-Caveat Lector-
C A R I N G F O R P R O F I T
How Corporations are Taking Over Canada's Health Care System
by Colleen Fuller, 1952-. Vancouver: New Star Books 1998 (copublisher:
Canadian Centre for Policy Alternatives, Ottawa), 321 pages,
bibliographic references, index. ISBN 0-921586-59-0
--reviewed 2001 01 28 by Dale Wharton, Montreal <[EMAIL PROTECTED]>
WORLD WAR 2 ended the Great Depression, laying bare one result: health
so bad that it caused 44% rejects among young men called to Canada's
forces. (The Sickness Survey of 1951 exposed two other effects of poor
health: lost production--millions of worker-days each month--and the
"welfare" outlays that emanate from illness, injury, and early death.)
After the war Ottawa feared socialism might expand beyond its usual
haunts, British Columbia (BC) and Saskatchewan (SK). Polls showed 80%
of Canadians craved a national health plan, so health pushed to the
top of policy agendas. Premier Tommy Douglas, following a 1945 outline
from Ottawa, led SK to adopt universal hospital insurance in 1947. BC
did it two years later. Ottawa took until 1957 to pass the Hospital
Insurance and Diagnostic Act (HIDS) over the protest of groups united
against state regulation, social spending, corporate taxes, etc. HIDS
marked federal funds for provinces with universal hospital insurance
as long as they met--a crucial proviso--uniform terms and conditions.
Incomes of physicians in SK were the highest in Canada. Douglas,
seeing $13 million coming into his province from HIDS, announced plans
to shift all health care expenses from the private to the public
sector. His mission: remove financial or other obstacles from access
by any resident to any health service. Battle ensued, led by Sifton
newspapers in Regina and Saskatoon. The press declared 1 July 1962,
when the plans went into effect, "the day when Freedom died" in SK.
Author Colleen Fuller follows and writes about health matters from
Vancouver. Her research yielded 16 pages of notes for this book. Its
14 chapters address historical alliances, a BC and SK freak, the
fight for national medical insurance, medicare 30 years down the road,
recreating health care, the politics of privatisation, the market gets
another leg up, those who pay the piper, managing care, dealing drugs
in Canada, traffic on the information highway, outsourcing the
hospital sector, MDS Inc--Canada's home-grown behemoth, and solutions.
The book has no graphics: neither picture, chart, nor table.
Ottawa marched on. In 1966 the Medical Care Insurance Act (medicare as
diluted by organised medicine and private insurers) swept through the
House of Commons. But a federal deficit loomed over the economy. A
pillar of Lester Pearson's minority government, Finance Minister
Mitchell Sharp, stood against medicare. He contrived to delay its
launch to July 1968--a year beyond the symbolic target, Canada's
centennial. (In 1977 Sharp became deputy chairman for North America of
David Rockefeller's Trilateral Commission. In 1993 he became personal
adviser to Prime Minister Jean Chretien.)
Provincial plans had to be publicly managed (to qualify for federal
funds) but care might be delivered in the private sector. Hospitals
and doctors could not charge patients more than they got from the
province. Complex, yes, but Canadians knew and cherished one thing:
the secure feeling the new regime granted. Since 1971 they need not
endure the pain and damage of malady left untreated. Nor risk-
assessments, means tests, and denial by insurers. Nor financial ruin
by market medicine. Canada's single-payer health insurance proved
itself person by person, day in and day out, a mari usque ad mare.
In 1977 Ottawa passed EPF (Established Programs Financing Act). It
broke the 50-50 health cost pact: cash transfers became unconditional.
That pleased the provinces, but reduced the federal role in social
services. It shook the balance of medicare. EPF let Ottawa cut future
transfers via the budget rather than via policy. (This would lessen
public haggling with the provinces.) Activists built the Canadian
Health Coalition (http://www.healthcoalition.ca) to fight back.
The Canada Health Act of 1984 decreed medicare 1) PUBLIC, nonprofit,
funded and managed by government; 2) COMPLETE, insuring all medically
necessary services; 3) UNIVERSAL, covering all residents without
regard to age, gender, state of health, or income; 4) PORTABLE,
available outside one's home province; and 5) ACCESSIBLE--no extra
billing, no user fees, no means tests, no other barrier to access.
The US public curses the insurance industry, yet Congress and state
commissions favour it. The sector (worth about $2 trillion) is least
regulated among major US industries. It remains free, in effect, from
antitust law and from control of price-fixing, monopoly, and bundling
unwanted extras. In 1988 Chrysler found that health benefits cost $700
for every car made in the US versus $223 for every car made in Canada.
Canada spends upward of $75 billion each year on health care. Such a
figure fires the greed of transnational corporations, particularly in
finance (insurance, speculative capital) and pharmaceuticals. Colleen
Fuller relates some ways profit-seekers siphon public health care
money. She adds that corporate taxes in Canada fell from 51% of total
tax revenues in the 1950s, to 17% in 1985, and to 9% by 1998.
Private societies (not the public) own most of Canada's 850 hospitals,
most of them nonprofit. These receive about 34% of provincial health
expenses, compared to 15% for physicians. Funding cuts have forced
them to close beds (30% nationwide) and to downsize. The public keeps
paying for services that hospitals farm out. The firms that do
outsourcing keep merging. (The largest work globally from head offices
in the USA. Public health millions trickle down across the forty-ninth
parallel.) Contracting out costs communities the loss of well-paying
unionised jobs and career options for a largely female work force.
High-grade health care does not come cheap. Canada cannot afford both
it and corporate profits at the same time. Citizens need to face the
fact, give up their ambiguity, and press issues such as pharmacare. #
--
THESE SITES amplify themes of Colleen Fuller's CARING FOR PROFIT (how
corporations are taking over Canada's health care system):
http://www.healthcoalition.ca Canadian Health Coalition
www.friendsofmedicare.ab.ca Friends of Medicare (Alberta)
www.savemedicare.com Save Medicare (Ontario)
www.ecej.org/wssdsaps.htm Globalism at work (IMF)
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