Are you Willing to Die for Public Health Care; Harper is Willing to Bet you Aren't

On May 2nd, 2011 Canadians elected a Harper majority government. While there was much talk of health care during the election, a lot of that was the hypothetical “if elected into office...”. Now with the results in, hypothetical scenarios are no longer necessary.

During the election, you may have caught some stories about a 500-page dossier being leaked which contained quotes that Harper’s handlers didn’t want you to see. Using that dossier, along with quotes from interviews, and the infamous Firewall letter, this blog is using Harper’s own words to shed some light on what the next four years could look like. 

Harper on Federal Leadership

Why we need Federal leadership on health care: While the provinces and territories certainly play a strong and perhaps the most prominent role in the administration and delivery of health care services, the federal government is not without its own equally important role. The federal government not only funds Canada’s health care system through transfer payments made to the provinces and territories[1], it is also the enforcer of the Canada Health Act (CHA) (to ensure that provinces and territories are providing the public with medically-necessary health care without extra-billing or user-fees) and historically has led the way on expanding publicly funded services[2].

On May 9th, 2005, when being interviewed on health care, Harper responded to the question: If you become prime minister, you say you’ll negotiate a comprehensive deal with the provinces on which level of government does what and how tax money will be divided.

With:

“I would rather have the federal government focus on the things it can do and let the other governments get on with the issues they are supposed to deal with.”[3]

On the same topic, Harper has previously stated: "I know this is a dangerous subject. My advisors say don't talk about it, but the fact is sometimes provinces have allowed in the past few years, they've brought in private services covered by public health insurance... Why do I care and why do we as a federal government care how they’re managed?”[4]

Our analysis: What this means for Canadians is that we’ll have a lack of federal leadership when it comes to our health care system. Harper is not interested in enforcing the principles and provisions of the CHA, he’s not interested in leading our country through the process of strengthening and expanding public health care. Under Stephen Harper there will be no national pharmacare plan, no national strategy on continuing care, and no expansion of the CHA or the creation of stand-alone legislation for home care, long-term care facilities or dentistry. What a shame!

Private Hospital Delivery

Our comments: While all of Canada has publicly insured health care[5], much of Canada also has publically delivered health care. “Alternative service delivery” is a code-word for removing delivery of health care from the public sector and giving it to private or not-for-profit companies. Harper no longer claims that he’s in favour of public health care, instead he claims to be in favour of universal public health “insurance”, meaning that the public system would pay private and for-profit companies (many of whom are American) to deliver health care services to Canadians. What’s wrong with that? Read our comments below Harper’s quotes. Don’t believe us? Read it straight from Harper’s mouth:

"Governments across this country have experimented with alternative service delivery….We're not going to wave the finger at provinces because they experiment with different delivery."[6]

“Several provinces are involved in pushing for alternative private delivery, even on a profit basis. This is a natural development. In a properly functioning system, profit is the reward that businesses obtain for making substantial, long-term capital investments.” [7]

“(The Canada Health Act) rules out private, public-delivery options. It rules out co-payment, pre-payment and all kinds of options that are frankly going to have to be looked at if we're going to deal with the challenges that the system faces.”[8]

“The biggest single thing is alternative delivery within the universal public insurance system...The existence of a wider range of private providers, that is what we’re talking about. We differ with the federal Liberals. We believe that is actually legal within the Canada Health Act.”[9]

"We also support the exploration of alternative ways to deliver health care. Moving toward alternatives, including those provided by the private sector, is a natural development of our health care.”[10]

“It should not matter who delivers health care, whether it is private, for profit, not for profit or public institutions...”[11]

"What we clearly need is experimentation with market reforms and private delivery options [in health care.”[12]

"...the private provision of publicly insured services should be permitted. The monopoly of provision of services is not a value that, in and of itself, is worth preserving."

