Communist Russia or Capitalist Calgary?

Why in the richest province in Canada does it take six weeks to get a CT scan? Why in money-money-Calgary does it take over a month to get that scan read? Seriously, that is about three months to get a test done that could have serious consequences for one's diagnosis and treatment!

I swear to you that these motherfuckers (by these mofos, I mean the provincial and federal governments) are purposely sucking money out of the health care system so people will think that public health care doesn't work. I was a sick kid and it was working then....so why isn't it working now? What scares me is that even I (a non-market-worshiper) joke/moan/rage to people that, 'I feel like I'm living in Communist Russia'.

In reality, it is the market system in the absence of other policy and planning, that allows production to outpace social reproduction, lending to the climate of scarcity that we might associate more with our stereotypical images of communist regimes.

I found an interesting article from Canadian Dimension that suggests that much of the health care crisis is owed to the private aspects of the health care system:

Many people like to think of Canada’s health care system as an example of “socialist” medicine. In reality, however, this label does not accurately reflect the true nature of the system.

Of course, it is certainly true that aspects of Canada’s health care system are publicly owned and/or publicly regulated. The public or social character of the health care system is most clearly seen in the principles of universality and distribution according to need (rather than according to wealth or social status). Not surprisingly, the principles of universality and needs-based distribution enjoy the broadest support amongst the Canadian people. They are what Canadians have indicated they are determined to fight to preserve.

At the same time, however, the private aspects of the system undermine its social nature. They effectively erect barriers to access and create a de facto two-tier or multi-tier health care system. The strongest evidence for this is the shortage of doctors in rural and northern areas and in First Nations communities. The absence of a universal system of pharmacare also generates inequities in health care delivery.

Moreover, while some aspects of Canada’s health care system are publicly owned, not-for-profit institutions, the same cannot be said for the health care system as a whole. In fact, Canada’s health care system generates enormous profits for various sections of the capitalist class — like the pharmaceutical giants and manufacturers of medical equipment and supplies. The profits of these companies are greater than any other section of capital. Not coincidentally, the fastest-rising costs in the Canadian health care system are also pharmaceuticals and equipment. In fact, these rapidly rising costs are one of the main reasons that the Canadian health care system is currently in crisis.

Medicare is not really a system of public health care; it is instead a public health insurance plan. It transfers payment for most medical services from individuals to a publicly owned insurance agency funded mainly through taxes (although Ontario recently instituted a system of premiums, as well). This public insurance system covers most basic medical procedures.

However, there is also a wide range of medical ser-vices — like dental care and physiotherapy — that are not funded by Medicare. These are paid for either by individuals or by private health insurance agencies. This privately funded aspect of the system introduces further inequities, as these health care services are distributed according to ability to pay.

For all these reasons, Canada’s health care is more correctly described as a mixed public-private system in which the non-profitable parts are publicly owned, while the profitable parts remain in private hands. This has become a major trend with the rise of neoliberalism, the aim of which is to seek to keep profits high by privatizing the most lucrative sections of the public sector. The growing privatization of the health care system means that ever-larger portions of federal and provincial health budgets are also finding their way into the pockets of capital. This may explain why the business organizations are not complaining as much about the announcement of increased federal spending on health care as they were in the 1990s, when they were demanding that spending on health care be slashed.

Contrary to the claims of the National Post and various right-wing think tanks, then, the crisis gripping the Canadian health care system is not due to the public aspects of the system, but rather to the private aspects.

The main cause of long waiting lists, for example, is a shortage of doctors. This is not the result of the failure of Canada’s public health system, but the failure of the American private health system. For various reasons, the American system of private universities and private health care is incapable of producing enough doctors to meet that country’s demand, so the U.S. is offering extremely high salaries to entice doctors from Canada and various other countries. (Canada has also been guilty of similar predatory practices in regard to India and South Africa.) This problem is compounded by the refusal of provincial governments to significantly expand enrolment in medical schools. It is also compounded by the absence of programs designed to attract medical students from working-class backgrounds, rural areas, or First Nations, who would be more likely to return to their communities to practice medicine.

In addition, most providers of health care in Canada are private entrepreneurs. This is true of most doctors, specialists and the vast majority of medical clinics. Only a small number of medical clinics are publicly or community-owned. The spirit of entrepreneurship gives rise to the problem of professional monopolies: for example, doctors insisting on maintaining an exclusive right to perform procedures that could easily be shared with or transferred to nurse practitioners. In addition, this entrepreneurial — perhaps free-loading is more accurate — spirit also means that the profession is generally hostile to any suggestion that new doctors should be required to perform a period of public service to repay some of the costs of their education. Medical education is heavily subsidized by the public treasury.

It is instructive to compare Canada’s health care system with that of Cuba, a totally publicly owned system. Despite over forty years of a brutal American economic embargo — which not only robs it of material resources but also makes it difficult to import medical supplies — Cuba manages to maintain a world-class medical system. Furthermore, it has no shortage of doctors. In fact, it has over 20,000 doctors working throughout Latin America and Africa, and it is currently training over 15,000 medical students from the poorest areas of the Americas, including the ghettos of the United States. It is also an international leader in preventive medicine and the development of cheap pharmaceuticals. In stark contrast, our health care system is geared predominantly to acute rather than preventive medicine, with the medical profession tending to minimize the environmental and social origins of many illnesses. So, with all our health care spending, public and private, we appear as a society to be sicker than ever. If Cuba can accomplish so much with a fraction of the budget that Canada spends on medical care, just imagine what Canada could achieve if it also had a fully public health care system.

