The CEO for Okanagan Health Region in British Columbia has been venting his disappointment and frustration in the press and in public meetings over the BC Nurses’ job action in their pursuit of higher wages and benefits. Nobody would question the CEO’s sincere concern for the consequences that the Nurses’ action has on the patient’s and the public’s well-being. It is also reasonable to believe that the majority of our Nurses share the CEO’s concerns, and many are also concerned about stretching society’s sympathies too far.

The real problem is that the strategic issues facing the Healthcare system - although they have been well known for the past twenty years - remain unsolved. The aging population, including doctors and nurses, and gains in science, technology, and how we prevent and cure disease, did not happen overnight! Unsolved, the issues have been allowed to become acute, escalating into adversity and conflicts; wasting tax dollars and ultimately blackmailing society.

Regardless whether healthcare is provided by the private sector or government, the costs of healthcare and other essential services must be paid by economic production and jobs in our business sector; through wages and taxes at our local grocery store, restaurant, car dealer, sawmill, manufacturing plant, etc. A needlessly high cost of healthcare places additional drain on government funds at the expense of other needs in the community. As with any government spending, the cost is ultimately carried by the public and business sector. This hampers economic production and job creation and in the end - good health. Good health is directly related to the socioeconomic conditions in which we live. It is affected by investment in education, in sustainable and internationally competitive businesses that distribute wealth via better paid jobs, and by a strong tax base, a good environment, clean air and water, and importantly a responsible government.

Unnecessary spending in healthcare is at the expense of this and other aims in the community that are the foundation of good health. Good socioeconomic and environmental standards are what good public health entirely depends upon. Our business sector cannot compensate for the high cost of healthcare by paying more taxes and raising prices. That will inevitably erode real income and jobs, and hence the socioeconomic standards that guarantee good health in our community.

To attract investment from investors at home and abroad, British Columbia needs to utilize business potential and create jobs such as in the value added forest sector. That will depend on radical changes to our over 9.2 Billion dollar healthcare system, exceeding 37% of BC’s tax spending -as well as radical changes to our government institutions from the local town hall and up.

This is the vicious circle that needs to be discussed by the CEOs, the politicians, and the bureaucrats. We have a politically driven healthcare system where too little is spent on preventing disease and where the trivially sick are treated at the expense of the really sick.

The outdated fee for service model, where physicians are doing jobs nurses could do, and nurses are doing jobs someone else could do, where politically driven regional decentralization duplicates administration, and poorly developed information technology systems hinder solutions. The system contradicts its own purposes and is in desperate need of renewal, not Band-Aids, but major surgery, to avoid that increased wages, and operational cost is masking unsolved underlying problems.

Lack of planning and timely action is leading to adversity that is fueling the pressure for privatization of our healthcare system, raising costs, and eroding our competitiveness. The boosters of privatization often seem to overlook that the US mixed public and private insurance system, has the highest healthcare cost per capita, which is a serious drawback for US business. At the same time, approximately 44 million people in the US lack health insurance and access to adequate healthcare.

The driving force for privatization in Canada is of course the astonishing amount of money to be made. The Toronto Stock Exchange’s TSE index would go through the roof and fortunes would be added from the privatization of the Canadian healthcare system. There would be little consideration for most Canadians, the small and midsize businesses, jobs, and quality of life in the local community.

The now acute health care problems could have been prevented, taxes saved and invested in the real factors that build good somatic and psychiatric health in the community. The present system is not sustainable, and that is not the nurse’s fault.

They realize that they and their families are also members of the community and share the penalty of a dysfunctional healthcare system. The problems are known and solutions available but nothing of significance changes. Short-term issues and crises continue to absorb resources and make the headlines, but little is done to address the core problems. After decades of ignoring the real issues and avoiding solutions, the Federal Government has formed a committee to study the issues. Unfortunately for the public, the best way to avoid accountability is to ensure that nobody is accountable by forming a committee.

Solving the nurse’s and other job action by paying whatever is asked is easy. Finding sustainable solutions to the real issues is more difficult. But in the long run, the latter is what will influence our overall health, quality of life, and international competitiveness. Will our new government in British Columbia make this a priority? Are they willing to do what is needed or simply what is expedient?

Okanagan Institute for Strategic Development

May 2001