Socialism is the Best Medicine

Socialism is the Best Medicine

The Fight to Save Ontario Hospitals

February 9, 2009

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As the fight for a single-payer medical system heats up in the United States, Canada’s single-payer system is being dismantled to support corporate profits.

On January 30-31, two-hundred representatives met in Toronto for a “Strategy Summit on Ontario’s Planned Hospital Cuts, Downsizing and Restructuring” convened by the Ontario Health Coalition. The OHC includes more than 400 labor and community groups committed to defending and improving a publicly-funded and publicly-administered healthcare system.

The Strategy Summit was called in response to planned funding cuts that will affect every hospital in the province of Ontario. These cuts will close Emergency Departments, eliminate local birthing services, reduce beds, and privatize paramedical and support services. The result will mean fewer services and higher fees for patients and their families.

The goal of the meeting was to organize a province-wide campaign to stop these cuts, and the first order of business was to expose the lies used to justify them.

The cuts are not a response to the recession

Back in 1994, the Ontario government presented its plan to transform the medical system into a cash-cow for the private sector.

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. (1)

One of these steps was to scrap regulations that ensured a minimum level of daily care for nursing home patients. Major cuts to hospital funding and services followed.

The cuts were so unpopular that the Conservative Party was voted out of office. In turn, the Liberal Party has betrayed its election mandate with this round of further cuts.

In 2006, before the recession, the Liberals passed the Local Health System Integration Act to dismantle the public hospital system under the guise of “integration.” The province was divided into 14 geographic areas, each of which was assigned a Local Health Integration Network (LHIN) with the power to  reorganize and cut regional medical services.

Economists warn that hospital cuts will deepen the effects of the recession, because every lost hospital job will cause a second job loss in the community. And increasing wait-times for medical services will cost billions more dollars in lost work and productivity.

The cuts are not about improving hospital efficiency

Hospitals are not being cut to make them more efficient, but to support the profitability of the private sector.

Ontario hospitals are the most “efficient” in the country. Between 1981 and 2008, the hospital share of the Ontario health budget fell from 52 percent to 37 percent.

The Ontario government is cutting funding for public programs in order to support corporate profits. Only 15 percent of Ontario’s GDP goes to support public services, compared with 17 percent for the rest of Canada. As a result, Ontario has the lowest per-capita government expenditure: $6,905 in 2007 compared with $8,692 for the rest of Canada.

Hospital cuts also help to move medical services (and money) from the public sector to the private sector. This is accomplished in a two-step process.

First, hospitals are funded below the level required to match the rate of inflation and population growth. Years of under-funding have pushed half of Ontario hospitals into deficit and 70 percent are expected to be in deficit by next year. Then hospitals are forced to balance their budgets by cutting services.

By Canadian law, medical services provided in hospital must be publicly funded and provided free of charge. Once these services leave hospital, they can be taken over by the private sector as profit-making opportunities.

The cuts are undemocratic

Instead of matching health dollars to the needs of the population, the population is expected to sacrifice its needs to budget mandates. There is no way to achieve this democratically.

According to the Ontario Ministry of Health,

The [LHIN] legislation places significant decision-making power at the community level and focuses the local health system on the community’s needs.

In fact, the LHINs are staffed by government appointees who are not elected and not accountable to anyone but the Ministry.

Small local hospitals are built and maintained by dedicated community fund-raising. They are vital to the economies of their areas, providing jobs and helping to attract new industry. The Ministry plans to close these hospitals over the protests of the people who built, maintain, work in, and rely on them.

All hospitals are required to sign “Hospital Accountability Agreements,” that compel them to meet restricted budgets by cutting services. Those that don’t “agree” have the cuts imposed.

Hospital CEOs who protest the cuts are fired and replaced by government-appointed supervisors. Community-elected hospital boards that reject the cuts are dissolved and replaced by government-appointed managers. Communities that protest this blatant  lack of democracy are told that hospitals are too large and complex to be democratically run!

Cuts kill

Most small and rural hospitals are scheduled to be closed. These hospitals are critical for providing timely care in outlying areas. Additional travel time to larger hospitals can mean the difference between life and death.

