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Medicare's 50th Anniversary

Medicare's 50th Anniversary


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Contents July 2012 marks the 50th anniversary of medicare in Saskatchewan

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Medicare: A People's Issue

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The Struggle to Implement Medicare

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My Experience in the Medicare Battle and the Woods Commission

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Medicare posts from NYC

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Privilege and Policy: A History of Community Clinics in Saskatchewan

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Dianne Norton on US Healthcare

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Canada: Doctors on Strike, TIME magazine retro

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The Saskatchewan Doctor's Strike, 1962

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"The First Fight for Medicare" - SFL

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The Hospital Employees’ Union Strike and the Privatization of Medicare

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Woodrow Lloyd and Medicare

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Sustainability of Health Care: Myths and Facts

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Working for Medicare

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Swimming into Darkness

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Video: The Saskatchewan Doctor's Strike, 1962

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The Guru and the Godfather: Henry Sigerist, Hugh MacLean, and the P...

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Saskatoon: The birthplace of medicare

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Moving Medicare Forward - A Health Care Message To Canadians

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The Roots of the Medicare Crisis

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The Road Not Taken

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Morbid Symptoms: Current Healthcare Struggles

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The pros and cons of medicare: CBC 1962

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Profit is not the cure

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Emmett Hall: Establishment Radical

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The First Ten Years: Saskatchewan's Community Clinics

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US Labour Celebrates 46 Years of Medicare

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CLC submission to the Romanow Health Care Commission

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Video: The fight for medicare in Saskatchewan

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Four Precursors of Medicare in Saskatchewan

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Flying Together: CACHCA

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NHS in the UK celebrates 63 years

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Norman Bethune – Book Review

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Tommy Douglas and the CCF: Health Care Achievements

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Canada's Medicare System: Building on the legacy!

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Why America Needs Health Care Reform

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Allan Blakeney, Pioneer of Canadian Health Care, Dies at 85

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The Roots of North America’s First Comprehensive Public Health Insu...

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Medicare’s 46th Anniversary Roundup (USA)

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Health Care in Scotland and Wales

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Tommy Douglas defends public health care - CBC Retro

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Debt Ceiling Deal Threatens Medicare, Medicaid

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Revolutionary Doctors

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Henry E. Sigerist:: Architect for Saskatchewan Medicare

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J. Wendell Macleod: Saskatchewan's Red Dean

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Health Care in the Mao Era

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The Fateful Summer of '62

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Greece's healthcare system is on the brink of catastrophe

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Canadian health system more efficient than U.S.: Study

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Health Economics in the USA

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Health, Health Care and Capitalism

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Green Mountain Dreams

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Tea Party, Canada-Style!

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Leading Economist Shatters Myth That Public Health Care is 'Unsusta...

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NHS among developed world's most efficient health systems, says study

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Saskatchewan's Community Clinics

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CETA trade deal threatens Medicare

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Unsung Heroes in Saskatchewan's Struggle for Medicare

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Prairie Giant's dramatization of the 1962 doctor's strike

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Physician Administrative Costs in the US vs. Canada

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The Case for a Pharmacare Plan in Canada

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Canadian Medical Hall of Fame: T. C. Douglas

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Physician Resistance and the Forging of Public Healthcare

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Ontario targets for-profit medicine

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Canadian alliance urges parties to step up action on health and hea...

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Health Care - The Movie

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CCF in Saskatchewan led the way in the 1940s

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Debunking Canadian health care myths

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Defending health care is not enough

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Canadian Doctors for Medicare Endorses CMA/CNA Principles

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The Foundations of National Public Hospital Insurance

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The Saskatchewan doctor's strike and nurses

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Jack Layton: R.I.P.

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Canadian Medical Hall of Fame: Dr. Norman Bethune

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The Case for Medicare

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Public Voice for Medical Care Insurance, Issue #1

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Keep our Doctors Committees in the Saskatchewan medicare controversy

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UNISON calls for a halt to UK Health and Social Care Bill

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A Look at the Venezuelan Healthcare System

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P3s in Health Care

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From Tommy to Jack: A (Hallucinatory) Dream of Universal Health Care

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The 1960 Saskatchewan Election

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U.S. Healthcare: Why it’s so expensive

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Health Care: False Arguments, Class Arguments

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The UK's Health Industry Lobbying Tour

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The Saskatchewan Doctors Strike - CBC 1962

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Medicare's pageviews by country

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Bad medicine from advisory panel at CMA annual meeting

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Everything You Ever Wanted to Know about Health Care and Taxes

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All Things Being Equal

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Neat, Plausible, and Wrong: The Myth of Health Care Unsustainability

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Sustainable health care begins with the social determinants of health

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Lord Taylor reminisces on settling the Saskatchewan doctor's strike

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The Struggle for State Health Insurance

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Saskatchewan: $5 Health Plan

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About Canada: Health Care

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Edgar Benson stood up for medicare

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US healthcare, babies and the national debt: The real cost

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Tommy Douglas and the Future of Single Payer in the USA

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Life Before Medicare

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Medicare: Facts, Myths, Problems & Promise

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Tommy Douglas: Keeper of the Flame

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Michel Moore's Sicko: Watch full documentary here

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Pack the trunk of this health-care elephant

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The end of the NHS as we know it

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The World Health Organization's ranking of the world's health systems.

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Solutions Within Medicare

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Dying is no laughing matter

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Saskatchewan CCF Election Program, 1960

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Britain: The Health and Social Care Bill and the Negation of Democracy

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Why the US health industry wants to raise the Medicare eligibility ...

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Report makes the case for Phamacare

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The Public Voice for Medical Care Insurance, Issue #2

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Tea Party campaign manager died for lack of private health insurance

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International Health Workers for People Over Profit

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Parliament needs to address Canada’s drug problem

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Attack on New Zealand health system

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Prelude to a Strike

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Practicing Revolutionary Medicine in Cuba and Venezuela

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U.S. Health Insurance Cost Rises Sharply, Study Finds

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The threat to health care from a ‘grey tsunami’ is a myth

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Improving Saskatchewan Health Care

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60 UK hospitals facing closure due to PFI debt

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Former Albertan doctor with public and private system experience fa...

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T.C. Douglas' December 1959 Speech

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Saskatchewan Doctor's Strike settled - Time magazine 1962

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The Coming Battle: Healthcare Privatization and the Ontario Election

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Lifespan shorter in USA than other developed countries

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Leftwords: Defending Public Healthcare

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The state of single payer in the states: Saskatchewan a model

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The Future of Medicare by Tommy Douglas

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Healthcare-NOW! Supports Occupy Wall St. Movement

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Careworker testimonies: the privatised future of the NHS

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Tommy Douglas on Future of Medicare (1983)

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Tell Canada to "Show Up" for health

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Introduction to “Sick and Sicker”

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Canadian Government "missing in action" at global health meeting

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The death panels are already here

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Happy Birthday Tommy Douglas!

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Tommy Douglas Remembered- CBC

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Why Healthcare Reform Matters to Occupy Wall Street

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Pay attention, because medicare is about to change

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The subtle contours of the new medicare debate

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2014 Health Care Accord action preparations

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Health as if everybody counted blog

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Federal health funding promise ends - for now

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The health-care sky is not falling !

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National Health Insurance vs. Public Health Insurance - 1953

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Why Canadians Should Fear Two-Tier

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Health care activists gather in Halifax for meeting of health minis...

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New Nanos Poll: Canadians want more federal investment in health care

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How Sustainable is Medicare?

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Support for public health care soars

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Arguments for state medicine in Saskatchewan (1943)

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Advocates call for higher taxes to pay for health care

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The dangerous myths about medicare

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Medicare gets a rough ride in Regina (CBC 1962)

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2,550 bankruptcies filed daily in US because of unpaid medical bills

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UK: The abolition of the NHS. That’s what is happening.

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Tommy's Heirloom: A backgrounder and screenplay

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Medicare turns 30

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Romanow fears 'patchwork-quilt Canada' health care

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Health Care Poll Results

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Canada’s never-ending medicare fight

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More Canadian public health coverage needed: Romanow

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The Canadian Health Act

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Fighting to Build Health Care

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Health care not a ‘commodity’

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Swift Current Led the Way in Saskatchewan

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Health care, E.I. dominate Atlantic premiers conference

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The Nerve! Saskatchewan private clinic director resigns

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Videos: Secure the Future of Medicare

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Bungled trade deal will hurt health care system

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Canada’s health care system is affordable

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History of Health: Why is it important?

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World Youth Study Medicine in Cuba

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The Problem with Profit-Driven Health Care

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Saskatchewan's Health Services Planning Commission, 1944–50

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'Sicker' Canadians most in need of health care, but cost a barrier ...

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Romanow’s 50-year fight for medicare

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Universal health care: If Cuba can do it, why can’t the USA?

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Let there be no blackout of health

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US Doctors Support OWS Because Wall Street Is Occupying Health Care

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Stats make U.S.-style health care a tough sell

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Commissioner on public service reform recommends nationwide privat...

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How poor nations prop up Canadian health care

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Finance Ministers Debate Health Care

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Fraser Institute report on wait times flawed

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Dr. Norman Bethune documentary

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Harper government attacks public health care

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Why the Harper funding diktat endangers medicare

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Passive-aggressive Tories tackle health funding

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Saskatchewan's Medical Care Insurance Act 1961

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Bad medicine: Harper's prescription for privatization Medicare

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The Thompson Committee (1960–62) and Saskatchewan Medicare

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Four comments on Harper's attack on health care

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Health Minister’s ‘what would Tommy do?’ rationale misses mark

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Saskatchewan's municipal doctors: A forerunner of the medicare syst...

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Saskatoon Community Clinic celebrates 50 years of medicare

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Meet the new 1%: healthcare CEOs replace bankers as America's best ...

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Unsung Heroes of Health Care Show: CBC Radio

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Doctor: Health care can survive baby boomer 'tsunami'

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Preserve Medicare

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Health care belongs to all Canadians

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Medicare in Saskatchewan: A nation building event

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The assault on universalism: how to destroy the welfare state

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Medical bills cause 62 percent of American bankruptcies

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Your Right to Health : Saskatchewan CCF (1960)

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Tommy Douglas on YouTube

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Harper's hands-off stance a threat to health-care system, unity: Ro...

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Crisis in care: Ontario pioneers the privatization of long-term care

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Ottawa needs to fix medicare

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Harper's Health Transfer Plan Offloads Costs to Provinces: Budget O...

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Health Care Accord: Provinces must take the lead

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Labour calls for Premiers to stand up for healthcare

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Why medicare needs Ottawa

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Romania rebels as health care threatened

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Harper’s plan would kill medicare in Canada

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A prescription for health care reform: think integration & coll...

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Canadians want feds to play strong role in health care: poll

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Many struggle to pay for prescriptions

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On the outside looking in: Indigenous peoples excluded from premier...

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The future of Canada's health care at stake: Maude Barlow warns of ...

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Will any government stand up for medicare?

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Harper’s health scheme will mean ‘Goin’ Down the Road’ for Maritimers

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Secure the Future of Medicare: A Call to Care

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Private delivery of public health a serious threat

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Harper’s health care agenda driven by ‘theory and politics

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The Struggle for Healthcare in Historical and International Context

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Informative and compelling online history of medicare

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The premiers want more health-care study? Seriously?

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Saskatchewan's medicare struggle begins...1962

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Privatization works! More Americans lack health insurance

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We should honour Tommy Douglas’ vision

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Canadian Health Care: Privatization and Gendered Labour

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Is this the end of Canadian medicare?

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Tanzanian doctors strike, civil society protests

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Harper Sticks Provinces With Take-it-or-Leave-it Health Care Approach

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Saskatchewan doctor's strike resolved, July 23 1962

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Video: The Saskatchewan Doctor's Strike of 1962

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U.S. citizens deserve better health care

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Canada’s threatened health care system

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Drummond: More Mike Harris than Mike Harris

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The Year We Became Us: A Novel About the Saskatchewan Doctors Strike

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Drumming Up a Healthcare Crisis: The Drummond Report’s Implications...

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Italy’s healthcare crisis

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UK: An end to Bevan’s dream of free healthcare for all Britons?

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Three Weeks in July: The Response of the Press to the 1962 Doctors’...

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Political Cartoonists Respond to Medicare

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Mending Medicare

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Medicare at 50: A Public Forum in Saskatoon

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Same fight, new foes

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Canadian national healthcare’s big benefit

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The Battle for the NHS

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The College of Medicine and the “Doctors’ Strike”

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The Politics of Canada's Health Care System

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It was struggle that created medicare

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Our History and the Struggle for Medicare

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"A rich man's tuberculosis"

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The Check-Off: A precursor of medicare in Canada?

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CBC Archives: The 1960 Saskatchewan election

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Bolivia Prescribes Solidarity

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Woodrow S. Lloyd

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Treating Sick Rich Folks in America

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USA: The Struggle for Universal Health Care

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“Keep Our Doctors” Committees

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The Lessons of Chile

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Quebec’s Health tax needs to be cancelled in this month’s budget

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Health Care Failure: The Occupied Palestinian Territories

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Saskatchewan NDP sponsors 50th anniversary dinner

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The Romanow Report

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CUPE Saskatchewan organizes 50th anniversary coalition

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Engels and the WHO Report

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The Saskatchewan Hospital Services Insurance Plan

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The Saskatchewan Farmer-Labor Party

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USA: Average Annual Health Care Premiums for Single and Family Cove...

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Spur provinces to be innovation incubators

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Medical Care in the Dust Bowl

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July 2012 marks the 50th anniversary of medicare in Saskatchewan Wednesday, July 20, 2011

Saskatchewan led the way for medicare in Canada when it passed the Saskatchewan Medical Care Insurance Act on November 17, 1961, and after two delays became effective on July 1, 1962. This blog will be posting articles and information on the historic battle that was fought in Saskatchewan to implement medicare. In particular, this blog will be focusing on the "friends and foes" of medicare...the forces that fought for it and those vested interests that opposed it. Posts on medicare battles and privatization today will connect old fights with new ones but still the same foes. Please contact NYC at redougie@gmail.com if you have contributions to make to the blog. - Next Year Country

Medicare: A People's Issue Wednesday, July 20, 2011 Next Year Country One of the best websites for information on the struggle for medicare in Saskatchewan is the Saskatchewan Council of Archives and Archivists website "Medicare: A People's Issue". It is best viewed with Internet Explorer as some tabs don't work well in other browsers.

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Link to site HERE.

The Struggle to Implement Medicare Wednesday, July 20, 2011 BY ALLAN BLAKENEY Witnesses to Medicare in Saskatchewan: Medicare Workshop at the University of Saskatchewan — Wednesday, 20 May 2007

Allan Blakeney reminisces on the public relations battle launched by the Saskatchewan College of Physicians and Surgeons, and fuelled by most local media, when the Cooperative Commonwealth Federation (CCF) government passed legislation in 1961 to deliver on their election promise of a province-wide single-payer medical care insurance plan, the provincial forerunner of Medicare in Canada. Blakeney details the major events leading to the doctors’ strike and recalls the role of some major players on both sides of the conflict. Blakeney highlights strategies conceived by the CCF to cope with the potential and realized eventualities of the doctors’ strike. 16

Medicare's 50th Anniversary


The Saskatchewan provincial election of 1960 was fought on the issue of introduction of a single-payer type of medical care insurance in Saskatchewan. It was a bitterly fought campaign, the most bitter that I have experienced in my eight campaigns, and in three or four other election campaigns when I was not a candidate, but which I followed with interest. What made it so hotly contested was the intervention of the organized medical profession. Operating under the name of the College of Physicians and Surgeons, they spent more money on electronic and print media than any political party. Their campaign was aimed against the Co-operative Commonwealth Federation (CCF) government of Saskatchewan. Following the election victory of the CCF in 1960 and the report by the Thompson Committee appointed to examine the proposal, the Medical Care Insurance Act was introduced and passed in 1961 and implemented in 1962. The opposition voted in favour of the bill on second reading— the decision in principle. The Act provided for the plan to be administered by a Medical Care Insurance Commission (MCIC). We were unclear how the medical profession would react to the legislation. I felt that the election had been fought on virtually a single issue. The electoral system had elected a government. The government had done what it had said it would do. And that the profession should be willing to accept the will of the voters and not take the position that the law did not apply to their profession, however distinguished. I was clearly naïve. The first sign of trouble was that the College of Physicians and Surgeons [the College] declared that it would not appoint any members to the Commission. Appearing before the federal royal commission—the Hall Commission—the College said that their members would not practise under the plan but would continue to serve their patients. I will not try to deal with all the twists and turns during the first few months of 1962. I’m not sure we fully understand the College’s strategy. One possibility was that they would continue to practise, send bills to patients and urge them to send the bills to the government. This would mean that either the government would pay any amount physicians billed or alternatively that the patients would receive only partial recovery depending upon the amount billed. Either result would have destroyed any single-payer concept of Medicare. To counter this strategy, we enacted legislation in April to give the Medical Care Insurance Commission the power to negotiate with members of the College on behalf of patients on the value of the services rendered. This is perfectly standard practice. If your car is involved in a collision, you take the car to an auto body shop and, at least in Saskatchewan, SGI (Saskatchewan Government Insurance)—the insurer—does the bargaining with the auto body shop. If a workman is injured, he goes to a doctor and the Workers Compensation Board—the insurer—does the bargaining with the doctor about his fees. The same was true for medical services provided to medical indigents. The legislation made clear that the same rules would apply to the Medical Care Insurance Commission in its role as an insurer. The College responded with a mass rally timed to coincide with the resignation of one of our cabinet colleagues—Walter Erb. It was a pep rally to solidify support for a doctors’ strike. This was in early May. Alarm was growing among the public fed by an unbelievable scare campaign run by the media, particularly the Regina Leader Post, the Saskatoon Star Phoenix and most of the weeklies.1 We began to prepare in earnest for a strike. The Cabinet divided its duties. Medicare's 50th Anniversary

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Premier Woodrow Lloyd was leading the team; Minister of Health Bill Davies and the MCIC were planning to maintain medical services. My job was to help Woodrow meet the countless delegations, later to take the many press conferences, and to devise strategies to ward off possible legal attack. Other cabinet ministers had other duties. Maintaining medical services included lining up as many British doctors as we could who would come to Saskatchewan if there was a strike. A fair number signed up in response to our ads in the British medical journal Lancet, and were interviewed by the Saskatchewan Agent General in London—Graham Spry—an under-appreciated great Canadian in many ways. A Saskatoon alderman, the late George Taylor, in his capacity as a member of the MCIC, went to London and helped with this work. The reason for the push for British doctors was that, in theory at least, they had a legal right to practices in Saskatchewan on showing simply that they were qualified to practise in Britain, whereas, in the case of US doctors, the College had the right to check their training and credentials. We felt that if we had recruited senior doctors from the Mayo clinic in Rochester, Minnesota or from Johns Hopkins in Baltimore, it would have taken the College many weeks to determine that they were qualified to practice in Saskatchewan. Nonetheless, we had a Plan B. If there was a near complete walkout, we lined up doctors from the Auto Workers medical plan in Detroit and the Steel Workers plan in Pittsburgh who would come. If there was a total break down, we felt that nobody would be quibbling about whether the College had found them to be qualified. Fortunately, that did not prove to be necessary. We tried to plan for the eventuality of the Lieutenant Governor dismissing the government and calling an election on his own. That would have been completely unconstitutional but we were not sure that the Lieutenant Governor knew his constitutional role. This was the same Lieutenant Governor who in 1962 would not sign a bill because he didn’t like its contents—he felt it was unfair to oil companies. And without any instructions from Ottawa, he reserved it for consideration by the federal Cabinet. This had never been done in any province in Canada before or since. Even with instruction from Ottawa, it had not been done for decades. We tried to plan for what would happen if an application was made to a court to have the Medical Insurance Act declared unconstitutional. There were absolutely no grounds for this, but with one or two of the judges, that might not have mattered. It would have taken us weeks to overturn a rogue decision. I devised a plan where we would pass an orderincouncil under other existing legislation to provide another legal basis for the plan. That approach might have been open to legal question but it would have taken time to attack and the strategy would have bought us time. Meanwhile, we were losing the war of public opinion. As a measure of this, I cite that when T. C. Douglas ran in the federal election of June 1962 in Regina city, which was a C.C.F. stronghold, he received just 29% of the vote. This was certainly not encouraging. July 1 dawned bright and clear. And most doctors’ offices were closed. They stayed closed. Public concern mounted. It was clear that we had a full-blown strike on our hands with a skeletal emergency service in a few major hospitals involving about 125 of the 1000 or so doctors who normally served patients. The provincial press began publishing horror stories. 18

Medicare's 50th Anniversary


It was a very tough few days. But then, British doctors began to come in—a good trickle of them. A nice problem for the College. They dragged their feet a little. But with the papers predicting doom, it was not easy to delay the licensing of these professionally and legally qualified doctors for long. In order to give the British doctors a venue for practice, community clinics were organized in Prince Albert—that is a story of its own—in Saskatoon, in Regina, and in other locations. Several survive today. And another thing happened. Reporters streamed in from all over the world. A doctor’s strike was news. There were reporters from the Canadian dailies, from the New York Times, the Washington Post, the London Times and many other papers. And about a week into the strike they began reporting on the two strikes that were going on—the one that the reporters were seeing and reporting on, and the other strike which was being reported by the Leader Post and the Star Phoenix. The Winnipeg Tribune, bless them, about a week into the strike, ran an editorial on how badly the Leader and the Star were reporting the strike. The Leader responded that these reporters from outside didn’t understand the issues and therefore couldn’t do a good job of reporting. For the Regina Leader-Post—hardly a world leader in journalism, then or now—to opine that the specialized health reporters of the New York Times, or the London Times or the Washington Post could not do a proper job on reporting was not a promising line of argument. Under the withering scrutiny of the world press, the Leader-Post and the Saskatoon Star-Phoenix had to amend their reporting and give at least some regard for the facts as observed by some of the world’s best medical reporters. Premier Lloyd had two press conferences a day with 50—60—70 reporters at each—more than I’ve ever seen before or since at a provincial press conference. Woodrow also had other things to do—he was out of the province for over two days without the press finding out— that’s a great little story. I took many of the press conferences in my role as the government’s legal joe-boy. It was fun. The tone of reporting began to shift from the day-to-day events to the propriety, or otherwise, of doctors going on strike. Gradually the tide began to turn. I feel that the tipping point was the rally organized by the Keep Our Doctors Committee— the KOD—in front of the legislature building on 11 July. It drew 4500-5000 people—not the predicted 20,000. The rally speakers were using a public address system hooked to the legislative building and operated by the Wascana Centre Authority. If necessary we could have cut off the PA system. Just before the KOD rally, Father Athol Murray had given one of his fiery and intemperate speeches in Saskatoon to a large audience. It was widely reported. The line that got lots of electronic coverage went something like this: “If the government doesn’t withdraw this Act—the Medical Care Insurance Act—there will be blood running in the streets—and God help us if it doesn’t.” Now this is pretty strong stuff from a clergyman at a public meeting in tense times. And I think it was too strong for many of the opponents of the Act. And I think it affected the turnout at the KOD rally. I felt we should have sent Father Murray a Friends of Medicare Medal. You know the rest. Rural doctors began to trickle back to their offices and serving patients. The community clinics were thriving—and on 17 July—the College, as I term it, sued for peace.

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Enter Stephen, Lord Taylor, who appointed himself as mediator and hammered out a compromise—the Saskatoon Agreement. It was certainly not what the College wanted. They conceded the key point—single-payer medical care insurance. It did not contain everything the government would have wanted—easier methods of transition to other modes of practice. But it brought peace. It brought relief to a stressed population and it brought Medicare to Saskatchewan and soon to Canada. It’s our job to take the next steps forward.

My Experience in the Medicare Battle and the Woods Commission Wednesday, July 20, 2011 BY ROY ROMANOW CBMH/BCHM / Volume 26:2 2009 / p. 538-541

In the 1960-62 period of the Medicare debate, I was still a student at the College of Law at the University of Saskatchewan. Like the province as a whole, the campus community was sharply divided over Medicare. Some of the divisions sprang from pure political forces of difference; others feared change from the known to the unknown; and still others, favoured choice and competition over public payment and delivery of healthcare (a political, but also a philosophical divide). When Premier Tommy Douglas came to campus during this period to explain and defend his policy, the meeting room—at the upper level of the student union building– was overflowing down the stairwell and to the lower floors. By that time, I had already decided I would support the CCF, and Medicare reflected an important aspect of the party’s political philosophy. As I chaired that raucous meeting, my convictions were not so strong as to be apprehensive about the student reactions—pushed by all the reasons I’ve stated and inflamed by fear engendered by the statements of the doctors, the Liberal party and the KOD. Sometime in the summer of 1962, Don Woloshyn, a student friend, and I travelled to 20

Medicare's 50th Anniversary


Regina to see what we might do to assist the government and its supporters during the doctors’ strike, already in full bloom. My sojourn was brief—several days as I recollect it—but memorable. I had never been in an environment where anxieties, worries, anticipations were so elevated. The activities reflected the gravity of the situation and I was struck—I might even confess to fear—by the cleavages in the wider community. Maybe for this reason, I returned to Saskatoon—and anxiously watched the developments unfold. Later, I returned to Regina in summer of 1963 to work as a junior assistant in the Department of Health. By this time, the Saskatoon Agreement had ostensibly resolved the crisis—but, I was soon to learn that this “resolution” was only on the surface. The undercurrents were strong and swift moving, as those who opposed Medicare so vehemently persisted to undermine it and the government. One major undercurrent was the issue of hospital privileges and the College of Physicians and Surgeons’ recurring rulings that Medicare doctors—primarily recruited from the UK—were somehow not qualified to be granted hospital privileges. Of course, with no hospital privileges being granted (or, at least, very few), the community clinics, the people who formed them, and the doctors who joined them—the network of support for Medicare—would fade. I’m not certain why I was asked to serve as Assistant Secretary to Ed Wahn, secretary, of the Woods Royal Commission on Hospital Privileges. Premier Lloyd established this inquiry to determine precisely the reasons for so many rejections. But I was thrilled to join Ed as his assistant and share living accommodations in Regina. I was also honoured to be a member—however junior—of the team that made up the Woods Commission. Mervyn Woods, the Commission Chair, had been a professor at the University of Saskatchewan’s College of Law but was appointed to the Court of Appeal by the Diefenbaker government. I knew him as a law teacher. He was a gentleman in his demeanour; humorous in a dry and, sometimes, cutting way; he could recite poetry endlessly; and he was scrupulously honest. Ed Wahn had been an early proponent of Medicare and had been involved in the Saskatchewan government in the early planning. His was a sparkling mind, but unassuming. Although he suffered from a severe case of arthritis, the disease did not impair his tennis or his thought processes. The Commission’s legal counsel was Derril McLeod of Regina. Tenacious, tough, and articulate, Derril led the witnesses in examination. As a young law student, I was highly influenced by both McLeod and Woods. As assistant secretary, I did what Ed requested which was to assist in the file-keeping, recording-keeping, and note-taking. Occasionally, I read early drafts for the Commissioner’s final report. That was the unimportant work. The important work was shouting, when Woods walked into the hearing room—“Order, order, the Commissioner.” He wanted this degree of formality, although he once said to me—“Roy, next time you yell ‘order, order’ I’m going to respond—“Bacon and eggs.” Our hearings were in Saskatoon, Estevan, and Regina—all involving pro-Medicare doctors whose credentials to practice in hospitals were challenged by the College. In Medicare's 50th Anniversary

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almost every case, counsel for these pro-Medicare doctors was George Taylor of Saskatoon. Taylor was a longtime socialist. He advised Premier Lloyd on legal issues and was active in giving political advice to government. A veteran of the Spanish Civil War—on the side of the Mac Paps (as they were called), there was little that could intimidate him. His cross-examinations were relentless and withering. This, then, was my introduction to Medicare. I was supposed to be neutral but, in truth, deep down, I was not. I saw the College of Physicians and Surgeons of Saskatchewan as mixing its professional obligations with its political agenda, an agenda that unfortunately did not die with the signing of the Saskatoon Agreement. It is true that Woods essentially found the same thing. His key recommendation was to establish an appeals committee for the College’s decisions. Lloyd did so. The functions of the College were divided, essentially—one was professional assessment; the other was the establishment of the political arm, the Saskatchewan Medical Association (SMA). This remains the case, but after Lloyd’s defeat in 1964, the Appeal Tribunal was dismantled by the Liberal government under Premier Ross Thatcher. But what was not dismantled—although there were some questionable actions like user fees (by this time I was in Legislature in Opposition)—was Medicare. The medical establishment and their civil society supporters knew that the game was over—at least for a time. Many years later, in the years preceding and following my time as Chair of the Commission on the Future of Health Care in Canada Commissioner, I saw the opposition to Medicare arise again. The attacks on my Commission’s report by the anti-Medicare establishment; the election of Canadian Medical Association President, Dr. Brian Day—a long-time proponent of private, for-profit health and an owner/operator of the private Cambie Surgical Clinic in Vancouver; the Chaoulli Supreme Court decision—these are all signs that this great, redistributive program we call Medicare may not yet be safe. One lesson is clear to me: as difficult as it is to gain, progressive change, like Medicare, maintaining it may be even more difficult and challenging. The old arguments have a strange way of arising to, again, present themselves as the new.

Medicare posts from NYC Wednesday, July 20, 2011 Next Year Country Below are links to posts on medicare previously published on the NYC blog. Click on title to view.

Douglas bio also medicare history

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Dr. Harper’s New and Improved Medicare

Moving Medicare Forward

Henry E. Sigerist:: Architect for Saskatchewan Medicare

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Unsung Heroes in Saskatchewan's Struggle for Medicare

The Fateful Summer of '62

The struggle for medicare in Saskatchewan

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Health Accord in hands of unelected senate — Canada Health Coalition

Green Mountain Dreams

Tommy Douglas: Keeper of the Flame

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Saskatchewan CCF Election Program, 1960

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J. Wendell Macleod: Saskatchewan's Red Dean

Tea Party, Canada-Style!

Privilege and Policy: A History of Community Clinics in Saskatchewan Wednesday, July 20, 2011 By Stan Rands 1994

Open publication - Free publishing - More ccf

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Dianne Norton on US Healthcare Thursday, July 21, 2011 Dianne Norton (Dianne is the daughter of former Saskatchewan Premier Woodrow Lloyd) The Guardian 14 August 2009

Woodrow Lloyd In the summer of 1962 we awoke to find the word "Commie" scrawled in bright red paint across the front of our family home and my father, Woodrow Lloyd, branded a "murderer". His "sin" was to lead the Saskatchewan government, which was trying to introduce the first "socialised" health scheme in North America. How little has changed in 47 years. ('Evil and Orwellian' – America's right turns its fire on NHS, 12 August). While the medical establishment in Canada was quite capable of generating its own propaganda – doctors would strike (they did), leading to the necessity of importing medics branded by one newspaper as "the garbage of Europe" – it was aided and 28

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abetted by professional bodies from south of the border, which financially backed the anti brigade as well as distributing leaflets designed to terrify the populace. The government would use its powers, they claimed, to legalise abortion and mercy killing, and everyone would have to no choice but to accept the doctor allocated to them by the government. Doctors insisted that, under the plan, government would control all aspects of their practices and no doctor would be allowed to practise outside the plan – all untrue. Women were particularly targeted with stories about threats to their unborn children not dissimilar to Sarah Palin's vision of "death panels". Families and communities throughout the province were riven apart as people took sides with a bitterness that lingered on for years. Two-thirds of the province's doctors declared their intention to strike on 1 July, but help was at hand in the form of scores of British doctors, who flew in and began establishing community clinics, with the help of supportive locals, in towns and cities throughout the province.The final act was conducted by the eccentric and determined Lord Stephen Taylor, a member of the British Labour party, who had earned his peerage for the vital role he had played in the design and implementation of the UK's National Health Service. Taylor hammered out a settlement between the doctors and the government that was to lay the cornerstone of "socialised" medicine throughout Canada. Within a very few years, every province in Canada benefited from its own brand of Medicare. Ask any Canadian what makes them different from Americans and they will cite with pride our Medicare system. The wedge that the American medical establishment so feared was well and truly driven into the continent that summer. It's sincerely to be hoped that President Obama can follow where Saskatchewan led.

Canada: Doctors on Strike, TIME magazine retro Thursday, July 21, 2011 Time magazine Friday, Jul. 13, 1962

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Some strikes no one wins, and a doctors' strike is plainly one of them. Last week, refusing to practice under a socialized medical insurance plan enacted by the Saskatchewan legislature, two-thirds of the province's 900 doctors locked up their offices and went off on vacation. Rather than bow to the government, the doctors gave free emergency care at 34 hospitals —but left behind only one practicing physician for every 3,000 citizens. The shock of not having the family doctor at the other end of the telephone was abruptly brought home on the first day of the strike. When Mrs. Vicky Derhousoff put her ninemonth-old son Carl to bed in their home at Usherville, he was running a fever. Next morning the fever was higher. Peter Derhousoff tried to phone the doctors in nearby Preeceville, was told that both were on vacation. A nurse at the Preeceville Hospital told him to take the baby to Yorkton, 91 miles away. On the road, says Derhousoff, "I began to realize it was a race with death." Three miles from Yorkton, the baby went limp in his mother's arms. Derhousoff tried mouth-to-mouth breathing, but the baby was dead on arrival at the hospital. No one could say that the baby could have been saved had there been a doctor; a preliminary report showed he had meningitis of a virulent sort. But that did not ease the parents' anguish. "I blame the government," said Mrs. Derhousoff. Just Like War. Across Saskatchewan, 79 hospitals were left without doctors, and closed for all but first aid during the first two days of the strike. Typical was Nokomis Union Hospital, where patients were told they would have to be discharged. A housewife, Mrs. Al Nagy, found the scene "just like a war. People were standing in groups on all the street corners, talking about it, trying to think of something they could do." The Saskatchewan plan to which the doctors objected was fathered by former Premier T. C. ("Tommy") Douglas, who, as leader of Canada's only Socialist provincial government for 17 years until last year, pioneered the continent's most far-reaching public health services. In 1946, Douglas inaugurated medical care for 50,000 of Saskatchewan's 925,000 people. The following year, the Douglas government launched Canada's first province-wide hospital insurance plan. The new medicare act is the capstone of Douglas' planning. A country cousin of Britain's NHS, it provides province-wide compulsory insurance covering payments for all medical, surgical and specialist treatment. Unlike the British plan, it does not cover dentistry, glasses or drugs. The cost, $22 million a year, is to be met by annual premiums ($12 for single people, $24 for families), and by increasing sales and income taxes. The act set up a commission, appointed by the government, and gave it the right to prescribe "the terms and conditions on which physicians and other persons may provide insured services for beneficiaries." The act required that all doctors conform to the plan, accept a schedule of fees fixed by the government, and not engage in any private practice on the side. Doctors United. Saskatchewan's College of Physicians and Surgeons denounced the plan as "peacetime conscription," saw in the act "an ingenuous method of controlling doctors and the practice of medicine in a political, economic and legislative sense." So fiercely did they oppose the plan that when Douglas resigned to lead Canada's New Democratic Party last November, his successor, Premier Woodrow Stanley Lloyd, postponed its scheduled start, offered to tone down the administrative commission's 30

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powers, and to allow doctors to practice outside the plan. The doctors found the act still "unacceptable." In the U.S., Dr. J. Bruce Henriksen, who is leading a group of New Jersey doctors against President Kennedy's medicare, applauded the prairie doctors' "fine example." But in both Canada and the U.S., many questioned the doctors' tactics. In Boston, Dr. Richard Ford, associate clinical professor of legal medicine at Harvard, volunteered to fly to Saskatchewan to investigate any deaths "that may be related to professional negligence by delinquent physicians." Dr. Gerhard . T. Beck, 53, left his yacht in Jacksonville, Fla., and flew to Regina to help, declaring: "It is not our professional prerogative to desert our patients." In the strike's first six days, the doctors and government communicated mainly by trading angry press communiques. Dr. Harold Dalgleish, president of the Saskatchewan College of Physicians and Surgeons, demanded that the act "be withdrawn while doctors are still available who are not fully committed to leave Saskatchewan." But at week's end the doctors had not softened their tone, nor had Premier Lloyd. Said the premier: "This is no longer just a matter of medical care service. It is now an outright challenge to the procedures of constitutional government. If one can envisage this spreading to other groups, then one has a situation of anarchy."

