The Elephant in the room for politics on PEI are healthcare costs. No party can make controlling them, if this means reducing services, an issue. But we are now in sight of the moment in time when if we don't control them, we will fail as a society.
Please let me show you what has happened and what will happen if we don't talk about this in a new way.
I arrived on PEI in 1996 - total expenditure on healthcare that year was $233 million. The estimate for 2010 is $630 million. In 2010 the Province expects to collect $784 million from its own resources and $617 million from the Feds leaving a deficit for this year of $85 million.
The average compound growth rate since 2005 is 11.8%. If growth continues at this rate, the total bill for Healthcare will be $1.2 billion in 2015! It will double to $2.4 billion in only 3 years in 2018.
This is an exponential curve and this is the "shape" that we all have not looked at before. Once growth becomes exponential, then we enter a new realm.
But as bad as this is, it is an underestimate for as the total population ages, the relative use of the system increases at a compound rate as well.
I think that this is a conservative picture of what confronts us.
This graph above shows the rate of spend by age group in the traditional system. Now look below at our demographic mix.
The combination of how we approach healthcare and our demography is the bomb that can blow us all up. The Tipping Point for this is not 3 elections away but 2 at the most. The time to act is now. So what to do?
First of all to get the true numbers out into the public domain - this is what was not done for instance when we looked at the schools. We have to take the crisis to the people first. Islanders have to see the numbers and know what will happen if nothing is done.
We also have to look at the projected revenue. Until now tax revenues and the Feds have enabled PEI to keep up with the relative rise of the healthcare budget. But the slope of the compound growth now will steepen as the effect of the aging population is felt. Also the weak underpinning of the economy means that it is not likely that tax revenues will keep up.
Also our aging population will affect tax revenue too as soon most Islanders will be over the age of 60 and we continue to lose most of ur best educated young.
Our demographic situation works both sides of the income statement.
So when we get the full picture out there - how do we look for solutions?
I don't think that the old ways of simple cuts will work. I think instead that we will have to look at where the dynamics of the system interact. Let me show you a few of these so that you can see what I mean.
Our system today has a number of "norms" that we don't question. We have to question them. Here are just 3 Norms that if changed will reduce our costs significantly.
Manors and or Retirement Homes - The Norm is that when we get old, we go to a manor. The cost of a seniors residence on PEI is roughly $36,000 a year for the residential portion. This is a significant strain on either a family or the state. 5,000 widows in nursing homes at this rate would cost PEI $180,000,000 a year or a third of the current healthcare budget.
The old idea of institutionalizing seniors as the only way will not be affordable. Other ways will have to be considered. At Veterans Affairs, the big push has been to help families keep their parents independent in their own homes for as long as possible.
Another factor is that many of the very old are disconnected from their families. Back in 1991 1/3 of senior women said that their closest family member lived in another town. 50% said that they had no close family member. 50% will come from Rural communities of less than 1,000 people, where there will be no alternative but institutionalization in a major centre. This will only get worse as more and more young leave rural areas or the Island.
I don't have THE solution for this but the norm has to be changed.
Work and Health - The old norm is that when I retire, I will see my grandkids and garden. This will not be enough for many. The easiest path to getting frail and ill as we get older is to no longer have a good reason to get up in the morning. Meaningful work is very helpful. Making it easy to find good work - it does not have to be paid - but it does have to be a help will help.
The new norm is that most of us will have to find work.
Death is a mistake - We spend nearly half the lifetime costs for a person in the last six months of life. So as the population ages this factor will drive the costs significantly. Why is this so and how can we change this?
Our healthcare system is based on dealing with “acute illness”, aggressive intervention is the only choice available to the patient, the family and the medical profession.
Recently, results of an eight-year clinical study of dying in America, (funded by the Robert Wood Johnson Foundation) revealed that half of the 9,105 terminally-ill patients studied spent at least eight days comatose, in intensive care, or in pain just before they died. Little relationship was found between what patients wanted and what, in fact, physicians did. Living wills made little difference.
Death for the elderly is not an acute illness. This is a challenge for both the profession and for families. The choice may often be - do we let mum go with flu or pneumonia or "cure" her to die of cancer or Alzheimer's. Not easy!
Finding a more holistic view of death that most will accept will be an essential new norm.
As I hope you can see, avoiding bankruptcy by healthcare will be hard work. If you thought closing schools was hard - this is will be much more complex.
If we make it political with one party promising that somehow we can go on as we have been and the other trying to do what is right, we will fail.
That is why I suggest that we instead engage each other and the Island with what is coming and what our choices are.
It need not be that we lose but that if we do this right that we gain.