Patients need social support to recover, and local hospitals provide easy access to family and friends. If local hospitals close, families will be forced to travel to larger centers to see their loved ones. No provision has been made to assist in this travel, so low-income families will be unable to visit at all.

Emergency Rooms will become even more congested. The deep cuts made in the mid-1990s (dubbed “the Harris cuts” after the Premier at the time) eliminated many hospital and chronic-care beds, making it more difficult to transfer patients out of Emergency.

Before the Harris cuts, Ontario’s ERs 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.

The backlog in Emergency Departments is not caused by too many people using ERs irresponsibly, but by sick, injured, and elderly people needing beds that are not available. Patients can spend hours, even days, in the ER waiting for a hospital or chronic-care bed while lying on uncomfortable stretchers in the hallways of a noisy, trauma-filled environment.

ER staff suffer high rates of burnout and turnover is high. Regular conflicts erupt between ambulance paramedics bringing new patients and ER staff who cannot cope with the demand.

Combine overcrowded Emergency Rooms, hospitals filled to capacity, and cuts to cleaning staff, and you have a perfect breeding ground for deadly hospital infections like SARS, MRSA and C. Difficile.

The medical system has no surplus capacity to handle an epidemic or mass trauma event even before the coming round of cuts that have been described as “Harris on steroids.”

The problem is not a lack of money

While the government squeezes hospital budgets, it is going hundreds of millions of dollars over budget to establish privatized “P3” (public-private-partnership) hospitals.

The 2008 Provincial Auditor’s report found that the cost of just one P3 hospital was $300 million more than it would have cost to build and operate the hospital publicly.

Despite their higher costs, Ontario has planned more than 30 additional P3 projects, because they serve as a conduit for transferring public funds to the private sector.

As OHC organizer Natalie Mehra points out,

“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.”

What will it take?

Repeated cuts to hospital services have provoked major protests across the province. Public rallies and marches, petitions, and thousands of letters to the editor have condemned the cuts. There have been a few small victories – some hospitals kept open, some services saved – but not nearly enough. It was clear to everyone at the meeting that much more is needed.

There were many suggestions of how to fight back. One was to try to convince the government and the LHINs that their “restructuring” plans are medically unsafe, economically unsound, and unnecessary. The OHC has compiled a mountain of evidence to prove it.

Unfortunately for us, the government does not care. It serves a business class that is locked in a fierce competition for profits, and protecting those profits is the priority.

Another strategy was to mobilize people in numbers large enough to “inflict political pain” on the ruling Liberal party. Suggestions included town hall meetings, mass leafleting and postering, door-to-door campaigning, media events, letters to the editor, rallies, marches, demonstrations, and civil disobedience coordinated across the province. This is definitely doable. Since the OHC was launched in 2003, it has organized a province-wide network of activists.

A few voices proposed hospital strikes and sit-ins. These suggestions were not taken up, despite the many union representatives at the meeting. Decades of defeats and  compromise have produced widespread demoralization among workers. Nevertheless, the power of organized hospital workers, backed by patients, families, and communities, is our best hope for winning this fight.

The stakes are huge: On the one side, the future of our public medical system. On the other side, the demand for profitability at all cost.

We can accept the logic of capitalism and, once again, allow human need to be sacrificed to profit. Or we can reject the lie that there is no alternative. We can build a movement that is deep enough and strong enough to ensure that 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, p.101.

1 Comments

1 Comment

  1. Good luck. My workplace just got the notice April 25/2010. All our SEIU Union jobs are being outsourced to agencies and guess what? The agency of choice is India. Try getting a job or re-employment from a layoff when the company works in India? Union Collective Agreement states “union members to get 5 months notice” – We got nothing, zilch. Union rep walked into meeting, sat down, didn’t look at the members, meeting over so union rep walked out, no help was offered to any members, didn’t even bother to state that if you have any questions or concerns feel free to contact SEIU. Plus, SEIU rep would not give any eye contact to any union members. Where is the justice in that? Where is the basic common courtesy to the union members who pay the SEIU’s salary? How hard is to say I’m sorry?

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  1. The Fight to Save Ontario’s Hospitals | We Are Change Northern Ontario - Thank you to Tyler from Burks Falls, Northern Ontario: https://susanrosenthal.com/articles/the-fight-to-save-ontario-hospitals

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