - research has been bound up in healthcare to the detriment of healthcare due to its excessive complexity, short-term funding, and overly-ambitious (but sexy) goals. In some places, I now see research slowly being restrained.
    - "new condo" syndrome has affected the ministry and the government as well as various boards, all of them thinking now that no proper health care can be done in a building less than 5 years old, with twice the space that they used to have, not to mention fancy millwork and cool chairs. Mostly ignored is Pareto's rule, which could achieve our current objectives for 80% of our health care needs with fewer resources than are spoken for each year.
    - some labour still thinks there's a class war in place. There hasn't been since 2006, and some places have been actively working on bringing front-line workers into decision-making since at least 1991.
    - some media make a bunch of money selling the line that "the problem is simple and so is the solution". I appreciate the Tyee is trying to address the issue from a balanced viewpoint, but after more than 20 years in the system, I'm aware that it's a lot more complicated than even I can get a proper handle on. I'm not sure how some of our columnists, who are nothing more than Australopithecines without the wits or legs to escape a sabre-toothed tiger, can provide so much insight with less.

  • RickW

    1 year ago

    zalm

    Quote:
    Australopithecines without the wits or legs to escape a sabre-toothed tiger, can provide so much insight with less

    You have just 'spained capitalism in one simple sentence. The complexities of life and economy are too much for simple minds. So they throw up their hands and say, "Let the market take care of it!" - even while they are raiding the treasury.

    "When plunder becomes a way of life for a group of men living together in society, they create for themselves, in the course of time, a legal system that authorizes it and a moral code that glorifies it." Frederic Bastiat (1801-1850), French economist

  • Camero409

    1 year ago

    Optics

    It's all about perception. This government made BC Rail look like a money drain and they are doing the same to the health care system. If they make it look bad enough and with enough media bombardment supporting the perception (Thanks to people like Jeffrey Simpson, blackie et el), they will at some point disassemble the system. It's all about make it fail to justify the end. In other words, give it to their political supporters, who by the way, aren't unions.

  • KWD

    1 year ago

    another Bastiat beauty

    Violence and mayhem is the result of what happens when, as Frederic Bastiat claims, the “plundered “classes seek … by revolutionary means rather than bringing legal plunder to an end … to get their share of the wealth.

    “Woe to the nations in which the masses are dominated by [thoughts of revolution; fight not flight] when they, in their turn, seize the power to make the law!”

  • G West

    1 year ago

    @zalm...lots 'mo money.

    I'd be interested in hearing more from you about the reasons costs are increasing and results seem to be, as it were, declining.

    I'd suggest it has a fair bit to do with the fascination, in some circles, with building new plant to consolidate services and reduce the 'community' nature of what real and effective acute care health services are all about.

    There's an enormous new monument to 'efficient' health care services delivery nearing completion here in Victoria...many many new rooms and ultra modern facilities. At the current stage of construction they're burning around one million dollars a day on the expansion of the Jubilee Hospital...but when they're done, as I understand it, they still won't have a maternity ward in the place for locals to use.

    Some community resource! I think the trend to mega facilities and specialization (with a few notable exceptions) is a big factor in pushing costs up and satisfaction down.

    This is especially true in family medicine and addressing the health needs of seniors.

    Be interested to hear your take on it.

  • dorothy

    1 year ago

    Right in front of our horrified eyes...

    "This government made BC Rail look like a money drain and they are doing the same to the health care system."

    Yes, they are, and those who work inside the system have absolutely no problem seeing how they do it. An endless, tireless, overwhelming deluge of revamping, reconfiguring, reshaping, reorganizing. New office spaces with new walls in new places. New signs. New or old people in new positions. New evangelia: LEAN. No, Rapid Improvement. Maybe just improvement Patient centered. Unit centered. Team-building. New vocabulary. New old ideas. New 'approaches'. New 'programs'. New, new, new. I cannot begin to imagine what it all costs. It adds zero value to patient care. It is still the same old tired soldiers faced with the same old issues out there on the factory floor, trying to hold it together.

    The new stuff is dictated by the government and its minions. The work is done by real people. Nothing new in that. Miracle weekend. Where are the miracles? On the side panels of the dreidel, you dolt! There and nowhere else...

    Cut the proverbial. Apply Cuban standards. Off with the fat and the new carpets! Health care is alive and well, under the blubber. No credit to the bean-counters. Those holding the hands and bringing and removing, serving and fixing and healing and PAYING ATTENTION have no problem knowing how to do their job! Market that.

  • Zetto

    1 year ago

    BC's GDP

    Correction to comment by KDF - B.C.'s GDP was $148 billion, not million, in 2008. see: http://www.bcstats.gov.bc.ca/data/bus_stat/bcea/bcea_faq.asp#Q2

  • KWD

    1 year ago

    Zetto

    I assume KDF is actually KWD, but even if not thank you for the correction.

    Yes, the chart I retrieved the info from shows the dollars in millions ... which would make it $158 billion and $198 billion

    http://www40.statcan.gc.ca/l01/cst01/econ15-eng.htm

  • tricia58

    1 year ago

    Thank you

    You explain so well what for years I have been trying to explain to others.

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