The following are a series of questions given at an All Candidates Debate on November 15, 2005 organized by staff from the Scarborough Hospital. The questions were provided well in advance of the debate by the following health care providers.
1. Dr. Paul Tam, a nephrologist who works in Scarborough
2. Ms. Louise LeBlanc, a nurse who works in Scarborough
3. Dr. George Teelucksingh, a family doctor who works in Scarborough
The Libertarian Answers are suggested responses to the questions. The technique is to have empathy for the problem, but challenge the presumed solution.
Round One: Knowledge of Healthcare in Scarborough
1. (Dr. George Teelucksingh): As I’m sure you’re aware, the federal government has announced that it wants to increase the number of immigrants coming to Canada. History shows that many of these new immigrants are likely to end up in Scarborough. This means that in order for us to prepare for the future, we’re going to have to expand our hospital facilities and introduce new initiatives to provide adequate medical care to the residents of Scarborough – both those already living here and those likely to arrive in the near future. Do you think that Scarborough has enough hospitals or hospital-based services given that it’s of comparable size to Hamilton and Ottawa, which have substantially more hospitals and hospital-based services?
(Libertarian Answer) Is there a shortage of dentists or optometrists in Scarborough? A shortage of grocery stores or food? Of course not! Then why is there a shortage of doctors and hospitals? The answer is because government is trying to run it. Central planning doesn’t work any better in Ontario than it did in the USSR. Free markets provide all of the food we are willing to pay for. Since we, the patients, aren’t paying for it, we only get as much as someone else thinks we need.
2. (Ms. Louise LeBlanc): The Scarborough Hospital is probably the oldest community hospital in the GTA. Despite this, we haven’t received any significant funding from the Government of Ontario to renew this facility so that we can increase services for our patients. Compared to other hospitals in the 905 area, our funding from the Ministry of Health has lagged significantly behind for the past 10 to 15 years. To add insult to injury, the Ministry announced two weeks ago that they plan to build a new chronic care hospital and expand the existing facility in Markham-Stouffville. Do you think it’s fair that Scarborough has been left out in the cold once again?
(Libertarian Answer) The average age of hospitals in Canada is 39 years. In the US it is 9 years! What incentive does the government have to invest in hospitals? Will it help them to win another seat in the next election? Maybe if you make enough noise, like this meeting, Scarborough will move up the priority list.
3. (Dr. Paul Tam): Providing top quality healthcare to a community the size of Scarborough has been a challenge for many, many years. The numbers tell the story. There were 95,000 ER visits last year to The Scarborough Hospital ER alone – not counting patients diverted to the Clinical Day Unit or After Hours Clinic. In the GTA, 35,000 ER visits typically require a full-service 24/7 ER. Over 25 per cent were over the age of 65 – the highest proportion of elderly for all GTA hospitals. These patients were also sicker – 17 per cent required hospital admission compared with the GTA average of 13 per cent. Add to this the fact that we have an acute shortage of anesthesiologists, neurologists, respirologists, operating room assistants and hospital-based pediatricians and you have a recipe for disaster. What specifically would you do to help us deal with the realities of delivering Healthcare here in Scarborough – both today and tomorrow?
(Libertarian Answer) As a Libertarian I am not likely to be able to help you today or tomorrow, or even the day after tomorrow. :-) Things will only get better when people realize you can’t get something for nothing. Then maybe we can take control of our health away from the politicians.
Round Two: Challenges of Delivering Healthcare in Scarborough
1. (Ms. Louise LeBlanc): Those of us who work in the health-care system here in Scarborough are only too aware that old and outdated facilities and equipment are a big reason why we’re having trouble attracting new physicians and nurses to work to at our Hospitals. The fact is, many young graduates would prefer to work in sparkling new 905 facilities that are being built rather than in aging and outdated ones here. It’s no wonder that the residents of Scarborough feel like second class citizens when they’re denied the best care available. With this in mind, what kind of expansion, renovations or construction of new facilities would you push for in Scarborough?
(Libertarian Answer) If I thought I could get it from the government, I would push for construction of a nice four-bedroom bungalow on a 50’ by 100’ lot. :-) I agree it is a shame that health care workers in Scarborough have to go begging to Queens Park for necessary health facilities. Thank God we don’t depend on them for food facilities. I think everyone would agree that food is more essential than medical care. Food is provided by free markets – you can get as much as you are willing to pay for. Loblaw and Dominion make sure there are enough shinny new facilities and quality products to meet our every desire, because they are run as a business. When hospitals are run as a business, then facilities will not be a problem.
2. (Dr. Paul Tam): Scarborough is a wonderful, vibrant, multi-cultural oasis – boasting more than 50 different cultures and ethnic groups. And as my colleague pointed out, even more immigrants are on their way and will be arriving soon. Given that Scarborough has become the first choice for so many of Canada's new immigrants, we feel it’s vital that we provide top quality health care to the ‘United Nations’ of Scarborough. Unfortunately, patients residing in Scarborough are usually sicker than those living elsewhere in the GTA because so many of them come from places without comprehensive health care. Which begs the question: Why is Scarborough getting short-changed when it comes to funding? Is it because the Government of Ontario doesn’t care about these new immigrants? Do you honestly believe that the residents of Scarborough should expect less than the best medical care we’re capable of providing?
