Thursday, September 22, 2011

Public / Private Health Care

Instead of podcasting my speech, I put it on YouTube with pics from the event for visual interest.

I was invited as a rep from the Green Party to the political panel of the forum on public health care on Sept. 18, 2011. None of the other invited parties attended, so the panel was cancelled. This topic, however, is one of my specialties, and the Greens are committed to an increase in democracy and public participation, so I spent my Sunday afternoon helping out anyway. I even worked the PowerPoint presentation of the keynote speaker, Diana Gibson, Research Director from the Parkland Institute.

Private health care already exists and always has in Canada. We are talking about two different public processes here, and the governments, both federal and provincial, deliberately obfuscate the two whenever they are trying to cut more funding in pursuit of their agenda and "free market" fantasies. 1) One is the creation, equipping, staffing, maintenance, and funding of public facilities like most hospitals, some clinics and even fewer research areas. 2) The other is the direct paying of taxpayer bills for medical care: i.e. public insurance. Everything else is privately owned. Everything. So whenever the Right starts talking about two tier or private health care, pretending we should have that conversation, it's only to decrease public and increase private further. There are therefore two ways they can do that, and usually do. One is to decrease the funding of the public facilities, like closing hospitals, public clinics, reducing staff and increasing hours, like any employer who wants to cut costs, and decreasing maintenance, letting equipment get older before replacing it for example. The other is to "de-list" services that are covered by the province's public insurance.

Ralph Klein, Premier of Alberta, did both. He closed and actually blew up hospitals, turned brand new hospitals into "extended care clinics", cut staff across the board, increased hours, and shut down nearly every mental health facility in the province. So naturally, those professionals fled to seek employment elsewhere if they could. Some went to other provinces, some switched to private practice, and some went to the States. As for public insurance, every so often, a new list came out that took away more and more services that used to be covered under public health insurance. We used to be able to get an eye exam every year, then every two, and now it's not covered at all. Same with certain surgeries, then even ambulance trips. If you don't want to have to pay for those out of your own pocket, now you have to pay separately for private insurance to cover those expenses, on top of the premiums he forced us all to pay for public insurance, despite the fact that it's illegal under the Canada Health Act, since it affects universal accessibility and portability. But people still need those services, and to pay for them. So many more private clinics opened up all over the province. Soon they were getting permission to do procedures they never were allowed to do before and which were originally under the purveyance of the government public facilities, but we have such long waiting lists in those places, doncha know, and this will help open up beds for those who really need it. So now these clinics are doing day surgery for knees and hip replacements. Or cataracts. I mean, it's crazy. And the public insurance of the province pays for it, since it medically necessary and they can't get it done in a timely manner in the public hospitals, so the private company pockets the money. And it costs twice as much! According the Parkland Institute, Albertans already pay the highest out of pocket cost for health care services in the country! So the province and its citizens are still paying, and paying more than anyone else, but the illusion is created that government can't afford to maintain the public facilities, and that private can do it better, offering "choice". Like we're shopping for a new heart like we need a new pair of shoes.

Private ownership and profit has always been a part of health care in this country, operating in conjunction with the public facilities the government maintains, the public insurance owned by the provinces, and private insurance. Family doctors, dentists, orthodontists, cosmetic specialists... They are all private companies, usually owned by the doctors themselves or in partnership. The labs used to be government owned in Alberta until Klein privatized them, too. So when you go to your family doctor, if you can find one, or a clinic or need lab work, the province pays for the visit to the private company, unless that visit is no longer covered for some reason. Then your private insurer pays. Unless you don't have one. Then you pay out of pocket.

Current practice is that the public health insurance plan pays for any procedure that is medically necessary and can't be done in a reasonably accessible public hospital or clinic. If you can't get the heart surgery you need in your province, the government will pay to ship you somewhere else in the country and then pay for the procedure. So the more cuts to public health care, the more private takes over. So instead they get the government money for the procedures. With increased procedures in private, it helps make the argument for more cuts to public, since we don't want duplication of services or anything... And the wheel goes on. That's how it's worked in all the countries that have toyed with a public/private system, and most are switching back to a more public balance.

