CANADIAN POLITICS-ONTARIO:

STARVING HEALTHCARE-FEEDING CORPORATIONS:

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.

HCHCHCHCHCHCHC

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,

President
Links and sources Ontario Public Service Employees Union (OPSEU) site

CANADIAN POLITICS:

HARPER DODGES THE BULLET ONCE MORE:

You actually have to admire Steven Harper, at least for his skill as a politician. "Sneaky Stevie" sits on top of what is an essentially unstable alliance, of social conservatives and hard line free market ideologues. Whatever his personal religious views they are certainly secondary in Stevie's world to the need for providing his corporate friends with the ability to make money (and not incidentally adding to his "sum of friends" when he finally leaves politics). Stevie's well-famed intolerance of dissent in his own party is a necessity for such a leader. Loosen the screws and, before you can say 'Timothy McVeigh' every single nut in the Conservative coalition will be publicly voicing opinions that would put the Conservative Party at the level of public approval of say the 'Marxist Leninist Party'. No, 're-education camps for homosexuals' is a non-starter in Canada.

But Sneaky Stevie's political sense extends far beyond knowing that the "terrorists for Jesus Brigade" is not the way to power. Like any good neo-conservative he throws the sexually obsessed the occasional bone, whatever his personal contempt for them, just to keep their preachers telling the congregations to come out and vote for the Conservatives. What is really masterful on his part is knowing when to backpedal on his core neo-conservative ideology. He has done this for some time now in relation to many issues, and the issue of medicare (which pretty well defines the separation of the USA from the civilized world) is perhaps the core issue where neo-con ideology conflicts with simple common sense.

Not that Molly is entirely satisfied with the Canadian medical system as it is. As a libertarian socialist I would much prefer that medical care be delivered through a network of cooperative institutions rather than through a statist single payer system that funds both overly bureaucratized "public" institutions and private practice. being as that is still far in the future, I have no doubt that our system delivers better medical care, at a considerably lower cost, than the American system where public bureaucracies are replaced with private ones and where millions of people have no coverage whatsoever. In terms of "bang for the buck" the American system actually delivers far poorer public health results than not just Canada, or almost every industrialized country. It is even substandard as compared to some "Third World" countries.

All that is obvious to those who bother to read and who are not consumed by ideology, as much of the American right is. The numbers are there. Look them up. Down USA way the frustrated right wing is focusing as the present Democratic health care proposals which are actually a far step below what the civilized countries have accepted as a standard of care. In this "holy cause" the right wing propagandists have stooped to every possible lie. The article below mentions one of them, the mendacious Shona Holmes ads. what is important about the following article is that, whatever Sneaky Stevie's public face of the moment, he has a long term commitment to turn medical care over to the tender mercies of his dream world of a free market.

Here's the article from the Harper Index, a website devoted to tracking the machinations of our beloved comrade Dear Leader.

CPCPCPCPCPCPCP

Health care defence intentionally vague:
Harper attempts to avoid debate over Canadian system because he despises it.
by Eric Mang
WASHINGTON, DC, August 13, 2009: While American debate rages over Canadian-style health care, Canada's prime minister is ducking the debate in order not to reveal his own feelings about a system most voters support wholeheartedly.

On August 10, Stephen Harper was interviewed by ABC News correspondent, Jake Tapper on issues raised at the recent summit between the leaders of Canada, the USA and Mexico, including H1N1, Mexican drug cartels, the coup in Honduras, and Afghanistan.

Given the raging health care reform debate south of the border, the Prime Minister's answers to Mr. Tapper's health care questions were revealing, as much for what they did not say as what they did.

Since the Conservatives were re-elected in 2008, health care seldom receives much attention as a federal issue compared with other portfolios or previous governments. Although social services are not a strong suit for the Conservatives, the government has tried to dodge accusations that they wish greater private involvement in Canada's health care system. As the record shows, these accusations are not unfounded.

In a response to the 2002 Throne Speech, Mr. Harper said: "A government monopoly is not the only way to deliver health care to Canadians. ... It [the federal government] must remove any barriers, any chill to increase private capital investment plans that the provinces have for our health-care system."