Find this article at: http://www.time.com/time/magazine/article/0,9171,827403,00.html

The Saskatchewan Doctor's Strike, 1962 Thursday, July 21, 2011 By Gregory P. Marchildon Encyclopedia of Saskatchewan

In July 1962, doctors in Saskatchewan began a province-wide general strike that marked the peak of a conflict between organized medicine and its allies against the government’s Medicare bill. One of the great crucibles of provincial history, the issues surrounding the strike divided communities and even families. Since it led a national debate on the merits of universal health insurance, interest in the strike went far beyond the province, and for three weeks national and foreign media focused on the strike in Saskatchewan. The origins of the strike lay in Premier T.C. Douglas’ promise, in a by-election speech in Medicare's 50th Anniversary

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Birch Hills, Saskatchewan, in April 1959, to introduce a pre-paid, universal and publicly managed system of primary physician care. Commonly known as “medicare,” this initiative was to complement universal hospital insurance introduced the decade before with the support of most doctors. In the 1950s, however, organized medicine in Saskatchewan became more opposed to universality. A new generation of more ideologically conservative doctors, some of whom were refugees from the National Health Service in Britain, along with a successful foray by organized medicine into the health insurance business (which the doctors wished to extend provincewide), translated into a strong opposition to any extension of universal Health Care coverage. In an effort to mitigate physician opposition to medicare, Douglas established in April 1960 an Advisory Planning Committee on Medical Care with nominees from organized medicine, government, business and Labour under the chairmanship of Walter P. Thompson. Delaying its establishment and then delaying its ultimate report, the nominees of the College of Physicians and Surgeons bought time for more organized opposition to the government. The medicare bill was introduced just before Douglas left the premiership to become leader of the federal New Democratic Party. It was left to his successor, Woodrow Lloyd, to implement the bill by April 1962. In March, however, Lloyd decided to extend the deadline to July in a last-ditch effort to find a compromise with the province’s physicians. However, the delay, along with the sharp drop in electoral support for the NDP in Saskatchewan in the federal election of June 18, simply served to strengthen the hand of the more militant doctors who concluded that the government would eventually back down. Threatening to leave the province if the bill was implemented, they helped establish numerous “Keep our Doctors” (KOD) committees throughout the province.

Despite the defection of his own ex-minister of Health to the Liberals in May and a threatened general strike by physicians, the Lloyd government proceeded with implementation on the July 1 deadline. The same day, the physicians began a strike which would last twenty-three days. Its high point was a demonstration in front of the Saskatchewan legislature in Regina on July 11 that attracted about 4,000 people, about one-tenth the number hoped for by the organizers. The strike officially ended twelve days later when Lord Stephen Taylor of the United Kingdom earned the trust of both sides and mediated what became known as the “Saskatoon Agreement.” This compromise ultimately set the terms for medicare in Saskatchewan (and Canada) by ensuring physician autonomy and fee-for-service remuneration in exchange for the provision of publicly administered, universal physician services for all residents.

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"The First Fight for Medicare" - SFL Thursday, July 21, 2011 Next Year Country Below is a short booklet published by the Saskatchewan Federation of Labour following the historic battle for medicare in Saskatchewan. It summarizes the events of 1962 and was distributed throughout Canada and internationally. The labour movement was aware of the historic importance of this accomplishment and wanted to share its lessons with the broader labour and social movements.

Open publication - Free publishing - More ccf

The Hospital Employees’ Union Strike and the Privatization of Medicare Thursday, July 21, 2011 By Benjamin Isitt and Melissa Moroz International Labor and Working-Class History, 71 (Spring 2007)

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In April 2004, the Hospital Employees’ Union (HEU) waged an illegal strike that mobilized sections of British Columbia’s working class to the brink of a general sympathetic strike. Influenced by BC’s class-polarized political culture and HEU’s distinct history, the 2004 strike represents a key moment of working-class resistance to neoliberal privatization. HEU was targeted by the BC Liberal government because it represented a bastion of militant, independent unionism in a jurisdiction that appeared overripe (from the neoliberal standpoint) for a curtailment of worker rights and a retrenchment of publicsector employment. HEU also represented a direct barrier, in the language of its collective agreements and collective power of its membership, to the privatization of health services and dismantling of Medicare. The militant agency of HEU members, combined with anger generated by a constellation of social-service cutbacks, inspired rank-and-file workers and several unions to defy collective agreements and embrace sympathetic strike action. This revealed differentiation in the strategy and tactics of BC’s labor leadership, and enduring sources of solidarity in labor’s ranks. Read HERE (0.1 MB PDF)

Woodrow Lloyd and Medicare Thursday, July 21, 2011 Making Medicine A History of Health Care in Canada

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Woodrow Lloyd and Tommy Douglas Born in Webb, Saskatchewan, Woodrow Stanley Lloyd (1913–1972) was a teacher and politician who succeeded Tommy Douglas as Premier of Saskatchewan in 1961. Lloyd began his teaching career in 1933, became active in the Saskatchewan Teachers’ Federation and was its President from 1941 to 1944. In 1944, Lloyd successfully ran for the provincial Co-operative Commonwealth Federation (CCF) in Biggar, Saskatchewan, the constituency that he would represent until his retirement in 1971. Premier Douglas appointed Lloyd as Minister of Education, making him the youngest Cabinet minister in Saskatchewan’s history. In this post, Lloyd successfully amalgamated over 5,000 school boards into 56 Larger School Units, giving students access to better facilities and specialized teaching. In 1960, Douglas appointed him as Provincial Treasurer. As Douglas’s successor, Lloyd implemented Saskatchewan’s medical care insurance plan in 1962, despite opposition from the medical profession, other provincial parties and “Keep Our Doctors” Committees. Although the doctors went on strike on July 1, 1962, Lloyd’s commitment to medicare and to resolving the dispute with dignity was successful and the plan was implemented. Lloyd’s resolution of the Saskatchewan doctors’ strike showed the rest of Canada that publicly funded, accessible medical services could not be blocked by the private goals of the medical profession.

Sustainability of Health Care: Myths and Facts Thursday, July 21, 2011 Canadian Health Coalition Medicare Privatization “Opponents of Medicare claim that public health care is ‘Fiscally Unsustainable’ and that the only viable solution is a shift to more private coverage. Bluntly, this is a lie.” -— Robert G. Evans, O.C., Ph.D. (Economics) Harvard

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By the Numbers 4% to 5% MEDICARE SPENDING - FOR HOSPITALS AND DOCTORS SERVICES - AS A % OF GDP FROM 1975 TO 2010. 15% AVERAGE ANNUAL INCREASES IN PRIVATE DRUG PLAN COSTS. 170.8 Billion Dollars AMOUNT REMOVED FROM PUBLIC SECTOR REVENUES BY GOVERNMENT TAX CUTS BETWEEN 1997 AND 2004. Public health care is sustainable The facts show that public health care is sustainable, and that the real driver of increases in health care spending comes from private health services not covered by Medicare, and from inappropriate use of expensive services. An “adult debate” on the sustainability of public health care must start from who and what drives health care spending. As Canadians, we value our public health care system. In fact, a recent poll showed that almost 90% of Canadians support public solutions to problems in the health care system and that health care is the most important national issue. In the words of Roy Romanow: “Medicare is as sustainable as we want it to be.”

The Myth: Our aging population will make health care unaffordable. The Facts: Private health care services, not an aging population, are driving health care spending. Population aging is a very small factor in increasing health care costs at 0.8% per year, less than other factors such as population growth (1%) and inflation (2.5%). There is also an increasing use of prescription drugs, medical imaging and other new and expensive medical technology, often in inappropriate ways. The real issue is the intensity and costliness of medical interventions, and the questions to ask are: ‘Where is the money going?’ and ‘Are we getting value for our money?’. The key cost drivers in health care services are the private, for-profit parts – pharmaceuticals, dental, diagnostic tests and other non-insured services. If one is concerned about rising costs, an aging population is not a reason to privatize the delivery of services.

The Myth: The cost of health care is eating up all the provincial budgets and crowding out other services. The Facts: Medicare spending takes up about the same share of provincial revenues as it did 20 years ago. It’s true that health care spending has taken an increasingly greater percentage of provincial health care budgets in recent years. But the reason is not uncontrolled health care spending; it is the result of a drop in provincial revenues created by large tax cuts over the years and cuts to other program spending.

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Medicare spending takes up about the same share of provincial revenue as it did 20 years ago. However, between 1997 and 2004, cuts in personal and corporate income taxes removed about $170.8 billion from public sector revenues at the federal and provincial levels. These cuts, combined with federal government cuts in financial transfers to the provinces, left provincial budgets hard-strapped. As a result, other nonhealth care programs were cut, making it appear that the share of the budget for health care was increasing. The problem is the drop in revenues in provincial budgets, not uncontrolled health care spending.

The Myth: Public health care spending is skyrocketing and out of control. The Facts: Public health care spending is stable. Spending on private health care is driving cost increases. From 1975 to 2009, Medicare spending - hospitals and doctors’ services - has remained remarkably stable at between 4% and 5% of our Gross Domestic Product. Total health care spending - which includes private spending on services not covered by Medicare (e.g. prescription drugs, dental, home care…) – is rising at a higher rate and is currently at 12% of GDP.

Clearly a public, single-payer system is an excellent way of controlling health care costs. And what is needed is more single-payer public insurance and less private insurance. A good place to start is with a universal public drug plan to replace the inefficient, inequitable and expensive patchwork of private drug plans. Not only is Canada’s public health care spending not ‘skyrocketing’, Canada’s public expenditures on health care are below the OECD average. The public share of overall health care costs in Canada is 70%. The OECD average is 73%.

The Myth: Privatization of health services will control health care costs. The Facts: Public health care is the best way to control health care spending. Privatization is not sustainable. Sustainability is often a code word for privatization and for-profit health care. Saying that public health care is unsustainable opens the door to privatization. Shifting from public to private spending shifts the cost burden from the wealthy to the sick. “Unsustainable” public spending is somehow magically sustainable when shifted from taxpayers to

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patients. Privatization is a way to avoid cost containment, and provides greater income opportunities for providers of care (and private insurers) outside public control. It is long past time, for an ‘adult conversation’ about the winners and losers from eroding or dismantling public health care in Canada. ….. About Robert G. Evans, O.C., Ph.D.: Robert G. Evans, O.C., Ph.D. (Economics, Harvard) is a member of UBC’s Centre for Health Services and Policy Research. He is an officer of the Order of Canada, and a fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences.

Working for Medicare Thursday, July 21, 2011 BY BETSY BURY CBMH/BCHM. Volume 26:2 2009

A long time promoter and political worker for Medicare realized that the first steps toward universal Medicare could be best met within the Community Clinics where Salaried Physicians worked in a team with other Health Professionals to look after the needs of the community.

I lived during the hungry thirties on a farm on the edge of the Dust Bowl. Being the seventh child in a family of ten, I learned the advantages and disadvantages of being poor. I joined the RCAF Women’s division when I became of age. I was able to go to the University of Guelph and graduate as a chef to serve in the air force for three years. During that time I became aware that there were no shortages of anything. Why did it take a war to make this happen? After the war, I came home to find the CCF under T. C. Douglas was the Government of Saskatchewan. Their policy was to improve conditions and to make medical care available to all regardless of their abilityto pay. I then spent three years in Wisconsin from 1950 to 1953. This was the period when Senator Joseph McCarthy accused any left supporter of being Communist. As a supporter of the CCF and Medicare, I was warned to say I was a liberal with a small L. 38

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When I returned home to Canada, I was pleased to become part of the enthusiastic workers for Tommy Douglas and the CCF. I worked in the party all through the 50s as Councillor and Vice-President, travelling to homes throughout the province. Everyone had a story to tell of a child, a parent, or a friend who had had a problem getting good medical care when needed. But many had already felt the benefits from the Hospital Plan after 1947. Political debates began to heat up when the legislation for Medicare was announced. A group of citizens decided to organize clinics as cooperatives where patients would be partners with the providers, with the objective being a comprehensive program and that the physicians would be paid on salary as part of the team. When the date of 1 July 1962, for the implementation of public medical care insurance was finally set … all hell broke loose. For example, women in their last stages of pregnancy were told their doctors were leaving the province and would be replaced by “the garbage of Europe.” People who supported the program were called Communists and received death threats. A local Priest stated that there would be blood flowing in the streets if the program was implemented. Families were divided out of fear and confusion. By this time, Tommy Douglas had left for federal politics, but I never had any doubt there would be a change of heart in the party under Premier Woodrow Lloyd. He brought a calmness and stability with such force, that those of us who were in the ranks speaking at kitchen table meetings had complete confidence that we would succeed. There was massive opposition by the profession to which he would comment, “We are doing things together for the benefit of all.” Although we were disappointed that all of our objectives were not met, when the strike ended, we were glad to have the first step toward universal care and went on working to reach that goal, thus the community clinics were set up as co-operatives to achieve it. Because there was intense community interest at the time, we were able to introduce a number of preventive health programs such as a weight loss club, an anti-smoking group, and a volunteer prenatal education class. This gave us hope that these programs would become a part of the universal health programs envisioned in 1962. A decade later, in 1972, we successfully renegotiated the method of payment from fee-for-service payment to individual doctors to a global clinic budget, and nutrition and foot care were added to our clinic programs. Now that the determinants of poor health are recognized as a component of universality, the big question for me is, will there be political will to move in that direction or will the stake holders continue to demand the status quo?

Swimming into Darkness Friday, July 22, 2011 Book Review: Swimming into Darkness by Gail Helgason, Coteau Books Reviewed by Jeffrey Canton Quill and Quire December 2001 issue

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It’s July 1962 and Thora Sigurdson isn’t enjoying being 13. She wants to be part of the in-crowd at West Beach, attaching herself to the popular Krywulak girls, but she doesn’t want to be disloyal to her bookish best friend, Gretchen McConnell. Further marring what should have been an idyllic summer is the Saskatchewan doctors’ strike, which is tearing apart the community. When one of the Krywulak girls loses her leg as a result of poor medical treatment, surface tensions explode and Thora finds herself caught up in a devastating tragedy. More than 20 years later, Thora, now an archeologist, finds herself grappling with the ghosts of that summer. Gail Helgason covers a great deal of ground in Swimming into Darkness, her first novel. The book not only explores the emotionally troubled waters of the doctors’ strike – when Saskatchewan doctors closed their offices to protest having to bill fees through the newly created Medical Care Insurance Commission, a precursor to the national Medicare system – but also delves into the rich history of the province’s Icelandic settlers. One of the novel’s subplots focuses on the life and times of an Icelandic-Canadian poet based in part on the real-life Stephan Stephansson. Moving fluidly back and forth between past and present, Helgason thoughtfully recreates the world of 13-year-old Thora. Helgason is particularly deft at mirroring teenagers’ muddled sense of themselves. Readers will likely be more impressed with Thora’s archeological work than with her involvement with poet Markus Olafsson. Helgason breezes over the connection between Thora and her poet – a story that could have been just as powerful as that of the doctors’ strike, minus the political complexity.

Video: The Saskatchewan Doctor's Strike, 1962 Friday, July 22, 2011 Next Year Country Canada's universal health care system was born in 1962 in Saskatchewan., but it was almost defeated before it began. Video includes archival footage. In two parts.

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The Guru and the Godfather: Henry Sigerist, Hugh MacLean, and the P... Saturday, July 23, 2011 BY JACALYN DUFFIN Hannah Professor of the History of Medicine, Queen's University, CBMH/IBCHM I Volume 9: 1992

Dr. Hugh MacLean In September 1944, Henry E. Sigerist (1891-1957), historian of medicine from Johns Hopkins University, conducted a survey of health services in Saskatchewan for Premier T. C. Douglas and his newly elected CCF government. His brief report became the basis for legislation that enacted Canada's first free hospitalization plan. The recommendations seem to have been prompted by Dr. Hugh MacLean (1871-1958), a relatively unknown surgeon who practised in Saskatchewan for over 30 years. MacLean had observed how the economic Depression resulted in inadequate medical care and he became an ardent supporter of "socialized medicine." Based on interviews with those who witnessed the events and on the personal papers of Sigerist and MacLean, this article explores the contributions of these two physicians to the Canadian health care system. Read article HERE (pdf).

Saskatoon: The birthplace of medicare Saturday, July 23, 2011 Saskatoon Community Clinic

Open publication - Free publishing - More ccf

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Moving Medicare Forward - A Health Care Message To Canadians Saturday, July 23, 2011 Wolf Sun Videos Health care experts send a message to Canadians and politicians about expanding Medicare for better health and lower costs.

The Roots of the Medicare Crisis Saturday, July 23, 2011 By Ken Collier Briarpatch magazine May 3, 2006

“Medicare’s history provides us with fertile ground upon which to consider opportunities for improving and expanding public health care.”

WHILE ALBERTA STAGES PROVOCATIONS aimed at privatizing at least part of medicare, the rest of Canada watches and wonders whether provincial programs elsewhere may meet a similar fate. Much argument is made about how to defend medicare, how to keep it public, how to cure ills such as long waiting times and uneven distribution of resources. This debate falls unevenly and haphazardly across the country, usually in response to some external event such as the Quebec Supreme Court rulings on timely access to treatment. In these circumstances, medicare could very easily become a casualty of the reactive, defensive nature of this debate. No political party has stepped forward to propose anything much beyond defending existing health programs. Merely defending public medicare, however, is a very limited (and limiting) goal. Medicare’s history provides us with fertile ground upon which to consider opportunities for improving and expanding public health care in bold and innovative ways. I attended the Saskatchewan Co-operative Commonwealth Federation (CCF) conventions in 1958, 1959 and 1960. Saskatchewan Hospitalization, the provincial plan 42

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that paid for hospitalization expenses largely out of general taxes, was introduced in 1949. The idea of medicare, which would cover the costs of physicians, kept recurring at these conventions as a natural addition to existing coverage. Each year resolutions to that effect passed resoundingly. Medicare was a central issue in the provincial election of 1960. Once the votes were in, the CCF government set to work planning how to institute the medicare program. In October 1961, at a special session of the legislature, medicare was introduced and passed, and formally began operation in July 1962, after some delays to accommodate administrative planning and organizing. During that delay, the Saskatchewan College of Physicians and Surgeons, which had opposed medicare in the form legislated, mounted an expensive campaign, partly orchestrated from outside the province, to stop the program. When they failed to do so, the College instructed its members to withdraw their services – the so-called Saskatchewan “doctors’ strike.” The history of that contest over medicare has been recorded elsewhere. Our current issues, however, arose from its resolution. Two weeks of “doctors’ strike” forced the CCF government, and the party, to make some difficult decisions. Some options hinged on a call to complete the “march toward comprehensive health insurance that will cover all our people and will insure a high standard of medical care to every citizen of Saskatchewan,” as promised by Premier Tommy Douglas in the legislature in 1960. Other aspects of the crisis hinged around electoral politics. Many CCF Members of the Legislative Assembly heard loud complaints from politically hostile or frightened constituents. By 1962, Douglas had moved into federal politics becoming leader of the CCF’s successor, the New Democratic Party. Also by that year, the CCF-cum-NDP was halfway through its term, and reelection was on the minds of most MLAs. Complexities also arose for MLAs who had relatives working in the health field, some of whom were doctors or others whose professional associations fought medicare. With Tommy Douglas gone to Ottawa, the new Premier, Woodrow Lloyd, led the government into the struggle over medicare, but the governing MLAs were not firmly behind the process. They largely wanted a way out of the conflict, though Lloyd and a few other cabinet ministers took strong positions to back medicare in the form they had promised during the election. After some further squirming, the wavering government members and the medical profession finally settled on a mediator: Lord Stephen Taylor, a British doctor with a background in helping set up the British National Health Service. On July 23, 1962, Lord Taylor announced the terms of the Saskatoon Agreement. Those of us who had organized in favour of medicare, waiting outside the Bessborough Hotel in Saskatoon as the negotiators emerged, were shocked to learn of the concessions given by the government. Many of the proposals for consultative bodies representing stakeholders in health services fields (including patients), whose aim was to maintain standards and prevent problems in medicare, were cancelled. The relevant professions, dominated by the College of Physicians and Surgeons, would resume their old ways of speaking on behalf of others with less power. Medicare provisions to uphold “quality of care” and gradual improvement of quality standards were cancelled. Government would be prevented from doing anything about quality issues that affected professional privileges, especially those of doctors.”…(T)he public agency responsible for disbursing enormous sums of money could make no Medicare's 50th Anniversary

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serious effort to guarantee that the money was well spent,” wrote Stan Rands, author of Privilege and Policy: A History of Community Clinics in Saskatchewan. The agreement also prevented the Medical Care Insurance Commission from making any regulations aimed at improving quality in the practice of medicine or health care in general. The medical profession would reassert its sole right to interpret its mandate. As a result, even before medicare was legislated, many of the hopes of pro-medicare forces in the CCF/NDP were quashed by party and government bureaucrats. Motions to include government support for healthy living, nutrition, early childhood development, prevention of disease and health hazards, healthy workplaces (and thus medicare’s relation to Occupational Health and Safety rules), health programs for women, community treatment of mental illness, and so forth, never made it into legislation, regulation, or even political party discussion papers. Additionally, research into nontraditional medicines and other methods of healing—-such as chiropractic, herbalist remedies, and acupuncture—-was proposed in many locales. But in the 1960s, these practices were controversial and normally overruled by the medical profession; the government signed away its right to encourage them. The Saskatoon Agreement provided the foundation for national medicare in Canada, and tragically, the bulwark against any improvement of it. Medicare wound up being little more than an insurance program to pay for health services, which are mostly about treatment for illnesses and injuries. Though medicare is government-run and operates under the five principles of the Canada Health Act (Public Administration, Comprehensiveness, Universality, Portability and Accessibility), these are the results of compromises that began in Saskatoon in July 1962. Many of the humanistic health concerns of progressive citizens who fought for medicare in the early years were suppressed by bureaucratic and administrative inertia, political weakness and compromise, and powerful, well-funded forces marshaled against them. Consequently, we have inherited a medicare system that was hobbled from the very start. “The Saskatoon Agreement provided the foundation for national medicare in Canada, and tragically, the bulwark against any improvement of it.” My own conclusion is that while the medicare we have is worth defending, we need to renew it from the roots up. The debates of the 1960s and earlier need to be infused with new energy and should be re-stated in light of medicare’s history. Medicare needs not only to be defended: it needs thorough re-working, re-thinking, updating and upgrading. New political organizations willing and able to carry the march toward comprehensive and high quality health programming, not just insurance, are needed.

Ken Collier taught Social Work at the University of Regina for 23 years, then moved to administrative roles at Athabasca University, from which he retired in 2005. He continues in progressive activism in Red Deer, Alberta.

The Road Not Taken Sunday, July 24, 2011 The 1945 Health Proposals and Physician Remuneration in Saskatchewan GORDON S. LAWSON 44

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CBMH/BCHM Volume 26:2 2009

Click image above to read leaflet The instrumental role of the Saskatchewan Cooperative Commonwealth Federation (CCF) government of 1944-64 in the development of Canadian Medicare has overshadowed the interpretations of many historians that the universal medical services plan introduced in Saskatchewan in 1962 was not what the CCF had intended when it first came to power in 1944. In his classic study of the Saskatchewan CCF, Seymour Martin Lipset states that the “party leaders originally envisaged a medical system in which all doctors would work on a salaried basis….” Frequently based on Lipset’s work, subsequent historical accounts of the establishment of Saskatchewan and Canadian Medicare often cite a Saskatchewan CCF commitment to a salaried medical service. The 1962 doctors’ strike has also overshadowed what existing historical accounts of the step-by-step development of Saskatchewan Medicare from 1944-62 indicate was a less dramatic, but equally formative, conflict concerning physician remuneration in 1945. In early 1945 the government’s Health Services Planning Commission (HSPC) devised a medical services plan for rural Saskatchewan that envisaged the expansion and development of the existing municipal doctor system into a salaried general practitioner service. Existing accounts maintain that Premier Thomas Clement (Tommy) Douglas (1904-1986) and his cabinet considered implementing the HSPC proposals despite the opposition of the College of Physicians and Surgeons of Saskatchewan (SCPS), but in negotiations during 1945 Douglas, in C. David Naylor’s words, “gave way” to the medical profession. This article seeks to determine why the Douglas government did not follow the HSPC 1945 recommendations for a salaried medical scheme. Read article HERE.

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Morbid Symptoms: Current Healthcare Struggles Monday, July 25, 2011 Colin Leys The Bullet November 20, 2009

Last year, Leo Panitch and Colin Leys brought out the 2010 annual volume of the Socialist Register, Morbid Symptoms: Health Under Capitalism, published by Merlin Press in London, Monthly Review Press in the U.S. and Fernwood Books in Canada.

The book provides a path-breaking assessment of health under capitalism, providing a systematic account of the antagonistic relationship between capitalism and human bodies, of how modern healthcare has been deeply penetrated by neoliberal capitalism, and the ways in which healthcare workers, activists and socialists are struggling and pursuing alternative paths of solidarity in human health. Socialist Project recently asked Greg Albo to interview Colin Leys about the book and about current healthcare struggles. SP: Colin, the latest Socialist Register, Morbid Symptoms: Health Under Capitalism, is gaining great accolades from health activists and practitioners, and from sections of the Left that have not traditionally been focussed on health. How did you and Leo come to focus on this issue as important for a Register audience? And how does it fit within your personal evolution as a Left intellectual in terms of your long-standing concerns with states and development in the ‘third world,’ especially Africa, on the one hand and states and parties in the advanced capitalist world, especially Britain, on the other? CL: Given the crucial importance of health in people’s lives it struck us that there was a major lack of critical left thinking about it – about how neoliberalism was undermining the health gains of the postwar years, about what was happening to healthcare as a field of employment, and above all how healthcare was becoming a massive new field of capital accumulation, with dire implications for population health – and for democracy – everywhere. The best contribution the Register could make, we felt, was to help develop a historical materialist analysis of health under capitalism. Over the last 30 years a 46

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handful of progressive health experts, such as Vicente Navarro in the U.S., and Lesley Doyall and Julian Tudor Hart in the U.K., have laid the groundwork for this, but the Left in general has not taken it on board as much as we should have. And the extent to which the mainstream health policy literature fails to confront the neoliberal agenda is frankly shocking. Dependence on government funding for research plays an obvious role there. With some honourable exceptions everything is presented as if the political-economic determinants of ill health are a (regrettable) given. We wanted to break decisively with this pattern, foregrounding the centrality of the capitalist health industry in policy-making, and showing how ruling-class interests are served by it. And yes, my own previous work in Africa and on development did give me a special interest in the theme. The routine normality of painful illness and early death in the global ‘south’ is so shameful, when we know that it is largely preventable; we also know that no amount of ‘aid’ is going to prevent it under the existing power relations of global capitalism. The determinants of poverty and ill-health, and of the lack of healthcare for all in the ‘south,’ are the same ones that are now driving the restoration of inequality and the dismantling of social protection in the ‘north.’ My work on British political economy under Thatcher and Blair took health policy as a test case of the way global market forces were driving domestic policy. What this revealed was a process that has ended in an amazing phenomenon – the British Labour Party, which 60 years ago set an example of universal and comprehensive healthcare that was followed all over the world – including in Canada – is now busy dismantling the integrated National Health Service and recreating a healthcare market – relying heavily on U.S. advisers and U.S. health multinationals to make it happen. SP: What are some of the key themes of the new Register? CL: There are really two core issues. One is the need to focus on the militant campaign that is now being waged by capital – the health insurance industry, the pharmaceutical and biotechnology industry, and big healthcare provider companies – to break up statefunded and provided healthcare systems in every country that has them, and turn them into fields of accumulation. In middle- and high-income countries we are talking of potential markets worth from 7 to 12% of national income or even more. The power of the corporations moving in on public health services is huge, and growing. In Canada and the U.K. and other advanced capitalist countries they are major actors in the restructuring of states on neoliberal lines that has been pushed through to a greater or lesser extent in all countries over the past 30 years. They are increasingly installed at the heart of government policy-making. Health ministries and departments have been downsized and policy development has been handed over to private sector personnel as consultants, or appointed to government posts, while ministers and career civil servants leave to take lucrative jobs in the private health sector. The boundary between public and private interests is increasingly blurred, especially in relation to health. This is not nearly as well understood as it needs to be. The second core issue is the fact that healthcare, important as it is, is not the most important thing: the crucial determinants of health, wherever you live – India, Canada, South Africa, the USA, it makes no difference – are good food, good shelter, safety at work and protection against infections, so whether you and your family are healthy or not is above all a matter of equality. The poorest countries have the worst health, and so do the poorest people in all countries, including rich ones. Unless public policy is geared toward equality, even in rich countries most people's health will remain a lot worse than it should be. But the more neoliberal a government is, the less policy is concerned with equality. In the U.S. and the U.K., where inequality has been dramatically increased, it is Medicare's 50th Anniversary

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condemning growing numbers of people to pain, disability and early death. The same is true internationally. As Meri Koivusalo shows in her essay in the volume, effective control over international health policy has been steadily transferred from the World Health Organisation to commercially-oriented and unaccountable organisations such as the Gates Foundation and the Global Fund to fight AIDS, tuberculosis and malaria. Even the WHO depends on ‘voluntary’ contributions from a range of sources for over four-fifths of its budget, as opposed to its core funding through UN member states. The bulk of health aid is thus increasingly controlled by agencies with links to corporate interests, especially those of big pharma. The WHO’s 1978 commitment to promoting ‘health for all’ via comprehensive primary care has given way to aid targeted at specific diseases largely chosen by these other agencies. The aim of improving people's health is compromised by the aim of making money. SP: How have healthcare and all its associated activities and sectors become integrated into neoliberal capitalism and its global dynamics? Are there any particular contradictions that this volume of the Register reveals? CL: There is an objective contradiction between capital's need for a workforce capable of providing reliable labour-power, and therefore being healthy enough to do so, and the compulsion on individual capitals – on companies – to constantly seek to pay less for it, well below what is needed to keep workers healthy. But this contradiction is less in evidence at present because of the huge pool of labour that is now available in China and India and other countries of the ‘south’; so far global capital has not found itself obliged to help keep this labour force healthy, and it has not. But there is also an immediate contradiction between healthcare's role in making capitalism acceptable to workers – its legitimation function – and healthcare capital's drive for profits. An important essay in the volume by Shaoguang Wang shows that in order to maintain political stability the Chinese government has felt obliged, for the sake of social stability, to give up its market approach to healthcare and at least aim to restore universal access to healthcare. Whether western electorates who have come to take universal access to healthcare for granted will accept seeing it converted back into a commodity, very unequally available, is a question that the Left needs to focus on as a matter of urgency. Will people be ready to accept the idea that it is no longer the responsibility of governments to keep everyone well? SP: It is striking that the volume is coming out in the midst of the U.S. healthcare struggle. Even as a Bill passes the House it seems it will be blocked and transformed in the Senate. What is your assessment of this struggle and what insights does the new volume bring to it? CL: Yes, the struggle over healthcare reform in the U.S. shows just how deeply access to healthcare goes to the heart of politics today. But it's also very significant that Obama and many Democrats in Congress felt unable to win what they had previously supported – a ‘single-payer’ (i.e. tax-funded) system, doing away with the grossly inefficient and rapacious health insurance industry. On top of that they then even proved unable to secure their alternative, extremely weak, market-friendly option – a public insurance plan that would compete with the private ones. Only a taxpayer-subsidised adjustment to the existing private sector oligopoly will – perhaps – be allowed to pass. What the story shows above all is just how far the private healthcare industry controls senators and congressmen by funding their campaigns. The health industry also devotes enormous resources to influencing public opinion against any form of ‘state medicine.’ In spite of that, in this instance public opinion supported a single payer system – but Congressmen have again proved more answerable to capital than to voters. The book had to go to 48

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press before this story had run very far, and we are still waiting to see the outcome; it's a measure of the quality of Marie Gottschalk's analysis of the U.S. situation that her essay stressed the severe limitations of the ‘public plan’ and assessed what was likely to happen very accurately. The lack of an anti-capitalist movement in the U.S. that could mobilise a powerful response has again denied the American working class what it voted for. It should and could prove to be a catalyst for change in this regard, as the consequences become clear. SP: Colin, another big issue right now is the H1N1 pandemic. This is being portrayed in the most narrow of terms as a public health issue to be managed by cleanliness, on the one hand, and mass vaccines, on the other, with other dimensions going unmentioned. One wonders whether we might see similar dynamic to that of a few years ago with respect to AIDS, which began as a technical issue seen as a minority problem but led to great struggles about social inequalities, sexuality and big pharma. Is it any more rational to treat swine flu as simply technical issue separate from the inequalities, institutions and dynamics of capitalism, or should we be looking at the linkages between the two?

CL: If it does develop as a serious killer disease like AIDS we will surely quickly become aware of those linkages. It spreads easily and affects everyone more or less equally and so can’t be attributed to ‘lifestyle choices’ the way sexually transmitted diseases or lung cancer often are. But given that those most liable to become seriously ill and even die from it are those whose health is already compromised, and that these are typically poorer people than the average, the class dimension of it will be there to see if it becomes more lethal. The issue of who gets the vaccine first has already revealed class privileges in Canada and elsewhere. A related question is whether the price charged by the big pharmaceutical companies such as GlaxoSmithKline who are supplying the vaccine to governments is right: how far should collective protection against a collective threat yield windfall profits for capital? SP: The IMF has now called for a decade of austerity in the public sector and in wages and benefits for workers. This comes on top of a long period of struggles against healthcare privatization and the working conditions of healthcare workers. You have been engaged in a lot of these struggles with the NHS in Britain and have, no doubt, kept up with some of the struggles in Canada given your frequent visits and continuing close contacts here. What do you expect might be coming in the way of confrontations? CL: This is a very important issue. In OECD countries other than the USA (where health is still treated as a commodity) people have been resisting – with varying degrees of success, depending on circumstances – the privatization of the publicly-funded and Medicare's 50th Anniversary

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managed healthcare systems that were established after WWII. In Canada, for example, the reality of the American healthcare market is there to be seen just across the border. Many Canadians have relatives there and know all about it. They didn’t need to see Michael Moore's film Sicko. Many Canadians are also relatively recent immigrants who are keenly aware of the ‘freedom from fear’ of illness or accidents that the universal healthcare system in their adopted country gives them. On top of this the labour unions have put resources into the fight to defend Canadian healthcare: the Canada Health Coalition has a high media profile and widespread support. The result is as near unanimity as you can ever get on anything in a free and democratic country – a recent poll found 89.9% of Canadians support or somewhat support universal healthcare. In spite of this massive public endorsement, the Canadian healthcare system has also been subjected to the application of neo-Taylorism in hospitals, to contracting out of the ‘ancillary’ work of hospital cleaning, laundry and cooking, and to the offloading of healthcare to the unpaid labour of families, and especially women. This comes across clearly in the essay by Pat and Hugh Armstrong on struggles for control in the Canadian healthcare workplace. The call for more public sector cutbacks and assaults on the rights of public sector workers will undoubtedly worsen these trends, but as the Armstrongs also show, there is a growing potential for alliances among ancillary workers, nurses and even doctors to confront further attacks. In England, where the assault on the public system has gone much further, campaigners against it are handicapped by the fact that it has been pushed through not by the Conservatives (who of course are happy to see it happen), but by a Labour government – and the trade unions are affiliated to the Labour Party. Even UNISON, the main health service workers’ union, is unwilling to attack Labour's marketization of the National Health Service publicly, even though its members are overwhelmingly opposed to it. As a result, while the NHS remains the most popular institution in the country there is limited understanding of how far and fast it is being broken up and privatized. Now that all the main political parties have signed up to the idea that everyone must just put their hands up and pay for the bankers’ greed by accepting a decade of cuts in public services, it will be interesting to see what happens when the cuts start to make a major impact on health services. There is an urgent need – and a major opportunity – for the Left to make the connections clear. The impact of austerity on health services could and should force the unions to finally detach themselves from their subservience to the neo-Thatcherite Labour elite, and encourage new political forces to coalesce around the need to reassert the right to healthcare as a basic political right, a component of equal citizenship. SP: Do you see the book as a handbook for healthcare activists? CL: We certainly hope it will be, and the essay by Sanjay Basu on what activists can learn from HIV/AIDS mobilizations to build a comprehensive public health movement is very important in this respect. But the book is aimed at a wider readership as well. One of the problems to be overcome is that what is happening to health and healthcare is so poorly reported and analysed in the media. The owners of most newspapers, magazines, TV channels and radio stations are part of the neoliberal order. This means that health features in just two ways: amazing stories about medical ‘breakthroughs’ in individual treatments, usually in surgery; and failures and scandals – and never the successes – of publicly-funded and managed healthcare systems. On the other hand editors working for public-service broadcasting or more critical newspapers tend to see health policy as too complex for most viewers and readers. Even medical students get shockingly little exposure to issues of health policy. Most medical training pays scant attention to the social and economic context of disease and its treatment, or to what forces are 50

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determining health policy, or how far current health policies fall short of reflecting what medical science tells us. You don’t need to be a socialist to see that this is wrong. You just need to have a concern for scientific evidence and the welfare of the society you live in. Morbid Symptoms should be read by medical students and doctors and nurses and everyone in the caring professions – in fact by everyone who thinks health matters. SP: The Socialist Register has always tried to have a vision of practical utopias for socialist struggles. This is something we have encountered as a problem in Canada in relation to healthcare – the need to go beyond just blocking any further erosion of public health. What contribution does the new Register add to practical utopias today and a programme for the Left in terms of health? CL: The principles that a socialist health programme should rest on come across clearly enough from the volume. In general, a socialist health policy would aim at making economic policy serve the goal of making everyone as healthy as possible, rather than making a few people as rich as possible. As Hans-Ulrich Deppe, an eminent German professor of medicine, says in his essay on the nature of healthcare, health is a universal need that should be a universal right, and this means that every aspect of health policy must be grounded in the principle of social solidarity. What this means in practice will vary widely, depending on the health system that already exists, public attitudes to health and medicine, country-specific variations in need, etc. And it can only be worked out in practice; blueprints made in advance are not going to help much. But a more democratic health policy, which must be the starting-point, will always imply some striking changes. For instance Julian Tudor Hart's powerful closing essay in the volume points out that in advanced capitalist countries an amazing third of all adults experience a mental health problem of one kind or another, but only a tiny fraction of the misery that this represents is even acknowledged, let alone treated – even in health systems that are supposedly equally accessible by all. A socialist health policy must obviously confront this, implying some major shifts of attitudes and resources, and a radical change in the social conditions that cause so much of the problem. It would aim to bring medical priorities into line with the findings of medical science – a very different thing from the priority now assigned to high-tech medical care for conditions that represent a tiny fraction of the burden of disease among the population at large (not to mention the populations of the global ‘south’). Thinking through what a socialist health policy would look like in any given society in fact opens up several extremely exciting vistas. It also opens up the possibility of new alliances in the struggle for socialism generally. For example, once it is recognised that good health depends more on social and economic equality than on healthcare – crucially important though healthcare is – healthcare activists thinking about the kind of politics needed to secure good health for all find they have natural allies in a whole range of movements struggling for equality – for labour, for women, for the unemployed, for undocumented people, and for minorities of many kinds. In the same way, envisaging the kind of state, and the kinds of democratic accountability, that could ensure that maximizing people’s health became and remained a core commitment of society, is a powerful way of focusing on the kind of state needed for achieving other solidaristic goals. Health is a deeply emotive matter, and the Left has every reason to make it a core issue of its own. And not just in defending publicly-provided, universal-access healthcare, but in a more radical sense too, as Leo and I suggest in the Preface to the book: “the contradiction between capitalism and health should become a pivotal dimension of a revitalized socialist strategy.” • Medicare's 50th Anniversary

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In addition to co-editing the Socialist Register Colin Leys is the author of various books including Underdevelopment in Kenya, Politics in Britain: From Labourism to Thatcherism, The Rise and Fall of Development Theory, and Market-Driven Politics: Neoliberal democracy and the public interest.

