HARPERS GOVERNMENT: PRIVATIZE MEDICARE

Rolf Auer
March 23, 2011
The Canadian Nurses Association and the Canadian Medical Association
released a Nanos Research poll [March 18, 2011] that suggests ! per cent of
Canadians thin" the federal #udget should $a"e health care a top priorit% in
the #udget, co$pared to 3! per cent &ho chose the econo$% and 1! per cent
&ho chose the en'iron$ent(
)*+ealth should #e #udget priorit%, poll suggests,- .loria .allo&a%, The
Globe and Mail, March 18, 2011
[To$$%] /ouglas [10011082, the founder of Canadian $edicare] &as 'oted
"The Greatest Canadian" of all ti$e in a nationall% tele'ised contest
organi3ed #% the Canadian Broadcasting Corporation in 200(
)http455en(&i"ipedia(org5&i"i5To$$%6/ouglas
7It does not matter who delivers health care, it $atters that e'er%one can
recei'e it(,89tephen +arper, Ma% 10, 200 :$% italics;
)http455&&&(&e#(net5<ohc5200fl%er(pdf
M=/>CAR=
?hat do Canadians thin"s of &hen the% consider the 'alue of Medicare@ The%
$a% thin" of *long &ait ti$es, for procedures in hospitals :#ut this is not a fault of the
s%ste$, as &ill #e sho&n;( Most li"el%, ho&e'er, the% thin" of free $edical care on
de$and, &ithout the necessit% to pa% for $edical ser'ices(
All around the &orld, Canada is held in high estee$ for its approach to health
care( Aounded on the t&in principles of uni'ersalit% and accessi#ilit%, the
Canadian approach $eans, in theor%, that the pro'ision of care is #ased on
need, not a#ilit% to pa%( Canadian Medicare e$erged in response to po'ert%,
not plent%( This &as the founding 'ision of To$$% /ouglas, &idel%
acclai$ed as the *Aather of Medicare,, and it has continued to ser'e and
inspire Canadians, &ho rightl% regard health care as their single $ost 'alued
social progra$B( Cu#lic confidence in the s%ste$ has #een regularl% tested4
#efore the ad'ent of Medicare in the 1030s during the .reat /epression- in
the 10!0s &hen negotiations failed to secure federal go'ern$entDs
participation- in the 1020s &hen MedicareDs introduction in 9as"atche&an
&as opposed #% a doctorsD stri"e- and in the 1080s &hen the s%ste$ &as
&ea"ened #% the i$position of *user fees(, =ach ti$e, the *right, to health
care as a #asic right of citi3enship &as challenged, and each ti$e the
funda$ental 'alues pre'ailed( CanadaDs histor% and eEperience displa% a
steadfast desire for eFual treat$ent, re'ealing in the process i$portant lessons
a#out the interface #et&een the health of indi'iduals and the health of their
societ%( We have learned that equity pays off. We have learned that striving
for equity means making sure everyone gets access to the same timely and
best available care, but that sometimes it means that interventions need to be
targeted to the most vulnerable groups. :$% italics;
)Monitor, *MedicareDs core 'alues,, periodical of the Canadian Centre for
Colic% Alternati'es :CCCA;, Ar$ine Galni3%an, Ma% 2002, p( 2
?hat happens &hen a societ% fails to recogni3e the i$portance of eFualit%
#et&een its citi3ens@
>ndeed, it $a% see$ o#'ious that pro#le$s associated &ith relati'e
depri'ation should #e $ore co$$on in $ore uneFual societies( +o&e'er, if
%ou as" people &h% greater eFualit% reduces these pro#le$s, $uch the $ost
co$$on guess is that it $ust #e #ecause $ore eFual societies ha'e fe&er
poor people( The assu$ption is that greater eFualit% helps those at the #otto$(
As &ell as #eing onl% a $inor part of the proper of the proper eEplanation, it
is an assu$ption &hich reflects our failure to recogni3e 'er% i$portant
processes affecting our li'es and the societies &e are part of( The truth is that
the vast maority of the population is harmed by greater inequality. :$%
italics;
)The !pirit "evel# Why More $qual !ocieties %lmost %lways &o 'etter,
