Fight For Medicare Requires All-Out Campaign
By Michele Landsberg
Toronto Star
April 28, 2002
IT'S AMAZING how the three most right-wing provinces - Ontario, Alberta and now British Columbia - are rushing to hammer the nails into medicare's coffin before the health-care commission headed by Roy Romanow can make its final report next fall.
The damage they are doing, slashing and burning the health-care infrastructure, is probably irreversible. That must be calculated. So, surely, are Senator Michael Kirby's interminable "interim" reports, with their forked-tongue obeisance to public health care along with urgings to privatize.
Why is it amazing? We know this is their ideology: Private profit above all. What's amazing is that even their own self-interest will inevitably be harmed by this rampage of destruction. Not the Senate, of course - they're safe in their sinecure, unaccountable forever. But the Ontario Tories, seemingly so indifferent to the suffering and chaos they have caused, will soon feel the sting of public disgust as more voters become aware of the terrible cost of those chintzy tax cuts. (Where's that $200 now, when you can't pay for your daughter's university fees or your aged father's home care?)
Here's the clincher: Gordon Brown, Great Britain's chancellor of the exchequer, has just announced a massive reinvestment in the National Health Service, with a steep increase in taxes to pay for it - and Labour is rising in the polls, while a previous climb in Tory support has been sharply reversed. A full 72 per cent of voters, including a majority of Conservatives, heartily supports the health tax increase. Over the next five years, Britain plans to have 15,000 more doctors; 35,000 more nurses, "home visitors" and midwives; 30,000 more therapists and lab technicians; and 42 new hospitals with 133 more in the works, with an additional 10,000 hospital beds. There will be 750 community health centres, of the sort promised by the Ontario Tories but never created.
So, health-care delivery reform, with higher taxes and a huge increase in services, is bringing Labour more support, not less.
Canadian right-wing ideologues seem oblivious to this news, as well as to solid evidence that every one of their proposed privatizations is a proven flop. Medical savings accounts; for-profit hospitals; internal market competition among hospitals; private, investor-owned nursing homes; user fees - every one has been shown to ratchet up costs while deteriorating the amount and quality of care.
Saskatchewan, for example, brought in user fees back in the '60s, when the thuggish Liberal Ross Thatcher defeated Tommy Douglas. What happened? The poor, the chronically ill and the elderly stopped going to the doctor. The wealthy went more often.
What of private, investor-owned nursing home chains? Last September, the American Journal of Public Health published the devastating results of a massive study of U.S. nursing homes. "Investor-owned nursing homes provide worse care and less nursing care" than non-profits, the researchers said. "Rates of severe deficiencies at investor-owned facilities were 40.5 per cent higher than at non-profit homes ..."
Of course. Profit has to come from somewhere.
Or do you still think, after Enron, Nortel, Teleglobe and the previously wonderful and now private Air Canada, that private enterprise is so much smarter and more efficient than publicly owned services?
Conservatives seem oblivious, I believe, because they are truly indifferent to what the majority wants. They are tuned exclusively to the corporate frequency.
A sobering scene took place two months ago in Ottawa. The committee headed by Senator Kirby, which is portentously examining Canadian health care and issuing frequent briefs from on high, heard from an expert witness.
Dr. Arnold Relman, professor emeritus of medicine at Harvard Medical School and editor-in-chief emeritus of the New England Journal of Medicine, came to Canada at the request of the Canadian Health Coalition (http://www.healthcoalition.ca). He is an expert on what he calls "the medical-industrial complex."
He blasted the commercialization of U.S. health care as the chief source of the system's numerous problems. "It is no coincidence that no health-care system in the industrialized world is as heavily commercialized as ours, and none is as expensive, inefficient and inequitable, or as unpopular."
Relman pointed out that private insurance companies admit that their administrative and "corporate" (i.e. profit-taking) costs run at 15 to 30 per cent. But Medicaid, the U.S. public insurance for the poor and the elderly, has administrative costs of less than 3 per cent.
How did so many people ever buy the lie that private business is more efficient? Maybe it's because private profiteers can afford to buy more media and push more propaganda.
Relman stressed that he is a capitalist and a believer in free markets. But "health care is clearly a public concern, and a personal right of all citizens."
Note his next words: "I am surprised and disappointed by your committee's interim report, which seems to be favouring policy options that increase private market involvement in Canadian health care," he said.
Relman also argued trenchantly for multi-disciplinary teamwork rather than solo competition among doctors, and for salaries rather than fee-for-service. The U.S. has a huge problem with fraudulent Medicaid billing in for-profit hospital chains, he said. "If you want to hear a scary story about for-profit systems running rampant, please ask about that."
But the committee didn't ask about that. Instead, one of the two physicians on the committee, Senator Yves Morin, argued with Relman about private providers and private clinics. He pressed Relman about whether he would eliminate all for-profit facilities and health-care businesses if he could.
"Yes," said Relman. As a scientist, he said, he is evidence-driven. "And no one has ever shown, in fair, accurate comparisons, that for-profit makes for greater efficiency or better quality, and certainly never shown that it serves the public interest any more. Never."
Curiously, not a word of Dr. Relman's evidence was quoted in the Senate committee's latest report. Time will show if his evidence evermakes it into one of Kirby's tomes.
Clearly, if we want to save medicare, it will be up to us to bombard Prime Minister Jean Chrétien, Health Minister Anne McLellan and the Romanow commission with our urgings. We'll have to do it ourselves. Tomorrow is too late to start; the battle is nearly lost.
I'll come back to this subject - but not until the fall; I'm off for the next few months to work on a book.