The pros and cons of medicare: CBC 1962 Monday, July 25, 2011 Canadian Broadcasting Corporation July 22, 1962 The opposing sides in Saskatchewan's Doctors Strike are split by differing philosophies on the benefits of centralized medicine. The doctors, led by H.D. Dalgleish and E.W. Barootes of the Saskatchewan College of Physicians and Surgeons, say government controlled health care threatens both their profession's freedom and the individual rights of the province's residents. Saskatchewan's CCF government (Premier Woodrow Lloyd), however, believes the public good can only be upheld by replacing private interests with a central, universal system. Watch the CBC video HERE.

Profit is not the cure Tuesday, July 26, 2011 Council of Canadians

Open publication - Free publishing - More canada

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Emmett Hall: Establishment Radical Wednesday, July 27, 2011 Dennis Gruending published a biography of Emmett Hall in 1985. Mr. Hall was a Supreme Court judge but is best known for leading the royal commission that recommended medicare for Canada. Dennis revised and updated the book in 2005 and spoke about Hall at the Ottawa Public Library in November. Dennis Gruending

Many people have asked me why I chose to write a book about Emmett Hall. I did so because Mr. Hall has had a greater impact on this country – and a greater impact on the lives of millions of Canadians – than almost anyone that I can think of. The late journalist Walter Stewart that sums up Hall’s contributions nicely: “A number of crucial factors have gone into making Canada the nation that it is today,” Walter said. “The Rockies, the St. Lawrence River, and Emmett Hall.” Hall sat on the Supreme Court of Canada for 10 years. He stood alone against eight of his brethren in 1967 when he insisted that Steven Truscott had not received a fair murder trial and should be awarded a new one. The Truscott case has not gone away – far from it. Thirty-five years after Truscott was released from prison, the federal minister of justice believes that a miscarriage of justice may well have occurred and Truscott’s case is being reviewed. It was Hall’s powerful dissenting Supreme Court judgment in the 1973 Nisga’a case that Medicare's 50th Anniversary

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set the stage for all future negotiations on Indian land claims. Hall also co-chaired the 1968 Hall-Dennis report that changed education in Ontario – and the results of the commission are still being hotly debated. Another Hall royal commission in the 1970s investigated the sensitive issue of rail transportation and small-town survival in western Canada – an issue that is revisiting us today at a time of economic crisis in rural areas. Hall’s legal judgments and his other work have an amazing contemporary relevance. But Emmett Hall is best known as a father of medicare. It was his royal commission in the 1960s that recommended publicly financed health care for Canadians. You owe him a debt every time you visit a doctor or go into the hospital. As a judge Hall weighed the evidence. He came to believe that a public health system is a far better plan than a myriad of competing private insurance plans duplicating services, spending millions on advertising, and leaving those who can’t pay to fend for themselves. In writing a biography of Emmett Hall, I felt that I was writing about a big swath of the history of 20th century Canada – but writing it through the focus and prism of biography. Hall was born in 1897 when Laurier was Prime Minister. When Hall died in 1995, Jean Chretien was in that post. That makes for 13 Prime Ministers who served during Hall’s lifetime. That’s an incredible sweep of history and Hall left his mark on our country in a way that few people have. So, that’s Emmett Hall on the wide screen. I want to tell you a bit about how I came to write the book, and about my encounters with Mr. Hall. Hall’s life & work Hall was born in rural Quebec in 1897, one of 10 children in a staunchly Catholic Irish family. His parents moved west to Saskatoon in 1910. When he was 17, Hall enrolled in the law school, where he was a seatmate, friend and competitor of John Diefenbaker’s. Hall practiced law in small town Saskatchewan, then for many years in Saskatoon. It was a general practice, but he also acted in several high profile criminal trials – including his defence of some of on-to-Ottawa trekkers in Regina in 1935. But Hall always harbored ambitions to play a prominent role on a wider public stage. He wanted to be a judge but Jimmy Gardiner, Saskatchewan’s most powerful Liberal politician in Ottawa, controlled those appointments. Hall was a Conservative and his name wasn't on Gardiner’s list of favourites. Hall tried his own hand at politics but lost on both occasions. In 1957, he was 58 years old and he and his wife Isabel had begun to plan for retirement. But all of that changed early on the morning of June 11. On the previous day, John Diefenbaker and the Conservatives had received enough votes in the federal election to indicate a minority government. As Hall later told the story, Diefenbaker called him early the next morning and reminded him that there was a vacancy on Saskatchewan's Court of Queen's Bench. How about it? Diefenbaker wanted to know. When could Hall start?

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With that promotion began an amazing era that propelled Hall from relative obscurity to national renown. Rescued from retirement, he proceeded to become Saskatchewan’s chief justice and later a member of the Supreme Court of Canada and the compassionate conscience of a nation. Hall as a judge As a judge, Hall was not a scholar in the manner of his good friend Chief Justice Bora Laskin. But Hall had long experience as a trial lawyer. He knew how the world worked, including its seamy side, and he had good insight into human nature. He was decisive. He wrote his judgments quickly and in what is now called plain language. He served prior to the Charter of Rights and Freedoms, which came into effect in 1982. In the post Charter era, courts have been called upon to play an expanded role in interpreting and guiding the law. Roy Romanow, who was instrumental in the negotiations leading to the Charter, told me that Hall would have been a progressive judge in this our post-Charter era. Hall served on the Supreme Court for 10 years then returned home to Saskatoon in 1973. My encounters with Emmett Hall I met Mr. Hall in 1982 when I was working with CBC Television in Regina. It was the 20th anniversary of medicare in Saskatchewan, and I was doing a documentary to recognize the occasion. I travelled to Saskatoon on a brilliantly sunny morning in June to interview him. He was gracious and entertaining. A year later, I contacted Hall and asked if I could interview him for a radio documentary that I had proposed about him to a national CBC Radio program called Sunday Morning. I approached him again in 1984 and suggested a biography. It was a great privilege to spend hours talking with him in his penthouse apartment along the riverbank in downtown Saskatoon. His wife had died a few years earlier and the mere mention of her would bring tears to his eyes. Hall was usually charming but he was tough minded and he could be blunt. He did not like questions that probed too deeply into his private life, although he was prepared to be more revealing as we went along. Nor did he appreciate questions that dealt with anything that might be considered a failure, such as his lack of success in seeking political office. I asked him why he wasn’t successful when he ran for the Conservatives. He growled at me, “Because I didn’t get enough votes.” One day he became annoyed with me and he said my questions were “stupid.” I shut off my tape recorder and told him that these questions were the only ones that I had prepared for that day. I left his apartment, and I fully expected that the whole project was going down in flames. I called him the next day. He was friendly and he asked when I was coming over. I told him that, given what happened the previous day, I thought that our project might be over. He seemed genuinely surprised, then said, “Hell, don’t let that bother you.” So we continued. There were aspects of my book that Hall did not like, but generally he agreed that it had been a good piece of work. I was able to visit with him in his penthouse apartment in Medicare's 50th Anniversary

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Saskatoon a number of times in the later 1980s, but then I moved and saw him only one more time – on a precious evening when hundreds of his friends and acquaintances gathered in Saskatoon to celebrate his 95th birthday in November 1993. He was lucid and gracious in his remarks that night, but a short time later he suffered a stroke from which he never recovered. He died two years later. Summing up Hall’s life & contributions Emmett Hall was a man of no small ego, but also a man of great principle, incredible energy and competence. He was a father of medicare and a libertarian judge who insisted that the law must be an instrument of justice as well as punishment. He was a champion of Aboriginal rights and a friend of the farmer. He was a justice seeker who opposed bigotry, hatred and ignorance with all of his impressive strength and persuasion. Laurier said the 20th century was to be the century of Canada, and Emmett Hall never stopped believing it. He was a social gadfly, an establishment radical, who believed in the system but insisted on reforming it. We are the richer for his having lived and worked among us.

The First Ten Years: Saskatchewan's Community Clinics Wednesday, July 27, 2011 By Dennis Gruending

Two black telephones sitting in a bare room of the third floor of Saskatoon's old Avenue Building was hardly an auspicious beginning for two doctors and a small group ofcitizens to pioneer the community clinic on that warm, gusty morning of July 3, 1962, armed with only their medical bags, doctors Joan Witney-Moore and Margaret Mahood settled into''a new venture in health care" . Executive members of the fledgling Community Health Services Association (CHSA) went scavenging for equipment. They found folding tables at the Union Centre and hauled them back. Covered with mattresses, they became examining tables. The doctors were busy until midnight. 56

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Events in 1962 precipitating the opening of community clinics had . provoked deep and emotional rifts in Saskatchewan, grabbed head¬lines and filled newspaper columns throughout North America. The Strike On July 1, 1962 a majority of Saskatchewan's 725 practising physicians went on strike opposing the CCF government's introduction ofthe first universal, tax-financed, medical care insurance plan in North America. Saskatchewan Premier T. C. Douglas, speaking in a 1959 provincial by-election, announced his government's intention to introduce the plan, fulfilling a promise made before the CCF rise to power in 1944. "The Premier had fired the first volley." Read this bookHERE. (large PDF, will take a few minutes to download). Or read the Ussuu flip page book below.

Open publication - Free publishing - More ccf

US Labour Celebrates 46 Years of Medicare Wednesday, July 27, 2011 Let’s all celebrate Medicare’s birthday By Lee J. Price for the Gainesville Sun Healthcare-NOW! July 27, 2011 Republican and Democrats alike are swarming at the opportunity to cut government programs under the guise of “balancing the budget,” and everyone’s eyes are on Social Security and Medicare. The problem is that Social Security hasn’t contributed a dime to the federal deficit. And Medicare runs more efficiently than private insurance while improving the lives of seniors. I should know; I’m alive today because of Medicare, alive because of government medicine. And I’m proud to have been a part of the fight to win Medicare — which celebrates its 46th birthday this month. It was not an easy fight, by any means. It was already defeated once, in the 1930s, as part of Social Security, and in 1948, when Harry S. Truman revisited the issue. But in 1964, Lyndon Johnson put Medicare again on the front burner. In the front ranks of supporters were the unions, which have always been in the forefront of health-care struggles. There was a massive nationwide campaign of petition drives. I was part of the effort as a member of the Florida Young Democrats, collecting signatures and tabling outside of supermarkets. As the vote in Congress drew nigh, there were huge rallies across the country. I’ll always Medicare's 50th Anniversary

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remember watching the bill being signed on TV, on July 30, 1965. President Johnson presented Medicare card No. 1 to a beaming Harry Truman. It was a great victory. At the time we thought, “We’ll take care of the old folks now, and soon we’ll expand it to everyone.” Unfortunately, private insurance companies came to profit off our hard-earned dollars and costs skyrocketed. Now Medicare is seen as the problem, when in fact it is the model we should be using. Medicare spends 97 cents of every dollar on health care. Insurance companies only spend about 80 cents and keep the rest for profit and overhead. Expanding Medicare to cover everyone would save over $400 billion a year — money that could be used to improve Medicare services and payments. I invite everyone to join me at a birthday party for Medicare on Saturday, July 30, from 1 to 2:30 p.m. at the Library Partnership, 1130 NE 16th Ave, in Gainesville. The Alachua County Labor Party will provide cake and refreshments and invites people to share their stories and concerns about Medicare. Call (352) 375-2832 for more info. I was young when the struggle began, and now I am old. It seems likely now that I will not see Medicare expanded as I had hoped. But I labor on, spreading the word about the only plan that covers all Americans, the only plan that actually saves money: Singlepayer Medicare for All.

Lee J. Price lives in Gainesville.

CLC submission to the Romanow Health Care Commission Wednesday, July 27, 2011 Canadian Labour Congress December 2001

The Canadian Labour Congress and its 2.5 million affiliated members believe that the attainment of the highest standard of health is a fundamental human right. In order to achieve that right, Canadian citizens must have equitable access to health care services along with other initiatives which promote good health. Included in the factors necessary for good health are access to decently paid jobs, safe and healthy workplaces, a clean environment, freedom from discrimination, and a variety of public programs which broadly promote economic and social security. 58

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Commissioner Roy Romanow called Medicare a ‘magnificent creation of citizens and governments,’ a characterization with which the CLC agrees. The labour movement played a role in supporting the establishment of Medicare because labour leaders of the day recognized the immense contribution good health and equal access to health care services would make to the living standards of working people, indeed, of all Canadians. Labour leaders today affirm the labour movement’s commitment to a national system of public health care, governed by the Canada Health Act, with services delivered on a nonprofit basis within the broad public sector. The labour movement strongly believes that health care is a public good, not a commodity, making access to health care a right of citizenship, not merely an entitlement. Therefore, for-profit health care is completely incompatible with these principles, and with core values historically held by Canadians – compassion, sharing, dignity, fairness, equality, and honesty. Read more HERE.

Video: The fight for medicare in Saskatchewan Wednesday, July 27, 2011 National Film Board of Canada

Four Precursors of Medicare in Saskatchewan Thursday, July 28, 2011 BY C. STUART HOUSTON, MERLE MASSIE CBMH/BCHM, Volume 26:2 2009

T. C. Douglas, on assuming power in June 1944 as the first social democratic premier in North America, began working in a step-like pattern as finances permitted, toward his goal of eventual province-wide Medicare. Douglas and his team were able to build on the success of bold initiatives already in place in the Depression-scarred rural municipalities of Pittville, Miry Creek, Webb, and Riverside. These municipalities developed medical and hospital plans that offered residents comprehensive coverage with freedom of choice of doctor. Built on idealism, prairie pragmatism and tenacity, these formative health plans served not only as models, but provided the leadership required during the creation and early years of Swift Current Medicare's 50th Anniversary

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Health Region #1. Key figures such as Bill Burak, Carl Kjorven, Stewart Robertson, and Charles Haydon brought experience, depth, and ambition to the task at hand. Envisioned as simply a demonstration region by the Saskatchewan government, HR #1 achieved more: a seamless integration of preventative medicine with medical care, combined with a sense of local empowerment. Read more HERE.

Flying Together: CACHCA Thursday, July 28, 2011 Canadian Alliance of Community Health Centre Associations CineFocus Canada short film telling the story of Canada's Community Health Centres (CHCs). CHCs are a key component of the Second Stage of Medicare and a health system solution for all Canadians.

NHS in the UK celebrates 63 years Thursday, July 28, 2011 By Sarah Williams Touchstone 5th July 2011

The creation of the NHS on this day in 1948 was not just one of the greatest achievements in our history but also a massive stride forward in the provision and distribution of public healthcare. It was the first time anywhere in the world that completely free healthcare had been made available to all regardless of ability to pay and it is that element that remains jealously observed by nations such as the USA today. Before the NHS, public health provision was patchy at best and was determined to a great extent by your ability to pay, where you lived and whether you were a man or a woman or a child. While poor workers were given free healthcare, their wives and children were generally not, reflecting the fact that the priority was not the patient, but the patient’s productivity within the labour market.

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Women and children were not “making money” and so were not prioritised. This resulted in approximately 1 in 20 babies dying before their 1st birthday. Although there were altruistic doctors providing their services for free to the poor in places, there was no imperative for them to do so. As a result they were always going to be doomed to only scratch the surface of health inequality. Had it not been for the outbreak of World War 2 forcing experienced medics to see the situation more directly and produce documentary evidence of their observations, the political movement to reform hospitals may never have got as far as the creation of the NHS. But what of the NHS today, 63 years after Anuerin Bevan managed to successfully argue for his new NHS to be available, free at the point of need and provided to 100 per cent of the population? Patient satisfaction with the NHS is at an all-time high. The Commonwealth funds ranking of health systems performance in 2007 which measured a number of factors including quality, equity and safety ranked the UK at number 1 (the USA’s mainly privatised and market driven system ranked last). As a percentage of GDP, even after the great increase in NHS spending undertaken by the last government, the UK still spends the least on healthcare in comparison to 8 other developed countries including the USA, (spending the most), France, Germany and Australia. Currently it would seem, we spend less and get more. No one in the NHS would dispute the need to adapt and change, and in physiotherapy we are constantly finding new and innovate ways to meet patients’ needs in the difficult financial climate. But despite the Government’s recent listening exercise on its controversial proposals for the health service, our message is clear: “The NHS as we know and love it is still at risk,” Phil Gray, the chief executive of the Chartered Society of Physiotherapy, has said.

Norman Bethune – Book Review Friday, July 29, 2011 By Anne Cimon Montreal Serai June 24, 2009

Norman Bethune

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By Adrienne Clarkson Penguin Canada At a conference on April 15, 2009 at Concordia University, Adrienne Clarkson, former governor general of Canada and now biographer of Norman Bethune, suggested that one of the reasons the internationally-known surgeon, medical inventor, visionary and humanitarian might not be recognized to the degree he should be in Canada is because he became a member of the Communist Party in 1935. Certainly this is a well-timed biography of Norman Bethune as it coincides with the seventieth anniversary of his death which is being celebrated in the city of Montreal with special events and exhibitions. This volume is part of a series entitled Extraordinary Canadians edited by John Ralston Saul. He is the husband of Clarkson and their collaboration has turned out a brilliant book. In his Introduction, Saul states there is a need for this series whose aim is to “produce a grand sweep of the creation of modern Canada.” Other “ethical leaders” chosen are as diverse as Lester B. Pearson, Big Bear, L.M. Montgomery, and René Lévesque. Certainly Clarkson’s Norman Bethune stands on its own. The stunning cover portrait by Canadian artist Carl Shinkaruk paints Bethune as a fiery tortured figure with the gaunt cheeks of the tubercular. This arresting image evokes a self-portrait of Vincent Van Gogh, another haunted extraordinary man. Clarkson writes with analytic acumen of Bethune’s childhood on the Canadian Shield. He was born in Gravenhurst, Ontario from “generations of doctors” and “men of peace.” Bethune was the grandson of Norman Bethune, a surgeon whose life became a template for his namesake. In the 1850s, his ancestor had tended to the wounded soldiers on an Italian battlefield and was described by a government official as a “generous foreign volunteer …spurred to help us out of a deep sense of human generosity.” Similar admiring words were applied to his grandson in 1939 by government officials in China where he died. Bethune was given the name Bai Qiu En which translates to The Light which Pursues Kindness. Clarkson convincingly discusses how Bethune’s Presbytarian heritage shaped him for a life of service. His rebellion against his fundamentalist father, Reverend Malcolm

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Bethune, whom he claimed he “hated,” was an early visceral reaction against any form of oppression. This rebellion took on a wider scope in his adulthood as he fought against the medical establishment’s status quo and later the forces of fascism. At the Concordia University conference, Clarkson mentioned that it was time that Bethune be written about “from a woman’s point of view.” In her extensive research, Clarkson is the first biographer to make use of the journals of Marian Dale Scott, the wellknown Canadian artist. As Clarkson defines her, she was Bethune’s “unique love of his life.” At the time they met in 1935, Bethune was divorced from Frances Campbell Penney, a conservative woman from a prominent Edinburgh family. Marian was married to the well-known Montreal lawyer and poet, F.R. Scott. In a sensitive chapter with the title ” A Tiger of Sweetness, Fierceness and Delight,” a line by Marian describing Bethune, Clarkson reveals through Bethune’s love letters and poems to her the depth of their creative and platonic relationship. As a young stretcher-bearer in the First World War, Bethune had survived a severe leg wound in France and had been hospitalized for six months, returning to continue his medical studies in Canada. At the age of thirty-six, he faced a far more difficult physical diagnosis that was like a death sentence. He had contracted tuberculosis in both lungs. TB was then epidemic as cancer is today and there was no known cure. Under the stress, Bethune and his wife divorced and she returned to Scotland. Unable to practice medicine, Bethune was admitted to the Trudeau Sanatorium at Saranac Lake, New York. His will to live was shaken and he planned his suicide. As an instinctive form of therapy, Bethune began to paint the interior walls of the cottage he lived in with murals he entitled “TB’s Progress.” When he heard of an experimental operation, he sought a doctor that was willing to perform it. The operation was a success though it left him disabled with only one functioning lung. This didn’t deter Bethune who decided to use his medical skills to eradicate this disease. In 1928, he accepted a prestigious position at the Royal Victoria Hospital in Montreal where he worked alongside the “father of thoracic surgery in North America,” Dr. Edward Archibald. Soon, Bethune clashed with his traditionalist mentor. Even though Bethune proved himself as a surgeon and even invented surgical tools that are still in use in the operating room today, Dr. Archibald decided to transfer him to another hospital, in effect dismissing him. As Clarkson explains, Bethune’s eccentric character could have been another reason: “The fact that Bethune changed his clothing as quickly as his moods was irritating to many as well. An apartment mate of his said that “his clothes (were) bought from the most expensive tailor in town….(he was) always insisting on white tie and tails at every appropriate occasion.”He was just as capable, however, of going out to a party wearing shoes, trousers, and an overcoat but no shirt or jacket; once, in response to a dare, he dressed as a lumberjack to do his hospital rounds.” Bethune didn’t agree with the concept of profit in medicine. In his practice in Montreal, he was often heard saying: “there are two kinds of tuberculosis: the rich man’s and the poor man’s. The rich man lives and the poor man dies.” At medical congresses he gave electrifying speeches that challenged his colleagues on this subject. In 1936, Bethune spearheaded a group of like-minded professionals, the Montreal Group for the Security of the People’s Health, which produced a manifesto for socialized medicine but it was ignored by his peers and the Quebec government. Not a man to be defeated, Bethune decided to go to Spain to fight the fascist army of General Franco. He was sponsored by Medicare's 50th Anniversary

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the Canadian Committee to Aid Spanish Democracy. In Spain, Bethune organized, with his Canadian team, the first mobile transfusion unit. Clarkson points out that this important contribution to the history of blood transfusion has yet to be fully recognized. The seeds for Bethune’s journey to China were planted in his religious childhood as Clarkson recounts how in the early twentieth century, China was regarded as the place for evangelization and many churches and institutions collected alms so they could sponsor missionaries to that country. In 1938, Bethune felt compelled to go to China under the auspices of the Canadian-American Medical Unit to help the Chinese in their fight against the Japanese invasion. Accompanied by the Canadian nurse Jean Ewen, who spoke Chinese fluently, Bethune trekked for weeks through rough mountainous landscape to get to his post as medical adviser to the Eighth Route Army. Ewen wrote a book about her experiences in China and Clarkson includes Ewen’s vivid account of the famous meeting in Yan’an between Bethune and the young Chairman Mao. In this chapter, Clarkson conveys the physical and emotional hardships that Bethune encountered as he performed his medical duties operating on the front line, setting up a model hospital, training Chinese teenage boys and girls as rudimentary nurses and doctors. One of Bethune’s inventions in China was a mobile operating room for the battlefield: “All the equipment was placed on three mules: the collapsible operating table, a full set of surgical instruments, anaesthetics, antiseptics, twenty-five wooden legs and arms.” Bethune spent much time typing letters to authorities and friends back home requesting urgently needed medical supplies. He also wrote articles for the Canadian and American newspapers, and medical texts and training manuals. His portable typewriter is now kept in the Bethune Museum in Shijiazhuang along with his stethoscope and other memorabilia. Danger never fazed Bethune whose dedication to saving the lives of the wounded included operating bare-handed if no surgical gloves were available. In the fall of 1939, at forty-nine years old, Bethune was frail from months of gruelling living conditions and overwhelming work, and when he nicked his finger during surgery he soon fell ill from blood poisoning. He’d been planning to return to Canada to raise funds for the Communist Army, but once he knew he was dying, he wrote his will which concluded: “So the last two years have been the most significant, the most meaningful years of my life.” The biography ends a bit quickly but more details can be found in the useful Chronology such as that Bethune’s remains are at the Martyrs’ Tomb in the same city as the Bethune Museum in China. There is an error that needs correcting for future editions which is the location of the memorial statue of Bethune in Montreal: it is not at the corner of Guy and Dorchester, but Guy and De Maisoneuve Streets. In Norman Bethune, Clarkson debunks myths and media sensationalism to capture the essence of this extraordinary man and Canadian. Like all larger-than-life people, Bethune transcended labels or contradictions and could be Communist and Christian, scientist and artist, temperamental and tender. Clarkson advocates for Dr. Bethune’s further recognition in Canada and surely this volume will do this.

Anne Cimon is a Montreal writer and reviewer. Her most recent book is a biography Susanna Moodie: Pioneer Author (Dundurn Press)

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Tommy Douglas and the CCF: Health Care Achievements Saturday, July 30, 2011 Tommy Douglas Research Institute Achievements

1944-1948 – Premier Douglas assumed the role of Saskatchewan's Health Minister during the first term of his government, during which time the first steps towards Medicare were taken. New policies and building projects were based partly on the recommendations of the new Health Services Planning Commission. Major innovations included: • Free health care for pensioners, • Free psychiatric hospital treatment for the mentally ill, as well as the construction of Mental Health Clinics, • Free cancer treatment for those in need, • The creation of the first comprehensive health services region, • Construction of new health care facilities, • The creation of the College of Medicine at the University of Saskatchewan, • Air Ambulance to transport those in rural areas to central or regional hospitals. January 1, 1947 – Douglas created Canada’s first universal and compulsory hospital insurance program – the Universal Hospital Services plan. It was the first program in North America to provide complete benefits to all residents. The legislation offered: • • • • •

Expanded hospital facilities (21 new hospitals over 4 years), X-rays and lab services, Common drugs and other hospital services, Compensation for a share of out of province medical costs, With payment for the insurance at a rate of $5 per person to a maximum of $30 per family.

April 25,1959 – Douglas announced his government’s revolutionary intention to introduce a universal and comprehensive medical care insurance program for the province.

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Nearing the end of his government’s fourth term in office, and with Prime Minister Diefenbaker’s newfound willingness to share in the cost of any universal health plan developed by a provincial government, the time was right for Douglas to proceed with his vision. His plan, however, was strongly opposed by the College of Physicians and Surgeons of Saskatchewan, which not only governed and upheld the competency of the province’s medical professionals, but also protected the interests of the doctors. June 8, 1960 – Douglas and his CCF Party’s overwhelming election victory represented the public approval necessary to bring the universal health insurance plan to fruition. Medicare, the revolutionary part of their election platform, was founded upon the following three major themes: • A public system was necessary because a universal and comprehensive healthcare package would require citizens of the province to pay extremely high private insurance premiums, • A lot of public money was needed to fund such an extensive program, • The largesse of the program would require the government to be accountable for it’s management. November 17, 1961 – Saskatchewan Medical Care Insurance Act The Act, put into legislation by new CCF Premier Woodrow S. Lloyd mere weeks after replacing the departed Tommy Douglas, gave the Medical Care Insurance Commission the power to run the new universal insurance system. In 1962 when the program came into effect, the premiums that replaced the payments for private insurance were $12 per individual per year or $24 for families. All Saskatchewanians would collectively pay for those who were sick, and all could be reassured that a terrible illness in the family wouldn’t lead to bankruptcy.

Canada's Medicare System: Building on the legacy! Saturday, July 30, 2011 National Union of Public and General Employees

Open publication - Free publishing - More canada

Why America Needs Health Care Reform Saturday, July 30, 2011

Allan Blakeney, Pioneer of Canadian Health Care, Dies at 85 Sunday, July 31, 2011 By DOUGLAS MARTIN New York Times April 19, 2011

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Allan Blakeney, the health minister of the Canadian province of Saskatchewan who helped start North America’s first tax-financed universal health care system in 1962, and was later the province’s premier, died Saturday at his home in Saskatoon. He was 85. The Saskatchewan government said the cause was liver cancer. In 1946, the government of Tommy Douglas, then Saskatchewan’s premier, enacted universal insurance coverage for hospitalization. Mr. Douglas’s successor, Woodrow Lloyd expanded the program in 1962 to include the costs of medical care provided by doctors. Nine out of 10 doctors responded by going on strike, people demonstrated in support of the doctors and newspapers editorialized in their favor. Mr. Blakeney, as the health minister in Mr. Lloyd’s government, became the main negotiator with the physicians. He succeeded in keeping the new system — partly by emphasizing its lower cost — but compromised to give doctors the right to charge fees for services, rather than going on salary. Mr. Blakeney later called the brouhaha the “the greatest social conflict I was involved in.” By 1966, universal medical coverage had been extended to all Canadians. Opposition to the plan in Saskatchewan, however, helped the Liberal Party defeat Mr. Lloyd’s government in 1964. Mr. Blakeney remained a member of the provincial legislature and practiced law. But by 1970, he had become leader of the provincial New Democratic Party, and he led it to victory the next year. As Saskatchewan’s premier, a post he held until 1982, he put into effect a flurry of programs he called a New Deal for People. These included a dental program for children, a prescription drug program, subsidized housing, home care and a guaranteed income supplement for the elderly poor. He helped pass a law to allow the government to purchase land from older farmers, so it in turn could rent the land to their children, making it financially feasible for them to stay on the family homestead. Mr. Blakeney aggressively increased the fees charged by the province for mining potash,

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a component of fertilizer. After foreign producers, largely American, refused to pay, Mr. Blakeney’s government seized the mines of companies producing more than 40 percent of the province’s potash, paying what it said was a fair market price. Both the companies and the United States government protested, but the action stood. Mr. Blakeney also became a force on the national scene during the discussions over Canada’s new Constitution in the early 1980s. He successfully argued for more power for provincial legislatures. Allan Emrys Blakeney was born on Sept. 7, 1925, in Bridgewater, Nova Scotia, and grew up dreaming of being a sea captain. He earned a law degree from Dalhousie University in Halifax, then studied at Oxford as a Rhodes scholar, earning a bachelor’s degree in politics, philosophy and economics. He worked as a civil servant in the Saskatchewan government until he was elected to the provincial legislature in 1960. In addition to being provincial health minister, he was also minister of education and treasurer. He ran unsuccessfully to return to the premier’s job in 1986, then retired from politics two years later. Mr. Blakeney’s first wife, the former Molly Schwartz, died in 1957. His survivors include his wife, the former Anne Gorham, and four children. Mr. Blakeney watched the United States’ debate on health care, which resulted in the Affordable Health Care for America Act of 2009, with keen interest. He called the American law “a painfully small step.”

The Roots of North America’s First Comprehensive Public Health Insu... Monday, August 01, 2011 By Aleck Ostry Linköping University Electronic Press

"Although less than eight per cent of Canadians lived in Saskatchewan in the 1940s, this province has played a large role in the development of national social policy.2 Western Canada, particularly Saskatchewan and Manitoba, was the crucible of the nation's Social Democratic movement which was based largely on the strong tradition of co-operative prairie wheat farming and marketing. Canada's first Social Democratic party, the Cooperative Commonwealth Federation (CCF), the forerunner of the New Democratic Party, was born during the Great Depression in Manitoba and Saskatchewan. The party 68

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came to power in the Saskatchewan provincial elections of 1944, becoming the first Social Democratic party elected in North America. The party remained in power until 1964. During this 20-year period the CCF crafted North America's first comprehensive public health insurance scheme. Province-wide public hospital insurance was started early in the CCF's mandate in 1946 and, after an acrimonious doctors’ strike in 1962, followed by public insurance for physician remuneration (Medicare) in 1962. The federal government, under the leadership of the Liberal Party, followed Saskatchewan's lead, and adopted a public scheme for hospital insurance in 1957 and Medicare in 1968. Saskatchewan, from 1944 to 1964, pioneered the development of Canada's national public health insurance plan." Read more HERE.

Medicare’s 46th Anniversary Roundup (USA) Monday, August 01, 2011 By Healthcare-NOW! August 1, 2011

July 30th was Medicare’s 46th anniversary and we’ve been celebrating all over the country. Improved Medicare-for-all supporters in 21 states organized over 45 events, rallies, birthday parties, and congressional visits aimed at preventing cuts to Medicare, Medicaid and Social Security while also calling for Medicare-for-all as the solution to, not the problem with, our national budget problems. Read more HERE.

