Heath care contract: adding and subtracting
Last week’s to-the-edge-of-the-ledge, past-the-last-minute contract settlement between Capital Health and its 3,600 health workers raises all sorts of difficult but intriguing questions.
The first, and most immediate, of course, is could the disruption—even without an actual strike, the anticipation cancelled 560 elective surgeries and emptied 172 beds—have been avoided?
The short answer is probably not. Both sides have legitimate, vital interests in the outcome and only the combined pressure of a looming deadline and smacking up against the real-life consequences of not settling creates the conditions necessary for compromise.
So long as there is collective bargaining, we will have brinkmanship.
But should we even have collective bargaining in health care? Let’s come back to that.
Is the settlement fair? We won’t know the full financial implications until an arbitrator picks either the union’s (nine per cent over three years) or the province’s (6.5 per cent) final position. The province’s finance department has undoubtedly already crunched both scenarios, so Premier Darrell Dexter should disclose them so we can discuss their merits now.
This year’s provincial budget includes a $199-million “restructuring” line item, supposedly to cover contract settlement contingencies above the government’s hoped-for one per cent salary increases, so the deal may not deflect the government’s goal of balancing the books by next year. But it will raise the bar for other public sector workers.
Other numbers also come into play when asking if the settlement makes sense. Nova Scotians’ cost of living increased by 3.7 per cent last year while wage settlements barely nudged 0.4 per cent. Even the union’s final demand just keeps pace with cost-of-living increases.
One more, different set of “numbers:” the settlement calls for an across-the-board wage increase, meaning those at the lowest end of the union’s 100 or so different job categories—those who need more most—will get the least. How fair is that?
Back to collective bargaining and essential services. Given that the final salary settlement ended up in the hands of an arbitrator anyway, why not cut to the chase and ban strikes in health care?
That, my friend, is a whole other discussion. What do you think?
Copyright 2012 Stephen Kimber
Nova Scotia budget: the cost of cutting v the value of investing
In the all-too-brief interregnum between Thursday’s bad-news federal budget and tomorrow’s more-bad-news provincial budget, it’s worth noting the across-the-board, cost-cutting Kool Aid fiscal policy makers in Ottawa and Halifax have swallowed is not the only—or necessarily best—way to slay the deficit dragon.
The Nova Scotia branch of the Canadian Centre for Policy Alternatives, for example, a progressive think tank, recently released its annual alternative provincial budget. Its “Forward to Fairness” document calls for “strategic investments” while finding “creative ways to save money and increase revenue.” Instead of rushing to balance the budget in 2013-14 “to fit the timing of the electoral cycle,” the CCPA wants the government to stretch the back-to-balance timetable to 2015-16 to “reflect the actual fiscal situation.”
“Austerity does not come for free,” says the CCPA’s Nova Scotia director, Christine Saulnier. The CCPA says the government’s decision to cut $772 million in public spending over four years will mean the loss of “well over 10,000 jobs.”
By contrast, the CCPA’s approach involves investing $492.5 million in social infrastructure and programs, including everything from $40 million to establish 10 new community health centres, fund 10 more nurse practitioners and 12 more midwives, to $45 million to phase in an early learning and child care system and $21 million for rural public transit.
Where would the money come from to pay for all of this. Primarily by shifting the tax burden, says the CCPA, from low and middle-income taxpayers “to the upper 45 per cent of income earners, especially the top 10 per cent,” those who have gained the most in the past decade.
Graham Steele
Don’t expect to hear any of this on Tuesday. While the CCPA had what Saulnier calls “a serious and engaged exchange” with Finance Minister Graham Steeele, the finance department “has framed the problem and the solutions in a way that precludes our proposals. In other words, they see declining enrollment in P-12 as a way to justify cutting; we see it as an opportunity to finally catch up with the rest of Canada and begin to really address quality.”
Pity.
Copyright 2012 Stephen Kimber
Has the NDP found its governing groove?
Have Darrell Dexter’s New Democrats finally, belatedly discovered their governing groove?
When Nova Scotia’s first democratic socialist government arrived at the governing starting gate in June 2009, they were already saddled with an embarrassment of their own making—how to renege, almost yesterday, on virtually every promise they’d made to get elected: a balanced budget, no new taxes, no program cuts, 24-hour ER services, a chicken in every pot…
Without passing Go, they stumbled into the grubby MLA expenses scandal. While that mess was not solely of their own making, they bumbled its handling, miscalculating the seismic depths of public outrage and squandering what remained of public goodwill.
For much of the rest of its first year-and-a-half in office, Dexter’s NDP has seemed unable to gain control of its own agenda.
Until recently.
Take last week, for example. Dexter began by piggybacking on a federal commitment of $20 million for tidal power projects to tout what he calls the province’s coming role as “a world leader” in clean energy. By the end of the week, he’d inked a tentative $6.2-billion deal with Newfoundland to bring hydro power from the Lower Churchill River to the Maritimes and the U.S..
Meanwhile, his ministers were introducing far less flashy but crowd-pleasing measures to protect used car buyers from lemons and cyclists from drivers, and to belatedly hand the auditor general the power he needs to muck about in government-business dealings.
Dexter’s government even appears to have grabbed the “big decision” ball. This fall, it said yes to a controversial new convention centre, no to oil and gas exploration on George’s Bank, no to online gambling, and yes to funding Lucentis to treat macular degeneration, the leading cause of blindness in people over 50.
