Last month I had cataract surgery at the Bochner Eye Institute, a private clinic in Toronto. It’s one of the 900 private clinics in the province doing simple surgery and diagnostics. The doctor asked me if I’d like to be able to see without glasses after surgery, pointing out that because I have an astigmatism, it would cost $4,000 per eye above OHIP. It’s called upselling but it didn’t work on me. I’ve been wearing glasses since I was 13. I barely recognize myself without them, so it wasn’t an issue for me.
As someone who has relied on alternative medicine all my life for most of my ailments, I’m used to paying for health care. All kinds of serious procedures and treatments whether dental, ocular, or psychological are not covered by health insurance. Moreover, up until very recently our Western medical system has ignored most preventative medicine. In that sense, public health care in Canada is a bit of a myth. Like most things, we compare ourselves to the U.S., who have about the worst health care system in the world and compared to them, our system is wonderful. For broken bones, cancer, and major surgery, public health care is excellent but it’s not perfect.
So why has Premier Doug Ford’s (aptly nicknamed Doug Fraud by playwright Brad Fraser) recent announcement about the funding of new private clinics set up such a storm of protest? As Globe and Mail health reporter André Picard just pointed out on CBC radio, we already have private clinics in many provinces, and they haven’t undermined public health care. Yet, I would add, when the biggest province in the country announces that there will be big bucks to set up private for-profit clinics, health care corporations around the world will take notice. The danger is that private capital sees another opportunity to make profit from public money on the backs of the vulnerable.
Ford famously said, “You will not need a credit card, all you’ll need is your OHIP card.” What he didn’t say is that the cost of that procedure might not be more for you, if you turn down the bells and whistles, but it will cost more to taxpayers because private, for-profit clinics care more for their shareholders than their patients. On top of that if there are more for-profit clinics, there will be more double billing. We had that fight in Ontario decades ago when doctors tried to argue that it was fair to pay more to get to the front of the line. They lost that fight but Mike Harris gutted the health system by refusing to increase funding to the public system. Today in B.C., a case is going through the courts with the same double billing argument. So far the court has rejected it but it’s on its way to the Supreme Court.
If you have any doubt about for-profit clinics just look at what happened in long-term care. In an analysis of 93 long-term care homes with COVID-19 outbreaks that have resulted in death, the Ontario Health Coalition (OHC) found fatality rates of nine per cent in for-profit homes, 5.3 per cent in non-profits, and 3.6 per cent in municipally owned facilities. Nevertheless, the Fraud government issued 30-year licenses and expansions for 18,000 long-term care beds to the same for-profit corporations responsible for the deaths of 4,000 long-term care residents. The same for-profit operators that had to have the army sent in to help with neglected and dying residents.
At this moment we are waiting to hear of the agreement made between the federal government and provinces for increased health care funding. There is a model for such an agreement in the daycare agreement released last year. The federal government under considerable pressure insisted that all new money go to non-profit or public daycare. Fraud has been working hard to get around that limit and the childcare movement is working just hard to counter those limits and to assist new non-profit daycares to establish themselves to meet the growing need. Why not include funding for only new private non-profit or hospitals sponsored clinics in the health care agreement?
Medical clinics to do simpler procedures and diagnostics is a good idea. It’s cheaper, more efficient, and more comfortable than hospitals but they don’t need to be for-profit. Quebec has an excellent model in CLSC’s, non-profit community clinics that serve many Quebecers instead of individual family doctors. The Ontario Medical Association is suggesting something similar called ambulatory clinics that would be run by hospitals. In another article here Karl Nerenberg argues that the most important problem is access to primary care and that non-profit clinics are the best solution.
The issue is not just private versus public, it is profit versus non-profit. Why should our taxpayer dollars pay the profit of more multi-national health organizations, which we already do through pharmaceuticals and long-term care? How much better would our response to COVID-19 have been if we still had a public pharmaceutical laboratory?
There is no question in my mind that Doug Fraud is out to privatize medicare and any other public service he can to enrich his buddies and live out his limited ideology that the market is best despite all evidence to the contrary. But in my view, the best way to fight him is to insist on non-profit private clinics not to oppose clinics altogether.
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