07 Feb Brief: Bill 126

Wednesday, 07 February 2007

Protect Medicare: Don’t Privatize It

A Submission from the
Nova Scotia Citizens’ Health Care Network
To the Minister of Health
Concerning Bill 126
The Health Facilities Licensing and Equitable Access to Insured Services Act

February 2007

The purpose of this presentation is to share our comments and concerns about Bill 126, the Health Facilities Licensing and Equitable Access to Insured Services Act.  The Nova Scotia Citizens’ Health Care Network opposes this bill on many fronts and seeks that the Bill be completely withdrawn.

The first and foremost concern with this piece of legislation and the accompanying discussion paper is that the Minister of Health, when first announcing there would be legislation to govern almost a year and a half ago, promised that there would be a in-depth public consultation before any legislation was introduced.  We fear that, faced with a minority situation, the government decided to ignore its pledge and bring this Bill forward to ensure the governments survival in the House of Assembly.

This bill has many holes.  It leaves the publicly funded and publicly delivered health system open to attack by health privateers.  This submission will look at the following key issues that are raised by this bill:

What is the goal of this bill?
How will this bill affect wait times?
Is privately delivered care less expensive than publicly delivered care?
How do our trade agreements, primarily NAFTA, affect this bill?
How will this bill be enforced?
Why are we turning to privatization?

It is our hope that by raising, and responding, to this key questions we will be able to demonstrate just how wrong this bill is for Nova Scotia and for our public health care system.

What is the goal of this bill?

Your government claims that this bill is designed to regulate the growth of private health care clinics and facilities, while at the same time ensuring that there can be no queue jumping at these private clinics.

The question that then arises is why are we looking to regulate the private clinics instead of bringing them into the public system?

There are only three possible responses.

1.To reduce health care wait times
2.To reduce the cost of delivering insured services
3.Due to an ideological decision on the part of the government

We do not believe that number 3 is a response because we do not feel that your government wants to see a two-tiered system of health care put in place.  We are confident that your government believes in Nova Scotia’s public health care system

This brief will demonstrate that this bill will not help to reduce health care wait times or reduce the cost of insured services.  By drawing on example from other provinces, the United States, and Europe the submission will demonstrate that wait times and costs will increase if this bill is passed.

The Question of Wait Times

Wait times in Nova Scotia are too long.  However the solution is not to begin allowing private for-profit clinics to operate.

It’s common sense really. Imagine the following scenario: a city has a non-profit hospital, where 100 doctors are employed. At some point, the city underfunds or mismanages the hospital, and waiting lists spring up. If that city allowed a for-profit hospital to address the temporary crisis, would it shorten the lists?

No. Because the for-profit institution would need to hire professional staff as well, and would have to do so by poaching doctors and other health professionals from the non-profit hospital. So some people would leave the waiting list to pay their way to see one of the 40 doctors at the for-profit hospital, but because only 60 doctors would be employed in the non-profit institutions (instead of the original 100), there would still be a waiting list for those who can’t pay their way ahead.

In fact, this is what happened in the United Kingdom and New Zealand. Both have a significant parallel private hospital systems, and both have longer waiting times than Canada or other countries with a single-payer, universal health insurance programi.

Waiting lists can, and should be solved in the public, non-profit system. They can be. Canada spent millions on getting a strategy to address waiting times, and it got one: the Final Report of the Federal Advisor on Wait Times, released in June 2006ii.

The Question of Costs

Advocates of privatization often suggest that procedures are less expensive in private, for-profit facilities than the public system.  If reducing costs is one of the goals of this bill, the exhibits below should demonstrate that this is unlikely to happen.

Exhibit A: In the U.S., between 1990 and 1994, private, for-profit hospitals had higher costs ($8,115) for every discharged patient, than private, non-profit hospitals ($7,490) and public hospitals ($6,507)iii.

Exhibit B: A 2004 analysis involving eight U.S. studies, a median of 324 hospitals per study and over 350,000 patients altogether, demonstrated that in the last 20 years, payment for care at private, for-profit hospitals was 19% higher than in non-profit hospitalsiv.

Exhibit C: In Canada, the fee schedule of public health insurance plans give doctors between $700 and $900 per total hip or total knee replacement. Adding the cost of the consultations, other payments to the anaesthesiologist and the nurses as well as the maintenance and capital costs associated with the facility, we reach a cost of about $8,000v. The same procedures in private facilities such as Brian Day’s Cambie Surgery Centre or Mark Godley’s Maples Surgery Centre vary between $14,000 and $18,000vi.

Exhibit D: A cataract surgery at Winnipeg’s public Pan-Am Clinic costs $700, while it cost $1,000 under its for-profit managementvii. At Winnipeg’s private Maples Surgical Centre, a cataract surgery costs $2,000viii.