*/%sfunctional 9ocieties,, Richard ?il"enson and Hate Cic"ett, 2000, p( 181
+ere are so$e of the ad'antages of CanadaDs pu#lic health care s%ste$, co$pared
to a for1profit s%ste$4
1( The Fualit% of care is #etter, in part #ecause the rich $ust use the
sa$e ser'ices as the poor and thus ha'e an interest in $a"ing sure all
ser'ices $eet a high standard(
2( Ad$inistrati'e costs are lo&er(
3( 9er'ices can #e centrall% planned so that the% are $ore fairl%
allocated across the countr%, especiall% in rural and re$ote areas(
( ?ait lists can #e centrall% $anaged to allo& an efficient and needs1
#ased accessi#ilit% to ser'ices( (Granted, wait times have lengthened
in many hospitals, but this too is the result of a failure to fund and
staff adequately, not an integral defect in the public system itself.) :$%
italics;
!( ?asteful duplication of ser'ices can #e reduced through MedicareDs
central planning(
2( Collecti'e, de$ocratic decision1$a"ing is possi#le, if not al&a%s
practiced(
I( Access is #ased on need, not a#ilit% to pa%(
8( Jo#s and &ages are #etter in the pu#lic sector, especiall% for the
o'er&hel$ingl% fe$ale la#our force that does $ost of the support
&or"(
0( =$plo%ers sa'e a lot of pa%roll $one% through a pu#lic health s%ste$,
&hich su#stantiall% lo&ers their #enefit costs in la#our agree$ents(
10( >nno'ation on a large scale has #een possi#le in the pu#lic s%ste$(
[The in'ention :a$ong others; of insulin &as $ade possi#le through
Medicare(]
The ad'antages of Medicare as a pu#lic s%ste$ are de$onstra#l% clear and
su#stantial(
)Monitor, *CanadaDs pu#lic health care s%ste$ has 10 clear ad'antages
(*ow can privati+ed care be an improvement,),- CCCA, Cat Ar$strong,
Ae#ruar% 2002, p( 10
M=N/ M=/>CAR=@
>s Medicare actuall% in crisis, due to so$e "ind of s%ste$ic failure@
The ?orld +ealth Krgani3ation sees health1da$aging eEperiences as
resulting fro$ *a toEic co$#ination of poor social policies, unfair econo$ic
arrange$ents and #ad politics(, /espite this e'idence, little effort has #een
$ade #% Canadian go'ern$ents and polic%1$a"ers to i$pro'e the social
deter$inants of health through pu#lic polic% action( Canada co$pares
unfa'oura#l% to other de'eloped nations in its support of citi3ens as the%
na'igate the life span( -ur income inequality and poverty rates are growing,
and are among the highest of wealthy nations. .anadian spending in support
of families, persons with disabilities, older .anadians, and employment
training is also among the lowest of these same nations. :$% italics;
)Monitor, *CanadiansD health is $ostl% shaped #% social deter$inants,,
CCCA, Juha Mi""onen and /ennis Raphael, June 2010, p( 12
:!ocial &eterminants of *ealth# The .anadian /acts is a'aila#le for free4
do&nload at http455&&&(thecanadianfacts(org- i#id(, p( 12;
The e'idence points to a $anufactured crisis, &hich &ould usher in pri'ati3ation
)or for1profit)of health care(
[A]n argu$ent has arisen a#out ho& se'ere the Medicare crisis is)or indeed,
&hether there is e'en a crisis at all( MedicareDs defenders donDt &ant to gi'e
the i$pression that the s%ste$ has #eco$e so i$paired that itDs in danger of
collapse( That &ould gi'e co$fort to its detractors( -n the other hand, they
don0t want to minimi+e the serious difficulties that have been caused by the
failure of governments to fund and manage the system properly, to enforce
the five basic principles of Medicare, and to curb the intrusion of private
providers. B( This pri'ati3ation prescription is #eing pushed despite
o'er&hel$ing e'idence that it &ill $a"e health care in Canada $uch &orse,
not #etter)as #ad as the [for$erl%)RA] pri$aril% pri'ate s%ste$ in the
Lnited 9tates, &here 2 $illion people ha'e no health care insurance at all
and $illions $ore are inadeFuatel% co'ered( The eEtent to &hich the foes of