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Health Care in Scotland and Wales Monday, August 01, 2011 ‘What Matters Is What Works’: The State and the National Health Service in Scotland and Wales By Colin Leys Socialist Project • E-Bulletin No. 498 May 6, 2011

As expert commentators have amply shown, the Coalition's plan to privatise the National Health Service (NHS) lacks any basis in evidence – no surprise there. What is less well recognised, and so far amazingly unmentioned in the debate – is that powerful evidence against privatization exists on our own doorstep – namely, the fact that in Scotland and Wales the NHS is working well as a publicly provided and managed system, based on planning and democratic accountability. NHS Not For Sale Marketization was tried, especially in Scotland, and rejected. The purchaser-provider split, which is at the root of the marketization project, was introduced but then abandoned in both countries, and neither Foundation Trusts nor payment by results were introduced in either of them. Private finance initiative (PFI) was used in Scotland under the first Labour government in Holyrood, and one private treatment centre for NHS patients was opened, but the Scottish National Party (SNP) has since scrapped the use of PFI and taken the treatment centre into public ownership. Wales has used neither PFI nor private treatment centres. The NHS in both countries is once again planned and managed through a mix of democratically accountable central and local structures, as it was in England before the 1990s.[1] Democratic and Accountable Planning But this doesn’t mean that the NHS in Scotland and Wales has reverted to the past. On the contrary, in both countries the NHS has been modernizing, but under the influence of very different drivers from those being promoted in England. Instead of fragmenting the NHS and opening it to commercial competition, Scotland and Wales have opted for democratic and accountable planning. There, the drivers of change are: a) the input of medical specialists and GPs (rather than businessmen) on the Area and Local Health Boards where key policies are developed; b) the input on the Boards of community health and social care/social work staff, crucial for integrating primary and secondary care 70

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efficiently; and c) in Scotland, input from members of the local community, elected to the Boards on a trial basis since 2009. The restoration of full political responsibility for health services has led to further democratizing or redistributive measures, including the abolition of prescription charges, and the abolition of charges for personal care in Scotland, and their radical reduction in Wales. Equally significant, and contrary to the claims of marketizers in England, health services in Scotland and Wales have steadily improved, on various measures, including waiting times. Scotland's have been among the shortest in the UK. The contrast with England – where the NHS is now being driven into decline and, increasingly, into chaos, in the interest of privatization – is dramatic. If ‘what matters is what works,’ as Tony Blair liked to say (confident that the catch-phrase was enough to justify privatization), it is actually publicly-provided and democratically-managed health services that work, and the evidence for this is right here in the UK. Lessons Learned There is a wider lesson here for everyone concerned to defend the public sector. It shows the state working in its active role as the agent and shield of the majority. This needs emphasizing. After forty years of ideological onslaught the very idea of ‘the state’ is close to joining others, such as ‘collective’ (not to mention ‘socialist,’ and even ‘left’), in the depository of Unclean Concepts. ‘State bad, private good’ may be a crude slogan but it is the very real starting-point of many politicians and most media commentators and BBC interviewers today, from John Humphrys down. ‘State’ is so often coupled with ‘nanny,’ ‘bureaucratic,’ ‘inefficient,’ ‘wasteful’ or some other negative adjective, that this hardly raises an eyebrow. It is never called ‘rational,’ ‘efficient,’ or even ‘democratic’ – even though commentators and interviewers like to stress the accountability of government (state) to parliament (also part of the state, and always called democratic) when criticizing extra-parliamentary forms of political action. Elements of the state that the corporate world likes and needs are usually treated as somehow not part of the state. The armed forces, the police, the judiciary, the monarchy and the Church of England are never described as part of the nanny state, or as being bureaucratic or inefficient. The nanny, inefficient, etc. state just means, in practice, those parts of the state which provide social and cultural services for everyone – schools, social services, and not least the NHS – and which the right doesn’t like. The effect of this incessant drip of denigration is to narrow down our concept of the state to just these parts of it, and to make us at best indifferent toward them. We unconsciously absorb the idea that they are by nature bureaucratic, inefficient, monopolistic, etc. Every fault they exhibit tends to be accepted as evidence of an inherently defective institution. We stop seeing them as the historic collective achievements they are, as expressions of what a mature society can accomplish through collective effort, achievements we have a collective responsibility to protect and sustain. Above all we are conditioned to think that if they need improving, we ourselves can have no role to play in doing so – and that the only route to improvement is via privatization. Yet the NHS in Scotland and Wales provides a dramatic contradiction of this whole way of thinking. The Scots and the Welsh have used their devolved powers to keep and develop the NHS as part of the state. This is partly a reflection of the stronger hold of Medicare's 50th Anniversary

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solidaristic values in Scotland and Wales – including within the political class and the commentariat, and the medical professions. It is also due to the fact that the voting system in both countries helps the majority to get the policies they want. It will be very interesting and important to follow what further improvements are achieved in Scotland and Wales – and how what counts as an ‘improvement’ is defined when it is patients’ needs, rather than business values, that are the measure of it. At the same time we should not expect improvements to run ahead of changes in other parts of the state in Scotland or Wales. The state was famously defined by the young Karl Marx as ‘the table of contents of civil society’: it registers the balance of social forces, and the level of democracy and solidarity and civic energy, that exist in the wider society. Without an expansion of the notion of democracy beyond the skin-deep variety, consisting merely of periodic heavily-managed elections, the progress made with the NHS in Scotland and Wales is bound to run up against limits set by the wider context. Yet the progress already made could itself encourage experimentation in other fields, from education to central government. And it offers a badly-needed antidote to right-wing ‘Anglo-Saxon’ ideology. At the very least, the ‘Celtic’ NHS shows that the state can be a democratic, rational, progressive state – if we want it to be.

Colin Leys is an honorary professor of politics at Goldsmiths College London, and former Professor of Politics at Queen's University in Kingston, Canada. Endnotes: 1. The situation in Northern Ireland is more mixed, but essentially close to the Scottish and Welsh pattern. Further details on the NHS in Scotland and Wales are given in The Plot Against the NHS by Colin Leys and Stewart Player, Merlin Press 2011, but comparative work on what is happening to the NHS in all three countries is urgently needed.

Tommy Douglas defends public health care CBC Retro Tuesday, August 02, 2011 CBC Retro

Debt Ceiling Deal Threatens Medicare, Medicaid Tuesday, August 02, 2011 August 2, 2011 by Healthcare-NOW!

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With a decision finally reached this afternoon on the debt ceiling, both the President and Congress have put Wall Street and the wealthy in front of the needs of their constituents. Our most important social insurance programs are squarely on the chopping block. The spending cuts will only exacerbate the economic crisis and people’s suffering. This process has made us deeply angry and frustrated. But there is one thing we have been able to count on: you. As the debt ceiling debate unfolded, you used your frustration to fuel the fight against injustice. You jammed phone lines and flooded inboxes on the Hill, filled waiting rooms in your Representative’s and Senators’ offices and inundated local newspapers with op-eds and letters to the Editor to demand our social insurance programs be protected. And you rallied behind our call to use Medicare’s 46th anniversary as a way to highlight improved Medicare-for-all as the solution to our fiscal crisis. Because of you, there were over 45 birthday parties, demonstrations at Congressional offices and public meetings in 23 different states–more than twice as many events as last year. Because of your dedication to equitably funded and distributed single-payer healthcare for all, you reminded us that there is still hope–that there are still people who care about our families and communities, and will fight to protect them. The deal leaves many changes to Medicare and Medicaid up in the air, and that means we need to keep working together to fight these threats. We need you to keep organizing, keep educating and keep advocating for improved Medicare-for-all. You can be more involved today. Go here to find local chapters of Healthcare-NOW! or one of our affiliate organizations near you. Need support for your chapter, or help getting organized in your community? Write to katie@healthcare-now.org for more information. Now is the time to continue build our skills and our network, so we can build a movement to win.

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Revolutionary Doctors Tuesday, August 02, 2011 How Venezuela and Cuba Are Changing the World’s Conception of Health Care Steve Brouwer Monthly Review Press Buy this Book

Paperback, 240 pages ISBN-13: 978-1-58367-239-6 Cloth (ISBN-13: 978-1-58367-240-2) May 2011; $18.95 Revolutionary Doctors gives readers a first-hand account of Venezuela’s innovative and inspiring program of community healthcare, designed to serve—and largely carried out by—the poor themselves. Drawing on long-term participant observations as well as in-depth research, Brouwer tells the story of Venezuela’s Integral Community Medicine program, in which doctor-teachers move into the countryside and poor urban areas to recruit and train doctors from among peasants and workers. Such programs were first developed in Cuba, and Cuban medical personnel play a key role in Venezuela today as advisors and organizers. This internationalist model has been a great success—Cuba is a world leader in medicine and medical training—and Brouwer shows how the Venezuelans are now, with the aid of their Cuban counterparts, following suit. But this program is not without its challenges. It has faced much hostility from traditional Venezuelan doctors as well as all the forces antagonistic to the Venezuelan and Cuban revolutions. Despite the obstacles it describes, Revolutionary Doctors demonstrates how a society committed to the well-being of its poorest people can actually put that commitment into practice, by delivering essential healthcare through the direct empowerment of the people it aims to serve. Steve Brouwer is one of the nation’s best front-line reporters from the ongoing class war. —Barbara Ehrenreich, author, Nickel and Dimed Steve Brouwer is the author of Robbing Us Blind: The Return of the Bush Gang; Sharing the Pie: A Citizen’s Guide to Wealth and Power in the United States; Exporting the American Gospel: Global Christian Fundamentalism(co-authored with Susan D. Rose); 74

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and Conquest and Capitalism, 1492-1992. He is also a carpenter and designer, and has organized worker-owned construction businesses and housing cooperatives. In 20072008, he lived in a rural village in the mountains of Venezuela and wrote about his campesino neighbors and the Bolivarian Revolution.

Henry E. Sigerist:: Architect for Saskatchewan Medicare Tuesday, August 02, 2011 Medicare: A People's Issue

Sigerist on cover of Time, 1939 Henry E. Sigerist was in Saskatchewan for less than a month but his recommendations would act as a blueprint for health care in Saskatchewan for the next fifty years. Soon after coming to power Premier T.C. Douglas contacted the Johns Hopkins professor who had written extensively and glowingly about Soviet medicine. Dr. Sigerist was born in Paris, received his M.D. from the University of Zurich in 1917 and, after a period of medical service in the Swiss army, devoted himself to the study of the history of medicine while teaching at the Universities of Zurich and Leipzig. In 1931 he came to Johns Hopkins as a visiting lecturer in history of medicine and the following year succeeded William H. Welch as director of the Institute of the History of Medicine. In 1933, Sigerist founded the Bulletin of the Institute of the History of Medicine, which later became the Bulletin of the History of Medicine. In Saskatchewan, the 1944 Sigerist Report gave sudden impetus to building new hospitals and to the forming new Union Hospital Districts. Forty-four new districts were created in three years. A major figure in the socialized medicine movement, Sigerist was also a pioneer in the study of the social history of medicine. In 1947 he returned to Switzerland to work on a comprehensive multi-volume history of medicine. He died in 1957.

The following article is from Time Magazine, Monday, Jan. 30, 1939 Medicare's 50th Anniversary

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Medicine: History in a Tea Wagon One fresh spring afternoon twelve years ago, a stout, bald American and a compact, bright-eyed young Swiss lingered over lunch in Leipzig's famed Auerbach's Keller. "This is the place," said Dr. William Henry Welch, dean of U. S. pathologists, shifting his big cigar to the other side of his mouth, "where my career started.'' He told how he had met great Dr. John Shaw Billings in Auerbach's Keller half a century before, how he and Billings had worked to establish at Johns Hopkins the first modern medical school in the U. S. Then he launched into a glowing description of Johns Hopkins' new Institute of the History of Medicine and the library that was to bear his name. As he listened, Professor Henry Ernest Sigerist, who w:as then teaching history of medicine at the University of Leipzig, little realized that the major phase of his career was starting in Auerbach's Keller. Five years later, a short time before he died, old Dr. Welch asked Dr. Sigerist to succeed him as head of the History of Medicine Institute. Before he accepted. Dr. Sigerist carefully explored the great medical centres of New York City, Chicago. Boston. Philadelphia, San Francisco and institutions in smaller towns. He studied history, economics and folkways, wrote home poetic letters on the bright beauty of New England autumn, the "whiplash" of Colorado winds. He found the U. S. "a great world, a gigantic historical process, strange and alluring," and felt that medicine's centre of gravity was shifting from Germany to the U. S. So he finally decided to settle down at Hopkins. Henry Sigerist is considered by many to be the world's greatest medical historian. He reads 14 languages, has taught and lectured from Cornell University to Zurich, is an expert on such things as medieval prescriptions and the 16th-Century treatment of gunshot wounds. To Dr. Sigerist, however, medicine is not only a science whose triumphs are technical improvements, but a service whose success is measured by the ability of a small group of men to make mankind's life more livable. Even in his first enthusiasm over the U. S., Dr. Sigerist felt medical care was unevenly distributed, that physicians had not yet found their proper place in a complex new society. In the early 1930's he became known to U. S. physicians as an articulate apostle of socialized medicine. No man's arguments are read by either side of the socialized medicine controversy with greater respect. Many a thoughtful U. S. physician opposes socialized medicine because, like a businessman, he dislikes the idea of government interference and fears the influence of politics. Nevertheless, in the past century every civilized government in the world has enormously increased its aid to the ill. And a strong current in favor of socialized medicine runs through recent writings of physicians on both sides of the Atlantic. Last week a Gallup poll on voluntary health insurance indicated that some 25,000,000 persons largely in the group earning over $980 a year would be willing to pay $3 a month for complete medical and hospital care. Only representative poll taken among doctors was last year when Modern Medicine asked its readership whether they favored use of public funds to provide medical care for low income groups. Over 16,000 doctor-readers replied of whom 54% said yes. No medical politician, Dr. Sigerist has never plunged into the bitter medical battles that rage in Chicago and Washington. But as a No. 1 Medical Historian who is convinced that history spirals toward socialization, Henry Sigerist has a big intellectual influence at this time when the U. S. Government is taking socialized medicine seriously.

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Washington Plans. No Administration has taken so deep an interest in medical legislation as Franklin Roosevelt's. Under the Social Security Act of 1935 Congress authorized annual expenditures of $3,800,000 for maternal and child health, $8,000,000 for grants to State health departments, $3,000,000 for the blind. In 1937, it appropriated $1,500,000 for cancer, in 1938, $3,000,000 for venereal disease. This week, as evidence of the Federal Government's increasing sense of its public health obligations, the President told Congress: "[We do] not propose a great expansion of Federal health services, [but recommend] that plans be worked out and administered by States and localities with the assistance of Federal grants-in-aid. The aim is a flexible program ... a sound investment which can be expected to wipe out, in the long run, certain costs now borne in the form of relief." Legislator most interested in Medical legislation is New York's Senator Robert Ferdinand Wagner, and this week he was dressing up a health bill which will closely follow7 the liberal recommendations of the President's Technical Committee on Medical Care. The Senator will ask for Government grants to States an 1 the U. S. Public Health Service amounting to $50,000,000 for 1939. The recommendations include extension of public health services, expansion of hospital facilities, medical care for reliefers and the "medically needy" (those whose low incomes make payment of doctor bills a hardship), workers' compensation for loss of wages through illness. The not so liberal American Medical Association (110,000 of the 170,000 U. S. doctors) has approved these recommendations, but objects to the further suggestion that all medical service in the U. S. be organized on a taxation or insurance basis. To A. M. A. leadership, this proposal smacks of socialized medicine. As the bill headed toward the floors of Congress, A. M. A. Leaders Irvin Abell and Olin West rushed to Washington to repeat their objections to President Roosevelt. Objections. Opponents of socialized medicine, especially the powerful A. M. A., have long argued that State control of medicine would be a radical and costly experiment. Millions of dollars would be spent on extra medical care at a time when the nation is in grave economic difficulties. All the fine old traditions of private practice would be swept away. A patient would no longer be free to choose his own physician, and the close relationship between patient and physician would be spoiled. Standards of medical care would be greatly lowered, for doctors would become involved in so much red tape that they would have no time for careful diagnoses or experimental" laboratory work. Physicians would have no incentive to improve their skill, for they would remain on fixed salaries. Worst of all, politicians would dictate to medical men, and public health officials would change with each election. Rebuttal. In his quiet lecture hall in Baltimore, 40 miles from the Capitol, Dr. Sigerist was repeating, in a new course on "medicine and its relations to society," his rebuttal to A. M. A.'s famous arguments. His chief points: 1) State control of medicine is not a radical departure. "More than sixty per cent of all hospital beds are owned and operated by the Government. . . . Only one-tenth of the work performed by the Public Health Service is devoted to ... control of water supplies, sewage systems. and so on, and nine-tenths of the work consists of new tasks which private medicine was unable to fulfill." In the past 30 years the duties of the Public Health Service have grown to include care for cases of tuberculosis, blindness, leprosy and narcotic addiction, and research on practically every disease, common and uncommon, Medicare's 50th Anniversary

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that is found in the U. S. 2) To finance a system of State medicine in the U. S. would not be difficult or extravagant. An estimated ten billion dollars of manpower is lost each year through sickness and premature death and the nation's medical bill is three-and-a-half billion dollars annually. This money is "spent in a haphazard and wasteful way. If the same amount were spent rationally, little more would be required to provide adequate medical service for the whole population.'' The most efficient system, under the present circumstances. Dr. Sigerist believes, would be one in which the indigent would receive complete medical care, free, in well-equipped Government health centres; the low income group would finance its medical costs through compulsory health insurance:*the higher income group would take care of their health in any way they pleased. All competent doctors who wished would be placed on salaries in medical centres. 3) To say that salaried doctors lose their incentive to do good work is an insult. Koch, Pasteur, Gorgas, Reed, Welch were all salaried men. So are the workers in the Mayo Clinic and the Rockefeller Institute and 15% of U. S. doctors who work in other institutional hospitals. "Whenever a [salaried] position is vacant, hundreds [of doctors] apply for it." (The average income of a U. S. general practitioner is under $3,500 a year.) 4) Although socialized medicine would certainly limit a patient's free choice of a physician, few people today are free to choose their doctors. Dispensary patients, farmers, and even city dwellers, usually have to accept the doctor who is handy. But socialized medicine should have this advantage: doctors on salary would be more competent for they would have time and money for frequent periods of postgraduate training which are neglected by most physicians today. And those who are attached to a family doctor would always have the privilege of calling him at a price. 5) Socialized medicine would not spoil the personal relationship between patient and physician. "The fact that [a] doctor is a member of an organized group . . . does not spoil the relationship. What spoils it today is that the doctor has to charge a fee ... and the patient has to pay the bill. Once the money question is removed, the relationship between physician and patient becomes purely human. ' 6) Socialized medicine need not lower the standards of medical care. "The quality of [medical] service given to most people today is," says Dr. Sigerist, "rather inferior, to put it mildly." Many patients cannot afford expensive examination and treatment, and most general practitioners have neither the special knowledge nor the equipment, to render such services in their offices. "Socialized medicine . . . endeavors to bridge the gap that exists today between individual and hospital practice by bringing the general practitioner into close contact with a health centre." 7) It will be serious if Government control brings politics into medicine. A recent shocking example: Philadelphia's ill-run municipal hospital for the insane at Byberry, which four months ago was placed under State control, is now being efficiently reorganized. But corruption and inefficiency do not need to occur in all Government activities. The old and able U. S. Public Health Service has never been touched by the breath of scandal, and many cities and States have honest health departments, free of politics. Dr. Sigerist argues that because the average citizen is more interested in his health than he is in highway construction, "political corruption in the medical field would not be tolerated; it would be opposed by public opinion in the strongest possible way."

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Theory v. Practice. No one realizes better than Professor Sigerist that theory, no matter how well bolstered with facts and figures, must be tested by practice. Next week in his book-lined seminar room he will give assignments to 30 medical and graduate students for the first course in practical socialized medicine ever held in the U. S. Each student will be given a Maryland county, told: 1) to investigate its economic groups, their incomes and occupations, health conditions and medical facilities; 2) to present an ideal plan for county medical organization that would emphasize prevention of disease and guarantee to every inhabitant the best possible medical care. In May the class will face the hard facts of how much it would cost to finance their plans. In this way Dr. Sigerist hopes to raise a generation of socialized medicine enthusiasts who will know what they are talking about. "Adventurous Career." Dr. Sigerist admits with pride that he has had "an adventurous career." Born in Paris in 1891. he moved at an early age to Zurich, Switzerland, later went to the University there. He also studied in England and Germany. When he was 14 he decided to become an Orientalist, ordered an Arabic grammar from an astounded bookseller, and rose an hour early every morning to plough through Arabic verbs. Then he plunged eagerly into Hebrew, Syriac, Persian, Chinese. His career as an Orientalist came to an end when his teachers wanted him to specialize. "All my life I have avoided specialization," says Henry Sigerist. He went into science, then medicine, and practiced obstetrics, then studied experimental pharmacology. After the War he thought he would be a country doctor in a Swiss valley. "I would love my valley," he said, "and keep it in order." But it dawned on him that a valley in Switzerland was too narrow for his ambitions, and he returned to the limitless world of scholarship. He has traveled in almost every European country, has studied their medical systems, histories, social systems. In Baltimore he spends most of his time at the Institute, on the third floor of the granite and limestone Welch Medical Library. Tucked among his books are large files of notes for a three-volume series on the history of Latin medical literature in the early Middle Ages, which Dr. Sigerist began 16 years ago. In a wheeled filing cabinet, called the "tea wagon" are notes for a definitive four-volume History of Medicine (he hopes to publish the first volume next year), and a two-volume Sociology of Medicine. To the lecture hall on the third floor go hundreds of enthusiastic students during the week from the schools of Medicine, Hygiene and Public Health. Three steps lead up to the lecturer's oaken platform, and a hand railing stands next to the steps. It was built for Founder Welch, who was so rotund that he could not see beyond his middle, had to use the railing for a guide when he came to the edge of the platform and descended the steps. No need for a hand rail has energetic Dr. Sigerist who often takes the steps in one leap. Students enjoy his lively classes, for Dr. Sigerist does not mind expounding his dynamic conception of medical history in hand-to-hand argument. A student once took issue with him, and when Dr. Sigerist asked him to quote his authority the student shouted, "You yourself said so." "When?" asked Dr. Sigerist. "Three years ago," answered the student. "Ah," said Dr. Sigerist, "three years is a long time. I've changed my mind since then." Medicare's 50th Anniversary

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*Of many foreign systems of health insurance, Dr. Sigerist is critical. For example the English system, under which a doctor receives about $2.25 a year to take care of each insured patient has led to a cheap type of bottle practice, and for the premium he pays, the insured patient receives only general medical care."

Find this article at: http://www.time.com/time/magazine/article/0,9171,760717,00.html

J. Wendell Macleod: Saskatchewan's Red Dean Wednesday, August 03, 2011 A revealing biography of one of the architects of medical education in Canada By Louis Horlick CA $34.95

Popularly known as Saskatchewan's Red Dean because of his progressive views and strong support of Canada's first medicare plan, J. Wendell Macleod (1905-2001) was a charismatic pioneer in social medicine and medical education. Louis Horlick mines Macleod's diaries, which span seventy-five years, in a vivid biography that also depicts the social and political complexities of health care in Canada in the twentieth century. Macleod was an ardent believer in the social principles of health care. His early awareness of the economic chasm that separated rich from poor provided the focal point of his career as first dean of medicine at the University of Saskatchewan - he taught that understanding the social, economic, and political world in which people lived was critical to good medical education and practice and made it the core of the curriculum. J. Wendell Macleod offers a revealing portrait of an early advocate of universal health care who passionately advanced his social agenda in his profession and practice. Macleod was appointed an officer of the Order of Canada in 1980. Review quotes "Making good use of his remarkable diaries, this book presents the life of a brave and admirable man complete with warts." Robert Spasoff, epidemiology and community medicine, University of Ottawa 80

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Louis Horlick is professor emeritus, medicine, University of Saskatchewan, and the author of Medical College to Community Resource: Saskatchewan's Medical School, 1978-1998 and They Built Better Than They Knew: Saskatchewan's Royal University Hospital, A History, 1955-1992. He is an officer of the Order of Canada.

Health Care in the Mao Era Friday, August 05, 2011

Facts and Details

Improved health care was considered one of the great success’s of the Mao era. Barefoot doctors brought modern medicine and prevention strategies to places that had minimal health care. These and other Chinese health care workers are credited with 1) reducing infant mortality to a lower level than in New York City, 2) eradicating small pox and nearly eradicating sexually transmitted diseases, tuberculosis and schistosomiasis and 3) raising the average life span of Chinese from 35 in 1949 to 68 years in 1979. Many of China's health statistics are comparable with those of a much richer country. In the Mao era everyone was covered by health insurance that was free or very cheap. Although the medical care was often less than ideal at least people were covered and if they did need hospitalization it wouldn’t bankrupt them. The cost of having a baby delivered at commune hospital in the 1980s was about $3. The state subsidized treatment for all kinds of illnesses. One Chinese factory told Reuters, "I never spent a penny. Often you’d be given a week's supply of medicine when you only needed it for two days. The rest you'd just throw away." In the 1950s, Mao launched a campaign to get rid of the snails that cause schistosomiasis by urging peasants to turn over soil in lakes and river beds by hand before the rainy season. People chanted slogans like "our strength is boundless and our enthusiasm redder than fire" and were inspired by banners that read "Empty the rivers to wipe out the snails, resolutely fight the big bell disease." The campaign came very close to eradicating schistosomiasis.

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Mao launched the program to kill the "four pests" (sparrows, rats, insects and flies). Every person in China was issued a flyswatter and millions of flies were killed after Mao gave the directive "Away with all pests!" The fly problem persisted however. The writer Hu Yua recalls his doctor father wearing a bloodstained smock in a small oneroom clinic across the street from his family house. Their home also faced a public toilet, where nurses often dumped tumors, and the local mortuary. On hot summer days, it was cool inside the mortuary, Yu recalled, and since the corpses were deposited only at night, I often took a nap there. Sleeping at night in our home, we would be woken by the sound of people crying. [Source: Pankaj Mishra, New York Times, January 23, 2009] Barefoot Doctors Doctors in the Mao era In the Mao era, around 1 million "barefoot doctors” were give six months of training and sent out to countryside to open rural clinics, provide immunizations and offer basic medical care. They often wore straw hats and carried small wooden medical boxes from their shoulder. Some of barefoot doctors only had an elementary school education. One 68-year-old man said he took an aptitude test on the suggestion of his mother. “They asked me, why does a train run so fast. I’d never seen a train before, so I racked my brain.” The barefoot doctors traditionally roamed the countryside, visiting around a dozen farmers a day, charging them a nominal registration fee and giving out medication for free. They didn’t do anything too complicated. One doctor told the Los Angeles Times, “I don’t treat serious illnesses. I don’t know how.” The barefoot doctor tradition lives on in services such as the Lifeline Express, a train that operates in poor areas in Xinjiang Province and offers cataract surgery for free to all comers. The cataract operations take 15 to 20 minutes, involve cutting the cornea and replacing a clouded lens with a clear artificial one,. The operations given in an assembly line fashion to patients by doctors who put in 12 hour days and volunteer their services for little pay for one-year stints. Although China's ‘barefoot doctors’ scheme relied on primitive supplies and under-trained doctors, it has been acknowledged by the World Health Organization (WHO) for the pioneering role it played in the development of China's rural primary healthcare.

Treatment by Barefoot Doctors Describing the difficulty in bringing good medical care to rural areas in China, one barefoot doctor told the New York Times, "When we go out and try to inoculate babies, some peasants are very frightened and hide their kids. Or they turn their dogs on us to bite us and drive us away...We give them injections for measles, and then the kid gets a cold. So the parents come, and complain. They say, 'You promised that my child wouldn't get sick!'" The inoculations themselves are fairly easy to give to young children because many of them don’t wear pants or they wear pants purposely made with holes in them.. These days the doctors don’t roam so much any more. Each village has its own doctor. A typical rural clinic run by a barefoot doctor consists of a single room in mud-brick, thatchroofed building or concrete, tin-roof structure with a couple of bamboo cots, a desk and wooden cupboard with some pain, fever, diarrhea, and cold medicines inside. It typically 82

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doesn’t have a phone but it does have disposable needles, an improvement from the old days when needles were reused after they were swabbed with alcohol. Rural clinics typically have dirt floors and lack sterilizing equipment, Many of the medicines are fake but are sold by doctors anyway because the drugs are their primary source of income. Equipment consists of a thermometer and a blood pressure machine that doesn’t work. Wish lists by barefoot doctors include a stomach pump, tools for extracting abscessed teeth, and oxygen cannisters for respiratory problems. With the introduction of economic reforms and capitalism, money for public health has declined. Barefoot doctors see fewer people because their patients have to pay considerably more than they did in the old days and people get sicker less. One barefoot doctor told AP, "Now the job is easier because vaccinations have eliminated so many diseases, like measles." One their most successful herbal medicines, pumpkin seeds, was used to rid victims of worms. Today the treatment is also used in Africa to combat schistosomiasis.

Pre- History of Barefoot Doctors Alexander Casella wrote in the Asia Times, “When the communists come to power in China in 1949, the country had some 40,000 doctors for a population of some 540 million, which meant on average one doctor for some 13,500 inhabitants (the figure today is one for 950). The vast shortages in terms of numbers was compounded by another problem. Most of the doctors were in the cities and except for some practitioners of traditional medicine, the countryside was practically deprived of any real medical care and epidemics. This meant infectious diseases and poor sanitation were pervasive.”[Source: Alexander Casella, Asia Times, January 16, 2009] “While many of its top leaders were of urban or semi-urban origin, the communist movement in China derived its strength from the fact that it had succeeded in mobilizing the peasantry in its support and, once in power, the party made rural healthcare one of its priorities.” [Ibid] “With trained doctors in short supply, the central government in 1951 decided that basic healthcare in the countryside should be provided by health workers rather than by fully trained physicians. In 1957, there were more than 200,000 such ‘village doctors’ whose administration was under the responsibility of the local authorities. While these village doctors had received only basic training and could not treat complicated cases, their impact was considerable and especially so in preventing minor ills or wounds from developing into complex medical problems and in implementing nation-wide vaccination campaigns.” [Ibid]

Early History of Barefoot Doctors “In 1968, the village doctor program was renamed ‘barefoot doctors’, with the name derived from southern farmers who would often work barefoot in the rice paddies. It was presented as one of the great achievements of the Cultural Revolution. Actually, it had been in force since long before but the rebranding suited the politics of the time. With millions of ‘educated youth’ sent to the countryside, the barefoot doctor scheme acquired Medicare's 50th Anniversary

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an iconic dimension. Actually, it was nothing more than ideology on the rampage combined with a reform of the existing medical system, which now included an expansion of the short-term training program of village doctors.[Source: Alexander Casella, Asia Times, January 16, 2009] “Reducing the number of years of training for doctors, a policy that now applied to all university education - was very much an obsession with Mao Zedong. The chairman had a strong mistrust of doctors, including his own, and used to claim that six or more years of medical training were a waste of time and resources when one or two were sufficient. Given the state of China's economy at the time, this view was not totally misplaced except it was not derived from an objective analysis, but rather from a personal suspicion of the medical profession. If implemented, it would have set medicine backwards in China for decades.” [Ibid] “Nonetheless, the impetus it gave to overall rural healthcare was considerable. Even though the supplies provided to the barefoot doctors - generally a few medicines, some needles and syringes and not much else - was primitive. Therein lay the weakness of the system; it provided the rural poor with a level of healthcare unknown before the revolution, but was unable to develop beyond the requirements of the most basic of health needs.” [Ibid] “Given, however, the requirements of China at the time, the flaws in the system were slight as opposed to the program's achievements, an accomplishment that was acknowledged by the declaration of Alma Ata of September 12, 1978, when a WHOsponsored conference recognized China's achievements in public health as a milestone for Third World countries.”

Collapse of the Barefoot Doctor System “Initially, the barefoot doctor scheme survived the Cultural Revolution and in 1980 the State Council directed that, after having passed an examination, barefoot doctors could qualify as village doctors. This was hoped to fill the gap in rural areas between primary needs provided by barefoot doctors and advanced healthcare provided by fully trained practitioners.” [Source: Alexander Casella, Asia Times, January 16, 2009] “The rural health system started to collapse in the late 1970s and early 1980s as a result of China's economic liberalization and the privatization of agriculture. Local medical facilities that had been financed collectively by the communes lost their source of income and had to close down. This in turn led to a collapse of primary healthcare and inoculation facilities and the result was that many diseases that had been eradicated reemerged in the countryside. Regarding hospitalization, the user-pays system introduced in the 1980s left many rural patients, practically all of whom had no health insurance, unable to pay for medical care, which led to a further decline in rural health standards.” [Ibid] “While the authorities were not totally unaware of the collapse of the rural health system as a price to pay for de-collectivization, no systematic measures were taken to redress some of the downsides of economic reform. Indeed, in this field, like many others, the regime demonstrated its inability at implementing parallel policies rather than skipping from one priority to another. By the early 1990s, the government had not only done away with the constraints of collectivization, but had also, in the process, seen the collapse of the rural healthcare system. This was akin to throwing the baby out with the bath water.” 84

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[Ibid]

Rural China Misses Barefoot Doctors Today primary care, even in the cities, is almost non-existent and with no independent doctors or neighborhood clinics, people have to go to hospitals even for simple healthcare needs. With hospitals told to finance their own costs and 79 percent of the population having no health insurance, the burden on the average Chinese is considerable, with the result that many simply cannot afford any healthcare at all.” [Source: Alexander Casella, Asia Times, January 16, 2009] “The one to 950 ratio of doctors to the population appears encouraging, but it only reflects part of the picture. It compares favorably to one for 500 inhabitants in Japan, 400 in Australia and 300 in Western Europe as opposed to 1,700 in India and 50.000 in Tanzania. But these numbers don't reflect the fact that most of China's doctors are concentrated in the cities. Likewise, while most general hospitals are clearly below Western standards aside from a few specialized hospitals which routinely perform complex operations with well-trained doctors and the latest equipment. These are increasingly catering to the need of the newly affluent Chinese.” [Ibid] “In a country where large swaths of the population do not have access to the most basic healthcare, it is this group which spends an estimated $2 billion a year on cosmetic surgery. This can only increase the gap between the haves and the have-nots. “ [Ibid] “According to current estimates, it would take half a million additional doctors, well distributed across the country, to provide the healthcare that the Chinese really need. This, however, would require not only additional training of doctors but also a reform of their status and remuneration. This would go a long way towards reducing the exodus of Chinese doctors, an increasing number of whom are now practicing in Africa, where they not only receive better wages but also have a higher social standing.” “According to Western medical sources, the Chinese government is coming to realize that it needs to address what could develop into a major health crisis in rural areas, but there remains a large question mark over what priority they have set for this and how they plan to address it.”

The Fateful Summer of '62 Saturday, August 06, 2011 Medicare's foes fail to stop its birth in Saskatchewan By Ed Finn CCPA

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Ed Finn, Ottawa, 2008 As a witness to the birth of Medicare in Canada, and as someone who played a very small part in bringing it to life during the turbulent summer of 1962 in Saskatchewan, I am sickened now by the spectacle of its slow, cunningly devised destruction. Public health care did not have an easy birth. It was bitterly opposed by the medical, business and media ĂŠlites, who saw it as a threat to their profits and privileged status. They lost the propaganda battle 45 years ago, but in recent years, having steadily underfunded and weakened "socialized medicine," they are circling it like vultures, eager to peck greedily at its entrails. Medicare in Canada had its inception in the mind of Tommy Douglas. When he was a boy, he fell and hurt his knee, and a bone disease (osteomyelitis) set in. His parents couldn't afford the services of a bone specialist, so he was put in a Winnipeg hospital as a charity patient. The doctors decided they had no choice but to amputate his leg. But he was lucky. An orthopedic surgeon was looking for patients he could use in his teaching classes, and, after examining Tommy's swollen knee, he told his parents he could save the leg if they would let him use the boy to help teach his students. Of course they gladly agreed, and Tommy escaped the planned amputation. "Had I been a rich man's son instead of the son of an iron moulder," he later recalled, "I would have had the services of the finest surgeon, and would not have had to depend on chance for a cure. All my adult life I dreamed of the day when an experience like mine would be impossible and we would have in Canada a program of complete medical care without a price tag." He took that dream with him into the Saskatchewan legislature when he first became premier in 1944. But, although some important steps toward that goal were taken fairly soon, including a province-wide public hospital insurance plan in 1947, it was not until Nov. 17, 1961, that the CCF government felt confident enough to pass the full-fledged Saskatchewan Medical Care Insurance Act. By then, Tommy Douglas had left provincial politics to become national leader of the New Democratic Party in 1961. But he had fought the 1960 election in Saskatchewan on the central promise of introducing Medicare, had shepherded the bill through its early stages, and felt safe in leaving its final implementation to his successor as premier, Woodrow Lloyd. The passage of the act ignited a firestorm of controversy and conflict that raged for 86

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months leading up to its planned starting date on July 1, 1962. And when that date arrived, it triggered a province-wide doctors' strike and a summer-long battle that raged even more furiously. I was plunged into the thick of that dispute shortly after it erupted when the Canadian Labour Congress, the Saskatchewan Federation of Labour, and Tommy himself sought my help as a writer and editor. The unions and other supporters of the legislation faced an onslaught of anti-Medicare propaganda launched by the doctors, the major business groups, and nearly all the newspapers and radio stations in the province. The doctors had succeeded in scaring and enraging many of their patients, warning them in personal letters that Medicare would deny them the right to choose their physicians and would destroy the important doctor-patient relationship. Patients who believed these lies started forming "Keep Our Doctors" Committees. Support for the K.O.D., fed by mass anxiety, came from the opposition Liberal and Tory parties, from business people, some clergymen, and from anyone with a grievance against the government. Behind the scenes, the powerful Canadian and American Medical Associations put their resources at the disposal of the Medicare foes. It was a one-sided public relations contest, but we managed to get the facts out to many residents, using the few media outlets that would accept our press releases, and by starting our own weekly newspaper, The Public Voice. This paper was widely distributed door-to-door by the many Citizens for Medical Care Committees that sprang up to oppose the K.O.D. Committees. As the war of words continued, we did some polling that revealed the anti-Medicare forces weren't holding onto nearly as much public support as they claimed. The doctors and their more fanatical backers turned out to be their own worst enemies. Their attacks on the bill, on Premier Lloyd, and on the few doctors who continued to provide services grew more wild and hysterical. Their posters that caricatured CCF leaders as Nazis and communists, and their burning of effigies of Tommy Douglas, disgusted many more people than they pleased. The turning point in the struggle came in mid-July, when the doctors and their K.O.D. allies staged what they boasted would be a massive public protest in front of the Parliament buildings in Regina. They predicted a turnout of at least 20,000, but barely 4,000 showed up on a warm, sunny day. The failure of this widely promoted rally broke the doctors' defiance. They had overestimated their public support and underestimated the grassroots sentiment in favour of a public health care plan. Their strike was called off after 23 days and a settlement was reached shortly afterwards with the help of Lord Taylor from Britain, who acted as a mediator. Medicare was soon solidly established in a Canadian province, providing a model that was extended across the nation with the adoption of the Canada Health Act in 1967. Tommy Douglas's dream had become a reality. My mind keeps returning to that historic summer in Saskatchewan as I see the precious legacy of a great Canadian leader now being torn to shreds. Every night during that fateful summer, we who brought Tommy's vision to the public met to share our concerns. We all wondered if the CCF government would have the courage to keep defending its Medicare's 50th Anniversary

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Medicare bill. It wasn't easy. The enormous corporate and media pressure brought to bear on Lloyd and his cabinet was truly awesome. It continues to astonish me that they remained resolute day after punishing day. Certainly, no government today would display such fortitude. It's ironic that the current attacks on Medicare are not being led by the doctors, who have largely been converted to its benefits. In fact, the Canadian Medical Association in 1998 enshrined Tommy Douglas in its Hall of Fame, the only non-physician to be so honoured. His plaque proudly identifies him as "the Father of Medicare." The attacks are now being directed instead by the huge private health corporations that stand to reap billions in profits from a two-tier system, as they do in the United States. The politicians who now serve these corporate interests are committed to dismantling Medicare. They include most provincial premiers and health ministers, and of course the federal government under both Conservative and Liberal party administrations. (Why else would Health Canada have given its written permission to former Alberta Premier Ralph Klein to allow doctors in that province to practise in both public hospitals and private clinics? Without that approval from Ottawa, Klein would not have dared introduce his Bill 11 to privatize some of the province's hospitals.) Medicare is dying in Canada because our corporate rulers want all of its potentially profitable operations privatized. And what they want these days, they usually get. The defenders of Medicare gathered in Regina recently to mount a stronger campaign to preserve this jewel of Canada’s social services. We should all pitch in to join this crucial resistance movement. Unless it succeeds, it may not be much longer before a boy in a poor Canadian family who falls and hurts his knee may have his leg amputated instead of healed. There's no profit to be made from operating on kids whose parents can't afford expensive treatment.

