November 2010 Archives

Kevin Drum, who blogs for Mother Jones, the venerable muckraking magazine in San Francisco, has an interesting column about the just released charts from the International Federation of Health Plans - the Canadian Blue Cross are members - that compare health costs across member countries. So, what does the date show us?

That the U.S. has the highest health costs across the boards, for every procedure. The Mother Jones column singles out the cost of hip replacements to demonstrate how the rapid availability of the procedure in the U.S. seems to be motivated by how much money there is to be made. The average hip replacement in the U.S. costs $34, 454. "Keep this in mind the next time someone starts going on about how you never have to wait in line for a hip replacement in America. It's not because our healthcare system is super efficient, it's because doctors are super eager to perform them," writes Drum.

In fact Canada is in the bottom percentile in nearly every chart - and never places higher than the middle for health care costs. The other countries in the bottom (with the lowest costs) all have some form of socialized medicine while the countries at the top (with the most costs) all have private health delivery.

You can view the charts here, so remember this the next time someone makes an argument for private surgical clinics or CT scans in Canada.

"Requiring patients to pay up front, and having them seek reimbursement from the covering province or territory, still satisfies the portability criterion of the act, as long as access to a medically necessary insured service is not denied due to the patient's inability to pay," said Tim Vail, speaking for Health Minister Leona Aglukkaq in a Globe and Mail article about the unequal application of the Canada Health Act between provinces, in this case Quebec and Ontario. 

The story in the Globe begins by mentioning that the Act, as it is presently, is only 26 years old - and it is - but you can't help but wonder given the direction of the rest of the Globe's coverage this week of Canada's health system if the idea here is that 'it's not that old'. That it's not so intractable that it can't be changed, scrapped for something different. What private advocates don't bring up is what it was like for a majority of Canadians prior to the introduction of universal health care - the farmer on the prairies, the dockworker in Halifax, the trapper in Yellowknife, the schoolteacher in Toronto.

Now the focus seems to be of time pressed Canadian professionals who need orthoscopic surgeries and want to speed up delivery (an understandable and universal feeling) and have the money to pay for it. Not the situation that led to the introduction of universal health care for Canadians or the situation that persists still for the majority. Allowing two-tier healthcare for those who can afford to pay will enshrine a two-tier society where there will be those who can afford to be healthy and those who can't.

What doesn't get communicated is that two-tier users and practitioners continue to draw on public resources while benefitting from their ability to pay for upscale service. Though not at all apparent in the soft toned feature of B.C. private clinic operator Dr. Brian Day in the Globe this week, Dr. Day is clear in a recent story in the Tyee how he double-bills his patients for the surgeries he offers. First Day's Cambie Surgical Centre bills the patient and then the province for the same procedure. The private U.S. health providers - as well as those homegrown - lining up to offer services to Canadians do so expecting the public system to pay. Remove the public purse and their bottom line suffers.

Implicit in the Globe series - and in much of the arguments made by two-tier advocates - is the idea that somehow private care is different, as if a diagnosis from a doctor paid out of pocket has access to greater insight, better skills and unique medical knowledge not possible from a medically trained professional working within the public health system. It's a subtle argument employed by public relations specialists meant to shift public opinion imperceptibly to a certain point-of-view, in this case that private care is better and more efficient, and the Globe with this series has bought right into it.

TORONTO, Nov. 9 /CNW/ - Hospital CEOs have been ordered to invest in nurses and frontline staff by an independent arbitrator who found Queen's Park's call for a compensation freeze unreasonable, in a ruling that renders the policy null and void in the health sector.

The decision published today means about 17,000 nurses and staff at more than 60 hospital sites will see their compensation rise in-line with inflation, while CEOs were also given a deadline of 60 days to start taking steps to address nursing shortages.

"The ruling is balanced and puts the interests of patients first," said Sharleen Stewart, head of the Service Employees International Union (SEIU), which represents more than 50,000 healthcare workers in Ontario.

Hospital CEOs have been withholding inflation increases dating back more than a year from frontline staff, while paying themselves up to $830,000 and spending millions on consultants through sole-source contracts that a recent audit revealed as wasteful and potentially fraudulent.

"Frontline staff are getting by on less than 5% of what some of these CEOs are paying themselves. Yet these executives think nothing of pushing a paramedic or nurse to breaking point while indulging in lavish spending on perks for consultants and bonuses for themselves. This is simply unfair. The hypocrisy is staggering," said Ms. Stewart.

Ontario Arbitrator Kevin Burkett ruled the CEOs' position unreasonable and found the government's goal of a wage freeze for nurses and teachers was not binding. The government had "spoken politically" but "not legally" or "legislatively", he said. Legislation is not a viable option for Ontario following a Supreme Court decision that ruled a similar move by British Columbia violated the Charter of Rights and Freedoms.

Marty Parker, head of the Ontario Hospital Workers Council, said: "The wage freeze is dead. The only way the government is going to reach its budget targets now is by delaying $2-billion in handouts to corporations. We just can't afford to pay for anymore corporate tax cuts."

The arbitrator also ordered CEOs to take steps towards making better use of Registered Practical Nurses, and ensuring patient safety is part of the professional responsibility of all nursing staff. "This is a call to action to make sure patients get the right nurse at the right time," said Carol McDowell, a Registered Practical Nurse in St. Catharines and head of SEIU's Nursing Division.

The arbitrator's ruling means SEIU will be the lead union in the next round of negotiations with CEOs in the hospital sector, with talks starting early in 2011 with a focus on capping runaway CEO pay and making public healthcare stronger and more sustainable.

The wage freeze has now been overturned in the hospital sector and nursing home sector, leaving only one major part of the health system to address: home care. Cuts are seen as untenable in the home care sector because of acute shortages and high turnover rates among staff who are already living below the poverty line, and because the sector is still struggling to live up to its promise as a solution to the pressures of an aging population.



For further information:
Pat Chastang
SEIU Canada
(416) 709- 0501
chastangp@seiu.ca