A year ago, British Columbians were promised that their health care system would be protected by a new Liberal government led by Gordon Campbell. Today, many are feeling betrayed as politicians chop, dice and slice that same system in a bid to make it financially sustainable.
Health care consumes 40% of a BC budget that is already forecast to produce a $4.4-billion deficit for the 2002/03 fiscal year. The economy is beset with problems and, in a blow to its collective ego, BC was recently declared a “have-not” province by Ottawa.
When Campbell became premier in the spring of 2001, he promised to maintain spending — essentially to freeze budgets — in 2 priority areas: health care and education. But it's tough to freeze health care expenditures, which were already increasing by leaps and bounds as Campbell made his pledge. In the past year, annual health care spending has risen by 10%, to $10.2 billion.
Now the government wants to maintain spending at that level until at least 2005, which means there will be no additional cash to deal with population growth and inflation, or to cover the cost of wage increases. The last issue is particularly contentious in British Columbia, where negotiations with health care workers were getting under way just as Campbell's Liberals took office.
Unfortunately for Campbell, his province is in a geographic pickle when it comes to paying these workers — it's adjacent to wealthy Alberta, which is attracting nurses and doctors by offering higher salaries.
He must also deal with some of the most determined labour unions in the country. Thus, nurses received a significant raise last fall — it cost the province $300 million — that put them in the same wage ballpark as their Alberta counterparts, but they were still dissatisfied and had to be legislated back to work.
Then came the battle with the province's 7800 physicians. The previous government set up arbitration processes to settle monetary disputes with doctors, but that panel reported after the government was defeated and the raises recommended went far beyond what Campbell says he can afford.
The government agreed to increases totalling $392 million but will not fully honour the arbitration award, leaving MDs feeling hostile. Doctors are also disgruntled because they now have no mechanism for settling future disputes.
Of course, someone has to pay for the pay increases, so Health Minister Colin Hansen announced that provincial sales and cigarette taxes would increase. He linked the need for the tax hikes directly to the doctors' pay hikes, and that put them in an even nastier mood.
So, how does the government intend to freeze health spending for 3 years?
In April, it announced a tough overhaul of health care delivery: thousands of jobs will be cut, 3 hospitals will close, some emergency departments will be eliminated or staffed only by a nurse during certain hours, acute care beds will be closed and administration will be pared down significantly (see accompanying article, page 1582).
The proposal generating the most controversy involves the elimination of some 3000 “extended care” beds. The government wants more seniors to live in the community, and has promised to expand home care to make this possible. However, governments have failed to deliver on this promise for so long it means little to most BC seniors and their families.
Some BC residents are genuinely frightened by the massive changes being ordered. A year after their election, the Campbellites are gaining a reputation as heartless penny-pinchers, and as a government keen to kowtow to the business community but uninterested in maintaining social programs for ordinary folk and the poor.
Hansen makes no apologies. He says the health care system “is still locked in the mindset of the last century” and it must change, even if the outcome is care that “may not look exactly like the health care we are all accustomed to.”
Campbell's government, like Ralph Klein's Conservatives on the other side of the Rockies, is not waiting for the federal Romanow commission to report before it overhauls BC's health care system.
And this is bad news for Ottawa, because it leaves the Romanow exercise looking increasingly like an expensive waste of time. — Barbara Yaffe, Vancouver (Yaffe is a political columnist at the Vancouver Sun.)
Figure. Solidarity forever! Photo by: Canapress