Private firms thrive as NDP ‘reinvents’ medicare

By David South

Today’s Seniors (Canada), August 1993

Many of today’s seniors fought for Canada’s internationally-admired public health system. But more and more people are becoming worried that the combination of health care reform, funding cutbacks and free trade is fuelling the growth of a second tier of private medical services serving the well off. 

The provincial government sees things differently, arguing Ontarians no longer expect government to pay for everything and rather than eroding medicare, the NDP is reinventing it. 

Whichever way one looks at it, private insurance companies, homecare providers, labs and other services designed to make money are becoming more and more involved in the health care business. 

Operating in the territory outside the guidelines of the 1984 Canada Health Act - which sets out the principles of medicare for the federal government to enforce - the private sector has room to expand, at the same time as OHIP coverage is scaled back from more and more services. 

Janet Maher, whose Ontario Health Coaltion (OHC) represents doctors, nurses and other health care workers, worries for the future of medicare. 

“A number of things like accomodation services - laundry, food services - are in the grey area of the Canada Health Act,” says Maher. “So with all these fees that are being introduced, by the strict letter of the law, there is no way to stop them. But as far as we are concerned the spirit of the Act isn’t being observed.”

In its current reforms, the government of Ontario is emphasizing paramedical professions like midwives who fall outside the CHA and aren’t covered by OHIP. The turn to community-based services means that people have to rely more on services and providers that aren’t covered under the CHA. 

Maher says privatizing accomodation services is a recent phenomenon, the result of hospitals finding creative ways to trim their budgets. 

“It’s a new area that hospitals are taking bids on,” she says. “The other thing around the accomodation services is that because they are not categorized, strictly speaking, as health care services, none of this is exempted in the Free Trade Agreement from U.S. competition.”

A recent report by two British Columbia researchers tries to put together this complex puzzle. Jackie Henwood and Colleen Fuller of the 7,500-member Health Sciences Association of British Columbia recently charged that a combination of free trade and budget-slashing governments is eroding the universality of medicare and ushering in a two-tier system. 

Fuller and Henwood identify the Free Trade Agreement as the culprit. While the health care industry created more jobs than any other sector of the Canadian economy between 1984 and 1991, they point out the job growth has been concentrated in the private sector since free trade was implemented in 1989. And they expect worse under the proposed North American Free Trade Agreement (NAFTA). 

“NAFTA will accelerate trends towards a privatized, non-union and corporate-dominated system of health care in Canada.”

One provision of the Free Trade Agreement has also made it possible for U.S. companies to compete against Canadian firms in health care. Chapter 14, “health-care facilities management services”, allows wide-open competition. 

Under NAFTA, provisions will bind all levels of government to consider for-profit health care companies on both sides of the border on equal footing with public providers when bidding for services, and entitles them to compensation if they can prove to an arbitration board they’ve been wronged. 

“That represents a substantial encroachment on the democratic right of local, provincial and federal governments to make decisions,” says Cathleen Connors, who chairs the national wing of OHC, the Canadian Health Coalition. 

It’s this plus health care cutbacks - federal and provincial - that’s resulting in service and job cuts and bed closures in the public sector and an increase in privatization, say Henwood and Fuller. These opportunities have not gone unnoticed by private companies south of the border. 

One such company is American Medical Security Inc. (AMS) of Green Bay Wisconsin. After hiring Canadian pollsters Angus Reid to do a survey, AMS saw a profitable market in offering American hospital insurance to frustrated Canadians awaiting surgery. Sixteen per cent of those polled said they wanted this service; that was enough for AMS. 

“One thing that comes across loud and clear is that Canadians for the most part are happy,” says spokesperson Carrie Galbraith. “They know they are taken care of during an emergency. But they are willing to pay a little extra if they need care.”

So far, AMS offers its plan to Ontario, B.C. and Manitoba, with Toronto its best market. Galbraith says plans are in the works to expand to all of Canada except the territories. 

Unfortunately, like most private health plans, AMS cuts its losses by avoiding what Galbraith calls “adverse selection” - anybody with a known serious health problem need not apply. 

Here in Ontario, private for-profit home care services take in close to half of all OHIP billings. Many clients pay out of their own pockets for additional services. 

The Ontario health ministry doesn’t keep statistics on the extent of the private home health care sector, says spokesperson Layne Verbeek. But the Ontario Home Health Care Providers’ Association, a trade group, estimates private homecare companies now employ 20,000 and serve more than 100,000. 

“It’s a market situation,” says Henwood. “If the services aren’t available to people within the public sector, they will go outside of it. We’ve seen this in other countries like England, where they had a public system and now have a parallel private system. If you erode a system enough that people get angry, they are going to start to look for alternatives, and the people with the greatest liberty are those with money.”

