Wednesday, April 6, 2016

Hoskins' Millions

I miss those great 1980s comedy movies.

You know, the ones that plunked two or three Saturday Night Live or Second City TV alumni down in front of a camera and let them do their thing. Ghostbusters was obviously the formula firing on all cylinders, and there was the odd stinker (Nothing But Trouble was spectacularly awful), but take any two or more established comics, put them in an absurd situation, and it made for a solid 100 minutes of entertainment, give or take.


One of my favorites from those days was Brewster's Millions with Richard Pryor and John Candy. The ludicrous premise: if Richard Pryor can piss away 30 million dollars in a month and have nothing to show for it, he inherits 300 million. Pryor's character comes up with a series of dumb ideas and intentional bad investments, culminating in a run for Mayor of New York as a kind of mirror-universe/"Bizarro world" version of Donald Trump, trying to convince the public they'd be idiots to vote for him.


If I were writing the screenplay, I'd have suggested a much quicker way to waste money: creating a Local Health Integration Network (LHIN). The Ontario government, growing more beleaguered than Canadians ever thought possible, came up with the idea for LHINs for, uh, reasons. LHINs have proven to be a true rarity, even for government agencies: by design, they are toothless, wholly redundant bureaucracies.

In general, a regional health authority (RHA) is a sub-office of the province/state health Ministry, charged with administration of local health services over a smaller area. The RHA typically has the power to merge or close hospitals, set and approve budgets, and in some jurisdictions run public health services as well.

What are Ontario's LHINs, then? Perhaps a better answer is to outline what LHINs can't do. They don't negotiate what and how doctors are paid; they don't control where doctors work; they don't determine what drugs will and won't be publicly funded; they can't fire Boards or executives of other institutions; and they can't merge or close hospitals. Sure, they can "build partnerships" and "encourage collaboration" (or other buzzword-rich stuff), but it's not like that doesn't already go on without dedicated bureaucracies.

By now you might be asking, what's the point? The most cynical observers guessed the LHINs were there to take heat off the politicians. ER wait times are too long in your hospital? Take it up with the LHIN. Can't find a family doctor? Call the LHIN. Lather, rinse, repeat.

After ten years, however, LHINs can't even do that. And really, why should they? The politicians (and the Ministry itself) are responsible for the scandals, spending, and toxic relations with health professionals. The public will always blame elected officials first, and rightfully so...they're the only ones the public can strip away power from.

So the LHINs haven't produced much in the way of tangible benefits to taxpayers, which isn't anything we should be surprised by given that they were created to do very little. Moreover, the Auditor General slammed the LHINs' kid brothers, the CCAC home care bureaucracies, for waste and mismanagement. You would think it would be a good time for the province to revisit the LHIN, right?


In what MBA schools should use as a case study in the Sunk Cost Fallacy, the government is putting the LHINs on steroids. The LHINs will be taking over the run of home care (no doubt with many of the same people that ran the CCACs so well). There will be new "sub-LHINs" created to improve(?) upon the chronic maldistribution of primary care doctors and nurses. And the LHINs will now be responsible for sending money to public health units, because...well, why not? They still won't negotiate with doctors, or have the power to merge and close hospitals, but they'll be busy...integrating, measuring, collaborating, synergy-fostering, and whatever other buzzwordificating that will divert badly needed money to no useful purpose whatsoever.


With 100% certainty, this plan is going to be the boondoggle to end all boondoggles, because that's what it's designed to create. Health Minister Dr. Eric Hoskins is going way beyond what Richard Pryor would have ever thought possible in Brewster's Millions. He's wasting hundreds of millions for the chance to waste billions.

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