The erosion of public health care picks up steam

The president is more than just a spokesperson for the CMA. He or she also has the bully pulpit from which to advocate for policy changes, and Day is a true believer when it comes to private clinics. Past CMC president Dr. Ruth Collins-Nakai was a stealth supporter of private clinics, so the seeds for a change in the CMA's philosophy of health care have been planted for some time. Despite the evidence supporting the effectiveness of a strong public system, doctors supporting public medicare have been fighting a losing battle for several years.

Dr. Danielle Martin of the newly formed group Canadian Doctors for Medicare says the election fight is a lightning rod for the public-private debate in Canada.

She says it is discouraging to see the topic coming up over and over again without resolution, whether it be in major medical reports like the one prepared by Roy Romanow several years ago, or at gatherings such as the annual meeting of the medical association.

"There are forces within our profession that stand to gain from private insurance and from private payment for medically necessary services," says Martin, a Toronto physician and a staunch supporter of public health care.

"Those forces keep coming up and keep attempting to dominate the debate. It's problematic for a lot of reasons. Every time someone calls for yet another debate on this issue, we have to drop everything and yet again restate the evidence, the rationale, the values behind why the system is structured the way it is."

Martin says the endless discussions are distracting doctors from moving forward on issues that really matter to patients, such as childhood health and the looming flu pandemic.

"Instead here we are again, having the same discussion Romanow had, the same discussion Kirby had. Over and over we have these debates."

The reason for the rhetorical deja vu is, of course, money. Doctors operating private clinics stand to make a hell of a lot of it. And the reason these same medical profiteers keep raising their heads is because they know that the public system has been successfully undermined by various provincial and federal governments for years. It is no accident that our once magnificent health care system has fallen on hard times.

It’s important to understand that the erosion of public health care was no accident. It was the intended outcome of a long-term strategy to discredit and undermine it so the door could be opened to private care as “the only alternative.” This strategy was working well even without Supreme Court endorsement, but the June 9 ruling could swell the privatization process from a trickle to a flood.

The plan to undermine Medicare had to be accomplished by stealth. A frontal attack on a program so beloved by so many Canadians would have been politically suicidal, especially when its dubious design was to inflate the profits of big corporations. So it was carried out incrementally, step by step, over many years. Consider its main elements:

1. Cut health care funding. Under the guise of eliminating government deficits, hundreds of millions of dollars were siphoned away from hospitals, labs, medical equipment, and other health care resources.

2. Lay off nurses and overwork those who remain. Many thousands of underpaid, overstressed nurses who survived the layoffs have since fled the profession or moved to the U.S. Without nurses, hospital beds are closed and treatments delayed. The quality of care declines.

3. Give drug companies long-term monopolies. With exclusive rights to manufacture, sell, and set the price of drugs for 20 years and often longer, the big pharmaceutical firms keep drug costs so high they drain funds from other health care needs.

4. De-list tests, procedures, drugs (for seniors): Denied public funding for treatments previously covered by Medicare, patients are forced to pay for private services.

5. Don’t enforce the Canada Health Act. The five principles of this Act, if properly enforced, would severely limit the privatization of health care. By ignoring the Act and allowing the proliferation of private clinics, laboratories, and other facilities (while creating a demand for them by undercutting Medicare), the federal government sabotaged the system it was supposedly committed to saving.

6. Don’t put any money into preventive health care. Helping people to stay well would ease the strain on physicians and hospitals. But this would have averted the present crisis and weakened the case for privatization. So the social causes of ill-health—poverty, malnutrition, inadequate housing, etc.—have been neglected. So has any effort to curb the industrial pollution of our air and water, or the carcinogenic chemicals in our food and other consumer goods.

7. Make it difficult for foreign doctors emigrating to Canada to practise here. Scores of qualified physicians from other countries are kept idle in Canada because of training, language, and other differences that would not adversely affect their patients.

8. Sign a free trade agreement with an “equal treatment” clause. This clause in NAFTA would be triggered if even one private American health insurance company were allowed to set up shop in Quebec. NAFTA would then force the entry of similar firms all across the country.

This carefully planned subversion of Medicare reached its desired culmination with the Supreme Court’s ruling in June. But you might never have suspected it from by the seemingly sincere concern over the verdict voiced by Prime Minister Martin and other federal and provincial government leaders.

“There will never be a two-tier health care system in this country,” Martin piously reassured us. This from the man who, as federal finance minister, ravaged Medicare with his multi-billion-dollar cuts in transfer payments. A man whose own personal physician, Dr. Sheldon Elman, is the president, CEO, and founder of Medisys, the largest private health care organization in the country. (Were you able to suppress your gagging reflex?)

The grim fact is that the almost-completed creation in Canada of a two-tier health care system—first-rate treatment for the rich, inadequate care for the rest of us—is the outcome of an unholy alliance between the medical/drug profiteers and the politicians who do their bidding. It’s another triumph for the free-marketers and their neoliberal agenda.

Well, perhaps they haven’t entirely triumphed yet. But time is fast running out for the millions of Canadians who treasure Medicare and want to preserve and benefit from it.

The successful takeover of the CMA represents a significant victory for the forces of privatization. Once the door is open, our public system will be further undermined by expanding private services, which will siphon off medical professionals from the increasingly starved public sector to private services. This means better care for the wealthy, while the level of care for average Canadians declines.

Two-tier health care is virtually a reality now in Canada. The decades long plan to scuttle public medicare is on the fast track, with a Supreme Court decision under its belt and a friendly face at the head of our most important medical professional organization. The general health of our population, once a considered a national responsiblity which we all shared, is now one more commodity to be bought and sold at the right price.

Update: Andrew at Bound by Gravity takes a more sanguine position on the election of Dr. Day.