Friday, October 06, 2006

Health 'conversation' too good to miss

VICTORIA - You can come up with a long list of reasons to shun Premier Gordon Campbell’s “conversation” on health care.
Maybe you’re irked at a $5-million budget for lightweight ads, wishing that money had gone to fix your knee.
And maybe you’re put off by the premier’s bogus claim that they within the next 10 years health care costs will somehow suddenly become this all-consuming monster. The facts contradict the spin. Health care costs represented about one-third of government revenue in 1985, and 1995, and 2005. Cost pressures are a concern, but there’s no crisis.
But the wise move is to leap into the debate and sign up for the chance to be one of the 100 citizens chosen for each of 16 regional forums.
For starters, give Campbell credit. He handed the question of electoral reform over to a random assembly of citizens even though it was not in his political interests. When their STV proposal was narrowly defeated in a referendum, despite majority support, Campbell decided on a second vote.
No Canadian politician has ever showed so much confidence in the good judgment of average citizens.
The health-care conversation owes a lot to the citizens’ assembly on electoral reform. There are opportunities to participate through web forums but the main element, so far, looks to be the regional forums on care.
The expectation is that a lot of people will want to talk about the future of heath care, knowing their deliberations might matter. So if 2,000 people apply to take part in one of the forums, a random draw will be used to select the 100 participants.
You can have a lot of confidence in the wisdom of 100 citizens, if they are genuinely representative. The group would then include some hard-nosed numbers types, a doctor and nurse or two, patients and people on waiting lists, perhaps an engineer and a therapist, strident lefties and archconservatives. You would have a vast amount of life experience, a broad range of skills and perspectives, With time and competent facilitation you can expect some very useful ideas.
But it only works if everybody is represented at the table. If unions or politicos of whatever stripe or any other interest group dominates the process, the results will be inevitably be second-rate. Too much experience and wisdom will be missing.
You can fix that problem by going to and signing up.
In the meantime, there are a lot of issues to consider and research to be done to help make for an intelligent debate.
It’s disappointing that the government’s ads promoting the health-care conversation have so been short on useful content. The PR flyer mailed to every household could easily have included some useful background material on budgets and wait lists and an explanation of the Canada Health Act and a directory of web sites. Instead it was devoid of useful content.
But there’s time for a full debate and a lot of exchanges of facts and ideas before things really get going.
For instance, what do we mean when we talk about controlling health-care spending? Some people seem to think allowing patients to pay for private care reduces health-care costs, when in fact it drives up total health spending significantly. The way the bills are paid changes, shifting from taxes to direct payments. But the money going out the door for health increases.
And what sort of changes are we prepared to make? About 25 per cent of health spending goes towards people in the last 12 months of their lives. In B.C. about $2.8 billion will be spent on 28,000 people who will die within 12 months, or $100,000 each. The average expense for the rest of us will be $2,100. Is that money well-spent, or are we committing large amounts for little benefit. (And perhaps prolonged suffering.)
These are big questions. You should take the chance to help answer them.
Footnote: This is the first time patients or consumers get a real voice in the health-care debate. Doctors, unions, business groups, big pharmaceutical companies, they all have clout. And politicians don’t really speak for patients, because they’re worried about cutting taxes and other pressures as well as health care. Finally, we get a real voice. The first regional forums are planned for Burnaby, Campbell River, Castlegar, Chilliwack, Cranbrook, Fort St. John, Kamloops, Kelowna, Nanaimo, North Vancouver, Prince George, Richmond, Smithers, Surrey, Vancouver and Victoria.

Tuesday, October 03, 2006

Not a housing strategy, but a small step

It's a fine idea to bring in a rent-subsidy program for about 15,000 poor families in B.C., but it doesn't qualify as the cornerstone of a housing policy.
Forest Minister Rich Coleman, who is also responsible for housing, unveiled what he called a housing strategy this week.
The general direction seemed fine, but there wasn't a lot of meat - or in this case money - on the bones of the plan, dubbed Housing Matters BC.
The most significant news was the $40-million available in rent subsidies for up to 15,000 of the province's poorest families.
People with children who are trying to live on less than $20,000 a year can apply for the subsidy. If they're successful, they will get a cheque every month to help them pay the rent.
That's obviously needed help. There is a 15,000-family waiting list for affordable housing in the province. In the meantime, families are struggling desperately to pay the rent and put food on the table, clothes on their kids and hope in their lives.
But the program is only a small start. The subsidy will be based mainly on the family's income and and number of children. Across most of the province, a family of four getting by on $18,000 a year would get a rent subsidy of $76.50 a month.
Coleman said the theory is that the program will help families keep their housing costs to 30 per cent of their income, a widely used benchmark for acceptable levels.
There's a catch. The government assumes that a family of four anywhere outside Greater Vancouver should be able to find housing for $705 a month. (Vancouver residents are allowed rents of up to $875 and a correspondingly higher subsidy.)
But in many communities acceptable rental accommodation for a family in that price range has become hard to find.
Coleman observed, rightly, that without the subsidies families are suffering and children's futures are at risk. Soaring rents have left families with so little money that children are malnourished and their education suffers, he said.
Which makes it both inexplicable and outrageous that the subsidy program is closed to people on welfare. The same family of four on welfare is allowed a maximum of $590 a month for housing. Anything more has to come from their already inadequate support. The notion that those children's suffering is less significant or that they are less worthy of help is appalling.
The subsidy program signalled a big shift from past policies. The government had focused on building - either directly or in partnership with non-profits - affordable housing units to increase the supply.
Coleman, a former developer, isn't keen on that approach. It takes too long to get affordable housing built, especially given NIMBYism and municipal zoning problems, and costs too much. More people can be helped more quickly with subsidies.
Which is partly true. The problems come when rental housing simply isn't available,a reality in many communities as developers choose condo projects over rental units.
The announcement included other measures - modest amounts of new money for shelters and seniors' housing and a small outreach program to support the homeless.
The theory behind all this makes sense. There is no one magic solution to homelessness and housing affordability. Subsidies will help some families. Government-supported housing is also needed to ensure there is an adequate supply of affordable rental units. Homeless people need shelters and places to live where they get the support needed to keep them from sliding back to the streets.
All the elements have to be in place. Outreach programs fail when there is no housing available for people ready to get off the streets.
The housing crisis in B.C., is real, and not just for the homeless or the extremely poor. More than 60,000 families are spending more than half their income on rent.
The government took a very small step toward dealing with a very large problem.
Footnote: There is more to come. Coleman wants tax breaks for developers willing to build rental units and municipal policies that don't slow development and push up costs. He's also keen on seeing existing affordable housing projects cash in on the value of their land holdings and use the proceeds to construct higher density projects.