There is a mantra among those of a right-of-centre ideology that bigger is best and the Ford government has run with that idea since first taking office, announcing plans to meld the province’s 35 public health units into 10 massive organizations, while at the same time cutting provincial co-funding. Under the previous cost-sharing, the province picked up 75 percent of the funding with municipalities (i.e. property owners and, by extension, renters) ponying up the remaining 30 percent. The province changed that formula to 70-30 percent, while offering up short-term funding to dampen ratepayer pain.
The proposed amalgamations would have, in theory at least, created only two health units to service all of Northern Ontario (with some hints of there being only one). Those amalgamation plans were put on hold by the pandemic, and the province has now committed to returning to the original funding split formula of 70-30, but now the provincial minister of health has floated amalgamation 2.0, offering cash-strapped health units who “voluntarily” amalgamate extra funding.
This remains a decidedly bad idea for the North—worse than bad—attempting to coordinate health services across that wide a geographical area will not only put greater strain on limited resources, the concept to service communities with immensely different profiles and needs, holds the potential to create delays and bottlenecks that could prove deadly.
As for the funding formula changes, then-Sault Ste. Marie mayor Christian Provenzano (and practically every municipal politician will confirm) noted, municipal levies are already stretched to begin with. By shifting even greater the responsibility to pay for public health onto the municipalities (with a consequential rise in property taxes), the province was making the housing shortage in the North even worse.
Bigger is not always better and the perceived “efficiencies” to be found in creating ever larger catchment areas would be eaten up (and then some) by the increased challenges of delivering and coordinating services over the vast expanses of the North.
We need only look to the fallout that occurred when the two-tier Regional Government of Sudbury was dismembered and the single-tier City of Greater was created from its pieces to discover the lie within the bigger is better ideology. There are few tighter reins held on the purse strings than a small rural municipality, not always perfect, but very rarely proliferate in their spending. Tax rates in those smaller communities dragged into the new entity soared and few would argue that services in those smaller communities improved apace with those tax increases.
The carrot of increased funding might prove enticing to smaller Northern health units, but it will prove to be of ephemeral benefit to those who depend on timely services in the health field.
The province should puncture this ill-advised trial balloon and let the concept of amalgamating Northern health units quietly fizzle away.
