Editorial

The Supreme Court Ruling and the Future of Medicare

On June 8, the Supreme Court of Canada struck down a Quebec law which forbids the sale of health insurance for medical procedures covered by Medicare. The rationale provided for the decision was that Canadians have a right to prompt medical care. If this was the real reason for the decision, then the Supreme Court ruling will do nothing to guarantee this right to the vast majority of Canadians. Instead, it will further exacerbate the current situation in which the rich get immediate care while everybody else has to wait in line for months.

Although there is a popular perception that Medicare is a public health care system, this is not actually the case. Medicare is actually a system of public health care insurance, while most of Canada’s health care system is in private hands. The main publicly-owned portion of the health care system is the infrastructure of hospitals. A portion of the hospital workers are public employees, but most of the doctors and an increasing section of the support staff work in the private sector. Increasing the percentage of the system which is in private hands will not solve the crisis of Canadian health care, but will actually make it worse. In particular, the Supreme Court decision clears the path for the establishment in Canada of American-style HMOs, which are medical clinics set up by, and in the service of, private health insurance providers. To the extent that such private clinics are set up, a portion of the doctors currently working in the public medical system will be drawn off into the private system. So, while the waiting times for the wealthy will be shortened considerably, the waiting times for everyone else will actually be lengthened.

The long waiting times for medical treatment are not the result of Medicare or the inefficiencies of public medicine. Rather, they are due to a shortage of doctors, nurses and technicians. This shortage has two causes, both connected to the private nature of Canadian health care. One cause is external, namely the growing demand for doctors and other health care professionals in the United States. This shortage of health care professionals in the U.S. is siphoning off health care workers from Canada, as well as many other countries. The second cause is internal and is a consequence of the fact that the provincial doctors’ associations control the admissions to medical schools. It is in the interests of doctors, the vast majority of whom are in private business, to keep the number of graduating doctors low, which, in turn, keeps doctors’ incomes high. This is a simple matter of supply and demand.

Underlying both of these causes is the bourgeois ideology which is fostered both by the capitalist system in general and private health care in particular. By its very nature medicine spontaneously engenders an outlook of public service. However, this spontaneous outlook is largely negated by the capitalist striving for maximum profits which infects private health care professionals. Medicine, far more than any other of the sciences, attracts students whose motivation in life is to become wealthy and the entire system reinforces such attitudes, encouraging them to become specialists instead of family practitioners in order to make even more money, etc. As a result of this intense ideological pressure emphasizing individualism and self-advancement, a significant percentage of health care professionals see nothing wrong with abandoning their patients and their country to make more money in another country. Within the country, there are severe shortages of doctors and other professionals in the urban areas and it is becoming increasingly difficult to keep doctors in small towns and rural areas. Not only can they make far more money in the cities, but the acute shortage of doctors outside of the major urban centres means that an onerous workload is placed on those who choose to work in these areas. In addition, the medical profession, in general, sees nothing wrong with deliberately maintaining a chronic shortage of doctors in order to keep salaries artificially high. This is how capitalism works.

In addition to the ideological pressures on health care professionals is the pressure resulting from the huge debt load borne by many graduating students, particularly doctors. This means that may new doctors must seek the highest paying jobs they can find in order to dig themselves out of debt.

Aggravating the problem of the shortage of medical professionals is the fact that the pharmaceutical industry is a highly monopolized industry which is able to hold entire countries to ransom. As a result, every increase in health care budgets is almost immediately eaten up by increases in the cost of drugs, which is the most rapidly rising cost in the Canadian health care system.

In other words, it is clear from even the most cursory examination of the Canadian health care system that the problem underlying the current crisis is not a lack of private health care. Rather, the problem is the surplus of private health care and the lack of a truly public health care system. The health care system in Cuba illustrates the truth of this. Cuba spends far less as a percentage of its spending on health care than Canada does. Yet, it not only has a world-class health care system, but has such a surplus of doctors that it has more than 20,000 doctors working in the poorest and most difficult conditions throughout Latin America and Africa. These doctors could easily “defect” to the United States where they would be welcomed with open arms and treated like kings. However, their deep commitment to public service and to the health of the people keeps them from doing so. The solution to the crisis of Canadian health care is to train medical professionals with a similarly high level of social consciousness. However, that goal cannot be achieved so long as health care is controlled by private capitalist interests. It can only be achieved by abolishing private health care entirely and establishing a genuine public health care system geared toward serving the health care needs of the Canadian people.

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