Monday, May 27, 2002

Demographics not dollars source of health care crisis

Times Colonist (Victoria)
One billion dollars is a lot of money. Think about winning a million-dollar lottery every year for the next thousand years, or imagine picking a $10,000 scratch-and-win ticket every day for about the next 274 years. That's how much a billion dollars is.

Now imagine what would happen if a government put a billion dollars in additional funding into our health-care system. You'd imagine all sorts of wonderful things happening, with people dancing on the streets, right? Wrong!
Since the Gordon Campbell government was elected last year, it has increased health-care funding by over $1 billion. A large chunk of this money was gobbled up by increased pay rates for nurses, doctors and other health-care workers. But there was still hundreds of millions of dollars left over.

For example, when Joy MacPhail was minister of health, she repeatedly announced her government's $125 million for mental-health-plan funding. In Victoria where, because of our mild winters, we get more than our fair share of mentally ill living on our streets, this came as welcome news. Unfortunately very little in the way of actual funding flowed from the NDP's announcements. It took the election of the Liberals to finally see the funding provided.

So with all this good news why do we see people protesting health-care cuts? The simple answer is that we have a public health-care system that is completely out of control. This is something that government officials have long been aware of.

When I worked as a ministerial assistant, I used to often say that if you wanted to watch a hundred million dollars disappear without a trace, just provide it to health, education or social services. Apparently nowadays, in the case of health, even a billion dollars doesn't make much of an impact.

We have now reached the point here in B.C. where half of every dollar spent by our provincial government is on health care. I suspect that if every dollar the province spent were on health care, it would still not be enough.

A few years ago a friend of mine predicted that if the health-care system was not radically reformed we would soon need only two ministries in British Columbia: a Ministry of Finance to collect taxes, and a Ministry of Health to spend it.

The consolidation of health-care services that is now occurring is a critical first step to saving our health-care system from collapse. But if we are to succeed, British Columbians need to understand that is not government underfunding, but demographics that is overstressing our public health-care system.

When Germany set up the world's first government pension plan more than a hundred years ago, they wanted to make sure that most people would not qualify for it. They picked the age of 65 because back then 98 per cent of the population did not live that long. Nowadays, average life expectancy has climbed in to the high 70s and many seniors are living into their 80s and 90s.

The front of the demographic bulge we call the baby boom is now entering their silver years. Thus demand for health-care services will continue to skyrocket.
At the same time, without increased immigration, the supply of new nurses and doctors will continue to decline. Even more importantly, the supply of healthy young taxpayers will also decline.

Given that we make far more use of the health-care system in our senior years than in our youth, this means that demand for our public health services will continue to outstrip the taxpayers' ability to pay for them.

Given that the tail end of the baby boom (those born after 1964) often found themselves shut out of jobs by older boomers, there is going to be very little willingness by that group to see their taxes double or triple in order to keep the "me generation" well taken care of in their golden years.

In fact, we may even see a backlash develop against aging boomers.
Some years ago a friend of mine (who was born in 1967) got into a rather heated discussion with a rather smug older boomer. When challenged as to what his generation hoped to accomplish, my friend caustically replied, "We're going to be the generation that pulls the plug on your life support."

Needless to say the conversation ended soon after, but the words had a chilling accuracy to them.

How acrimonious the health-care debate ultimately gets will depend on what decisions governments make today. The fact that the Campbell government has had the courage to start reforming our health-care system should be viewed with relief rather than alarm.