What's wrong with privatizing health care? Plenty.
That's the blunt conclusion of Health Care, Limited, a new synthesis report on the state of Canada's health care system, prepared for the Council of Canadians by the Canadian Centre for Policy Alternatives.
Its conclusion? "Medicare can either be preserved or privatized. It can't be both."
Released just a few days before the scheduled election debates between the federal party leaders, the CCPA report contains facts and figures on the privatization of Medicare that underline its importance as a key election issue.
Prepared under the guidance of health care analysts Pat Armstrong, Hugh Armstrong, and Colleen Fuller, it reports that the privatization of health care in Canada--some of it clearly in violation of the Canada Health Act--has increased and accelerated in the past decade. It has taken several forms:
- privatizing the costs of health care by shifting the burden of payments to individuals or their private insurance plans;
- privatizing the delivery of services by contracting with private for-profit providers, and by shifting care from public institutions to private households where it is mainly women who are expected to do the work without pay;
- hiring for-profit firms to provide the laundry, housekeeping, food, and other services within hospitals and other institutions; and
- introducing into the health care system management techniques such as re-engineering, "total quality management," and requests for proposals developed by and for the for-profit sector.
The report shows that the for-profit system is inefficient, leads to inequality and inaccessibility, conscripts family members (mostly women) into providing unpaid care formerly provided by hospitals, and reduces democratic accountability because private operators are more difficult to monitor than public institutions. Contrary to the claim of private clinics that they are needed to reduce long waiting lists, the queues for public care actually get longer with greater access to private care.
At the provincial level, the report describes how the approach to the health care "crisis" has varied in different parts of the country, with some provinces taking steps to curb privatization and others actively promoting it--often with the tacit or explicit consent of the federal government.
"The more that Medicare is privatized," says the report, "the more it will come to resemble the largely private, for-profit system in the United States. The many problems that have developed there--documented in many studies--should serve as a deterrent to adopting the U.S. model in Canada." These problems include higher costs, reduced access, an unhealthy fixation on profit-making, and many cases of fraud and corruption.
The report warns that trade agreements such as NAFTA and the General Agreement on Trade in Services are making it easier for large for-profit health care companies to invade our public health care system. It shows how both senior levels of government consent to privatatization.
The report details the underfunding and neglect of health care by both federal and provincial governments, and decries "reforms" that have been motivated more by a market-driven neoliberal ideology than by a genuine concern for the sick or for the mostly women who provide both paid and unpaid care.
"The emphasis has been on efficiency, with efficiency defined in for-profit terms. The application of market principles rationalizes the transfer of services from the public to the private sector. Processed and released from health care facilities 'quicker and sicker,' Canadians are being forced to rely more on the unpaid care of relatives and friends, or, increasingly, on care provided by the for-profit sector...More and more care is coming to be based on ability to pay.
"These 'reforms' could work only if body parts could be treated like auto parts...Instead of privatizing Canada's health care system," the report concludes, "our governments should be revitalizing and rebuilding a public system that recognizes that care parts are different from car parts and that health is a democratic right of all citizens."