Opinion | Ontario’s health care expansion is not ‘privatization’


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“I don’t even like the word ‘private,’” said Ontario Premier Doug Ford at a news conference last month, responding defensively to a question about his government’s interest in expanding the number of privately run surgical facilities whose services are covered by Ontario’s public health insurance program. A few days later, unveiling the specifics of his plan, the premier and his health minister strenuously avoided using the p-word to describe the type of clinics that will be covered by OHIP, the Ontario Health Insurance Plan, instead favoring such adjectives as “independent” or “community.”

Ford’s nervousness was understandable, given that much of the Canadian public has an almost Pavlovian response to hearing the words “private” and “health care” used in proximity — even when the goal is strengthening the public system. Much of the media coverage following the premier’s announcement certainly seemed to validate the apprehension, with headlines in progressive outlets charging Ford with “privatizing hospitals” and making “a dramatic step to privatize health care in Ontario.” A cartoon in the Toronto Star depicted Ford driving a hearse with a sign reading “Universal Health Care on Board.”

Ontario’s opposition New Democrats vowed to fight “Ford’s health care privatization scheme,” while national NDP leader Jagmeet Singh decried Ford, the leader of the Progressive Conservatives, for “cannibalizing” public health care and giving millions of tax dollars to “CEOs of for-profit American-style care.

The shamelessness of such rhetoric is striking, because it exists for little reason beyond escalating public ignorance and anxiety about the state of Canadian health care — a topic Canadians are already encouraged by their leaders to understand in only the most half-informed way.

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Canada’s public health-care system has always been primarily based around government-provided health insurance, run by the provinces, which makes Canada different from a place like Britain, where the public system is based around a single, government-managed provider — in Britain’s case, the National Health Service — which runs hospitals and directly employs doctors, nurses and surgeons. While government-run hospitals are the Canadian norm, many other medical services that Canadians rely on are provided by privately run businesses — most notably doctors — that simply bill government insurance plans. According to the Commonwealth Fund, around 80 percent of Canadian doctors work in some form of private practice.

At his news conference, Ford himself noted that public insurance coverage for privately-administered services has long been part of Ontario’s status quo — “All we’re doing is expanding on it.”

The Canadian people, alas, often seem oblivious to this reality. Casual understanding of Canadian health care tends to be far more dogmatically black-and-white than the system itself, with private and public sectors assumed to be in a zero-sum battle in which only one survives. Such naivety is enabled by Canada’s pervasive cult of anti-American patriotism, where “free health care” is constantly asserted as Canada’s defining superiority, as contrasted with fantastical ideas of how health care supposedly works in the United States (i.e., all medical procedures are paid for entirely out-of-pocket). It’s a mythology that has proved good for nation-building and political demagogues, but less great for actually maintaining quality health care for Canadians themselves.

For all the fear-mongering about his “privatization schemes,” what Ford is actually attempting to do bears a closer resemblance to nationalization. As wait times for all manner of surgeries in Canada reach unprecedented highs because of chronic capacity problems at public hospitals, the Ontario government is seeking to relieve some of this pressure by authorizing nongovernment clinics to perform medical procedures they would otherwise be legally unable to, then reimburse members of the public who use them. In no way does this set-up resemble a march toward the “American-style” horror story of Canadian folklore, and Ford made a great show of repeatedly reciting some version of the phrase, “You’ll access these services with your OHIP card, never your credit card.”

The various overheated commentaries written in response to the Ford announcement barely contest these facts; hence their heavy reliance on empty sloganeering. Rather than specifics, Ford’s critics can only muster theories; incorporating more private clinics into the public system could, maybe, eventually lure some surgeons out of public hospitals. Or maybe a private clinic might, theoretically, someday, try to “upsell” some dopey member of the public something their government insurance doesn’t cover. (“An ailing person, under pressure to get surgery, is an easy mark for high pressure sales tactics,” fretted one columnist).

It is worth remembering that the alternative to these abstract worries is a pressing reality: massive declines in quality of life, and even death, caused by essential medical procedures delayed far beyond what any nation as rich as Canada should tolerate.

Is it nobler to die waiting to get into a public hospital than to receive free treatment from a private one? In the hyper-ideological world of Canadian health-care discourse, that seems to be the argument some seriously want to make.



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