Naturally, there are other factors at play, but any serious examination of Canada’s health care system reveals that it is precisely the private sector of our health care system that is creating the problems — and also blocking any workable solutions to these problems. For instance, the focus on pharmaceutical solutions rather than on preventative medicine occurs largely because of the disproportionate role played by the profit-seeking pharmaceutical industry in our health care system. Similarly, if a national system of pharmacare is instituted while the pharmaceutical industry remains in private hands, it may well ensure broader access to drugs — but it will also actually intensify the health care crisis because even more of the health care budget will end up in the pockets of the pharmaceutical companies.

Last winter’s agreement between the federal and provincial governments on the future of Canada’s health care system was supposed to have reaffirmed the commitment of all levels of government to keeping the system public. Now we have the recent Supreme Court ruling that, in light of long waiting lists for testing and surgery, forbidding individuals the right to obtain private insurance violates Canada’s Charter of Rights and Freedoms. In truth, the Supreme Court ruling is a better guage to where we are headed; the privatization of health care service in Canada is a growing reality. But far from solving the health care crisis, any further expansion of privatization will actually make matters worse. In our view, the solution to the health care crisis is to expand the public sector and eliminate the private sector entirely.

Here, in Capitalist Calgary, the problems of the health care system are further compounded by a market boom that has not been modulated by policies favouring social reproduction. The result is a housing crisis, longer commutes to work, shortage of daycare spaces, three months waits for CT scans, and so on. All in all, for everyone but Big Oil, living here feels a lot like one imagines it was like Communist Russia.

Links:

'Canada Needs a Real Public Health Care System' via Canadian Dimension

Comments

[Grant Neufeld]

You’re right on the money with this post.

The corporate ideologues have been deliberately sabotaging the Canadian healthcare system (especially here in Alberta). Then, as the system crumbles, they claim that it proves that public healthcare doesn’t work and therefore we must privatize.

Sigh.

There is apparently an infinite capacity for evil in the universe.

[Polly Jones]

Fortunately we have you, Grant, to combat the forces of evil!

Hopefully, I will see you out in the community soon if I can get my health somewhat back on track despite the crappy health care system.

[Herbinator]

Hey Grant and Polly.
Good post for bringing this thinking to the public. The perspective is excellent.

I have no objections to a public system especially as it has been so well executed by Cuba. It would be flattering to my Canadian ego if we could export medical assistance to the world.

Still, I have to evaluate attainability as well. A fully public system is not likely to fly here as America and corporates and even our political parties will not champion this tact.

I think consumer-driven health care is attainable, though. People-prioritized health as opposed to medico prioritized health.

[Polly Jones]

I'm not sure that I have as much faith in the consumer as you do, Herbinator. The market system always leads to those with extreme benefits and those with extreme losses.

I do think that we need more public funding for preventative medicine and care-based medicine (like when the docs actually look at you and listen to you and pretend like they care). I know you NDs do that. You need to write a manual for the MDs.

Also, what is this about attainability and the poltico-corps not championing things? Where's the FUCK THE CHR spirit? ;)

[CR]

Here in the US, out of the early Clinton era health-care "compromise," we often end up feeling the same way (Communist Russia) - we have rationing, though it would never be called that, plus somebody's sucking profit out on top.

Funny the drift: we may end up with a socialized medical system after the next election (big business wants out of the duty to provide health care) just as Canada drifts to the market system...

But you're very right about what's wrong with the Canadian system. A little story: my dad (Canadian brain-drain new-American) got a case of the prostate cancer last year. Guess where he had his high tech (and successful) surgery - Toronto. Paying cash. The form of surgery wasn't easily available in the US - but one guesses that there are a few Canadians out there waiting for service that were made to wait so that this clinic could work on the long line of Americans willing to pay for the operation. I went up with him that day - the entire place was full of Americans...

[Polly Jones]

That's a very interesting story about your dad. I am glad that he got the surgery he needed!

I have heard about Massachusetts pushing for a public medicare. Although, my sister who lives in Boston says that the forecasted monthly rates are very high - around three hundred dollars a month! And, of course, people would likely still want additional coverage for prescriptions, etc. if they could afford it. Of course, in Canada, many people do pay for additional coverage as well.

I always have the impression that the medical services in the States are better than in Canada for those who can afford the health insurance. It surprises me that the high tech surgery your dad needed was available in Canada. I would have thought that because of the brain drain, it would generally be the other way around.

[CR]

My dad's issue was an issue of board approval of the form of surgery, which happened earlier in Canada and the US. (This may well be a financial issue as well, as this form of surgery is less invasive and ultimately cheaper than hacking people open, which is the best practice currently available down here... Money is always involved in medical decision making down here, on one side or the other...)

Medical services, in some cases, may be better down here. But they are not available to all, at least not easily... Emergency rooms are in many cases the first and last resort for uninsured people, which is expensive and unpleasant for them and inefficient for the ERs themselves.

Plus... Insurance is costing both businesses and workers more and more money every year, and more and more companies are finding ways not to give health care at all. (Cut full time jobs that come with health care into part time jobs that don't, hire freelancers...)

One horrible effect that this has is the fact that you have a very, very hard time leaving a job to move, look for another one, etc.. For instance, when I finished my Ph.D. and got a job as a professor, I had to pay about $6000 to cover my family for the four month gap between the end of benefits at the old university and the start of benefits at the new one... Which seems a bit silly, but we had a new baby, and every uninsured American is just one major accident away from a lifetime of debt penury (get hit by a car, owe the hospital $150,000 for putting you back together...)

It's a mess, and it will likely be socialized soon. Let's hope both Canada and the US properly fund humane systems that are driven by the welfare of individuals rather than profit....