With the long waiting lists and public facilities shutting down all over the country, to get treatment in a timely manner, some patients are going to where they can get their treatment, paying the bills, and asking to be reimbursed later. That sometimes doesn't happen, if the government don't agree that you needed to go *there* to get *that*. These aren't the rich, either. Just people who hold BBQ's or put up their houses for collateral so they or their families can get treatment. It's already happening here. Creating an even greater system where this can degrade further is the tide we have to stem. Renewing our commitment to care, facilities, staff, equipment, and patients means giving back the funding to public health care, removing the muscling in of private in those areas, and the balance will again shift to an efficient, sustainable, equitable system across the entire country, and that used to be the envy of the world.

The rich will always head to Mexico to get their valves massaged or whatever. It's a status symbol. They always have. But before the cuts to public health care, all the treatments they actually needed were available in a timely manner, by professional, caring, healthy staff, in the finest of facilities with the best of equipment. So they were seen as a bit of nutters and weren't recompensed. They certainly didn't have to fly to the States for basic heart surgery...

The States have already tried for-profit health care. Not only is it an abomination and a complete failure, they have some of the highest costs and worst care per capita in the developed world. 60% of all bankruptcies in the States are directly related to medical bills.

Investors, not doctors, suddenly make the calls about patient care, equipment, staff, and facilities. The brightest and the best of medical practitioners leave for private practice because they can get better pay. We saw that happen in Alberta with the Klein Kuts. Hundreds of practitioners fled, leaving only the most dedicated or those who had difficulty getting jobs elsewhere staying here in the public system, with pay cuts and huge hour increases. Expensive diagnostic machines cease to be lifesavers and become moneymakers. After all, ya gotta pay for 'em... So they are used on those who can afford them, whether they need the procedure or not, and those who need it but can't afford it can wait for the charity of a public system. This isn't "House", you know, where he doesn't seem to care who pays... You think increasing private care will help take the strain off the public system? Not a chance. Since there are so many new clinics making money off people's pain and desperation and suffering, it's just all the more reason to cut it further, leaving public health care a desiccated husk that even rats won't gnaw on.

None of this has anything to do with "standards", of course. Those are different regulations that all facilities, public or private, have to follow according to the law, both federal and provincial. There's alot of leeway, though, and many things aren't covered that should be. The doctors and other professionals are licensed by the provincial government, but on the advice of the independent College of Physicians and Surgeons or other professional groups whose job they have taken it upon themselves to decree what is required for their profession. Usually those are in conjunction, and the government doesn't deviate from those recommendations unless it has an agenda it wants to follow. It certainly didn't hear a thing when it de-listed from public insurance many of the services that the College considered "vital", like ambulance rides, and it ignored pleas for the children's hospital, which took more than 20 years to build and is now a charity hospital linked to a University hospital that's gets much of its funding through raffles.

We have always had a public/private system. We always will have one. There have been fat farms and other clinics operating outside the public system. It's a matter of degree. Allowing more private, even regulated and having a "base standard of care", means a degradation of those same services in the public system. In this new myth of "private can do better", or "private costs us less", the new private clinics and services suck the talent and patients away from the crumbling public system, leaving a dangerous, intolerable mess that can only be cured by, you guessed it, more private health care.

Injecting money back into the public system means less staff attrition, more recruitment, better facilities, and less tax revenues flowing to States. There is no possible way a facility that is required to make a profit can provide services as cheaply as a government. They can't buy in the same bulk, they can't actually outbid a government on wages if that government actually cares to pay their people enough, it can't get the same deals on equipment, and a government isn't even required to break even, much less make a profit. In a government system, services can be provided at a much greater efficiency, with greater safety, and with only patient care and workplace security in mind. In for-profits, just imagine the mishmash of insurance providers, coverage, and the hundreds of staff required just for processing all that paperwork. In the public system, mistakes or problems that happen in one centre can quickly be dealt with and new regulations and procedures passed on all across the country in days, rather than going unnoticed in an avalanche of private facilities. It all comes down to who is going to get paid, and who is doing the paying. Someone is going to provide the drugs, the procedures, the facilities, and the staff. It's all a matter of who do you want to get the money. Private for-profit companies, who are designed to make money specifically off of their patient's suffering, not necessarily relieving it, or diverting that money directly back into the public purse and a government who at least theoretically is more concerned with getting the citizenry productive again?

It's gone beyond an obscene and flagrant disregard for the Canada Health Act, universality and public health care. We've always had a two tier system, and now they are just getting out the bone cutter to start hacking the corpse of public health care to more easily transportable bits. Easier to smoke on the BBQ, doncha know...