September 2004 IBEW Journal

Any discussion about health care in Canada starts and ends with medicare, the publicly financed system with one level of service for everyone, regardless of health, age or employment status. Canadians go to the doctor of their choice and receive hospital care for free. It has been called Canada’s greatest social achievement.

Canadians cherish medicare, and they are prouder of it in light of the United States’bumbling attempts to relieve its national health care crisis. But medicare in Canada has its own challenges. Rising prescription drugs costs have paralleled declining federal subsidies to provinces and territories. System overuse and the growing number of medical services that are not covered have tortured medicare to the point that provinces are experimenting with big changes that threaten to destroy the system’s national cohesion.

Jointly funded by federal and provincial revenues, its stability is threatened by reduced federal contributions and fear that individual provinces might opt out completely.

"The system certainly needs to be fixed," said IBEW Eighth District International Executive Council member Joseph Fashion. "It’s not completely broken, but it needs to be fixed in a lot of ways."

The question for many Canadians is: Is medicare worth saving? And if so, what is the best way to make it sustainable?

"If we are able to keep medicare, it will take time, energy and money to get it right," said IBEW First District Vice President Philip Flemming. "What we have today can easily change tomorrow depending on public perception, public manipulation and the privatization promoters who are forever looking for their opportunity."

What is medicare?

A preacher and former newspaper printer named Tommy Douglas was the father of Canada’s modern health care system. As premier of Saskatchewan in the early 1960s, Douglas presided over the first universal health care system in Canada, and gradually the rest of the country adopted the model of the progressive province.

The 1984 Canada Health Act enshrined Canada’s current national health care system. The federal government sets standards and shares funding while the provincial governments are the hands-on providers, implementing their health care rules and providing the medical services. Thirteen interlocking provincial and territorial plans comprise the national system.

The Canada Health Act does not permit private payments for services that would otherwise be covered by medicare, but medicare does not cover everything. Supplemental insurance—bargained with employers, or purchased by consumers—is a key component to health care delivery in Canada, covering all those services medicare does not—most notably, dental, eye care and prescription drugs.

Publicly funded, the medicare system never presents patients with a bill following a hospital or doctor visit—but "there’s nothing free in this world," said Yves St.-Germain, Local 568, Montreal, Quebec, business manager. "It’s free when you’re going to the hospital, but every week I’m paying for it," he said. Federal and provincial income taxes range between 17 and 45 percent combined, depending on income, and medicare is funded by general revenues.

A Dwindling Share
Spawns Independent Action

The federal government distributes money to the provinces to manage and deliver health care. But as the federal government has emphasized tax cuts in recent years, federal "transfers" provide a dwindling pot of health care funding, leaving the provinces and territories with a greater financial burden.

"As Ottawa’s share of the national health bill has shrunk over the past 30 years, the provinces have become increasingly resistant to federal attempts to dictate the terms of medicare," said Toronto Star columnist Carol Goar. "They contend that Ottawa has no business telling them how to deliver health care when they pay 84 percent of the cost."

For instance, in the western province of Alberta, Premier Ralph Klein (Conservative) has dealt with the decline in federal funds by increasing privatization—sometimes even in violation of the Canada Health Act.

Klein has authorized private, for-profit surgical clinics and allowed residents to buy medically-necessary services outside the public health care system. Although the federal government could penalize Alberta for violations of the Canada Health Act, observers are concerned that the province could leave the national health care system for good.

In Quebec and Ontario, federal cuts led to mass staff reductions in hospitals, which contributed to the SARS epidemic in Toronto. Fashion, who is also business manager of Toronto Local 353, said the cuts have hurt the quality of medical care. "Our doctors and nurses are underpaid, so quite a number of them go to the United States to work," he said. "That means you’re always dealing with inexperienced people now. It didn’t used to be that way."

Medicare
Shows Its Age

Although hospital and physician services are covered by medicare, an increasing percentage of the health care dollars in Canada are spent on prescription drugs and other services that are not covered. Complaints about long waiting lists and a lack of significant investment in new technology and equipment have plagued the system for years. An aging population, higher prevalence of chronic disease and increased demand for services are also contributing to escalating health care costs.

Prescription drugs in particular are costing Canadians dearly. From 1987 to 1996, the cost of prescription drugs increased by 93 percent, compared to overall inflation of 23 percent. In a boon for the companies, the Canadian government has repeatedly extended patent protections on popular drugs for pharmaceuticals, preventing competition from low-priced generics.

Long waiting lines for diagnostic services and non-life-threatening elective surgery are a common criticism of the medicare system. Private imaging clinics, like those offering MRIs, have started to spring up, particularly in Quebec.

Fashion said in Ontario four- or five-month waits are not unusual for MRIs. And cancer patients must wait up to three months for chemotherapy treatments. "That kind of waiting time is unacceptable and I think it’s criminal," said Fashion, adding that in some cases, the local’s health plan sends members across the border to Buffalo, New York, for treatment.

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