Greece's healthcare system is on the brink of catastrophe Saturday, August 06, 2011 Patients who cannot afford treatment and hospitals without critical supplies are among victims of the financial meltdown Peter Beaumont in Perama guardian.co.uk Friday 5 August 2011

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The accident and emergency ward at a hospital in Athens – hospitals here face regular shortages of materials and equipment. Photograph: Sean Smith for the Guardian Adonis Kostakos is unemployed and diabetic. Aged 50, he last worked regularly four years ago in the port of Piraeus. Back then he used Greece's public hospital system to have his blood sugar checked and get his medication. These days, receiving no unemployment benefit, he cannot afford to pay for his drugs or the new €5 hospital fee introduced as part of Greece's austerity measures. So today Kostakos has come to a free clinic in the shipbuilding town of Perama, where he lives, to pick up his medication. The drop-in surgery run by the global charity Médecins du Monde was originally set up to cater for illegal immigrants. But today, there are only native Greeks. Posters on the wall show war and famine, but the solitary doctor, George Padakis, 30, is dealing with a different kind of catastrophe – victims of the financial meltdown, which has pushed Greece's health system to the brink. "I have no insurance and I'm unemployed," says Kostakos. "I heard about this clinic from a friend. I was going to the public hospital, but nowadays I can't afford to do even that. I know lots of people in this town who are in the same situation as me, 10 of them personally." Next in line is Nikos Famalis. He is 72 and has multiple health problems. "I've been coming here since it opened," he says, when he emerges clutching a handful of boxes of medicine. "I used to have insurance when I was younger, but I don't have the right papers now. I'm trying to get papers for free treatment in the public hospital but it takes time." The Greek system is a bureaucratic nightmare, with endless paperwork to fill in and hoops to jump through. Those without resources of any kind can qualify for free healthcare, but even then the state will only pay for some medicines. And even those entitled to reduced or free medication often cannot find pharmacists to provide them and are instead asked to pay the cost up front and seek reimbursement. Others come into the clinic. A middle-aged man with swollen legs from heart disease needs diuretics; a younger man, who once worked in the nearby shipyards, comes in to be treated for high blood pressure. "When I came here," says Padakis, "I didn't expect to be treating Greeks. I had no idea

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so many Greeks had these problems. I thought I would be working with illegal immigrants. On a typical day the clinic sees around 20 people. "The problems are never simple. Sometimes people don't have the correct insurance or it takes time for the right papers to come through. Sometimes it is as simple as the fact that they don't have a few euros for the bus to go to the hospital for an appointment, so they come here. "These people are often new poor [created by the financial crisis] and an additional problem is that the hospitals are now charging each time someone visits. The Greek heath system is just getting worse and worse," he adds sadly. "A health system that was not the best is becoming worse and worse." "The people who can afford it can get immediate treatment. But what is happening in areas like this with high unemployment is that people with health issues are not getting checked up or, perhaps, like one patient – a 42-year-old man with diabetes – have not been taking medication when they should because they can't afford it, so what should be a manageable health problem turns into a crisis. "He said to me: 'Look, I have four children and I only worked three days last month."' If the clinic in Perama is an example of how bad things have got for those at the bottom of Greece's ruined economy, elsewhere doctors and patients have their own horror stories to tell in a corrupt health system where paying bribes to doctors is commonplace. As a result of the crisis, doctors' wages in the public system have been cut in line with other government workers, while hospitals fear being merged and face regular shortages of materials. Most damaging is how an already unequal health system has become more unequal still – a three-tier affair that discriminates systematically against those most vulnerable and least able to afford health care, marginalising them still further in society. Even the private hospitals have not been immune to the crisis. In the Iasso maternity hospital Jenny and Pantedis Ioannidis, two young registrars, are celebrating the birth of their first child. A bright, busy and modern place which handles 16,500 deliveries a year, the hospital has had to cut its fees by 35% in response to the crisis to ensure the flow of patients through its doors continues. The man who performed the operation is sitting with them, Anastasios Pachydakis, 38, who trained for a while at London's Homerton hospital in Hackney. Pachydakis has performed two operations this year for free for some long-term patients whose business he hopes to keep in the future, because they did not have the money to pay him. "Most colleagues working in private hospitals have had to cut their fees," says Pantedis Ioannidis. Working in public hospitals – Jenny as a radiologist and Pantedis as an ophthalmologist – they have seen where the impact of the crisis has hit most acutely.

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It is a crisis whose consequences will be inherited by their newborn son, not least the â‚Ź35,000 of debt now owed by every new child born in Greece. For the two doctors so far one of the biggest impacts has been on their income in a country where the salaries of public servants, including doctors, had traditionally been bumped up by bonuses at Christmas and for the Easter and summer holidays, amounting to an extra two months' earnings. Those "presents", as they are known, have been abolished as part of the Greek government's austerity programme. "It is not just the bonuses," says Pantedis, "they have cut other allowances as well including an allowance for expensive medical text books." Then there are the problems confronted by the hospitals. In one busy Athens accident and emergency department the ambulance drivers complain they are not always sure if they will be paid, while many hospitals have periodic shortages of equipment. "I work in Athens's biggest hospital," says Jenny, "and there have been times this year when we've been missing a lot of important stuff. Because the hospital owed suppliers money, we had no stents. Then there were two weeks when we had none of the paper towels we use for wiping gel off patients. We were using toilet paper and kitchen towels. That was six months ago." Pantedis's story is more shocking. A says a shortage in interocular lenses for cataract operations earlier this year at hospitals in Athens meant a run on his own hospital, which was still well stocked, forcing his hospital to refuse new patients needing the procedure. The Nikaia public hospital is very different to the modern Iasso. It is clean but old with gloomy corridors, the rooms bare and functional. Outside one of its buildings a dog suns itself where the ambulances drop off their patients. Dr Olga Kosmopoulou, a specialist in infectious diseases including HIV, is wearing a badge on her coat. She explains it marks a six-year-old campaign to eradicate corruption by doctors and others in Greece's health system. It is a campaign, she explains ruefully, that was "completely unsuccessful". "We have a private sector that has been highly profitable and we have had a public sector that has delivered good results," she says. "But the fact is it is not working now and it is not because doctors have had their wages cut. "The problems are the shortages of materials that are essential in the public system and the fact that I don't feel I really work in public medicine any more because people have to pay at so many points," she adds. "I chose to work in the public sector," she says with emphasis. "I had plenty of offers to work in the private sector, but I chose to work for people who could not pay." Defiantly, she says she has only charged one of her patients the new â‚Ź5 fee. The rest were simply too poor, so she refused to charge them. She is aware her stand against the new rule could get her into trouble, but says she is not scared"I have a patient who is HIV positive," says Kosmopoulou. "He was a journalist who worked on a little paper in Piraeus. He wasn't working and he owed his insurance company money and now he is uninsured. He has cancer. He can stay in the hospital and not pay. He can get his HIV Medicare's 50th Anniversary

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medication and not pay. But I have a huge problem trying to get his chemotherapy paid for." She returns to the same story I have heard from Jenny Ioannidis and other doctors – about endemic shortages. Kosmopoulou reaches into her pocket and pulls out a needle required for affixing an IV line. "I always keep one in my pocket because the right size is so difficult to find." She says bleakly: "We can't survive this crisis," and adds that she is afraid there is a plan to destroy Greece's public health system. In some respects, it is already in ruins.

Canadian health system more efficient than U.S.: Study Saturday, August 06, 2011 By Bradley Bouzane Postmedia News August 5, 2011

The study from the University of Toronto and New York's Cornell University says U.S. doctors pay an average of nearly $83,000 each for administrative costs associated with insurance documents. In Canada, for doctors based in Ontario that cost is significantly less at just over $22,200. The Canadian health-care system may be plagued by countless stories of lengthy wait times and crowded emergency rooms, but a new study shows the amount of time and money spent on administrative duties is a fraction of that required by the U.S. system. The study from the University of Toronto and New York's Cornell University says U.S. doctors pay an average of nearly $83,000 each for administrative costs associated with insurance documents. In Canada, for doctors based in Ontario that cost is significantly less at just over $22,200. In addition, nurses, medical assistants and other hospital staff dedicate nearly 21 hours per week to filing insurance papers and other duties required to push insurance claims through. For the same duties in Ontario, just 2.5 hours are spent each week. The findings of the study, published in the August edition of the journal Health Affairs, 92

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show that the "single payer" health-insurance system in Canada is largely responsible for the difference between countries. It said the need for many U.S. patients to carry coverage from multiple insurance providers leads to the more demanding time commitments to file the appropriate documents. Dr. Dante Morra, the study's lead author, said the time savings felt in Canada go back to help the people who need it most. "When we look at health care in Canada . . . there's a lot of areas for improvement, but at the end of the day, sometimes we have to sit back and realize there is good access to care for Canadians," said Morra, a Toronto doctor. "There are a lot of benefits to the way we have structured our system and one of those benefits is this almost non-existent cost associated with dealing with payment. That time is directly invested into caring for patients." The study, which surveyed physicians on how much time was spent by themselves and other staff on filing insurance documents, said that if U.S. doctors were able to reel in the administrative costs to a level on par with those polled in Ontario, it would result in an annual savings of more than $27 billion for the American health-care system. Morra said the high financial and time costs can often deter U.S. doctors from working in some medical environments. He noted, however, that the current political climate in the U.S. will likely not allow for a significant overhaul to allow for a streamlining of paperwork to allow doctors more time doing what they do best. "As physicians, we know how to submit the claims . . . it's simple . . . but it's something we in Canada don't have to worry about," he said. "A lot of people (in the U.S.) actually choose not to do primary care and office-based work because the hassle factor is so high it's unbearable, and they feel they're spending very little time with their patients. "This is a benefit of the way we've organized health care in Canada and it's one of the reasons why health care is cheaper here and we get better results because we don't have to deal with these multiple health plans."

Health Economics in the USA Saturday, August 06, 2011 MRzine August 6, 2011

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Terry Everton is a cartoonist. Visit his blog Working Stiff Review . Cf. "State of Working America Preview: A Staggering Rise in Health Insurance Costs " (Economic Policy Institute, 15 December 2010); Don Trementozzi and Steve Early, "Romney, Obama Health Care Reforms Offer No Relief for Unions" (Labor Notes).

Health, Health Care and Capitalism Sunday, August 07, 2011 By Colin Leys Socialist Register 2010 Morbid Symptoms

There is a widespread belief that capitalism is responsible for the huge improvements in health that have occurred over the last century and a quarter. Capitalism is seen as the supreme engine of growth, and growth is seen as the crucial condition for health improvement. But it is not. Poor countries can and sometimes do have better health than rich ones.

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The US is held up as a ‘world leader’ in medicine when it is really a world leader in healthcare market failure, spending almost a fifth of its huge national income to produce overall health outcomes little better, and in some respects worse, than those of neighbouring Cuba, with a per capita income barely a twentieth as large. ‘Breakthroughs’ in health science and technology – in nuclear medicine, genetic medicine, or nanotechnology – are treated as triumphs of capitalist investment in research. But most innovative medical research is actually done in state-funded medical schools and research laboratories. The origins of the idea that capitalism is good for your health lie in the ‘mortality revolution’ that began in England in the late nineteenth century. Throughout all prior recorded history the physical health of most people, as measured by life expectancy, remained very poor. Infectious diseases were prevalent, many of them originally transmitted from domestic animals following the development of settled agriculture. People ate contaminated food and drank water from rivers that also served as sewers, as hundreds of millions in the global ‘south’ are still forced to do today. When industrialisation moved masses of people into towns from the countryside the effects became even worse. Read more HERE.

Green Mountain Dreams Sunday, August 07, 2011 The not-so-secret plan to bring Canadian-style health care into America via Vermont. By David Weigel Slate Wednesday, May 11, 2011

The people who want America to adopt a single-payer health care system like to tell a story. It's about how universal care had a demo in one of Canada's less populous provinces, where it proved so popular and successful that the rest of the country couldn't help but copy it. "Saskatchewan was the first province in Canada to get universal health care," said Rep. Jim McDermott, D-Wash., outside Capitol Hill on Tuesday. "The most beloved Canadian is Tommy Douglas, who started it." In the early 1960s, under Premier Tommy Douglas, the rural Canadian province introduced something like Medicare that covered everyone. Panic and protests ensued. The province had to import doctors temporarily to cover for the ones who'd gone on Medicare's 50th Anniversary

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strike. But the plan worked. It was popular. By the end of the decade, all of Canada had the plan. And in 2004 Douglas was named the "greatest Canadian" in a poll, surging past Wayne Gretzky, Pierre Trudeau, and the bassist from The Tragically Hip. So that part's not hyperbole, either. McDermott was telling this story partly to explain why he hadn't just wasted his time. He and Sen. Bernie Sanders, I-Vt., had just rolled out the latest version of their single-payer plan, the American Health Security Act (PDF). There was not much media present; there were no other members of Congress. Sen. Kent Conrad, D-N.D., cast a quizzical look at the event as he passed by walking his dog. The first question to McDermott and Sanders was about why they thought they could pass single-payer health care in 2011 when it couldn't win enough votes even when Democrats controlled both houses of Congress in the last session. The answer: They didn't. But the state of Vermont will. On May 26, Gov. Peter Shumlin of Vermont is expected to sign legislation that will create universal coverage in the state—eventually. Vermont will use subsidies from the Affordable Care Act to help create a Canada-style system. And its system, or so the theory goes, will become so popular and cheap that the rest of America will want to copy it. "Many of our Republican colleagues say they don't trust the federal government," said Sanders. They don't want the federal government getting involved in health care issues across the country. And what Jim and I are saying is, OK. Let the states be the laboratories of democracy. Maintaining certain minimal standards, let those states that choose go forward and a different direction. It may well be that Vermont will lead the country. And if the Vermont experience works well, as I believe it will, I think you're going to look at other states, and they're going to say, "Gee, they're covering all their people. They're doing it at lower costs!" It may be the state of Washington, or the state of California. And then eventually you might have a universal health care system across the country. That's an awful lot of "mays." The plan takes a very long time to go into effect—there is no instant gratification, like there was when Tommy Douglas was the toast of Saskatoon. The law creates a five-member board that studies and manages the transition. By Jan. 15, 2013, the board must settle on a plan. In 2014, the state is expected—as every state is required—to set up a health care exchange. And in 2017, the theory goes, the state will get a waiver from the Affordable Care Act to shut down its exchange and adopt a singlepayer model. "Ideally, we'd get some waivers," said Deb Richter, the head of Vermont for Single Payer, who has spent 11 years trying to pass a bill like this. "We need exchange waivers to opt out of the exchange; otherwise we're going to waste a lot of time building it and not intending to use it. We'd need half a dozen worker's compensation waivers. It's a tall order. It's complicated." It could become easier. Sens. Scott Brown, R-Mass., and Ron Wyden, D-Ore., have legislation that would allow states to get waivers as early as 2014. If you're a state legislator who wants a single-payer system, but you don't want to build an exchange that'll become irrelevant in 36 months, here's your out. You can put together your dream health care plan and use subsidies to help pay for it. You can get it started before a Supreme Court decision or a new president threatens the Affordable Care Act's 96

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existence. One small problem: Brown-Wyden isn't going anywhere right now. It's attracted only seven co-sponsors, none of whom is brimming with confidence about the bill's prospects. "Right now we're on spending, deficits, oil and gas," said Sen. Mark Begich, D-Alaska, one of the co-sponsors. Wyden, no surprise, was more optimistic. "I think it's at the head of the queue," he said. "The fact is, it's the only bipartisan major policy issue on offer in the health care area." But it's not that bipartisan. No other Republicans have gotten behind the bill. "We've heard that it's not going to happen," said Pat McDonald, chairman of the Vermont GOP. Sen. John Barrasso, R-Wy., a doctor who's been one of the GOP's point men on health care, pointed out that Republicans will oppose anything that leaves the ACA in place. It doesn't matter if residents of one state or another state will be spared a mandate. They're building the system with blueprints that Republicans desperately want to burn. "The concern I have with Sen. Wyden's proposal is that to be able to qualify you have to meet all the obligations of ObamaCare," said Barrasso, pointedly not mentioning Brown's co-sponsorship. "Those aren't obligations people should have to live under." Barrasso was just as skeptical that Vermont's plan would become a shimmering ideal that other states would want to copy. "I think there's at most three states this might ever apply to," he said, referring to the early waiver. "For 47 states, this won't apply, ever. I'm in favor of state's rights, but look at what we saw with the Massachusetts state plan. The waits to see a doctor are exceptionally long. Their insurance premiums are on average much higher than the rest of the country." It is something both sides have in common: a rock-solid belief that the other guys can't possibly win. When I asked Sanders what would happen if the Affordable Care Act was overturned in full by the Supreme Court, he dismissed it as a hypothetical question, like asking if an earthquake would screw up the plan. "I understand what some of our ultra-conservative people believe," said Sanders. But I think the overwhelming majority of the American people—even our friends at the Supreme Court—believe the U.S. government has the right to be involved with health care. [Go] outside the Beltway, and take a walk a mile away, and say, "Gee, there are some people in Congress who think the government should not be involved in Medicare, S-CHIP, and the Veterans Administration." You find 2 percent of people who agree with that, and I'll be very surprised. The single-payer Democrats don't want to hear about what could go wrong. They've found their Saskatchewan. They know how this movie's supposed to go. "Some of these people have trouble imagining what could happen," said McDermott. "Once they see it, they'll say, 'Wow, we can do that! We're as good as those people in Vermont, for Chrissake!' "

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Tea Party, Canada-Style! Sunday, August 07, 2011 America's battle over health care reform started in Saskatchewan By Christopher Flavelle Slate

Nearly 50 years before Sarah Palin gave us "death panels," the American Medical Association was testing the limits of health care scare tactics in the Canadian prairies. During the 1960 provincial election in Saskatchewan, the AMA helped fund an advertising campaign aimed at defeating the Co-operative Commonwealth Federation, a quasisocialist party whose leader, a former Baptist minister named Tommy Douglas, had promised to introduce universal, government-funded health care in the province. The AMA, together with Saskatchewan's College of Physicians and Surgeons, warned that if the CCF won, doctors would leave the province in droves. But here was the kicker: As Dave Margoshes writes in his 1999 biography of Douglas, the campaign told voters that if the state were permitted to take over health care, "patients with hard-to-diagnose problems would be shipped off to insane asylums by bungling bureaucrats." The campaign failed. Douglas won the election, and the CCF government went on to introduce his health care plan in 1962, creating the model that the rest of Canada would later follow. (So far as we know, insane-asylum panels did not come to pass.) But the fight for health care reform in Saskatchewan, which the AMA worried could spark change in the United States, was a precursor to the battle in America today—a mix of populist anger, political opportunism, and disinformation. As Democrats debate whether to pursue health care reform in the face of growing opposition, they might consider the lessons of Saskatchewan.

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Like the Democrats after their 2008 victory, the CCF moved slowly at first to implement its plan, a delay that emboldened the opposition. In an attempt to win the support of doctors, the government created an advisory panel for their concerns. Doctors used the panel to stall, and the government waited more than a year to pass its reforms, with the start date delayed until July 1, 1962. The province's doctors responded with a vote to strike if the plan was implemented. The events of the next 10 months were ugly by Canadian standards. Douglas' push for health care reform "lit the fuse of the incendiary bomb that would tear Saskatchewan apart into its two opposing elements," wrote Doris French Shackleton in her 1975 biography of Douglas. Part of the unrest came from doctors themselves. In the months leading up to the new plan, physicians across Saskatchewan put up office signs reading, "Unless agreement is reached between the present government and the medical profession, this office will close as of July 1." Douglas' wife, Irma, described how a doctor would tell his pregnant patient, after a check-up, "I'm afraid this is the last time I'll be able to see you." The doctors' worries about being paid by the province, rather than patients, may have been genuine. But those concerns were amplified by Saskatchewan's opposition Liberal Party, which had been shut out of power since 1944. Like the American Republicans 50 years later, the Liberals fought health reform in two ways: directly, by opposing it in public; and indirectly, by supporting groups that could provide the appearance of broadbased public anger. In Saskatchewan, the public opposition to health reform came in the form of a movement called Keep Our Doctors, which organized rallies and protests across the province.

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Sometimes, the Liberals blurred the line between political opposition and rabble-rousing. At a Keep Our Doctors rally outside the provincial legislature, Liberal leader Ross Thatcher used the occasion to call for a special session of the legislature, which wasn't sitting at the time. To illustrate his point, he invited TV cameras to follow him up to the locked doors of the legislature, which he then made a show of trying to kick down. But in another precursor to today's Tea Party movement in the United States, the unrest over health reform in Saskatchewan proved to be more than just political theatrics. "The fears inspired by the doctors and fanned by the Liberal party," Shackleton writes, "convinced many people at least briefly that the CCF was a dictatorial, power-mad, ruthless group of politicians who would rather see people die for lack of medical care than back down." Shackleton described "a sense of civil war." (Read more about the unrest in Saskatchewan.) Public anger against the plan found its lightning rod in Douglas, who had resigned as Saskatchewan's premier to run for federal office as the member of Parliament for Regina. Election Day was June 18, 1962—just two weeks before the new health care plan was to take effect. A woman who worked on Douglas' election campaign recalled the venom of the time. At night at the campaign office, "teenagers would come up and hiss at us through the glass," she remembered later. "The city's residents had been whipped into a near-hysteria by the doctors' anti-medicare campaign," Margoshes writes, adding, "There were graffiti threats on city walls and calls in the middle of the night to Tommy's house. His campaign manager, Ed Whelan, got frequent calls from a man threatening to 'shoot you, you Red bastard!' A few homeowners placed symbolic coffins on their front lawns."

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As in the United States today, opponents of the health reform plan weren't sure whether to denounce the CCF as Communists or Nazis, so they did both. Protesters greeted Douglas' motorcade with Nazi salutes—when they weren't throwing stones at it. Other opponents painted the hammer and sickle on the homes of people thought to be associated with the party. The doctors made good on their threats: When the new health care plan was introduced on July 1, doctors across the province walked off the job. But the government was ready, flying in replacement doctors, mostly from Britain. The strike ended after three weeks, the health care plan stayed in place, and four years later, the Canadian government passed the Medical Care Act, which provided funding for every province to create a similar plan. Douglas and his party were vindicated. Once their plan took effect, Shackleton writes, it "was soon so well accepted that no political party had the temerity to suggest its abolition." But that vindication came too late. Douglas, who had led the CCF to five straight provincial victories, lost his federal campaign that June, receiving barely half as many votes as his opponent. Two years later, the Liberals defeated the CCF for the first time in 20 years. The party that passed health care reform would spend the next seven years out of power.

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The events leading up to the 1962 doctors' strike in Saskatchewan are different from today's Tea Party movement in important ways, of course. Saskatchewan wasn't seized by the same level of broad distrust for government that U.S. opinion polls show today. The idea of a government role in health care was already accepted, to a degree: Saskatchewan had already passed the Hospital Insurance Act in 1947, which paid for hospital care. And the changes Democrats have called for stop well short of single-payer health care, notwithstanding the charges of their critics. Even the AMA supported Obama's plan. But the anger of those months in Saskatchewan undermines a key belief in the debate over health care reform. When confronted with the overall success of Canada's brand of government-funded health care—better health outcomes at much lower cost—Americans tend to respond that such a broad government role is anathema to American culture. This has the ring of an excuse—after all, the idea was apparently somewhat anathema to Canadian culture in 1962. As Douglas said then, "We've become convinced that these things, which were once thought to be radical, aren't radical at all; they're just plain common sense applied to the economic and social problems of our times." The point isn't that U.S. and Canadian cultures aren't different. Rather, it's that cultural attitudes aren't static. However much some segments of U.S. culture may resist Obama's proposals, the Saskatchewan experience suggests that resistance will dissipate if the plan produces a system that works better than the status quo—especially since, as in Saskatchewan, the government was elected on a promise to make that change. The other lesson of Saskatchewan is less exciting for Democrats: Even if people come around to the reform itself, they may not come around to the party that pushed it through. If they want to achieve health care reform, that may be a chance that Democrats have to take. But re-election qualms shouldn't be dressed up with bromides about the limits of what's possible. As Canadians can attest, health care reform takes a little more backbone than that. -------------------------------------------------------------------------------Doris French Shackleton, a biographer of Tommy Douglas, describes the mood at the time:

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The anger crackled in the air. Every business interest, every insurance agent, every local Chamber of Commerce ‌ now aided and abetted the doctors' cause with every resource at their disposal. Stores were closed to swell "Keep Our Doctors" rallies and parades and marches on the legislature. Newspapers and radios bristled with accusations. There was, as many testified, a sense of civil war. Shackleton tells of the story of an elderly priest, Father Athol Murray, inciting a "Keep Our Doctors" rally in Wilcox, a small town 25 miles south of the provincial capital, Regina. "This thing may break out into violence and bloodshed any day now," Father Murray told the crowd—"and God help us if it doesn't." A volunteer on Tommy Douglas' federal election campaign, which came at the height of the unrest in Saskatchewan, tells this story: "I drove home one day with a taxi-driver. He was a man who could really have benefited from Medicare. He had no teeth: he had had them all extracted. He said he had five children and a sick wife. And he blasted me about Medicare and about Tommy. There was no arguing with him." Christopher Flavelle reports for ProPublica, the nonprofit investigative newsroom in New York City. He is Canadian. Article URL: http://www.slate.com/id/2245037/ Become a fan of Slate on Facebook. Follow us on Twitter.

Leading Economist Shatters Myth That Public Health Care is 'Unsusta... Sunday, August 07, 2011 Pins Blame for Soaring Costs on Private Health Care Spending Market Wire June 17, 2011

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OTTAWA, ONTARIO- One of the world's leading health economists came out swinging today, shattering the myth that public health care is unsustainable and laying the blame for rising costs at the feet of private health services not covered by Medicare. The message was delivered to Members of Parliament by Dr. Robert G. Evans, an internationally renowned health economist. "Since 1975, Medicare spending – hospitals and doctors' services – has remained remarkably stable at between 4% and 5% of our Gross Domestic Product," said Dr. Evans. "The key cost drivers in health care are the private, for-profit parts – pharmaceuticals, for-profit diagnostic tests, dental and other non-insured services. For example, private drug plan costs are rising 15% a year. "Opponents of Medicare claim that public health care is fiscally unsustainable and that the only viable solution is a shift to more private coverage. Bluntly, this is a lie," Dr. Evans said. "Sustainability is often a code word for privatization and for-profit health care," Dr. Evans said. "But any debate on the sustainability of public health care must start from who and what drives health care spending, and include a clear identification of the winners and losers of any erosion or dismantling of Medicare." Speaking to Members of Parliament and senior government advisors at a breakfast meeting on Parliament Hill, and later at a news conference on the Hill, Dr. Evans took on several of the most popular myths about health care costs. "Canada's public health care spending is not skyrocketing," Dr. Evans said. "In fact, our public expenditure on health care is below the OECD average." Dr. Evans pointed out that Medicare spending now takes up about the same share of provincial revenues it did 20 years ago. "The problem isn't uncontrolled public health care spending," Dr. Evans said. "It's uncontrolled private health spending combined with a drop in provincial revenues created by large tax cuts over the years." Dr. Evans also dismissed the myth that the needs of an aging population will make health care unsustainable. "Population aging is a very small factor in increasing health care costs at 0.8% per year, less than other factors such as population growth (1%)", said Dr. Evans. "Panic-mongering about a "grey tsunami" is simply a distraction." 104

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Canadians consistently show they support public health care. Nik Nanos, president and CEO of Nanos Research, joined Dr. Evans on Parliament Hill to present results of a recent national poll that showed almost 90% of Canadians support public solutions to problems in the health care system, and that health care is the most important national issue. Dr. Evans, O.C., Ph.D. (Economics, Harvard), F.R.S.C., is the University Killam Professor in the Department of Economics at the University of British Columbia. His internationally respected work includes groundbreaking comparative studies of various health care systems and funding strategies. The briefing session was hosted by the Canadian Health Coalition, a public advocacy organization dedicated to the preservation and improvement of Medicare. Its membership is comprised of national organizations representing nurses, health care workers, seniors, churches, antipoverty groups, women and trade unions as well as affiliated coalitions in nine provinces and one territory. Contact Information: Canadian Health Coalition Michael McBane National Coordinator 613-277-6295 mike@medicare.ca

NHS among developed world's most efficient health systems, says study Monday, August 08, 2011 Report in the Journal of the Royal Society of Medicine finds health service second only to Ireland for cost-effectiveness By Randeep Ramesh guardian.co.uk Sunday 7 August 2011

The NHS is one of the most cost-effective health systems in the developed world, according to a study (pdf) published in the Journal of the Royal Society of Medicine. The "surprising" findings show the NHS saving more lives for each pound spent as a proportion of national wealth than any other country apart from Ireland over 25 years. Among the 17 countries considered, the United States healthcare system was among the least efficient and effective. Medicare's 50th Anniversary

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Researchers said that this contradicted assertions by the health secretary, Andrew Lansley, that the NHS needed competition and choice to become more efficient. "The government proposals to change the NHS are largely based on the idea that the NHS is less efficient and effective than other countries, especially the US," said Professor Colin Pritchard, of Bournemouth University, who analysed a quarter of a century's data from 1980. "The results question why we need a big set of health reform proposals ... The system works well. Look at the US and you can see where choice and competition gets you. Pretty dismal results." The study will be a blow for Lansley, who argues that patients should choose between competing hospital services and GPs. Pritchard's last academic paper, which argued that surgeons were being distracted from frontline work by "unfunded" targets in the NHS, was used by Lansley to justify government reforms. Using the latest data from the World Health Organisation, the paper shows that although Labour's tax-and-spend strategy for the NHS saw health spending rise to a record 9.3% of GDP, this was less than Germany with 10.7% or the US with 15%. Not only was the UK cheaper, says the paper, it saved more lives. The NHS reduced the number of adult deaths a million of the population by 3,951 a year – far better than the nearest comparable European countries. France managed 2,779 lives a year and Germany 2,395. This means, the paper says, that dramatic NHS improvements have led to a situation where that there are now 162,000 fewer deaths every year compared with 1980. The paper says the US suffers from a "relatively huge bureaucratic burden needed to monitor the costs, behaviour and risks of customers, as well as the immense legal costs required to control payment". Looking at elderly patients, the difference was even more stark with the best performers – Ireland, the UK and New Zealand – having health systems that were three times more effective and efficient than the worst – Switzerland, Portugal and the US. Pritchard said that only Ireland's position today would be significantly different – because its economy has shrunk. "I think Ireland would have slipped back today." The paper also takes Lansley to task over his claims that "if UK cancer survival rates were at the European average, we know we would save 5,000 extra lives a year." It says: "In terms of actual cancer mortality rates, rather than the more ambiguous 'survival' rates, the UK had better results ... which appears to be linked to major additional funds going to cancer care." Pritchard points out that even Adam Smith, the Scottish economist and father of marketbased ideology, thought the state was "probably better" at health and education. 106

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"It's naive to think that Lansley does not want more privatised health service. But there's no evidence why it be better. There's a lot to suggest it would be worse." A Department of Health spokesman said that the paper was "mistaken to think that competition is an end in itself, or will necessarily increase the independent sector's role in the NHS". He added: "Under our modernisation plans we are improving choice for patients to drive up the quality of care and improve patient experience ... We are investing an extra £12.5bn in the NHS to improve the quality of services and safeguard the NHS for future generations."

Saskatchewan's Community Clinics Monday, August 08, 2011 By Dennis Gruending Encyclopedia of Saskatchewan Saskatchewan’s community clinics were born amid turmoil and controversy in July 1962. Most of the province’s doctors withdrew services on July 1, and Saskatchewan was plunged into a bitter 23-day strike. The CCF government had introduced North America’s first public, tax-financed health insurance system, and the medical profession was opposed. As the strike loomed, however, some doctors and consumers organized to provide Health Care during the crisis. In Saskatoon, doctors Margaret Mahood and Joan Whitney-Moore began to see patients on July 3 in a threadbare room in an office building. Dr. Samuel Wolfe, an internationally known physician and researcher, and a professor of medicine at the University of Saskatchewan, resigned his academic post to work at the clinic and was later to become its first medical director. Similar community health associations were organized in twenty-five centres, including Regina, Moose Jaw, Nipawin, Biggar and Wynyard. In Prince Albert, Dr. Orville Hjertaas was a Pioneer and enduring presence in the community health clinic. The strike ended with the signing of the Saskatoon Agreement on July 23. Under terms of that agreement, doctors were to be paid on a fee-for-service basis. That created immediate difficulties for the co-operative clinics, which would have preferred global budgets, encouraging a different relationship between medical professionals and their consumer boards. There were continuing strained relations between doctors who had opposed Medicare and those who supported it, particularly those who chose to work in the clinics. A number of physicians new to the province, including Dr. Reynold gold of the Saskatoon clinic, were denied hospital privileges for months. Despite these and other difficulties, community clinics have provided health services for forty years, and continue to exist in five Saskatchewan centres. They offer a comprehensive range of services to 85,000 people in settings where medical professionals work in formal co-operation with citizen boards. This type of practice has frequently been lauded by governments, but less often Medicare's 50th Anniversary

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supported financially. With the endorsement of primary health care in 2003 by two prestigious government reports (the so-called Romanow Report, and the Senate report popularly known as the Kirby Report), community health centres or their equivalent may come into their own at last.

CETA trade deal threatens Medicare Tuesday, August 09, 2011 Canadian Health Care Coalition

There are serious concerns about the Canada-European Union Comprehensive Economic and Trade Agreement (CETA). Europe, on behalf of the big pharmaceutical companies, is pushing for Canada to lengthen the period of its monopoly drug patents and delay the availability of lower-priced generic drugs. The proposed changes would add almost $3 billion annually to Canada’s drug bill. Canada’s high prescription drug prices are already a barrier to medically necessary medicines for millions of Canadians, and CETA will only make the situation worse. A second threat to Canada’s public health care system in the CETA negotiations is the European demand that Canada weaken NAFTA protections that shield Canada’s health care system from international trade deals. We fought hard to get these protections and want them strengthened, not eroded. If the Harper government is going to pursue a deal, it must negotiate a carve-out for Canada’s health care system that says “nothing in the CETA shall be construed to apply to measures adopted or maintained by a party in relation to the health sector or public health insurance”. Canadians want the public health care system protected and improved, not traded away.

