Ontario, Ford, And "Private" Health Care

On Ford's Big Announcement

Let’s start not with what Doug Ford’s announcement on Monday was, but with what it wasn’t.

It’s not, as much as many of the left both in Ontario and outside are saying, “US-style” healthcare. It’s just, really, plainly not the case that a health system’s private or public nature is defined by who pays staff wages and not whether or not the service is paid for by tax dollars or citizens. The UK’s NHS is a public health care system, as is Medicare in the US, and both of those would not be defined as “public” by the definition being applied to Ford’s plans.

The wording the UK always uses on the NHS is “free at the point of use”, which is the right one. Whether a health care system is public or private is about whether a 24 year old who dislocates his shoulder has to pull out a credit card to get care or not. None of this is to say this is a good move, but it is also the case that when I dislocated my shoulder in the summer of 2021, I had to wait 10 hours to be seen by a doctor for a procedure that ended up taking 25 minutes, and pretending that the current status quo in health care is good enough is a battle that will be lost.

If this sounds like I’m defending Doug Ford, I am and I’m not. What am I doing is making one thing very clear – if you think the left in general and the Federal Government in specific is going to fix this through strongly worded tweets you’re deranged.

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I am not going to pretend that thinking that Justin Trudeau et al have to Do Something Now isn’t an idiotic opinion, because what a lot of people want is a government that both never makes a mistake and acts immediately at all times. If you’re going to pick an intergovernmental fight with a government you’re trying to negotiate with, it’s probably worth making sure you A) have the legal authority you think you have and B) figure out what your leverage is before coming out and fighting.

This weird obsession with posturing and presentation over substance – the very thing I railed about Trudeau doing too much in these pages Friday – that much of the left has is incredibly destructive. What will help the old and the infirm and those who fucking trip on a Friday night and smash their shoulders into a sidewalk is not going to be a strongly worded press release but a coherent fucking strategy, and sometimes that takes more than a day to come up with.

Again, private provision and public funding of health care is not some weird idea – whether it is good or not, it is literally the European norm – and the Federal government is not in the wrong to want to see if it’s actually fucking viable, or if there’s some case for it here. If private provision could increase total system capacity – even at a premium to taxpayers – then there’s probably a lot of people who would go for it. As someone who’s been in an overcrowded and understaffed ER in the COVID era, I’m not sure I’d oppose it, and I’m not exactly a fan of Doug Ford.

Will it work? I have exactly zero idea, but I know a lot of people have a vision for a “better” health care system in Ontario that amounts to pay nurses more and our problems will be solved. Some of them might be eased if the nurses of Ontario got a 15% pay rise tomorrow, but “Treat Nurses With Respect” has gone from a statement of principle to a catch all solution for all that ills a health care system, and at some point on that journey it passed into farce.

The problem with all of this is we haven’t had an honest conversation about health care in this country since, what … Martin, kind of? It’s been a pair of decades of ideology over practicality, from McGuinty chucking good money after the unions to try and keep them happy after years of Harris to Ford’s imposed real wages cuts, and from Harper’s reduced transfer increases to the Liberals choosing different priorities for their spending. It’s been a disaster waiting to happen for years, but COVID just sped up the decline.

Canadian smugness made us complacent, because every time we would hear a story of someone’s hospital bills in the US – either on the news or in our lives – we would just pat ourselves on the back, tell our story of being better than the Yanks, and then move the fuck on. It’s not an honourable life, but it’s the one we chose for so long.

Is the answer Ford’s answer? Enough people in the health world seem to think not to make me think they’re probably right, but nobody has properly articulated what it is, then. We are in a crisis of health care capacity and all the left can fucking talk about is conditions for those employed currently, as if those aren’t separate issues. Yes, paying nurses more would return some of that capacity, but it’s not a solution, and anyone who genuinely thinks it is in and of itself a solution is kidding themselves.

For all the smugness amongst anti-Ford voters from last year, the reason Ford won is that neither the NDP or the Liberals offered an actual, substantive vision for what any of this would look like if they got rid of Ford. I still have no idea what a Premier Horwath would have done differently to materially change this outside of repealing Bill 124, because the left has lost their ability for vision.

What won Justin Trudeau and Barack Obama terms in office wasn’t just their opponents’ unpopularity, but they sold a vision of what their countries would look like after they won. Hope And Change might be cringe, but it was a snappy way of condensing the entire Obama salespitch into one – youth, vitality, generational change. Trudeau’s pitch – trusting experts, unmuzzling scientists, deficit spend for infrastructure, legal weed, the Child Benefit – all came from the same intellectual headspace of technocrats in charge, not ideologues.

Right now, the left has no vision in this province or this country, and so getting it to vote for anything other than stasis is impossible. I’m not saying any of this with my endorsement, but if the left wants Doug Ford to feel some fucking pressure, they need to explain what they would do differently in a way that actually has a chance to fucking fix shit.

I hate Doug Ford and I hate this government, I’ve been very clear about this and miscalled how the electorate would respond to him in 2022 in many ways because I assumed my level of hatred was more widespread than it was. Right now, what those who oppose him need to do is come up with an actual fucking alternative, not just workshop self-righteous owns on Twitter. If this is as serious as everyone is telling me it is, then maybe just maybe we should give the Feds a chance to respond with the seriousness it deserves.

If we don’t, who the fuck knows what happens next.