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Fighting privatization in the heartland of medicare

Last week the Council of Canadians and CUPE Saskatchewan conducted a five city tour to raise awareness about the increasing privatization of public health care in the province. Sadly, we are seeing, “increased creeping privatization” in the heartland of medicare. Brad Wall has been behind backdoor cuts and policy and legislative changes. The founding principle of medicare – need and universality – is being eroded.

People from across Saskatchewan explained why public health care matters so much to them. In Prince Albert, CUPE Saskatchewan president Tom Graham highlighted that medicare is “something we should be preserving – not selling off… It started in this province and it needs to carry on. We can’t be having private surgeries, private MRIs, private laundry, private food services; who knows what’s next?”

In Yorkton, we heard about how hospital laundry services, and the jobs in the community that they provide, have been contracted out to Alberta. Audience members shared stories of how laundry is coming back unfolded, moldy and even with blood stains still on them. In North Battleford the audience told us that the process for the P3 prison/hospital complex has been nothing but a boondoggle; locals questioned the competence of those in charge of the project (prior to the 2011 election, the provincial government priced the new building at $100 million but recent estimates have already ballooned to $175 – 250 million).

In Weyburn, the epicenter of medicare in Canada, we heard a disturbing story from an audience member about how her grandmother, before medicare, had to sell her cow to get enough money for cancer treatment. If it wasn’t for neighbours who offered to share their cow’s milk with her children, she would not have been able to pay for treatment. While times have changed, the audience member highlighted no one should ever be put in the position where ability to pay comes before need.  Lastly, in Regina we heard how the provincial government refused to vote for legislation to make P3 deals more transparent and accountable, preferring to keep the terms of the deals to themselves.

With the federal government walking away from its responsibility to provide quality health care to Canadians, people were concerned that provinces are facing a difficult situation. Without a renegotiated Health Accord, health funding will receive only $43.5 billion over eight years. In Saskatchewan, the cumulative projected loss is $1.37 billion and already (from March 2014-2015) the province has seen a loss of $33.2 million due to changes in the equalization formula for the Canadian Health Transfer. While this situation creates challenges, instead of showing leadership the Saskatchewan government is following in the footsteps of the Harper government and putting ideology ahead of fairness. Across the province, we heard from people who questioned how after “8 year of prosperity” in Saskatchewan there was so little to show for it.

In every city we visited people were fed up with the rhetoric and fictions coming from the Brad Wall government. The recent changes to legislation to bring in private pay-for-service MRI scans isn’t about better care or decreasing wait times. It is about smuggling in a two-tiered US style private health care into the province. The result will be queue jumping for the wealthy. This inequitable system is being proposed by the same Premier Wall who said in 2009 that, “his government’s health reforms will not allow anyone “to use a bulging wallet to jump the queue.”

While wait times are an important issue to address, this government seems to have learned little from other provinces that brought in private MRIs and saw their wait times increase. This model of care has been shown in study after study to increase wait times for the majority of patients. There are a limited number of technicians to work the machines, and when private clinics enter into the equation they poach workers from the public system. For example, when Alberta introduced private MRIs, one Calgary hospital lost three of five diagnostic technologists to a new MRI clinic that offered large signing bonuses. According to the Canadian Institute for Health Information, Saskatchewan’s wait times for MRIs are around 28 days, a typical number for public hospitals. Whereas in Alberta, where pay-for-service private clinics proliferate, wait times for an MRI scan is 80 days. These waiting lists exist despite Alberta having the second highest number of scanners per capita in the country. After introducing pay-per-use imaging to address wait times, the Government of Alberta moved away from the policy at great cost.

Along with resource drift from the public system and lengthening wait times, there are no financial savings to the hybrid system and no increase in accessibility. In fact, there is actually no real evidence for provinces to promote patient-pay imaging centres. It simply takes government off the hook as it pretends to be doing something – it doesn’t have to invest in the public system, but in health care privateers. This is a step backwards that defies common sense. Everywhere we spoke, people were outraged that the Saskatchewan government is putting ideology and rhetoric ahead of evidence and fairness.

Another place quality public health care is being weakened in Saskatchewan is in the use of public private partnerships (P3s). These “deals” are a waste of public money that should be invested in services. There is no health policy or business case for P3s; study after study demonstrates that P3 hospitals and health services cost more, are less transparent, and are not accountable. In addition to expensive financing and construction costs, P3 hospital deals often include hidden privatized services such as maintenance, security, cleaning and laundry, adding tens of millions more to the final price tag and reducing health outcomes for patients. Yet, the Saskatchewan government is aggressively privatizing health services through P3 deals and building P3 hospitals.

Recently, the Saskatchewan Auditor General report on P3 showed that rather than learning from the mistakes of other jurisdictions, the government is repeating them. The report found that the risk assessments, the primary means used to justify the cost effectiveness of the P3 model, were made without any empirical or historical evidence. SaskBuilds, in charge of P3 deals, has already spent $5.6 million on Partnerships BC, who provide advice on virtually all P3s in the province. Yet Partnerships BC generates all of its income by promoting P3s and providing biased advice. They have yet to suggest that the public option is better. As we heard on the tour, this is like going to buy a truck and paying a salesman to tell you that his trucks are the best.  

Saskatchewan is the home of universal public health care, the heartland of Canada’s most cherished social program. When Tommy Douglas first campaigned to introduce medicare in the 1960 Saskatchewan provincial election, he had long term aspirations and integrity. His dream was visionary in scope and revolutionary in effect. The people of Saskatchewan have not forgotten what this means and are sending a clear and simple message to the government: our health care must be based on need and not the ability to pay.

More photos from the tour can be found here

Further Reading:

Council of Canadians & CUPE health care tour concludes in Regina (September 18 blog)

Council of Canadians and CUPE launch 5-city tour against the privatization of health care in Saskatchewan (September 14 blog)