Amid the hubbub following the release of the Drummond Report, I can’t help but think of one of the biggest financial scams of the past century: Bernie Madoff ’s Ponzi scheme, which wiped out hundreds of formerly well-heeled investors. The lesson from Bernie? If something seems too good to be true then it probably is. Which is exactly what Don Drummond is telling us. For years we’ve been paying taxes to prop up a mismanaged health-care system in the expectation that it will be there when we need it. Now, Don Drummond is telling us the Ponzi scheme is coming to an end. To keep the system going requires major changes: Drummond supplies 362 recommendations spanning 532 pages, 105 recommendations on the health-care system alone.
Reading over them, it’s clear Don has done his homework. Rarely has a government-commissioned report featured prose so concise, or so readable. Rarely has a report provided such an honest assessment. “We cannot count on the magic bullets of faster economic growth or rapid productivity gains to finance our health care needs and wants,” he notes. And: “The public debate in Canada has been poisoned in recent decades by a widespread failure to comprehend the issues … by politicians (and media outlets) who have been too willing to pander to fear-mongering…”
For a policy wonk like me, some of this is refreshing stuff. The report contains several recommendations that will have hospital administrators reaching for the Alka Seltzer, such as a greater tying of executive compensation to strategic outcomes rather than procedures performed. And especially, the lofty goal of capping provincial health-care budget increases to 2.5% until 2017-2018.
But two recommendations later, Drummond provides us with this one: “Achieve spending restraint by moving the health-care system towards a more efficient overall design.” Well, sure. But how? He doesn’t say.
For all his lucidity, Drummond leaves the reader with an impression that is not entirely accurate. He promises “hard answers” and “difficult solutions.” But he was hampered by his government-provided mandate, which, he writes in the report, prevented him from recommending “privatization.” The Drummond report provides the impression that all we have to do is follow his 105 health-care-related recommendations, and we will be back to Ontario the prosperous. Except many of the recommendations summon to mind the vague directives of the Romanow Commission report — released 10 years ago.
Drummond describes his general approach as including “a shift towards health promotion rather than after-the-problem treatment….” He describes a “system centred on patients rather than hospitals.” He wants us to pay more attention to chronic care rather than our current focus on acute care. Plus: More co-ordination! And more attention to the 1% of our patients who account for 49% of hospital and home-care costs!
All wonderful, in theory. But too many of these recommendations are platitudinous — what one might get after a brainstorming session with a Grade 6 class. Too many are incremental rather than revolutionary, when a revolution is what we require. This does not involve LHIN 2.0, FHTS or NPLCS, or ABCS. It means more competition, some by private providers, leading to a realignment of incentives, so that those who provide care receive the financial penalty of a loss of business if they fail to treat the patient like a valued customer. It means greater use of health-savings accounts, user fees and insurance deductibles, so that those who receive care are discouraged from treating the health-care system like it’s an open tab at happy hour.
The Drummond Report is impressive. It is thoughtful, erudite, comprehensive and impressively blunt. But its list of incremental changes is not the panacea some pundits have seen. If we’ve learned anything from recent financial history, it’s that there is no free lunch. The biggest problem? The recommendations still leave the government in the monopoly position of managing our health care. We’re still investing our money in an unsustainable system that promises returns too good to be true.