Health Minister Maureen MacDonald, who also recently struck a deal to cut costs for generic versions of the anti-cholesterol drug Lipitor, framed her own announcement as “an important first step” in getting fairer drug prices for Nova Scotians.
As if there might actually be a plan…
Darrell Dexter’s NDP is still a long way from proving it deserves a second mandate, but it has finally begun the climb back to where it began.
Copyright 2010 Stephen Kimber
Pay for performance? What a concept
Ontario Premier Dalton McGuinty is proposing legislation—delightfully entitled the “Excellent Care for All” bill—to connect the salaries and bonuses of provincial hospital chief executive officers with their on-the-job performance.
We’re not talking here simply about how well the CEOs manage to shave operating room costs or slash vital support jobs to meet too-small budgets, but what they do to improve the quality of patient care. Has the hospital reduced the rates of infection among patients from one year to the next, for example? Has it reduced the number of patients who are discharged, only to be re-admitted? And what about the number of medical errors? Up? Down? As patient care goes, so goes executive compensation.
McGuinty thinks this is such a good idea he’s considering applying it to the CEOs of every Ontario crown corporation and agency.
Why not do the same in Nova Scotia? And why stop with the public sector? What if we applied more than just bottom-line calculations to private sector compensation?
Last month, Emera, which owns our electrical power utility, announced its CEO, Chris Huskilson, had earned more that twice as much in bonuses and stock options—a nudge above $1.5 million—as he took home in salary, which in 2009 amounted to a paltry $649,038. Rob Bennett, the president of Emera’s Nova Scotia Power subsidiary, received more than twice his $336,692 salary in benefits.
The company’s management circular attributed the executives’ good fortune—both men did even better in 2009 than in 2008—to Emera’s showing in the stock market.
But what if those bonuses had been based on other factors? Customer satisfaction, for example? Electricity rate increases not requested? How about the number of times power outages were not blamed on salty fog? Better, the number of outages that didn’t happen, or the speed with which power was restored when they did?
Those are all also signs—perhaps more telling in the long term—of a well run company. Why not recognize them when doling out bonuses?
Or how about Eastlink, one of the companies that got federal and provincial funding but failed to meet its deadline—“the project completion date has moved,” in corporate-speak—to supply broadband Internet service to all rural Nova Scotians? Why not reduce its CEO’s compensation package for each day it fails to complete? In 2010, that’s 126 days… and counting.
Dalton McGuinty is on to something here. There are other important measuring sticks for success beyond the bottom line. Time to factor them in too.
Copyright 2010 Stephen Kimber
IWK book to launch October 8
Th
e IWK Health Centre and Nimbus Publishing
are celebrating the launch of
IWK: A Century of Caring for Families
a new book by Stephen Kimber
Where:
The Gallery of the
Richard B. Goldbloom Pavilion,
IWK Health Centre
5850/5980 University Ave.
When: Thursday, October 8, 11:00am
Copyright 2009 Stephen Kimber
Scotia Surgery deal cosmetic
This week’s revelation that our on-its-way-out-turn-on-the-taps Tory government renewed a controversial contract with Scotia Surgery in early June—just six days before voters shoved it onto the political trash heap—was… well, interesting. But not surprising.
More intriguing—and perhaps more telling—was Health Minister Maureen MacDonald’s shrug response. “They’re entitled to sign contracts right up to the day they’re no longer the government,” she blandly told reporters this week, adding with Zen-like detachment: “Things that have already happened, I have to learn to accept and move on, and focus on what it is I need to do.”
You could almost smell the relief in her words.
In March 2008, then-Conservative Health Minister Chris d’Entremont announced a one-year, $1-million “demonstration” project to reduce then-18-24 month wait times for orthopedic surgery. Under the arrangement, privately-owned Scotia Surgery was to perform more than 500 minor procedures at its Dartmouth clinic in order to free time and space in Capital Health operating rooms for more complex cases like hip and knee replacements.
Harrumphed then-Opposition leader Darrell Dexter: “This is being billed as innovative reform, but in fact there's nothing new and nothing innovative about this whatsoever.” He called it “a million-dollar quick-fix… taking money out of the public system and putting it into a private facility,” and added: “This is really about the larger question of public policy, and is it the direction that we want health care in this province to go in?”
Pre-Premier Dexter was right.
But the problem for Now-Premier Dexter is that—at least as quick fix—this one appears to be working.
For starters, Scotia Surgery, unlike many private clinics, operates in concert with the public system. No one gets to jump the queue simply because they can afford to pay. And the clinic’s patients, concedes NDP Health Minister MacDonald, are satisfied with the service.
Given those realities, it would have been tricky for the new NDP government to have simply canceled the contract after they took office in June. The Tories took them off that hook.
But Dexter’s larger questions remains: Will this quick-fix work for the long term? What are the pluses—and minuses—of using private clinics to deliver public services? And is this really the direction in which we want public health care system to go?
Before Scotia Surgery’s oh-so-convenient contract extension comes up for renewal seven months from now, our new government will need to answer those questions.
Copyright 2009 Stephen Kimber
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About
STEPHEN KIMBER, a Professor of Journalism at the University of King's College in Halifax, is an award-winning writer, editor and broadcaster. He is the author of one novel -- Reparations -- and seven non-fiction books.
Buy his books at Amazon.