The crisis in Medicare is about more than money it's about ideology, and the desire by corporations and a few powerful politicians to abandon public health care to the free market. The fight to preserve Medicare will only be won if the back benchers in Parliament break their complicit silence and if thousands more, tens of thousands more Canadians become intentional citizens active, informed, committed, determined citizens. They must do so quickly. Time is running out!

Medicare is in crisis. But it s not the crisis you keep hearing about.

For the vast majority of Canadians, their experiences with publicly funded health care are still very positive. It s true there have been massive cuts to Medicare. And it s also true we see dozens of stories in the media about long waiting lists and patients in hospital corridors.

The real crisis in Medicare, however, is a corporate threat. For over 15 years, corporations from insurance companies to private hospital firms to giant U.S. health conglomerates have been steadily chipping away at the public armour of Medicare, trying to find profitable ways into the system.

The phony crisis the hysterical reports about waiting lists, the tabloid style horror stories, the denigration of the public system as inefficient and unreliable is a deliberately created crisis. It is an ideological assault designed to undermine confidence in the system. This manufactured crisis is not unique to health care. It s become a standard tactic of politicians seeking to impose a strategy of privatization. In a videotaped speech to civil servants a few years ago, former Ontario education minister John Snobelen talked glowingly about creating a "useful crisis" in education. Only if citizens perceived there was a crisis (to be brought about by massive cuts) would they rise to the occasion and accept a suitably radical solution. In fact, that exact scenario has been played out in Ontario s education system.

The same strategy is being used with Medicare. The betrayal of Medicare is being led by three governments the federal Liberals and the provincial Tories in Ontario and Alberta. The two provincial governments are quite open about their commitment to permitting partial privatization, and Ottawa, while not at all open about it, has been their willing partner.

In 1996, Ottawa had been effectively fining Alberta $420,000 a month because the province was allowing private eye clinics to charge "facility fees" of $1,275 per eye, for cataract operations a clear violation of the Canada Health Act and its five basic principles universality, public administration, comprehensiveness, accessibility and portability. Bureaucrats in Health Canada wanted to avoid a nasty fight and secretly fashioned a compromise. The federal Liberal government was intent on appeasing the provinces and cutting costs, with the result that a private, parallel health care system has since taken root in Alberta, and Ontario. The result, according to Alberta health economist Richard Plain, was that "Private and public practice could be combined in such a way that a physician could recommend additional private services on top of the insured Medicare services, bill the patient directly for the additional services and still stay within the Medicare plan." It was virtually two tier health care. 

Prime Minister Jean Chr彋ien, meanwhile, was publicly outlining his own vision of medicare as a "no frills" plan covering only "major surgery." These changes in the interpretation of the Canada Health Act by the Prime Minister, clearly cut the ground out from under his own Minister of Health, Diane Marleau, who was ready to impose a fine on Alberta. She was subsequently pulled from the health portfolio and swiftly sent to the back benches.

The real impact of that federal decision is now being played out in Alberta and could soon be repeated across the country. On March 2, Ralph Klein introduced legislation that will legalize private, for-profit hospitals. The fight is not over in Alberta. Thousands have already responded to this threat to Medicare by swarming the legislature demanding that Bill 11 be withdrawn. But if Klein and his corporate backers prevail, Canada will have the first of many for- profit hospitals. 

The fatal flaws in for-profit care

Virtually every credible study ever done says that private, for-profit health care is more expensive, less efficient, and of lower quality than public health care. But this does not stop the ideological assault on Medicare because the criticism of Medicare is not about health, it is about investment and profits, and it is driven by free-market ideology. 

The most blatant myth put forward by the Klein government is the claim that for-profit facilities reduce costs. A for-profit facility simply has far too many additional costs and financial burdens that a non-profit or public facility does not. First, investors expect a return on their investment of 15%, they also expect constant growth. Compared to public health administrators, health CEO's earn huge, often multi-million-dollar pay packages. For- profit hospitals must spend enormous amounts of time and effort on marketing, on investor relations and on acquisition strategies.

The U.S. experience offers sobering evidence of the failure of for-profit hospitals. An article in the August 5, 1999 issue of the prestigious New England Journal of Medicine reported: "For decades studies have shown for-profit hospitals are 3 to 11 percent more expensive than not-for-profit hospitals; no peer-reviewed study has found for- profit hospitals are less expensive." The article went on to reveal huge marketing budgets, large executive bonuses and a lower quality of care. 

The Herdrich case was the first U.S. Supreme Court challenge to Health Management Organization policies critics charge sacrifice patient care to reduce costs. The policy of paying bonuses to doctors who order fewer tests; Herdrich says, presents a "conflict of interest" between a doctor's pay and his duty to a patient. 

