These past few weeks, I’ve been oscillating between a decision to stop paying attention to the “political” issues that get brought forth in the popular media, and the opposite position of wanting to attack much of what gets talked about in public discourse as so much horseshit. It continually amazes me that a citizenry will so patently avoid dealing with issues of such importance as health care in a more aggressive fashion.
You really do have to love media “debates”. Once again we’re being told by conservative pundits about the virtues of privatizing healthcare while at the same time the horrors of a for-profit health system are being expounded by the left. It pains me to no end to continually hear the same bullet points from both camps while any debate about the issue is perpetually stifled. I don’t want to get into the issue of why there is no space for such discussions in the public sphere (an issue of both corporate hegemony over broadcast sources and public apathy to that which is not immediate to them).
More importantly, I think it’s key to look at precisely that which is not being said, falling to the margins of public discourse. Health Canada is reminding us of the economic burdens of particular lifestyle choices. One wonders why government does not take a more active stance against things are known to be harmful to our health. Prevention should be the mantra of our health system, and yet all of the public discourse surrounding healthcare involves funding various treatment issues.
Every time you turn go to the Canadian news media these days, you hear about the various failures of the health care system. From wait times to bed shortages, it’s all a big love-in of negative punditry. And yet solutions are rarely, if ever, given. Except the mantra of privatization, which gets held aloft as a white knight leading us to the promised land. The only manner to improve the system according to the proponents of privatization is to allow private capital to be invested in the system. We need more beds, more doctors and nurses, more equipment, and more physical space in hospitals.
According to such thinking, the health system needs an injection of capital to expand and meet the needs of Canadians. If we were to allow doctors to set up private clinics, those doctors will be able to secure loans to expand health infrastructure in this country. They would then pass on the expense of these (privately accrued) loans along to their customers along with some conception of a profit margin to thus provide what Conservative thinkers like to call “adequate service”. That profit would then be used to further invest in the system and find ever more opportunities for “market expansion”. So that is the grand strategy on the part of proponents of privatization. According to these people, systems only work when somebody is making a profit. Of course, isn’t the system then more expensive, when in addition to health services it has to pay for mansions and cars and such for its investors? I’ll get to that math in a second.
Some of us are currently asking why, if Canadians have so much money that they wish to put to health care, there is no further injection of money into the public system. If all we need is investment, why are we not investing? After all, it’s far more efficient and less expensive for the government to secure loans for investment on a system-wide level than it is for thousands of small investors. As well, governments can accommodate losses in one sector of the budget (let’s say healthcare, as a continual expense) with gains in another (energy stocks, anyone?). Furthermore, the federal as well as a few provincial governments are enjoying surpluses that could easily be used to further investment in health care. All of these things would keep the overall price of health care lower than if the private sector were to be in charge.
So why are such investments not forthcoming? Well, let’s just say there’s a whole hell of a lot of money in the health system, and the financial sector is chewing at the bit to gain access to these public funds. When profit comes from people being sick, corruption is quick to follow.
There’s one aspect unique to health care that makes it impossible to marry profitability to a sense of human compassion and what we might call “good governance”. Every time somebody gets sick or has an accident, a cost in incurred. By its very nature, taken as a whole health is a depreciating economy. There is simply no manner to make a profit without either isolating access to only those who can pay for the continually-increasing profit margins of all the middlepeople in the health services chain, or to downgrade services when they are universally accessible and cut costs to the bare minimum.
A great example of this kind of health care is provided to the south where HMOs, which are America’s attempt at universal coverage, do not cover a vast majority of health services and more importantly are not accepted by a majority of hospitals or doctors. Since profitability is the raison d’être of the system, patients who are not profitable are perishable. They will remain externalities to a system which chooses not to account for their existence.
So yes, health care is expensive and will continue to burden governments who choose to socialize its access. Health care spending in this country was pegged at about $121 billion for 2003, which represents nearly 10% of our GDP. Shouldn't the healthy lives of a citizenry be worth ten percent of what the country is worth? By the way, America spends 14.6% of its GDP on medical care. While all that money is footed by taxpayers, many Americans lack the quality of care that every single Canadian receives. Interestingly enough, the OECD found that while the USA spends nearly twice as much per person on health care, Canadians live on average two years longer (I realize this might have to do with crime statistics and environmental protections, and might not reflect wholly on health policy).
A body politik must be healthy to be wealthy and productive. You might hear about wait times in Canada, which many espouse as representative of an "ailing" health care system. That's not during life-threatening situations, except when organ donations are required. The wait is for elective surgeries, like hip replacements and such. Health care needs to prioritize. It's more important to save a person's life than it is for one to get a new hip. Sorry, that's just the way it is. Conservatives in Canada complain because they can't access health care the way they can access the mall. They want service they can pay for, and because many of them are wealthy they think they "deserve" it. Tough. Despite some elements to the contrary, the wealthy do not represent the centre of human rights in Canada.
This whole ideology of profit, which leaves everyone to their own devices in terms of fending for themselves when they are sick, is an abject failure. You will not see the results of that failure if you concentrate your studies on affluent Americans who don't seem to have any problem buying into adequate health coverage. You will see it in the disenfranchised who do not have any coverage at all (the US Census for 2003 states this to be 15.2% of the total US population, or about 43.6 million Americans -- ten million more than the entire population of Canada!). You will see that failure in the low-to-mid of the middle class (about 100 million), who do not have coverage which equals the coverage every single Canadian is assured by our constitution. You see it in the record number of bankruptcies that are filed every year when families have to pay tens or hundreds of thousands of dollars for medical treatments out of their own pockets.
Most reasonable Americans have had enough of these beliefs. They are sick of paying ridiculous prices for medicine. They are sick of getting turned away from hospitals which do not recognize their insurance. And most especially, they are sick of insurance companies who do everything they can to get out of paying for medical treatments. In this capacity, America represents a travesty. The USA has enough wealth that every citizen should have the best treatment in the world. Instead, you get a reality where a family must seriously consider the consequences of paying $200,000 for heart surgery and possibly face bankruptcy or instead allowing a family member to die. That is unacceptable in the modern world. Now is not the time to bring such hideous complaints to Canada, when our national wealth is rising substantially and our population is expanding.
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