Medicare ha'e succeeded in under$ining it has posed a dile$$a for
MedicareDs supporters( 9hould the% sound the alar$ a#out deteriorating
conditions and thus ris" #olstering the position of the pri'ati3ers@ Kr should
the% tr% to $ini$i3e the deficiencies or e'en dis$iss the$ as inflated or
eEaggerated@ :$% italics and underlining;
)Monitor, *Mending Medicare,, CCCA, editorial, Jul%5August 200I, p( 2
The fi'e #asic principles of Medicare are as follo&s4 :1; co$prehensi'eness,
:2; uni'ersalit%, :3; accessi#ilit%, :; pu#lic ad$inistration, that is, the go'ern$ent is the
single pa%er for all co'ered ser'ices, and :!; porta#ilit%( These &ere enacted in 1028(
:http455&&&(nursesfor$edicare(ca5$edicare5default6e(aspE;
Hno&ing that pri'ate health care is &orse for Canada than its current health care
s%ste$, Medicare, can Medicare reall% #e attac"ed@
?hat the cha$pions and defenders of Medicare ha'e going for the$ is that
its attac"ers ha'e no 'alid grounds for the argu$ents the% $a"e( Their clai$
that $ore co$$erciali3ation of health care &ould sol'e its pro#le$s is so
riddled &ith falsehoods that it &ould #e laugha#le if so $an% people &ere not
deluded into ta"ing it seriousl%( The fight to save Medicare is therefore very
much a struggle for public opinion and support. It0s a contest that can only be
won by the dissemination of truth1the most effective weapon of all. :$%
italics;
)Monitor, *Mending Medicare,, CCCA, editorial, Ma% 2002, p( 2
Cerhaps it could #e attac"ed on the grounds of #eing inco$plete4 that is,
prescription drug co'erage isnDt full% i$ple$ented( Mut thatDs not a fault of Medicare-
thatDs a fault of the go'ern$ent in po&er, :that is, +arperDs go'ern$ent;, failing to enact
the appropriate policies(
The poorest fifth of the Canadian population spends $ore $one% out1of1
poc"et on prescription drugs than the richest fifthB( >nternationall%,
Canadian pu#lic spending on drugs as a percent of total drug costs, or on a
per capita #asis, ran"s near the #otto$ of the list of industriali3ed countries(
The onl% place that consistentl% has a &orse record than Canada is the Lnited
9tates(
)Monitor, *>tDs ti$e to end CanadiansD long &ait for Characare,, CCCA, Joel
NeEchin, /ec( 200I5Jan( 2008, p( 1
+ARC=R, N=KN>M=RAN>9M, AN/ CR>OAT>PAT>KN
B[9tephen] +arper, the first trul% neoli#eral Cri$e MinisterB
)The *arper 2ecord, edited #% Teresa +eal%, pdf, Canadian Centre for
Colic% Alternati'es :CCCA;, *=cono$%, Trade and >n'est$ent4 Aoreign
K&nership,, Mel ?at"ins, 9epte$#er 22, 2008,
p( 102
The current do$inant ideolog% guiding go'ern$ent decision is neo1
li#eralis$(
)The 3olitical e4ine 5 .anada, *The Neo1Ni#eral /og$a Q Canada,,
http455politics(lilithe3ine(co$5The1Neo1Ni#eral1/og$a1and1Canada(ht$l,
Naila A#u1Ja3ar, August 2000
?hat is neoli#eral ideolog%@
Neo1li#eralis$ is a set of econo$ic policies that ha'e do$inated [Canadian]
politics for the last 2! %ears( =ssentiall%, neo1li#eralis$ contains $an%
ele$ents( The foundation of neo6liberalism is a free6market economy, where
there is as little government intervention as possible. !econdly, neo6liberals
aim towards the privati+ation of public services. They argue that the private
sector will deliver these services more efficiently. 7eo6liberals also advocate
for less spending on social services in order to minimi+e government
intervention. :$% italics; K'erall, a neo1li#eral state is one in &hich each
indi'idual co$petes against e'er% other indi'idual 8 e'er%one is out for hi$
or herselfB( Neo1li#eralis$ is credited &ith econo$ic gro&th, #ut it is also
#la$ed for econo$ic and social disasters such as the &idening gap #et&een
the rich and the poor in de'eloped countries, and the current glo#al financial
$eltdo&n that &as created #% the deregulation of #an"sB( >n the past 2!
