[].

    "ACCOUNTABILITY" is a piece bogoid spincrement invented to avoid

    "RESPONSIBILITY" by the Government and it's agents.  

    That is why it takes you a hundred lines to say that accountants
    are accountable but not responsible for the bottom line.

    Stop bullshitting yerself and the rest of us.

Dhu

previous thread snipped

Politicians, unions, lobbyists and activists all talk about accountability,
especially at election time, but this does not mean accountability actually
exists for the public health care system in Canada.  Accountability within
the medical profession exists and does so largely due to professional or
legal demands. Accountability for qualitative and quantatative standards at
the government level is what's lacking. Few people deny this. Most everyone
argues about the best way to achieve it.  The provinces and the feds have
been arguing about wait time standards since the Romanow report in 2003 and
they are only marginally closer to agreeing what that means.

One important reason for this is that responsibility for health care is
split among two levels of government and then within provinces among
different health regions who are responsible for delivery of care (at least
this is the Alberta model I am familiar with). Thus when the overall
standard of care slips in Calgary or Ottawa or Halifax, who's actually
responsible? The health care managers at the regional level? The provincial
government bureaucrats? The provincial politicians? The federal bureaucrats?
The federal politicians? Split jurisdictions have also given rise to local
professional colleges and associations which act as a barrier to mobility
and entry into the profession from external sources. (More on this later)

As I see it accountability has several important parts. First,
accountability requires clear,  identifiable and attainable standards.
Second it requires that healthcare suppliers, public or private,  are
provided with or attain the means to meet those standards. Third, that there
are both incentives for reaching standards and punishments for failing to
meet it.  The first requirement is relatively easy compared to the second
and third. Especially for governments. Sure politicians can be voted out of
office for failing to meet voter expectations on health carer but that
typically takes time and voters' memories are short. And just because a
government fails on the health file doesn't mean they're not doing well
elsewhere or can't bribe the electorate with a few baubles (See Paul Martin
and Ralph Goodale's recent budget if you don't believe me).  For example,
federal and provincial deficit cutting in the early 1990s exacerbated
problems in the health care system yet rarely were these governments voted
out and then usually only long after the damage has been done. See the
Harris government in Ontario, the federal Liberals and the Alberta Tories
for examples.

One of the draws of the private system is the (theoretical) ability of
governments to impose standards on what are essentially private contractors.
If Company A is given a contract to manage Hospital B then the government
can include financial incentives and penalties within  the contract to help
ensure the quality of service (again, theoretically). Thus Company A has
good reason to meet its contractual obligations. The BC government, for
example, recently penalized Maximus, the private company that manages the
province's MSP program for failing to address shortcomings in its telephone
access service.  Most people saw this as a failure of privatization
but missed the point that at no other time in the history of public health
care had the province been able to enforce standards in this way. The
penalties were imposed when Maximus failed to meet standards for telephone
access. The company has been fined in each of the four months it has been in
operation. I'm willing to bet that Maximus improves sooner rather than
later.

(citation:
http://www.tricitynews.com/portals-code/list.cgi?paper=74&cat=23&id=534002&more=).

Despite this benefit, I don't think that moving to a fully privatized health
care system is the answer. We moved away from this type of system 45 years
ago precisely because it has serious drawbacks. More precisely I don't think
that private medicine is necessarily the FIRST answer to Canada's health
care woes. The question is whether or not there is a way to achieve a
government-to-contractor like relationship within health care that provides
the benefits of contractual accountability and standards yet preserves
maintains health care within the public sphere? One of the most important
changes that could be made is streamlining responsibility for health care.
In short, the responsibility for health care should be reversed, meaning
that federal
government should be made fully responsible for all aspects of health care.
Responsibility would neither be delegated to nor delivered by the provincial
governments. Instead health care services would be the responsibility of
federal crown corporations or some similar yet better regulated entity
within each province and territory.These health care crown corporations, for
lack of a better description, would have to be insulated from such political
tinkering like patronage
appointments but still fall under the federal government's regulatory and
auditing power. (Crown corporations fall outside the jurisdiction of the
Auditor General so they are not the best solution). Yes this means a
constitutional amendment but it is one I believe Canadians would largely
support.

One benefit of nationalizing public health care (and let's face it, the
Canada Health Act is an attempt at doing so within the Canadian
constitutional framework) is that responsibility and accountability are also
streamlined. The prime minister and the governing party can no longer pass
the buck to the provinces for the state of health care and the provinces
cannot blame Ottawa. The federal government would be able to establish true
national standards and have the means of enforcing them. A second benefit
would the creation of a national standards for medical professionals and
national requirements rather than 10 different bodies and 10 sets of
regulations. Another benefit is that a department of Health Care Auditor
General of some similar body could be created with the sole purpose of
ensuring standards are met from province to province. I would also advocate
on a separate health tax, one that is clear and transparent and used solely
for health care.

I realize that this is not a perfect answer and is fraught with
difficulties. The question to ask is it an alternative to the public health
care mess we have now and the privatized mess politicians are looking to
give us?

pc