While the Premier muses about private healthcare, the Vancouver-based Fraser Institute is suggesting that diagnostic scanning equipment, to be purchased by the Province of New Brunswick for hospitals in Saint John and Moncton, should be used to serve both a public healthcare mandate and a private healthcare mandate. This is wonky.

The Institute is proposing that one class of healthcare users should be given nine to five access to the PET scanning equipment but should also expect long waiting times for the service while a second class of healthcare users should be given quick access to the equipment but outside of regular business hours. The catch is that the midnight to eight folks would pay a fee for their quick access.

While reduction of waiting times must be an essential goal of our healthcare providers, the rationing of services to create a premium midnight market is ludicrous. The notion of timed access to this scanning equipment, based on a person’s ability to pay is ridiculous because the equipment will be purchased with taxpayer dollars and as such should be available to everyone in the province on an equitable basis.

If the Provincial Government decides to provide ‘quick-service diagnostics’ only to people with the money to pay for them, what would come next? Would low income heart-attack victims be shunted aside in the emergency room for people with the money to buy shorter waiting times?

There is a fundamental difference between a service offered by a private sector operator who invests in the equipment, facilities and personnel to provide the service and a service offered by an operator using tax-funded equipment, facilities and personal. The Fraser Institute’s model would have your government ration access to life-saving diagnostic equipment so it could shorten waiting times for people who could afford to pay for reductions in waiting time.

The idea has been tried in Britain.

The results are not pretty as we can see from the example of Rachel King’s experience, reported in the Toronto Star. “King, 32, suffered head injuries and several broken bones after being hit by a car in January. When dizzy spells and blurred vision persisted, her doctor referred her to King's College Hospital in London for a brain scan. A couple of weeks ago, the hospital sent King a letter saying a lengthy waiting list could delay her scan for 80 weeks.

At the bottom of the letter, a handwritten note from a hospital official offered an alternative — a phone number to call if she wanted to "go privately." The number was for the hospital's "self-pay" private clinic. When King dialed it she was told she could get the MRI scan in two weeks — for $2,260”.

Ms. King’s experience suggests that the existence of private care doesn’t necessarily relieve pressure on waiting times in public hospitals. Further, it suggests that inequities in the delivery of health care can be magnified when a private and public system operate in the same hospital with the same equipment, where profit and ability to pay determine who gets treated first and who gets diagnosed in a timely fashion.

Canada’s Supreme Court has ruled that it is unconstitutional to ban private health insurance when the public system fails to provide healthcare services in a reasonable time-frame. It noted that in Western Europe private health insurance has long co-existed with public or state-funded insurance programs and noted further that the existence of one does not appear to lead to the eventual demise of the other. Insurance provides more access to services but not everyone has access to insurance, either because of economic circumstance, age or health status.

In Western Europe, according to the World Health Organization (WHO)) access to publicly funded healthcare systems is virtually universal except in Germany and the Netherlands. In some countries, social health insurance operates as a parallel system whereby people in certain occupations receive care superior to that offered to the rest of the population served through taxation. In some cases, people with private insurance plans cannot access national health-service facilities.

So what’s the answer for New Brunswick? Logic would tell you that the quickest way to reduce waiting times is to increase service capacity by hiring more doctors, nurses and technicians, by building more operating rooms, by investing in more equipment and by utilizing facilities and equipment 24/7. The problem is that capacity increases cost money and the Province doesn’t have any.

The UK has sought to deal with long waiting lists for elective procedures by collaborating more closely with private sector institutions. Other European countries are searching for new ways to combine public and private services.

Publicly funded systems are being reinforced in Britain and Sweden. Germany has added new funds for long-term care and France has added public funds to purchase supplemental insurance for low income citizens. According to the WHO, no national government has adopted any strategy of explicit rationing for publicly financed or controlled healthcare that would discriminate against the less well off.

I like the French approach where the Government purchases supplemental insurance for low income citizens so they can access healthcare services on a more equitable basis. Maybe New Brunswick could apply the supplemental insurance principle to diagnostic services by introducing diagnostic premiums to fund 24/7 services where waiting times justify them. If 250,000 New Brunswick taxpayers paid $20 a year in such premiums, it would buy a lot of incremental MRI and PET time.

Or maybe the New Brunswick Government should just get out of the healthcare business, join with the rest of the provinces and amend the Constitution to transfer responsibility for healthcare to the Federal Government.

Two things have happened in recent weeks that should give everyone pause for concern.