%ears &e ha'e seen leaders i$ple$ent neoli#eral policies such as the
pri'ati3ation of CanadaDs hospitals, schools, $unicipal ser'ices, co$$unit%
centres, social ser'ices and utilities( The% also pro$ote free trade agree$ents,
&hich ha'e #een descri#ed as *corporate #ill of rights, :Heuhn, 2008401;( >t
also includes the cuts in funding a$ong ser'ices that &ere once funded #% the
go'ern$ent such as education, child care pro'isions and &elfare progra$sB(
>n our conte$porar% Canadian state, 9tephen +arperDs go'ern$ent is as neo1
li#eral as the last( +arper see"s to $aEi$i3e $ar"et oriented 'alues( !tephen
*arper has decreased ta8es for citi+ens while decreasing state funding in
programs such as education and health care ('rown, 9::;#<=). :$% italics
and underlining;
)The 3olitical e4ine 5 .anada, *The Neo1Ni#eral /og$a Q Canada,,
http455politics(lilithe3ine(co$5The1Neo1Ni#eral1/og$a1and1Canada(ht$l,
Naila A#u1Ja3ar, August 2000
9o one can see that pri'ati3ation flo&s naturall% fro$ the +arper go'ern$ent
ideolog%( Medicare presents a con'enient target as it is one of the #igger go'ern$ent
#udget eEpenditures, and it is a 'icti$ of lost taE1cut re'enues(
CR>OAT>P= M=/>CAR=@
?hat follo&s is a discussion of the fla&s of the pri'ati3ation of, in this case,
Medicare, and &h% it isnDt a 'ia#le option(
Ne& initiati'es ha'e sho&n that &aits can and are #eing #rought do&n
Fuic"l% &ithin the pu#lic s%ste$ through changes in ho& treat$ents and
&aiting ti$es are $anaged( >ntroducing pri'ate insurance &ill onl%
eEacer#ate the pro#le$s( The e'idence is clear)and e'en confir$ed #%
[conser'ati'e thin"1tan"] Araser >nstitute econo$ist +er# =$er%)that
pri'ate insurance &ill not reduce costs to the pu#lic s%ste$, #ut it will reduce
access for the 'ast $aRorit% of Canadians( The onl% thing pri'ate insurance
&ould achie'e is to ensure access for the &ealth% fe& &ho can afford high1
pre$iu$ gold or platinu$ co'erage( >t is not a#out choice- it is a#out
pri'ilege and creating a societ% #ased on class differences(
)Monitor, *I $%ths a#out alleged #enefits of pri'ate health insurance
:The%Dre easil% refuted;,- CCCA, /iana .i#son and Colleen Auller, Ma%
2002, p( 18
>n the March 20, 2010 issue of The Globe and Mail appeared this article, *The
pro#le$ of sa%ing no to the sic",, #% Michael Mliss, &hose #%line read, *+istorian and
professor e$eritus at the Lni'ersit% of Toronto(, ?hat &asnDt stated is that Mliss sits on
the Araser >nstituteDs =ditorial Ad'isor% Moard, &hich alread% gi'es an idea of &hat
direction his article is headed( >t opens thus4
Modern health1care s%ste$s donDt &or" 'er% &ell(
Reall%@ >n Michael MooreDs docu$entar% !icko, Moore 'isits a nu$#er of single1
pa%er health care s%ste$s #ased in =ngland, =urope and Japan( All are sho&n to &or"
#etter than that of the Lnited 9tates :pre1K#a$a refor$;( :Aor an article on MooreDs fil$,
see the Monitor, 9epte$#er 200I, pp( 3011(; Ma%#e Mliss $eant to sa%, *The Lnited
9tates health care s%ste$ doesnDt &or" 'er% &ell(, Then MlissD article finishes4
Kur histor% of struggling &ith the pro#le$s of containing the costs of health