In the National Post in 2000, Mr. Harper said: "[former Reform MP and current Liberal] Dr. Keith Martin is a highly intelligent and capable member of Parliament. He is also advancing perhaps the most important issue of the next generation the need for private health care competition."

Harper's answers to health care questions were revealing, as much for what they did not say as what they did.

In the Conservative's 2006 election platform, they advocated a "mix of public and private health care delivery…"

However, the Conservatives, who are attempting to learn from their political missteps, are aware that a majority of Canadians support a universal, single-payer health care system. A recent Harris/Decima poll found that 70% of respondents thought our system to be working well and that 82% prefer our system to the American one. Notably, more than half of respondents thought more services should be covered in the public system (e.g. dentists) while only 12% thought more of the system should be private. Further, a Nanos Research poll found that 86% of respondents supported or strongly supported "public solutions to make our public health care stronger".

Wanting to slake the public's thirst for improvements in health care, in 2006 the Conservatives issued five commitments they would act on if elected to government; one of those pledges was a Patient Wait Times Guarantee: "Work with the provinces to develop a Patient Wait Times Guarantee to ensure that all Canadians receive essential medical treatment within clinically acceptable waiting times…"

When it appeared that the Conservatives could not meet their wait times commitment, it was quietly replaced by an ambiguous statement of a "strong, united Canada".

The Conservatives are now fully distanced from their 2006 promise of wait times guarantees. When asked by Mr. Tanner whether our wait times are too long, Mr. Harper replied, omitting any reference of a federal partnership with provinces: "Yes, but the responsibility for the health care waits, in our country, are the responsibilities of provincial governments."

The Canadian health care system has been used as a political football by many legislators and right-wing commentators in the United States. Unfortunately, many of their contentions are false, misleading and/or heavily embellished.

In a response to exaggerated claims made by Republican Senator Mitch McConnell, Conservative Senator Hugh Segal was quick with a rebuttal: "The notion that we have some bureaucrat standing next to every doctor between the patient and that doctor is a complete creation, there is no truth to that at all…What you have[in Canada] is a longer life span, better outcomes and about one-third less costs [compared to the US]. That's what you have."

When Mr. Harper was given an opportunity by Mr. Tapper to correct misconceptions about Canada's health care system, Mr. Harper did not attempt to address the more specious falsehoods. Rather, he downplayed the federal government's role in health care, despite our system being a single national plan through the Canada Health Act, and responded: "In Canada, health care is principally the responsibility of our provincial government. The federal government provides some transfers. We do some of the drug regulation, a number of other activities. But it is principally a system run by our provincial government [sic]. So first of all, I don't feel qualified to intervene in the debate."

While it may not have been politically prudent for Mr. Harper to allow himself to be dragged into the Shona Holmes debacle (Holmes' claims have been largely debunked) he could have taken a cue from his colleague, Conservative Senator Hugh Segal, and been tactful and truthful about Canada's health care system.

Mr. Harper's comments on health care spending in Canada were also misleading. Defending his government's choices in allocating tax revenue, Mr. Harper oversimplified public sector budgeting meeting public demand: "At the same time, all of this costs money. If you are prepared to spend an unlimited amount of money, you can do an almost unlimited number of things in people's health care. But you don't have an unlimited amount of money no matter what your system is. And these are challenges that every system has to address."

While Mr. Harper is correct there is a finite source of tax dollars and revenue-raising instruments available his government's decision to cut the GST reduced government revenue by more than $12 billion. Further, tax credits and more tax cuts have deprived the federal treasury of a few more billion dollars.

There are very few in health care or in any sector who believe governments have unlimited funds or have only one spending priority. But most would agree that governments exercise decisions and make choices. When the decision is made to reduce the amount of revenue a government collects, the choices to fund government programs becomes increasingly limited.

Health care consistently rates as one of the top policy issues on the minds of Canadians and polls indicate that a majority support the public system. Although the Conservatives are reticent to involve themselves in health care issues, there were a number of points in his interview with Mr. Tapper where Mr. Harper could have set the record straight in front of an American audience and acknowledged how much Canadians cherish their health care system.

