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.
This article appeared in the September/October 2005 issue of Canadian Dimension (The Battle for Canadian Universities).