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CLICK HERE TO SEND A LETTER TO THE PRIME MINISTER RELATED RESOURCES: • Proposed EU-Canada trade agreement raises health concerns in both Canada and European Union, June 26, 2011 • The CETA and Health Care Reservations: A briefing note for the Canadian Health Coalition, Canadian Centre for Policy Alternatives. • Canadian Health Coalition letter to the Federal Minister of International Trade. • Read the briefing note on the potential impact on costs of brand-name drugs from CETA. • Read the new study – CETA: An Economic Impact Assessment of Proposed Pharmaceutical Intellectual Property Provisions. • Read the Globe and Mail article: “EU trade deal could cost Canadian drug plans billions”. RELATED MEDIA: • Globe and Mail (July 16, 2011) Perplexing silence hangs over proposed Canada, E.U. trade pact • Toronto Star (June 26, 2011) Watchdog: deal will boost drug prices • Open Letter to the B.C. Premier (June 21, 2011) EU trade deal could cost Canadians billions • Globe and Mail (February 2, 2011) EU trade deal could cost Canadian drug plans billions

Unsung Heroes in Saskatchewan's Struggle for Medicare Tuesday, August 09, 2011 By Jim Harding No Nukes August 29, 2010

While mainstream discourse on the struggle for Medicare tends to credit the high-profile

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political leaders who fronted the movement, the struggle was in fact a collective one, won through popular grassroots support and the tireless work of countless community activists. These activists, whose combined voices were the real strength of the struggle, are however left out of the history books. They are systematically ignored in Saskatchewan’s Centennial Encyclopedia. History is typically reconstructed by those currently in power, which serves to help stabilize the status quo. The idolization of Medicare’s political champions disregards the contributions of the popular grassroots movement to Medicare’s success across the country, which is disempowering and leaves us all more inclined to wait for the next Tommy Douglas to help us make history. In view of the imperative of tackling the climate crisis and moving towards sustainability we really can’t engage in such a waiting game. Remembering the grassroots history of Medicare is also a good first step toward reengaging to rejuvenate today’s deeply troubled healthcare system. The text book history

Tommy Douglas The standard story of the origins of Medicare highlights the contributions of Saskatchewan premiers Tommy Douglas and Woodrow Lloyd, Minister of Public Health Bill Davies and high-profile opponents of Medicare such as Father Athol Murray and Saskatchewan Medical Association (SMA) president Dr. Staff Barootes. Douglas is most readily associated with Medicare, which is likely why he won CBC’s “greatest Canadian” poll a few years back. In 1944, on a radio announcement during his election campaign, he famously declared “We believe…we can ultimately give our people a completely socialized system of health services, irrespective of…individual ability to pay.” In 1947, as Minister of Health as well as Premier, he brought forward the Saskatchewan Hospitalization Act – the first public financing for hospitals in Canadian history. Then, in 1959, when the economy was stronger and federal government under John Diefenbaker more supportive Douglas announced his plan to proceed with Medicare. This deeply aggravated the province’s doctors who at the time jealously guarded private enterprise medicine. The Saskatchewan College of Physicians and Surgeons vocally opposed the plan, and they were supported by “Keep Our Doctors” (KOD) committees, which were established among mothers who were erroneously told they would lose their personal doctors under Medicare. The only mothers who were threatened during the

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actual crisis were those who were expecting babies and whose pro-Medicare doctor was refused hospital privileges. One pregnant mother protested this by parking herself on the doorsteps of a hospital. The political forces whipped up recently in the U.S. to oppose Obama’s watered-down attempt to get a public option in healthcare insurance are reminiscent of the extremist rhetoric of the KOD campaign. Some people feared for Premier Lloyd’s safety. We also now know that in 1962 American medical and pharmaceutical organizations worked behind the scene to try to stop Saskatchewan from becoming a continental beachhead for Medicare.

Woodrow Lloyd/Tommy Douglas In 1961 Douglas left Saskatchewan to head up the newly founded New Democratic Party (NDP). Premier Woodrow Lloyd picked up the gauntlet for universal health coverage, introducing and eventually passing the Saskatchewan Medical Care Insurance Bill, making Saskatchewan the first province to have free universal medical insurance. As Minister of Public Health, Davies helped the province to avert a potentially catastrophic doctor shortage during the Doctors’ Strike of the summer of 1962 by bringing in doctors from abroad. After the Doctor’s Strike ended, Allan Blakeney replaced Davies as Health Minister. Later Blakeney became NDP leader after Woodrow Lloyd was forced out of this position in 1970, after losing the 1964 election to Ross Thatcher and the provincial Liberals. Lloyd went on to briefly work in international development with my father Bill Harding in the United Nations Development Program (UNDP) until his untimely death in 1972. In 1979 Diana Lloyd published a compelling and politically revealing biography of her father, entitled “Woodrow”. Soon after Medicare was established, Chief Justice Emmett Hall headed a federal Commission appointed by Diefenbaker that recommended that Medicare be expanded across Canada, and in 1966 the Lester Pearson Liberal government passed the Medical Care Act which guaranteed publicly funded universal health insurance for all Canadians. The heated struggle in Saskatchewan had laid the basis for a Canada-wide plan. In 1984, under the committed leadership of the federal Health Minister, Monique Begin from Quebec, the liberal government passed the Canada Health Act to set out conditions for federal transfer payments for provincially-controlled healthcare. Medicare however continued to be threatened by the expansion of for-profit medicine.

The role of community clinics

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Community clinics played a critical but often ignored role in the struggle for Medicare. While the Lloyd government was weakening, after the KOD rallied 5,000 people to the legislature on July 11, 1962 to oppose Medicare, grass-roots meetings were being held across the province to raise money to buy buildings and start community clinics that could hire doctors who supported Medicare. Thousands of people were mobilized. Doctors like Sam Wolfe and Orville Hjertaas helped establish clinics in Saskatoon and Prince Albert. British doctors were hired in Regina and elsewhere. Sam Wolfe went on to co-author the still definitive 1967 book, Doctor’s Strike: Medical Care and Conflict in Saskatchewan. Woodrow Lloyd consistently praised the role of the community clinics in consolidating support for Medicare. Jack Kinzel, the first Secretary of the Medical Care Insurance Commission (MCIC), called the birth of the community clinics “a very important aspect of putting Medicare in place.” According to him, the “the activities of the clinics – the opening of the clinics in key centres in the province, small and large – did frighten the doctors and did make them uncertain about their ability to bring off what they were trying to do.” Speaking to Regina Community Clinic’s 1987 AGM, past Premier Allan Blakeney said that “Community clinics were on the very front line in the Medicare battle in 1962. They made Medicare possible”. Unsung heroes

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Stan Rands, who became the executive secretary of the Community Health Services Association (CHSA), is one of the unsung heroes in the development of community clinics and the launching of Medicare. Rands quit his 11-year job in Psychiatric Services, most recently as Assistant to the Director, to take on the new position in the midst of the heated conflict between doctors and government. In the Introduction to Rands book, Privilege and Policy: A History of Community Clinics in Saskatchewan, published posthumously, retired theology professor Ben Smillie wrote, “Rands, who calmly stood with [his wife] Doris in the eye of the storm, is one of the true heroes of Saskatchewan Medicare, and therefore a national hero of Canada.” Stan worked closely with the CHSA’s founding President, Bill Harding, who had just returned from his first assignment with the UNDP to later become Provincial Secretary of the NDP and was Chairman of the Regina clinic board from 1962-65. These two men worked to the edge of exhaustion to establish clinic groups in 35 locations throughout the province. Stan and Bill also worked closely with Ed Mahood, renowned professor of Educational Foundations at the University of Saskatchewan, who was the first chair of the board of the Saskatoon clinic, which pioneered interdisciplinary community medicine in the province; and with Roy Atkinson, known most for being president of the National Farmers Union, who was founding Vice-President of the CHSA and followed Harding as its president There were hundreds of others putting their heart and soul into this work, but Stan Rands, Bill Harding, Ed Mahood and Roy Atkinson were the peaceful “generals” in the grassroots struggle for Medicare. They kept their cool in the face of provocation that tried to polarize and escalate the conflict and derail the Medicare legislation, and put organizational voice to the broad-based grass-roots support for Medicare. Several other citizens groups sprung up in support of Medicare. Citizens for a Free Press, founded by long-time community activists Ben and Adele Smillie, lobbied the Saskatoon Star Phoenix newspaper to stop rejecting pro-Medicare letters to the editor. Saskatoon’s Citizens in Defense of Medicare also rallied people to show their support for Medicare.

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Roy Atkinson Though Medicare is certainly the highest profile event in Saskatchewan’s first hundred years, none of the major community clinic activists are mentioned in Saskatchewan’s Centennial Encyclopedia. (A tiny piece by Denis Gruending, who in 1973 authored The First Ten Years, Saskatoon Community Clinic, mentions only the doctors involved with the birth of the clinics.) Contrast this with high-profile opponents of Medicare. One of the most vocal anti-Medicare spokespersons was Father Athol Murray who regularly made incendiary speeches on behalf of the KOD, once saying “We must get off the fence and make our views known”, continuing, “This thing may break out into violence and bloodshed any day now, and God help us if it doesn’t.” He is profiled in the Centennial Encyclopedia as the founder of Notre Dame College at Wilcox, home of the Hounds hockey team, and being in the Saskatchewan Sports Hall of Fame, but his provocative, outrageous opposition to Medicare isn’t mentioned. Another high-profile, staunch opponent of Medicare profiled in the Encyclopedia is Dr. E.W. (Staff) Barootes, who was the SMA President in 1962, went on to be appointed to the Senate by the Mulroney government, and like Father Murray, was appointed to the Order of Canada. The important role of the labour movement in creating Medicare is indirectly acknowledged in mainstream history. Public Health Minister Davies, who helped bring pro-Medicare doctors to Saskatchewan, came from labour into politics, as did Walter Smishek, Minister of Health under Blakeney, who the Centennial Encyclopedia notes stood alone in opposing user and deterrent fees when he sat on the Advisory Planning Committee prior to Medicare. The Encyclopedia also notes that long-time labour activist Clarence Lyons was the “first president of the Saskatoon Community Clinic.”

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Margaret and Ed Mahood Women have been mostly left out of the discourse around the origins of Medicare. During the Doctors’ Strike, when the overwhelming majority of doctors closed their doors, it was female doctors like Saskatoon’s Marg Mahood and Joan Whitney-Moore that kept their doors open to provide medical services. And the community clinics wouldn’t have gotten off the ground without women’s unpaid domestic labour – organizing fund-raising events, physically setting up and decorating the new clinics, and doing some volunteer office work. My mother, Bea, worked many long nights to sew curtains for all the Regina clinic office windows. An unfortunate compromise Desperate to end the Doctors’ Strike, the Lloyd government agreed to a compromise with the SMA. On July 23, 1962 the two parties signed the Saskatoon Agreement, which saw government acquiesce to doctors’ demands to keep fee-for-service as the sole form of payment. Those working at the grassroots to build community clinics tried to get the provincial cabinet to hold out for more popular support, but the government buckled under the political panic created by the strike. It agreed to alter the legislation to allow doctors to practice outside Medicare, to pay doctors under the plan 85% of the College of Physicians fee schedule, and to increase the power of the doctor’s business association, the SMA, within the MCIC. In his official centennial history, Saskatchewan: A New History, Professor Bill Waiser oversimplifies this by saying this was “removing sections…that implied government control of doctors.” This was the SMA’s clarion call but not what the conflict was about; it was primarily about defending for-profit , fee-for-service medicine or replacing this with a public system, like our educational system. This rolling back of public policy was devastating to the community clinics. As Bob Reid notes in his 1988 popular history, More Than Medicine, the Regina clinic went through years of internal power struggles over community versus medical control of staffing and policy. Still having a monopoly on the clinic’s earning power, some doctors wanted to keep organizational power, and a clinic so divided could not build the needed team-work. The introduction of global budgets in the 1970s helped by providing some resources for interdisciplinary and preventative program development, but by then the momentum for community (“socialized”) medicine had waned. The hopeful province, which had seen 25 community clinics spring up from the grass-roots in less than a year, ended up by the mid-1990s with only 5 struggling clinics. The history we create today

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Despite passionate and hopeful beginnings, public healthcare in Canada is now in relapse. In 2001, with the growth of for-profit clinics threatening to expand two-tiered medicine, past Saskatchewan Premier Roy Romanow was appointed to head the federal Commission on the Future of Healthcare. One main recommendation was about the need for primary healthcare reform. As Romanow said in 2002 “no other initiative holds as much potential for improving health and sustaining our healthcare system.” This will require full-service community health clinics, such as were envisaged during Saskatchewan’s struggle for Medicare. It was telling and a little ironic that Romanow had to go outside Saskatchewan, to a community clinic in Sault Ste. Marie, Ontario, to find what he called “the best kept secret in the country”. Today, only four community clinics survive in Saskatchewan. Rather than Medicare leading to community-based access to progressive medical practice, much of the province’s and country’s population is dependent on impersonal, for-profit, walk in clinics. Provincial health care systems are a hodge-podge of private and public services, with important preventive services in Saskatchewan like massage and chiropractics now totally un-funded, while there is escalating public expenditure for many unnecessary, ineffective, risky but profitable pharmaceutics. Pharmacare user-fees discriminate against the disadvantaged and disabled, homecare for the bulging senior population is severely under-resourced, and dental insurance is far from universal and remains in private hands. Evidence-based medicine makes only slow progress in an environment where private interests dominate and could have flourished much better in a thoroughly public Medicare. Meanwhile, many families are without continuity of care from family doctors. During the visionary days of the struggle for Medicare no one imagined the widespread indignity to come. Learning a balanced history of the struggle that acknowledges Medicare’s grass-root pioneers is the first step to creating new momentum to realize the vision of Medicare. Better knowing this popular history can also inspire us for making other vital social changes, such as the shift to a public, democratic renewable energy system.

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Prairie Giant's dramatization of the 1962 doctor's strike Thursday, August 11, 2011

Visit the official Prairie Giant: The Tommy Douglas Story website HERE. Purchase from Amazon HERE.

Physician Administrative Costs in the US vs. Canada Sunday, August 14, 2011 By Liz Borkowski The Pump Handle August 12, 2011

The US spends far more per capita on healthcare than any other developed country -$7,538 per person, compared to $3,129 in the UK, $4,079 in Canada, and $5,003 in Norway (the second-biggest spender), according to 2008 totals compiled by the Kaiser Family Foundation. One contributor to our high healthcare costs is high administrative costs, which is the natural consequence of having hundreds of different insurance plans with different policies, networks, and rates. A new study in the journal Health Affairs focuses on one aspect of administrative costs: the time physician practices spend interacting with payers. They surveyed US and Ontario practices and quantified just how much time and money the US proliferation of payers costs physicians. Medicare's 50th Anniversary

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Read more HERE.

The Case for a Pharmacare Plan in Canada Monday, August 15, 2011 Canadian Centre for Policy Alternatives

The Economic Case for Universal Pharmacare Costs and Benefits of Publicly Funded Drug Coverage for all Canadians From the Executive Summary A public drug insurance plan should form an integral part of a country’s pharmaceutical policies. The plan must tie together social programs designed to provide a minimum of well-being for all citizens, health policies designed to optimize public health, industrial policies aimed at attracting foreign investment, intellectual property policies, and tax policies designed to ensure greater fairness in redistributing wealth. A drug insurance plan that includes a drug assessment process can also help distinguish between drug products in order to ensure the quality, safety, and cost-effectiveness of prescription drugs. A drug insurance plan is not only a way to compensate for or reimburse drug expenses, but also a way to control costs through efficient pharmacoeconomic assessment of new drugs and by developing bargaining power when dealing with powerful transnational drug companies. The complexity of these various aspects of Pharmacare must be considered in order to determine the best drug insurance plan to meet the common goals of a community. As far back as 1964, the Royal Commission on Health Services recommended that a universal drug insurance plan be established for all Canadians. The National Health Forum, under Jean ChrÊtien in 1997, recommended universal drug coverage. The Romanow Commission in 2002 recommended catastrophic drug coverage as a first step towards universal Pharmacare. But the National Pharmaceuticals Strategy, implemented 118

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since 2004, has failed to achieve even catastrophic drug coverage for all Canadians. The lack of political enthusiasm for Pharmacare can mainly be explained by fears of the escalating costs such a plan is expected to entail. But this argument, which also predominates in the media, is completely lacking in substance. Download the groundbreaking report, The Economic Case for Universal Pharmacare. The report lays out the formula for a Pharmacare program that not only covers all Canadians, but could annually save up to $10.7 billon in spending. The report garnered the endorsement of eminent doctors, nurses, economists and researchers. Download the Report

[2.2 mb] Download the Executive Summary Download the Fact Sheet Download the Reality Check on Rx&D Download the Pharmacare Index Read the Media Release Read the Media Coverage

Canadian Medical Hall of Fame: T. C. Douglas Monday, August 15, 2011 Canadian Medical Hall of Fame

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Š Irma Coucill and the CMHF Honorable Thomas C. DouglasBorn: October 20, 1904, Falkirk, Scotland Died: February 24, 1986 Education: B.A. - Brandon College; M.A. - McMaster University, 1933 Category: Builder Medicare Thomas Clement Douglas was born in Falkirk, Scotland in 1904 and emigrated to Winnipeg, Manitoba with his family in 1910. He earned his B.A. at Brandon College and graduated with his M.A. from McMaster University in 1933. Two years later, Douglas won his first election. This was to be the start of his 44 year run as an elected official. Douglas will always have the distinct title of "The Father of Canadian Healthcare". Douglas envisioned, built and tirelessly promoted our national system of healthcare. The proposal for medicare in 1959, was that it would be universal, pre-paid, publicly administered, accepted by both providers and receivers of the medical service and it would provide high quality care, including preventive care. The very same principles introduced by Douglas in 1959 are found in the 1984 Canada Health Act. His leadership has provided long term benefits to medical science in Canada and the Canadian health care system remains as a model and source of envy to other countries around the world. To recognize his achievements, Douglas was awarded the companion of the Order of Canada and a national scholarship has been established in his name. Douglas died in 1986 but prior to his death, he had already become an integral part of Canadian history and one of Canada's most respected visionary politicians.

Physician Resistance and the Forging of Public Healthcare Tuesday, August 16, 2011 A Comparative Analysis of the Doctors’ Strikes in Canada and Belgium in the 1960s BY GREGORY P. MARCHILDON and KLAARTJE SCHRIJVERS

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Organised medicine in a number of advanced industrial countries resisted the post-war trend toward more state involvement in the funding and organisation of medical care. While there were eight doctors’ strikes during the peak of reform efforts in the 1960s, two of the most prolonged and bitter struggles took place in Canada and Belgium. This comparative analysis of the two strikes highlights the philosophy, motives, and strategies of organised medicine in resisting state-led reform efforts. Although historical and institutional contexts in the two countries differed, organised medicine in Canada and Belgium thought and responded in very similar ways to the perceived threat of medical insurance reform. While the perception of who won and who lost the respective doctors’ strikes differed, the ultimate impact on the trajectory of public healthcare on the medical profession was remarkably similar. In both countries, the strike would have a long-standing impact on future reform efforts, particularly efforts to reform physician remuneration in order to facilitate more effective primary healthcare. Read this article HERE.

Ontario targets for-profit medicine Wednesday, August 17, 2011 Tom Blackwell National Post Aug 17, 2011

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As provincial governments across the country grapple with the thorny issue of for-profit medicine, Ontario has taken the unprecedented step of setting up a toll-free snitch line for people to report cases of illegal private health care — and says it has triggered 35 investigations in barely a month. The service was prompted by evidence that doctors and clinics are routinely flouting medicare rules with sometimes creative methods of generating extra income, Deb Matthews, the province’s Health Minister, said Tuesday. The government has ordered 4,500 patients to be reimbursed out-of-pocket fees they had been levied by colonoscopy clinics in the last few years, while Ms. Matthews said she has heard of a surgeon charging $100 for a post-operative glass of orange juice. “There’s no doubt in my mind that people are trying to get around (the law)…. I think it’s really important that we all protect our universal health-care system,” the Health Minister said in an interview. “It’s just important that we are ever-vigilant.” Critics, however, call the initiative a politically motivated waste of money that could be better spent on improving actual medical services. In the lead-up to this fall’s provincial election, the Liberal government seems anxious to portray itself as a steadfast defender of public health care. “How is this going to improve patient care for anybody?” Brett Skinner, president and health-care analyst at the conservative Fraser Institute think-tank, asked about the snitch line. “It’s not helping patients get better access. In fact, it’s designed to prevent patients from getting better access.” The Canada Health Act generally forbids health-care providers from charging patients directly for services that are covered under medicare. Various private health services have cropped up in Quebec, B.C. and Alberta in recent years, however, with little interference by the federal government. The Ontario Liberals, on the other hand, have presented themselves as strenuous foes of private health care. Since the “extra-billing and queue-jumping report line” and email address were set up in June, the province has received 130 calls and 60 emails from patients who believe they were wrongly forced to pay for health care, Ms. Matthews said. Those have in turn led to 35 investigations, some dealing with cataract surgery clinics where patients were 122

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allegedly required to pay for tests or lenses as a condition for receiving the operation, the minister said. She conceded that unlawful private health is not “rampant” in Ontario but said there are signs that it is occurring regularly. Since 2006, for instance, the Health Ministry has investigated 16 clinics offering colonoscopies — diagnostic procedures that check for symptoms of colorectal cancer — and found that four were charging illegal “block fees” directly to patients, in addition to the payments they received from medicare. Those reviews resulted in 4,500 people having fees totalling $226,000 — or about $50 each — reimbursed by the clinics, said Ms. Matthews. An aide to the minister said officials were unable to separate out the cost of the hot line, which is being funded out of the ministry budget. One private clinic that offers colonoscopies to its clients — and says it follows all the appropriate rules — stressed that bolstering the public system is important, but questioned how seriously that system is being threatened. “It’s hard to tell whether going to this length is worth it as the government has not indicated the extent of the problem,” said Bronwen Evans, a spokeswoman for Torontobased Medcan. “We would hate to see precious health dollars and ministry staff time diverted away from other things, like reducing wait times.” An official with the group representing registered nurses applauded the hot-line initiative, however, saying the incursions by private medicine are significant, and could be leading to a system where those who can afford to pay more will get better service. That in turn pushes up the total cost of health care, and draws doctors away from the public system, said Rhonda Seidman-Carlson, president-elect of the Registered Nurses Association of Ontario. “That is a slippery slope,” she said “You start having a for-profit system.”

Canadian alliance urges parties to step up action on health and hea... Wednesday, August 17, 2011 CACHCA August 17, 2011

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This week, the association representing Canada's Community Health Centres (CHCs) submitted key health and healthcare questions to the leaders of all political parties seeking office this Fall during provincial elections in Manitoba, Newfoundland and Labrador, Ontario, Prince Edward Island and Saskatchewan. These questions will also be submitted in early September to all candidates seeking office in the Northwest Territories, once official candidate lists are released. The survey of political parties, submitted by the Canadian Alliance of Community Health Centre Associations (CACHCA), is intended to help voters in each province understand where each party stands on key commitments to improving health and health care. Responses from all parties will be posted and circulated in mid-September. You can read a general version of the letter and survey here. Beginning today, CACHCA is also encouraging members of the public to become involved in calling for key measures that will boost provincial health systems and improve access to high-quality, comprehensive health services. The association today released online petitions in each of the six provinces and territories, calling on the next government in each of these provinces/territories to commit to improving health and health care. Canadians are urged to sign the online petitions, which may be found here: • Manitoba petition • Newfoundland and Labrador petition • Northwest Territories petition • Ontario petition (via Association of Ontario Health Centres) • Prince Edward Island petition • Saskatchewan petition Over the coming weeks, CACHCA will be providing further updates about how Canadians can become involved in calling for a more effective health system for all Canadians -- what Tommy Douglas and Medicare's other founders called the "second stage/phase of Medicare".

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Health Care - The Movie Thursday, August 18, 2011 The HealthCare Movie The United States health care system is the most expensive in the world, but the U.S. consistently under-performs relative to other countries on most dimensions of performance. This feature length documentary explores the health care system in Canada: how it came to be, how it works for ordinary Canadians, how it is paid for, and how it compares to its American counterpart.

The issue of health care in America goes far beyond a line in the budget. It reaches into the center of the American soul and answers the question, "How in the world do we want to treat each other?" We interviewed Health Policy and Economics experts in both the United Sates and Canada, a Canadian Senator, and the incoming president of a provincial medical association, who told us what doctors are saying about the health care system in Canada. It was our privilege to interview a former Premier of Saskatchewan who was the Minister of Health at the time when Canada was fighting for what is now its universal medicare plan. We visited two Community Clinics in Saskatoon, and met with patients there, and then we had a chance to talk with a Saskatchewan politician. We had the honor of meeting an author whose new book about the heroes behind the scenes in Saskatchewan was hot off the press. We drove through unusually wet prairies to visit the small Saskatchewan town where some say Canada's health care system was born. And we visited a family in Winnipeg, Manitoba whose challenging health care story began with the birth of their first child almost three years ago. Many, many more people in both Canada and the United States have become a part of the Healthcare Movie. Now we are putting it all together, with historical images and video clips to bring the story to life. We need your help. Support the HealthCare Movie HERE.

"The real health care crisis is in public confidence and understanding, not in financial sustainability‌ the public needs much more and better information about the real strengths and weaknesses of the health care system" Dr. Bob Evans, professor at the Center for Health Services and Policy Research, University of British Columbia.

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"Outstanding film. A must see." D.E. Healthcare Advocate "Excellent" I.L. Saskatoon Clinic "We're being duped" R. C., Physician, Salem OR

CCF in Saskatchewan led the way in the 1940s Thursday, August 18, 2011 Medicare: A People's Issue

The four years between the provincial elections of 1944 and 1948 were times of rapid change in health care delivery in Saskatchewan. It was the initial mandate of North America’s first social democratic government whose election platform had included a promise to set up medical, dental and hospital services “available to all without counting the ability of the individual to pay”. Some of the changes were innovations while others were developments of existing programs. 126

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The newly elected premier, T.C. Douglas, wasted little time in contacting Dr. Henry Sigerist, professor of the history of medicine at Johns Hopkins University, and author of Socialized Medicine in the Soviet Union, to head a health study commission. Sigerist quickly produced a report that recommended several changes be made. He called for the establishment of district health regions for preventive medicine, advocated rural health centres of eight to ten maternity beds, and noted that the public should seek medical advice at the centre, so that each doctor would no longer “spend a large part of his time driving around the country.” Sigerist’s recommendations were quickly incorporated into the Health Services Act which was passed before the year was out. As a result of the Health Services Act and other enabling legislation Saskatchewan took several steps toward its goal of universal health care. Some the changes and developments of the next three years included: • First comprehensive plan for pensioners and widows. • Formation of the Saskatchewan Health Services Planning Commission. • Health Region No. 1, Swift Current created. • Saskatchewan first province to provide capital grants for hospital construction. • Appointment of Canada’s first full-time cancer physicist, Harold Johns. • Swift Current becomes the first region in Canada to combine public health with medical care. • Cornerstone laid for the College of Medicine at the University of Saskatchewan. • Funding approved for the construction of the University Hospital in Saskatoon. • First universal hospitalization insurance program in North America.

Debunking Canadian health care myths Friday, August 19, 2011 Written by Rhonda Hackett The Best Article Everyday

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one. Often I’ll avoid answering, regardless of the questioner’s nationality. To choose one or the other system usually translates into a heated discussion of each one’s merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems. Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes. Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a singlepayer health care system. Opponents of such a system cite Canada as the best example Medicare's 50th Anniversary

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of what not to do, while proponents laud that very same Canadian system as the answer to all of America’s health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments. As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system. Myth: Taxes in Canada are extremely high, mostly because of national health care. In actuality, taxes are nearly equal on both sides of the border. Overall, Canada’s taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average aftertax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent. Myth: Canada’s health care system is a cumbersome bureaucracy. The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn’t when everybody is covered. Myth: The Canadian system is significantly more expensive than that of the U.S. Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services. What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly. Myth: Canada’s government decides who gets health care and when they get it. While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be. There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don’t get one no matter what your doctor thinks – unless, of course, you have the money to cover the cost.

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Myth: There are long waits for care, which compromise access to care. There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists’ care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs. Myth: Canadians are paying out of pocket to come to the U.S. for medical care. Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is. Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government. Princeton University health economist Uwe Reinhardt says single-payer systems are not “socialized medicine” but “social insurance” systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are selfemployed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government. Myth: There aren’t enough doctors in Canada. From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system. And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn’t the big bad “socialist” bogeyman it has been made out to be.

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It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty – who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care – will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

Defending health care is not enough Friday, August 19, 2011 By Sam Gindin Introduction to Whose Health Care? Challenging the corporate struggle to rule our system

Most Canadians reject a private health care system that is driven by the accumulation of profit, that limits people’s access to the size of their wallets and provides health in exchange for the risk of financial debt. Affordable public health care – for one’s own family and as a shared right with others – is something worth defending. Defending public health care is not enough. It doesn’t prevent a slower ‘death by a thousand cuts.’ Indignant government campaign speeches against privatization only lead to more subtle forms of privatization – privatization by stealth. Even where privatizations are curbed, the rules under which hospitals are run are transformed so they reflect the thinking and practice of competitiveness and commercial values, not social values. Cutbacks may be checked today, but revived tomorrow after tax cuts or an economic downturn lead to budget deficits that ‘demand’ new restraints. Any problems in the health care system that do occur lead to public frustrations which are then politically manipulated to develop support for ‘repairs’ and ‘innovations’ (based on giving private corporations greater control over our health). 130

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At the same time, examples from abroad are brought into the debate – sometimes via misinformation, sometimes without reference to the larger context, and sometimes presenting defeats as victories – to convince us that our resistance is futile, that we are swimming against an inevitable tide. And because we are overwhelmed by defending the health care system, we forget that our health care system is incomplete. Health care depends on much beyond itself – from the impact of poverty on a minority, to the working conditions many of us face, to the polluted air we breathe. We need to both extend health care and place the fight for health care in a broader context. The attack on health care is part of a broader corporate offensive taking place throughout the world. This offensive’s promises of security and rising living standards have been widely exposed as false. Like a virus, neoliberal ideology (the freedom of corporations, not the expanded freedom of people) is permeating every sector of society, and health care increasingly lacks a sufficient firewall or political antidote. Unless we wage a larger battle for a different kind of society, health care will be marketized and eventually eroded. The struggle over the future of health care, then, provides us with a vital opening for a larger struggle to expand its underlying principles. Only defending our health care system will eventually place us in indefensible positions. Health care costs have been escalating and some services are not what they should be. If we ignore these realities, we risk losing even what we have. Our response must be twofold. First, we must reject the privatization of health care. The privatization of our health care system is in fact a cause of the existing system’s problems. Second, the health care issue is indeed (as the corporate supporters of increased dependence on private health care constantly remind us) about free, equal, and democratic choices. We do have to decide how much of a priority health care is in itself, and in the context of a society that prides itself on freedom, equality and democracy. But the privatization of health care will only expand the choices of an enriched few (defined by their ability to pay for health care as a commoditized service) while weakening the choices of the majority (by undermining their access to public health care as a right). Arguments that budget-crunching alone dictate that government can no longer pay for rising health care costs creates the illusion that private health care will cost less and provide better service. Yet we live with a tell-tale example of the ramifications of a private system to our immediate south, where the lesson is, as even General Motors has belatedly recognized, that the more privately-oriented the health care system, the higher the overall costs and the worse the human care. Addressing cost and service concerns require the expansion and improvement of our health care system, not its commercialization and contracting of its work at the sacrifice of quality. Important questions need to be asked regarding the costs of health care. • Why is public pharmacare not a concern? If the drug companies make money by selling new medicine, will it be in their interest to both prevent sicknesses and effectively research the potentially negative and long-term side-effects of medicine at the same time? • Are expensive new health care technologies being used and allocated Medicare's 50th Anniversary

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appropriately? Expensive corporate-generated technologies drastically escalate health care costs as hospitals, managed like mini-corporations, see new equipment as way to attract ‘customers.’ This leads to waste, a distortion of care, and a misuse of technological potential. • How should doctors be paid and how should we relate their role in the public health care system to their role as private practitioners? • How should hospitals be run? Certainly, all large institutions suffer from bureaucratic problems. But turning hospitals into corporations adds anti-socialgoals to existing bureaucratic irritations. Rather than turning hospitals into corporations with a tiny and overpaid yet theoretically savvy managerial class at the top, we should invent new models of social administration that allow for a deeper democratization of health care. A new model could include greater input from those people receiving the service and more importantly, those workers that provide the services: doctors, nurses, technicians, and other hospital workers, that have handson experience. Given what we are up against, health care won’t be saved without a much greater public commitment to political mobilization than we’ve seen to date. This pamphlet hopes to contribute some tools for discussing over the present and future of health care; it also hopes to support present and future political struggles over health care. The articles that follow are written by both activists who work at the base of the health care system and academic-activists who have studied the recent transformations in our health care system. In this pamphlet, rigorous research and critical analysis is fused with popular political struggles to defend and extend our health care.

Canadian Doctors for Medicare Endorses CMA/CNA Principles Sunday, August 21, 2011 Canadian Doctors for Medicare August 21, 2011

ST. JOHN'S, NEWFOUNDLAND -- Canadian Doctors for Medicare is pleased to endorse the CMA and CNA's "Principles to Guide Health Care Transformation in Canada" - and it has thoughtful ideas about how to apply them. "The CMA and CNA principles demonstrate a clear commitment to a national framework that builds on the Canada Health Act to ensure our system is based on need, not ability to pay," said Dr. Bob Woollard, a board member of Canadian Doctors for Medicare. "The principles reflect what Canadians said at the CMA town halls this summer, and they recognize the need for an equitable system that respects the foundations of publicly funded health care: universality, accessibility and quality."

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CDM recognizes that the principles in the CHA are key to enhancing the patient experience, improving population health and getting value for money in our health care system, and all are critical to any transformation. In particular, the principle of an equitable system that addresses the social determinants of health is a significant inclusion. In the spirit of heath care transformation, Canadian Doctors for Medicare has proposed a number of ways to apply these principles to Canada's health care system. CDM's "Health Care Transformation Top 10" outlines ways to improve Canada's health care system, and the "Bottom 10" highlights the practices that are doing the most harm, and ought to be stopped. "We know that there are smart, cost-effective ways to make our system more efficient, and to ensure that patients are at the centre of our system," said Woollard. "We are delighted to add them to the debate. At the same time, we need to be vigilant to ensure that reforms uphold the CMA/CNA principles, and strengthen our publicly-funded system." The Health Care Transformation Top Ten and Bottom Ten are available at: www.canadiandoctorsformedicare.ca

The Foundations of National Public Hospital Insurance Sunday, August 21, 2011 BY ALECK OSTRY CBMH/BCHM / Volume 26:2 2009

This paper first describes the development of two-tiered hospitals in many Canadian cities to the 1920s. The second section illustrates the chronic fiscal problems these twotiered institutions faced and demonstrates the failure of this model of hospital financing under the economic stress of the Depression. The third and fourth sections of the paper shift to a discussion of Saskatchewan focusing on the roots of the rural hospital system and the implementation of a province-wide public hospital insurance plan. The fifth section outlines the continuing fiscal stresses facing hospitals in provinces without public or with partly public hospital insurance plans in the 1950s as they faced postwar pressures with inadequate financing mechanisms derived from the Victorian era. The final section outlines the main reasons why all the provinces

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signed onto a national public hospital insurance plan. The purpose of this paper is to provide the background to provincial and federal government acceptance of a national public hospital insurance plan in Canada. Read this paper HERE.

The Saskatchewan doctor's strike and nurses Sunday, August 21, 2011 100 Years of Nursing on the Prairies 2005

Although the doctors' strike is a large part of Saskatchewan's medicare history, nurses, surprisingly, did not take a partisan role in the conflict. The Saskatchewan Registered Nurses' Association (SRNA) urged nurses to decide for themselves where their loyalties lay. Some nurses were in favour of implementing the medicare scheme while others were adamantly opposed, taking part in the Keep Our Doctor Committees (KODs). The implementation of medicare did not even merit close attention in The First Fifty Years , the history of the first fifty years of the SRNA. The fact that medicare was such a non-issue for nurses is interesting in itself. While the whole province was in turmoil over a change to the health care system as it had existed for decades, nurses showed professional integrity and stayed in at work. They did not walk off the job in support of doctors, but rather picked up the slack in hospitals and dealt with the large numbers of patients who needed medical care. Georgiana Chartier, a nurse, remembers being outraged at the hospital's treatment of patients during this time. Her son had been out playing in the campground where the family was vacationing and had taken quite a vicious fall. His mother, being a nurse, automatically thought of all of the things that could have been wrong with her son due to his injury and thus rushed him to St. Paul's Hospital in Saskatoon. Chartier remembers her feelings at the time:

"And there was a form I had to sign before they would care for him, and it was literally, to me, the way I read it, was that if anything goes wrong, nobody was responsible. So I signed the form. But then in brackets, I put "under duress," which made me very unpopular...I thought that this was against their oath...that you're literally leaving your patients...I didn't think it was right, and I guess it was this sort of thing that you took an oath to look after people. You didn't leave them like that. I guess I found it sort of against 134

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what you were supposed to be doing. You were caring for the sick and there were oaths that you took to care for your patients" (Interview: Georgiana Chartier). While Chartier's views are not representative of all nurses, they do reflect some of the frustrations at the time.