insurance suggests there are no practical panaceas, Fuic" fiEes or eas%
ans&ers( ?e can and should reRoice at the &onderful successes that $odern
$edicine and $odern social policies ha'e gi'en us in ter$s of %ears of eEtra
life, health and producti'it%( ?e can Rust as rightl% ring [sic)RA] our hands
at the $ess &e create &hen &e lean on other people to help pa% to $aintain
our personal health(
>n other &ords, i$plies Mliss, pri'ati3eS >tDs the neoli#eral, free1$ar"et solution to
e'er%thingS
?hat is the role of the Araser >nstitute in this pri'ati3ation #lit3@
As the nationDs largest thin"1tan", the Araser >nstitute has the greatest $edia
presenceB( >n 2000, Al#erta health researcher He'in Taft chec"ed the
sources in a Araser stud% that #ac"ed the Ralph Hlein go'ern$entDs plan to
allo& pri'ate hospitals to operate in the pro'ince( The stud% clai$ed that a
sur'e% of reports co$paring pu#lic and pri'ate hospital perfor$ance re'ealed
*the ad'antages to pri'ate pro'ision of hospital ser'ices( Those ad'antages
are lo&er costs and higher Fualit%,, the stud% concluded, *ena#ling $ore and
#etter health care to #e pur'e%ed to Canadians, enhancing health outco$es(,
Mut the e'idence in the stud%, Taft found, didnDt support this conclusion( +e
co$pared the clai$s for the superiorit% of for1profit hospitals the institute
$ade in its stud% against the original research papers it cited( +e found $an%
discrepancies, including papers in &hich the institute ignored findings that
countered its desired conclusion and those in &hich the institute $isreported
their conclusions( 7onetheless, the report received favourable coverage in the
.lo#e and Mail and Calgar% +erald, which ran a positive opinion piece by
.algary !chool professors 'arry .ooper and &avid 'ercuson. :$% italics;
)7ot % .onspiracy Theory# *ow 'usiness 3ropaganda *I>%.?!
&emocracy, *Chapter !4 The Cropaganda Machine >n Action4 the 1000s and
#e%ond,, /onald .utstein, 2000, pp( 1I213
+ence Mliss)#eing a $e$#er of the Araser >nstitute)recei'ing fa'oura#le
co'erage in The Globe and Mail for an article filled &ith neoli#eral, pri'ati3ation
propaganda(
Than" goodness for the s"eptics, ho&e'er( +ereDs one of their follo&1up letters1
to1the1editor :eEcerpt; on MlissD article4
Mar"et forces i$pl% ha'ing choice( >n acute e$ergencies, treat$ents $ust #e
done, here, no&( >n non1e$ergent care, &hat patient "no&s enough a#out
$edicine to Fuestion the doctor@ ThatDs not a free $ar"et( >f doctors stand to
gain significantl%, free $ar"et forces encourage o'ertreat$ent( ?orst of all,
$ar"et forces co$pro$ise the funda$ental principle of professionalis$ in
$edicine4 the pri$ac% of patient &elfare( The challenge of controlling health1
care costs is daunting, if not i$possi#le( Cri'ati3ation and introduction of
$ar"et forces are not the solution(
)3ainful choices, letter to the editor, Ja$es Channing 9ha&, M/- The Globe
and Mail, March 30, 2010
The MC Ni#eral go'ern$ent)&hich is ideologicall% identical to the federal
Tories)is pursuing a health care pri'ati3ation agenda of their o&n( The% o#'iousl% ha'e
