Wednesday, September 03, 2003

Learning from the fires: what happens next
By Paul Willcocks
VICTORIA - A friend called from Kelowna, 12 hours before the fires swept through more than 200 homes. He is middle-aged, calm; his home was in no danger.
But the awe and fear in his voice came through the phone line. The sight of the flames against the night sky had shaken him.
As I write this the fires have eased, at least briefly. It's time to begin considering what comes next.
There's been an obvious financial impact on the government, and the people of the province.
Firefighting costs will top $200 million this week, and have been climbing at up to $7 million per day. On top of those costs, emergency aid has cost about $30 million so far, and is running about $1 million a day.
The government had budgeted $55 million for firefighting this year, so Finance Minister Gary Collins has an obvious problem.
He says the province still has the flexibility to deal with the overruns. There's a $170-million contingency fund, intended to cover all the unexpected spending by ministries. Collins has also set aside a $500-million 'forecast allowance,' a super cushion to let the government come in on budget even if things go wrong.
But the contingency fund, for all ministries for an entire year, is gone before the fiscal year is half over. And a big bite will be taken out of the forecast allowance.
The budget calls for a $2.3-billion deficit this year. Given Collins' conservatism, most observers would have expected the target to be beaten by more than $500 million. That looks much less likely.
The other question is how badly the fires will hurt the economy. Some 3,000 forest workers are off the job already, barred from tinder dry woods. Sawmills are running out of logs, and unless the situation improves the job losses could mount with each week. (The fear of lost production has pushed up prices, so mills in other areas should be more profitable.)
Tourism is taking an immediate hit. People who planned a houseboat trip on the Shuswap are hesitating. Americans considering a trip to B.C. are staying home. That's business that won't be recaptured.
The larger question is whether there will be a lasting impact on tourists who fear that B.C. has become a less attractive destination. A special tourist marketing campaign will be needed to cope with the fallout from SARS and the fires.
So far, the focus has been on fighting the fires and helping the dispossessed. Desperate people have celebrated the efforts of firefighters and the visits by politicians.
But once the smoke has cleared, an independent inquiry is badly needed.
Fires are part of life in a forested province, where people want to live among the trees. But B.C. has been much less active in clearing fallen trees and other wood waste from forest floors than other jurisdictions. The province's auditor general warned two years ago that years of successful efforts to reduce small fires had allowed a dangerous concentration of fuel, setting the stage for much large blazes.
And he warned that B.C. was ill-prepared, offering a number of specific recommendations to avert disaster, or at least reduce its cost.
Progress on his recommendations has been slow. Even Liberal MLAs complained a year ago that too little was being done by the government. (For example, Solicitor General Rich Coleman created a provincial fire department in response to these blazes; the auditor general warned two years ago that such a change was needed.)
Along with the inquiry, there will have to be extraordinary help for the people and communities involved. The federal and provincial governments have a disaster relief formula. But finding homes for hundreds of families and helping communities cope with lost infrastructure will strain the normal programs.
Fires, even terribly damaging fires, may be part of life in B.C. But we need to be sure that we are doing everything reasonable to manage the risk. And independent inquiry will help make sure that happens.
Footnote: The first political pressure point will likely be compensation. Premier Gordon Campbell says the province will ease a policy which denies compensation to people who could have bought insurance, but expect some conflict.