But in a recent interview, health minister Ruth Grier was adament this scenario wouldn’t be allowed to take place in Ontario. She strongly disagreed that medicare is being weakened due to recent changes, and said the government has actually “reaffirmed its commitment to medicare.”  

Health care on the cutting block: Ministry hopes for efficiency with search and destroy tactics

By David South

Today’s Seniors (Canada), August 1993

It’s search and destroy time at Ontario’s ministry of health: search out savings and destroy inefficiency and waste. But many remain apprehensive that not all the cuts are going to be logical and fear the province’s health and well-being will be affected. 

As part of the social contract deal, the Ontario Medical Association must find $20 million in cuts from the list of services covered by OHIP. The OMA and the provincial government are currently haggling over which procedures and examinations will be cut. 

“We look at services that aren’t medically necessary,” says health ministry spokesperson Layne Verbeek. “Because we were wealthier in the past, we were able to cover some services. We aren’t in that position now. But I don’t see how eliminating medically unnecessary treatments will affect the population.”

The fallout of the Rae government’s attempts to reign in costs and recover lost revenues may take years to unfold, but it is already apparent that Ontarians will be paying more. 

“Access to necessary treatment should not depend on a person’s ability to pay,” says health policy critic Carol Kushner. “What disturbs me about any delisting program is that virtually every medical service could be termed medially necessary. There are very few services that are an out-and-out waste of time.

“We often point to the fact that Ontario spends $200 million a year treating the common cold. Well, most of that is a waste of time. But delisting even that kind of service would be a detriment to the public’s health, because a small group of patients really do need to see a doctor when they have a cold.”

OMA spokesperson Jean Chow says it’s too early to pin down the exact cuts that will be made. “It’s a little premature to try and speculate what the final list will be.”

The newly-created Non-Tax Revenue Group is hard at work finding fees, fines and penalities the government can add or hike to boost revenue from this source from $5 billion to $10 billion a year. 

The spring budget saw the first hit, with the addition of $240 million in non-tax revenue. 

A radical reshaping of medicare is taking place. Private sector services - for which consumers pay directly or through insurance companies - now make up 34 per cent of Ontario’s health care funding, compared to 42 per cent in the United States, according to a recent study by the Canadian Medical Association. 

Health minister Ruth Grier has also floated the idea of widespread hospital closures. Both the Toronto and Windsor district health councils (DHCs) are carrying out feasibility studies on “reconfiguration.” The ministry is remaining tight-lipped about which hospitals will get the chop. 

“One suspects there’s room for efficiency - there are a lot of empty beds in a number of different places,” says ministry spokesperson Verbeek. 

“All hospitals are being reviewed, with a view to closing one or two hospitals,” says health planner Lisa Paolatto, who is working on a feasibility study on “reconfiguration” for the Essex County District Health Council, along with Toronto’s DHC. 

Closing hospitals could present a serious political hot potato for the government. In Britain, the Conservative government is still recovering from the bad feelings surrounding proposals to close world-renowned hospitals in the London area. The public feels great loyalty to local hospitals, a feeling that has been further fostered by hospital charities that raise millions a year from the communities’ good will. 

“This is going to open up new discussions of money between doctors and patients,” says Kushner. “Seniors are a unique group in Canada because they remember what it was like before medicare - what it was like not to be able to pay for the doctor, to forgo treatment that they thought was necessary. They understand the financial hardship that could occur if they were unlucky enough to have a family member who needs expensive medical treatment.” 

Channel Regulation: Swedes will fight children’s advertising all the way

By David South

Financial Times New Media Markets (NMM) (London, UK), November 30, 1995

The Swedish government is set to clamp down on satellite channels which carry advertising aimed at children and will tell channels to drop such advertising or face legal action. 

The centre-left government’s threat of tough action follows Sweden’s winning extra powers last week through an amendment to the European directive on transfrontier broadcasting agreed by European culture ministers (NMM 13:42). 

The main focus of the Swedish government’s wrath is the TV3 channel, owned by Kinnevik, which uplinks to the Astra 1a and Sirius satellites from the UK. TV3 based itself in the UK in order to benefit from the Independent Television Commission’s more liberal rules on advertising.

TV3’s main commercial television rival, TV4, has long protested to the government about what it sees as unfair competition from TV3 and other foreign-based channels. 

The government will initially go after TV3 and the Luxembourg-based cable and satellite channel Femmen. The Ministry of Cultural Affairs said that pro-European satellite channels such as TNT/Cartoon Network and the Children’s Channel were lesser priorities, but could face action in the future.

