The Supreme Court’s recent decision favouring private health insurance didn’t sound the death knell for Medicare, but it did grease the skids for a faster slide into a two-tier system. Ralph Klein and other neo-con provincial politicians rightly see it as condoning their privatization policies. The big U.S. health insurance companies are slavering at the prospect of fattening their profits in Canada. The wealthy expect to get prompt access to the best medical care, while the rest of us keep trying to cope with a decaying public system.
Is this too gloomy an assessment of the implications of the jurists’ ruling? Perhaps. Hope still lingers that an aroused and mobilized Canadian citizenry will succeed in saving and improving Medicare. But let’s face the reality that, as much as we treasure and support this jewel of our social services, we haven’t been able to prevent the already extensive incursion of the privatizers—nor have we kept the standard and accessibility of treatment in the public system from badly deteriorating.
The Supreme Court’s decision would have been entirely different had Medicare not been plagued with such long waiting lists and other staffing and resource problems. No one could then have been denied needed surgery for a year and been able to make such a strong case to be allowed access to private treatment. The jurists were basically indicting the terrible state of Medicare. They were saying that, if an ailing Canadian couldn’t count on the public program to treat him, he should have the option—assuming he could afford it—to buy the treatment privately.
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:
- 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.
- 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.
- 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.
- De-list tests, procedures, drugs (for seniors): Denied public funding for treatments previously covered by Medicare, patients are forced to pay for private services.
- 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.
- 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.
- 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.
- 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.
(Ed Finn is the CCPA's Senior Editor.)