Sometimes people just die and it's not a medical crisis
By Paul Willcocks
VICTORIA - It's time we thought a little harder about how significant it is that 4,000 people died in France during a heat wave, or that eight people died in a Surrey nursing home after a 'SARS-like virus' struck.
People get edgy if you suggest some deaths matter more than others.
But they do.
Take the emergence of a mysterious virus at the Kinsmen Place Lodge in Surrey. Eleven people have died since the outbreak began six weeks ago, out of about 150 people at the home. That sounds pretty serious.
But in a typical month at the lodge, four or five people die. The residents are old, and many are unwell. The number of deaths even potentially linked to the disease is smaller than it may appear.
The normal rate of five deaths a month means 60 people die at the facility in a normal year. The average lifespan for someone admitted to the lodge is thus something like 2.5 years.
And that means that the three additional deaths in recent weeks have resulted in something like 7.5 years of life lost.
That's not a measurement most of us use, although actuaries, insurance companies and public health officials are all keenly interested. But we should. A disease that claims healthy young victims robs them of decades; an infection in a nursing home that strikes the most vulnerable may simply mean death comes a few months early.
I'm not questioning the significance of the loss for the families involved.
But it's a matter of math. Car crashes among 15 to 24 year olds claimed 85 British Columbians in 2000, with an average loss of 55 years of expected life for each victim. Three extra deaths mean something like 155 years of life lost. Those deaths are more significant -- for society, the economy, family.
The equation will be much the same in France, where the government -- and families -- has been much criticized for the deaths of up to 5,000 people in the current heat wave, many of them elderly or sick.
If there has been neglect, or a failure to act, then that is shameful. If there are public health lessons to learn, we should heed them.
But we should also be open to the possibility that for many victims, already weakened, death within months was almost certain. The heat wave may have advanced the end, but not by much.
That doesn't mean, again, that we should do nothing about the illness or environmental problems that kill the old and the sick. Life has value, at 90 or at nine.
But it doesn't have equal value, especially given the limit on available resources and the apparently inexhaustible supply of new, costly treatments.
We are all going to die. By the time we are somewhere like the Surrey lodge, we are going to die fairly soon. And it's time to shed the notion that all deaths, or illnesses, call for the same response.
We aren't close to coming to that realization. A major U.S. study found that 27 per cent of health care expenditures in California and Massachusetts went towards patients in the final 12 months of their lives.
The figure for B.C. is similar, which means about $2.7 billion will be spent on 28,000 people who will die in the next year, or $100,000 each. The average expense for the rest of us will be about $2,100 each.
That's not necessarily wrong, if the spending is wise, bringing comfort to a person's final months or a real chance of success.
But the same study found one in eight patients over 85, with cancer unresponsive to chemotherapy, had received the costly and unpleasant treatment in the last three months of their lives.
To what end?
It's not our job to consign people to death once they pass a certain age.
But it is our job to make intelligent, rational decisions about how we try to deal with the real world of health challenges, whether it's in a Surrey nursing home or a Paris apartment.

Tuesday, September 02, 2003

Liberals' new care rates for seniors fair
By Paul Willcocks
VICTORIA - The Liberals' implementation might be a little harsh, but there's nothing wrong with their plan to increase the cost for seniors in residential care.
Not everyone sees it that way. Some seniors organizations have reacted angrily to fee increases that will hit more than 7,000 people in long-term care, dinging them for an average increase of $2,360 a year.
About 1,000 people at the top end of the income scale will see their costs jump by 30 per cent. The accommodation, board and care that have been costing $1,520 a month will suddenly jump to almost $2,000.
That is too big a jump, even given the five-month notice the government has provided. It would have been fairer to cap the increases at 10 per cent, and phase them in. Few of us could cope with a 30-per-cent increase in our living costs, at a time when our income is fixed. (Though fees haven't increased since 1997.)
But the basic principle behind the increase is sound, and the new rates don't seem unfair.
About 25,000 people live in government-supported residential care facilities, which provide more support than an assisted-care facility and less than a hospital. They pay a fee based on their income, and get 24-hour nursing care, room, board and recreational programs.
About three-quarters of them won't face any increase. People with gross income under $18,000 pay $825 now, and most have very little left over for any other expenses. They won't pay more until 2004, when the government plans to start levying annual hikes based on the consumer price index.
Everyone else faces increases.
Residents pay on a sliding scale. The higher your gross income, the higher your monthly bill.
For all residents, the rates represent a pretty good deal. People pay between $825 and $1,975 a month. But the government estimates the cost of providing residential care at $4,500 a month. Taxpayers - some facing their own tough times - are already subsidizing the cost. (That $4,500 cost isn't inflated. Ask any family that despaired of long waiting lists and had to go out and find a private facility for an aged relative.)
The taxpayer subsidy is money well-spent. Affordable residential care doesn't just mean a better quality of life. Helping people live with lower levels of support is far more cost-effective than the alternative, which too often ends up being much more costly acute care.
Is the government charging too much? Someone with $12,000 a year in income pays $825 a month for food, shelter and care. That's more than 80 per cent of their income, but it still leaves about $175 a month for other expenses.
At $25,000, a resident would pay $1,080 a month, about half their income, leaving about $1.000 or other monthly expenses.
And at $65,000, a resident would pay a little over one-third of his income - about $1,975 - and have $3,430 for other expenses.
It's easier to make the case that some residents should be paying more than it is to be critical of the government's direction.
Seniors' irritation is understandable. The Liberals have pushed their cost of living up sharply, reducing Pharmacare benefits and hiking MSP premiums. For those in residential carte, this is another aggressive hit, one that should have been phased in.
And the government should have announced that the $17 million from the increases would be used to used to open new residential care beds. The money is enough to cover the operating cost for about 400; the announcement would have shown that the increases aren't just a cash grab. (To be credible the announcement would have to specify places and communities, instead of offering vague platitudes.)
But those are questions of implementation.
The principle, that people who receive benefits should pay for them, at a fair price that is within their means, is reasonable. The new rates don't appear to place an excessive demand on residents. They are fair.