Canadian Medicare Defenders

September 24, 2023

Most of them are poor defenders

The date of this article is September 24, the day before The Big Day for the Ontario Health Coalition (OHC). It and its labor movement associates have put great resources into building a mass demonstration at the Ontario legislature, Queen’s Park, in Toronto. I will not be there.

This is not just because I am a covid exile. I long ago decided to stop participating in mere protests. I have been around political activism long enough to have observed that this way of doing politics does not work in the neoliberal age.

Unless a movement against some neoliberal measure can cause serious disruption, the power does not care. They can and will just roll ahead. The rollback of public health care in Canada has been going on for decades and has accelerated in recent years.

Health care is said to be a ‘third rail’ in Canadian politics. The public wants it and can be easily mobilized to fight for it. Politicians are often afraid to be seen to interfere with it.

However, it is also one of the main red flags to the libertarian right wing of Canada. It is one of the largest government expenditures and one of the hardest for austerian governments to restrict. It contradicts the idea the owner class has of society, that the mass of people are a great herd they are managing for their own benefit.

Thus, what irritates the elite about socialized health care is that most of the money is spent to keep unproductive people alive; the elderly and disabled. They want the best health care for themselves. They want the ‘useful population’ kept reasonably healthy and able.

So they do not really want a fully private system. They want a health system for themselves that is private to the extent that they access it through private clinics and have special facilities reserved for themselves. But they still want someone else to pay for maintaining health care infrastructure.

They do want their worker drones and their families to receive a basic health care so they can go on being good worker drones. But the elite want the servants to pay for it themselves, through private insurance and through taxes to support infrastructure. Seen this way, the reengineering of the health system by right wing provincial governments can be understood.

Some sagacious observers of the health care chaos assert that the solution for this is to nationalize the health care system. That is, to have the federal government take control of it from the provinces. This would be fine until a Pierre Poilievre type comes into office in Ottawa.

In fact, this could be said about most of the problems with Canadian government. Powers should revert back to the federal government. It should be closely studied as to why Canadian national governments are generally so reluctant to deal with rogue regimes in the provinces.

However, that is a subject to be gone into in another blog post. At present, the main defence for critical public systems such as health care is mass movements to protect them. The Canadian public is not really very good at doing mass movements and stopping government abuses.

We are in the neoliberal age. Oligarchic interests have got very good at neutralizing the public. Their most effective tactic seems to be to prevent effective leadership groups from emerging, while encouraging useless ones.

We are also in the boomer age. We have a generation now in its years of greatest influence who are disposed to demonstrative behaviour, but who tend to fold when faced with really hard struggle. They grew up in an easy time when it was assumed everything would keep getting better on its own.

Thus, while there is huge public support for preserving and expanding health care in Canada, effective mobilization has not really been there. Leadership has come mostly from labor and from one political party which likes to take credit for establishing medicare in Canada. There are problems with both of these.

The New Democrat Party did not found medicare in Canada. They wrecked it. A nation wide movement of community clinics or community hospitals was developing during the nineteen sixties.

This was a reaction to the failure of government in Canada to do anything to get a public system going, despite the example of public health services established after the world war in other commonwealth countries. If this system had been allowed to develop, it would have been the best possible model for a public health system. The system brought in by the NDP government in Saskatchewan in the 1960s preempted this system.

The basic feature of this system was that it forced everything to be done in or through hospitals. It also kept doctors as independent contractors on a fee for service basis. It was a mockery of the “Beveridge” system introduced in the United Kingdom, in which health care is organized by a national health service, with most doctors on salary.

The Canadian medicare system never included drug or dental coverage. It was left to be managed by provincial governments, who often had an ideological problem with running ‘socialist’ programs. These problems have never been corrected.

When medicare was introduced, the promise was that improvements would be made gradually as right wing resistance abated. Sixty years later, opposition from right wing economic interests remains as intense as at the start. There has been no significant improvement to the system since it began.

The system is finally beginning to collapse under the coordinated attack of right wing provincial governments. While this happens, we are in the ridiculous situation of the leader of the NDP using the Liberal government’s minority situation to get it to create a national pharmacare program. This is an extreme example of someone chasing the wrong ball.
The critical thing to be understood here is that if the public health care system collapses, a national Pharmacare system will not matter much. Vulnerable people would not be able to access a doctor who would write the prescription. Worse, it would be easier to drug people up so they are less troublesome as they languish from lack of medial care.

