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Images from the emergency department of Royal Victoria Hospital, 201 Georgian Drive, in Barrie. (Peter Power/The Globe and Mail/Peter Power/The Globe and Mail)
Images from the emergency department of Royal Victoria Hospital, 201 Georgian Drive, in Barrie. (Peter Power/The Globe and Mail/Peter Power/The Globe and Mail)

POLICY EXPERIMENTS

Fear of scandals must not paralyze Ontario's health care reform Add to ...

For Deb Matthews, it must have been a welcome reprieve.

Through an entire luncheon speech to the Toronto Board of Trade, and most of a subsequent news conference, Ontario's Health Minister got to talk about changes she wants to make to the provincial system – not the mess she's spent the past couple of months trying to clean up.

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But even as she unveiled her “action plan,” the spectre of Ornge hung over her. Because as Dalton McGuinty's Liberals try to do what's needed to make health care sustainable, they will have to get past the stigma created by their previous mistakes.

Despite Ms. Matthews’ characteristically reassuring tone, most of the reforms she proposed on Tuesday – including bringing family doctors under the purview of Local Health Integration Networks, shifting high-volume procedures from hospitals to specialized clinics, and moving toward more “evidence-based” medicine – require a willingness to experiment. That in turn means the government has to be trusted, and trust itself, to take risks.

A saga like the one at the province's air-ambulance service does not help. A public-private model aimed at simultaneously improving service and containing costs, Ornge began as an example of creative thinking. Today, with auditors and provincial investigators swarming, its operations curtailed and its leadership ousted amid reports of questionable business practices, it looks more like a cautionary tale.

To some extent, the lessons drawn from Ornge should help avoid similar messes in future. It will be a long time, and rightly so, before an Ontario government allows an agency to function with such blurry lines between for-profit and not-for-profit operations, or with as much power in the hands of one entrepreneur as president and CEO Chris Mazza seemed to have.

But the nature of experiments is that not every one will work out. So unless the government puts in place such oppressive safeguards that everyone involved is afraid of his or her own shadow, it has to accept that reforms will generate some bad-news stories.

If the government moves forward with funding more surgeries in not-for-profit clinics, rather than hospitals, not every one will perform as well as the Kensington Eye Institute – the cataract-surgery provider that Ms. Matthews held up as the gold standard. And even if the vast majority perform to expectations, the minority that underperform will probably get more attention.

The same goes for the province’s 14 LHINs. Most of them may eventually live up to their promise of decentralizing decision-making, while providing cost-saving co-ordination between local providers. But some will use their power better than others, and enterprising journalists or opposition members could well find a place where it’s being abused.

Evidence-based medicine, basically code for rationing care more effectively, has the potential to be even more politically damaging. By ensuring that money is spent on the treatments that are most needed and most effective, the government could save a lot of lives, net. But not funding certain surgeries or tests or prescriptions would likely lead to allegations of individual lives lost because of government decisions.

In other words, each policy change presents enough alarming scenarios to push any government toward a state of paralysis. And a government in its ninth year, having accumulated baggage along the way, is all the more susceptible.

Ms. Matthews, despite mixed accounts of just how bold she is behind the scenes, seemed to recognize on Tuesday that the status quo is in fact the most dangerous risk of all. “If we do not make these changes,” she said, then “one of the best things about being a Canadian, universal health care,” will not survive.

Less than a minute after the minister had finished her news conference, NDP MPP Cindy Forster stepped in front of the microphones to tell reporters that Ornge and eHealth proved that the Liberals can’t be trusted. It was the obvious thing for an opposition party to say, and Ontarians will have to take it into account the next time they go to the polls. But in the meanwhile, they should hope the Liberals don’t believe it themselves.

 
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