Canada's Health Care "Crisis": Accumulation by possession and the neoliberal fix

By Heather Whiteside 
Studies in Political Economy
Autumn 2009

Public health care in Canada (“medicare”) is based on five principles, and its realization balances precariously on the method by which this public service is provided. At one end of the delivery spectrum, medicare could be a fully decommodified public service similar to the public education system; at the other end, public health care insurance could exist alongside the private, for-profit delivery of services and infrastructure. However, these varied delivery options are not interchangeable equivalents, since the increased commodification of health care serves to erode the five principles, a process that has been steadily underway since the 1980s. Thus, while medicare may remain formally tied to its core commitments, the Canadian landscape is now dotted with public-private partnerships, privatized support services, and newly sprouting private clinics, and it has been subject to chronic underfunding.

Addressing the various stages through which medicare has passed — the struggle over its formation, its eventual implementation and brief stabilization, and its current internal erosion — is a complex issue that may be approached in a variety of ways, ranging from the synchronic to the diachronic.3 While much can be gained from a slice-in-time approach, a policy that aims to provide free and universal public health care to all citizens is not one that operates in a vacuum, as it is intimately bound up with the prevailing social relations of power and thus with developments occurring within capitalism itself. In this regard, the growing exposure of medicare to the logic of capitalist profitability underscores the need to explore the relationship between crises, fixes, and the framing of public policy bound- Studies in Political Economy 84 AUTUMN 2009 79 aries. This leads to the conclusion that commodification has less to do with the often-lamented efficiency problems of medicare than it does with a crisis of accumulation. Furthermore, it is a reminder that Canada is not alone in its reforms, given that crises are global in their reach, and thus restructuring is a national phenomenon only in a limited sense.

Read more HERE. (pdf)