“Spending more money will not cure the serious long-term problem plaguing our health care system. As long as health care remains government monopoly, the system will continue to deteriorate."[13]

“I think it (a parallel private health care system) would be a good idea. I think we’re headed in that direction anyway.”[14]

And, although not a direct quote, this comment was found on Harper’s Alliance leadership website, written by his party: “Our health care will continue to deteriorate unless Ottawa overhauls the Canada Health Act to allow the provinces to experiment with market reforms and private health care delivery options.He (Harper) is prepared to take tough positions including experimenting with private delivery in the public system."[15]

Our analysis: Private and for-profit institutions are accountable to their shareholders. While the private sector is indeed competitive and can keep costs lower for themselves, they often do this at the expense of the Canadian public. Private companies cut costs by finding as many corners to cut as possible. This leaves all of us in a vulnerable situation wondering where these cut corners are in our local hospital or clinic.

Public-private partnerships (P3s) are another way the government has been privatizing the system. P3s have been used in many areas of public policy. They allow the government to disguise the actual cost of infrastructure and non-medically necessary services. In the long-run P3s cost Canadians more money. Corporations are not able to borrow money from banks at the low rate governments are; P3s require multiple (often long-term) contracts and therefore expensive legal fees must be paid; and in the past private companies have sold their contracts to other companies or declared bankruptcy leaving governments and medical practitioners scrambling.[16] For a great (and illustrated!) explanation of how P3 hospitals costs us more, see Steven Shrybman’s presentation at: http://vimeo.com/2156095

Harper Doesn’t Believe in the Canada Health Act

Our comments: The Canada Health Act contains the principles and provisions of our universal public health care system. It’s a short and straightforward document that ensures your family has access to medically necessary health care anywhere in Canada by showing your health care card (not your credit card). The Federal government is responsible for funding transfers to the provinces and territories, equalization transfers (to ensure you have adequate care regardless of which province or territory you live in) and enforcing the provisions and principles of the CHA. But the Harper government doesn’t want to be bothered by having to protect your health care. They want to reform the CHA, and they want to offload the responsibility of protecting public health care to the provinces. In fact Harper encourages provinces and territories to ignore the CHA.

Resume provincial responsibility for health care policy. If Ottawa objects to provincial policy, fight in the courts. If we lose, we can afford the financial penalties Ottawa might try to impose under the Canada Health Act. Albertans deserve better than the long waiting periods and technological backwardness that are rapidly coming to characterize Canadian medicine. Alberta should also argue that each province should raise its own revenue for health care — i.e., replace Canada Health and Social Transfer cash with tax points, as Quebec has argued for many years...It is imperative to take the initiative, to build firewalls around Alberta....”[17]

“…the Canada Health Act has to change. The federal government has to stop grandstanding and get out of the way.”[18]

“Is it important that the (health care) system be free?”[19]

“...the Canada Health Act does have to be reformed...there’s going to have to be significant reform.”[20]

“And what we should be doing is not figuring out how we can have the most equal system but having the best system. The best system means having a system where you have as many tiers as possible...”[21]

Our analysis: Without strong federal leadership to protect and enforce the Canada Health Act, medicare is vulnerable to American privatization through agreements such as NAFTA. The Canadian health care system is only protected from American interests when it is fully public. Once privatized, the system must give “national treatment” rights to American private hospital chains. We need a government who will defend the CHA. From these statements, Harper is planning to further privatize the system.

Harper Doesn’t Like Our Public System

Our comments: In 1966, this country made a bold move. We decided to look after each other regardless of how much money someone has. We believed then, as the vast majority of us still do, that every Canadian has a right to health care. Yet Harper doesn’t agree with that. He believes that health care is welfare and that providing for one another in a time of need is a sign of dependency. Again, here are Harper’s own words:

“Canada is a Northern European welfare state in the worst sense of the term, and very proud of it.”[22]

“Those who like an existing policy know why they like it, and there’s a whole demographic out there that has, for better or worse, come to rely on the current system. That’s the welfare state- it breeds dependence.”[23]

“The establishment came down with a constitutional package which they put to a national referendum. The package included distinct society status for Quebec and some other changes including some that would just horrify you, putting universal Medicare in our constitution, and feminist rights, and a whole bunch of other things.”[24]

