Winnipeg Free Press
December 21,2001They're prying open medicare
By Frances Russell
The late Justice Emmett Hall, the legendary Father of Medicare, spoke and wrote in a very straightforward black-and-white style that left no shade of doubtful grey.
In the early 1980s, the retired Supreme Court judge was asked by the Trudeau government to take a second look at his creation because some provinces were undermining universality by imposing hospital deterrent fees and permitting extra-billing by doctors. Hall, as usual, didn't mince words.
Universal health care, he said, can only be defended if doctors and health institutions have to choose between being either fully inside the system or fully outside it.
But there are billions of dollars of private profit to be made out of prying open Canadian medicare, long called "the biggest unopened oyster in the North American marketplace". Ideologically sympathetic governments in provinces like Ontario and Alberta are eagerly handing the pliers to corporate party donors. Half-in, half-out doctors and health institutions are not only the "health reform" flavour of the month, they are touted as medicare's "salvation". Private hospitals are opening in both provinces where doctors are free to bill patients directly while continuing to practise within the public system.
Studies by the New England Journal of Medicine, the Manitoba Centre for Health Policy and Evaluation and the Consumers Association of Alberta demonstrate that semi-privatization causes longer waiting lists in the public system and higher costs overall. Private hospitals are less efficient and there is an incentive for doctors to practise where they can earn more.
Not to be deterred, a Senate committee is adding its voice to the privatization clamour. "Is is fair to deny people who can afford to buy health services the right to buy those services?" asks the interim report of the Senate committee on social affairs, science and technology entitled Issues and Options -- The Health of Canadians. The committee, chaired by Liberal Senator Michael Kirby, makes its ideological position in favour of for-profit delivery, user fees, medical "savings" accounts etc. known early and often.
"The committee believes that many of the problems facing the health care sector can be successfully addressed only if the industry is prepared to transform itself into a 21st Century service industry, rather than remaining mired in a 19th Century structure and outlook." Out with the old "outdated" five principles of the Canada Health Act -- universality, accessibility, public administration, comprehensiveness and portability -- and in with the "new" world of profit-driven corporate medicine.
Disturbing as this relentless privatization tub-thumping is for a majority of Canadians, there is cause for even greater alarm because of the interests and outlook of at least three of the senators, especially its chairman. Sen. Kirby is a director of Extendicare Inc., the private nursing home giant based in Ontario, and sits on three of its committees. Sen. Wilbert Keon, the Ottawa heart surgeon, who has written about the need to "change our health care system into a modern business capable of meeting the needs of health care consumers", chairs the clinical advisory board of the Worldheart Corp. And Sen. Yves Morin is currently mandated by the federal health minister to facilitate the commercialization of health research in Canada.
It isn't ethical for individuals who would personally benefit from privatized health care to use their public positions to advance such privatization. Sen. Kirby referred his conflict of interest to the federal ethics commissioner who let him off the hook because his report is not binding on the federal government.
The Canadian Health Coalition, a pro-medicare lobby group, isn't reassured. In its report entitled Extendicare is Not a Model for Medicare the coalition details the company's involvement in the largest nursing home abuse and neglect verdict in Florida history and its withdrawal from both the Florida and Texas markets to lessen its "exposure to litigation".
Records of the Extendicare nursing home in Pinellas County, Fla., showed an Alzheimer's patient may have gone unfed for a month, was not given medication, and did not receive treatment for a bedsore that eventually turned gangrenous, requiring removal of portions of the bone. The patient died. The family provided evidence of chronic nursing staff shortages and falsified records and was awarded $20 million.
The ill and the elderly are not analogous to a consumer strolling a shopping mall looking for a stereo or a sweater. They are, as the U.S. Justice Department said in a report last year, "vulnerable" to those with financial motivations. To commodify health care by placing it in the private profit marketplace is to repeal its status as a core value, to turn a right for all into a privilege for a few and at increased cost.
frussell@escape.ca