What Is Medicare For?
the privatization of medicare
Chapter 1: Where We Are
My thanks to the many people who helped me in the writing and research of this book.
My wife, Tanya, and my children, Sophie, Raphael, and Sam, for their forbearance and encouragement.
My brother, Peter, for helping me locate many of the newspaper stories I have included in the book.
My father, Peter, for his help in clarifying his family's history in Cabbagetown.
My mother, Joan, for her help in understanding her own family's history and her parents' life in Cabbagetown.
My brother, Gordon, for his help with the technical work of preparing the manuscript.
The staffs of the libraries and archives in Toronto that I used for my research.
The librarians and archivists at the following institutions who helped me research the book: the Toronto Public Library on Church Street, the Toronto Reference Library, the John M. Kelly Library at the University of Toronto, the York University Library, the Archives of Ontario, the Toronto Star library, the Ryerson Library, the Canadian Genealogical Research Library at the Toronto Reference Library, the Toronto Telegram Library, the Star Weekly Library, the Toronto Sun library, the Canadian Labour Press Archives at the University of Toronto, the Royal Ontario Museum library, the National Archives of Canada, the Merril Collection of Science Fiction, the Ethical Culture Society library, and the Toronto Telegram fonds at the National Archives of Canada.
Michael Valpy, who gave me the idea for this book, and who has continued to give me encouragement and advice.
The staff of the UBC Press, for whom the book was originally written, and who have been enthusiastic about it to the point of offering to publish it again.
The many people of Cabbagetown and other parts of Toronto who have helped me in my research and made the project possible.
Finally, as always, I am grateful to the Canada Council for the Arts and the Ontario Arts Council for their support.
Preface to the new edition
The Second Edition of What Is Medicare For?
begins with two completely new chapters and with a note on the impact of the 2008 financial crisis on health care in Canada.
The 2008 financial crisis led to a global recession and falling employment rates. As a result, tax revenues decreased drastically, and governments across the country—including the federal government—were forced to cut spending to balance their budgets. Because Canada's health care system is a provincial and territorial responsibility, it was up to the provinces to cut their health budgets. Some of these cuts were so severe that it was feared that the federal government would have to step in to make up the difference, a move that would have been contrary to the federalist principles on which Canada's constitution is based.
In June 2009, the federal government did step in, offering the provinces $1.5 billion in emergency funding. This money was slated for health care, and was to be used to avoid service cuts or hospital closures. The provinces accepted this money and used it to avoid more drastic cuts. However, in the end, the federal government could not insulate the provinces from the effects of the global recession, and had to abandon its constitutional principles and pass the 2009 Health Accord and the 2010 Canada Health Act. These two agreements, which were signed by all of the provinces, meant that the federal government would make up the difference in health care funding for the current fiscal year, even if it meant running a deficit. This move was made possible by the government's belief that if it did not do so, Canadians would suffer from the state of the economy and look to the state for help.
This is the new health care reality in Canada. The federal government has a new role in health care. While this may seem to contradict the federalist principles of Canada's constitution, it is worth noting that the federal government rejected the NHS in the 1940s, and it was the provinces that insisted on its creation. The provinces have always insisted on having some control over health care, and the federal government has always preferred to maintain control over this important public good. If the provinces want more funding for health care, they must agree to more federal control over the system.
The 2009 Health Accord and 2010 Canada Health Act are a new, long-term deal on health care in Canada. The provinces will get $30 billion over ten years, although they will not have to pay anything in return.
Section 15 of the Canada Health Act substantially amends the bill's original wording. It reads:
With respect to insured services that are provided outside of Canada, the Act will not apply to insured services that are provided to residents of another province or territory or to residents of other countries, except in the circumstances described in the schedule.
In other words, Canada's health care is becoming a national program. If Canadians in any province want to go to a hospital in another province, they will receive the same health care they would have received if they had stayed at home.
While this is a major change from the original Act, it is not the largest change. The biggest change is in section 18, which reads:
2. An insured person who is temporarily resident in a province other than that in which the person is ordinarily resident is entitled to receive, on the same basis as residents of the province, the insured services available in the province.
In other words, the federal government has a new role in health care, and that role is to make sure that people get the same health care regardless of where they live. In the past, people in some provinces were entitled to receive health care in other provinces, but they would have to pay the bills themselves. Now the federal government will pay the bills, and will be able to force the other provinces to cover the costs of health care for