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This article was published 27/9/2017 (1091 days ago), so information in it may no longer be current.

Opinion

Par for the course.

That’s how Health Minister Kelvin Goertzen and Dr. David Peachey, a consultant advising the province, describe the protests and complaints that have accompanied recent changes to the health-care system.

The minister and the consultant, who met Tuesday with the Free Press editorial board, acknowledged that change is hard, and that, initially, people tend to rage against change until they can see the wisdom and potential net benefits. "It was expected," Peachey said.

They are not wrong. Bold change is so hard that many of the people affected will strenuously object almost as a reflex, without considering the potential benefits.

That having been said, both the minister and the consultant are wrong in their assertion that there is no reason to be concerned about the tone and magnitude of the opposition to changes in Manitoba’s health-care system.

Many Manitobans are still confused about exactly what it is the province is planning and how it is going about delivering the change. This has been exacerbated by what was initially an amateurish communications effort and by the fact that audits of the health-care system, conducted by accounting firm KPMG, have not been made public despite a pledge by Premier Brian Pallister to give everyone a look at the results.

However, opposition to change is not just a consequence of the attempt to reorganize Winnipeg hospitals and reduce the number of ERs. It is also driven by a healthy dose of austerity that is being served up at the same time.

The province calls it a "sustainability" exercise, but strip away the elegant semantics, and what you have is a blatant and arbitrary decision to give health care less money than it needs in its current form.

Goertzen is quick to point out that his government did not cut health-care spending in the 2017 budget. And that is true; health expenditures were forecast to go up by $105 million this year.

However, the Tory government was patently aware that was not enough to help the system absorb the combined forces of inflation, population growth and demographics, particularly our aging population. The end result was an edict to regional health authorities to cut tens of millions of dollars in staff, overhead and — ultimately — clinical programs with little or no direction on how or what to cut.

For the Winnipeg Regional Health Authority, this means a shortfall of $78 million that is being made up through a combination of efficiencies, layoffs and program reductions or terminations. Winnipeggers have seen a downsizing of an effective program to help older women avoid expensive hysterectomies, and the elimination of outpatient physical therapy for joint-replacement patients, along with a host of other, less obvious cuts.

Add it all together and you have two distinct streams of change: broad, systemic changes driven by a need to do more with better outcomes at a more predictable cost; and quick and dirty changes designed solely to cut costs now without any consideration of whether it means more or better service down the road.

As an aside, Goertzen’s insistence that his government has not cut health funding is pretty weak. Remember, this is the same government that accused Ottawa of "cutting" hundreds of millions of dollars from health transfers after the federal Liberal government decided unilaterally to give the provinces a smaller annual increase in funding — three per cent annually, down from six per cent — than they had been receiving. If that’s a cut, then so is the Pallister government’s decision to deliberately underfund RHAs.

The real risk here is that the austerity part of the government’s health policy will undermine, and possibly derail, the promising and more thoughtful systemic changes. Pallister has certainly signalled that there is more austerity on the way.

In his recent decision to float the idea of a health tax, Pallister essentially admitted he does not think he can continue to starve the health-care system of financial resources as he did this past year. He has portrayed the tax — a controversial idea for a politician who thinks taxes are a crime against humanity — as perhaps the only way of avoiding further service cuts.

On the systemic side of the equation, major strides are being made in expanding home-care services to help free up hospital beds and ease the backlog in ERs. New provincewide clinical standards will ensure all physicians working in Manitoba have the same guidelines for ordering tests and scans. Focused efforts at improving procurement policies could lead to lower overall costs for medical supplies. Even the decision to close some ERs has the potential to be a net benefit for the system if executed properly.

Many of these initiatives began under the former NDP government’s watch, which means they are not ideologically driven. Governments of all stripes understand the need to change the way we deliver health care to improve outcomes and slow overall spending.

However, it is unclear why the Pallister government would want to jeopardize the outcome of these needed changes by muddying the water with austerity. The province needs to find a way of slowing the relentless upward pressure on health-care expenditures. But surely that will come from developing better and more innovative ways of delivering services, not by cutting money from the system without any way of knowing the full impact.

Change is hard, and there will always be people that will resist it regardless of its potential to improve our lives. That does not mean you should ignore opposition to change, or portray it as predictable or unavoidable or banal.

The minister, and his premier, would be well advised to listen carefully to what the opponents of change are saying, and let it guide future decisions on health-care funding.

dan.lett@freepress.mb.ca