Eric Mang lives in Toronto and was a former political aide in the Harris government in Ontario and in the Campbell government in British Columbia. See more of his writings at www.ericmang.com.
Posted: August 13, 2009
Harper Index (HarperIndex.ca) is a project of the Golden Lake Institute and the online publication StraightGoods.ca

CANADIAN POLITICS/MEDICINE:

EXPOSING THE MYTH- PRIVATE CLINICS DON'T !!! REDUCE WAITING TIMES:

The Canadian public is exposed to an unending barrage of statements in the media that Medicare isn't functioning well and that we need more private medical clinics to reduce waiting times for various medical procedures. The argument looks good on the surface, but do private clinics really reduce waiting times in the public sector ? The following item from the Nanaimo Daily News suggests that they do not, and it gives the reasons why.

Pundits of the neo-conservative variety expound endlessly on the virtues of the market, and they do so as well when it comes to medical care. No doubt they will be a little less self-confident (at least some of them will) in the wake of the recent banking crisis and market meltdown. Still, in regards to medicine the proponents of a "free market" have always had to ignore a lot to make their case. Their model- the American system- has resulted in the highest per capita outlay on health care related expenses on Earth, and the results have been less than stellar when compared to other jurisdictions. A lot is indeed done. Americans are the most medicated and most surgically treated nation on the planet, but all this busywork has failed to produce the outcomes that less profligate systems have.

Part of the reason for the overmedicalization of the American populace is dealt with in the article below. private practitioners are in an inherent conflict of interest, and it is highly likely that they will err on the side of the most expensive and invasive course of action. This is not to say that they are deliberately dishonest at all. It just that self interest often helps, quite often unconsciously, to weigh the scales when inherently difficult decisions have to be made.

Another reason why market fundamentalism often fails to describe the real world is the lack of recognition that what is being described is an imaginary abstraction where all other things are held constant while either supply or demand change. In the real world prices usually fail to respond to the signals of supply and demand in the rapid fashion that seems academically predictable. This is called the stickiness of prices.

In the case of medicine what is sticky is the supply- of trained medical personnel and their time. The reason that private clinics actually increase waiting times in the public sector is that physicians withdraw their services from the public sector, producing an even greater shortage in that area. It takes many years to train a doctor, and supply is essentially held constant. what goes into one box has to be taken from another. A market cannot respond in a timely fashion in such a situation as the good to be produced- physicians- takes far too long to make to respond to increasing demand. This is also dealt with below.

There is, of course, another model of medical service delivery separate from both the state provided and the private clinic model. The cooperative model is actually an alternative that marries the best of both systems and is superior to both. It's unfortunate that it is rarely mentioned in debates about medical services in Canada. I'll return to this model at the end of this post, but first, the article.

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Private clinic, public cash:
Surgical centre sees 62% more business from VIHA between 2006 and 2008
Dustin Walker, Daily News

Published: Wednesday, October 22, 2008
The number of publicly funded surgeries performed at a private clinic in Nanaimo has more than doubled in the past year, as the local hospital grapples with a growing waiting list for procedures.

There were 238 surgeries done at the Seafield Surgical Clinic in 2006-07 at a cost of $148,000 compared to 620 procedures for 2007-08.

The sharp increase is due to Nanaimo's growing population of older people who require a more complex level of care, said Vancouver Island Health Authority spokeswoman Anya Nimmon.

VIHA signed a five-year deal with a number of private clinics, including Seafield, in late 2006 in an effort to reduce waiting lists for day procedures, and to free up hospital operating rooms for longer, often more complicated inpatient procedures, such as cancer and hip and knee replacement surgeries.

Procedures to treat cataracts or hernias are among those performed at the clinic, said Nimmon.

But a year-long study of the effect of private clinics on Canada's public health care system released earlier this month says wait times are longest in areas where private clinics take personnel from the public system.

"We haven't seen any evidence that private clinics are making any contributions to reducing waiting times," said Colleen Fuller, a health policy researcher with the B.C. Health Coalition, who worked on the report entitled Eroding Public Medicare: Lessons and Consequences of For-Profit Health Care Across Canada.

"Although they may feel they are alleviating pressure on the public system, in fact they are piggy-backing on the public system."

