What $41-billion buys

You have to hand it to the provinces. No -- you have to hand it to them. It’s not like they’re going to do anything to earn it.

When it comes to disappointment, the provinces deliver. Every time you think they can’t possibly fall further short of expectations, they surpass expectations of their shortfall from what was expected of them. It doesn’t matter how little was expected. The provinces look upon that as a challenge.

And so to this week’s “agreement” on wait times among the health ministers. To put this in perspective, return with us now to those thrilling days of yesteryear, last September to be exact, when the provinces last reached an “agreement” on wait times, in exchange for $41-billion in federal money. And to put that agreement in perspective, consider how most of the world works.

I make a product, a good or a service of some kind. To induce you to buy it, I promise to deliver it quickly -- as quickly as you like, or at any rate quicker than my competitors. And just to make sure you get the message, I agree to pay some sort of penalty -- “thirty minutes or it’s free” -- if I don’t deliver it on time. These sorts of peformance guarantees are commonplace outside government.

Now consider the situation prior to last year’s first ministers’ meeting. Having notably failed, notwithstanding enormous infusions of public money, to deliver health care in a timely fashion -- timely, as in within the limits of what is medically safe, never mind what patients might find pleasing or even adequate -- the provinces agreed, in return for still more money, to do …. what? To deliver care in a timely fashion? To at least tell people how long they had to wait -- data that has been in almost as short supply as timely care?

No, and no. The provinces were not required to make any immediate improvements in performance as a condition of all that extra cash. Nor were they required to commit to any particular targets for future progress. The only thing they were required to do was to set out what they thought were acceptable wait times for different procedures -- to set the bar for themselves to step over.

Not that they agreed to actually step over it, or even to say when they might. But at least the people of each province would know to what extent their provincial government was failing to deliver care in time to save their lives -- though since each province was allowed to set its own “benchmarks” it would be difficult to make any comparisons. At any rate, the provinces were given 15 months to accomplish this feat. All except Quebec, which reached a separate agreement to do the same thing.

And they couldn’t even manage that. With three months to go, we are now told the provinces might be able to come up with benchmarks for, oh, maybe five treatments. The exact number they couldn’t say. It’s just so hard to collect the evidence to support them, they complained. Never mind that the Wait Time Alliance, a doctors’ group, has already produced benchmarks, presumably evidence-based, for seventeen different types of treatment. But these suffer from not having been tailor-made to each province’s specifications. I’m told people die slower in PEI than they do in Quebec.

However, we are assured that more such benchmarks will be available sometime down the road. As to when these targets will be met, that’s been left for later. I mean the process of setting out a timetable for meeting them is for later -- actually meeting them is for later still. You understand what’s going on here, don’t you? They’re setting benchmarks and timetables for when they might get around to setting the benchmarks and timetables. Not that anyone’s making any promises.

That’s what the Prime Minister bought with our $41-billion -- on top of the $28-billion the previous Prime Minister gave them the year before, on top of the $21-billion they were advanced in 2000. The wait time on defining wait times, let alone shortening them, seems to be whatever the provinces find congenial.

Inconveniently, patients seem determined to die on schedule. A year ago at this time, the Supreme Court was considering evidence, in the Chaoulli case, that wait times had become a threat to life and limb. Since then, the Fraser Institute estimates the average wait for care has shortened by a single day, from 18 weeks to, um, 18 weeks. In its decision, the Court noted that, having established a monopoly as the “single payer” for health care, the state has a special responsibility to deliver care within a medically safe time. But here’s a funny thing: the same monopoly means it has precious little incentive to do so. As the health ministers have just confirmed.

Meeting with reporters afterward, Ontario health minister George Smitherman lectured them, “you need to be a little bit patient.” No, no we don’t.