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PNHP RESOURCES

Resistance to Attacks on Universal Health Care Mounts in Canada

by Linda Gouriluk

Health care was the number one issue for Canadians who went to the polls November 27 to elect a new government but, in Canada, the battle for universal health care is galvanizing outside the arena of electoral politics. Health care activists remain convinced they must organize the public to resist their government to save Canada's Medicare system. While no government could expect reelection on a platform to dismantle public health care, rather than give citizens what they want on this score, the Canadian government has engaged in dissimulation regarding the preservation of Medicare for more than a decade. This has prompted hundreds of thousands of Canadians to become defenders of universal health care.

The current Liberal government's primary method of subterfuge is to make public promises to protect Medicare while simultaneously acting to undermine it. They had taken over this role from the Conservative party after winning the 1993 election. The Liberal's first duplicitous actions were unprecedented cuts to federal government funding of the health care system, despite loud and sustained public protests and eventually, pleas for the contrary. Starving Medicare was part of a plan for the federal government's withdrawal from its responsibilities under the Canada Health Act, the opposite of the platform the Liberals had run upon in the 1993 election.

Like real estate agents that disparage houses to homeowners that refuse a low bid, politicians claimed Canada could no longer afford its health care system and kept on calling it costly.

The entire time that the government made this unwanted retreat from the principles of universal health care, citizens were falsely told that rising health care costs justified "reform." Like real estate agents that disparage houses to homeowners that refuse a low bid, politicians claimed Canada could no longer afford its health care system and kept on calling it "costly." Health care costs politicians claimed to be out-of-control were actually stable. Government reductions in healthcare spending precluded the possibility of such a claim being true. The only health care costs that went up were out -of- pocket expenses for individuals as governments "delisted" services, de-regulated pharmaceuticals and cutback drug plans.

In 1995-96, there appeared to be an attempt to gain a mandate to reform the health care system in light of what can only be called a manufactured crisis. Most likely seeking a mandate the government never received electorally, the Liberals held a series of public discussions about the supposed crisis.

The National Forum on Health conducted the discussions and released a report in 1997. It did not indicate public approval for downsizing Medicare. Although Forum literature suggested to Canadians, for the first time, that public-private partnerships and a role for the private sector ought to be examined, this was not an idea Canadians were interested in discussing. Instead, they talked about improving and enhancing the health care system and keeping a strong social safety net to address the social and economic determinants of health.

In the meantime, the Liberal government deliberately hid from Canadians its plans to sign the Multilateral Agreement on Investment (MAI) at the OECD in November of 1996. The secret agreement, kept from municipal and provincial governments and even some Federal Members of Parliament, would, said critics, undermine Canadian sovereignty as well as health care and other social programs. The secret got out and the MAI was quashed by public protests organized through an international ground swell.

The Liberals also had signed the North American Free Trade Agreement (NAFTA) which came effective on that famous day of insurrection in Chiapas, Mexico, January 1, 1994. NAFTA was a legacy of the previous Conservative government that had also failed, despite pronounced claims to the contrary, to protect Medicare in its negotiations of the Free Trade Agreement (FTA) with the United States. There was tremendous public agitation against these agreements precisely because critics felt that Canadians were going to lose good full time jobs along with Medicare. The Canadian government tried to placate protesters with more promises to protect Medicare but gradually, it has weakened this promise which so many said was lame in the first place.

According to a document recently released by the Canadian Union of Public Employees (CUPE), "Trade Minister Pierre Pettigrew won't offer blanket, iron-clad protection of health care and education from any trade deals. This represents a dangerous retreat from Canada's historic position."

The government fails to inform Canadians of the implications of major restructuring of the health care system that involves inviting large private corporations, many based in the United States, to sit on new independent "private-public" bodies that now administer public funds.

Such a retreat is reflected by the fact that the government fails to acknowledge nor inform Canadians of the implications of major restructuring of the health care system that involves inviting large private corporations, many based in the United States, to sit on new independent "private-public" bodies that now administer public funds previously administered by government departments. Two examples of such bodies are the Canadian Institute of Health Information and the Canadian Health Services Research Foundation.

The passage of Bill 11, a bill establishing private, for-profit hospitals in the province of Alberta last May, is a more blatant act that reflects the federal government's abandonment of its commitment to Medicare. While still issuing continual denials of its disregard for the Canada Health Act and the wishes and needs of Canadians, the Minister of Health has refused to intervene in regards to Bill 11.