al&a%s ta"en their $arching orders fro$ the Araser >nstitute( Kne eEa$ple4 here is a Ma%
I, 2010 @ancouver !un headline4 *Cro'ince #egins to charge user fees for
con'alescence(,
There is a lot of $one% to #e $ade in #rea"ing Medicare( > #elie'e this is the
reason /r( Mrian /a% is pro$oting pri'ate, for1profit clinics( +e is #ringing
the L(9( $odel of in'estor1o&ned health care to Canada, and con'incing
people that this is the onl% &a% to re$ed% &aiting ti$es or other pro#le$s in
our health care s%ste$( +e "no&s this is not true( Re$e$#er4 e'er% doctor
&ho lea'es the pu#lic s%ste$ to &or" at /a%Ds for1profit clinic in Oancou'er
$a"es &aiting ti$es longer( =Epert research e'idence sho&s this seriousl%
co$pro$ises access to care in the pu#lic s%ste$s #% ta"ing #adl% needed
surgeons, nurses, and technicians out of the pu#lic hospitals(
)Monitor, *Cri'ate health care pro'iders ha'e one o'erriding $oti'e4
profits,, CCCA, 9hirle% /ouglas, Ma% 2002, p( 28
There are 10 /a% Medicare pri'ati3ation $%ths #usted in the 9epte$#er 200I
issue of the Monitor, p( 284 *Re#utting the ne& CMAA presidentDs false Medicare
clai$s, #% Michael McMane(
Just ho& insidious is the Araser >nstituteDs influence@
The Araser >nstitute, #ased in Oancou'er, held its thirtieth1anni'ersar%
[200)RA] gala cele#ration in Calgar%, signif%ing the i$portance o'er the
%ears of the Al#erta oil patchDs support( The scene &as the glit3% >$perial
Mallroo$ at the +%att Regenc%, &here 1,200 adoring li#ertarians and
conser'ati'es paid T2I! each)or T200 for a seat at the O>C ta#le)to hear
conser'ati'e politicians Ralph Hlein, 9tephen +arper, Mi"e +arris and
Creston Manning pa% tri#ute to the Araser >nstitute for its success in pushing
CanadaDs political agenda to the right(
)7ot % .onspiracy Theory# *ow 'usiness 3ropaganda *I>%.?!
&emocracy, *Chapter 4 Muilding the >nfrastructure4 the 10I0s and 1080s,,
/onald .utstein, 2000, p( 118
9tephen +arper, a Araser >nstitute acol%te@ >s an%#od% surprised@ Araser >nstitute
head Michael ?al"er once said, *Cri'ati3e e'er%thing( Cri'ati3e e'er% sFuare inch of the
planet(, :The .orporation, docu$entar%, 2003; /o %ou thin" the lin" #et&een the Araser
>nstitute and 9tephen +arper)as &ell as his &ell1"no&n neoli#eral ideolog%)&ould
allo& for an%thing #ut creeping pri'ati3ation of Medicare all o'er Canada@
CKNCNL9>KN
There $ight #e hope(
9o &hile changes in go'ern$ent ideolog% $a% so$eti$es #e a$ong the
causes of changes in inco$e distri#ution, this is not part of a pac"age of
policies intended to increase the pre'alence of social pro#le$s( Their increase
is, instead, an unintended conseFuence of the changes in inco$e distri#ution(
Rather than challenging the causal role of ineFualit% in increasing health and
social pro#le$s, if go'ern$ents understood the conseFuences of &idening
inco$e differences the% &ould #e "eener to pre'ent the$(
)The !pirit "evel# Why More $qual !ocieties %lmost %lways &o 'etter,
*/%sfunctional 9ocieties,, Richard ?il"enson and Hate Cic"ett, 2000, p( 101
9o all &e need is a go'ern$ent that doesnDt pro$ote ineFualit%( 9o all &e need is
a ne& go'ern$ent(