Thursday, January 11, 2007

The politics of wait times

In Toronto today Steve Harper took a baby-step towards fulfilling his infamous missing fifth priority. Appropriate it was a baby step, since he made the announcement at the Hospital for Sick Children.

The unfulfilled priority I refer to of course is this one:

…work with the provinces to establish a Patient Wait Times Guarantee

And I say infamous because, as first noted by Paul Wells, it simply seemed to disappear from Harper's list of priorities at some point without much progress having been made or acknowledgment given. Over the last few months the sense of abandonment on this priority generated a dollop of media attention, and with an election coming some time soon (I'm betting not before a by-election in Outremont though) Harper's need to nip this one in the bud grew, no doubt bringing us today's announcement:

Ottawa will invest $2.6-million to help 16 pediatric hospitals across Canada set up a data base to collect information on how long children are waiting for surgeries…The 15-month pilot project will develop the first pan-Canadian system to measure waiting times for six key surgical areas: cancer, neurology, cardiac, sight, spinal deformity and dental treatment that requires anesthesia.

The problem with Harper's campaign promise on the wait times priority was that it was one he knew he couldn't follow through on. But it was still politically attractive at the time to make it anyway. It was an election and he wanted the votes.

Take a look at the income trusts issue: again, he new economically he'd have to tackle trusts, but it was politically advantageous in the campaign to promise otherwise.

Back to the vaunted five priorities though. All the other five priorities were quick deliverables that he could easily deliver on himself, solely within the federal realm: child care, GST. Bam, done.

For wait times he needs to rely on the provinces. Health is a provincial domain. The only lever he has to get the provinces to act is money, but even if he had lots of money for it and was willing to use it as a club to beat the provinces with, the fact is fixing wait times isn't as simple as spending more money. You need to identify metrics and standards, set definitions, and get multiple cross-jurisdictions on board. It's a real logistical and management headache.

The Libs made their own wait times promise in 04 as part of Paul Martin's healthcare "fix for a generation" (we loved that double entrende out in B.C. btw, our jaws dropped in our little rural campaign office when we heard it...might have moved a few votes out in EastVan) and when he tried to follow through on it post-election he ran into a wall, threw some money over it and declared victory.

So, when I heard that promise from Harper in the last campaign I knew immediately that was going no where. And so did Harper.

Therefore, politically they should take a hit for not keeping the promise. They knew full well keeping it wasn't near as easy as they implied, yet they decided to reap the political benefit (votes) for making the promise anyway.

However, if Harper and Clement are actually serious about starting the hard work to tackle this problem (jury is still out there) then I'll be happy. From the brief bit I've heard on today's announcement I think they may be on the right track; it sounds like a good start on doing the work that needs to be done. Let's hope it is.

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Olaf said...


Don't you love it when a comment somewhere turns into a post?... But yea, I agree with you almost completely. I may even be a little more skeptical than you about Harper's motives, for once, judging by your relatively optimistic conclusion (and is "step in the right direction" a cautious compliment?).

knb said...

I'm a lot more skeptical. The provinces were not consulted about this pilot at all. The project was not designed by the Fed's, it was an independent plan drawn up by the hospital's. I do think it's a good one, but that is not the point.

This was a photo-op, with a minimal financial contribution (2.6 million for the whole country) and a snub to the province.

Think what Clement's reaction would have been if Chretien swept into town and made such an announcement.

Harper's campaigning in that grand way that frames non-announcements as a big deal.

A BCer in Toronto said...

It does make things easier and save time Olaf.

And Olaf and knb, as I've heard more about the announcement, yeah, I've gotten more skeptical. Particularly given the snub to the province; that's particularly galling, and fertile ground for criticism, given Harper's past unflagging commitment to the separation of powers and the respect of jurisdictional boundaries.

And I've never doubted that Harper's motives are purely electoral. But if some good could get done anyway despite the motive, that would at least be something positive to take from it.

Anonymous said...

Why would it take 25 months to collect data/research to deal with wait times and, why only children - because it's a bandaid to look like Harper's dealing with wait times.

Funny, when Clement was Minister of Health in Ontario my mother, in her 70's at the time, waited 3-1/2 years for hip surgery during which time she was in agony. She was finally operated on only because the hip severed and she was hemmoraging badly. It took such a toll on her health she had other problems following. Also, the cut backs were so bad that there weren't enough maintenance and cleaning staff in the hospitals and when I visited I would find dirty swabs on the floor, which I with kleenex in hand picked up (we bought the kleenex).

Ya, you did a heckuva job Tony.

Harper is following the advice of his "American" strategist - keep slamming about corruption and appeal to the moms - that's why they are trying to look like they are caring about their kids.

How many stupid people will fall for this?

Olaf said...

Thing is, Harper's between a rock and a hard place. If he were to leave it all up to the Provinces (as he should, both logically and jurisdictionally speaking), nothing would happen. Nothing.

Plus, then the Liberals would play the "we need a strong central government to take the lead on our wonderfully perfect socialistic healthcare system that only needs minor tweaking and maybe a bit more money" card.

knb said...

Things are happening Olaf.

Harp's only between a rock and a hard place politically and this was a bad card to play. A winner would have been to bring the provinces in, at the very least Ontario where it was being announced and then I'd expect Ontario to invite all other provinces to participate.

The system needs more than money, but it needs that too. This initiative, on it's face is smart. It will yield nothing for at least 15 months, but a worthy start.

The kudo's go to the hospital's however, not Harper and not Clement.

As an aside, does anyone else find it weird that the PM announces these things, never the Minister involved. They are allowed to say a few words, but then back to the PM.

I will say this. He is well versed on every file he presents. That tells me just how intelligent he is, though I cannot think that is a good way to govern, let alone manage.

A BCer in Toronto said...

If he were to leave it all up to the Provinces (as he should, both logically and jurisdictionally speaking), nothing would happen.

I didn't say he needs to leave it all up to them Olaf. He needs to work WITH them. He needs to be a united, not a divider. A compassionate Conservative, if you will.

As an aside, does anyone else find it weird that the PM announces these things, never the Minister involved.

I have. He's a micromanager. That's why it was silly Baird in enviro was hailed as a change in direction. It's not the dummy that's really talking, it's the ventriloquist.

It's an interesting strategy for Harper. If only just for his health, I hope he never gets a majority. Four years of running the government all by himself would kill him.

And then he won't ever have time to write the faboo hockey book we're all waiting for.