Friday, February 03, 2006

Knee, hip plan a step forward for health care

VICTORIA - There’s much to praise in the government’s plans to reduce the wait for knee and hip surgery.
The problem has been terrible. Every time I write about the issue, I hear from people with stories of suffering, economic hardship and physical deterioration as they wait for surgery that keeps getting pushed farther and farther away.
Now the government has announced a plan that should make a significant long-term difference.
And at the same time it offers a model that can be used to deal with other, similar problems.
The plan has five elements.
At the centre is a new Centre for Surgical Innovation at UBC, with two operating rooms dedicated to knee and hip work. The centre will be able to do about 1,600 operations a year. That alone should take care of the wait problem for the next few years.
The problem, on one level, is simple. Wait lists grow because the government won’t pay for treatment for people who need it. The health care system has received enough funding to allow about 7,000 knee and hip procedures a year. About 7,300 people require the operation each year, so wait times grow. The extra capacity at the new centre should reverse the trend.
That’s not the only advantage. The new centre is a kind of ‘Hips and Knees R Us.’ That’s all the centre will do, so it will become very good at prepping people, operating on them and sending them on their way with a good rehab plan. As it learns better ways of sticking in a new hip and helping people recover, it will pass them on to hospitals around the province.
It makes imminent sense. Mr. Muffler finds efficiency in doing one thing; so can hospitals.
The government has also come up with $5.5 million more for the Research Centre for Hip Health at Vancouver General Hospital, the first institute in the world that’s looking at ways of avoiding hip problems and improving outcomes.
And another $5 million will be spent to set up a proper waiting list, or ‘provincial surgical patient registry.’
It’s discouraging that only now is government starting to try get a handle on the basic task of managing the wait for treatment. Only by 2007 will patients be ranked by urgency, and given some idea of how long they can expect to wait. Only then will the health authorities have basic wait list data. It’s a confession of mismanagement, but at least the problem is being addressed.
Finally, there’s $25 million to be split among the health authorities to fund extra operations in an effort to cut into waiting lists.
Again, one could argue - I certainly would - that the province could and should have provided that funding years earlier. Fixing knees and hips, relieving peoples’ suffering, getting them back into life seem both a good investment and a moral imperative. But at least it is now happening.
The other encouraging element is the way this whole initiative was developed.
The idea of a knee and hip centre was tested at Richmond Hospital by the Vancouver Coastal Health Authority. By running two operating rooms and other measures, the pilot project was able to double the number of operations surgical teams could do in a day, from three to six. It knocked a day off the average four to five-day hospital stay, and cut waiting lists. (The UBC centre is now supposed to take those lessons across the province.)
The chance to learn from small, regional experiments - on wait times, and addictions and employment training - is too rarely seized.
It’s amazing how unmanaged our health care system really is. Despite an extraordinary number of bright people looking at the issues there is almost no useful data for making decisions and setting priorities.
The knee and hip project is a step towards smarter, better managed, more effective public health care.
Footnote: Give some credit to the departing Paul Martin for this effort. The First Ministers' agreement to address wait times in five critical areas in return for more money helped drive this initiative. B.C. does well in cardiac, cancer and cataract care, but was spurred to deal with orthopedic wait problem by agreement.

Wednesday, February 01, 2006

Ready report delay ramps up risk of fall school strike

VICTORIA - Some sort of teachers' strike this fall has just become more likely.
Sorry to be negative. But Vince Ready's inability to come up with proposals for a new bargaining structure is not good news, at least in the short term
Ready was supposed to report by Jan. 31 on a better way of bargaining teachers' contracts. But instead he told Labour Minister Mike de Jong that the problems were too serious, and he needed more time. He now has until March 31.
That creates big problems. The government used legislation to shut down talks with teachers last fall. Their contract was extended, unchanged, until June 30.
The law was supposed to head off any disruption in the schools. If teachers defied the legislation, the government expected the public would turn against them.
It was a miscalculation (one that I shared). Teachers launched an illegal strike, the public supported them and the union won a partial victory. Teachers got more money, and acknowledgment that class size and support for special needs students were legitimate bargaining points. The government had refused to negotiate those issues.
And Ready was tapped to find a better way of negotiating teachers' contracts.
But the one-year contract extension hasn't bought enough time.
Ready will likely meet the March deadline, but the parties will then need time to decide if his proposals are workable.
Meanwhile, the clock is ticking. In an effort to encourage speedy negotiations, Finance Minister Carole Taylor promised a $1-billion bonus fund for public sector groups that signed new agreements before their contracts expired March 31.
She's prepared to tap next year's budget contingency fund to offer a similar bonus for teachers - a $130-million carrot..
But it's hard to see how that money can play a useful role. Assume Ready reports March 31, and both sides take time to respond. Legislation would then likely be needed to change the bargaining structure.
That means late-April at best for a start on talks under the new model. Given the complexity of the issues, the chances for a deal by June 30 look slim.
Especially because Ready is considering big changes. His interim report didn't have much substance. He emphasized how dysfunctional the bargaining relationship has been for more than a decade, since province-wide bargaining was introduced.
And he highlighted the teachers' union proposal for a two-round bargaining process - with the right to strike available each time.
First, the union and government would negotiate the total amount available for teacher compensation, to be divided among school districts.
Then, union locals and school districts would bargain about how best to apply the money. One district might decide to hire more special needs support staff. Another might choose to pay teachers more. An isolated district might need incentives to attract teachers.
It's an interesting model. Certainly the existing bargaining structure is a failure, with the problems made worse when the Liberals outlawed negotiations on workload issues like class size.
The BCTF proposal would allow real bargaining on money, between the union and the actual decision-makers. And it would restore more local flexibility.
But it brings new problems. The union could target the weakest districts, win concessions and then demand parity. School districts and local unions lack the experience and skills to bargain effectively after a decade away from the table.
The public is unlikely to be keen on two chances for a strike in each set of talks.
And the fundamental problem remains. Teachers do not have a real right to strike. No government, left or right, will allow education to be disrupted for more than a brief period. An alternate way of resolving deadlocks - like the final offer selection proposed in the Wright report - needs to be adopted.
Realistically, that is not going to happen in the next few months.
And that means a risk of more conflict - and job action - as teachers and government bang heads in the same old way.
Footnote: The union is meeting in early March to develop its bargaining mandate, and expects talks to start soon after. The union is looking for significant wage gains, arguing teachers here have fallen behind. The government mandate suggests it expects a settlement at around 2.7 per cent a year. Add class and composition issues, and the stage i set for tough talks.