Exhibit E: The cost of hip replacement in a UK private hospital or clinic varies between £6,000 and £15,000ix, inclusive of private hospital charges and consultant’s fees. In non-profit hospitals, the cost of a hip replacement varies around £5,000x. A coronary bypass operation in the United Kingdom’s for-profit institution costs the public insurance £6,320 in 2002-03. The same procedure cost the public an average of £12,060 in a for-profit settingxi.

The Question of Trade Agreements

Unlike Europe, Canada is next to the last remaining Superpower.  We also have a trade agreement with that Superpower, NAFTA.

The healthcare sector has been protected from the application of the agreement through Annex II (c), which stipulates that:

Canada reserves the right to adopt or maintain any measure with respect to the provision of public law enforcement and correctional services, and the following services to the extent that they are social services established or maintained for a public purpose: income security or insurance, social security or insurance, social welfare, public education, public training, health, and child care. (Emphasis ours).

In a widely respected legal opinion written in March 2000xii, trade expert Steven Shrybman showed that under the current rules of NAFTA, Canada’s health care could come in for a challenge in the future. As provincial governments legislate the existence of private, for-profit medicine, the probability of such a challenge dramatically increases.

A U.S. for-profit healthcare corporation could claim that they are prevented from accessing a market that Canadians have. Because according to NAFTA, Canada must give U.S. companies the same treatment it reserves to its own businesses (the national treatment clause).

Not only would they very likely win, thus creating a parallel private system, but they could also challenge Canada’s public healthcare system, accusing it of unfair competition by virtue of being subsidized. This challenge wouldn’t be unlike the one launched by UPS against Canada Post and Purolator.

Sweden, France and the United Kingdom don’t have to contend with this possibility. Canada does.

The Question of Enforcement

One of the goals of this bill, according to your government, is to insure there is no queue jumping.  The bill requires health practitioners to report any instances they see of individuals jumping the queue, either for money or because they know the physician.

The problem is that there is no real enforcement mechanism.

Because the bill does not restrict health practitioners to either the public or private system, there is no way to stop a health practitioners from working two day a week in the public system and three days a week in the private, or some similar combination.  Essentially, a health practitioner could refer patients that he or she is unable to see in the public system to his or her private practise.  At that point there is no way to enforce the legislation against queue jumping because in the private practise the other workers are reliant on the company or individual health practitioner for their livelihood.  As such, they may be unwilling to speak out against queue jumping for fear of losing their job.

Additionally, there is little incentive for physicians to stay in the public system full time if they are able to refer patients to their private practise where, as demonstrated earlier in the submission, they will make more money.  This also reduces the ability of the government to enforce the bill because physicians will be less likely to report queue jumping.

The Question of Privatization

One of the biggest questions that this bill raises is the role of privately delivered health services.  Also, the biggest problem with this bill is that it automatically accepts and legitimizes the role of privately delivered health care in our province.

Instead of regulating and slowing the advance of for-profit health services, the provincial government seeks to legitimize them; allowing the first strains of a two-tiered system to emerge.

The advocates of privately delivered health services, including Dr. Jacques Chaoulli, are privateers in the worst sense of the word.

After winning the his case before the Supreme Court of Canada, Dr. Chaoulli ran down to the United States, pledging to single handily destroy Canada’s single-payer health care system.  He said to the Heritage Foundation, a far right Think Tank, “I have a dream. My dream is to show the world how to get rid of a new and subtle form of tyranny hidden under the cover of a Welfare State’s compulsory health care program.”xiii  Mr. Chaoulli corrupts Dr. Martin Luther King’s speech on equality to attempt to justify his destructive goal of privatizing health care services in Canada.

As the submission has shown, the real tyranny occurs when private companies are allowed to line their pockets with public gold and profit from the illness of all Canadians.  The privateers are not seeking to shorten wait times in the public system.  They are not seeking to reduce governments health related costs.  They are seeking making large sums of money while simultaneously destroying one of the foundations of the Canadian state, Medicare.

Nova Scotia must reject this vision of health care; we must reject private delivery and for-profit health care services.  The Health Facilities Licensing and Equitable Access to Insured Services Act should be withdrawn and a new bill created.  This bill should:

– Establish a moratorium on the opening of new private health clinics in Nova Scotia
– Enshrine the Canada Health Act in provincial legislation, including a new clause that requires not only Public Administration but Public Delivery
– Require the Minister of Health to set a schedule for bringing the existing private health facilities into the public system
– Eliminate double-dipping by requiring health practitioners to work in either the public system or the private system
– Develop a comprehensive, centralized wait list strategy

The solutions to the problems confronting public health care are found in the public system.  Not the private system.