Soc 210 Health Care

Health Care
Public health care in Canada -“Medicare”
Sociology 210
Canadian Health Care - How did we get here?
• Universal government health insurance – widely regarded
as triumph of postwar Canadian state
• Estimated 47 million Americans have no health-care
coverage (1/5 population)
• many more have inadequate coverage
• In U.S., health-care costs = leading cause of personal
bankruptcy – most with health insurance, get through job
Canadian Doctors for Medicare
Co-founder: Dr. Robert Woolard
“As a doctor, I know the value of our public health
care system. Everyday, I see patients getting the
care they need regardless of their ability to pay.
And I know that without Medicare, Canadians would
have to worry about whether they could afford to
get care when they’re sick or injured.”
http://www.canadiandoctorsformedicare.ca/ -
www.canadiandoctorsformedicare.ca/
Canadian Health Care - How did we get here?
  Post World War II: Conditions in Canada
  popular demand for public health care
  good economic times
  positive experiences of government
intervention during & after the war
  political will on part of individuals &
governments
Political Will
  One of most famous individuals = Tommy Douglas, Premier
of Saskatchewan, 1944
  As child, infection in leg. Would have lost leg if care
depended on family’s ability to pay.
  Doctor offers services, using young Tommy to illustrate a
new technique.
  Douglas decides health care must not be dependent on
charity or accident (i.e. doctor offering aid without pay)
http://www.cbc.ca/archives/categories/arts-entertainment/media/media-general/and-the-
greatest-canadian-of-all-time-is.html - http://www.cbc.ca/archives/categories/arts-
entertainment/media/media-general/and-the-greatest-canadian-of-all-time-is.html
  1947: his social-democratic government introduces
1st public hospital insurance plan in Canada
  Becomes model for public-health care system
  Opponents: fear government intervention + loss of
private control
  Hospitals: mainly owned/operated by non-profit/
charitable or religious organizations.
  Often financially troubled – patients unable to
pay for hospital services
  Across Canada, see growing demands from
individuals, organizations & regional governments
to follow Saskatchewan
  Resistance from certain provinces - fear federal
government interference
  Health care primarily a provincial responsibility
(first under “British North America Act”, then
“Canada Act”, 1982)
  1950s: Despite opposition from wealthier provinces
(Ontario, Quebec, Alberta, B.C.), federal
government proceeds
  1957: introduces national hospital insurance plan
  Offers to pay 1/2 hospital operating costs if
provinces agree to certain basic principles
  Provinces agree
  Late 1950s: Douglas proposes doctors get a paid
salary from the government
  Many doctors not amused - some strike, some
continue to work – long tradition of private,
independent practice
  1962: Saskatchewan legislation - Doctors continue
in private practice, with fees paid by government
  Doctors: public payment for private practice, with
everyone covered for doctor care
Next step = Doctors
  At Federal level: Progressive Conservative Prime
Minister, John Diefenbaker
  Gives in to doctors’ pressures
  Calls for Royal Commission to search for
alternatives to universal public health care
1964-5: Report of the Royal Commission on
Health Services
  Recommend single payment system
  argue: everyone covered for doctor care +
full range of health services
  Cover all services - from hospitals to
long-term care & home care, drugs,
doctors, nurses, dentists + preventative
programs
  Argued would increase efficiency &
effectiveness
Federal proposal:
provide universal insurance to cover physician
care
  1966: Liberal Prime Minister Lester Pearson - only
adopts recommendation on doctors - assumed will
move on to other services later
  “Medical Care Act” becomes law - many doctors
protest - over next few years provinces decide
whether to support
  1972: All provinces pass legislation
5 Principles of Canada Health Act (1983)
  Universality
  Accessability
  Comprehensiveness
  Portability
  Public Administration
Universality
  Everyone in province (except tourists, visitors,
transients) must be covered for public health
insurance under same terms & conditions.
  Care defined as a right
Accessibility
  Services must be similar for everyone.
  Must be reasonable access to health care
  Must be unimpeded by financial or other
barriers
  Doctors cannot extra-bill, hospitals cannot
impose user-fees or charge patients for
essential services
Comprehensiveness
  All medically necessary services guaranteed
  Means: those associated with medical practitioners,
dentists performing required services in hospitals,
and hospitals - not all health services
  For hospital care: Everything needed for care in
hospital must be provided without charge (even
private rooms – if medically necessary)
  Doctors decide what medically necessary.
Portability
  Can take health insurance from province to
province - also from job to job
  If visiting another province, get sick, home
insurance must pay for care, and pay at rate
in other province
  When move, take health insurance with you
for 3 months, until other provincial health
coverage in place
Public Administration
  Health insurance plan of each province/
territory be publicly administered
  Administered by non-profit agency -
responsible to government
The Present:
The profitization of Canada’s Health Care System
  Must position the politics of medicare in
period where mounting pressures to
dismantle post-war Canadian state
  Public health care being undermined
  erosion of 5 principles of Canada Health
Act
  massive “hemorrhaging” of programs/
services outside of public coverage
Massive health-care reforms:
Medicare remains, but gets ‘hollowed out’
  Neo-liberal governments in Canada shifting locus
of care outside hospitals & doctors’ offices
  Therefore, outside the ‘rules’ and universal
entitlements of medicare
  Important - doing reforms this way, avoids intense
political debates that would follow direct assaults
on medicare
  Concern about potential conflict between private
profits & public interest
Privatization is not a cure
Pat Armstrong
• Chapter focusses on women as health care
users and providers
• Argues: Fundamental transformations in
Canada’s public health care system
undermining:
Women’s access to health care
Women’s work in health care sector
Privatization of Health Care
• Refers to different policy initiatives:
• Limit role of public sector
• Define health as private responsibility
From the Welfare State to the Managerial State:
Building for Sale
• Privatizing Costs
• Privatization through Deinstitutionalization
• Privatization through For-profit delivery
• Privatization through Management
• Privatization through Home Care
Privatizing Costs
• Services cut back
• Increased various forms of private payment
• Delist certain services (eg: eye exams)
• Redefine hospital care (short term stays)
• “acute care”
• Move people from hospitals -> long term care
facilities & home care (where fees can be
charged
Privatization through Deinstitutionalization
• 1990s – key part of health care reform:
• Shift from institutional -> home &
community-based care
Privatization through For-profit delivery
• Canada now has for-profit laboratories, for-
profit cataract surgery, for-profit dialysis,
for-profit cancer care, for-profit home care
• All justified as compensating for inadequacies
in the system
• Inadequacies created by government
cutbacks
• Consequences for women’s access to health
care & wages in sector