Fuller said because there are a limited number of medical professionals, when they choose to work in private clinics wait times increase at public facilities. "It's not a criticism to say they have to get a return on their investment, that's the way the market works, but it's not supposed to be the way the health care system works."

She added that there are also questions around conflict of interest and whether allowing clinics to perform publicly funded procedures influence a doctor's judgement about where or even if a patient receives surgery.

Fuller said there is a movement worldwide to provide more procedures on an out-patient basis rather than in hospital. This creates a stronger market for private clinics looking to pick up work from the public sector.

Nanaimo seniors advocate June Ross thinks Nanaimo Regional General Hospital needs to find other ways to manage their waiting lists instead of relying on the private sector.

"You've got to improve the existing system, and not do it by using private clinics," she said. "It erodes our existing system."

But the Ministry of Health says health authorities purchase services from private clinics in order to ensure patients receive timely access to needed surgeries. Less than 2% of publicly funded surgeries performed in 2006/07 were at private clinics.

"Using the private sector to enhance the province's capacity to deliver timely surgical services makes sense as the demands on our health system continue to grow," reads a statement from the ministry.

B.C. Health Minister George Abbott told Canwest News Service that the Canadian Health Coalition study is the work of unions and the NDP who don't want the health-care system to modernize.

Repeated calls to Surgical Centres Inc, which operates Seafield, were not returned.
DWalker@nanaimodailynews.com
250-729-4244

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THE COOPERATIVE ALTERNATIVE:

As I said above there is a third way besides the state controlled public hospital system and the private clinic model. The cooperative or community clinic model is associated in the Canadian mind with the province of Saskatchewan, but the earliest cooperative clinic was in fact set up in Québec. At the present time that province is still far more advanced than other Canadian provinces with the majority of cooperative health clinics in the country. There are even other services provided by other "medically related" coops in Québec such as ambulance coops, home care coops and even funeral coops. People in that province have seen the coop model as being useful and timely, and they have joined in far greater numbers than elsewhere. In many ways this is reminiscent of earlier times, before the welfare state, when ordinary people insured themselves against the vagaries of life via a network of mutual benefit societies. As the limits of statist welfare become more apparent people are returning to the cooperative model.

Not that the model is restricted to La Belle Province. As a recent (August 2008) report from the federal Cooperatives Secretariat titled Canada Health Care Cooperatives says this system is becoming gradually more popular across the country. This report gives snapshots of the movement from across the country,from PEI, Québec, Manitoba, Alberta, Saskatchewan and BC. What this shows is that the move to cooperative health care is growing, and there must be reasons for this.

The cooperative model is quite simple. A group of people form a non-profit coop, paying a membership fee that entitles them to the services of the coop. The organization hires personnel and either rents or constructs facilities. The members have open access to the services provided by the facility. What are the reasons why this is attractive ? Here are a few that come to mind.

***Cost savings. As the article from the Nanaimo Daily News points out there is an increasing move away from hospital facilities to outpatient treatment for many procedures due to the rising costs of hospital treatment. Many procedures are far less costly when done outside of a hospital, and cooperative clinics are just as good as private offices for delivering such services.

Coop clinics have a further advantage over private medical offices in terms of cost savings in that the physicians and other staff are usually on salary rather than being paid on a fee for service basis. In the end this means that fewer unnecessary procedures are done as there is no incentive for such things. The government report mentioned above makes the observation that cooperative clinics are better at saving revenue than not just hospitals but also private clinics as well. Coop clinics also often offer a range of services, depending upon the economics of scale, that only the largest group practices in the for-profit sector could offer.

***Convenience. Modern medicine is highly fragmented, and entry into the system often involves multiple visits to multiple offices and other facilities. The cooperative model often hires not just physicians but other health care professionals as well, and dealing with a problem in a cooperative will more often be "one-stop shopping" than it is in either the private or public systems. The economy of scale afforded by the cooperative model also means that high patient volumes can be shared out amongst several physicians, and waiting times are thereby reduced without the detrimental tendency to push patient volume at the expense of detailed attention that can occur in a fee-for service private clinic.

