Pellerin: Why do we tolerate the underfunding of public health care?

The weekend surgery arrangement at Ottawa’s Riverside hospital campus raises the question of why nurses and others aren’t being paid properly under the current regime.

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The news that empty operating rooms at the Riverside Campus of The Ottawa Hospital are being used for weekend publicly-funded-but-privately-delivered surgeries reminds me very much of Denys Arcand. I don’t know if he meant it to be, but his 2003 film, Les invasions barbares, was almost painfully prescient.

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In that film, the sequel to Le déclin de l’empire américain, which earned many awards including the Oscar for best foreign-language film, one character becomes terminally ill and his son finds a way to transform a vacant hospital floor into a private palliative care unit, using resources that taxpayers bought but failed to keep operative (as it was) through chronic underfunding. The poaches nurses and other personnel, too.

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The only thing that has changed in the 20 years since the film came out is that public health resources are even more stretched — and open to being diverted to for-profit interests.

There are now 2.2 million people in Ontario without a family doctor, including about 150,000 in Ottawa alone. A recent report by the province’s Financial Accountability Office says that the average wait at emergency for patients who get admitted to the hospital (in other words, for people who were right to go to ER, as they actually did need to be in the hospital) was 20.9 hours, the longest average wait time in over 15 years. We’re so deep into scarcity that we’re becoming unable to think rationally about what we’re doing to our system. We’re only thinking about quick fixes that make problems worse.

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Can anyone blame orthopedic surgeons and staff working weekends for giving new knees and hips to people who’ve been waiting for months if not longer?

Nope. But that’s the wrong question.

Why do we have empty operating rooms and so many people waiting in pain? Because we don’t have enough staff. We don’t have enough staff due to chronic underfunding. We know this. The right question to ask is: why do we tolerate it?

The problem with stories such as the Riverside knee-and-hip weekend surgeries is that they use resources that should belong to the public sector. Reports suggest registered nurses have been offered as much as $750 per day to work those weekend orthopedic shifts, $550 a day for registered practical nurses, and $600 a day for clerical staff.

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Yes, of course I’d take it if I were them. Wouldn’t you?

But then what happens when people naturally need a break? Which shifts get dropped? The less remunerative ones, obviously. That’s what you do in a market when you have options. You choose the best ones for yourself.

We already have critical staffing shortages in health care. The Ontario Nurses’ Association says The Ottawa Hospital alone has more than 500 nursing vacancies. A new report from the Ontario patient ombudsperson says grievances about staff shortages and lack of access to care make up the bulk of the 3,000 complaints the office gets every year.

Why would we exacerbate that problem on purpose?

When you have waiting lists for surgeons and operating rooms that are unused, you shift public resources to use the rooms needed to clear the surgery backlog. Don’t tell me it can’t be done. People are doing it now — proving that when you offer staff better working conditions, they show up. Even on weekends.

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If we are going to have a public health-care system, we’re going to have to manage it so people want to keep working on it. Do not continue to offer working conditions that make them quit or go to work for private agencies or in private weekend-care delivery.

Two decades ago, an award-winning filmmaker offered us a dark vision of what happens when we stop thinking about systems and only see a few quick fixes that aren’t. We didn’t have to let it happen in real life, and we don’t have to keep putting up with it now that it’s here.

Brigitte Pellerin (they/them) is an Ottawa writer.

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