Canada's universal public health care system continues to deteriorate. Waiting times for all but emergency treatments get longer. Hundreds of thousands of Canadians are denied family doctors. Many with limited incomes go without the prescription drugs they need because pharmaceuticals are still not covered under Medicare. For-profit clinics are allowed (perhaps even encouraged) to offer private care to those who can afford it.
Taking advantage of Medicare's failings, for-profit clinics are sprouting up all across the country. At last count there were 130 of them, most set up in the last five years. Linked with U.S. private health-care chains, they are aggressively pushing two-tier medicine in Canada. Of course, with cataract surgery costing up to $2,000 and knee surgery as much as $20,000, this more prompt private treatment is available only to the privileged upper-income tier.
These private clinics are undermining the basic precepts of the Canada Health Act, which requires governments to make the same timely and high-quality care accessible to everyone. This means prohibiting two-tier medicine in Canada. Instead, our federal and most provincial governments seem to be, at best, condoning its growth, or, at worst, encouraging it.
Whether or not a two-tier system is being deliberately facilitated, government policies and actions in the health care field over the past decade have had that effect:
* Cut funding: In the late 1990s, under the guise of eliminating government deficits, hundreds of millions of dollars were siphoned away from Medicare.
* Lay off nurses: Thousands of nurses were laid off, and many of the underpaid and overstressed nurses who remained fled their profession or moved to the United States. Without nurses, hospital beds are closed and treatments delayed.
* Give drug companies long-term monopolies: With exclusive rights to manufacture, sell, and set the price of drugs for 20 years and often longer, the pharmaceutical firms keep drug costs so high that they drain funding from other health care needs.
* De-list tests, procedures, drugs (for seniors): Denied treatments previously covered by Medicare, patients are forced to pay for private services.
* Don't enforce the Canada Health Act: The five principles of this Act, if properly enforced, would sharply limit the privatization of health care. By ignoring the Act and allowing private clinics and laboratories to proliferate, the federal government sabotaged the system it was supposedly committed to preserving.
* Ignore preventive health care: Helping people to stay well would ease the strain on physicians and hospitals. But this would weaken the case for privatization. So the social causes of ill-health - poverty, malnutrition, inadequate housing, etc. - have been neglected. So has any concerted effort to curb the industrial pollution of our air and water, or the carcinogenic chemicals in our food and other consumer goods.
* Don't let foreign doctors emigrating to Canada practise here: Hundreds of qualified physicians from other countries are kept idle in Canada because of training, language, and other differences that would not adversely affect their care of patients if the barriers blocking their practice were removed.
* Sign a free-trade agreement with an "equal treatment" clause: This clause in NAFTA would be triggered if even one private American health insurance company were permitted to set up shop anywhere in Canada.
NAFTA would then force the entry of similar firms across the country. Whether this incremental subversion of Medicare happened by design or accident, it has to be stopped. Otherwise, a full-blown two-tier system-first-rate treatment for the rich, inadequate and delayed care for the rest of us-will be the inevitable outcome.
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