Opponents view Bill 11 as a dangerous threat to Medicare because of NAFTA. According to Heather Smith, President of the United Nurses of Alberta (UNA), under the provisions of NAFTA, since business opportunities opened in any one province must be opened up across the country, all Canadians are in danger of two-tiered health care and queue-jumping. In the weeks before its passage, UNA nurses gathered for nightly vigils outside the Alberta Legislature. In Edmonton, a quiet parkland city where deer still wander, the peaceful nurses among others were confronted by police dressed in riot gear.

Smith pledged that UNA, with coalition group, Friends of Medicare, will "make every effort to preserve our universal and equitable health system." They have been joined by Canadians in other provinces and by the Canadian Health Coalition (CHC), a coalition of labour and citizen groups including the Canadian Labour Congress (CLC), the Canadian Federation of Nurses Unions (CFNU) and the National Action Committee on the Status of Women (NAC). They called upon the federal government to instruct the lieutenant governor of Alberta to delay Royal Assent of Bill 11 until the passage of emergency Federal legislation to stop the bill. But Prime Minister Chretin thwarted his own Minister of Health, Allan Rock, by siding with the Alberta government.

Concern about a lack of democracy in Canada has escalated since the passing ofÊ Bill 11.

The Canadian Health Coalition has posted on its web site a "Working Understanding" agreed to by the Federal Government with Alberta in 1996. (www.healthcoalition.ca/working understanding.html ). The document illustrates the forked-tongue syndrome plaguing Canada over this issue. One "key" principle cited is to "Ensure access to a full range of appropriate, universal, insured health services, without charge at point of service." Another reads: "Ensure a strong role for the private sector in health care, both within and outside the publicly funded systems." Such contradictory statements have generated public mistrust. Concern about a lack of democracy in Canada has escalated since the passing of Bill 11.

"The government has no mandate to trade away what we hold most sacred." Judy Darcy, President of the largest union in Canada. Canadian Union of Public Employees President, Judy Darcy, has declared to the half million CUPE membership, and to Canadians via the CUPE web site, that "The government has no mandate to trade away what we hold most sacred (universal health care)."

No Mandate, No Democracy

Government can't get a mandate to dismantle universal health care in Canada butÊ an alliance between the federal government (and some provincial governments) and the private sector is becoming more clear not just by the formation of so-called public-private partnerships and increased rhetoric to support such partnerships but through attempts to get at least the appearance of a mandate by means other than the electoral process.

Province by Province Strategy

Last spring, before Alberta passed Bill 11, the Province distributed copies of the proposed law (which contained falsehoods and contradictions) to each Alberta household. The provincial government spent millions of dollars promoting the bill, clearly an attempt to garner public support that never materialized.

In October, the Saskatchewan government sent out an information package to 400,000 households in the province. Entitled "Caring for Medicare," this twelve page brochure is for use at public forums intended to discuss the so-called health care crisis. This brochure also points misleadingly to out-of-control health care costs. Written in a breezy tone, the transfer of control of public assets to private corporate entities is depicted as harmless.

Colleen Fuller, author of Caring for Profit: How Corporations are Taking Over Canada's Health Care System says, "When public officials talk about privatization, they suggest a benign process but they are talking about corporate controlled health care. If this happens in Saskatchewan, hospital services will be lost and so will outpatient programs. Certain services will disappear in rural areas such as obstetrics, gynaecology, physiotherapy and occupational therapy programs."

The "Caring for Medicare" brochure is excerpted from a longer version posted on the Saskatchewan government web site. Its distribution, along with the passage of Bill 11 and the federal government's lack of intervention, has led to plans for a confrontationÊ meant to stop the attacks on Canada's health care system.

Showdown in Saskatchewan

The Health Care Union Council, a Saskatchewan coalition between unions such as the Saskatchewan Union of Nurses (SUN), the Saskatchewan Government Employees Union (SGEU) and the Service Employees International Union (SEIU) aims to reverse the erosion of the present system that occurred over the last decade. They also plan to do what Tommy Douglas did at the inception of universal health care in Canada: use Saskatchewan as the beach head for a country-wide campaign. The goal is an Rabout faceS in a new effort to do what Canadians have wanted all along, to expand and improve CanadaUs health care system.