On June 6th, General Motors Chief Executive, Rick Wagoner’s announced that GM will lay off at least 25,000 workers in the United States. Canadians need to be concerned because it’s estimated that 175,000 other jobs could be affected by the cuts.

Canadians should also be aware that Mr. Wagoner, in part blamed runaway health care costs for the need to cut U.S. jobs. GM is the largest private purchaser of health care in the United States. The company expects to spend $5.6 billion this year on health benefits for workers and retirees, more than it spends on steel for its vehicles according to Mr. Wagoner.

He says the cost of healthcare translates to $1,500 for every car or truck produced by GM and the costs continue to go up. As costs rise, his business becomes less competitive, particularly in the global marketplace where most industrialized nations provide some kind of national healthcare. Mr. Wagoner says that GM needs major reductions in its health care cost to be competitive against foreign manufacturers.

GM is part of a coalition of more than 150 major U.S. corporations, unions, healthcare organizations, religious groups, and pension providers, representing more than 150 million Americans. The group came together at the end of May to tell Congress and the President to embrace a plan for universal coverage that would give every American some kind of healthcare service within five years. It also presented an analysis claiming such reform would save the U.S. as much as $125 billion annually.

Quentin Young, co-founder of ‘Physicians for a National Health Program’ is also calling for a universal government system of health insurance in the U.S. He wants a private delivery system where hospitals and doctors would be free of government control but funded by the tax system. He believes that enormous savings could result from a standardized insurance program. Tell that to Canada’s ten provincial premiers.

An estimated 45 million Americans (that’s a population nearly 50% greater than all of Canada) lack health insurance of any kind. The U.S. Medicare program only provides coverage for about 42 million American retirees and people with disabilities.

In Canada, we have a different kind of healthcare crisis. Our crisis is characterized by waiting times, hospital closures, doctor/nurse shortages and the whine of provincial governments. Our crisis is part economic and part ideological and that leads me to the second happening.

On June 2nd, The Supreme Court of Canada ruled that Provincial legislation prohibiting Quebec residents from buying insurance to obtain private sector health care services is not legal under the Quebec Charter of Rights and by extension, the Canadian Charter.

With delivery of its ruling, the Court pointed to evidence that shows that in the case of certain surgical procedures, waiting-time delays increase a patient’s risk of mortality or the risk that his or her injuries will become irreparable or that delay will prolong pain or disability and prevent the enjoyment of any real quality of life.

The Court also said that the effect of prohibition on private health insurance is to create a circumstance where only the very rich, who can afford to pay for their healthcare without the help of insurance could avoid waiting-time delays in the public system and that would violate fundamental principles of justice.

Some cheer the court ruling as the end of publicly-funded healthcare. Some fear that it will lead to a two-tiered system where the poor have access to one standard of healthcare and those who can afford insurance will have access to a higher standard of healthcare. Still others see it as an opportunity to fix the public system.

The Court assures us that the experience of other western democracies with public health care systems that permit access to private health care, counters the argument that the availability of private healthcare negatively impacts the quality of public health care or that it leads to the eventual demise of public health care.

Canada already has a modified two-tiered healthcare system. Private insurers provide coverage for semi-private or private hospital rooms and special care needs. They top-up healthcare insurance coverage for us when we travel outside the Country.

We have dozens of private clinics in Canada; some offer advanced diagnostic services while others specialize in out-of-hospital, high-demand surgical procedures. We even have brokers who arrange for medical procedures in U.S. hospitals and clinics.

The Supreme Court decision should be viewed as a warning shot. We need to fix the Canadian system but we also need to steer clear of the flawed U.S. model where huge numbers of people are denied access to healthcare because they have no insurance, where costs are rising in double-digit increments, where jobs are being slashed in the name of healthcare and where the cost of insurance is being shifted from businesses to individuals to make the businesses more competitive.

Canada needs to preserve the principle of universality when it comes to healthcare but it also needs to improve the quality and timeliness of healthcare delivery without increasing the cost. There may be ways in which the public system could sub-contract services to the private sector when the public system is overloaded.

Surely there are ways in which private healthcare providers could improve the delivery time of services without denying improvements to those who can not afford insurance and there must be ways to harmonize the funding and delivery of public and private healthcare without diminishing the standards of care for those who need it most.

There may even be economic opportunity in our healthcare crisis if we can get out in front of change. Wouldn’t it be a bonus if the U.S. healthcare crisis persuaded American businesses to move jobs to Canada to reduce their U.S. healthcare costs?

