Medicare takes centre stage in election

"Two-tier" debate has highlighted the erosion of health care through privatization, underfunding, and inaction

By: Cindy Wiggins

  Medicare has become a central issue in the federal election and rightly so. Canadians were not reassured that the First Ministers' agreement in September ensured medicare's survival. They had serious concerns about what wasn't in the deal and about the new funding.
  First, the money. Each year's additional funding is not added to the base of the CHST fund. Rather, it's like an annual bonus instead of a wage increase. At the end of the five year agreement, the base will be back to where it is today. According to a Library of Parliament analysis, federal cash spending on health will not reach the level it was in 1993-94. This is a very real problem. In five years, the federal contribution will be so small as a share of total public health spending that the federal government's authority to enforce medicare's national standards will be diminished if not extinguished. On this basis alone, the Liberal commitment to ensuring the survival of our public health care system is suspect.
 

Will added public attention to medicare lead to a push to ensure health care is protected from free trade?

  The greatest concern is what wasn't in the deal. Canadians know that Medicare is threatened by the growing privatization of the public system and by the Liberal government's unwillingness to uphold its own law - the Canada Health Act. They see evidence of two-tier health care in private, for-profit MRI and cataract clinics, in other for-profit clinics like the King's Health Centre in Toronto as well as in the de-listing of previously publicly insured services. Alberta passed legislation allowing for-profit hospitals and allowing physicians to practice in both the for-profit and the public system at the same time, a fundamental and direct attack on Medicare.
  This makes Stockwell Day's 'No Two-Tier' flash card all the more hypocritical. The fact that two-tier health care already exists has been a 'stock' argument all along in the Reform/Alliance rational for a second tier of care. Since Emperor Day is fresh from the provincial government which gave the go-ahead to for-profit hospitals, portraying himself and his party as defenders of medicare leaves them somewhat, well, naked, shall we say.
  Indeed, all the emperors appear skimpily clad when it comes to giving Canadians a solemn commitment to maintaining and expanding our single-tier public system of health care. The First Ministers' agreement was silent on the reality of growing privatization en route to a two-tier system. Just as it was silent on expanding the public system. Shifting hospital care into the home and community, de-listing publicly insured services and experiments with for-profit hospitals are the seeds for a private, for-profit tier of health care. Those seeds are sprouting up all over and have been for some time. The federal watchdog has ignored them, part of a tacit agreement to weaken the federal role in enforcing national health care standards in favour of greater provincial control.
  It took an election to get the Liberals to admit the existence of these seeds. As Medicare took centre stage, the Liberals are promising to take action. Letters have been sent to provincial governments regarding for-profit clinics where ability to pay extra guarantees access to medical services covered by public health insurance plans - a direct violation of the Canada Health Act. We need a guarantee that the use of public dollars in for-profit hospitals and clinics will be prohibited as the NDP has promised. We need a guarantee to expand the public system to include home and community care. We need to work towards a national pharmacare program. We need a federal government willing to act in the national interest where Medicare is concerned by taking its legal responsibility to uphold the Canada Health Act.
  Canadians need promises made and promises kept.
  A critical issue hasn't made it into the election debate yet. While the vast majority of Canadians have made it clear that they want the federal government to ensure the survival of our public health care system, one reality threatens to make what Canadians want a moot point. The federal government has not been forthcoming about the implications for public health care of the ongoing World Trade Negotiations on trade in services. Many countries in the WTO, particularly the United States, are determined to gain free trade in services, including health and education. If they win, public health care systems will be in dire jeopardy.
  We need one more promise - a promise to exclude health care from all trade agreements. So far, our government is complicit in the agenda for expanding trade in services. Let's get this aspect of health care onto centre stage before the election is over.

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