Defending health care is not enough

By Sam Gindin
Introduction to Whose Health Care?
Challenging the corporate struggle to rule  our system

Most Canadians reject a private health care system that is driven by the accumulation of profit, that limits people’s access to the size of their wallets and provides health in exchange for the risk of financial debt. Affordable public health care – for one’s own family and as a shared right with others – is something worth
defending.

Defending public health care is not enough. It doesn’t prevent a slower ‘death by a thousand cuts.’ Indignant government campaign speeches against privatization only lead to more subtle forms of privatization – privatization by stealth. Even where privatizations are curbed, the rules under which hospitals are run are transformed so they reflect the thinking and practice of competitiveness and commercial values, not social values. Cutbacks may be checked today, but revived tomorrow after tax cuts or an economic downturn lead to budget deficits that ‘demand’ new restraints. Any problems in the health care system that do occur lead to public frustrations which are then politically manipulated to develop support for ‘repairs’ and ‘innovations’ (based on giving private corporations greater control over our health).

At the same time, examples from abroad are brought into the debate – sometimes via misinformation, sometimes without reference to the larger context, and sometimes presenting defeats as victories – to convince us that our resistance is futile, that we are swimming against an inevitable tide. And because we are overwhelmed by defending the health care system, we forget that our health care system is incomplete. Health care depends on much beyond itself – from the impact of poverty on a minority, to the working conditions many of us face, to the polluted air we breathe.

We need to both extend health care and place the fight for health care in a broader context. The attack on health care is part of a broader corporate offensive taking place throughout the world. This offensive’s promises of security and rising living standards have been widely exposed as false. Like a virus, neoliberal ideology (the freedom of corporations, not the expanded freedom of people) is permeating every sector of society, and health care increasingly lacks a sufficient firewall or political antidote. Unless we wage a larger battle for a different kind of society, health care will be marketized and eventually eroded. The struggle over the future of health care, then, provides us with a vital opening for a larger struggle to expand its underlying principles.

Only defending our health care system will eventually place us in indefensible positions. Health care costs have been escalating and some services are not what they should be. If we ignore these realities, we risk losing even what we have.

Our response must be twofold. First, we must reject the privatization of health care. The privatization of our health care system is in fact a cause of the existing system’s problems.

Second, the health care issue is indeed (as the corporate supporters of increased dependence on private health care constantly remind us) about free, equal, and democratic choices. We do have to decide how much of a priority health care is in itself, and in the context of a society that prides itself on freedom, equality and
democracy. But the privatization of health care will only expand the choices of an enriched few (defined by their ability to pay for health care as a commoditized service) while weakening the choices of the majority (by undermining their access to public health care as a right). Arguments that budget-crunching alone dictate
that government can no longer pay for rising health care costs creates the illusion that private health care will cost less and provide better service. Yet we live with a tell-tale example of the ramifications of a private system to our immediate south, where the lesson is, as even General Motors has belatedly recognized, that the
more privately-oriented the health care system, the higher the overall costs and the worse the human care.

Addressing cost and service concerns require the expansion and improvement of our health care system, not its commercialization and contracting of its work at the sacrifice of quality.

Important questions need to be asked regarding the costs of health care.

•  Why is public pharmacare not a concern? If the drug companies make money by selling new medicine, will it be in their interest to both prevent sicknesses and effectively research the potentially negative and long-term side-effects of medicine at the same time?

•  Are expensive new health care technologies being used and allocated appropriately? Expensive corporate-generated technologies drastically escalate health care costs as hospitals, managed like mini-corporations, see new equipment as way to attract ‘customers.’ This leads to waste, a distortion of care, and a misuse of technological potential.

•  How should doctors be paid and how should we relate their role in the public health care system to their role as private practitioners?

•  How should hospitals be run? Certainly, all large institutions suffer from bureaucratic problems. But turning hospitals into corporations adds anti-socialgoals to existing bureaucratic irritations. Rather than turning hospitals into corporations with a tiny and overpaid yet theoretically savvy managerial class at the top, we should invent new models of social administration that allow for a deeper democratization of health care. A new model could include greater input from those people receiving the service and more importantly, those workers that provide the services: doctors, nurses, technicians, and other hospital workers, that have handson experience.

Given what we are up against, health care won’t be saved without a much greater public commitment to political mobilization than we’ve seen to date. This pamphlet hopes to contribute some tools for discussing over the present and future of health care; it also hopes to support present and future political struggles over
health care. The articles that follow are written by both activists who work at the base of the health care system and academic-activists who have studied the recent transformations in our health care system. In this pamphlet, rigorous research and critical analysis is fused with popular political struggles to defend and extend our health care.