The past two months have seen an increasingly public debate about possible reforms to healthcare proposed by United States President Barack Obama. While there is huge confusion on all sides about what exactly Obama is proposing, it is clear that nothing he has put on the table so far will come close to ending the healthcare crisis in the US. The ins and outs of the Canadian healthcare system have also become a significant part of this debate, and people living in Canada should take an honest look at the realities and shortcomings of healthcare in Canada. What are the issues at stake and what are the practical solutions for the millions whose lives are at risk due to problematic medical care on both sides of the Canada/US border?
[i] Insurance premiums: the cost or rate that people are paying towards their insurance coverage
The state of healthcare in the US is grotesque. Healthcare is not guaranteed for its 350 million residents, and over 50 million people do not have any health insurance at all. Families USA recently issued a report detailing how rising insurance premiums[i] and growing unemployment contribute to an average of 44,230 people losing health coverage each week.
A 2008 study published in Health Affairs Journal found that the US had the highest rate of preventable deaths before the age of 75 out of the 19 countries it examined. It concluded that as many as 101,000 deaths a year could be prevented by ensuring that all patients receive quality care in a timely manner.
Why can’t the world’s largest “super-power” provide healthcare for its population? Is it a lack of spending? Definitely not. The US spends twice as much as other industrialized nations on health care—$7,129 per capita. That’s around 15.3% of its Gross Domestic Product, over $2Trillion (2 followed by 12 zeroes!) a year.
Who’s at Fault? How do we fix it?
Obama is not wrong to blame private insurance companies for taking advantage of people and making a huge profit doing it. Harper’s Magazine noted in its 2009 census that since 2002, the average premiums paid to large US health-insurance companies have gone up 87%, and that the profits of these companies have skyrocketed 428%. The US also has the largest pharmaceutical industry in the world. In 2007, its pharmaceutical revenue totaled $315Billion.
The basis of Obama’s current healthcare campaign states its guiding principles as, “Reduce costs, guarantee choice, and ensure quality care for all.” Criticism has come due to his lack of concrete proposals, but most agree that the form it would take would be similar to what is already in place in the state of Massachusetts – where it is now illegal not to have health insurance. The government is responsible for a subsidized insurance plan, but other than that insurers are left untouched. There was also discussion about a “single payer”[ii] public insurance option, but most agree that this bargaining chip was given up long ago.
But how would this strike back against the insurance companies? All it would do would be to guarantee them tens of millions of new customers, often with government subsidies.
An article in the LA Times summarized the situation, “Some insurance company leaders continue to profess concern about the unpredictable course of President Obama's massive healthcare initiative, and they vigorously oppose elements of his agenda. But Laszewski (Robert Laszewski, former health insurance executive and president of Health Policy and Strategy Associates Inc) said the industry's reaction to early negotiations boiled down to a single word: ‘Hallelujah!’”
Another important distinction is that having some level of health insurance does not mean full access to necessary healthcare. A recent study found that 62% of all bankruptcies filed in the US in 2007 were linked to medical expenses, and that of those who filed for bankruptcy, nearly 80% had health insurance.
With the Republican Party trying to ensure absolutely no decrease to current healthcare profits, the debate in hotly contested town hall meetings and on television screens across the country has also featured the Canadian healthcare system. Shona Holmes of Waterdown, Ontario became a celebrity in the US when she appeared in a commercial of the conservative group, Patients United Now, saying that she “would be dead” if she hadn’t travelled to the US (and paid almost $100,000) for treatment of a brain tumour. Citing long waits and outdated facilities in Canada, the commercial warned, “Now, Washington wants to bring Canadian-style health care to the U.S,” and re-opened the debate in Canada about the sorry state of Canada’s national healthcare system.
To be clear, Canada’s healthcare system is not “socialized” like some in the US have called it, although the government does have a mandate to provide all eligible people in the country with reasonable access to insured health services on a prepaid basis, without direct charges at the point of service. It hasn’t always been that way, and this mandate was won by the important fight of poor and working people across the country.
However, despite the mandate, about 30% of all Canadian medical expenditures now happen in the private sector, with expenditures on drugs increasing more than any other area. This year, spending on drugs is expected to account for 17.4% of healthcare spending, more than double what it was 30 years ago. Basic services such as dental, optometry, and physiotherapy are also not covered. “Luxuries” such as ambulance services must also be paid for.
The Push for Privatization
There has also been an extreme push for privatization by Canada’s business elite. This was punctuated by the June 9th 2005 decision by the Supreme Court of Canada that struck down a Quebec Law that prohibited people from buying private health insurance to cover procedures already offered by the public system. Citing the long wait times which now accompany almost every medical procedure in Canada, private healthcare companies have pushed for a more “flexible” system that would allow those who have the money the ability to pay for health procedures. They have succeeded in opening dozens of for-profit private health clinics across the country.
Canada does pay for more hospital days and doctor visits per capita than the US while spending about 40 percent less, but even then Canada’s healthcare crisis is still obvious. Four million people cannot find a family doctor, and conservative think tanks have had a field day pointing out all time highs in waitlist times. A 2007 Fraser Institute Study unfortunately found an average wait of 18 weeks between visiting a doctor and receiving surgery, even though Canada is spending more on healthcare than ever before.
“European Model” Not the Answer Either
This year’s Canadian Medical Association (CMA) convention saw a push from outgoing President Dr. Robert Ouellet to adopt a “European-model” of healthcare. While the CMA is creating a “blueprint of transformation” for next year, Dr. Oullet and others are advocating a mix of the “best” aspects of public and private systems, with a healthy dose of competition to stimulate efficiency.
