The dark side of the Canadian Healthcare systemÕs decline


Dorothy Guellec

My

wise uncle told me that the real meaning of Globalization “is to make the

world safe for the American and other multinational corporations to penetrate

and take over as much as the world’s economy, country by country, as

possible”. He is right, and this is why the once sacred Canadian healthcare

model is in trouble right now.

How

did this happen? Who is responsible? Who is suffering? What is the future going

to be? I will try and look at some of these questions. The answers are very

complex indeed; so do not anticipate an easy solution. My commentary has leaned

heavily on the work of Colleen Fuller and her wonderful book “Caring for

Profit: How Corporations are taking over Canada’s Health Care System “. I am

deeply grateful to her.

Canada

has enjoyed a single payer system for 30 years, and there are many citizens who

have never even seen a bill for services. The machinations at hand to try and

dismantle this hybrid system known, as “Medicare” is a real shock for most

Canadians, and they are understandably mystified, apathetic or catatonic. The

corporate powers that were interested in infiltrating the Canadian system had to

convince the people that making a profit from healthcare was moral. They also

had to also deal with the “entitlement mentality” and with the notion that

healthcare was a universal right. These positions held so long by Canadians were

“undermining efforts to deal effectively with the problems besetting the

economy, in particular the deficit.”

By

1971 all provinces had established a system of public health insurance. 

The provinces had chosen not to rigidly define which services were covered or

not covered. Thus, there were many gray areas and the public was left with a lot

of questions about how this very complicated system worked. To qualify for

federal funds, services had to be administered in a non-profit fashion. This

does not mean that physicians worked on salary for the government. They were

free to bill the province for services to patients. The introduction of Canadian

Medicare in 1966 did not exclude private entities from delivering health-care.

The Canada Health Act used the terms “medically necessary” in its criteria

in 1984, “a caveat that enabled private insurers to develop, then expand a

market niche in supplementary health benefits.”

So

briefly what happened? First was the removal or “delisting of medical services

from public health plans and the increased deductibles for prescription

drugs.”

This

allowed the private sector to step right in and expand and encouraged global

pharmaceutical companies to do the same. Many Canadians viewed delisting as a

threat to universality, private interests thought it was a “boon,”

predicting” the potential for millions of dollars of new business.” Second,

Corporations managed to get across the idea that spending on health should be

reduced, so individuals who want to spend can do so on their own rather than

adding to the deficit. The tortured history of the intrusion of private

companies such as Liberty Mutual and Blue Cross mark the beginning of the slide

into the privatization of the health sector. Boston-based Liberty Mutual is one

of many examples of “cross-border harmonization or integration, of North

America’s insurance industry.  U.S. insurers such as Aetna, Prudential

and Mutual of Omaha spent a good part of the last two decades on the acquisition

trail in the U.S. Then there was NAFTA!  Strangely, John K. Iglehart who

wrote “Revisiting the Canadian Health Care System” in the New England

Journal of Medicine –June 29,2000 did not in 10 pages put any blame on the

encroaching NAFTA mentality spearheaded by the U.S. A few years after NAFTA came

into being one could hardly notice any international boundaries that once

governed the insurance industry. The sale of Ontario Blue Cross to liberty

International, a subsidiary of giant U.S. company Liberty Mutual was “made

possible by the Canada-U.S. Free Trade Agreement and by NAFTA. These trade deals

had removed a law imposing a 25% percent ceiling on foreign ownership in the

insurance industry” You can see where all this is heading to: one big common

market here (Canada, the U.S. and Mexico) to rival the European EEC. Health

companies in Canada are being fueled by the almighty dollar. Although Ottawa has

declared its commitment to Medicare (the Canadian one payer system) and the

principles of the Canada Health Act, “these pronouncements are contradicted by

deep cuts in federal funding and the strengthening of policies specifically

designed to assist corporations investing in the sector.”

The

Canadian Medical Association and its provincial divisions have warned Canadians

about what they refer to as “passive privatization.” This would create a

second tier of medicine for the wealthy. Most people would suffer with this kind

of arrangement because the federal funding would decrease gradually as it has

been. The CMA’s (Canadian Medical Ass’n) position is for the citizens to

face up to the cuts to the provinces by the federal government and allow policy

makers “alternative sources of funding,” which is nothing more than “a

veiled reference to the private insurance industry.”

In

the U.S. by the middle of 1994 more than $100 million had been spent on a

campaign to defeat a movement for single payer. “Newspaper editorials and

columnists across the country (especially those in the New York Times, four of

whose twelve directors sat on the boards of insurance companies) defended the

record of private enterprise.” By mid 1997, more than 75% of all HMO’s in

the U.S. were operating as for-profit managed care companies, up from 18% in the

early 1980′s. That’s a staggering statistic, and all this was unregulated,

unobserved, undebated.  It represented the “largest transfer of

charitable assets in U.S. history.” But Medicine is fundamentally something

else entirely, or should be. A British physician more than a century ago wrote:

If all professions have their safeguards they also have their temptations, and

our own is no exception…..Unfortunately the game of medicine is played with

the cards under the table. Whether a clergyman be a good preacher or pastor,

whether a barrister conducts a case well or ill, whether a tradesman sells good

soap or bad, is not only a matter of which the public can form some fair

judgment, but also these transactions are, so to speak, in market overt. In the

intimacies of medical counsels, on the other hand, who is there to note the

significant glance, the shrug, the hardly expressed innuendo of our

brethren….Thus we work not in the light of public opinion but in the secrecy

of the chamber.

The

big loser in this debate has been the patient whose health is being sacrificed

because of competing political ideologies. Policymakers say that they can no

longer afford expensive technologies, demand, an aging population and the poor

economic situation that we have today. They also want to amend the Canada Health

Act to allow for private clinics and services, where only private moneys are

exchanged. This would create an unequal system, not to mention the intrusion of

the profit mentality, shareholders, the bottom line, and all the rest that goes

with the corporate mentality

In

the Z forums someone from Quebec wrote, “I read tons about this subject, and

everyone I know from any social class (I’m friends with squeegee kids, sex

workers, MBA graduates, business owners, welfare moms, cashiers etc) is

depressed and resigned that there’s nothing they can do. This is largely due

to the fact that they have no idea why any of this is happening.” He goes on

to say that most people can’t ask or answer basic questions about NAFTA or

free trade. I guess they can’t internalize the idea that they have been sold a

bill of goods.  NAFTA is all about minimizing costs and maximizing profits

for the private sector, moving factories to Mexico, putting US and other

American based unions out of work, and destroying social programs that have been

in place for decades all over the world.

                              

yes”>   

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