Canada: Public vs for-profit health care
by Doug Allan The Canadian public has said "no" to the erosion of universal, single-tier public health care. Indeed, popular pressure forced a recent Canadian Royal Commission to propose expansion of the public system. The Canadian system provides hospital and medical coverage for all. The richest and the poorest may well be seen by the same doctor and treated at the same hospital. Despite the universal nature of the system, costs are much less than in the American system. Forty years ago, the Canadian system resembled the American system. Now Canadians see universal public health care as one of the country's defining accomplishments. Despite endless corporate campaigns to erode confidence in public health care, the Royal Commission promotes publicly funded health care and recommends its expansion. Some home care services would be incorporated into the Canada Health Act and covered as insured services. User fees, extra billing, and medical savings accounts were rejected. While this is positive, there is also the key issue of the privatisation of health care delivery. Right-wingers have been forced to recognise that the Canadian public strongly supports universal health care insurance. So many of them have decided to lie low and refrain from attacking public health care insurance. But there is a growing attack on public health care delivery. With a guarantee of public money, corporations are trying to take over the delivery of health care, beginning with support services. With billions and billions of dollars of public money at stake, the corporations pursue this goal with a furious hunger. During the last British Columbian provincial election, the major right-wing party opposing the social democratic government promised health care workers they had nothing to fear. However, after the election, that same party passed legislation removing collective agreement protections against privatisation for health care employees. The rights and provisions to protect workers facing layoff were also eroded. British Columbia had some of the country's best hospital collective agreements. But the giant corporations trying to take over the work will cut wages almost in half — not enough to support a family or retain experienced workers. When the struggle first began, taped conversations with corporate representatives suggested that thousands of hospital employees would be blacklisted. A regional manager for one transnational corporation stated he would not hire union members if his company succeeded in a bid for work done by those members. In another call, a consultant with a management labour relations company said his firm would be reluctant to hire any union members for fear they would vote their old union back in if they were forced to work for about $10 (Canadian) an hour, rather than the current $17 an hour. Initially, the main health care union tried to negotiate concessions to keep the work unionised. However, when put to a vote, the workers rejected the concessions. The government is now proceeding with the privatisation of many thousands of hospital support jobs. In Ontario, the Conservative government tried to privatise important hospital diagnostic services and introduce "public- private partnerships" ("P3s"). Canadian hospitals are not-for-profit. Introducing full for- profit hospitals would not be accepted — so the Conservatives tried the thin edge of the wedge. With a P3 hospital, a for- profit corporation would finance a new hospital facility, provide support services, and lease the facility back to the hospital over 25 to 60 years. The Conservatives proposed two P3 "pilot projects" — one in a suburb of Toronto (Brampton) and another in Ottawa. Unfortunately for the Conserv-ative government, the unions and health coalitions pounced on the issue. The social democratic party, which had caved in to corporate pressure when it had governed in the early 1990s, came out on a platform of "public power", opposing privatisation and calling for a much broader role for the public sector. The business-oriented Liberal Party was also forced to come out against the P3s. During the recent provincial election, the president of the Ottawa hospital caused outrage when he revealed the hospital planned to sign a P3 deal before the election. Foolishly, he noted that the cancellation penalties would be so large no new government could cancel the project. This affront to democracy severely embarrassed the ruling Conservatives, who were in on the project. For this and other sins, they were soundly defeated in the October 2 election, with all three Brampton Conservative incumbents thrown out, including the Minister of Health who led the privatisation campaign. The Liberals, who assumed power on October 23, have also promised to reverse the Conservative government's privatisation of hospital diagnostic services. Privatisation has been set back and strong popular support for public health care continues. But the corporate campaign continues — and so, too, does the fight back!
* * *Doug Allan is a Canadian trade union health care researcher and health coalition organiser.