(Libertarian Answer) Many people like Dr Tam believe that government is benevolent, that it cares about the little people. The government consists of politicians and civil servants. I don’t think one politician outside this room knows me from Adam, and the only civil servant who knows who I am is the local Returning Officer. So the Government of Ontario doesn’t even know me, let alone care about my desire for the best available medical care or the best available steaks. But I bet most of the politicians and many bureaucrats know the presidents of Bell Canada and Imperial Oil. And we know they listen to the president of Ford and GM. They got lots of money for new facilities. Does Toyota qualify as an immigrant? :-) Otherwise, you’ve got to believe that immigrants are well down the list when it comes to spending priorities.
The level of health care we get is a priority question. Health care takes over one quarter of the provincial budget, and it is growing. It is gradually squeezing out other spending priorities. When you vote, you get one chance at setting those political spending priorities. But every dollar you spend on hamburger or steak is a vote for your spending priorities. Health care should be run more like the food industry.
3. (Dr. George Teelucksingh): Capital funding for new hospital buildings has traditionally relied upon community fund-raising, which the government typically matches at a 1:1 ratio. While this ratio works well in other parts of the GTA, it doesn’t work in Scarborough because so many of our residents are recent immigrants who are either too economically challenged or too isolated to contribute to these projects. This means that money is hard to raise, which in turn delays these much needed facilities from being built. In addition to this, Scarborough doesn’t have the corporate headquarters and/or major philanthropists in sufficient numbers to help fund these kinds of major projects the way other communities do. If elected, are you willing to make a commitment to the people of Scarborough to overcome these restraints by lobbying the Government of Ontario to come up with new and innovative ways to make significant investments in healthcare here in Scarborough without any further delay?
(Libertarian Answer) The introduction of private health care facilities and private insurance would overcome the funding problems. Many other countries with universal access allow private health care and have very short wait lists. Canada spends more per age-adjusted-capita than almost every other OECD country, but ranks average or below on most measures of health care, like number of doctors and diagnostic equipment.
Round Three: Commitment to Healthcare in Scarborough
1. (Ms. Louise LeBlanc): You might be surprised to learn that there are nearly 6,000 births per year at The Scarborough Hospital, and that approximately half of this volume is being handled by only three staff pediatricians and three staff anesthestists. We know that two anethestists have already left or plan on leaving The Scarborough Hospital. Should one more of these six other critical specialists depart, there will be a serious crisis in the provision of maternal newborn care. In view of the need for two maternal newborn health units at The Scarborough Hospital, are you prepared to lobby the Ministry of Health for adequate funding – whether it be in the form of monetary incentives or new alternative payment plans – in order to support these two units so that we can attract additional key staff?
(Libertarian Answer) Those of you who work in our health care system have my sympathy. The politics of funding must be very distracting from providing the best care possible. And I am sure many of you feel you are not being paid what you are worth. It is too bad so many health care professionals leave the province because of these two problems. If I’m not happy with my pay, I can look for another company. It is getting to the point where you need to book your obstetrician before you get pregnant!
Because your funding is fixed by the bureaucrats, you don’t have the money to pay enough to attract and keep enough qualified Anaesthetists. If your hospital were run like most businesses, you would find the money somewhere to pay what is required.
2. (Dr. George Teelucksingh): As has already been mentioned, Scarborough has a very high percentage of new immigrants and members of the lower socio-economical class. We need an MPP who’ll speak up for those without a voice. They have been ignored for far too long. This can’t be allowed to continue. We need the Government of Ontario to make a commitment to help the poor and the disadvantaged people here in Scarborough. Can you make a firm commitment here tonight to help us obtain new funding for facility renewal and new programs so that these people – our neighbours – can get what they deserve?
(Libertarian Answer) If I understand you correctly, you want the government to give you health care professionals more money so you can provide the “poor and disadvantaged people of Scarborough” what YOU think they “deserve.” Wouldn’t it make more sense to give the money to the “poor and disadvantaged people of Scarborough” directly and then they can give you what THEY think YOU deserve? In fact, wouldn’t everyone be better off it the people who want your services were the people who paid for it, either directly or through insurance? If the facilities were supported by the not-so-poor people of Scarborough, wouldn’t you provide your services for free or at a reduced cost to the “poor and disadvantaged people of Scarborough?” Or would you still expect the taxpayers to pay you for your services.
3. (Dr. Paul Tam): The Scarborough Healthcare Coalition and the residents of Scarborough have to look to the Future and the Future is Now. Clearly, the evidence shows that Scarborough has been ignored in the past 10 to 15 years. We need you, our elected officials, to speak up for the people of Scarborough. We’ve been short-changed, ignored, neglected, and left out in the cold for far too long. You must demand that the Government of Ontario start to listen to the people of Scarborough. We need your commitment now – here tonight – to stand up and advocate on behalf of your constituents – our patients – for more funding and more support. Are you with us, or against us?
(Libertarian Answer) Am I with you or against you? Yes. I am WITH you when you say that the residents of Scarborough have been short changed, possibly more than many other areas of our province, when it comes to health care. I am dismayed when a gun shot victim from Lawrence and Morningside has to be transported to Sunnybrook and dies after passing by Centennial Hospital.
Yes, I am AGAINST you when you say that the answer to the problem is more of the same government funding and control. We are using the wrong model when we think a government-run monopoly provides the best service for our citizens. We need to use a free market model, the model that provides the most and best goods and services at the best price. Health care is not the only government-run service that suffers from shortages and rationing. Look at electricity. What business asks you not to use so much of their service? What business makes you wait 17 weeks on average before they look after you? OHIP is bad for our health and I will commit only to dismantling it as quickly as possible.