By Miguel Aguayo
The Toronto Star

Talk of privatizing the health-care system in Canada began to emerge shortly before my immigration from the United States.

Its proponents spoke positively, even enviously, of the speed with which medical treatment was received south of the border. No lining up in queues and more choices in treatments were offered as evidence that a private system is better than Canada’s universal health coverage. These testimonials, however appealing, are not the complete story.

In my youth, becoming ill and going to the hospital was expensive. When someone in the family needed medical attention, the cost of health care was paid either out of pocket or through health insurance.

Even those who were lucky enough to have health insurance did not walk away without debt. The insurance policies usually required a co-payment of 20 per cent. This payment structure encouraged people from the working class (or lower) to delay seeking treatment in the hope that the symptoms would subside. If not, it usually meant a trip to the emergency room because the disease or injury had progressed to the point that the trip became necessary.

This was a gamble that my father once played and lost.

Instead of rushing me to the hospital when I became stricken with meningitis, my parents waited almost three days before we made the trip. Consequently, I became deafened for life. At first glance, this may seem like a case of bad parenting, but in context, this delay in seeking medical attention is somewhat understandable.

Over the years before my illness, my siblings and I experienced a series of illnesses. My sister’s birth had a few serious complications. I had an appendectomy. My bother had abdominal surgery.

These successive hospitalizations kept my parents from getting ahead financially. So it is not surprising to me that my father would try to avoid another hospital bill. Accruing a large hospital bill has led many to, consciously or subconsciously, delay seeking treatment for illnesses.

Americans are more likely to buy over-the-counter medications than seek medical help. This is true even when a fever is present, which is the medical “red flag” that something is wrong. Pop a couple of acetaminophen tablets, cross the fingers, and hope for the best. An expensive trip to the emergency room was made only if the illness persisted.

Eventually, insurance companies developed the managed care concept to control the spiralling cost of medical treatment that resulted from this practice. Under managed care, Americans could seek treatment without being stuck with a bill afterward. Unfortunately, the price they paid was costly insurance premiums and a rigid set of rules to follow. If a rule was broken, the patient got stuck with the bill.
My experience with managed care was not better than the old insurance system. My share of the premiums, after my employer’s contribution, was an annual $4,000 for a family of three. Worse yet, some of the rules that patients had to follow were simply unrealistic. For instance, unless it’s a life-threatening condition, you are supposed to call the hospital before seeking treatment.

I once got stuck with a bill that amounted to several hundred dollars when an anxiety attack put me in a hospital without contacting my primary care centre in advance. Never mind that I thought I was having a heart attack or that deaf people rarely have an accessible phone handy while in public places. The important issue was the call was not made.

Although these stories are worst case scenarios, they provide a contrast to the picture that proponents of privatization wish to paint. What they would like Canadians to believe is that allowing the medical system to chase dual goals of providing optimum care and realizing a profit will not hurt the system.

They seem to believe that allowing private medicine into our system will somehow improve services and reduce costs. After living under the American system, accessing medical treatment here is liberating. When I feel ill, I call my doctor and get help.

I don’t have to worry about the cost. I don’t have to worry about special rules that can place the full cost of service on my shoulders. Sure, there are problems in the Canadian health-care system, but opening it up to privatization, to me, is simply not the way to go.

Miguel Aguayo is a member of The Star’s community editorial board.
Copyright 1996-2001. Toronto Star Newspapers Limited. All rights reserved.

by Sarah Sexton

Even before its meeting in November this year in Qatar, the WTO has already begun talks to expand one of its agreements – the General Agreement on Trade in Services or GATS.

Services are now a significant part of the economies of industrialised countries and are governed by complex domestic regulations. These countries are now trying to revise the Agreement to increase international trade in services. If they are successful, GATS could be used to overturn almost any legislation governing services from national to local level.

Particularly under threat from GATS are public services – health care, education, energy, water and sanitation, for instance. A revised GATS could give the for-profit sector further access and could make existing privatisations effectively irreversible.

Experience in the United States and several Latin American countries, where health services have been run for profit over the past decade or so, suggests that the result will be a decline in accessibility to health care worldwide.

This briefing outlines the growth in services in recent years, the main provisions of GATS and its proposed revisions, and some key corporate aims in extending the Agreement. It details how public services may not in fact be excluded from GATS.

It considers what may happen if private companies are enabled to capture the most profitable components of publicly-provided and -funded health care services: a two-tier health system in which a reduced public sector has to cope with the elderly, chronically sick and the poor who most need health care and who can least afford it..

Sarah Sexton/Larry Lohmann/Nicholas HildyardÊ
THE CORNER HOUSEÊ
PO Box 3137Ê
Station RoadÊ
Sturminster NewtonÊ
Dorset DT10 1YJÊ
BRITAINÊ
Tel: +44 (0)1258 473795 Fax: +44 (0)1258 473748 Email Ê
Website: http://cornerhouse.icaap.org/

Download here (MS Word format).

