The Limited Vision of Majority Governments

I spent a lovely day at home celebrating Family Day in Ontario. As I reflected on how much I was enjoying this new holiday, it occurred to me that there are three “creations” of the McGuinty Liberal regime that I believe could be significant in posterity, if only they continue to exist into the future. Whether these “creations” endure is not at all in our control, as citizens, but under the control of government, unfortunately a majority government.

Family Day is a new holiday, celebrated in only four Canadian provinces. Canada is one of ten countries with the lowest annual number of paid holidays by law: http://www.huffingtonpost.ca/2012/05/10/vacation-time-canada-holidays-by-country_n_1506752.html

Considering the role that leisure plays in mental health, there is an argument that Canadians could use extra time off, especially during the winter which is also hard to endure for many. Whether this extra day of winter vacation will be of benefit in the long run cannot be immediately assessed of course, but I suspect that most of us who have the day off are not complaining.

A second innovation of the McGuinty government was full-day kindergarten. Love it or hate it, there is evidence that there is a benefit, especially for children with high needs or whose families are financially poorer. If you want to, you can find research on either side of the argument, but this is a very fair appraisal of the research in a report from the London Free Press: http://www.lfpress.com/2014/04/17/evidence-of-whether-full-day-kindergarten-was-worth-the-15-billon-effort-remains-unclear-four-years-later

The greatest criticism of full-day kindergarten is that families need to have choices and full-day kindergarten may limit parental choices. As well, there is no doubt that there continues to be good evidence that a parent or family member can provide young children with an enriched environment that cannot always be replicated in the classroom. For many families, however, the main choice that may be promoted by full-day kindergarten, especially if you think it is primarily child care, is the choice to have enough money to pay for food or housing because a parent now has access to the workforce. There is some excellent research on the impact of providing parents, particularly female parents, with better access to the workforce: http://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&ved=0CD4QFjAF&url=http%3A%2F%2Fwww.dol.gov%2Fasp%2Fevaluation%2Fcompleted-studies%2F2013-2014-scholar-programs%2F2013-2014_DOL_Scholars_Paper_Series_Gibbs_Chapter.pdf&ei=gFriVM7VHc-rogTo_4DQAQ&usg=AFQjCNGUKiU7zLtyemSOZSr0MbMQSce4qQ&bvm=bv.85970519,d.d24 This elegant study demonstrates the economic impact of having more people in the workforce. Finally, what is most important about all the research is that more is needed, researchers report, not so that this program can be discontinued but so that it can be improved. The Drummond Report, now a few years old, recommended discontinuing full-day kindergarten because of the cost: http://www.fin.gov.on.ca/en/reformcommission/chapters/ch6.html#ch6-e So far, the government seems to be ignoring that advice.

Another innovation of the McGuinty Liberal Government was the introduction of the team model for delivering primary health care. The model had been previously well-researched and the evidence continues to be strong that team-based health care has the best long term outcomes. In the Globe and Mail this weekend, Kelly Grant reported on the Wynne Liberal Government’s decision to stop funding these models to the extent that is required so that every Ontario resident can have access to team-based primary health care. This is the article: http://www.theglobeandmail.com/life/health-and-fitness/health/ontarios-curious-shift-away-from-family-health-teams/article22989363/

I am not going to focus on what a bad idea this is since other bloggers including OMA Past President Dr. Scott Wooder have done an excellent job: https://drscottwooder.wordpress.com/2015/02/03/mixed-messages-about-family-medicine/ although I will note that, once again, the government is ignoring the Drummond report in which recommendation 5-62 was “Make Family Health Teams (FHTs) the norm for primary care and design the incentive structure of physicians’ compensation to encourage this development.”

My concern is the extent to which majority governments can bulldoze good policy to suit their political needs. Each of these three ideas, Family Day, full-day kindergarten, and team-based primary care, is good but all would benefit from a thorough discussion that includes every possible opinion. There seems to be no effective way for opposition parties and stakeholders to meaningfully affect legislation and policy.

If one were to examine the implementation of these policies with a risk management lens, I believe that one would find that the only risks that were managed were the political risks. Why else would Government not listen to small businesspeople worried about an extra day of paid vacation? Why not ask some parents what choices they want? Why not include doctors in decisions about primary care health teams?

We have reached a point where there are no effective checks or balances on a majority government. This has limited the impact dissent can have to improve policy. To me, it limits citizens to their vote in an election, with no opportunity to have an impact other than that vote. That is not enough for, as James Bovard said, “Democracy must be more than two wolves and a sheep voting on what to have for dinner

One thought on “The Limited Vision of Majority Governments

  1. Pingback: Ontario’s Doctors in the News | Ontario’s Doctors

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