Wednesday, February 17, 2010

The following opinion piece was written by the President of the Ontario Public Service Employees' Union and published in the online news journal Public Values. I reprint it here if only because there seems to be a need of periodic reminders of how good Canada (and the rest of the civilized world ) has it in terms of health care when compared to the USA. Through the thunder of their (often mindless ) debate down there on the proposals to reform their healthcare system one can discern the almost comical ignorance that many (most ?) Americans have about how their system compares unfavourably with almost all developed and even a few underdeveloped countries. They spend more money and get fewer results. Not the least reason for this inefficiency is that a good proportion of the funds available are skimmed off as profit by the insurance companies, amongst others. Whatever the inefficiencies of other systems at least other countries don't have to apportion money to this class of parasites.
Up here our health care system is under attack and underfunded. Governments, such as those of Ontario, as mentioned in the following article, would much rather spend the money on corporate handouts. Not that our system is perfect by any stretch of the imagination. Molly has expressed her own preferences here at this blog before ie a system of community clinics and mutual cooperative insurance. The beginnings of such a system could easily be initiated even under our present system, with the mutual insurance covering things not presently covered by medicare. The single payer system would have to be retained until such time as non-government methods of social insurance were more fully developed. That process would have to be gradual to avoid unnecessary suffering. In the process of such a "withering away of the state" the first thing to go would obviously be grants to the corporations. The last thing to remain would be corporate taxes and taxes on the wealthy.
Until this process begins, should it ever begin, it can easily be demonstrated that the Rube Goldberg American system is demonstrably inferior to not just that of Canada but also to that of most of the developed world.
Here's the article.
Canada spends one-half per capita on health than US does, yet we are healthier:
Government pleads poverty, yet proceeding with tax cuts to Ontario corporations.
by Warren (Smokey) Thomas
How sustainable is health care? Opponents of Medicare regularly question the public sector's ability to pay the bills as health care creeps up as a share of provincial budgets. New data from the Canadian Institute for Health Information (CIHI) suggests health care costs may be more sustainable than we think.

Affordability is best determined by looking at health costs as a percentage of our overall economy, not by the size of government. The CIHI data suggests that health care costs have escalated roughly in step with the economy, whereas the size of government has been getting dramatically smaller.

Health care accounted for 10 per cent of our economy in 1992 – the last period of recession. In 2009, health care is expected to be 11.9 per cent largely due to a shrinking gross domestic product (GDP), not rising costs. In 2008 it was 10.8 per cent, less than a percentage point above the 1992 levels. This hardly indicates a lack of sustainability.

"As a share of the overall health pie, hospitals have been shrinking. In 1975 hospitals accounted for 44.7 per cent of health expenditures. Today it’s 27.8 per cent."

There is no question we are living longer and better as a result of the investments we have made. From 1996 to 2006 our average life expectancy was extended by three years – the biggest leap in mortality rates since they have been kept.

Federal funding to reduce wait times is having a positive impact, particularly for hip and knee replacements as well as cataracts. This is something Canadians all said we wanted and were willing to pay for.

According to CIHI, money has also been invested in tailored drug therapies, diagnostic technology, training health care professionals and to increase class size in medical and nursing schools. These last investments are necessary if we hope to replace the soon to retire legion of baby boomers serving as professionals within our health system.

While spending as a percentage of our economy has nudged forward over 20 years, it has not been entirely in lock step. In the 1990s governments dramatically slashed funding to health care, leaving present governments with a major infrastructure deficit. It is far more costly to play catch-up than it is to keep the system on an even keel. Finance Minister Dwight Duncan admitted this when speaking to the Ontario Hospital Association Conference last fall.

Hospitals always appear the target of restraint, but are hardly to blame for rising health costs. As a share of the overall health pie, hospitals have been shrinking. In 1975 hospitals accounted for 44.7 per cent of health expenditures. Today it’s 27.8 per cent.

"Total public sector spending used to account for about half the economy. Today it is closer to one third."

In 2009 Canadians are expected to spend $5,452 per capita on health care – both public and private. That’s slightly less than France, Germany, Switzerland and Belgium. It's much less than the United States, which spends almost double per capita and yet leaves 45 million Americans uninsured and many more underinsured. On almost every objective measure, Canadians do better with their health than Americans, from infant mortality to our overall longevity.

In the past year there has been an attempt to divide the progressive community by portraying health care as an insatiable monster crowding out education, housing, transportation and even poverty reduction.

The McGuinty government continues to shrink the pie and is happy to see us all fighting over the scraps. Total public sector spending used to account for about half the economy. Today it is closer to one third.

While the government cries poor, it is stampeding ahead with a series of tax cuts, including a $5 billion reduction to Ontario corporations.

We need to defend all our social services, including health care. When we start pitting our sectors against each other, we all lose.
In solidarity,

Warren (Smokey) Thomas,


Werner said...

Cooperative clinics were established across Saskatchewan at least until Medicare arrived in 1962. There were about 25 in the province at a high point in the sixties. There are only about five now. In the UK cooperatives were also commonplace. In the early fifties a coop dentist in England would charge about 10 shillings (half a pound)for a filling and about one "quid" for a gold cap. Part of the costs for this mutual aid system was supplied by the state through the employed-worker-only "national insurance" system begun in 1911. The trade unions enlarged this coverage through voluntary payments. It should surprise no one that state takeover of these networks has made it easier for politicians to use health as a political football. When Margaret Thatcher introduced the "internal market" system the National Health went from the most efficient in terms of cost per service worldwide to the present situation where many can not find a doctor or dentist under the NHS (and wild stories about people pulling teeth with pillars) and are forced to go to the parallel and very expensive private system. Still public opinion supports the NHS as Canadians generally support medicare. IF people could be convinced that the "basic idea" of socialism has been distorted by state interference rather than throwing out the baby with the bathwater then things might pick up.

Werner said...

A Co-op system is best, with state funding(Canada,UK)/regulated enterprise(continental Europe) tying for second place and others placed far back in the field. In the meantime I'd favour much more pressure for an increased range of services regardless of the funding method. After all no one argues about the need for a fire department regardless of who is running it! Some things like dentistry should be included while garbage like psychiatry would be rolled up into neurology. The need for some type of universal income is obvious here. No poverty, no insanity, unemployment for psych majors and all that other good shit.