The dark side of the Canadian Healthcare system's decline

By Dorothy Guellec, Z/Znet Commentaries, 19 July 2000

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.

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