Nobody with any familiarity with health policy and administration – or at least nobody that I know of – still holds on to the belief that a reshuffling of administrative structures can improve healthcare delivery. In 2014, when Québec boldly declared it was going for yet another iteration of such nonsense, there was an across-the-board consensus that it was a terrible idea. Five years later all the indicators suggest it was: none of the advertised benefits have materialized, but all the predictable side effects and downsides are being acutely felt. Quebec’s regrettable example is only one among a long list of such failures. From the near 30 years of redisorganizing the NHS in the UK, to the ups and downs of regionalization in Canada, the fact that health care delivery performance isn’t driven by administrative structures has now been emphatically proven. This then, begs the question: why, in the name of the Great Ford Nation, is the Ontario government currently trying to sell the idea an administrative game of musical chairs is what the health care sector needs? This is an honest question, but one where I fear none of the possible answers are reassuring.
As the saying goes, never attribute to malice that which is adequately explained by stupidity. The most likely, and possibly most worrying, reason for the decision could then be that the people behind it genuinely believe in their proposition. This is fairly unsettling as it would mean those in charge of running the largest sector of the largest province in Canada – one with a budget in billions and lives at stake on an hourly basis – have no clue whatsoever about the business they are in. And while it does happen that elected officials can have minimal knowledge of their new field upon taking office, bureaucratic structures are supposed to buffer such transitions. However, at the end of the day, whatever the details can be, pleading ignorance isn’t a great excuse for silly (and in this case, potentially harmful) behaviour-as any judge will tell you.
A second possibility is that the Ford government knows full well that what they propose isn’t going to work the way they advertise it. There are quite a few reasons they might want to move forwards nevertheless. For example, they could be after short term political gains. In that case they anticipate being able to surf the wave of dissatisfaction about the current system by spinning the idea that they are working to fix it. This is the oldest political trick in the world, one that has been used and reused coast-to-coast to such an extent one could have expected it would have lost its appeal. But maybe it hasn’t. The problem here is the appropriation of short-term political gains at the expense of very real long-term damages to service delivery.
Along the same lines, there always is the Machiavellian possibility that the goal is actually to harm the health care system itself. For a government that isn’t exactly known for its love of the public sector it wouldn’t be out of character to take aim at its largest component. The challenge for the government then being that Ontarians tend to be deeply attached to their public and universal health care system, despite all its deficiencies, disconnections and small frustrations. Therefore, the best bet for a Canadian government with the unvoiced objective to dismantle or privatize health care would be to give it a poison pill. The objective here would be to ‘accidentally’ make the system so dysfunctional it would lose most of the public support, which would be the same moment that shiny new private health care options appear on the table.
There probably are a few other explanations of the same nature. After all, the consultancy contracts this policy will generate will total tens, if not hundreds, of millions of dollars and this kind of money has been known to motivate pretty damning human behaviour. But any answer will remain speculative as it is unlikely the main players would speak openly of their motivations. And sure enough, one could argue that we are wrong to posit from the onset that this policy avenue is doomed – even if one would have a hard time finding any scientifically credible evidence to support this Ontario Health nonsense. The main point we want to make here is that the Medicare model faces many threats, but our generally passive acceptance of utterly doomed large scale administrative reforms and lack of any creative willpower to envision and implement genuinely helpful reforms is among the largest.