The ‘Auditor General Act’ proclaimed by the Provincial Government of New Brunswick in 1981 says “the Lieutenant-Governor in Council (the Provincial Cabinet) shall appoint a qualified auditor to be Auditor General of New Brunswick, for a term to be determined by the Lieutenant-Governor in Council, of not less than five years and not more than ten years”.

On August 31st, the current Auditor General, Daryl Wilson will have served the Province for eight years. Recently, he asked the Government for a four month extension of his term so that he could complete his investigation and report on the governance of NB Power and in particular the Government’s $750 million decision to refit NB Power’s Coleson Cove generating station for Orimulsion..

Mr. Wilson’s request, had it been granted would have extended his term from eight years to eight years and four months, well within the ten year time frame of Auditors General appointments.

The Premier said no, claiming that approval of the extension would break the law. One would think that because the term of appointment is determined by the Lieutenant Governor in Council and Mr. Wilson’s term has not reached the10 year maximum, the Government would have the legal authority to extend his appointment, so long as the extension did not exceed the ten year maximum.

If the Government is bound by some fine point of law and has no authority to extend the appointment for four months, it does have the authority to reappoint the Auditor General (Subsection (1) of the Auditor General Act).

Certainly Mr. Wilson has the credentials to warrant reappointment. Consider that he has served the Province for nearly eight years as Auditor General and before that, the City of Saint John as Commissioner of Finance. He’s a Chartered Accountant who spent five years with the international accounting firm Ernst and Young as Audit Manager. He also has a long list of credentials in service to his profession and his community

Me thinks there is more than the law at play here. In the past few years, Mr. Wilson has challenged the Government’s claims of budget surplus by pointing out that it has drawn down funds from the Fiscal Stabilization Fund to mask its operating deficits. Mr. Wilson has also taken a special interest in the decision-making processes of government as relates to choices involving the expenditure of taxpayers’ money.

That brings me back to NB Power. On October 10, 2004, the Government of New Brunswick, as mentioned above approved the expenditure of $750 million for the conversion of NB Power’s Coleson Cove generating plant from oil to Orimulsion. The Premier made the announcement himself. The decision was based on the assumption that Orimulsion would be less expensive than oil and would save the Corporation $100 million dollars a year in fuel costs for the next 20 years.

That assumption was supported by a “memorandum of understanding” (but no signed contract) with a single-source supplier, Bitumenes Orinoco, S.A. (Bitor), an oil company owned by the Government of Venezuela. Months after the New Brunswick Government made the decision to refit the Coleson Cove plant, the Venezuelan Government announced that Bitor would not be able to supply Orimulsion to Colson Cove.

The Premier declared that officials at NB Power would be held to account for not ensuring that a signed agreement was in place when the Government authorized the Coleson Cove refurbishment. The Minister of Finance called for heads to roll and the Province sued Bitor for $2 billion (the projected 20 year, $100 million a year loss in fuel cost savings projected with Orimulsion). Allan Fotheringham might have characterized the response as so much obstification.

Earlier this year and surely by coincidence, NB Power announced a two part rate adjustment. The first part, a 3% increase, took effect April 1st and did not require approval by the Public Utilities Board (PUB). The second part was to take the form of a retroactive 4.5% fuel surcharge and it required PUB approval. Last week, the PUB announced it would not approve the ‘retroactivity’ in the fuel surcharge.

In desperation, NB Power responded to the PUB decision with a second 3% rate increase to take effect July 7, 2005. Like the April increase, it will not require PUB approval, this time because of some technicality related to the timing of NB Power’s metamorphosis from one to six operating companies. With announcement of its second 3% rate-increase in three months, NB Power declared that its application for a 4.5% fuel surcharge will be amended to make it effective next year instead of this year.

Is it any wonder, the Auditor General wants an extra four months in office to complete his audit report on Government decisions affecting NB Power? Is it any wonder that the Government wants to get this Auditor General out of its hair as soon as possible? The dollars attributed to the Orimulsion fiasco are many times greater than anything reported in connection with the Quebec sponsorship fiasco. Power rate increases of 9% over fifteen months are many times greater than the rate of inflation.