Protecting and Defending the Canada Health Act

“I would suggest that not many Canadians are willing to die for a health care ideology in a health care line-up. They may be willing to die for their country but they are not willing to die for the Liberal definition of the health care system.”[25]

Our comments: Perhaps dying is a little extreme, but there are less intense ways to ensure our health care system remains public. As I’ve mentioned in many blogs in the past, 86 per cent of Canadians believe in a public health care system. We all need to be strong advocates for single-tiered public health care (both publicly insured and publicly delivered), perhaps more now than ever. With a Harper majority we’re looking at the increase of privatization in our health care system. If you believe in keeping a strong, single-tier health care system; if you believe that changes need to be made to the system, but that the fundamental principles (universal, portable, publicly administered, comprehensive, accessibility) and provisions of the CHA should be enforced; then please join us. Over the next few months health care organizations, non-profits, patients’ rights groups, and advocacy organizations like the Council of Canadians will be meeting to discuss how we can protect the CHA and prepare ourselves for the Canada Health Accord renegotiation in 2014 under a Harper majority government. This blog will serve as just one way to keep you informed of upcoming events and actions in your community and across Canada. Your local Council of Canadians Chapter is another way to get informed and involved. Of course we encourage you to take your own actions as well, writing to MPs, hosting information sessions, organizing events and rallies. In the words of Canada’s greatest Canadian and the father of medicare, Tommy Douglas:
"Courage, my friends; 'tis not too late to build a better world.[26]


[1] For more information on the 2004 and upcoming 2014 health care accord negotiations refer to: http://www.parl.gc.ca/Content/LOP/researchpublications/prb0852-e.htm; http://www.thehilltimes.ca/page/view/healthaccord-02-07-2011

[3] MacleansHarper on Health Care: Hard to Make it a Vote Driving Issue. April 20th 2011. http://www2.macleans.ca/2011/04/20/harper-on-health-care-hard-to-make-it-a-vote-driving-issue/

[4] Conservative leader Stephen Harper at the leadership debate, June 15th 2004. http://archives.cbc.ca/politics/parties_leaders/clips/15777/

[5] For medically necessary services.

[6] English-language Leader’s Debate, 2011

[7] Hansard. Government Orders (Canadian Health Care System). 28/10/2002

[9] Globe and Mail. Harper Advocates Private Hospitals. 26/09/2002.

[10] Toronto Star. October 2002.

[11] Hansard. Leader’s Response to Throne Speech. 01/10/2002.

[13] The Bulldog. “NCC Says Fedeal Budget’s Tax Cuts a Timid”. 02/01/1999

[14] CBC News. “Panel Discussion on the Health Care System”. 17/08/1997

[17] Stephen Harper. ‘Firewall’ Letter. January 24th, 2001.

[18] National Post. 07/01/2002.

[19] Hansard. Government Orders (Canadian Health Care System). 28/01/2002

[20] Global Sunday. “Medicine for Medicare”, 06/01/2002

[21] CBC News. “Panel Discussion on the Health Care System.” 17/08/1997.

[22] CTV (via Canadian Press). Montreal Meeting of the Council for National Policy. June 1997. Full Text of Harper’s 1997 Speech. Posted Wednesday December, 14th 2005. http://www.ctv.ca/CTVNews/SpecialEvent7/20051213/elxn_harper_speech_text_051214/. Last accessed: May 11th, 2011.

[23] Report Newsmagazine. 22/01/2001

[24] CTV (via Canada Press). Montreal Meeting for the Council of National Policy. Full Text of Harper’s 1997 Speech. Posted Wednesday December 14th, 2005. Full text of the speech can be found at: http://www.ctv.ca/CTVNews/SpecialEvent7/20051213/elxn_harper_speech_text_051214/. Last Accessed May 11th, 2011.

[26] Douglas Coldwell Foundation. http://www.dcf.ca/index_en.htm