According to Rosalee Longmoore, President of SUN, "It is essential that the role of the federal government remain paramount in the funding, planning and administration of Medicare." She admonishes the government for selling out the health care system to corporate interests. "It's imperative that the province and the federal government quit compromising the rights of citizens to control their public services by capitulating to legislation such as Alberta's Bill 11, NAFTA and the General Agreement on Trade in Services (GATS). These are written as irrevocable invitations to import costly, inefficient American for-profit health care delivery corporations."

The Council has wrote a five page declaration that demands that governments recognize that equality rights are essential to good health. Says Barb Byers, President of the Saskatchewan Federation of Labour, "Comprehensive health policy must be linked with policies to reduce poverty and unemployment." The declaration says that achieving "health for all" means increased opportunities for education, housing, paid maternity leave, family income support and increased minimum wages, among other things. The declaration and an action plan was adopted unanimously on November 2 in Regina by the Saskatchewan Federation
of Labour.

It's understandable why the "Caring for Medicare" document has provoked a confrontation in Saskatchewan. Frustration has mounted over a decade. The immediate catalyst comes from the casual suggestion in the package that Canadians just give up on universal health care. This "possible choice" was presented as a legal, benign and somewhat economically pressing policy option in "Caring for Medicare." Yet this effectively means not just turning over care of Canadians' bodies to profit corporations, emulating health care American-style but giving American corporations access to their bodies as a market. Adult Canadians consider Medicare to be a defining feature of Canada's national identity.

Members of First Nations and Quebecois, substantial numbers of whom do not identify themselves as Canadian, also bitterly resent the suggestion that they give up the right to universal health care. The right to health care is a right under the United Nations Declaration of Universal Human Rights, something the Americans still refuse to sign but which is deeply embedded in the moral standards of most residents of Canada.

The "Caring for Medicare" packet reads: "It is time to move toward a private health care system, which allows people to buy the services they need and want, when the public system cannot meet those needs and wants." Nowhere in the package is there any mention of how much US health care corporations will profit from such a change.

Although the long version of the package mentions higher mortality rates in the US, it fails to mention the logical corollary that Canadians are in store for death rates comparable to the US if they "Americanize" their system. The pronounced lack of financial and moral analysis in the package as well as the failure to connect interrelated facts is a major cause of alarm for the Saskatchewan universal health care advocates. Canadians are in store for death rates comparable to the US if they "Americanize" their system.

The author of the package is Kenneth Fyke, a National Advisor on the Canadian Institute for Health Information (CIHI), chaired by Michael Dector. Dector is vice president of US-based APM, Inc., a firm that advises hospitals on how to partner with corporations. CIHI is a major privatization project in Canada whereby huge amounts of public monies are used, according to Fuller, to generate health information that primarily serves commercial interests. CIHI covers roles previously played by government departments such as Health Canada and Statistics Canada. These departments used to provide information to the public as a free service.

Since 1994, relying on consultants to shape Canada's health policy has been a part of a general dramatic shift in public procedures and policy that increasingly exclude the public. CIHI and outcomes measurement is an example. CIHI is funded by 180 partners including private companies such as IBM, Hewlet-Packard, Smarthealth, a subsidiary of the Royal Bank, SHL Systemhouse, a subsidiary of US-based telecommunications giant, MCI, Walmart, Glaxo Wellcome, 3M, and Data General. Measuring outcomes was originally suggested by doctors, nurses and citizens concerned about accountability in the health care system. Outcomes measurement could reveal when unnecessary surgeries were performed e.g. cesarean sections, gall bladder removal, hysterectomies, or, when certain health problems went unnoticed (e.g. environmental illness).

"The direction of outcomes measurement in North America has been influenced more by insurance and pharmaceutical industries than by concerns about accountability." according to Fuller. CIHI sells back health information to the governments as well as to private corporations. Fuller is concerned that community groups such as women health networks or the disability movement are not only not consulted about research parameters but they cannot afford to purchase information they need in order to assess and suggest health
policies.

Individual researchers and reporters may also be at a disadvantage. They may need to rely on government departments for information but these departments have been greatly reduced as a part of the dramatic shift mentioned above. "If you are a member of CIHI's 'Core Plan' (which costs between $8,000 and $160,000 annually) you don't have to pay for bits of information such as the Annual Hospital Survey for which a non-member would pay about $500." says Fuller.