This is the situation we are in as the Ontario Health Coalition organizes a mass protest in front of the “Pink Palace”, as the legislature returns from summer recess. The Ford government has already passed legislation to enable their transformation of the provincial health system. OHC’s type of ‘performative’ resistance will do nothing to stop this.

Governments like this back off when they are threatened with disruption. Ford cancelled the “greenbelt steal” when it became clear it would face massive and continuous resistance throughout the spectrum, from legal action to sabotage of construction projects. He stopped attacks on labor when the public employees union began preparing a general strike.

A generation ago, “Mean Mike” Harris resigned when university students began organizing ‘snake marches’ which shut down central Toronto.

Also for a generation now, I have been observing OHC’s defence of health care in Ontario. To reiterate, they have been losing slowly for many years, and are now losing fast. The value of the public system has been declining as important services quietly disappear from it with remarkably little notice or resistance.

The problem has been in OHC’s way of going about organizing the defence. Its aims are not really congruent with the public’s interest. Yet OHC is the end all and be all of protecting the Ontario Health Care system.

Despite its ability to attract large numbers of volunteers from many backgrounds and interests, OHC is a creation of the hospital unions. It is totally focussed on protecting these union jobs. It has no interest in services which are not performed in hospitals by unionized staff, even if these are very important to the public.

In a time when unions in Canada are becoming noticeably more militant and socially aware, hospital unions remain very conservative. The same is true of the medical professional associations. This is to do with the culture of health care systems generally, which are widely noted as highly conformist and unwilling to challenge authority.

This is shown up by the performance of OHC during the long time I have been interested in it. During all this time, Natalie Mehra has been head of OHC. I have had occasion to question her a few times.

I have asked why OHC only seems to come alive when hospital budgets are being cut, but is always asleep when medical services are being delisted? Also, why there is no interest at all in improving the health care system, only an immobilist defence of things as they are? Finally, why is there no evident awareness that health care has not advanced in forty years in Canada and in many ways has been rolled back?

Mehra seems to reject all best practices from around the world and bites heads off people who point them out, including mine. That is, free medical care is of limited use without free medicines. Some types of services are, in fact, better delivered by small private clinics.

Most importantly, as little as possible should be done in hospitals. General practice doctors should be on salaries and patients should meet them in community clinics close to where they live.

Natalie seems particularly bugged about community clinics. She has the idea that they inevitably get bought up by investors and turned into private, for profit clinics. This is not the reality in most places where they are operating.

Some services would do better if operated by small, owner operated clinics on a fee for service basis; dentistry, physiotherapy, psychotherapy, ophthalmology, and so on. Mehra assumes they will be bought up by chains run by investors. Of course, all government has to do is disallow this.

Mehra seems to be as paranoid about ‘private’ as the libertarian types are about ‘public.’ We do not need fanatics from the left or the right trying to control how our health care will work. We need it run according to the interests of those it is for, the whole public, and not for private business, or for hospital and union bureaucrats.

To have health care run that way, we first need effective, actually democratic government. We do not have this in Canada. Until we do, to have health care set up and run properly, and to keep it that way, will take effective organization by the public.

OHC seems unable to provide this. They are often in the way. At least its federal counterpart, CHC, seems to have a somewhat broader vision and more useful approach.

To preserve health care we cannot be always on the defence. It should have been understood sixty years ago that the public health system will be either grown out and perfected, or eventually killed by private interests. It should also have been understood that letting each province have its own system would not work.

Public health care has become the flagpole for everything else public in Canada. The libertarian elite see themselves as being close to achieving their goal of high quality, subsidized health care for themselves, and minimal public health care for the rest of us. If our health system goes down, everything else public will soon follow.

We cannot be on the defensive. We must attack by expanding and nationalizing the system. That is why the national Pharmacare program is so important and the beginning of intelligence about preserving health care.

It must be followed up with a national dental program. The federal government must stand up to the provincial governments, enforce the Canada Health act, and closely monitor the provinces use of federal money. Ontario in particular must be made to pay back money it has not spent, or else spend it appropriately.

Back at the provincial level, the public needs to find the right organizing frame and begin driving the Ford government out of office. OHC is really not adequate. 

It must be understood that these are interim measures. We will not have a secure and efficient health system until we have a better system of government and economy. All potential for libertarians, eugenicists, and other fanatics to influence health policy must be eliminated.

Enough said.