profit is not the cure

Originally published on The Hill Times

Canada stands at a crossroads. For many Canadians, access to health care—the lack of family doctors, backlogs of surgeries, and long waits in emergency rooms—are all evidence of something deeply troubling. Clearly, we have not invested enough to maintain a resilient system of care.

There are two potential paths ahead. If we follow one, we rebuild and revitalize a robust infrastructure of public non-profit health-care services. The other path would see that infrastructure gradually dismantled—or at least diminished—and replaced with corporate control.

We need look no further than our own front doors to see that the expansion of for-profit health care in a number of provinces is dividing residents into health-care “haves” and “have nots,” and has resulted in significant costs for everyone. Ontario Premier Doug Ford repeatedly promises patients “will never have to pay with their credit card, only their OHIP card,” even as his government privatizes surgeries and diagnostic tests from our public hospitals.

Yet evidence is mounting that private clinics are getting both higher funding from the government, and also charging elderly Ontarians thousands of dollars for cataract surgeries. The extra charges are not only exorbitant—many times higher than public surgeries—but also, crucially, should be unlawful under the Canada Health Act. British Columbia’s private clinics tried to get the courts to strike down the prohibition on extra-billing patients. They may have lost at the Supreme Court of Canada, but they still want to bill the public system and charge patients on top. Quebec seniors had to threaten legal action to force a roll back of burgeoning user fees at private clinics. Clinics in Alberta now claim that they can charge patients who travel from other provinces as much as $28,000 for joint replacement surgeries.

The prices that private clinics are charging patients are often double or more the cost in our public hospitals. And so, privatization has become a slippery slope to two-tier health where working people fall further behind, and many are marginalized based on the economic determinants of health.

We only have to look at long-term care in Ontario to see where this path leads. For many years, long-term care was overwhelmingly provided by non-profit community-based groups or municipalities. But then-Progressive Conservative premier Mike Harris ushered in the massive shift to fund and expand private long-term care in the late 1990s, and most facilities are now run by corporate chains. In the height of the pandemic, these companies were exposed for their shocking dereliction of duty to their residents and staff. The COVID death toll in the for-profit homes was double that of non-profits and nearly five times that in publicly owned long-term care. Horrific scenes of neglect were uncovered daily. Their business model of low-paid part-time staff with few benefits or sick pay sparked widespread outrage, particularly when the Army had to be called in to rescue neglected residents.

Despite promises by the government to crack down, very few penalties were imposed. It’s worth noting that in 2020, Harris was paid $223,000 a year as part-time chair of the board of Chartwell, one of the largest private chains. That’s far more than he earned as premier, and some might conclude that he is being amply rewarded for his policies in office by those who have benefited so richly.

As Canada travels further down the privatization highway, finding an off-ramp will become more and more difficult. What’s at stake now and in the next election is the role of the federal government in upholding standards and accountability under the Canada Health Act. Provincial premiers keep demanding that funding flows with no strings attached as many of them champion more private delivery of services. But ordinary Canadians want to know that our public health care will be protected, and expect the federal government to play a proactive role in defending it. We certainly can’t afford to have a prime minister who will enable even more privatization of this vital public service.

Canadians should be on guard: a significant transformation is underway, and if we allow it to proceed, too many of us will be sidelined by high-cost privatized medical care in the future. The fact is that we need more investment in our health, but profit is not the cure.