Fuller concludes, "With respect to one of the most important debates in the country how to protect medicare and remove profits from our health care system QCIHIUs role is limited and conservative. The participation of global corporations precludes a more useful role for CIHI."

The Canadian Health Services Research Foundation (CHSRF) was given $65 million in start-up funds in 1996. A public-private operation, CHSRF is described on its web site as structured "to promote partnership and sharing." The site invites partners to join and this requires a financial committment. Their goal is to "Invest between $200 and $300 million in health services research over the next five years and build an endowment to sustain operations for the long term." The language used by the CHSRF promotes privatization and ignores entirely negative consequences of this. By "putting knowledge to work" the foundation intends to improve the health care system by weighing "costs and benefits" and aims to "organize health services to maximize value for every dollar invested."

The web site provides this imperative: "Achieving this goal is not just the government's business - not when private health spending accounts for more than a quarter of the country's health bill - and not when a variety of organizations are concerned with health research. This is everybody's business."

The posting also reads: "The Foundation is an investment in maintaining the best health services in the world." This claim requires some scrutiny since the Foundation reflects the will of the Canadian government when it comes to health care. If health care in Canada is going to go the way of corporate controlled health care as in the United States, then the question arises, does the US have the best health care system?

During the 1990's corporate medicine in the United States has clearly failed to deliver adequate health services to that nation's population. Over 40 million have no health insurance. Deaths due to hospital error caused by cost-cutting hence profit-making activities such as short staffing and using faulty monitoring equipment run at 100,000 deaths annually. Health insurance costs 4 to 10 times more than in Canada but covers less. Pharmaceutical drugs are relied upon in leau of disease prevention programs and often cost four, five or more times as much as they do in Canada.

In order to generate profits, American health corporations have resorted to crime and been successfully charged with criminal offenses.

According to American doctor, Deborah Richter, President of Physicians for a National Health Program (PNHP). In order to generate profits, American health corporations have resorted to crime and been successfully charged with criminal offenses. Major corporations such as Tenet and Columbia HCA were charged hundreds of million of dollars in fines for fraud and other offenses. An especially bizarre case was NME (later called Tenet) which was caught paying bounty hunters to capture psychiatric patients for forced "treatment". NME then released their patients/prisoners on the day their insurance ran out. "Many of them were children who were denied contact with family members." says Richter.

Richter had two patients, a brother and a sister, young people with low paying work and no health insurance. They couldn't afford needed medication for diabetes. Rather than quit work and social life to go on welfare to get health benefits denied to the working poor, they chose to live as long as they could without proper medication. They both died painfully in their early twenties.

Canadian, Kevin Taft co-authored with Gillian Stewart, Clear Answers: The Economics and Politics of For-Profit Medicine published this year. He found that "...there was a striking consistency in studies of health economics: study after study, decade after decade and in country after country has found that health care is a market failure." What this means is that according to economic theory, caring for our health simply isn't profitable. The corollary of this is that if profit is made, then it is at the expense of our health. Taft asks, "If, as the research consistently shows, for-profit medicine cannot be described as being in the public interest, then in whose interest is it?"

The story of Richter's patients brings tears to the eyes of nearly all who hear her tell the story. This tragic story gives the answer to another question raised by Taft and Stewart. "Trust is at the heart of the debate of public versus private health care. People in need of health care must be able to trust that their weakness will not be exploited. Will we be able to trust for-profit clinics and hospitals to serve our needs above their own?"

Canadians are resisting attacks on their health care system now as attacks on the public good Q as attacks against humanity. Some Canadians are unaware of the situation but substantial numbers of health care advocates are armed with knowledge, and now a moral outrage has ignited in Saskatchewan.

Saskatchewan advocates want to rid their province of so-called private-public partnerships that will otherwise pave the way for corporate controlled health care, especially by American corporations that are capable of a swift takeover. A major contract in Health District Number One with US-based Marriott will not be renewed due to public outcry.

Since Saskatchewan still has a high degree of public control over it's resources, it's citizens have an excellent chance of successful resistance. In a world of concentrated corporate and financial control, Saskatchewan is a new kind of battleground that bears watching by the outside world.