There are already some terrible examples of this method in Canada, called P3s or “Public Private Partnerships”. P3’s involve hospitals contracting a private consortium to design, build, finance, and operate all non medical services of a hospital. The private companies are then guaranteed huge profits for decades.
In England, one of the 5 countries Dr. Ouellet visited to form his proposal, after 15 years of “Private Finance Initiatives (PFI)” (their P3 equivalent) the National Health Service was forced to invest $77Million dollars in a crash program of hospital cleaning after an audit revealed that most of the hospitals relying on private contracts failed to meet cleaning standards. Staffing and qualification levels have been slashed to cut costs. The British Medical Journal reports that, on average, 26% of hospital beds have been cut and staff reduced by 30% (14% of doctors, 11% of nurses and 38% of support staff).
But are they cheaper for the public? No, and there is huge amounts of research to demonstrate this. A separate study in the British Medical Journal found that the PFI costs at four hospitals were almost double the estimated costs of a similar scheme funded by public finance. Where does the money go? Professor Jean Shaoul of Manchester Business School found that the rate of return for the companies on twelve large PFI Hospitals was 58%.
Back in British Columbia, Canada, while Premiere Campbell celebrated the opening of the new Abbotsford Regional Hospital under a P3 scheme, the Hospital Employees’ Union pointed out that building the hospital rose from $211Million to $355Million after it became a P3 project. Another fact being protested by the union is the absurdity that the provincial government has placed its own privatization agency– Partnerships BC – in charge of value-for-money audits of P3s!
Meanwhile, the lives of hundreds of elderly and special needs patients were thrown into jeopardy when in August 2009 the Fraser Health Authority (FHA) announced it was cutting thousands of elective surgeries, as well giving 30 days notice of its decision to cut significant funds to Mental Health and Addiction Services as well as Seniors' Services due to a $160Million budget shortfall. The FHA also happens to operate the new over-budget P3 Abbotsford Hospital.
The situation seems pretty desperate – the US healthcare system spiralling downwards, the dead-end of the “European model” and the Canadian healthcare system following close behind. Luckily for the entire world, another option exists in small island of Cuba.
“We pledge to serve the revolution unconditionally wherever we are needed, with the premise that true medicine is not that which cures but that which prevents, whether in an isolated community on our island or in any sister country in the world, where we will always be the standard bearers of solidarity and internationalism.”
- Cuban Medical Graduate’s Oath
An American Association for World Health study concluded in 1998 that years of the US blockade on Cuba had “dramatically harmed the health and nutrition of large numbers of ordinary Cuban citizens,” but that, “a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventative health care to all citizens.”
Despite a US blockade, Cuba has a comparable life expectancy to Canada at almost 80 years, and the lowest infant mortality rate in Latin America at 4.7 deaths per 1000 live births, which is also lower than the United States. By 2007 there were also 6.5 doctors for every 1,000 citizens in Cuba, compared to 3.1 per 1,000 in Western Europe, and 2.4 per 1,000 in the US. Canada came in at a dismall 2.2. Cuba’s numbers will also only improve as this year over 25,000 health professionals will graduate in Cuba, the largest number ever.
Remember, Cuba is a third world country under a brutal economic blockade by the US for almost 50 years. Its per capita spending on healthcare is also only $251, that’s over 28 times less than the US, and 21 times less than Canada. How does it do it? Cuba recognizes healthcare as a fundamental right, not as a potential market, and therefore focuses healthcare on the simplest and most beneficial areas, which means prevention as opposed to pharmaceuticals. In Cuba, healthcare is a human rights issue, not like the US, Canada, Europe or any other western capitalist countries, where your personal well-being must be bought. Thus the universal healthcare becomes a profit making entity for healthcare related companies. In other word, in the US or Canada, the well being of a person is a private matter, in Cuba, on the contrary, the well being of a person is a public matter. No individual is denied because of market value, rather in Cuba all individuals unequivocally enjoy universal healthcare– for free.
Revolutionary Cuba Shows the Way
A Cuban family doctor’s day to day work includes a detailed prevention programs, consisting of categorizing each patient yearly into a group (healthy, at risk, ill or chronically ill, and special needs) and visiting them in their home a certain number of times a year, according to what group they're in. Have any doctors come to visit your house lately, FOR FREE?
True to its oath, the most amazing aspect of the Cuban medical system is its commitment to the health of others outside its borders. By November 2008, Cuba had more than 70,000 doctors, allowing it to send 17,697 abroad to serve in 75 countries, along with 20,847 other Cuban health professionals. There is also currently 24,000 foreign students studying medicine for free in Cuba, where since 2005, 1,500-1,800 students have graduated from 40 different Latin America, Caribbean, and African Nations. Cuba even trains doctors from the US, asking only that they commit to practicing in under-served parts of their communities.
The debate in both the US and Canada about the future of healthcare really does boil down to people or profits. Instead of trying to figure out the best way to use competition and corporations to improve healthcare, why don’t we just learn from over 50 years of the example of the Cuban Revolution and its incredible healthcare system? We must defend every single public aspect of the Canadian healthcare system as gains that were won by the fight of poor and working people, but why stop there? Cuba shows it is not only desirable, but possible to win free, universal, and accessible healthcare for all.
[ii] Single-payer health insurance operates by arranging the payment of services to doctors, hospitals, and other health care providers from a single source established and managed by government.
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