Supreme Court Decision Opens the Door to Deeper Attacks
29 June 2005 – The Supreme Court of Canada’s June 9 decision overruling the Quebec government’s ban of private health insurance for services covered by the public health care system is a significant move toward a two-tier medical system, with inferior care for working people and high-cost, higher quality care for the rich. The decision, adopted by a 4-3 majority, is another step in a lengthy government offensive to reduce social benefits for working people and give greater tax and other fiscal benefits to the wealthy class.
In the 1960s and 1970s, working people in Canada won government-funded health care for all residents. Parallel, private services for those willing to pay became restricted by law to services deemed “cosmetic” or otherwise non-essential to life and limb. In contrast to many advanced capitalist countries, all residents of Canada are served by the same publicly-financed health system.
Most Canadians have come to regard the universal health care system as a human right, even a symbol of national identity, taking pride in its superiority over private insurance in the United States. But over the past two decades, big business and its national and provincial governments have run down the quality of publicly funded care, aiming to blackmail the public to accept the need for parallel services outside the insurance plan. Their aim is to allow the privileged to receive treatment they can afford, even if the poor suffer or die for lack of care.
Governments have not dared legislate a two-tier system. Now the Supreme Court has weighed in and many political and corporate leaders intend to use its decision to open the door to expanding private services.
Canada’s health system is sick
The health care system in Canada is fundamentally driven by the private, profit-seeking system of capitalism. Pharmaceutical and equipment-supply companies earn fabulous sums from sales and research. Professionals–from doctors to hospital and government administrators—are paid a very high price for their skills. Public insurance is absent or limited for dental and optical services, physical therapy, care for the mentally ill, and scores of other basic medical services. Breakthrough diagnostic and advanced drug treatments are often unavailable, or only available for exorbitant fees.
The greatest victims of diminished care are women, many of them immigrants. They are the ones who perform the hard labor in hospitals and other public institutions for the least pay. When the health system is cut back, it is mainly women who lose their jobs and union protection.
The system utterly fails to address the urgent health problems of Aboriginal people.
Canada’s health insurance downgrades the prevention of disease. This is largely left to the alternative medical practitioners whose often high-priced services are not covered under the plan. In its 2001 submission to the Commission on the Future of Health Care in Canada, the United Steelworkers union quotes James Gilligan, author of Violence: Our Deadly Epidemic and Its Causes, in which he writes, “the acute health care services can be thought of as the ambulance waiting at the bottom of the cliff to retrieve the victims cast off by the violent aftermath of societal structure.”
In their attack on publicly-funded health care, governments have:
- Restricted the numbers of doctors that can practice in Canada, preventing many fully qualified physicians and nurses from other countries from practicing here. Canada lags behind even the U.S. with only 2.1 physicians per l,000 population.
- Reduced health care by closing hospitals and other institutions, and eliminating thousands of nursing and health assistant positions in the institutions that have remained open. The number of hospital beds per capita in Canada has dropped, and patients are routinely released prematurely.
- Imposed long delays in hospital emergency wards and in obtaining essential tests and surgical treatment—delays that cause needless suffering, permanent injury, and death.
- Downgraded service and cleanliness within hospitals.
- Reduced community care services in the home, even for those with chronic and grave illnesses.
- Radically reduced the number of nurses, health care aides, and support staff in long-term care for the sick or elderly.
Government attacks have not gone unchallenged. Whenever given the opportunity, voters have sought to defend the public insurance system. Health care workers have staged strikes and protests throughout the country, and they have won the support of other unions and the general population. The union-backed Ontario Health Coalition, is currently mobilizing against attempts to privatize 23 hospitals in that province. In June, 2000, 10,000 health care workers defied Alberta’s restrictive labour legislation, forcing a settlement of their contract issues, including raises. In April/May of 2004, more than 40,000 health care workers went on strike in British Columbia. On May 1, in the midst of the strike, several tens of thousands of people marched in support of the strikers and against strikebreaking legislation aimed at the Hospital Employees Union. A general strike movement was underway in the province in support of the strikers. (For a report on that strike, see Socialist Voice #3.)
It was this and many other examples of steadfast resistance to health care cuts that led enemies of public health care to turn to the courts for assistance.
The Supreme Court decision
The case before the Supreme Court was brought by a Quebec physician, Jacques Chaoulli, who wanted to set up a clinic for private medical services, and his patient, George Zeliotis, who waited nearly a year for a hip-replacement surgery. Chaoulli and Zeliotis argued that Quebec’s ban on buying private insurance for services already covered by the pubic health-care system (but in practice not readily accessible due to long wait times) violated both the province’s Charter of Human Rights and Freedoms and the Canadian Charter of Rights and Freedom.
Dr. Amir Khadir of the Union des forces progressistes, a left-wing Quebec political party, responded to the court decision in these terms, “See where the cutbacks have landed us! The waiting and suffering imposed on sick people by these cutbacks give Dr. Chaoulli the pretext to attack the Quebec public health system.” In fact, Chaoulli was merely a tool of a massive legal and publicity campaign bankrolled by the super-rich Desmarais family, whose Power Corporation owns two large private health insurance companies—London Life and Great-West.
Morgentaler case is no precedent
Ironically, this court ruling was based on the 1988 Supreme Court of Canada decision that struck down Canada’s restrictive abortion laws. The Chaoulli/Zeliotis ruling draws on more than two pages of comparisons between the two cases. The 1988 decision, named after the abortion rights hero Dr. Henry Morgentaler, established that women faced systematic delays and obstruction in obtaining abortion from public hospitals and therefore had a human right to seek treatment from private clinics. This decision was a huge victory for women’s rights, paving the way first to create private abortion clinics across the country and then to win the inclusion of abortions in these clinics in the public health insurance plan.
