Sunday, June 04, 2006

Crisis In Health Care

I’ve deliberately chosen a provocative title for this article, as it is a tactic so often employed by those who are in fact causing the erosion of our single payer, universal, Medicare system.

The most recent report to come out on the Canadian system of health care delivery was published in the May 30 2006 edition of the American Journal of Public Health.

Their study showed the following;

  • over 85% of Canadians have a family doctor, fewer than 80% of Americans do
  • 5.1% of Canadians are unable to pay for needed medication, the US rate was double
  • 13.2% of Americans had unmet health needs as compared to 10.7% of Canadians

“So it would suggest that a universal coverage system is acting to ameliorate some of the discrepancies that are otherwise found in our society.” [1]

The World Health Organization notes that the US spends 15 cents of every healthcare dollar on administration expenses, a Canadian system by contrast uses only 4 cents out of every dollar for administrative costs. If the US moved to a Canadian system their country would save $280 billion dollars a year.

Support for the current system often comes from unexpected sources, for instance, Fraser Institute economist Herb Emery says that private insurance will not reduce costs to the public system, but will reduce access for the vast majority of Canadians. The Canadian Stock Exchange strongly supports universal health care as it gives us a strong economic advantage over the US and encourages investment in Canada.

“As a former premier, Mr. Romanow understood that many arguing for private alternatives were offering the excuse that “our health care costs are eating everything else up.” But he also understood the facts, which clearly show that whether we are compared to the US or the European hybrid experiences, our Canadian single- payer model—even without the major overhaul Mr. Romanow recommended – still provides the best bang for the buck”[2]

With all this information and even large corporations such as the American auto manufactures supporting our method of health care delivery, why are so many trying to convince us otherwise?

Listening to the critics of Medicare, one soon catches on to some key words and ideas. Choice, consumer, alternatives, these are all buzzwords which try to change our thinking from health care as a right to health care as a commodity.

“This shift is evident in the ‘marketization’ of social discourse and social programs… Universities, hospitals, and clients as consumers. But, while citizens have right and duties conferred by the state-and benefits that accrue from these rights-customers have only choices that are defined by their purchasing power. This change from citizen to customer has the potential of undermining the social fabric of the community. It undermines and encourages public institutions to abandon their social obligations.”[3]

Clearly there is support for us moving towards the user pay system. Think of that 280 billion dollars mentioned earlier. There are fortunes waiting to be made and those waiting are not standing idly by. They are doing everything in their power to lobby our governments and to weaken public confidence in the current system.

In the United States the health industry spent more than $300 million dollars on lobbying in 2003, and have contributed $300 million on campaign contributions since 2000.

On the Charter Health Fund [4] website you will find this claim, “In British Columbia, health care costs now consume 43% of the total provincial budget - up from 30% in 1995. A similar situation exists across the country and the Canadian Taxpayers' Federation estimates that unless action is taken, 100% of provincial revenues will be consumed by health care within 2 to 3 decades.” These numbers appear staggering and one would think that economic collapse is imminent, however, as these figures from Ontario show these types of claims do not provide full information.

“…a closer look reveals that total program and operational spending have declined in real per capita dollars. What this means is that while health spending has stayed relatively constant over the decade studied, the rest of the provincial budget has shrunk. It is tax cuts, not health spending that is “eating up the provincial budget.”

In 1994 health care spending as a percentage of provincial revenue was 40.4%, in 2003 it had shrunk to 37.9% without the tax cuts it would have shrank dramatically to 32.5% [5]

Dr. Brian Day is president of the Charter Health Fund, he is also president elect of the Canadian Medical Association [ a vocal lobby group which represents more than 60,000 medical professionals across Canada.] and is part owner and medical director of Canada’s largest for profit medical centre.

Dr. Day was also instrumental in raising money and otherwise supporting the Chaoulli Supreme Court case. Who better then to head the CMA, which is calling for a two-tier health care system? Claiming the current system is ‘ill’ and that only by allowing doctors to opt out and wealthy patients to pay for their own care is the system going to be healed.