Nurses at KOD rally, 1962

Jack Layton: R.I.P. Monday, August 22, 2011

"When you're sick, you present your medicare card, not your credit card. New Democrats will not stand idly by. We will be fighting each and every day for our precious medicare system." - Jack Layton

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Canadian Medical Hall of Fame: Dr. Norman Bethune Wednesday, August 24, 2011 Dr. Norman Bethune Born: March 3, 1890, Gravenhurst, Ontario Died: November 12, 1939 Education: M.D. - University of Toronto, 1916 Category: Mobile Blood

In 1890, Norman Bethune was born in Gravenhurst, Ontario. He went to the University of Toronto, where his education was interrupted when he enlisted as a stretcher bearer in World War I. He received his M.D. in 1916. Dr. Bethune's impact on medicine can be categorized into three distinct areas. Bethune wrote extensively on the development of new surgical instruments, helping to establish a body of work that would be an essential reference for any surgeon. In 1936, while living in Montreal, Bethune proposed a universal health care system for Canada. Although the suggestion was not readily accepted, Bethune's good works abroad and compelling recommendations would eventually find a place in the Canadian medical system. And finally, Bethune is probably most remembered as being the first to introduce the mobile blood bank to the battlefield, where he performed countless blood transfusions in the midst of heavy fighting. A doctor to the very end, Bethune died of blood poisoning in 1939, while ministering to a Chinese Army. Canada remembers Bethune as a medical genius, China reveres him as a saint.

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The Case for Medicare Wednesday, August 24, 2011 Canadian Doctors for Medicare The 40-year struggle for universal health care - from private failure to public success

Private medicine dominated Canadian health care until the mid-1940s. Canadians who couldn't afford to pay for a doctor or hospital bed generally relied on charity or went without care. Some sacrificed homes and life savings to get medical attention for desperately ill family members. This still happens in the United States, the only developed nation without a universal, publicly-funded health care system. The federal government establishes Medicare 1966-68; and strengthens it with the Canada Health Act, 1984 Saskatchewan Premier Tommy Douglas - the Father of Canadian Medicare - set the stage for Canadian Medicare when he introduced a public insurance plan for hospital services in his province in 1947, and physicians' services in 1962. In 1966 Lester Pearson's federal Liberal government followed Douglas` lead by introducing The Medical Care Act. Implemented in 1968, the Act set out the principles of Medicare: • coverage of all necessary physician and hospital services - comprehensiveness; • availability to all insured citizens - universality; • access to all under uniform terms and conditions, in particular, regardless of ability to pay -accessibility; • a single payer for all covered services, i.e. the government - public administration; and, • ability for citizens to use their coverage across the country - portability. The Canada Health Act In 1984, responding to a proliferation of direct charges by physicians to patients, the Trudeau Liberal government introduced the Canada Health Act (CHA). Passed unanimously by the federal parliament, the CHA allows the federal government to deduct one dollar from federal transfers to any province for every dollar of direct patient charges Medicare's 50th Anniversary

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in that province. The CHA, for a period, ended user fees for insured physician and hospital services. Accountability for healthcare spending decreases In the 1968 legislation, the federal government offered the provinces a dollar of cash transfers for each dollar they spent on healthcare programs that met the principles in the federal legislation. The proportion of healthcare funding, and the form of that funding, subsequently changed. The provinces negotiated a transfer of "tax points", allowing them to levy taxes, which they could use for (among other things) healthcare delivery. Determining federal contributions to health care (and thus holding the federal government accountable) became even more difficult when, in 1996, the federal government rolled education and health funding in to a single package, the Canadian Health and Social Transfer (CHST). The 1990s - Governments cut healthcare funding In 1992, Canada spent 10.2% of its gross domestic product (GDP) on health, more than any country other than the United States. In the mid-1990's, troubled by their large budget deficits, the federal government made huge cuts in transfer payments to the provinces, and provincial governments ended the practice of substantial yearly increases in healthcare funding. Yearly increases in health spending averaged 11.1% from 1975 to 1991, but dropped to increases of 2.5% annually in the late 1980s and early 1990s. As a result, increases in health spending failed to keep pace with economic growth, and health spending dropped to 9.2% of the GDP, an extraordinary decrease that did not occur in any other industrialized country. Even after the catch-up spending of the last few years, described shortly, Canadian health spending as a percentage of GDP approximates that of 1992. In the same period, all other OECD countries had increases in health spending of 1.5% to over 2% of the GDP. The 2000s - Governments play catch-up in healthcare spending • An immediate infusion of federal dollars and increased accountability for the way those dollars are spent. • Creation of the Health Council of Canada to facilitate collaborative leadership in health and new approaches to primary care www.healthcouncilcanada.ca • Stable and predictable long-term funding • More integrated, team-based care • Investment in diagnostic technologies and training programs to reduce waiting lists • Centralized management of waiting lists • A national home care strategy and improved service to rural and remote communities • A National Drug Agency and improved coverage of prescription drugs. The Romanow Report Since 2000 federal-provincial relations have been characterized by periodic federalprovincial agreements, in which the federal government has gradually made up its reductions in health transfers of the mid-90s. The trend was spurred by Roy Romanow's 2002 landmark report on health care reform. After a dozen focus groups, 21 days of public meetings and several dozen expert reports, Commissioner Romanow concluded Canadians place high value on equitable access to high quality health care delivered on the basis of need, and not ability to pay. Among his recommendations: 138

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A new federal-provincial deal In February 2003, the provinces reluctantly signed on to a deal that represented significant increases in funding, with few (if any) accountability strings attached. Given the extent of prior funding cuts, the explosion in expensive health technology, and the aging population in the context of a system that tends toward more aggressive treatment of the elderly, it is no surprise that these increases proved inadequate. As a result, the 2004 federal election became, to a large degree, a debate about the future of health care in Canada. Less than two months after the election, Liberal Prime Minister Paul Martin convened a First Ministers' conference on health care. The ultimate deal that emerged from this meeting provided for a $41-billion federal infusion into the system over 10 years, a sum that was trumpeted by the federal government as closing the "Romanow Gap". Missed opportunities for federal and provincial governments Commissioner Romanow recommended the federal government use its leverage with the provinces to "buy change" - in other words, to ensure new money would be targeted to meaningful healthcare reform and fixing the system. Despite the stated intentions of all governments to direct new money into healthcare, however, the 2003 and 2004 accords did not stipulate that expenditure be targeted toward particular needs (e.g. training health personnel), or innovations (e.g. integrated multidisciplinary, chronic disease management), nor did it provide sufficient accountability mechanisms to ensure that money flowed into these important areas. This has led to concerns that governments may not be flowing money into areas where change is most needed, and research in some provinces indicates that planned increases in expenditures fall short of the money provided by these two large cash infusions. The privatization of universal health care The Canadian health care industry represents an untapped market for investors and insurance companies, but it`s a challenging way to make money; investors could sell enhanced access to create a second tier of health services, they could ``cherry pick`` low risk, low cost patients, leaving the sickest patients to the public system, compromise care and sell unnecessary services. Inevitably, privatization of our healthcare system would have winners and losers; the winners would be private investors, the insurance industry and those Canadians wealthy enough to buy their way to the front of the line, and thereby avoid waiting for diagnostic tests or treatments. The losers would be the vast majority of Canadians who would face not only longer wait lists but also deteriorating standards. Two key factors explain deterioration in publicly funded care when a parallel private system exists. First, scarce human resources are extracted from the publicly funded system, a particularly Canadian concern given the current shortage of nurses and doctors in our country. Second, a parallel private system decreases pressure from politically influential, privileged Canadians for maintaining the quality of publicly funded care. Other losers would be those Canadians who feel pressured to buy private insurance but forego other potentially more important purchases, like high-quality childcare or a postsecondary education, large corporations whose employees would demand private health Medicare's 50th Anniversary

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insurance as a condition of employment would also suffer. To the extent that this happens, Canadian industry would lose its competitive advantage relative to the United States. The Chaoulli Decision Championed by a few think tanks and advocacy groups (such as the Fraser Institute and National Citizens' Coalition) and a few outspoken media commentators, Medicare opponents received a huge boost from the Chaoulli decision of June 2005 (CDM Bulletin on the Chaoulli decision) when the Supreme Court of Canada, by a 4-3 vote, declared that Quebec's prohibition of private insurance for publicly insured services violated the provincial Charter of Rights. With regard to the Canadian Charter of Rights, the decision split 3-3. Most legal opinions see the Chaoulli decision, which flowed from a perception of excessive wait times for procedures such as joint replacements, as having limited implications. However, more important than its legal implications has been its political impact. The decision has resulted in increased pressure for a two-tiered private insurance alternative, as well as for increased for-profit health care delivery. Most recently, Quebec has responded to the Chaoulli decision with a plan which, at first look, provides little threat to public funding of care, but potentially increases the role of investor-owned forprofit health care provision. Potentially even more serious are initiatives in British Columbia, and off and on again in Alberta, which could make the provision for open queue-jumping and ready access to private insurance for publicly insured services. New Charter challenges are underway in Ontario and Alberta. What about doctors? Doctors who work in privately funded for profit facilities and value higher incomes over the delivery of equitable care might benefit from privatization, if they could put up with the increased bureaucracy and scrutiny of care that would accompany the introduction of private health insurance. Still, most doctors would not be better off. Conditions in the public system would worsen, the average patient would be sicker and frustrations would be higher. With two tiers of patients there would also be two tiers of physicians. Collegiality would undoubtedly suffer. The truth is that Medicare is not only good for patients; it is also good for doctors. The case for Medicare is as strong today as it was in the 1960s, and is now buttressed by strong research and by decades of physician experience and Canadian commitment to the values it represents.

Public Voice for Medical Care Insurance, Issue #1 Wednesday, August 24, 2011 Medicare: A People's Issue As the struggle for medicare escalated to the doctor's strike in Saskatchewan, citizens supporting medicare started their own publication to counter the expensive ads and commercials launched by the KOD.

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Initiated through the Saskatchewan Federation of Labour, "Public Voice" was issued four times in July of 1962. Below is the first issue of the Public Voice.- NYC

Open publication - Free publishing - More doctors strike

Keep our Doctors Committees in the Saskatchewan medicare controversy Wednesday, August 24, 2011 By Ahmed Mohiddin Mohamed University of Saskatchewan September, 1963

Shortly after the doctor's strike in Saksatchewan, Ahmed Mohiddin Mohamed researched Medicare's 50th Anniversary

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and wrote his MA thesis on the Keep Our Doctor's Committees that had been formed to support the doctors. It remains an important and valuable resource for those researching and understanding the fight for medicare in Saskatchewan. - NYC Abstract: The main task of the study has been to trace the development of the KODs how, when, where and why did they come into being. Chapter II discussed the background to the Medicare controversy, the doctors' "unalterable" opposition to "StateMedicine", the College's efforts to educate the profession and the public on the matter and the Government's endeavours to meet what it considered the doctors' legitimate concerns. As the controversy developed, however, it soon became apparent that the real issues were those of differing social and political philosophies, of the concept of society and of the place of the individual and his relation to political authority. As neither the College nor the Government trusted the other, the issue became insoluble. Download full report HERE. (large PDF)

UNISON calls for a halt to UK Health and Social Care Bill Wednesday, August 24, 2011 Unison 24/08/2011 UNISON, the UK’s largest union, is today calling for an immediate halt to the Government’s Health and Social Care Bill. A lethal cocktail of economic uncertainty, spiraling waiting lists, and budget deficits, means that now is the worst possible time to bring in a major, untried, untested reorganisation, warns the union. The latest statistics show NHS waiting times are increasing - those waiting 6 months or more for treatment have increased by 61% in the last year. And the Government’s demand for £20bn in so called “efficiency savings” is leading to ward closures, staff cuts and rationing across the country. Christina McAnea, Head of Health for UNISON said: “If the Health and Social Care Bill goes ahead, the outlook for the NHS and patients looks bleak. The Government’s polices have already led to NHS patients waiting longer, often in great pain, for their operations. “The Bill will make matters worse by taking the cap off the number of private patients that hospitals are allowed to treat. It will be an enormous temptation for cash strapped hospitals to boost their income by prioritising paying patients, pushing NHS patients even further down the ever-spiraling waiting lists. “Even fourteen of the elite group of foundation trusts ended the last financial year in deficit, a grim warning for the future of NHS finances. “The economic uncertainty and budget deficits add to this lethal cocktail and should be

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obvious to the Government that now is not the time to bring in this massive, damaging NHS reorganisation."

A Look at the Venezuelan Healthcare System Thursday, August 25, 2011 By Caitlin McNulty Venezuela Analysis June 30th 2009

The right to health care is guaranteed in the Venezuelan Constitution, which was written and ratified by the people in 1999. Through implementing a state-funded social program called Barrio Adentro, or inside the barrio, free comprehensive health care is available to all Venezuelans. Beginning in June 2003 through a trade pact with Cuba, Venezuela began to bring Cuban doctors, medical technology, and medications into rural and urban communities free of charge in exchange for low-cost oil. The 1.5 million dollar per year program expanded to provide a broad network of small neighborhood clinics, larger regional clinics, and hospitals which aim to serve the entire Venezuelan population. (1) Chavez has referred to this new health care system as the "democratization of health care" stating that "health care has become a fundamental social right and the state will assume the principal role in the construction of a participatory system for national public health." (2) In Venezuela, not only is health care a right; it is recognized as essential for true participatory democracy. Some of what characterizes this movement towards health care for all includes popular participation, preventative medicine, and evaluation of community health issues. Western medicine typically operates in a top-down fashion. Doctors treat symptoms, and often fail to evaluate the larger picture of community health issues or teach prevention. (3) In a private for-profit system, there is little incentive to prevent costly illnesses. In Venezuela, however, Barrio Adentro began constructing clinics within neighborhoods where many had never been to a doctor. Through this program, a community can organize to receive funding to build a clinic and bring in doctors. The community is responsible for creating health committees, the members of which go door to door to assess the specific health issues of their community. Doctors who live in the communities also make house calls. (4) People participate in the process of serving the health needs of the entire population.

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The extensive health program is also being used to train a new generation of Venezuelan doctors. The training program takes place within the clinic system itself and relies heavily on experiential learning. The program seeks to build a new relationship between doctor and patient based on the values of service, solidarity and compassion. Doctors participating in the training program are coming from the communities they are learning in and serving, building on their intimate knowledge of the communities to provide truly compassionate and personalized care. Using popular forums, medical professionals are able to respond to the needs of the community and offer education, treatment and consultation addressing unique public health issues.(6) Although the system began by focusing exclusively on preventative health, it has expanded to include emergency health services, mental health services, surgeries, cancer treatment, dental care, access to optometrists as well as free glasses and contact lenses, support systems for those with disabilities and their families, as well as access to a large variety of medical specialists. They have succeeded in taking an under funded, corrupt public health care system and changing not only the quality and accessibility but also the mentality of those working there. Instead of a for-profit industry systematically denying access to large sectors of the population, health care in Venezuela is seen as a basic human right. No one is turned away, and no one is denied care. In Venezuela, they treat whole person, not simply their illness, and money stays where it belongs- outside of the health care system.(7) During my time in Venezuela, I developed a cough that went on for three weeks and progressively worsened. Finally, after I had become incredibly congested and developed a fever, I decided to attend a Barrio Adentro clinic. The closest one available was a Barrio Adentro II Centro de Diagonostico Integral (CDI) and I headed in without my medical records or calling to make an appointment. Immediately, I was ushered into a small room where Carmen, a friendly Cuban doctor, began questioning me about my symptoms. She listened to my lungs and walked me over to another examination room where, again without waiting, I had x-rays taken. Afterwards, the technician walked me to a chair and apologized profusely that I had to wait for the x-rays to be developed, promising that it would take no more than five minutes. Sure enough, five minutes later he returned with both x-rays developed. Carmen studied the x-rays and informed me that I had pneumonia, showing me the telltale shadows. She sent me away with my x-rays, three medications to treat my pneumonia, congestion, and fever, and made me promise to come back if my conditioned failed to improve or worsened within three days. I walked out of the clinic with a diagnosis and treatment within twenty-five minutes of entering, without paying a dime. There was no wait, no paperwork, and no questions about my ability to pay, my nationality, or whether, as a foreigner, I was entitled to free 144

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comprehensive health care. There was no monetary value connected with my physical well-being; the care I received was not contingent upon my ability to pay. I was treated with dignity, respect, and compassion, my illness was cured and I was able to continue with my journey in Venezuela.

This past year, a family friend was not so lucky. At the age of 56, she was going back to school and was uninsured. She came down with what she thought was a severe case of the flu, and as her condition worsened she decided not to see a doctor because of the cost. She died at home in bed, losing her life to a system that did not respect her basic human right to survive. Her death is not an isolated incident. Over 18,000 United States residents die every year because of their lack of prohibitively expensive health insurance. The United States has the distinct honor of being the "only wealthy industrialized nation that does not ensure that all citizens have coverage".(8) Instead, we have commodified the public health and well being of those live in the US, leaving them on their own to obtain insurance. Those whose jobs do not provide insurance, can't get enough hours to qualify for health care coverage through their workplace, are unemployed, or have "previously existing conditions" that exclude them from coverage are forced to choose between the potentially fatal decision of refusing medical care and accumulating medical bills that trap them in an inescapable cycle of debt. And sometimes, that decision is made for them. Doctors often ask that dreaded question; "do you have insurance?" before scheduling critical tests, procedures, or treatments. When the answer is no, treatments that were deemed necessary before are suddenly canceled as the ability to pay becomes more important than the patient's health.(9) It is estimated that there are over fifty million United States residents currently living without health insurance, a number that will skyrocket as unemployment rates increase and people lose their work-based health care coverage in this time of international financial crisis.(10) Already this year, 7.5 million people have lost work-related coverage. Budget cuts for the state of Washington this year will remove over forty thousand people from Washington Basic Health, a subsidized program which already has a waiting list of seventeen thousand people.(11) As I returned to the US from Venezuela, I was faced with the realization that as a society, the United States places a monetary value on life. That we make life and death judgments based on an individual's ability to pay. And that someone with the same condition I had recently recovered from had died because, according to our system, her life wasn't insured. Many in the United States fear that people would abuse a free health care system, causing overcrowding and a compromised level of care. Others claim that a single payer system would limit the freedoms of both doctor and patient. These claims, propagated by the corporate media in the United States, are a hollow attempt to keep those in the US

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from organizing to demand single payer health care. Primary care and preventative medicine are seen as the first steps towards sustainable universal health care, keeping people out of costly hospital stays, tests, and treatments down the road. Socializing the costs of medicine keeps costs low by preventing expensive treatments and health problems. It is difficult to understand how much quality, free health care means until you find yourself in a position of vulnerability and need. I felt a sense of security traveling in Venezuela that I do not feel in the United States; in Venezuela, there is a safety net ready to catch you when you fall. People in the US must ask themselves, as a country, where our values lie and how we have not only let people slip through the cracks but worked to systematically exclude them. Do we believe that insurance corporations and the medical industrial complex should be profiting from denying care and keeping sick people from receiving treatment? Or do we believe that care should be separate from an individual's ability to pay? As a nation, we must embrace our humanity and value life over profits. Notes: 1 Wilpert, Gregory. Changing Venezuela The History and Policies of the Chavez Government. New York: Verso, 2006. 2 "Mision Barrio Adentro." Mision Barrio Adentro. 02 June 2009 <http://www.barrioadentro.gov.ve/>. 3 Wilpert, Gregory. Changing Venezuela The History and Policies of the Chavez Government. New York: Verso, 2006. 4 "Mision Barrio Adentro." Mision Barrio Adentro. 02 June 2009 <http://www.barrioadentro.gov.ve/>. 6 "Mision Barrio Adentro." Mision Barrio Adentro. 02 June 2009 <http://www.barrioadentro.gov.ve/>. 7 ibid 8 "Insuring America's Health: Principles and Recommendations -." Institute of Medicine. 02 June 2009 <http://www.iom.edu/?id=19175>. 9 "PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS." 02 June 2009 <http://www.who.int/inf-pr-2000/en/pr2000-44.html>. 10 "Census Revises Estimates of the Number of Uninsured People - Center on Budget and Policy Priorities." Center on Budget and Policy Priorities. 02 June 2009 <http://www.cbpp.org/cms/?fa= view&id= 245>. 11 "PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS." 02 June 2009 <http://www.who.int/inf-pr-2000/en/pr2000-44.html>.

P3s in Health Care Friday, August 26, 2011 Public-Private â&#x20AC;&#x2DC;Partnershipsâ&#x20AC;&#x2122; (P3s)

Canadian Health Coalition The Issue:

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A Public-Private ‘Partnership’ (P3) is a business venture which is funded and operated through a partnership of government and private sector companies. Problem is, P3 schemes costs taxpayers: the public pays and private investors profit. That’s not a partnership! Furthermore, evidence shows that in P3 schemes, costs go up, quality goes down and there is little or no accountability.

Resources: P3 hospitals – the wrong direction New report from CUPE, April 2011 P3s = Private Profits, Public Pays Canadian Health Coalition Factsheet, 2010 Health Care Privatization Research Archive Canadian Health Coalition, 2010 Report: Eroding Public Medicare Ontario Health Coalition, 2009 Expert tells Romanow: Public-Private Partnerships Are Not The Answer Dr. Allyson Pollack, May 2002

Media: Québec Auditor General pans PPPs, says cost estimates wrong Montreal Gazelle, June 10, 2010 P3 bailouts expose health-care hypocrisy The Globe and Mail, February 12, 2009 In this P3, taxpayers are the ones who paid The Globe and Mail, February 5, 2009 Warning: The P3s are coming Winnipeg Free Press, July 21, 2002

From Tommy to Jack: A (Hallucinatory) Dream of Universal Health Care Saturday, August 27, 2011 By Julie Devaney The Huffington Post August 26, 2011

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Tommy Douglas appeared to me once in a drug and trauma-induced hallucination. It was 2002 and I was bearing the brunt of British Columbian Premier Gordon Campbell's vile cuts to healthcare. My immobile body on a stretcher was literally being stored in a closet in an over-crowded Vancouver emergency ward. Unfortunately, the drugs were all medically-administered and more disorienting than pleasurable. As the Archangel of Canadian health care, Tommy had come to fly me and my leaking, numb and closeted body away to the well-funded public facility of all of our dreams. It didn't really surprise me that Tommy showed up. I'd always counted him among my closest comrades (and also, I was very ill and medicated). I cut my political teeth in Mike Harris' Ontario. As a teenager on the lawn of Queen's Park as hundreds of thousands of people shut down the city of Toronto, I got the impression that this is what always happened when health care and other social program cuts are unjustly meted out on a population -- we rise up, fight back. And Tommy knows a lot about fighting back. Last night I dreamt of Jack Layton. We were drinking beer. We talked about the messy, unpredictable vulnerability of all these human bodies we walk around in (this part made me cry, even in my sleep). And that surely, fair and equitable access to care for these bodies is essential to a just, humane and democratic society. How can we even pretend to be a democracy while we slowly eke out privatization that will limit access for poor people and increase it for the wealthy? In that beautiful sleep-state where amazingly contradictory things seem to just make sense, I simultaneously accepted both that he passed away this week and that he'd continue to take a principled stand for universal, public health care.

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As we finished our beers, Tommy showed up just in time, with another round. The three of us sat and drank and talked the night away. They smiled at Jack's amazing election victory this spring -- how millions more people are engaging visibly and audibly to defend public health care. Then we talked about how Stephen Harper can't be trusted to negotiate a new healthcare agreement with the provinces in 2014, and I got a bit panicked. "What are we going to doooo?!" I demanded as they peaceably sipped their beers. "And ohmygod what if Hudak gets elected in Ontario? What will happen to rural hospitals and home care and nurse practitioners and family doctors and health teams? We're already in a perfect storm of under-funded hospitals, under-resourced communities and unsupported healthcare professionals! Tommy! Jack! Ahh!"

They spoke together, in one voice (which seemed so normal and plausible while I was asleep), "You are all going to defend, public accessible medicare -- free to everyone, well-funded, high quality -- and we are going to have your backs." I looked at them both, my beer goggles in full-effect by this point. I could see so clearly how Jack flew into the position of the leader of the largest Official Opposition on Tommy's wings, sharing his vision of a fair and equitable society. That every time the doomsday messengers of privatization show up with their axes at our public hospital doors, Canadians in our masses rise up and push them back. And awake now, with the soft light of day pouring onto my computer keys, I can see how this is all more than a hallucinatory dream of beer and solidarity -- it's what's going to happen. Because Tommy and Jack have our backs.

The 1960 Saskatchewan Election Saturday, August 27, 2011 Medicare: A People's Issue Saskatchewan voters went to the polls in June of 1960. The main issue of the campaign was the pre-paid, universal, compulsory medical-care plan promised by the government. Premier Douglas asked the electorate for a strong mandate. Of the three opposition parties only the Socreds completely opposed Medicare. Criticism from the Liberals and Conservatives focused on the details and the timing of implementation. The most vocal opposition came from the province’s doctors, represented by the College of Physicians and Surgeons. Douglas used the physicians' lack of political experience and division in their ranks to portray himself and the province as underdogs. The doctors’ campaign was badly handled.

Open publication - Free publishing - More ccf Throughout 1961, the proposed medical care plan remained the top political issue in Saskatchewan. To fulfill its promise of consultation, the government created the Advisory Planning Commission on Medical Care, mandated “to study and report upon a medical care insurance program for the province and on the public need in other fields of health.”

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The former President of the University of Saskatchewan, Dr. W.P. Thompson, was invited to act as chair. It was an onerous job, made especially difficult by the attitude of the medical members of the committee. 49 briefs of more than 1,200 pages were submitted by individuals and groups from across the province. In September of 1961 the Committee produced an Interim Report which recommended: • Universal coverage for all residents. • Comprehensive benefits based on residence, registration and payment of personal premiums with additional finances to be drawn from general government revenues. • Utilization fees. • Fee-for-service payment. • The creation of a commission responsible to the government to administer the plan.

U.S. Healthcare: Why it’s so expensive Monday, August 29, 2011 By medicareblogger The Tuscon Citizen Aug. 29, 2011

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appointments, and check in patients. Those are the front desk duties of the office staff, but there is much more: Checking a person’s insurance coverage to determine the patient’s co-pay; Contacting insurance companies to get prior approval for tests and referrals; Resubmitting documentation to insurance companies that won’t pay a bill until they get one more piece of paper. The list goes on and on. I always figured the way the American health care system works, with dozens of insurance companies requiring different paperwork and paying different fees for services rendered, was inefficient. But now there is a study that shows just how inefficient and expensive our convoluted system is. A study published in the Health Affairs Journal says that American doctors pay out more than four times as much as Canadian doctors because American doctors must deal with dozens of insurance companies (and Medicare). The study surveyed physicians and administrators in Ontario, Canada about time spent interacting with payers, and compared the results with a national companion survey in the United States. The findings: Physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. More findings: US nursing staff, including medical assistants, spent 20.6 hours per physician per week.interacting with health plans—nearly ten times that of their Ontario counterparts. Billions could be saved: The study found that if US physicians had administrative costs similar to those of doctors in Ontario, the total savings would be approximately $27.6 billion per year. Americans are told they have to pay more for their care, but I haven’t heard any talk about fixing the payment system for health care that is clearly inefficient and expensive. Why hasn’t this issue been addressed? Have the hundreds of insurance companies, each negotiating prices with doctors, kept health care costs from rising each year? The answer is clearly “no”, and the current system is clearly broken. So, before our government pushes more cost onto seniors and working people, why not fix the system?

Health Care: False Arguments, Class Arguments Monday, August 29, 2011 By Colin Leys From Whose Health Care December 2005

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Health care must remain a right of citizenship for two fundamental reasons: for the sake of democracy, and for the sake of good health care. We need equal access to health care for the same reason that we need equal access to schooling and university; real democracy cannot survive without a basic equality of life chances for every voter, and health care is crucial for that. But health care, like education, also needs equal involvement of all citizens. So long as judges depend on the same health services as janitors, judges (and politicians and senior policy-makers) will see that they are adequately funded and well run. As soon as the powerful stop relying on it, it starts to be allowed to decline. The rich don’t use it and they don’t want to pay taxes for it. The propagandists for the rich – the Fraser Institute and the like – use three main arguments. One is that the share of national income devoted to health care is already too high. But there is no particular proportion of the national income which should be spent on health care. The fetishism around this is due to the fact that health care in Canada and most other rich countries is financed out of taxes, and the more affluent don’t want to pay what only a few decades ago was seen as their reasonable share of the cost of services enjoyed equally by everyone. The fact that 14 per cent of the national income in the USA – half as much again as in Canada and the UK– is spent on health care doesn’t arouse concern in the US media. Why? Because only some of this is paid for out of taxes. The rich can buy their own health care on the market, without having to pay much in taxes for anyone else’s. The second argument advanced by the right is that private provision, driven by competition, is more efficient. Yet all the evidence points the other way. The U.S. is the best source of evidence on privately-provided health care. As pointed out above, while spending 14 per cent of one of the highest national incomes in the world on health care, the US market system leaves between 45 million and 75 million people (depending on how you measure it) with no health coverage at all. In addition, the administrative or ‘transaction’ costs of health care in the USA, where every procedure and swab has to be recorded and billed for, where hospitals and doctors advertise to get patients, and where legal fees and fraud make off with huge sums, are conservatively estimated to consume no less than 25 per cent of all health care spending – double the UK figure (and more than four times what the UK percentage was in the 1970s, before Mrs. Thatcher started to ‘marketise’ the National Health Service). And the health of U.S. citizens is no better than those of any other OECD country. On some 152

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indices their health is significantly worse. The third argument is that ‘two-tier’ provision as it operates in Europe brings in additional resources – from the ‘top-up’ fees paid by the better-off for speedier service or ‘enhanced’ treatments – and gives more satisfaction. This is really a call for private access to better health care, and would hardly be worth challenging if it were not that appealing to the ‘European model’ is apt to seem persuasive. If it works in France or Britain, people may feel, why not in Canada too? But in fact the European experience doesn’t support this argument at all. What is really going on at the moment is a world-wide drive by the private health industry to open up tax-funded (or ‘social insurance’ funded) health care as a huge source of almost risk-free revenues. Its lobbyists have captured the WTO and the OECD and to a large extent the WHO, so that European governments are under huge pressure to open up their health care systems to ‘market providers’, and they have increasingly succumbed to this pressure. Britain is a leading example. Not content with already having a two-tier system, with expensive, mostly company-paid health insurance for the affluent, Blair’s government has committed itself to the creation of a full health care quasimarket, in which the publiclyowned National Health Service or ‘NHS’ hospitals will have to compete with supposedly more efficient private providers. But the story so far shows that the privatizers’ arguments are completely false. NHS hospitals no longer get annual budgets, as in Canada, but are paid for each completed individual treatment, at prices set nationally by the government, and any private health care provider that wants to can bid to treat NHS patients at these prices. The idea is that competition from private providers will make the NHS hospitals more efficient. So private health care corporations were invited to begin by setting up ‘Independent Sector Treatment Centres,’ surgical clinics specializing in highly standardized, low-risk surgery – mainly cataracts and hip and knee replacements – which were seen as offering the best prospects for the supposedly more efficient private providers to make a profit. But the government then found that none of them was willing to do this at the prices paid to the NHS. So in desperation the government is paying them 40 per cent more than NHS prices – and guaranteeing them a supply of patients for five years; i.e., not competition, but featherbedding! The reality is that NHS hospitals, with internally well-integrated services treating all types of illness and surgical needs, can do it far more cheaply – and more safely. Whether private health care corporations will go on getting special deals from the British government allowing them to make money, in spite of being less efficient than the public hospitals, remains to be seen. What is plain is that they offer no magic formula for being cheaper. The other slogan used by the British government in support of its drive to bring in private providers is ‘patient choice.’ By the end of next year people are supposed to be able to choose to be treated at any hospital in the country – including any private hospital that will treat them at NHS rates. A survey by the government’s own Consumer Council showed, however, that the great majority of people don’t want to choose between hospitals, any more than they want to choose between post offices. What they want is to Medicare's 50th Anniversary

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have a really good hospital near them. When Prime Minister Blair had a heart problem last year he didn’t want a choice, he wanted good care, promptly, and got it in an NHS hospital in London. Very few people want anything different. To take another European example, France is often cited as showing the advantages of a ‘two-tier’ health service, including private provision. In fact, very little in the French system is really for-profit. All hospital medical costs (as opposed to the ‘hotel costs’) are covered by insurance premiums paid to state-controlled insurers, or by the state, and paid at rates set by the state which are the same for private as for publicly-owned hospitals. The popularity of the French system seems largely due to having been better financed than most, and setting very few limits to what either patients or doctors could do. But this has made it expensive, and the French government is currently on a campaign to cut costs by introducing restrictions, chiefly by instituting some limited ‘gate-keeping’ for access to specialist care, to stop what the French call ‘medical nomadism’ – people seeing several different doctors for the same complaint – and also by trying to limit excessive spending on drugs and sickness benefit (income support for people certified as ill by their doctors), and false billing by doctors. But an earlier de-listing of a vast range of useless drugs already caused a strong public reaction. Now the government is aiming to cut costs through a new system of inspection and penalties. It is not clear that this is going to save more money than it costs (in increased monitoring, a huge IT program to create a universal patients’ records system, etc), and it will certainly be resisted. The French system thus does not support the idea that ‘two-tier’ insurance and private provision makes for cheapness or efficiency. Private provision in France is actually very limited, and shows no signs of boosting efficiency in the rest of the system. If anything, private sector pressure to keep fees high has contributed to making the French system exceptionally expensive. In general, what the European experience shows is that private and ‘twotier’ provision is both more expensive and socially divisive. The decisive ‘no’ votes in both France and the Netherlands on the proposed EU constitution, which endorsed the private provision of public services, show that people understand this. West European governments, at least, will encounter more and more resistance to any further attempts to privatize health care and make it less egalitarian. Canadian governments should beware of putting the ambitions of their friends in the health care industry before the wishes of the electorate.

The UK's Health Industry Lobbying Tour Monday, August 29, 2011 Keep Our NHS Public Watch this short film about how the private health care industry has its tentacles in the heart of government.

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The Health Industry Lobbying Tour from Mancha Productions on Vimeo.

The Saskatchewan Doctors Strike - CBC 1962 Tuesday, August 30, 2011 CBC Archives Broadcast Date: July 1, 1962 July 1, 1962: Saskatchewan's Medical Care Act becomes law. However, taking advantage of the public health scheme proves difficult since most of Saskatchewan's MDs have responded by going on strike. With Cold War tensions approaching their climax in October's Cuban Missile Crisis, this showdown between the CCF's socialist ideals and the individual rights the doctors say they are defending puts Saskatchewan on front pages throughout the Western world.

ClickHEREto watch the CBC's coverage.

Medicare's pageviews by country Tuesday, August 30, 2011 Canada 964 United States 463 France 85 Mexico 33 Germany 29 United Kingdom 25 India 20 Russia 17 Philippines 12 Denmark 9

Bad medicine from advisory panel at CMA annual meeting Wednesday, August 31, 2011 By Dr. Danielle Martin Canadian Doctors for Medicare Rabble.ca August 31, 2011

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Imagine you're feeling sick. You have an inexplicable pain in your stomach. So you go to your doctor, and she sends you for a test. The test for your stomach pain is inconclusive. "I think I know what the problem is. And I probably have something I could give you for it," says your doctor. "How about you pay me an extra $50, and then we can discuss it further?" Most of us would think that's unacceptable. We already pay taxes to finance our universal health care. We would want our doctors to run more tests, give us a diagnosis and write us a prescription. Sadly, asking Canadians for more money is exactly the kind of solution many economists and policymakers are suggesting as a fix for Canada's health care system. At this year's annual meeting of the Canadian Medical Association an independent advisory panel, including Don Drummond, former federal Finance assistant deputy minister and chief economist at TD Bank, suggested we look at more funding options, like user fees, and private funding. This is the wrong way to go. Canadian Doctors for Medicare has a Top 10 list of positive ways to transform our health-care system, and a Bottom 10 of practices to avoid. User fees are number one on the Bottom 10, and private funding isn't far behind. We know that user fees don't work. They put up barriers to health care, shifting the burden of payment from the healthy and wealthy to the sick and poor. People who can't afford the user fee will wait until a small health concern becomes a big one before they go to the doctor. And a full-blown disease will be far more expensive to treat than a common, curable infection. What's more, the revenues collected from user fees barely make a dent in the overall costs. We would expect a better suggestion from Drummond, the head of TD Economics. And privately funded health care needs to operate where there are economies of scale, and people with money to spend, in order to turn a profit. This leaves out a lot of Canadians -- people in rural or remote communities, Aboriginal communities, marginalized urban populations, and people needing complex care, mental health care, and emergency care. Essentially, private funding benefits richer people in bigger cities. Our health-care system is supposed to be for everyone.