The journal of the American Medical Association recently reported on a 1999 study which concluded: "The decade-old experiment with market medicine is a failure. The drive for profit is compromising the quality of care, the number of uninsured persons is increasing....costs are escalating rapidly."

The U.S. health care system is "the most expensive and most inadequate in the developed world," charged the New England Journal of Medicine in another recent series of sharply critical articles. 

About 13.6% of the money in the U.S. economy is currently devoted to health care, and that rate is expected to rise to 16.6% in 2002, the Journal declared.

Home-grown two-tier medicine

In Calgary, with Alberta's highest number of eye surgeons per capita, all such surgeries are done in private clinics and waiting lists average between 16 and 24 weeks. A patient who wants an upgraded lens pays an average of $400 extra. In Lethbridge, where all cataract operations are done in public facilities, the waiting list is 4 to 7 weeks and there is no charge for the upgraded lens, which the regional health authority purchases for less than $100.

Corporate predators

At the centre of the fight over for-profit hospitals in Alberta which is pitting consumer groups, unions, health care coalitions and opposition parties against the Klein government is the former Grace Hospital in Calgary. Closed in the massive budget cuts, it is now partially leased by the private Health  Resource Group (HRG), which has spent millions preparing the third floor for major surgeries, just waiting for the legislative green light.

The HRG consortium has a Calgary face, with several prominent business and medical personalities on its board of directors. But looks can be deceiving. Behind the scenes some very huge corporate players are guiding the operation and investing money. HRG's orthopaedic surgeon also happens to be Chief Medical Officer for Columbia Health Care Inc., a for-profit rehabilitation company with 33 operations across Canada. A large U.S. corporation, Sun Healthcare, formerly the owner of Columbia, is also represented by Tom Saunders, former vice-president of Canadian operations for Sun.

Last but not least is MDS, one of the largest shareholder-owned health corporations in Canada. In her book Caring for Profit: How Corporations Are Taking over Canada's Health Care System, Colleen Fuller devotes an entire chapter to MDS, which she calls "Canada's home-grown behemoth." MDS has seven divisions, including lab services to pharmaceuticals and a venture capital arm that has helped create 40 new for-profit health companies. (Possibly an excellent source of job opportunities for retired politicians.)

The threat from trade

Corporations eager to get access to Canada's $72 billion health care system have a powerful ally in their corner: NAFTA. And very soon they may have another the World Trade Organization (WTO), in the form of the General Agreement on Trade in Services (GATS). Right now the WTO is in the midst of negotiations led by Canada that would literally destroy our public health care and education. The passing of the original Canada-U.S. Free Trade Agreement and NAFTA opened the door to large U.S. insurance companies that quickly offered a raft of new services services aimed at filling the gap in the steadily eroding public system. 

But the major threat from NAFTA and WTO comes from what it means for government powers of regulation. Ottawa is committed to the principles behind NAFTA and those principles are inherently hostile to Medicare. Privatization and deregulation doesn't work for a system which depends on government control and tight regulation

The supporters of NAFTA and the WTO are determined to introduce what they refer to as "market-based reforms" into our health care system. In other words, market reforms are being undertaken for their own sake with no pretense they will improve health care. 

Tax cuts take a slice out of health care

The pressures bearing down on Canada's health care system are myriad: giant health corporations applying enormous political pressure, right-wing governments applying free market zeal to every social program, "trade" agreements and, lastly, the relentless corporate campaign to cut taxes. This latter campaign aims at permanently reducing the revenue governments have to provide services including health care. Paul Martin's millennium budget was the clearest declaration yet the federal government intends never again to be a full partner in Medicare. Having slashed billions from its share of the health care budget nationwide, the Chr彋ien/Martin Liberals are setting those cuts in stone by reducing the amount of revenue Ottawa will have in the future. The $58 billion in tax cuts announced February 28 virtually ensures that governments in the future will not be able to restore Medicare. 

Thus it maintains Ottawa s radically decreased partnership position in Medicare at less than 19%, compared to 50% when national health care was established in 1967. Under the Mulroney Tories, health funding was slashed by a total of $30 billion. The Liberals chopped it by a further $6.5 billion. 

The massive tax cuts represent a fundamental shift in government policy a gradual surrender to the private sector of government s role in managing the economy and providing services. As Ottawa already knows, the slow starvation of health care and other social programs will inevitably lead to more and more privatization. Indeed, ever since the cuts to Medicare began, Canadians have seen an inexorable shift to private spending. As Colleen Fuller points out, in 1975, 76.4% of  the total health bill in Canada was publicly funded; by 1986 it was down to 73.3% and by 1997 it had slipped to 68%. The rest is covered by private plans or personal out of pocket spending.

The 2000 federal budget provided only $2.5 billion for health, education, and social programs. This minuscule one-time payment is spread over four years and so does not become part of the long term funding for health care. 

