Thursday, July 02, 2009

Defining the terms of the debate

Dr Stephen Murgatroyd's Troy Media column of July 2nd Reinventing government in Alberta featured this quote:
" 1)Lay out the next 25 to 50 years of expenditure on a no-change basis, pegging oil prices at current prices and gas drilling at current prices and show Albertans what would happen. For example, if revenues remain roughly on a par with the current projections but health care continues to increase at 13% annually, at what stage does Alberta become unable to pay for health care?

2) Rethink how we manage and fund health, schools (K-12) and care for the elderly. These three items are large expenditures, with the care for the elderly a growing issue for all developed societies. No one is ever happy talking about changes to these three services, but change is inevitable. It is time to engage in a serious discussion about user pay for these services – health care premiums, a higher level of educational taxes and a means tested provision for elder care."
A 13% annual increase sounds like a terrifying thing that might even justify such Dickensian policies as Murgatroyd suggests, but like most of those using this number, or others like it, Dr Murgatroyd inexplicably omits just what exactly healthcare is increasing at 13% of annually. It's not new hospital beds and basic healthcare infrastructure, this government has been far more enthusiastic about blowing up hospitals than constructing new ones, or opening them when they are constructed. It's not percentage of GDP, of the economy as a whole, that number the simplest, most useful measurement of any public expenditure has been almost completely static for years. Lets repeat that: Healthcare expenditure as a percentage of provincial GDP has not increased significantly in literally decades, in fact it's down since the early 90's.

No the 13% Murgatroyed seems to be referring to, is the percentage of the provincial budget devoted to healthcare. A number that is explicitly political, that is dependent on the government in power's ideological approach to revenue collection and the public sector, a number easily distorted by past political decisions by the government in charge. For example the Alberta healthcare system is still recovering from the irresponsible budget cuts of the 90's and that recovery unsurprisingly, took the form of spending increases. Repairing extensive vandalism is usually expensive.

It should be clearly understood by all, that the argument against a sufficiently funded public health system has absolutely nothing to do with fiscal responsibility or real sustainability and never has. It is, and always has been an explicitly ideological argument based on a visceral objection to the public sector in any form. And the argument that increasing costs should be off-loaded onto those least able to pay and most likely to suffer from the policies suggested by Dr Murgatroyd among others, is also purely an ideological prescription.

All that is happening is that the public system supported and cherished by the majority of Albertans is now bumping against the leading edge of the Conservative fetish with diminishing the public sector, transferring public wealth to private hands and reducing the contribution of upper income Albertans to the social contract. These endless entirely artificial healthcare funding 'crisis situations' are as predictable as the tides. They will continue either until the government manufactures sufficient consent for throwing the health care of Albertans into the waiting hands of the insurance industry or until the public says no and makes it stick.

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