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More Drama Than Truth in Healthcare Crisis

Editor's Note: Editor's Note: Larry Brown is Secretary-Treasurer, National Union of Public and General Employees (NUPGE).

Canadians like their public health care system. They just want it to work well - a pretty reasonable goal.

That's what they want. What they are being told is that their most cherished national achievement is in a state of crisis. It has become unsustainable. It is on life support. It is so bad that we cannot even wait another few months for the Romanow Commission to report. Provinces will have to immediately apply their own solutions. The status quo is not even an option!

Whew. Dramatic stuff. Not true, of course, but certainly dramatic.

Let's close our ears to the clamour for a minute and think about who is leading the charge to convince us that we can't afford medicare. The Premiers of Ontario, Alberta and British Columbia are clearly the most vocal and the most strident. Yet each of these governments have drastically cut taxes in their provinces - cut taxes in such a way that the wealthy have gotten a huge break on their tax bill while the average taxpayer gets a very modest tax cut. So when these premiers say they can't afford medicare, they really mean they have chosen to give the wealthy a major tax cut rather than use those taxes for health care. Provinces together have cut taxes by some $22 billion by one estimate. So now they have less money? What a coincidence!

It's an interesting line; that "we" can't afford public health care. Who is "we" exactly? Whatever happens, "we" will provide health care to ourselves and our families to the best of our abilities, of course. The only question is how will it be paid for. If governments don't provide health care from the public revenue, then individuals will have to provide it through their own spending. So we're not talking about actually saving money here, we're just talking about moving the cost from the collective public purse to the private pocketbook.

If the public purse doesn't cover the costs of health care, individuals will have to, and those with more money will be able to afford more than those with less money. It's a bit too blunt to admit that the goal is a system where only the rich will have the privilege of good health care, so we hear this nonsense about how we can't afford a public system.

Ah, but health care costs are just exploding! Well, no, actually, they aren't. The only thing that's exploding is the rhetoric.

Even Mr. Mazankowski, the private health care company Board member who concluded that public health care in Alberta was unsustainable, acknowledged in the fine print that Alberta's costs have remained at a pretty steady 30 to 34% of the province's Gross Domestic Product for the last decade.

Nationally, health care costs us about 9.5% of GDP - a reduction from the high of 10.2% reached in the early 1990's. In the US with its private system the cost of health care is close to 14% of GDP.

Health care is a bigger part of provincial spending than it used to be - but not because health care has grown out of control, but rather because provinces have cut everything else. There are two ways to make a fish look bigger in his pond; grow the fish or shrink the pond. Health care looks like a bigger fish because governments have shrunk the pond. The total role that governments play in the economy is less than it used to be; it's gone down from 18% to 14% of GDP, as the provinces have cut their expenditures by about $22 billion. (Where did we see this figure before? Oh yes, that was also the size of their tax cuts.)

So if you look at health care as a portion of spending, it's gotten bigger because everything else got smaller. If you look at health care compared to provincial revenues, it's virtually the same now as it has been for years, at 32.5%.

I like mystery novels. In mystery novels, when the good guy is trying to figure out who the bad guy is, the question is "Who benefits from the crime?" Well, if this were indeed a mystery novel, it wouldn't have much mystery in it. In the US, health care is a huge and hugely profitable private industry. In Canada it's a public service. If the public service can be eliminated or weakened, the private sector can move in and do here what they've successfully done in the States; turn the provision of health care into a license to make buckets of money.

They do have good health care in the States - for those who can afford coverage. Mind you, 43 million Americans don't have health care coverage. Infant mortality among the poor is at third world levels. The leading cause of personal bankruptcy in the US is health care costs. Health care companies, not doctors, decide on treatment. But the wealthy get good health care.

We can certainly reform our system. It would be nice to see the drug companies relieved of the burden of their excessive profits, for one thing. Drug costs are the one area of spending that really has increased dramatically.

But when some people talk of reform, they mean destroying the public system in order to make more space for private profit. That would definitely be unsustainable. Our public system, on the other hand, is one of our best bargains as citizens. It isn't for sale.