The federal budget was a profoundly antidemocratic policy statement. In poll after poll, Canadians have stated their top priority is health care. Most Canadians say Medicare defines us as a nation. In the most comprehensive poll done each year, the Ekos "Rethinking Government" poll (partially financed by the federal government), tax cuts placed seventh out of eight priorities for spending the budget surplus: health, education, child care, child poverty, debt reduction and job creation all ranked ahead. In fact, in many polls Canadians say they would actually be willing to pay more in taxes if the money went to these other priorities.

This budget left Canadians asking: "What happened to the children's budget?" It left them wondering what has to happen to our health care system to get a response from the government of Canada. It left Canadians appalled at the seriously twisted priorities that put more weight on cutting capital gains taxes for the highest income 1% of taxpayers than on dealing with the crisis of homelessness in all of our major cities.

Forget the rhetoric about giving money back to Canadians who sacrificed to win the battle against the deficit. This budget gives most of the medals to those who never went near the battlefield. 

Mr. Chr彋ien promises to save medicare, while Mr. Martin refuses to restore the billions of dollars he has cut from it. Jean's fighting words mean very little if Paul isn't prepared to provide the funds to make it happen. It is becoming painfully clear, despite their pious protestations, the Chr彋ien/Martin Government is  more interested in pleasing their friends, the powerful business lobby, than saving Medicare.

The political and economic elites in Canada have quite clearly abandoned the national project, have abdicated their role in nation-building. Their positions on international trade and investment treaties are the most aggressively neo-liberal of any OECD country; the shameless giveaways to corporations and the wealthy in the budget reveal they are prepared to take us back to the kind of social inequality that existed in the 1930's. The same Ekos polls that showed what ordinary Canadians want, reveal that the elites want just the opposite: privatization; deregulation; more military spending; a focus on inflation, not unemployment; and an investment "climate" free of any accountability for corporations.

The fight for Medicare is the fight for Canada

We are in the fight of our lives to defend Medicare. It is a fight we have to win. Medicare is symbolic of the public space that three generations of Canadians fought hard to create. If we really believe that Medicare and the values it symbolizes are what gives Canada its character, then we have no choice but to fight like the citizens of Alberta with everything we have to save it.

If we cannot even manage to defend Medicare, the heart of the nation, then we will surely lose everything else. Canadians should see Medicare as the bulwark stopping the forces of corporate privatization from sweeping over public education, environmental protection, municipal services, pension funds, national parks and literally dozens of other programs and institutions that make us different from the U.S. and make a market economy liveable for the majority of citizens.

To do so we must change our way of thinking. Governments are no longer the expression of community and nation-building they once were. If we continue to behave towards them as though they were, if we maintain our former expectations of what we want them to do, we will be complicit in handing over our democracy and popular sovereignty to the world s largest and most ruthless corporations. The fight will only be won if the back benchers in Parliament break their complicit silence and thousands more, tens of thousands more Canadians become intentional citizens active, informed, committed, determined citizens; and only if they do so quickly. Time is running out.

Editorial with materials exerpted from Murray Dobbin and Colleen Fuller Murray Dobbin s latest book is The Myth of the Good Corporate Citizen: Democracy Under the Rule of Big Business, published by Stoddart.

Editorial note: From the current Alliance Party leadership race, they appear to be interested in saving Medicare for their friends, the private multinational health care corporations. The Chr彋ien/Martin Liberals seem to be most interested in saving themselves. It is to be hoped the "Third Way" doesn't turn out to be a convoluted rewording of the "First" and "Second" ways, designed with the purpose of getting the Chr彋ien/Martin Liberals reelected for a "Third Term".

What Canada desperately needs as we enter the new millennium is; leaders with the courage, philosophical commitment, and political will, to meet the challenges threatening both our sovereignty and our quality of life; leaders who are truly committed to preserving government of the people, for the people and by the people; leaders who will give Canadians a renewed sense of hope for a better quality of life for us, our children and our grandchildren.

In earlier times, if a person sold out their country they were called a traitor. Now we call it 'good business.' If a person does a good job of selling out our country, we might even award them with the "Order of Canada." At this critical time in our history, one is reminded of the 19 th century social activist poet Josiah Holland's poem entitled:

Wanted!

God give us Men, The times demand strong minds, great hearts, true faith and willing hands.

Men whom the lust of office does not kill;

Men whom the spoils of office cannot buy;

Men who possess opinions and will;

Men who have honour;

Men who will not lie;

Men who can stand before a demagogue

And damn his treacherous flatteries without winking,

Tall men, sun-crowned, who live above the fog,

In public duty and in private thinking.

For while 'our leaders', with their thumb worn creeds.

Their large professions and their little deeds

Mingle in selfish strife, lo! Freedom weeps,

Wrong rules the land, and waiting Justice sleeps.

From Father's Scrapbook