Doug Ford has promised “whatever it takes” to get Ontario through the COVID-19 crisis. This week, his government delivered an emergency spending plan to rescue our hospitals, health-care agencies and the larger economy.

It’s a promising start, but it doesn’t keep the promise. The bigger problem is that Ontario’s health-care crisis — or more precisely, its blind spots — long predate this pandemic and this premier.

Never mind, for the moment, the short-sighted decisions made by Ford in his first budget — which are only partly remedied in this week’s mini-budget. Those funding shortfalls of a year ago merely compounded the long-term decisions of past decades, laying the groundwork for the perfect storm of a pandemic that caught us short.

This is not the time for recriminations, but it is very much the time for hard truths to help us find our way. Today our hospitals are facing a surge in patients and a shortage of equipment, but also a dearth of funding and a lack of planning.

It is not just the slow starvation but chronic inattention that has hit our hospitals hard. Health-care spending has been rising at seemingly unsupportable rates for decades.

Governments of all political stripes have strived to suppress the growth curve, lest it crowd out other worthy investments such as education and infrastructure. It began not as a partisan spat but an honest policy disagreement among Progressive Conservatives back in the Bill Davis era, when cabinet ministers fought openly over health-care costs and hospital closings.

It continued under subsequent Liberal, NDP, PC, Liberal and PC governments over the past four decades: Control costs, reallocate resources, budget efficiently and “spend smart” while avoiding unpopular tax hikes.

Politicians who tried raising taxes for health care — as Dalton McGuinty did shortly after becoming premier in late 2003 — were pilloried by public opinion. Yet politicians who won power vowing to ramp up hospital spending had to cope with spending curves that quickly veered out of control.

With an aging population, complex diagnostics and ambitious life-saving treatments, health-care costs seemed on track to take up nearly 50 cents of every dollar in government spending. And so every government tried to change with the times.

Just as auto factories shifted to just-in-time delivery to reduce warehousing costs, hospitals adapted to just-enough-time treatments to reduce patient stays. We discovered that knee surgeries could be done in a day and women could deliver healthy babies with fewer overnights.

Now we know the limits of limiting costs. Just as the private sector has been caught short by just-in-time supply chains that freeze up in a lockdown, so too our hospitals have been caught out in a pandemic by capacity limits that were just-barely-enough in the best of times.

But it shouldn’t have come as a complete surprise. The sudden appearance of “hallway medicine” in the last couple of years wasn’t so much due to severe cutbacks as sudden surges in influenza that burdened hospitals unexpectedly (albeit inevitably).

Past governments brought in annual flu shots, available free at local pharmacies, to inoculate the population. But that sensible investment couldn’t insulate the province from the need for prudent funding for extra hospital capacity (even if it came at the expense of efficiency).

Instead of just-barely-enough, we came close to never-enough beds. If the annual flu season could catch us short, it’s unsurprising that a once-in-a-century pandemic would catch us napping.

Ford won power promising to fix hallway health care by blowing up the system. The great disrupter meddled with Cancer Care Ontario and broke up the unloved LHINs (Local Health Integration Networks).

This is not to defend the old system, which encouraged hospitals to reduce duplication through regional co-ordination but also fostered bureaucratization. Yet sometimes the cure really is worse than the ailment, especially if downsizing the superstructure fails to free up money for “front line” practitioners — and only freezes up the system.

The premier proudly declared himself a change agent. But with COVID-19, times changed and Ontario was caught out.

The trouble with disruption is disarray. Not only was the system blown up but funding dried up.

By unilaterally cutting transfer payments for public health, and dialing down increases for hospitals, the premier created an uproar that forced him to back down last year. In the aftermath, there are not only shortfalls and staff shortages, but a disconnect caused by all the disruption.

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The restructuring of regional co-ordination happened at the worst possible time, causing the loss of institutional memory and communication channels when needed most. That is not all Ford’s fault, for he could not have predicted a pandemic, but it generated the double jeopardy of funding shortfalls and structural upheaval.

Against that backdrop — long-term constraints going back decades, and short-term upheaval in Ford’s first budget — Ontario’s health-care system barely saw the pandemic coming this year. Just as it didn’t see SARS coming 17 years ago.

And next time? Whatever it takes.

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