Monday, January 30, 2006

Thorpe should bail on bid to invade B.C. shoppers' privacy

VICTORIA - Rick Thorpe's bid to make Costco to hand over the shopping records of thousands of British Columbians should be dead by the end of this week.
The B.C. government has been trying to force the retail giant to hand over eight years' worth of information on British Columbians who shopped in the companies' Alberta stories - name, address, what you purchased.
The government is worried that too many people who live in communities near the B.C. border are heading into Alberta to shop so they can avoid the seven-per-cent provincial sales tax.
That costs B.C. tax revenue, perhaps $12 million a year. But the larger aim is to placate businesses on this side of the border, who complain they're losing more than $200 million in sales a year.
Thorpe's revenue ministry has been quietly pushing Costco to hand over the files for three years. The company has just made the dispute public, heading to BC Supreme Court to get an injunction blocking the government's bid.
The court ruling likely won't be necessary. Once the government's plan became public it was slammed by everyone from the Canadian Taxpayers' Federation on the right to the NDP on the left. Liberal MLA Blair Lekstrom first defended the plan, then joined the critics.
And B.C. Privacy Commissioner David Loukidelis reminded Thorpe that provincial law requires a privacy impact assessment before government launches such surveillance programs. That hasn't been done.
Thorpe initially defended the plan. But he received a report from the deputy minister of labour on the issues last week, and was to announce a decision on the plan by Friday. Expect him to back off.
The Costco gambit fails on a number of levels.
Governments have powers it can use to go after people suspected of illegally avoiding tax.
But this is a huge, intrusive fishing expedition. The data being demanded is enormous. It forces Costco into a major effort, and more importantly to violate the trust of its customers. People gave their names and addresses to Costco for its use, not to share with government.
And British Columbians' privacy - even people who paid all appropriate taxes - would be violated. The government would get a list of what they bought, and when, going back almost a decade.
The problem is real enough, especially for businesses in border towns. The chance to save $200 in provincial sales tax on a big-screen TV makes the drive to Alberta worthwhile. That's bad news for the local electronics store. (British Columbians are supposed to fill out a form and pay the sales tax voluntarily when they return home.)
But the solution is arbitrary - no other stores have been targeted - and an unwarranted attack on personal privacy.
The border communities have proposed an alternate solution. They want a special lower sales tax for border communities, reducing the benefits of cross-border shopping.
The government - after waffling for a year - rightly rejected the proposal, saying the plan would just shift the problem. If border towns had a discount sales tax rate, soon businesses in communities just a little further into B.C. would be complaining that they were losing sales.
There are bold options. The government could reverse its 25-per-cent personal income tax cut, which would bring in about $1.8 billion a year. It could then cut the sales tax to four per cent for all British Columbians, returning the same amount of money. The implications, for tax fairness and business competitiveness, would require a lot of study.
But don't expect any such major changes. The cross-border shopping problem just isn't that high a priority.
Expect more studies, as that's always a safe bet for a government in a tight spot. The province could also usefully fund local campaigns aimed at reminding people of the consequences for the local economy of shopping in Alberta.
But don't expect Thorpe to push on with the ill-conceived attack on the privacy rights of thousands of British Columbians.
Footnote: The Liberals' own past anti-tax rhetoric is part of the problem. In opposition Gordon Campbell suggested taxes steal money from peoples' pockets, and Geoff Plant likened taxes to extortion and said people were driven to evasion by excessive taxation. Not exactly the way to encourage people to obey the tax laws.