WHEREAS every person residing or employed in Ohio, without regard to sex, age, race, income, place of residence, place of employment, or any other circumstance, is entitled as a matter of right to quality health care, the same as any other person; and

WHEREAS there is a growing crisis in health care in the State of Ohio, manifested among other ways by massive layoffs, steep increases in premiums, copayments and deductibles, a steady increase in the number of persons without health insurance, and the closing of many health care facilities, especially those serving low-income segments of the population; and

WHEREAS insured persons now commonly experience unacceptable, sometimes life-threatening delays in obtaining approval for needed health care services by private, for-profit health insurers; and

WHEREAS the complexity and redundant bureaucracy arising from the existence of multiple, for-profit insurance plans, each with its own distinct program of coverage and benefits, its own costly administrative and executive structure, and its own system of processing managed care approvals, payments of benefits and/or reimbursements, etc., wastes up to 30% of premiums paid for medical coverage by Ohio employers and private citizens, resources which otherwise could be used to provide benefits; and

WHEREAS the administrative burden to health care providers in complying with the bureaucratic requirements of dealing with a multitude of insurers and plan provisions distracts physicians, hospitals and other health care providers from their central mission to provide quality health care for the people of Ohio; and

WHEREAS the added costs of care and insurance premiums created by these inefficiencies and structures are a drain on the financial resources of the taxpayers of Ohio, on those Ohio businesses currently providing their employees with health care benefits, and on every level of government throughout the State; and

WHEREAS Ohioans and Ohio businesses are burdened by unchecked increases in the costs of insurance premiums, prescription drug costs and medical costs in general, imposing ever greater hardships on Ohio residents and employers and driving many businesses and individuals to reduce or eliminate medical coverage or benefits; and

WHEREAS tens of thousands of Ohioans, including the elderly, children, the unemployed, the poor and those whose employers do not provide health insurance benefits, are forced to do without necessary medical care or to pay beyond their means, leading to over 40% of personal bankruptcies; and

WHEREAS a single-payer, publicly-funded, not-for-profit health plan will eliminate the redundant bureaucracy caused by a multiplicity of insurers, greatly reduce administrative costs associated with providing medical care, free up additional financial resources to provide improved medical care for all Ohio residents, allow physicians, hospitals and other medical providers to put all of their efforts into providing quality care, and reduce the cost of health care coverage for Ohio residents and employers; now, therefore, be it

RESOLVED:

i. That the Ohio General Assembly commit to enact, without delay, “Ohio Care” — a comprehensive, publicly funded, not-for-profit health insurance program covering: (a) all residents of the State of Ohio as well as all dependents of Ohio residents, whether residing within the State or elsewhere, and (b) all persons employed in the State, regardless of residence within or outside the State, as well as their dependents;

ii. That upon its effective date, Ohio Care will provide health insurance to all persons employed in the State and their dependents by or through their non-federal public and private employers, including all health insurance previously provided by the State government to its employees, and thereby will relieve Ohio employers of the cost and administrative burden of providing health insurance coverage;

iii. That Ohio Care will provide to every person covered by it one uniform program of health insurance benefits, the same as provided to every other covered person, including prescription drug coverage, dental care, vision care, long-term care, and coverage for mental illnesses on full parity with coverages for all other types of illnesses;

iv. That an Ohio Care Commission will be created, as an independent agency of State government, to implement and administer the Ohio Care program, with the composition of the Commission and the method by which its members are selected to be determined by implementing legislation;

v. That a health insurance benefit provided by the Ohio Care benefit program to a person covered by the program may in any given instance exceed, but not be inferior in scope or amount to, the benefit to which an otherwise similarly situated person would be entitled if that person were a federal government employee;

vi. That the Ohio Care benefit program will be designed and maintained so as to guarantee health care services of excellent quality, timely delivered and accessible to all; full support for ongoing medical research, medical education and training; full choice of providers; and access to comprehensive, preventive and long-term care;

vii. All federal funds allocated for health care purposes by Medicare, Medicaid, Veterans Administration, and other programs will be paid to Ohio Care, after obtaining the necessary waivers from the federal government;

viii. That any person who while covered by Ohio Care requires health care services anywhere in the world will be entitled to Ohio Care benefits to pay for such services to the extent payment has not otherwise been provided; and the Ohio Care Commission may enter into reciprocal arrangements with other jurisdictions to meet the health care needs of persons while traveling;

ix. That any Ohio resident displaced from employment by the private health insurance industry in this state as a direct result of the enactment of Ohio Care will be eligible to receive, at state expense, retraining and temporary financial assistance to facilitate reemployment without significant loss of income, and will receive preference for hiring for employment by the Ohio Care Commission in any position for which the displaced resident is qualified; and

x. That Ohio Care will be funded by utilizing federal, state and local monies that currently are used to fund existing Ohio health care programs, savings realized by eliminating administrative waste and profits of the current health care system, and any additional funding mechanism deemed necessary to ensure that Ohio Care is fully funded, with adequate reserves.

[Submitted by the Single-Payer Action Network Ohio (SPAN Ohio) on November 19, 2001. For copies write us c/o GCIU Local 546M, 3227 West 25 Street, Cleveland, OH 44109 or call 216-368-2631.]

Adobe PDF, downloadable here.

by Raisa B. Deber, PhD
Department of Health Administration, University of Toronto

Dr. Raisa Deber presented this paper at the symposium on Canadian and American health care, at the Canadian Consulate General in NYC.

Download the article (Adobe PDF, Acrobat required).

This and other papers are available here: http://www.utoronto.ca/hlthadmn/dhr/4.html

A life and death drama is unfolding in South Africa at this very moment as a consortium of pharmaceutical corporations, many based in the United States, fight to preserve their property rights in the face of the AIDS pandemic and the outrage of progressive humanity. Complete coverage can be accessed by going to .Ê — Sandy Eaton, RN, Quincy, Massachusetts, USA