We cannot wait, said Albertas Health Minister in yesterdays The Globe and Mails headline.
Cant wait for what? Apparently, to raise taxes regressively (premiums) and start pulling procedures off the medically necessary list so they can be offered privately to those with money. But really, I think he couldnt wait for people to finally agree that health care is in such crisis that it must be overhauled.
The effort to create panic about health care has lasted more than a decade. Insolvent. Hit the wall. Yadda yadda. The longer it goes, the more facts emerge to contradict it. Health care now accounts for just 9.45 per cent of GDP, versus 10.2 per cent ten years ago. The U.S., bastion of private care, spends 14 per cent. Per capita costs have not risen.
Its true the chunk of provincial budgets going to health has grown (though even in Alberta its now falling), but what do you expect if you cut taxes, lowering revenues, and slash most programs except health.
Of course the health slice expands. I dont know anyone who likes the emergency room congestion or understaffed hospitals, but most Canadians see these as problems to be solved and remain generally satisfied with our system.Dont blame the privatizers. Theyve tried everything, including accusations of timidity. I hope you will overcome the fear of change, Ralph Klein told Albertans this week. I love it when Ralph talks about the need to change.
Good luck on his recent pledge but, that aside, its hard to think of anything thats changed during his years in the public eye, from his haircut to his ideas. Lately, the privatizers have acquired a new word to batter the system with: unsustainable, which they plucked from the environmental movement, just as they once swiped change and revolution from the left.
Fifteen years ago, I recall economist Marjorie Cohen shrewdly eyeing negotiations over the first Canada-U.S. free-trade deal and asking what the U.S. was really after, since it already had most of what it wanted here. Its services! she declared. Huge pots of money were being spent in areas such as health and education, which were shielded from U.S. investors. Private services such as banking were also protected, but the big prizes were in the public sector. That quest never ceased.
The main item now before the WTO is a U.S. demand for a general agreement on trade in services, which will facilitate a global market in private health care, welfare, pensions, education and water, supplied naturally by U.S. companies (The Guardian). In this global campaign, the Kleinians are mere foot soldiers.
Do you find this explanation conspiratorial? Let me argue back that it at least provides a rational motive on someones part (i.e., private service providers) for tearing down a system that is working reasonably well, is supported by the vast majority, and to which the alternatives are clearly inferior.
But what is a service anyway? Isnt it just another thing for sale good health, good food, good wine? That seems implied by the Klein view. Yet listen to Saskatchewan Premier Lorne Calvert: If our view of health care becomes & something we buy and sell, like any other consumer good, then I think we do begin to very quickly move away from & health as a service in a civilized society.
What an interesting distinction. A service is something inherently more personal than a commodity. When you buy, say, a fridge, youd like a nice sales clerk but mostly you want the fridge. With a service, the person delivering it and the item (health, education, breakfast) are more closely tied.
Even the good morning served with your coffee may feel less satisfying when delivered by the employee of a multinational such as Starbucks than by your local cafÃ© owner. (Or not.) That's why it makes sense to choose your own doctor and for private practitioners to be included within public health care.
Its also why many people intuitively prefer private corporations kept out of hospitals: because the intrusion of the profit motive imposed by bean counters at corporate HQ can muddy delicate personal relationships.Does this mean all services should be publicly run? Of course not. But it means they fall more naturally to independent individuals and small businesses than corporations. Listen, the most formidable dry-cleaning establishment on Bloor, and possibly in the universe, Knob Hill Cleaners, recently changed hands.
The sense of service provided by the Chow family for forty-five years was palpable. They searched for your stuff, got you buttons and Velcro, gave special rates. Their public face was Debbie, from her teen years. Her memory for names and dry wit (dry cleaning is my life) were legendary.
Perhaps she can move on to be the UN secretary-general. When I made my final visit, her mother, always more reticent than her, was teary as I thanked them for helping build a sense of community. She seemed happy about getting some rest at last but sad at ending that contribution. Then she hugged me and we had rarely even talked.
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