Health care change a needed gamble
By Paul Willcocks
VICTORIA - Give the Liberals pretty good marks for their health care changes.
It's not going to be pretty or fun, the next couple of years. The fact is, some people are probably going to die because care is 20 minutes farther away than it used to be. Some people are always going to die, even if a doctor followed each of us around every day.
But the reality is that the system can't keep rolling along in the same old way. Spending increased 6.5 per cent a year for the past five years; it already is about 40 per cent of the total provincial budget. Few of us want to see more and more of our income going to health care.
So the Liberals have frozen health care spending for the next two years, and divided the province into five regions, asking health boards to cut costs.
The regions unveiled their plans this week in a five-hour marathon press conference. It wasn't good news for many communities. The services they have come to expect will no longer be available in town. They will lose part of their economic base.
The new model relies heavily on centralization within the regions. Instead of six obstetricians in four hospitals, they will be grouped in two hospitals. Longer drives, but reduced overhead and a better chance of keeping specialists who can share on-call duties.
It also looks for significant savings from contracting out. Running a cafeteria isn't actually a necessary part of the health care business.
And it cuts back on the space available in the system, with hundreds of acute and long-term care beds being closed across the province.
The result is some 8,000 job losses across the system over the next three years.
The theories are all sound. The health region CEOs talked about how up to one in six hospital beds was being occupied by someone who didn't belong there, who needed lower cost care. Those people could move into long-term care. And up to one-third of the people in long-term care - nursing homes to you - could be in some sort of less costly, more independent assisted living.
Maybe. But most people I know are dragged, kicking and screaming, into long-term care. They might be reluctant to be moved out. And they might be justifiably concerned that the promised help would be clawed back as soon as times got tough. (That has been the pattern, after all.)
The health regions all received funding increases this year, averaging 7.4 per cent. The Island region got a larger increase, a reflection of past under-funding.
But that amount is slated to be frozen for the next two years, despite inflation, high wage settlements and population increases. The pressure on all programs will be intense.
How hungry will the health regions be for revenue? The Vancouver Coastal Region is looking to sell operations to Americans in off hours - Buy a bypass, get a free Canucks' ticket. Other regions are looking to charge for room amenities and sell the rights to be the official soft drink supplier to the hospital.
And that should be a concern. I was jarred to read a financial report on an American private hospital corporation that lauded its success at increasing revenue per patient. That measurement didn't seem to have much to do with health or efficiency.
But still, the Liberals have outlined a plan. Its basic strategic directions make sense. And by freezing funding they've forced change.
It would be helpful if they would simply admit that services will be reduced as a result of the funding freeze. The concept of more with less is beloved of managers, but in life one generally ends up doing less with less. The challenge is to be smart about what you stop doing.
British Columbians likely accept that. On with the experiment.

Paul Willcocks can be reached at willcocks@ultranet.ca



Courthouse closure battle shows Liberal weakness
By Paul Willcocks
VICTORIA - The brawl between Attorney General Geoff Plant and judges and lawyers is ultimately a sideshow, but it's one that demonstrates three of the Liberals' critical weaknesses.
Provincial court judges are mad at Plant over his plans to close 24 courthouses, and his failure to consult with them. Lawyers are angry about the same issue, and also about legal aid cuts that they say will deny many people access to justice. Lots of Liberal MLAs, facing anger back home about the courthouse closures, aren't much happier.
The tussle is an important one, even if few people are likely to pay much attention. A wrangle about the independence of the judiciary seems less important than the loss of a hospital.
But it's important to have an independent judicial system; that's one of our protections against abusive governments.
The issue here is what independent means. Chief Provincial Court Judge Carol Baird Ellan believes that independence means judges must have a significant say on whether courthouses should close. Plant believes that is a budget decision that is the responsibility of the government of the day.
Baird Ellan has a point. Surely a decision to close courthouses or make the job of judges more difficult or unpleasant could be used to interfere with the independence of the courts. It's tough to imagine that judges can really function independently if the government can choose to close courthouses without consultation.
Plant has a point too. He wants to save money, buy closing courthouses and cutting people off legal aid. He believes the voters gave the Liberals the right to make those decisions.
You get to decide who is correct.
But the whole battle highlights three serious weaknesses of this government.
First , Plant didn't consult with the judges - even in a superficial way - before he made the decision to close the court houses, although he did offer to discuss implementation after the fact.
That shows a government that thinks it has all the answers, that wisdom resides only at the centre. Shouldn't it have been seen as a possible that judges might just have some useful ideas on costs and efficiency? The move to ignore the advice of people in the system makes the government look arrogant and unreasonable. It also makes them vulnerable to big mistakes.
Second, the fact that the cuts were made without consultation indicates that they were made without a real plan. Critics have been fearful that the Liberals have set targets for spending cuts arbitrarily, without really considering the impact of the changes. The courthouse closures support that. A serious review couldn't have been done without consulting the judges.
Finally, the spat highlights the gap between the positions the Liberals took in opposition and their new stance.
The NDP tried to close fewer court houses, and Plant was critical. The chaos that would result wouldn't justify the savings, he said then.
He was an even sharper critic of the NDP's practise of siphoning money from a special tax on lawyers' services - intended to pay for legal aid - into general revenues. Now his government is increasing the tax and diverting about 10 times as much money into its coffers, while cutting more than one-third of legal aid within three years. It's a dramatic flip-flop on what was once a question of principle.
The Liberals aren't likely to retreat. Baird Ellan wrote Plant saying the judges had lost confidence in him as attorney general, but then fell silent. The Law Society of B.C. is suing over the legal aid cuts and closures, and its members will meet May 21 in an extraordinary meeting to vote on censuring Plant. Plant observes correctly that all he needs is the confidence of Premier Gordon Campbell.
But politically and practically, consultation would have been the right course, the one that created the best chance of a good public policy decision.

Paul Willcocks can be reached at willcocks@ultranet.ca