Chapter 6 of Sick and Sicker: Essays on Class Health and Health Care
The history of how Canadian medicare was won and how it is being lost provides offers valuable lessons.
Until the 1960’s, the Canadian medical system was dominated by the private sector. Charitable organizations provided minimal care for the poor. Regular medical care was reserved for those who could pay and for those whose employers would pay for them.
Along with their American counterparts, Canadian physicians and insurance companies vigorously opposed any reforms that hinted of “state medicine” or “socialism.” Neither business nor government supported universal access.
Like the United States, Canada was deeply affected by the social protest movements of the 1960s, including the demand for universal health care. In 1962, the Canadian Labour Congress (CLC) declared its preference:
“We favor a system of public health care that will be universal in application and comprehensive in coverage. We favor a system that will present no economic barrier between the service and those who need it. We are opposed to any provision which will require some people to submit themselves to a means test in order to obtain service. We look to a system of health care that will be regarded as a public service and not as an insurance mechanism.”(1)
Despite the popular demand for socialized medicine, where the State is both payer and provider, the Canadian Medical Care Insurance Act of 1966 established socialized insurance, a publicly-financed, private enterprise system “free of government control or domination.” It took five more years to implement the Medical Care Insurance Act in all provinces.
In the province of Quebec, union demands peaked in the 1972 general strike. To buy labor peace, Quebec incorporated medical services into a broad social benefits system, paid for and provided by the provincial government. The Quebec working class is rarely credited for winning the most comprehensive socialized medical system in North America.
Rolling Back the Gains
Under the initial funding arrangement, the federal and provincial governments agreed to split the cost of medicare 50-50. In 1977, the federal government reduced its share of medical funding to 20 percent. Because the provinces varied in their ability to pay for medical programs, the principle of equal access was undermined. Less funding was followed by rounds of cuts to hospital budgets and medical services.
Medical care was still free, but there was less of it available.
Private insurers rushed into the breach. The more services were cut from the medicare basket, the more individuals had to purchase insurance, pay out of pocket, or go without.
In 1984, the federal government passed the Canada Health Act to reassure nervous Canadians that medicare was safe. While universal access was promised on paper, not enough funds were provided to make it happen. This was a deliberate strategy. Behind the scenes, politicians were preparing to open medicare to the private sector.
In 1994, the Ontario government stated,
“To have the effective launching pad it needs, the health industries sector must expand its share of its own home market. Steps must be taken to ensure that, as in other countries, the domestic market supports the development of globally competitive companies.”(2)
To boost profits in the nursing-home industry, the province scrapped regulations that ensured a minimum level of daily nursing care for patients.
During the 1990s, hospital funding was cut dramatically. Before these cuts, Ontario’s Emergency Departments were moderately congested 9 percent of the time and severely congested 0.5 percent of the time. After the cuts, they were moderately congested 23 percent of the time and severely congested 6 percent of the time.(3)
The hospital cuts were so unpopular that the Ontario Conservative Party was voted out of office in favor of the Liberal Party, which implemented more cuts.
While the Ontario government squeezes public hospital budgets, it has invested hundreds of millions of dollars to establish “P3” hospitals (public-private-partnership).
A 2008 Provincial Auditor’s report found that the total cost of just one P3 hospital was $300 million more than it would have cost to build and operate the hospital publicly. Nevertheless,
“the only advisors that the government listens to are those who come from the P3 industry – the financiers, law firms, service privatizers and giant construction firms who directly benefit from the exorbitant costs of this privatization policy.”(4)
The federal government also supports the privatization agenda. In 1997, it declared,
“Promoting Canadian companies as global health-keepers is the main objective driving the strategies and plans of the government for the medical devices, pharmaceutical and health-services sector.”(5)
Behind the mask of healthcare “reform” and “restructuring,” the Canadian medical system is being handed, piece-by-piece, to private industry in much the same way as Britain’s National Health Service was dismantled.(6)
Canadian law mandates that medical services provided in hospital must be publicly funded and provided free of charge, so hospital cuts and closures are the primary means of moving medical funding and services to the private sector. This is done by formula:
- public medical care is under-funded to the point of crisis, then condemned for its inadequacies.
- private sector is proclaimed the only possible savior, and opponents are ridiculed as old-fashioned and sentimental.
- When the market fails to deliver, the public is told to adapt to “the new reality.”
While most Americans long for a Canadian-style medical system, that system is disintegrating under the pressure of market forces.
Tens of thousands of hospital nursing jobs have disappeared at the same time that hospital stays have been cut, so that fewer nurses care for much sicker patients. Deadly, infectious diseases sweep through hospitals that no longer have enough cleaning staff.(7)
Most rehabilitation and chronic-care facilities have closed or gone private, transferring the cost of caring to the individual patient and their family.
The closure of hospital outpatient clinics means that discharged patients are directed to private clinics or family doctors for follow-up care. However, there are not enough family doctors to meet the demand.
