When the shift hits the fan

Dr. Danielle Martin has practically catalogued the various attacks on Canada’s Medicare system over the last two decades. The Chair of Canadian Doctors for Medicare says that while the arguments continually “shift,” the prescription from the right is always the same – two tier health care and privatization is the answer no matter the question.

She says this shift is part of an ongoing attack that has never resonated with Canadian values, but shows signs of making inroads with Canadian politicians.

At first it was the argument that the rich should have the right to use their money how they see fit and buy their way to the front of the line. Clearly Canadians saw the unfairness and lack of equity in that argument. Then the privateers argued the public system was broken, until the 2004 federal-provincial accord brought down wait times across Canada. Then the story became an aging population would break the bank, until health care economists noted aging only accounted for less than one per cent of health care cost increases, well within the normal capacity of economic growth. Now the latest argument is that health care is unsustainable and about to consume provincial budgets.

Martin tells a story that many progressive health care advocates have been using recently. A family of four sends a child away to university in another province. The remaining child is told they are no longer sustainable as a result. The parents argue that the child used to eat one-fourth of the family food. With the other child gone, now they are consuming one-third of the dinners. When someone argues health care is taking money away from other services, this is essentially what they are arguing. Health care is not unsustainable – tax cuts are.

In fact, the impact of income tax cuts between 1996 and 2002 were felt the sharpest in Alberta, Ontario and Saskatchewan. Income tax reductions in Ontario means the province has $12 billion less each year to fund health care, social services, education and other services. The impact of recent corporate income tax reductions has meant another $2 billion a year gone.

While Canadians may find two tier health care repugnant, clearly some politicians have been listening regardless of the evidence.

The messy consequences include the current federal abandonment of health care, leaving the future of public health care entirely in the hands of provincial governments. Martin calls this the shift hitting the fan.

Without the Federal government participating as an active player, there has been no action on developing national standards for system improvement. Neither has there been a vision for next steps.

Instead of negotiating an accord, the Federal government told the provinces not only what they would receive, but changed the balance by simplifying the transfers to per capita funding. Only one province comes out a winner in that scenario – Alberta.

Without the Federal government at the table, there is no talk of expanding Medicare despite Canada having among the lowest percentage of public coverage among developed nations (next to, of course, the United States).

Martin says that if Canada really wants to be more like Europe, we should be expanding public coverage from 70 per cent to 80 per cent or more, not increasing privatization.

If there is a key to winning this ongoing battle, Martin says we need to recognize the rhetoric, return to our values, use evidence and offer a better alternative.

That includes recognizing where the cost drivers are – most of them in the privately funded portion of the health system, including pharmaceuticals.

Martin says that one of the biggest cost drivers has been increased utilization of health care by all ages – much of it unnecessary.

Not only does private delivery cost more, but it fragments service delivery, making it more difficult to achieve integration and coordination of care.

Canadian Doctors for Medicare are currently mobilizing opposition to the Harper government’s short-sighted cuts to the Interim Federal Health Program for refugees.

The program presently extends health care coverage to protected persons, refugee claimants and others who don’t qualify for provincial or territorial health coverage.

The program is effectively being cut for all but those whose need is of an urgent or essential need. The cut is effective June 30.

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