Residents of New Brunswick need some answers. The Government is attempting to muzzle the Auditor General by denying reasonable extension of his term. If the Premier forces Daryl Wilson to leave at the end of August, Mr. Wilson will be justified, indeed, it will be his duty to issue an interim report to put facts of the Orimulsion decision on the table. While it may not help us recover the $2 billion loss in fuel savings or the $750 million in refit costs, it may help us judge the merits of future decisions involving the refurbishment of the Point Lepreau nuclear plant.

Premier Lord refuses to do a deal with the Federal Government on the issue of childcare.

His initial response to the signing of an agreement with the Federal Government (that would have delivered $100 million to the Province) was that funding for childcare and funding for the refurbishment of the Point Lepreau nuclear generating station should be linked.

When that didn’t fly, he shifted to the notion that New Brunswick’s childcare needs are different from the rest of Canada and therefore terms of funding should be different for the Province.

Some make the argument that the proposed child care program is great for Toronto and the bigger provinces of Canada but not for a smaller province, like New Brunswick, where a larger percentage of the population resides in a rural community.

Others make the argument that a tax-funded childcare system is unfair to those who have no children or to those who provide homecare for their children. The latter is a spurious argument. If it applied to the real world, people who don’t use healthcare wouldn’t pay for healthcare through their tax payments. People without children in school wouldn’t pay property taxes. People who were employed wouldn’t pay their EI premiums.

We all pay taxes, based on our ability to pay. We all benefit from those tax payments in some way or another. The roads we drive on, as bad as they may be, are paid for with tax dollars. Healthcare, education, public works, economic development, tourism promotion, energy, fisheries and forestry management, agricultural subsidies, etc., etc. are all funded with tax dollars. Not everyone benefits from a specific program. Not everyone can match their tax investment to a specific service return.

On the matter of childcare, governments have made the decision to intervene with dollars and programs. Some argue for direct subsidization. Others push for tax-deductibility. A tiny few advocate tax credits.

Not many argue the case against government-funded childcare. It’s easier to support the notion that families, with both parents working outside the home, need help with the cost of daycare. It’s even easier to say that a single parent working outside the home needs help with daycare.

To provide context for contrary views, one might note that a growing number of businesses provide on-site daycare services as a means of attracting and retaining skilled workers. It begs the question, is government-funded childcare necessary if the private sector is willing to help fund it?

People marry and people cease to be married. Either way, they have children. That’s not the state’s problem. It’s also not to say that the state couldn’t take an interest in population growth by offering state-funded daycare programs but I don’t think the intent of today’s policy is to grow the population.

Most children of the 21st century come into the world as a result of a conscious decision by the parents to have them. In a traditional world, the parents are and should be responsible for the care and upbringing of those children. When there is a market need for skilled labour, the market could and often does provide daycare services as an employment benefit but the practice is not universal.

An employer, without need for a labour-force encumbered by children shouldn’t be required to provide daycare services. A government without need to promote economic activity shouldn’t be investing in universal childcare, even if there is a social case to be made for helping single-parents. We could do that with direct payment subsidies or we could do it with tax credits (as distinct from tax deductions) on the assumption that working parents would be earning taxable income.

In my view, the case has not been made for a government-funded, universal daycare system in Canada and/or in New Brunswick. The Federal Government has put $100 million on the table for childcare in the Province. That’s a big sum of money but it would do very little for individuals if made available on a universal basis. Do the math.

We have something in the order of 217,000 households in this Province. Let’s assume for a moment that 25% of those households have 21/2 children at home between the age of one and twelve. That would leave us with almost 135,000 children in care mode. Assuming an annual payment of $100 million by the Federal Government, the amount available for each child would be $740 a year.

Yes, that would be a help but if we assume further that an average daycare cost might be $100 to $200 a week per child, we’re only talking about a four to eight week cost holiday per child. This would be a bonus, but not enough to make a life-changing difference for most people, particularly a single parent.

If the funding was targeted exclusively at single-parent families and one assumed that 10% of childcare households are headed by a single parent, the payment could shoot up from $740 a year to $4,608 a year per child. That would be huge. Even if the lowest-paid, dual income families were added to the payment roster, it would still be significant.

Is Premier Lord acting responsibly by holding out for a rural-based childcare formula?

My view is that he has his cards mixed up. The issue isn’t rural versus urban childcare. The issue is who reaps the benefit of a national childcare program? At this point, the benefits and/or the return on tax-investment are not clear. In the absence of more persuasive information, I’d rather see the money invested in the post-secondary education of our children. Improve the quality of education.

Make it more accessible by lowering the cost and it will bring new economic opportunity to the Province.