The Chaoulli case is similar in legal form but opposite in its essence: its goal is not to strengthen and expand public health care, but to weaken and limit it by expanding private services.
The Supreme Court majority claims its decision is a remedy for overly long wait times. In fact, as the Ontario Health Coalition points out, “two-tier health care will pull precious human resources out of the public health care system and will mean longer waiting lists for most people in order that a select few are able to buy their way to the front of the line.”
Health care and Quebec sovereignty
The Chaoulli decision is a blow to the justification for Canada’s rule over Quebec. As Pierre Dubuc in l’Aut Journal explains,
“In this decision, the two pillars that have come to be defined as the basis of English-Canadian identity have collided: the Charter of Rights and Freedoms and the public health system…. The Supreme Court decision has destroyed one of the last myths of Canadian federalism, namely, that federal institutions stand as a rampart against privatizing our health system.”
Throughout Canada’s history, Dubuc says, “this theory of the federal guardian angel is part of the federalist arsenal against Quebec sovereignty…. It is now clear that the way to preserve our public health system [in Quebec] is to achieve national independence.” This Supreme Court decision is all the more irritating to Quebec national feeling coming on comes on the heels of the Gomery revelations on the Liberal Party “sponsorship” scandal in Quebec. (see Socialist Voice#41.)
The two-tier society
The example of Cuba shows that there is no need nor excuse for long waiting times for health care. Cuba has found the means not only to care for its own population, but also to extend international medical aid throughout Latin America and to other underdeveloped countries. (See “Cuba’s Development”.)
Cuba has received the highest praise from the World Health Organization, World Intellectual Property organization, and International Labor Organization for its medical accomplishments. The Latin American Medical School of Havana has trained tens of thousands of health professionals from more than 123 countries, including the United States. Twenty thousand Venezuelan citizens have recently regained their sight after receiving free cataract and other eye operations from Cuban doctors.
Cuba provides an example of what can be achieved when workers are in government and organize society to meet human needs.
Perhaps the Paul Martin government should ask Cuba to add Canada to its list of medically deprived countries in need of help. The Cubans would gladly train Canadian doctors, and they could help ease wait times here for medical procedures.
But the Canadian health care system is rooted in the profit system which runs counter to human needs. Industry and corporations want to increase their capacity to use health care, like any other piece of merchandise, as a source of private accumulation. Canada’s rulers do not aim at this time to destroy the public insurance system–it is even lauded by some capitalists as a way to reduce the burden of employee benefits. But they do aim to degrade public care to the point where many people will come to accept a two-tier system. Two-tier health care is the logical outcome of a two-tier society.
Labour’s reaction
The Supreme Court decision prompted quick protests from labour organizations. Ken Georgetti, President of the Canadian Labour Congress called on all federal and provincial governments to “move quickly to reassure Canadians that our cherished public medicare system is still in place and will be there for us all when we need it.” In fact, it is these very governments that have devastated the “cherished system,” to the point where it is often not “there for us when we need it.”
Jack Layton, federal leader of the union-based New Democratic Party, and Jean Crowder, its health critic, echoed Georgetti’s sentiment, saying the decision “should be a wake-up call to Paul Martin to honour the promises the Liberals have made to patients in four elections.”
Claudette Carbonneau, President of the Confederation des syndicats nationaux (CSN), states that the Supreme Court decision is “a major defeat for Quebec’s health system, which opens the door to a two-tier medical system.” She notes that “the decision will worsen the shortages of personnel because many doctors will be tempted to make the leap into private medicine,” but makes no call for action.
By contrast, Henri Massé, President, Federation des travailleurs et travailleuses du Quebec (FTQ), pledges that the unions will “prepare a most vigorous response, because this decision is very serious.
“More than 30 years ago, we as a society made our choice in favor of a system of free access to quality health care,” says Massé. “We can’t allow four individuals, even if they are Supreme Court justices, to overturn this decision.”
Indeed, the court cannot on its own authority overturn a health insurance system so strongly supported by the Canadian population. In estimating the relationship of forces, the ruling class has utilized the Supreme Court to give their opinion that the time has come for a frontal attack. But is their estimate correct? It is up to the labour movement and its allies to prove them wrong.
It is not enough to elect politicians who promise to defend health care–only to betray those promises when elected. As Quebec’s left-wing political parties, Option citoyenne and Union des forces progessistes, propose, what we need is “a true united front of social movements, political parties, and citizens to defend a health system that is free, universal, and accessible.” The Ontario Health Care Coalition has set a modest example with their untiring and consistent demonstrations of resistance.
It is not enough to defend the “cherished system.” The public health care system must be rebuilt and expanded–for example, by including in its coverage dental and optical care, physical therapies, prescription medications, and expanded care for the mentally ill. Steps are needed to challenge and restrict profiteering–for example, by developing a publicly owned pharmaceutical industry. Preventive health care needs to be emphasized. And health sector workers need better wages, staffing ratios, working conditions, and an assured right to union protection to allow a delivery of high-quality care.
The Supreme Court decision should be a wake-up call for labour throughout Canada and the NDP to educate and mobilize sentiment of working people. We need to rally massively behind the unions of health care workers. Our focus should be not the courts but the streets—with large and loud public demonstrations throughout Canada. That is the only language that will be understood, particularly by the owners of industry and the insurance moguls. There is more strength in our numbers than in their laws!
First printed Socialist Voice