Canada: Public vs for-profit health care

by Doug Allan

The Canadian public has said "no" to the erosion of universal, 
single-tier public health care. Indeed, popular pressure forced a 
recent Canadian Royal Commission to propose expansion of the 
public system.

The Canadian system provides hospital and medical coverage for 
all. The richest and the poorest may well be seen by the same 
doctor and treated at the same hospital.

Despite the universal nature of the system, costs are much less 
than in the American system. Forty years ago, the Canadian system 
resembled the American system. Now Canadians see universal public 
health care as one of the country's defining accomplishments.

Despite endless corporate campaigns to erode confidence in public 
health care, the Royal Commission promotes publicly funded health 
care and recommends its expansion. Some home care services would 
be incorporated into the Canada Health Act and covered as insured 
services. User fees, extra billing, and medical savings accounts 
were rejected.

While this is positive, there is also the key issue of the 
privatisation of health care delivery. Right-wingers have been 
forced to recognise that the Canadian public strongly supports 
universal health care insurance. So many of them have decided to 
lie low and refrain from attacking public health care insurance. 
But there is a growing attack on public health care delivery.

With a guarantee of public money, corporations are trying to take 
over the delivery of health care, beginning with support 
services. With billions and billions of dollars of public money 
at stake, the corporations pursue this goal with a furious 
hunger.

During the last British Columbian provincial election, the major 
right-wing party opposing the social democratic government 
promised health care workers they had nothing to fear. However, 
after the election, that same party passed legislation removing 
collective agreement protections against privatisation for health 
care employees. The rights and provisions to protect workers 
facing layoff were also eroded.

British Columbia had some of the country's best hospital 
collective agreements. But the giant corporations trying to take 
over the work will cut wages almost in half — not enough to 
support a family or retain experienced workers.

When the struggle first began, taped conversations with corporate 
representatives suggested that thousands of hospital employees 
would be blacklisted.

A regional manager for one transnational corporation stated he 
would not hire union members if his company succeeded in a bid 
for work done by those members. In another call, a consultant 
with a management labour relations company said his firm would be 
reluctant to hire any union members for fear they would vote 
their old union back in if they were forced to work for about $10 
(Canadian) an hour, rather than the current $17 an hour.

Initially, the main health care union tried to negotiate 
concessions to keep the work unionised. However, when put to a 
vote, the workers rejected the concessions. The government is now 
proceeding with the privatisation of many thousands of hospital 
support jobs.

In Ontario, the Conservative government tried to privatise 
important hospital diagnostic services and introduce "public-
private partnerships" ("P3s").

Canadian hospitals are not-for-profit. Introducing full for-
profit hospitals would not be accepted — so the Conservatives 
tried the thin edge of the wedge. With a P3 hospital, a for-
profit corporation would finance a new hospital facility, provide 
support services, and lease the facility back to the hospital 
over 25 to 60 years.

The Conservatives proposed two P3 "pilot projects" — one in a 
suburb of Toronto (Brampton) and another in Ottawa.

Unfortunately for the Conserv-ative government, the unions and 
health coalitions pounced on the issue. The social democratic 
party, which had caved in to corporate pressure when it had 
governed in the early 1990s, came out on a platform of "public 
power", opposing privatisation and calling for a much broader 
role for the public sector. The business-oriented Liberal Party 
was also forced to come out against the P3s.

During the recent provincial election, the president of the 
Ottawa hospital caused outrage when he revealed the hospital 
planned to sign a P3 deal before the election. Foolishly, he 
noted that the cancellation penalties would be so large no new 
government could cancel the project.

This affront to democracy severely embarrassed the ruling 
Conservatives, who were in on the project. For this and other 
sins, they were soundly defeated in the October 2 election, with 
all three Brampton Conservative incumbents thrown out, including 
the Minister of Health who led the privatisation campaign.

The Liberals, who assumed power on October 23, have also promised 
to reverse the Conservative government's privatisation of 
hospital diagnostic services.

Privatisation has been set back and strong popular support for 
public health care continues. But the corporate campaign 
continues — and so, too, does the fight back!

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Doug Allan is a Canadian trade union health care researcher 
and health coalition organiser.