***Patient control. Entrance into the public system means a massive surrender of personal autonomy, and even private clinics demand a great degree of deference to the doctor/owner. While one can "vote with one's feet" in a private system the available options may be either quite limited or even non-existent. For the ordinary citizen the details of the publicly owned medical system are, given their inherent size and centralization, far beyond any democratic control whatsoever. Problems with the system have to be addressed through a lengthy and opaque political process. In the cooperative system the patients are the owners, and the scale of the organization means that democratic control is far easier than elsewhere. Problems can more easily be corrected. It is also a fact that the concerns and needs of patients are not necessarily those of either a private practitioner nor,especially a medical bureaucracy and their political masters. The cooperative system puts the patient/owner in the centre of policy setting.

***Community Empowerment. Neither the public nor private sector puts the needs of a community front and centre. It is the case that cooperatives are often formed to provide the services that both private and public sectors think are not "cost-efficient" but that a local community thinks have priority. The location of a medical facility is not just a benefit to the patients involved but also to the surrounding community in general. This is especially true when the team approach of the clinic leads it to address collective social problems in the neighbourhood, problems that are automatically ignored by both public and private sectors. The existence of a coop also builds community just by getting people together, and this sort of benefit shouldn't be downplayed.

***Quality of Medicine. As previously mentioned coops can provide the sort of team approach that only the largest of private group practices can provide. By their informal nature they are also less bureaucratic than the public sector, and poor outcomes and practices can be more easily identified and corrected without the petty politics involved in large organizations such as the public medical system. As also previously mentioned the cooperative model frees the physician from the pressing need to increase patient volume at the expense of good medicine. This means not just greater attention to detail and diagnosis but also far fewer unnecessary interventions. All of which makes good outcomes more likely.

There are undoubtedly many other advantages to the cooperative model that I haven't mentioned above.What is plain is that the limitations of both the welfare state approach and the free market "alternative" are becoming plainer and plainer in the case of medical services, and the cooperative model offers a reasonable alternative that combines the best of both systems.

MEDICINE IN CANADA:

THE POOR GET LESS:

There's an interesting new article in the open publishing Canadian medical journal Open Medicine. The gist of the matter is a massive study on use of medicare in the province of British Columbia, and the conclusion is that, aside from visits to GPs, the lower your income the less service you receive from the medical system but the higher the eventual costs due to emergency in-hospital acre. Hardly astounding, but its nice to see it proved.

The following is the abstract of the article. To read the full article GO TO THIS LINK.

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Income-related inequities: Cross-sectional analyses of the use of medicare services in British Columbia in 1992 and 2002:
Kimberlyn M McGrail
ABSTRACT
Background: The primary demonstration of the principle of income-related equity in Canada is the provision of health care services based on need rather than ability to pay. Despite this principle, Canada, along with other OECD countries, exhibits income-related variations in the use of health care services. This paper extends previous analyses to include surgical day care, assesses changes in income-related equity between 1992 and 2002 in British Columbia and tests the feasibility of using administrative data for general equity analyses.
Methods: Data derive from the BC Linked Health Database and from a custom tabulation of income tax filer data provided by Statistics Canada. Cross-sectional analyses measure inequity in the probability and conditional use of services using concentration indices, which summarize health care services use for individuals ranked by income, after standardization for age, sex, region of residence and need for health care services.
Results: Small but systematic relationships were found between income and use of health care services for all types of services, with the exception of visits to general practitioners (GPs). Lower income is associated with greater conditional use of GPs and greater use of acute inpatient care. Higher income is associated with the greater use of specialist and surgical day care services; the latter inequity was found to grow substantially over time.
Conclusions: Deviations from equity deserve further investigation, especially because the use of day care surgery is continually expanding. For example, an understanding of the reasons for differential admission rates to acute and day surgery might provide insight as to whether community-based services could help shift some acute care use among lower income groups to surgical day care. It is possible to use administrative data to monitor income-related equity, and future research should take advantage of this possibility.