Britain has been working with a two tier system and this is what Michael Meacher [British Labour Party] has to say;

“There are two things wrong with this whole approach. First, it’s the wrong mode; there is no evidence that private-sector health is more efficient, cost effective or better-managed, or even that it provides net additional resources. Rather it is ideologically driven, and bought at a high price in terms of the enormous transaction costs and waste that the market has generated. What is needed instead is a genuine public-service model. That does mean tackling the delays and queues that were allowed to develop: partly by the huge extra resourcing steadily coming onstream; partly by greater internal management transparency to drive up standards; and partly by stronger local democratic involvement and a rigorous system of complaints and redress. But at the same time it means restoring the principals of comprehensiveness, universality and equity – and the professional morale that goes with them-that the market has subverted.”[6]

Britain has also been dealing with PFI’s, known as P3’s in Ontario. P3’s mean public infrastructure like roads, schools and hospitals will no longer be public institutions instead there will be for profit ownership of public infrastructure and services. Corporations finance the building and delivery of services and get paid by the public through taxes and other fees. They build it own it and we pay for it. In Britain P3’s cost 53 million pounds just for consultants, and resulted in 30% fewer hospital beds and 25% reduction in staff budgets.

P3’s mean less accountability. In a P3 hospital in Cumberland shortcuts in construction and design lead to;

  • Two ceilings collapsing narrowly missing maternity patients
  • A sewage system which could not cope with number of users, flooded operating theatre with sewage
  • Clerical and laundry staff unable work in their offices because they are too small
  • A transparent roof and no air conditioning means temperatures on sunny days can reach over 33C

In Nova Scotia P3 school deals exempt for profit owners and builders from any legal responsibility for poor construction, wiring or plumbing problems. In a Halifax P3 students and staff used bottled water for over 12 months as the for- profit owners accepted no responsibility for dealing with arsenic in the water supply. In another instance in New Brunswick students were not allowed to hang artwork on the walls or play on the grass as this might “damage the company’s asset”.

Community groups are also affected. The cost of renting a double gym in a P3 school is $75 dollars an hour, contrasted with the publicly held school gym which charges $7.50/hour for a single gym used for youth programs and $30/hour for adult groups.

Also in New Brunswick volunteer labour by parents was required when the P3 school decided it was not their responsibility to unload furniture into the school. “While public-private partnerships are often said to promote ‘the best of both worlds’, for taxpayers they have come to mean public risk for private profit.”[7]

P3’s work no better for hospitals than they do for schools. The PEI government upon realizing that the P3 hospital would cost more abandoned the idea. Brampton didn’t fare nearly as well. The William Osler Health Centre cost $174 million dollars more than if it had been built through public means, came in behind schedule and was smaller than originally planned.

Already there have been labour issues with the P3 trying to cut costs through outsourcing and reassigning of duties. While CUPE Local 146 successfully resolved that issue, it stands as evidence as to the nature of how these institutions will be run. P3’s are really just a way to backdoor privatization.

The Ontario Health Coalition [8] has run plebiscites in Hamilton, St. Catherine’s and St. Sault Marie more are planned. In all 80,000 Ontarians have voted and results from each city thus far have been overwhelmingly in favour of keeping their hospitals public.

These were the results; 97.7% in Hamilton, 98% in St. Catherine’s and 96.2% in St. Sault Marie. These figures combined with these quotes from Mr. McGuinty make one wonder why he is in fact moving ahead with these P3’s:

“We believe in public ownership and financing. I will take these hospitals and bring them inside the public sector.” (May 28th 2003)

“I’m calling on Mr Eves to halt any contract signings when it comes to P3’s. I stand against the Americanization of our hospitals.” (Sept. 26th 2003).

“It does not matter who delivers health care it matters that everyone can receive it.”[9]

In fact it matters greatly who delivers our health care. Under the terms of the NAFTA agreement anything other than a fully public system requires us to open the way for US based companies to compete for our health care dollars.

We must not allow the profiteers to force us into a system, which would add to our country’s debt and drastically change our way of life. We must remind our federal and provincial governments their responsibilities are to the people of this country and to its welfare.

Continuing the theme of treating patients as consumers the Ontario government is also pushing through Bill 36.[10]

“There are some significant dangers in this legislation. While it specifies how the LHINSs, Ministry and cabinet can exercise their powers to order restructuring and indemnifies them from liability for those decisions, it is short on provisions for democratic control, public input, public notice, and principals to guide this health restructuring. For those of us who support an enhanced and strengthened public non-profit healthcare system, this legislation does nothing to extend the public health system or promote non-profit health care. In fact, the legislation promotes privatization in several ways and facilitates the spread of competitive bidding through the hospital system”[11]

The government freely admits it is changing health care from a universal needs based system to one of corporation and consumer.

From the Ontario LHIN FAQ:

“When the LHIN’s are up and running, it is expected that the ministry would function more like the headquarters of a major corporation.”

Governments are not corporations. Governments have a responsibility to care for and listen to the citizens they represent.

Politicians are public servants. We are the public and we have every right to expect our government to serve our needs, not the needs of those who can spend millions of dollars on lobbyists whose objective it is to make them forget their obligation.

