Healthcare under siege, one more time, by the Mission Creeps

Healthcare in Canada belongs to the public sector. That status is permanently and irrevocably enshrined in the 1985 Canada Health Act legislation. If this amounts to a form of public-sector totalitarianism, we console ourselves with the belief that at least it is totalitarianism that works. That is, it mostly works, most of the time.

Not, however, all of the time, and the fails, when they occur, tend to be doozies. The most recent example concerns the Ontario entity improbably named ORNGE. ORNGE is one, among several, new curiosities that have sprung up routinely in Canadian medicine during the 21st Century. These novel agencies are created within our already byzantine network of health ministries, regional authorities, and other governing bodies—which are themselves often hastily constructed institutions.

These innovative undertakings are devised with laudable motives, with the aim of delivering care more efficiently and rationally, with fewer of the impediments associated with the worn-out ways of yore.

Corresponding to their newness, the incipient healthcare bodies tend to embrace the visible mannerisms of the fast-paced, lavishly financed IT sector—the high-minded mission statements, the extravagant use of consultants, the palatial headquarters, the grandiose management compensation—with only one exclusion. Unlike the IT model, these entities, owing to the Canada Health Act, are funded not with Bay Street capital, but with a portion of your income and ours. It is public dough at risk in these half-formed ventures: money that might otherwise be used, perhaps less imaginatively, for the improvement of care provided to patients, through better conditions for low-wage caregivers, or, dare we imagine, by adding efficacious new pharmaceutical agents to formularies.

But those essentials are regarded in the new climate as passé, if not part of the problem. Somehow our scarce public resources seem not to find their way to exhausted workers, or to breakthrough therapies, but land somewhere deep within the business plan of a dubious new experiment. In this giddy atmosphere, with no oversight from a bedazzled or disengaged governing authority, it is possible for irresponsible or unscrupulous managers of these new entities to quickly burn through a billion dollars of cash with no tangible outcome. That point was illustrated, infuriatingly, through Ontario’s recent, and reprehensible, “e-Health” scandal. And now it is retold, involving several of the same protagonists, through the ORNGE fiasco.

The evidence behind this scandal continues to unfold, with breaking details available online here.

Smitherman, Ontario's ex-health minister

ORNGE is a “non-profit” transport-medicine agency created in 2005 under then-Health Minister George Smitherman. Mr. Smitherman consented to transfer the province’s assets to the startup for the sum of one dollar. According to the group’s website, the chief task of ORNGE is to “link hospitals together enabling access to specialized care for the people of Ontario.” If that sounds a tad non-specific, that’s only the beginning of the problem. As was the earlier case regarding the now-notorious agency e-Health Ontario, ORNGE instantly became affected by a severe case of mission-creep, and the inevitable accompanying symptom, secretiveness.

Ontario taxpayers sank $150 million annually into the operations of this service, only to discover that the air-ambulance operation had altered its intended course. Reportedly, management had quietly established a web of private businesses vaguely affiliated with the non-profit entity, outrageously including a scheme to sell international health insurance to Saudi billionaires. Investigative reporting by Kevin Donovan of the Toronto Star suggests that the province was to receive a three per cent share of the profits of these non-core ventures, while the privately held operation would retain the remaining 97 per cent. The venture has also been marked by stupefying levels of management compensation, with founder Dr. Chris Mazza pocketing $1.4 million as his annual stipend. There are reports of systemic improprieties involving Dr. Mazza and his team, which are now under investigation by forensic accountants.

Ironically, Dr. Mazza, a go-getting former ER physician, is now on medical leave, presumably receiving the full attention of Ontario’s publicly funded healthcare system.

If the ORNGE cock-up can be said to represent anything, it underlines the extent to which the delivery of services has become an unwieldy—bordering on unsteady—mission. It is one thing for the operators of the privately owned HMOs in the United States to rapaciously reward themselves at the same time as denying patients access to medical services. Canadian are continuously reminded by politicians, during elections, that we are better than that. But, are we? For, what does it mean when the Canada Health Act is invoked to dissuade potentially worthwhile private-sector initiatives—only to find that the Act opens the door to allow gross malfeasance by scavenging insiders? You ask: If healthcare is a sacred trust, where is the oversight? Where is the vigilance?

Where, indeed? With operating funds casually depleted by billions, and virtually nothing to show for it, all that’s left now is the 50-year-old dogma of Medicare. For millions of Canadians who are disgusted by the plundering of our healthcare system, and outraged by an absence of accountability at the highest levels of government, pieties and doctrine are no substitute for managerial competence.

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