TNT/Cartoon Network has a Swedish soundtrack and many Children’s Channel programmes are subtitled in Swedish on cable systems.

The Ministry of Cultural Affairs plans a two-pronged attack to remove the advertising it finds offensive and which is banned under Swedish broadcasting law: advertising aimed at children under 12 and carried in breaks around children’s programming. 

First, the consumer-protection agency the Konsument Ombudsmanen will take action against advertising agencies which produce children’s advertising. Monica Bengtsson, a legal adviser to the Ministry of Culture, said that agencies will be warned once and then fined if they violate the rules a second time.

If this fails - and some observers believe that it will, because advertisers could move their accounts to non-Swedish agencies - the Ombudsmanen would then try the riskier move of taking channels to court to stop the ads.

The Ombudsmanen is not expected to act until it hears the results of the case it has already taken to the European Court of Justice against Italian children’s magazine publishers De Agostini for allegedly placing commercials targetting children under the age of 12 on both TV4 and TV3. Judgement is expected in mid-1996. 

The Swedish government is also banking on public opinion to help pressure satellite channels to stop showing children’s advertising. The political climate in Sweden is strongly in favour of strict controls on advertising aimed at children. Swedish prime minister, Ingvar Carlsson, made cracking down on such advertising a key part of his opening speech to the present session of the Swedish parliament. 

The amended directive (which still needs the approval of the European Parliament) allows a member state to ban children’s advertisements under its own rules even if the channel satisfies the rules of the country from which it is broadcast. 

The Swedish government believes that the combination of the amended directive provisions and its ban on children’s advertising is all it needs to prevent the adverts. 

Per Bystedt, vice-president of TV3, insisted this week that the channel is UK-licensed and therefore does not fall under Swedish law: “We are following the Independent Television Commission’s rules.”

New definitions on which countries are responsible for regulating channels, adopted by the European culture ministers last week, could lead to TV3 being regulated in Sweden rather than the more liberal UK if it is deemed that the channel is really established there. However, the Swedish government has investigated the extent to which TV3 is based in the UK and, according to Bystedt, has declared that it is satisfied that the company is British. 

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Economy Still a Sick Puppy

By David South

Id Magazine (Canada), December 27 to January 8, 1997

It was a year when banks recorded their highest profits ever; it was a year when the economy was supposed to be chugging along as the stock market hit new records. Despite our political and corporate masters telling us otherwise, government statistics tell a grim tale for anybody who isn’t making over $100,000. 

After years of being told high government debt must stop, all three levels of government managed to take debt up another $45 billion, to a record level of $796 billion. It makes you wonder what all the food banks, unemployment and poverty is achieving. 

Prime minister Jean Chretien’s rallying cry of “jobs, jobs, jobs” has not panned out. A combination of high levels of immigration, seniors clinging to jobs for longer and a growing working age population is keeping unemployment high. The percentage of the working age population employed is 58.5 per cent, according to Statistics Canada. It was 58.4 per cent in April 1992, before 944,000 mostly part-time jobs were created. Youth are the ones suffering the most, with only 52.3 per cent actually working, down from 62.7 per cent in 1989. 

If that isn’t evidence enough that 1996 was a bad year, according to the Labour Relations Board, more people are spending time out on the picket line. The number of days lost to strikes in 1996 was 1,783,700, up from 473,000 in 1995. The bulk of those days were lost in the crippling public servants and auto workers strikes. 

Cops Crackdown on Hemp Store

By David South

Id Magazine (Canada), December 27 to January 8, 1997

London hemp crusader Chris Clay has been hit with a string of charges after police raids. 

Clay’s house and both the Hemp Nation shop and warehouse he owns were raided by London police and the RCMP on December 6. Two of Clay’s employees were charged with trafficking and two of his friends with possession. Clay faces six charges, including possession of a narcotic (a single gram of pot), cultivation of marijuana, selling drug paraphernalia and breach of bail conditions. 

The breach of bail charge stems from Clay’s arrest over a year ago for selling small marijuana plants out of his shop. Along with Toronto law professor Alan Young, Clay is turning those charges into a constitutional challenge to be heard next year. It is this legal challenge that Clay suspects is the reason for the raids. “It is obvious the police are trying to put pressure on me to plea bargain and drop my upcoming court challenge; the government wants me to stop it at all costs.”

London police would not allow id to talk to the arresting detective, Tom Gaffney. A bristly and rude public relations flack, Sergeant Jack Tourney, would only confirm the arrests and charges. He refused to give a reason why Hemp Nation was singled out for a raid, while almost every major city in Southern Ontario has at least one store selling hemp merchandise and paraphernalia. 

Clay is looking for help with his high legal bills.