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CANADIAN POLITICS:
CANADIAN MEDICINE-POLITICAL INTERFERENCE:
The following item is from the website of the Canadian Union of Public Employees (CUPE), about recent statements about how the federal government is using public forums to denounce Vancouver's Insite safe injection site and also about how the past and present heads of the Canadian Medical Association are using their position to speak out against our medicare system, despite the wishes of many Canadian doctors..
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CMA ignores evidence in privatization push:

The head of the Canadian Medical Association was right to criticize federal health minister Tony Clement for sidestepping the facts about safe injection sites for drug users.

But Dr. Brian Day is equally guilty of ignoring the evidence as he and his successor continue to push for more health care privatization.

Outgoing CMA president Day was indignant when Clement used his speech to the association’s recent annual meeting to question the ethics of doctors who support Vancouver’s safe injection site for drug users.

Responding to Clement, Day told the media the CMA had a position “based on scientific evidence.” If only the CMA leadership would pursue evidence-based policies and practices for health care delivery and funding.

Instead, Dr. Day and incoming president Dr. Robert Ouellet are aggressively promoting health care privatization, calling for more privately-delivered services and a funding formula that forces public hospitals to compete with each other.

Day couches his pursuit of public-private partnerships, private clinics and performance-based funding in the language of health care “transformation”, dismissing public health care defenders for their “tedious and tiresome propaganda.”

Newly-elected president Ouellet made it clear the privatization torch will pass seamlessly from Day. He told the media it was “time Canada accepted [the] reality” of private, for-profit delivery of health care.

Ouellet operates a string of Montreal-area private diagnostic clinics, including the country’s first private diagnostic clinic, which opened in 1987. Not surprisingly, he supported more privately-delivered care as recent president of the Quebec Medical Association.

CMA leadership is also promoting ‘patient-focused funding', a formula that paves the way for commercialization and competition. This funding formula, also known as ‘payment by results’, ‘activity-based funding’ and ‘volume-based funding’, is a ruse for privatization. In most countries where it’s been introduced, and certainly in Canada, it comes with competition and commercialization, forcing hospitals to compete for patients and the public dollars they will bring with them.

Canadian Doctors for Medicare founding chair Dr. Danielle Martin says the formula will mean “lower quality, reduced accessibility, reduced efficiency and higher costs; particularly where it is linked to increase private for profit delivery.” Martin and other doctors went public before the CMA meeting, criticizing the organization’s prescription for privatization.

British doctors also have serious concerns about ‘payment by results’ (PBR) as it’s known in their country. In Britain, PBR has driven up administrative and overall costs, and increased hospital admission rates. The British Medical Association has said PBR leads to ‘fragmenting care into saleable bits on which profits can be made.’

At their recent annual meeting, BMA president Dr. Hamish Meldrum called on the Labour government to get rid of the market in health care. “Let’s stop pretending that healing the sick is like trading a commodity. Let’s stop diverting doctors’ energies into unholy bidding wars for jobs they already do,” said Meldrum, who attended the CMA meeting.

The BMA position is backed by a recent study finding patients are no better off in an national health care system that's riddled with competition.

The CMA strategy session on ‘transforming’ health care was hosted by Claude Castonguay, author of a report recommending sweeping privatization of Quebec health care.

But the CMA doesn’t speak for all doctors. In fact, many doctors want to protect and expand public health care, explicitly rejecting the CMA’s push to privatize.

On the eve of the CMA meeting Canadian Doctors for Medicare and their Quebec allies, Médecins québécois pour le régime public, released a declaration signed by prominent doctors.

The declaration says more privately-funded and delivered health care is a ‘deadly’ treatment based on the wrong diagnosis, debunking the myth that public health care is unsustainable.

With a federal election looming and the ongoing absenteeism of the Conservative (and previous Liberal) government when it comes to enforcing the Canada Health Act, CUPE will continue to mobilize members and work with its coalition partners to stop the spread of health care privatization.

Related articles

• Tell Tony Clement to keep health care public
• Over 4,000 rock for public services in Sturgeon Falls with Trooper, High Holy Days
• Proposed privatization of public services in West Nipissing comes at high cost – CUPE
• HEU members approve Bill 29 settlement
• Shelve Castonguay, support medicare

External links

• Medical Reform Group
• Canadian Health Coalition