At the end of last year Shadow Health and Social Care Secretary Wes Streeting decided to wind up Labour supporters and delight Telegraph readers by proposing increased use of the private sector as a key element in reducing the 7.2m NHS waiting lists.
He may well have thought he was echoing the decision by Tony Blair’s government to use private hospitals and create “independent sector treatment centres” in the 2000s.
New Labour’s obsession back then was to carve out a share of the substantial increase in NHS funding to expand the puny private healthcare sector and create more of a competitive “market.” However any decision now to use private providers would mean taking even more money (and staff) from a financially hobbled NHS.
Now in Canada Ontario’s hard right provincial government, led by Doug Ford, has controversially opted for an almost identical policy – as part of an agenda to entrench the private sector in the lucrative provision of elective hospital care.
Ontario, like England, has been plagued by chronic under-funding, desperate shortages of beds and staff, and with huge waiting lists for treatment. On January 16 Ford and Ontario Health Minister Sylvia Jones announced plans to respond to this – by “significantly” expanding the number and range of publicly-funded operations performed in privately-run for-profit health facilities outside of hospitals.
The provincial government plans to contract for an extra 14,000 cataract surgeries a year, about 25% of the current wait list, and to invest C$18 million in existing private centres to fund medical imaging and certain surgeries. And new legislation will aim to expand the provision of services and surgeries in private clinics.
This is not what Ford and co told the public in the run-up to provincial elections last June: Ford’s “Progressive Conservative Party” toured the province time and again denying any intention to privatise health care.
Nonetheless, just as campaigners had warned, two months after the votes were counted Sylvia Jones revealed the real plan – to “help stabilise” the province’s health-care system by increasing the number of publicly funded operations performed at existing private clinics.
Ford and Jones have now made clear that they regard up to 50% of the work done in Ontario’s hospitals as “easy” work that could be handled safely in smaller and less-well resourced facilities – leaving the tougher and costlier cases to the main hospitals.
The latest moves threaten to undermine the universal single-tier, publicly-funded system that so many Canadians have been proud of, and see as distinguishing them from the disastrous system in their powerful neighbour to the south.
In Ontario the Private Hospitals Act banned new private hospitals in 1973: as a result there are currently just three for-profit hospitals in the province.
Federal law (the Canada Health Act, which in 1984 enabled the country to break from the previous American-style insurance-based health care system, and established a tax-funded system of universal social health insurance) largely prevents the private delivery of hospital care. It also bans extra billing for necessary services, a provision which is regularly violated in private clinics.
Because the Canada Health Act is focused on hospital care, in recent years, as public spending has been constrained by provincial governments, there have been increasing efforts by the private sector to get around the letter of the law – by expanding the provision of diagnostics and various elective procedures outside hospitals, in free-standing “clinics” and other facilities.
The latest proposal to make extensive use of these for-profit providers to perform uncomplicated joint replacements and cataract surgery, paid for through the tax-funded Ontario Health Insurance Plan (OHIP) has triggered an angry reaction from health-care professionals, concerned that the move would drain resources from publicly funded hospitals and benefit the owners of private-sector clinics without improving patient care.
The anger is increased by the fact that underfunding of health care by Ford and previous Ontario provincial governments has left many public hospitals with operating rooms that are closed in the evenings, on weekends, for days and months at a time, or even permanently, due to lack of staff. MRIs and other diagnostic services in public hospitals have also been limited due to inadequate funding and staffing.
Rather than fund the public hospitals properly, the Ford government plans to pay substantially more per operation to private providers. Back in January 2020 a call for “Applications to License Independent Health Facilities for the Provision of Cataract Surgeries in Ontario” made clear that these operations would be paid for at 20% above the going rate in public hospitals.
The College of Physicians and Surgeons of Ontario, the agency that regulates doctors in the province, says it was not informed of the government’s latest plans to implement the changes. Spokesperson Dr. Nancy Whitmore argued using private providers is not the solution to the health-care crisis, and warned “It would further tax our health human resources shortages and further increase wait times for more urgent hospital-based care.”
Bob Bell, a former chief executive of the University Health Network in Toronto, and a deputy minister of health in Ontario under the previous Liberal provincial government, has argued in favour of performing certain operations outside of hospitals in purpose-built community surgical facilities, but insists they should be run by non-profit hospitals.
He told CBC News “I totally agree with their desire to do more surgery by moving it out of the hospital into the community. But moving it to a for-profit model is simply dumb.”
The danger is that any increase in simple elective activity by for-profit providers simply hoovers up staff from hard-pressed public hospitals, leaving even weaker core provision of services for patients with the most serious and complex needs. Last March an Ontario Hospital Association survey found one in eight full- and part-time permanent positions vacant for registered nurses and more than one in ten for registered practical nurses.
Ford likes to campaign on the slogan “For the People,” and insists that because the treatment would be paid for through the publicly-funded system, it’s not really privatisation at all: “I don’t even like the word ‘private’ because it’s really not. No Ontarian will ever have to pay with a credit card. They will pay with their OHIP card.”
But funnelling of public funds into private sector provision will further undermine public provision, and increasingly open up a market in which those able to pay for treatment seek to jump queues by going private.
Campaigners have been warning of the potential ruinous cost of private treatment with the various additional charges that are likely to be added. In the most recent study done by the Ontario Health Coalition, clinics were caught double-billing, charging patients thousands of dollars and charging the public health system at the same time for the same procedure.
The report showed patients are routinely charged ten times the public health system cost for private for-profit shoulder surgeries, four or five times the cost for private cataract surgeries, and three times or more the cost for private MRIs.
So while campaigners do emphasise the scale and impact of medical debt in the US (and in other provinces of Canada that have gone further and faster than Ontario), the main danger in Ontario is not American health corporations but grasping Canadian capitalists; not the restoration of the US system based on private insurance, but the increasing privatisation of publicly funded elective care.
This offers the private providers the easiest profits, while the public hospitals would remain saddled with the emergencies and more serious cases.
The way this is being argued by Ford’s right-wing government in Ontario should be a warning sign to Labour to change course: all of the negative consequences of the policy would apply equally here.
The Ontario Health Coalition (OHC), which over the years has had to fight and repel a number of previous attempts to undermine the single-tier publicly funded Medicare system in the province, now warns that once again it faces an existential threat.
Speaking to a well-supported February 1 online rally that drew in a dozen members of the provincial parliament, community organizations, trade union and political leaders and academics, OHC director Natalie Mehra stated the need to build the biggest and broadest-possible movement in defence of Medicare, to stop the Ford government in its tracks.
In an emotional appeal, Natalie made clear her concern that after her 27 years of constant campaigning against the privatisation of health care in the province, defeat this time could have long-lasting and serious consequences. “Once they [private providers] are in, it will be very difficult to get them out again.”
With strong support from major unions, OHC is holding ‘town hall’ meetings across the huge province in the second half of February, planning resistance when the plans come to the provincial parliament in Toronto, and planning to hold referendums in every area to show the scale of the public opposition “anywhere we can put a ballot box and gather votes” – with a target of getting a million votes from the province’s 15 million population.
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