In 2006, fewer than 10 percent of Ontario family doctors were accepting new patients and five million Canadians (one in six) had no family doctor. Patients can wait weeks to see a family doctor, months to see a specialist, and many more months for treatment.
Canadian medicare is so underfunded that, in 2004, Canada’s Supreme Court declared,
“The Canada Health Act [does] not promise that any Canadian will receive funding for all medically required treatment.”
Funding cuts have severely damaged Quebec’s model medical system. In 2005, Canada’s Supreme Court ruled that lack of timely access to treatment in Quebec was so serious that the province could no longer prohibit private funding for medically necessary services. Similar legal challenges are expected in the other provinces.
CUPE Hospital Strike
Unionized hospital workers have mounted the strongest defense against privatization, fighting cuts to hospital staff and programs and the outsourcing of hospital services to for-profit, non-union corporations.
In 1981, hospital workers organized in the Canadian Union of Public Employees (CUPE) struck the Ontario Hospital Association. At one hospital, workers locked out management and continued working under their own elected committee.
For seven days, 13,000 strikers defied provincial back-to-work legislation, the jailing of top union officials, and the firing of key strike leaders.
When management refused to budge, the next step should have been to mobilize the other sections of CUPE for an all-out public-sector strike. Unwilling to take that step, union officials caved. The defeat was substantial.
Many small, local hospitals were closed. Other hospitals were merged into giant conglomerates managed by business consultants.
Although Canadian hospital workers continue to fight, they have failed to mobilize sufficient forces to stop, let alone reverse, the cuts.
The Canadian experience reveals that:
- Governments will under-fund medical systems to meet the needs of the capitalist class.
- Changing politicians and political parties does not change the priorities of the capitalist system.
- Awareness campaigns are not enough. Capitalism is structured to prevent the majority from changing society regardless of what they know.
- Union bureaucrats will sacrifice the needs of workers and patients rather than challenge the capitalist system.
- Only rank-and-file medical workers fight consistently for patients’ rights.
Most pro-medicare organizations are dominated by a two-pronged strategy: educate the public on how bad things are, and plead with the people in power to make better decisions. Calling for more intelligence at the top of the capitalist hierarchy has proved to be a failing strategy.
The people in power know exactly what they are doing. They choose to put profits first.
If we are serious about putting people first, we must reject capitalism and build a working-class alternative. We need demand democratic decision-making in the medical system, where those who do the work decide how it will be done and are provided with enough funding to do it.
Class Solidarity is the Best Medicine
Support for universal medicare remains strong in Canada and in the United States.(8) However, capitalism is not a system of majority rule. That leaves only one way forward – building a mass movement that is large enough, strong enough, clear enough, and determined enough to advance our demands over the opposition of the ruling class.
It took a revolution in Paris to scare Germany into establishing Europe’s first national medical plan in 1883. In Britain, the National Insurance Act of 1911 was rushed through Parliament during a strike wave. And Canadian medicare was consolidated in 1972, the year of the Quebec General Strike.
During the social crisis of the 1930s, President Roosevelt conceded the New Deal, but excluded national medicare. To quell the protests of the 1960s, President Johnson conceded Medicare and Medicaid, but held the line on universal coverage.
The US remains the only industrialized country without a national medical plan because the American labor movement has not been strong enough to wring this concession from the world’s most powerful ruling class.(9)
In 2007, union drives in the US medical industry enjoyed a higher-than-average rate of success.(10) Despite opposition from union bureaucrats, health workers are pushing for real improvements in working conditions and patient care, fighting for more services, higher staff-to-patient ratios, and the right to blow the whistle on deficient and dangerous conditions. However, they cannot win on their own.
We need a fighting labor movement that will reject medical rationing, demand universal access, and keep pushing to create a truly healthful society where people’s’ needs come first.
1. Cited in Fuller, C. (1998). Caring for profit: How corporations are taking over Canada’s health care system. Ottawa: Canadian Centre for Policy Alternatives.
2. Healthy and wealthy, a growth prescription for Ontario’s health industries. (1994). Report of the Health Industries Advisory Committee to the Ontario Ministry of Health, March.
3. Reported at the annual conference of the Ontario Health Coalition, Toronto, January 31, 2009.
4. Ontario Health Coalition. (2008). When public relations trump public accountability: The evolution of cost overruns, service cuts and cover-up in the Brampton Hospital P3. January 7.
5. National Sector Team: Health Industries. (1997). Canadian international business strategies – ‘97-’98, Report for Industry Canada, March 20.
6. Pollock, A.M. (2004) NHS plc: The privatization of our health care. New York: Verso.
7. Valiquette, L. et. al. (2004). Clostridium difficile infection in hospitals: A brewing storm. CMAJ. July 6, Vol.171, No.1.
8. CBS News/New York Times poll. (2009). American public opinion: Today vs 30 years ago. Conducted January 11-15.
9. Quadagno, J. (2006). One nation uninsured: Why the US has no national health insurance. Oxford U. Press.
10. ASHHRA 30th Semi-Annual Labor Activity Report.