Appointed boards will head LHIN’s; these boards are to be hand picked by the government and answerable only to the government, not the community they serve.

When the LHIN’s are in place decisions will be made as to which hospitals can provide the most surgeries for the lowest price, the first five considerations will be:

  • Cancer Surgery
  • Cardiac Procedures
  • Cataracts
  • Hip Replacement
  • Knee Replacement

In the case of the Central East LHIN the population area runs from Algonquin Park to

Scarborough. A senior in Haliburton may be forced to travel, at their own expense, from their home to a hospital in Scarborough for care. Not because it is the earliest opening, but because it is their only choice.

As contracts will be awarded on a competitive bidding basis, services may not stay at any one hospital. This will result in upheavals for all health care providers involved in your treatment. They will have to reapply for work as contracts end, and may have to relocate if their area of expertise moves to another city or town.

A January 2006, Vector Research poll showed that 82% of Ontarians know little or nothing about LHIN’s.

If the public is unaware of LHIN legislation, how are they to know that their health care may soon require more out of pocket expense? “Drugs and medical devices are key areas where new user fees may be introduced as health services are transferred out of hospitals. Patients could potentially pay for entire services out of pocket, which is permitted under the LHINs legislation (section 25.3 of the Act).”[12]

No indication has been given that the government has thought how seniors, who no

longer drive, or any patient who is without a car would travel such long distances for care. No thought seems to have been given to how follow up or emergency aftercare is that same long distance away. No thought seems to have been given to the fact that patients may now be required to have surgery and recover in a community far from home, without friends or family able to visit, and of course no thought or concern seems to have been given as to how patients are to cover these new expenses or to how these changes will affect health care providers. Although these are the initial five considerations, eventually all health care will be subject to these conditions, including maternity care.

At this point there has been talk that women will have ‘booked’ delivery dates. On those dates they will be expected to turn up at hospital to be induced or deliver by C-section. Both these procedures carry much higher risks for both mother and child. Because of the higher risk these types of deliveries require more interventions, so that cost of birth will be considerably higher and births will also be riskier. No doubt that will soon become apparent and more cost will be downloaded onto patients.

The LHIN’s obviously are not local neither are they integrated. Their umbrella does not cover;

  • Physicians
  • Ambulance
  • Laboratories
  • Independent Health Facilities
  • Homes for Special Care
  • Public Health
  • Provincial Drug Programs

Why have these vital portions of the health care system been left out?

If the government were serious about wanting to amalgamate all areas of health care into one cohesive package it would not be leaving out these essential areas.

The government is in fact dealing solely with illness management and not with preventative structures that would actually help alleviate costs to the healthcare system by keeping us healthy to begin with.

Clean water, good housing, clear air, proper nutrition, prenatal care, access to addiction counselling, good jobs, adequate social assistance payments, all contribute to good health outcomes. Is the government putting in place legislations to deal with these important issues? As long as governments do nothing to ensure good health, health care needs will continue to rise.

As long as nothing is done about smog, asthma rates will continue to rise, as long as nothing is done about pollutants in our environment, cancers will continue to flourish, as long as nothing is done to help alleviate homelessness, diseases of poverty such as TB will continue to rise, as long as voters allow government to focus on health care costs and not the serious issues affecting our health, nothing will be done to deal with the root causes of rising health care needs.

We must fight to ensure that our voices are heard; that governments remember whom it is they serve; that health care does not go backwards to a time when want of money also meant want of service. We cannot allow our governments to disregard democracy.

Further Reading and Resources:

Ontario Health Coalition

LHINs email listserve

subject: subscribe LHINS listserve

Ontario Health Coalition

Accessibility Handbook

Canadian Doctors for Medicare

Speak Out Against LHIN’s

P3 hospitals: Murray Dobbin

Nurses open Letter to Dalton McGuinty

Doctors Letter to Dalton McGuinty

Canadian Health Coalition

[1] Dr. Tom Noseworthy, director of the University of Calgary’s Centre for Health and Policy Studies and a founding member of Canadian Doctors for Medicare.

[2] Charles E. Pascal

Romanow, Romanow, where art thou?


[3] John Ralston Saul, The Unconscious Civilization (1995)


[5] Figures from Department of Finance Canada.

[6] Going Private can seriously damage your health service

By Michael Meacher British Labour Party (The Guardian Jan 12/06)

[7] Andrew Coyne, National Post columnist

[8] 15 Gervais Drive, Suite 305
Toronto, Ontario M3C 1Y8

[9] Stephen Harper May 10, 2004


[11] Ontario Health Coalition, Bill 36 Analysis

[12] Media Release FEBRUARY 28, 2006,



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