Canadian Doctors for Medicare has other ideas -- we think we ought to do the hard work and fix the problems in our system before we ask Canadians for more money, or bring in 156

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private corporations. We need to change, but we need to be smart and make our system more efficient. So what does work? Here are just five of our Top 10 ideas for health-care transformation. 1) Primary and community health-care reform We know that too many people are in expensive hospital beds when they should be in a long-term care home, or in community-based rehabilitation, or at home, receiving support. Expanding access to these kinds of community-based health care take the pressure off of overcrowded hospitals, and it's much more cost effective. 2) Electronic health records In 2009, 94 per cent of the 322 million visits to the doctor by Canadians still resulted in a paper record. But we know that EHRs help prevent dangerous drug interactions, reducing the number of visits to the emergency room. EHRs help to ensure that you're getting the right kind of care and medicine you need, no matter if you're at your family doctor, a hospital or a clinic -- the health professional serving you will understand your history. 3) Wait times initiatives There are a number of successful programs in Canada that reduce wait lists for surgical procedures. Strategies include having a single common wait list for a region instead of lists for each individual doctor, and implementing pre-surgical programs that prepare patients for surgery. Dr. Cy Frank, an orthopedic surgeon at the Alberta Bone and Joint Institute, led a team that reduced wait times for hip and knee surgery from 82 weeks to 11 weeks. We should be learning from Dr. Frank. 4) National pharmacare Canada pays more for prescription drugs than any other OECD country except the United States, and yet we have one of the lowest rates of public drug coverage. A national program with competitive bulk-purchasing of drugs could save us a bundle -- one study pegs the number at $10 billion per year, a whopping 43 per cent of our current $25 billion drug bill. 5) Health promotion and prevention Poverty, physical inactivity and poor nutrition are just some of the culprits that contribute to poor health status. We can do more to encourage better choices, and to provide assistance to our most marginalized citizens. Lower-income people tend to have worse health, and more complex conditions -- not only is that unfair, it creates a very expensive group of people to treat. We can do better to build an efficient, cost-effective health-care system without sacrificing equity, universality and a patient-centred approach. We may need to invest more in health care in the coming years, but let's not rush to introduce methods of financing that create winners and losers, especially when there's no evidence to back it up. The Top 10 and Bottom 10 are available HERE.

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Dr. Danielle Martin is a family physician and Board Chair of Canadian Doctors for Medicare. She is clinical staff at Women's College Hospital and lecturer in the Department of Family and Community Medicine at the University of Toronto. She served on The Health Council of Canada from 2005-2011. Dr. Martin helped launch Canadian Doctors for Medicare in May 2006.

Canadian Doctors for Medicare provide a voice for Canadian doctors who want to strengthen and improve Canada's universal publicly-funded health care system. We advocate for innovations in treatment and prevention services that are evidence-based and improve access, quality, equity and sustainability.

Everything You Ever Wanted to Know about Health Care and Taxes Wednesday, August 31, 2011 Ontario Health Care Coalition August 31, 2011 Leading into the provincial election on October 6 we are working to make sure that Ontarians are aware that there is a choice to improve health care within our public health care system. To that end, OHC has produced an easy-to-read colourful newsprint tabloid that gives the real story on how much we all benefit from public services, and who is benefiting from tax cuts. PDF HERE.

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All Things Being Equal Thursday, September 01, 2011 Trades Union Congress (UK) As the UK government's controversial Health and Social Care Bill receives its third reading in the House of Commons, we're standing vigil to show Parliamentarians the level of concern around the country about the threats to our National Health Service. Please join the vigil online by uploading a photograph of yourself to this site. We'll be combining the pictures into a powerful mosaic image, to use in lobbying Parliament. It only takes a minute from each of us, but will build into something much bigger. http://www.goingtowork.org.uk/nhs-mosaic/ Music: "All Things Being Equal" by Le Emu Tavern

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Neat, Plausible, and Wrong: The Myth of Health Care Unsustainability Thursday, September 01, 2011 Canadian Doctors for Medicare February, 2011

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Sustainable health care begins with the social determinants of health Thursday, September 01, 2011 It's time to get it right By Errol Black, Shauna MacKinnon Manitoba Office, CCPA June 2, 2011

Click here for report On May 13, 2011 the Conference Board of Canada announced the formation of the Canadian Alliance for Sustainable Health Care (CASHC) to “provide Canadian business leaders and policy makers with insightful, forward-looking, quantitative analysis of the sustainability of the Canadian health-care system and all of its facets.” A central purpose of the CASHC is to clarify the financial sustainability of the system with a focus on “current and future health-care spending, fiscal balances, and public and private investment and expenditures, current funding structures, and the challenges these present.” They also aim to look at “the relationship between health-related costs, workforce health and firm performance... [and] ways in which the health-care system can be improved, while addressing quality of care.”

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The Conference Board is calling on private and public sector investors to support their project. Their website lists current investors from both sectors but particularly notable is the strong representation from the financial sector. While the CASHC’s aim is to fix a system that is assumed to be broken, there is a growing body of evidence indicating that Canada’s health problems have more to do with the ongoing deterioration in the economic and social conditions that promote health. But the source of the CASHC’s financial support and the exuberance with which they present a picture of an ailing system suggests a focus on opening up the public health-care system to greater private-sector involvement. It is unlikely that broader systemic weaknesses that create inequities and inevitably put pressure on the system will be addressed. In The Social Determinants of Health in Manitoba (CCPA-MB, 2010) York University Professor Dennis Raphael describes the living conditions that are the primary determinants of health of individuals. He goes on to explain how “a social-determinants of health approach sees the sources of health as being how a society organizes and distributes resources, [and] directs attention to economic and social policies as a means of improving health. It requires consideration of the political, economic, and social forces that shape these policy decisions.” Two of the key social-determinants of health relate to the inequalities in the distribution of income and rates and levels of poverty. Research that focuses narrowly on the healthcare system, without considering the flaws of an increasingly inequitable social and economic system is unlikely to prove fruitful. What we are likely to get from the CASHC is a series of recommendations that will simply accentuate the bias already inherent in our approaches to health and health care. Inefficiency and Poor Performance? The CASHC research focus appears to be shaped by the Conference Board’s recent study How Canada Performs: Health Spending Rankings. It shows Canada’s health spending to be the fourth highest of the 17 countries they assessed, while ranking 10th in overall health performance. Canada’s scores on infant mortality and potential years of life lost are shown to be especially shabby, placing us at 16 and 12 respectively in the rankings. As a result of these and other scores, the Conference Board vice president concludes, “Canada has relatively high overall spending and middle-of-the-pack outcomes.” The study suggests that expenditures on health-care in Canada as a proportion of GDP is, at 10.4%, out of step with other countries in their sample. But according to OECD data, we spend less than the U.S. (16.0%), France (11.2%), Switzerland (10.7%) Germany and Austria (10.5%), and we are in-line with Belgium (10.2%), Netherlands (9.9%), Denmark (9.7%), and Sweden (9.4%). It is also notable that total expenditures include both public and private spending. Further breakdown shows that the U.S. has the lowest public expenditures at 46.5% followed by Switzerland (59.1%), Australia (67.5%), Canada (70.2%), and Finland (74.2%). Public expenditures in Sweden, Japan, Norway, U.K and Denmark exceed 80%, with Denmark the highest at (84.5%). This is important to know because governments are better able to control public expenditures.

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Countries also commit resources to an array of programs and policies that affect living conditions and health outcomes. OECD estimates of net public social spending (including public expenditures on health care) indicate that “on average public social spending accounts for 24.4% of Net National Income (NNI) across OECD countries.” The countries that spend the most are: Sweden (33.6%); France (33.2%); Austria (32.1%); Denmark (31.5%); Germany (31.1%); Belgium (31.0%); and Finland (30.5%). The countries that spend the least are the U.S. (18.1%); Canada (19.3%); and Australia (21.2%). These data confirm that most countries in the Conference Board sample spend much more on programs designed to maintain and/or improve the living conditions of their populations than do the U.S. and Canada. Income determines Outcome Finally, it is important to recognize that income inequality and poverty are critical determinants of the health. When countries are ranked on the basis of Gini Coefficients, the United States at 17 is the most unequal, followed by Italy 16, the U.K. 15, Ireland 14, Japan 13 and Canada 12. Sweden is the most equal followed by Denmark, Austria, Finland, France and Belgium. As for poverty rates (based on a 50% median income threshold), the U.S. ranks poorest with an 18% rate. Canada’s rate is 13%. The U.S. also has the highest poverty rate for children at 21%, followed by Ireland and Italy at 16, and Canada at 15%. Denmark, Sweden, Norway and Finland have the lowest child poverty rates 3, 4, 5 and 4%, respectively. The CASHC focus on the relationship between health care spending and selected health outcomes is overly narrow and creates misconceptions about the nature of health problems and their impact on the health-care system. The sustainability of our health-care system cannot be examined outside of the broader social and economic context. Indeed, the Conference Board itself has shown in previous research that social and economic policies effect population health and living conditions. The evidence shows that more equal societies are healthier societies. If we want “sustainability” we must focus our attention on improving the conditions that will contribute to good health rather than focusing all of our efforts on the limited dimensions proposed by the CASHC.

Errol Black is a CCPA-MB board member; Shauna MacKinnon is the director of CCPAMB.

Lord Taylor reminisces on settling the Saskatchewan doctor's strike Friday, September 02, 2011 Saskatchewan adventure: a personal record. By Lord Taylor, B. Sc., M.D., Hon. LL.D.,F.R.C.P., F.R.C.G.P. 720 CMA JOURNAL/MARCH 16, 1974/VOL. 110

About Lord Stephen Taylor:

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Lord Stephen Taylor of HarlowBorn in Marlow-on-Thames, England, Stephen Taylor (1910–1988) was a doctor, civil servant, politician and educator. In 1945, he entered politics as a Labour Member of Parliament, serving as Parliamentary Private Secretary to the Deputy Prime Minister, as well as Lord President of the Council. As a policy adviser during the creation of the National Health Service, Taylor’s policy experience and political acumen brought him international recognition.

Taylor knew about Saskatchewan and the health policy goals of the Co-operative Commonwealth Federation (CCF) through a visit he made in 1946 when the CCF launched the Hospital Services Plan. He played a crucial role as negotiator between the provincial government and the doctors during the 1962 strike. Both sides accepted Taylor because both saw him as an expert neutral figure who understood their positions. Taylor stated that he thought the government’s medicare plan was good, but that the enabling legislation had been badly written and rushed. He was able to resolve the strike by winning concessions from both sides, and on July 23, 1962 an agreement was signed. Taylor’s role in resolving the Saskatchewan doctors’ strike paved the way for Saskatchewan to demonstrate medicare’s effectiveness to the other provinces. I have been asked to write an account of my part in the remarkable series of events which took place in Saskatchewan in 1962, and to comment on the effectiveness of the solution. My story is part history, part sociology and part autobiography. It records what was in effect the final stages of an unusual industrial dispute. Professional people do not as a rule resort to the ultimate weapon of withdrawal of services, if only because they are as a rule "self-employed". But once a profession is converted, or in danger of being converted, into a public service, the situation is different. Earnings cease to be determined by professionally- devised scales of fees and the haggle of the market. Instead, the profession has to struggle for its share of the available public revenue. It also has to struggle to retain its professional autonomy in the performance of its work...

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The Struggle for State Health Insurance Saturday, September 03, 2011 Reconsidering the Role of Saskatchewan Farmers BY HARLEY D. DICKINSON Studies in Political Economy 41, Summer 1993

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Saskatchewan: $5 Health Plan Saturday, September 03, 2011 Time Magazine Monday, January 06, 1947

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In Saskatchewan last week taxpayers poured into municipal offices and queued up before wickets to fork over their $5. They were getting under the wire with payment of the new head tax levied by the CCF for the first Government-controlled hospitalization plan in North America. Maximum tax: $30 a family a year. Those who failed to pay faced a 10% surtax and a $25 fine. All told, the CCF collected about $2,000,000. That, plus the $1,000,000 coming from other Government revenue, was considerably short of the $4,500,000 a year the plan is expected to cost. On a doctor's recommendation, paid-up members will be admitted to any Saskatchewan hospital ward for at least 21 days, and will get free meals, drugs, X rays and blood tests. The Government will pay the hospital $4.50 a day for ward patients, or the same amount toward the cost of a private room. The hospitalization plan is the CCF's second major step toward socialized medicine. On Jan. 1, 1945, it instituted free hospital and medical care for some 25,000 old-age pensioners, the blind, orphans, those receiving mothers' allowance and all their dependents. Now Saskatchewan hopes to work out a Government plan to pay medical bills too.

About Canada: Health Care Monday, September 05, 2011 By Hugh Armstrong and Pat Armstrong

Fernwood Publishing Paperback Price: $17.95 CAD Publication Date: Apr 2008 Pages: 158

Health care is Canadaâ&#x20AC;&#x2122;s best-loved social programâ&#x20AC;&#x201D;and for good reason. For more than 30 years, Canadians have enjoyed high quality health care based on need and not on ability to pay. But it is a complex system: changes proposed and those already underway can be difficult to understand and evaluate.

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What do ‘public’ and ‘private’ mean as they apply to our current health care system and in proposed reforms? As the boomer generation ages, will the growing number of seniors bankrupt Medicare? What do we mean by wait times and are they increasing? Who pays for drugs and how can we ensure Canadians have equitable access to necessary drugs? Can technologies significantly improve care and reduce costs? This book explains how the Canadian system works and assesses reforms underway. Contents • Why Care? • How Did We Get Here? • What Did We Get? • What We Did Not Get • Reforming Primary Care • What are the Main Issues today? • Public Strategies and Shared Solutions

Buy HERE!

Edgar Benson stood up for medicare Tuesday, September 06, 2011 Influential Canadian By Tori Stafford and Elliot Ferguson The Whig-Standard September 6, 2011

As a cabinet minister in the Liberal governments of the 1960s and 1970s, Edgar Benson was on the front lines of some of the defining moments of Canadian history. The FLQ crisis, the flag debate, tax reform and the introduction of medicare – Benson was involved in them all.

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Yet he was content not to draw attention to the work he did during the period when Canada embraced the social reforms many take for granted now. "I don't think Kingstonians know how important this man was," said Arthur Milnes. "Kingston itself definitely should be honouring this man. He was an incredible representative during a really crucial time in our history." Benson died Friday. He was 88. Those who knew him described Benson as affable, friendly, tenacious and intelligent. He was a cabinet minister for Lester Pearson and Pierre Trudeau, which proved he had the talent to do the job. An accountant by trade, Benson found his political calling in the finance and revenue ministries. In 1966 Benson was among the Liberal ministers who took a public stand when opposition to medicare from within their own party threatened to derail the proposal. "Every time you go to the doctor, and you think of medicare, you should think of a man like Edgar Benson," Milnes said. "He played a crucial role in the Pearson Cabinet of bringing Canadians medicare. A truly crucial role." Milnes said Benson's motivation for seeing medicare become a reality was deeply personal for the man, recounting a story Benson told him of how his father was struck with a debilitating illness. Benson's family went bankrupted trying to care for him. "Many today who criticize Medicare don't have the memories of the people like Edgar Benson or John Diefenbaker, in all fairness, the Conservative, or Tommy Douglas, NDP, of what it was actually like to live in a country where you had to write a cheque to the doctor," Milnes said. "Well, Ben Benson remembered." "Mr. Benson was that rarest of animals â&#x20AC;&#x201C; a reform finance minister," said Tom Axworthy, who worked as a policy researcher with the Liberal economic ministries in the 1960s. "I personally remember Ben Benson at the 1966 Liberal party convention," Axworthy said. "He publicly opposed the attempt by finance to delay or prevent the introduction of medicare. 'Either we will have medicare or we will have one less minister,' he told our young liberal group. "A great liberal Liberal." As finance minister in Pierre Trudeau's government he introduced tax reform that introduced a capital gains tax and made for the eventual introduction of RRSPs.. The reform modernized the tax system and made it easier to understand. But the capital gains tax was not popular with business. 166

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"He took an awful lot of abuse for it," said friend and colleague Bob Little. "I don't think he worried about what people would think about him." Former Kingston and the Islands MP Peter Milliken credited Benson for getting him interested in politics. "I went to his first nomination meeting and I found it very exciting. That's what got me working in politics. I hadn't done anything like that before, but having seen that happen and having heard his opening speech and the nomination meeting where he had to get elected," Milliken said. "I had a great time and it was after that that I started working in elections and participating actively in the political life." After politics Benson worked for 10 years at the Canadian Transport Commission and then he was appointed Canadian ambassador to Ireland.

US healthcare, babies and the national debt: The real cost Wednesday, September 07, 2011 Healthcare-NOW! September 7, 2011 By Jonathan D. Walker, M.D. for Frost Illustrated –

The term “infant mortality rate” is a measure of the number of babies that die under one year of age per 1,000 live births. It is a useful indicator of how effective a healthcare system is—the lower the number, the fewer babies die. Although there are a lot of people who feel the U.S. has the best healthcare system in the world, according to the Center for Disease Control, the United States actually ranks 29th in the world for infant mortality. And it gets worse. Infant mortality for African Americans is consistently more than twice Medicare's 50th Anniversary

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that for white Americans—infant mortality among African Americans in 2007 was 13.3 deaths per 1,000 live births compared to a rate for non-Hispanic whites of 5.6. There are a lot of reasons why this disparity exists—it happens to be a very complex issue. One big factor is simply the lack of access to appropriate healthcare. Healthy babies need healthy mothers, and the process starts well before a woman gets pregnant. But, that process can’t happen if you don’t have insurance and can’t afford to see a doctor. Every other developed country in the world has decided that people should be able to get the care they need when they need it, and without having to worry about going bankrupt. In America, the healthcare system has ended up protecting the interests of forprofit companies over the needs of individuals and, as a result, people are left without access to care. And, the problem is spreading—even people with insurance are finding that their copays and deductibles are becoming so expensive that they put off needed care because they can’t afford it. And, now we have the debt crisis, and a lot of politicians who want to simply cut back on spending without thinking about the consequences. Unfortunately, this means that there will be less money available to solve problems like our higher infant mortality rate. And, that means that not only will babies continue to die, but people who need all types of medical care will only show up sicker and in worse shape, which means it will cost us even more to take care of them. Those politicians don’t seem to get the fact that when you cut back on healthcare, not only do you hurt people, but you also make it more expensive for everybody else. Instead of blindly cutting back on spending, we should start by making sure that everyone gets the care they need. Then we could sit down as a society and begin to control the free-for-all that exists amongst the for-profit companies that are fighting to get healthcare dollars while people suffer. Every other developed country has figured this out, and their babies live. But, we seem to be incapable of trying to learn from them—powerful vested interests want us to think that any way besides our way must be wrong. An entire world of solutions is out there, but in America, lobbyists and politicians can literally stop the debate with irrelevant accusations of “socialized medicine” or “government takeover of healthcare.” So we all end up paying more for healthcare and more people are afraid to go to the doctor because they can’t afford it. If we could say that we actually had the best results in the world, perhaps this would be tolerable. Unfortunately, the real result is that the youngest, sickest and poorest of us will be hurt, and we will all pay the rising cost of treating the ones that survive. It means that babies—and especially African American babies— will be dying because no one wants to look at the obvious solutions that are all around us.

Dr. Walker is a local physician and member of Hoosiers for a Commonsense Healthplan. If you have a group that would be interested in learning more about healthcare, he is available to give talks on the subject and can be reached at his office: Allen County Retinal Surgeons, PC, 7900 West Jefferson Blvd. #300 Fort Wayne, IN 46804 (260) 436 2181.

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Tommy Douglas and the Future of Single Payer in the USA Thursday, September 08, 2011 By Ralph Nader Single Payer Action June 7, 2011

To secure single payer here in the United States –We have to understand how Canada did it. And to understand how Canada did it, we have to understand Tommy Douglas. And not just that Canadians voted him The Greatest Canadian in a recent poll. Or that he’s the grandfather of the actor Kiefer Sutherland. But we have to understand how Tommy Douglas built a political movement that toppled the two corporate parties in Saskatchewan in the mid-1940s. And what the lessons are for citizens in the USA. Tommy Douglas was born in Scotland in 1904. His family moved to Canada when he was six. Tommy Douglas became a Baptist minister who supported unions and a public health insurance system. He became premier of Saskatchewan by running against Canada’s two major parties. In a dramatic and decisive confrontation in 1962, Douglas then overcame a doctor’s strike against Medicare plan. The Medicare for all single payer plan became law that same year in Saskatchewan. And in 1966, his single payer program was adopted by the national government. Medicare's 50th Anniversary

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For a donation of $100 to Single Payer Action today, we’ll send you the acclaimed 334page paperback biography – The Life and Political Times of Tommy Douglas by Walter Stewart.

And we’ll also send you the riveting three-hour Canadian Broadcasting Corporation (CBC) docudrama DVD – Prairie Giant: The Tommy Douglas Story. Show it to your friends. As you know, single payer full Medicare for all is supported by a majority of the American people, doctors and nurses. But last year the single payer bill in Congress (HR 676) was shoved aside by the insurance and drug companies, their two toady parties and President Obama. There was not one full Congressional hearing on this majoritarian proposal. We need to learn from Tommy Douglas and the Canadian experience to prepare ourselves for the next round – coming soon. So, to get both the biography and DVD, donate now. Together, they will give you a deeper understanding of how Tommy Douglas got it done in Canada. So that we can get it done here in the USA.prairie giant Your donation will be supporting the good work of Single Payer Action, which has just launched a county by county pilot campaign to demand the resignation of Congresswoman Shelley Moore Capito from West Virginia. She not only opposed single payer, but in her extremism, she recently voted in the House of Representatives to put Medicare on the road to extinction.

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The campaign is part of our ongoing effort to find new ways to break through the united greed and cruelty of the corporate supremacists. Thank you for your continued support. Onward to single payer full Medicare for all,

Ralph Nader PS: This offer ends July 1, 2011. But supplies are limited. (The publisher of the biography informs us there are fewer than 600 copies left in print.) So please donate now to secure your book and DVD.

Life Before Medicare Thursday, September 08, 2011 Ontario Coalition of Senior Citizen's Organizations Cross-posted from Straight Goods August 27, 2011 Purchase "Life Before Medicare"HERE.

Canadians should not forget that Medicare was born out of the misery of the Great Depression. Concern about the future of health care was the inspiration for this book about the days before it existed. An excerpt... PREFACE

It was a soft June evening in 1993 when the coffee party was held at Owl House Lane, Toronto, the home of Jean Woodsworth. As president of One Voice, the Canadian Seniors Network, Jean was introducing some of its board members to the leaders of various Ontario seniors' organizations. To the coloratura of the birds, we discussed the burning question that Jean quietly posed: "What is the most important issue seniors face today, in the nineties?" Medicare's 50th Anniversary

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The consensus was, the erosion of Medicare. The Canada Health Act was born out of the socialist government in Saskatchewan, and out of the misery of the Great Depression that stretched across Canada and lasted up to the Second World War. This great piece of legislation provides for an equitable system of health care for everyone, the rich and the poor. Its erosion could end the universality and public administration of health care for which seniors have fought so hard. Jean said that we needed to begin a re-education about Medicare's reason for being. "If only all Canadians knew about the bad old days," Jean thought aloud. Sister Gisele Richard, with calm clarity, offered a short, startling memory: "My mother had tuberculosis, and died after a lengthy illness when I was only eight. My dad was still paying for her hospitalization five years later, when I started taking the payments to the hospital every month." As the discussion went slowly around the circle, my eyes returned again and again to Sister Gisele's face, to me reflecting character and wisdom. Without a mother , this child had turned into a responsible daughter. She also helped to raise the family, and that childhood moulded the determined leader she is today, without a doubt. Depression years are indelible times. I was a Depression baby, but don't remember those times. I needed to learn. Jean remarked that a book of stories about people's lives before Medicare could reeducate us, our families, policy-makers, and all people born since the fight for Medicare began. Although she spoke quietly, this was nonetheless clearly a directive. I thought Jean might possibly have meant me to take it on, although she didn't look at anybody in particular. I certainly felt linked to Sister Gisele, because of her story. The thought of compiling a book was both daunting and energizing. I felt challenged to start, at least. Being a seniors' activist had been hard work - meetings with government, and committee and consensus work - when I was co-chair of the Ontario Coalition of Senior Citizens' Organizations (OCSCO). All this meant travel from our home on the outskirts of Orillia. Maybe the book project could be done from home, with fewer meetings in Toronto, and provide a way to become more involved in the Orillia community. And so it happened. Once we committed to Life Before Medicare, it began to grow on its own. HOME REMEDIES

The homesteaders' medicine chest contained dry mustard, Epsom salts and aspirin. The Epsom salts were used to clean wounds of man and animals too, the dry mustard was used for mustard plasters on the chest and of course, the aspirin was used to cure everything else. - Birgit Ethier - Medstead, Saskatchewan

I once knew a family who told me their little boy had whooping cough when he was an infant. This happened during winter in a house in the country where their only source of heat was a wood stove. The family took turns holding the baby day and night for five weeks. When one tired, another took over the task until he recovered. 172

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- Emily MacPhee - Perth, Ontaro SURGERY AT HOME

It was around 1921 or 1922. My father's dad was in an auto collision between Teviotdale and Harriston, Ontario - side-swiped, overturned in the ditch, and suffered some severe skull/brain trauma. He was removed from the accident site and taken to their home in Listowel. Doctor was summoned and the dining room was eventually turned into an operating theatre. Excess fluid pressure in the skull had to be relieved. My dad's mother's assignment was the cloth/boiling needs. My dad's was "to hold the light." I recall my dad saying that the doctor said to him words to the effect, "This isn't going to be pleasant. Do you think you can do the job? Once I start I have to have the light till I'm done." The doctor then proceeded to hand-drill through the skull in an attempt to remove the excess fluid and relieve pressure. The operation was to be unsuccessful and his dad died some days later, not regaining consciousness from the time of the accident. Why wasn't his father taken to a hospital? Maybe there was none very close, maybe my family couldn't afford it. Maybe the doctor felt that the remedy could be done just as effectively at home as at a hospital, at less cost. It's hard for me to believe: to be an attendant to an operation, performed in my own home on a close family member, at the age of fifteen or sixteen, and then to see it all for naught, anyhow. - John Hallman - Oro, Ontario NEIGHBOURHOOD HELP

I recall the winter of 1932. January was very cold and stormy. The temperature would hover between thirty-five and forty-five degrees below zero. That's when my mother took it upon herself to nurse our neighbour who lived a mile away. So every morning she walked and nursed our neighbour with mustard plasters and hot chicken soup. This kept on for three weeks. There was no thought of going to the hospital, because there was no money. - Birgit Ehier - Medstead, Saskatchewan

When I was pregnant with my first, and later with my second child, I did not visit the doctor until I was five months pregnant. The first fee of $40 took us about two years to pay off. The family doctor allowed us to pay it as we were able. When the second child arrived, the fee was slightly higher, but it was the same arrangement. At that time we didn't have a hospitalization plan either, so the hospital, delivery and nursery charges were approximately $50. We were able to pay that a bit at a time, over two years. - Ruth Mayor - Winnipeg, Manitoba COMMUNITY DOCTORS

We lived in Kirkland Lake, Ontario, in the early forties and my mother was very ill. Dr. Rumball said she must have a hysterectomy, no ifs, ands or buts about it. We had no money. My dad was furious. My mother was in tears for days. My mother went next door Medicare's 50th Anniversary

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and phoned my Dad at work and said that this was a life and death situation and not to worry about paying.

To make a long story short, the hysterectomy was performed the next day. Mom came home about a week later with her stitches in and was to return to have them removed. About the second day home, Mom said there seemed to be something wrong with the incision. We removed the bandage-binding to take a look. Mom's incision wasn't healing; the stitches hadn't held. I ran next door to the service station and phoned the doctor. He said, "I'll be right there." He was there in about two minutes. He took the bottom sheet on the bed and put it on Mom like a diaper, picked her up and we put her in his car. Back in the hospital, Mom was stitched up again with a different type of stitching. We never did get a bill. Mom lived to be ninety-one. - Katherine Morrison - North Bay, Ontari) COMMUNITY COVERAGE

I'm a retired Cape Breton coal miner. I went to work in the coal mines after I returned from overseas military service. The reason I went to work in the coal mines is because I have never found a better lifestyle than is offered here and it was the only employment offered here. During my mine employment we, and my father before me, had a system of Medicare long before Tommy Douglas even thought of it. Every week we had a deduction from our pay. In my time it was twenty cents for the doctor, and twenty-five cents for the hospital. They called it "check off". This allowed us and our families to receive free medical care from our doctors and the hospitals. I, and my family, and my father's family, have been in the hospital many times and there was no extra cost to us because of the check off. We even made the check-off payment to the hospital after Medicare came in to pay for extras, such as private rooms and better meals. Regardless of what people think, the Cape Breton miners had Medicare long before Tommy Douglas. I think it started in the twenties. - Tony Trociuk - Glace Bay, Nova Scotia *** Published by The Ontario Coalition of Senior Citizens' Organizations: ocsco@web.net A brief history of Canada's public health care system: www.healthcoalition.ca/dates.html Published as part of the Seniors and Health Care Project, a program of the Ontario Coalition of Senior Citizens Organizations

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Medicare: Facts, Myths, Problems & Promise Thursday, September 08, 2011 Canadian Centre for Policy Alternatives Edited by Bruce Campbell and Greg Marchildon

Purchase Book HERE. Contents and Preface HERE (pdf).

Most health care professionals are committed to the principles of medicare, and so are most other Canadians. Yet everyone recognizes that the health care system has serious problems, and often does not provide the level of care the public expects. Getting a realistic picture of what is good and bad about the system, and how it can be fixed while staying true to the fundamental principles of publicly-funded health care is the focus of this book. Editors Bruce Campbell and Greg Marchildon have gathered 34 contributors who offer a wide-ranging, authoritative portrait of medicare in Canada today. Experts from Canada and around the world provide unbiased data on costs, quality of care, wait times, and the overall health of the population. There are international comparisons which show how Canada's system ranks with the rest of the world. Front-line health care practitioners describe the key successes and failures of the Canadian system today. Policy makers discuss the potential impact of attacks on the system aimed at opening up health care to profit-oriented corporations, and point to alternatives for better care from inside the public system. Visionaries set out the potential of the system to move from a disease orientation to a focus on ensuring a healthy population of children and adults. For anyone involved in health care - and for every citizen who cares about the future of this social program - this book offers a unique source of reliable, independent information and analysis from experts who share a basic commitment to the values of medicare. At a time when ideologues and advocates of privatization capture much of the attention of the media and politicians, this collection is an invaluable source of information and ideas.

BRUCE CAMPBELL is the executive director of the Canadian Centre for Policy Medicare's 50th Anniversary

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Alternatives, and the author and editor of several books on Canadian public policy issues. GREG MARCHILDON is a former director of the Romanow Commission, and former senior civil servant in Saskatchewan. He is now at the Graduate School of Public Policy, University of Regina.

Tommy Douglas: Keeper of the Flame Friday, September 09, 2011 National Film Board of Canada This feature documentary traces the political career of T.C. (Tommy) Douglas, former premier of Saskatchewan and leader of the New Democratic Party, who was voted the Greatest Canadian in 2004 for his devotion to social causes, his charm and his powers of persuasion. Known as the "Father of Medicare," this one-time champion boxer and fiery preacher entered politics in the 1930s and never looked back.

Michel Moore's Sicko: Watch full documentary here Saturday, September 10, 2011 Sicko By Michel Moore

After exploring the predominance of violence in American culture in Bowling for Columbine and taking a critical look at the September 11th attacks in Fahrenheit 9/11, activist filmmaker Michael Moore turns his attentions toward the topic of health care in the United States in this documentary that weighs the plight of the uninsured (and the insured who must deal with abuse from insurance companies) against the record-breaking profits of the pharmaceutical industry. Watch the full documentary now

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Pack the trunk of this health-care elephant Monday, September 12, 2011 By Naomi Lakritz Calgary Herald August 24, 2011

Tory leadership candidate Gary Mar has been reading too much F. Scott Fitzgerald lately. Fitzgerald's 1925 short story, Rich Boy, starts off: "Let me tell you about the very rich. They are different from you and me." Mar thinks the rich are so different, that they should be able to buy their way back to health, while the rest of us unmonied members of the great unwashed queue up in the public system. Now, this is nothing new. It's ideological baggage from the Ralph Klein years, which mercifully are past, and it just goes to show that Mar has not evolved in his thinking. Do we really want our next premier to be someone who checks into the legislature still carrying the same worn-out, frayed suitcases he had when he left? Mar appears to have conveniently forgotten how his confreres had to back away with noticeable and precipitate haste from the Third Way, after Albertans made it clear they didn't want anything to do with it. Now he's back with, quite possibly, the Fourth Way. How about the Highway, Gary? Ever heard of the Highway? How about taking that path with your recycled schemes to let the rich pay? Mar says he's not talking about critical care. So if a rich person needs a quadruple bypass, they can't buy their way into their cardiologist's favour. But he puts forth the same fallacious argument that others put forward when promulgating the privatization of health care, and that is, as columnist Graham Thomson wrote recently, that private clinics would take the pressure off the public health system.

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There are a finite number of doctors in Alberta. If some of them go over to the private clinics to work, they will remove themselves and their resources from the public system. The public system will be left with fewer doctors, which will create longer queues. It's simple math. Too bad the only math the proponents of schemes like Mar's understand is the increased jingling of profits in someone's pocket. Dr. Harvey Barkun, whose impressive list of credentials includes 16 years as executive director of the Montreal General Hospital, writing in the McGill Journal of Medicine in 2008, had this to say about why privatization does nothing for the public system, whose fundamental problem is wait times: "You wait to see a family physician; you wait to see a specialist; you wait in emergency rooms; you wait for elective surgery; you wait for laboratory and radiological procedures. And will an infusion of private money cure these ills? Not at all. These long wait times exist because of a very serious lack of health care personnel ... Proper treatment requires a proper diagnosis. The diagnosis of our current ill is a lack of people, not lack of money. Privatization is the wrong treatment. The Ottawa-based Canadian Health Services Research Foundation cites a study that showed "countries with parallel public and private health-care systems have the longest waiting times . . . England and New Zealand, which have parallel private hospital systems, appear to have larger waiting lists and longer waiting times in the public system than countries with a single-payer system, such as Canada . . . Waiting times in England and New Zealand are also longer than in countries such as the Netherlands, where a separate private hospital system exists for the wealthiest citizens, who are not able to use the public system." As well, "Studies in both Australia and England have found the more care provided in the private sector in a given region, the longer the waiting times for public hospital patients." The CHSRF cites Manitoba, where, "until 1999, patients paid an additional facility fee or 'tray fee' if they chose to have cataract surgery in a private facility (the surgery itself was still paid for by the provincial health plan). At the time the fee was in place, the Manitoba researchers found that patients whose surgeons worked only in public facilities could expect a median wait of 10 weeks in 1998/99; however, patients whose surgeons worked in both public and private facilities could expect a median wait of 26 weeks." The CHSRF also says: "Since health-care practitioners can't be in more than one place at the same time, creating a parallel private system simply takes badly needed doctors and nurses out of our public hospitals . . . it's hard to see how removing them from the public system will help alleviate public waits. Since doctors earn more in the private sector, they have what economists call a 'perverse incentive' to keep public waiting lists long, to encourage patients to pay for private care." Or, as another Tory leadership candidate, Alison Redford, put it at a Herald editorial board meeting this week, allowing privatization does not fix the public system. Mar calls privatization "the elephant in the room." Well, an elephant in the room poses a danger to humans, who could get trampled by it.

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Let's lasso this elephant and hustle it out of that room.

Naomi Lakritz is a Herald columnist. nlakritz@calgaryherald.com

R e a d m o r e : http://www.calgaryherald.com/business/Pack+trunk+this+health+care+elephant/5298606/ story.html#ixzz1XlvbRFzy

The end of the NHS as we know it Tuesday, September 13, 2011 The health bill is the final stage of a project that began 25 years ago to turn this vital public service over to the private sector By Colin Leys guardian.co.uk Thursday 8 September 2011

What Wednesday's vote on the health and social care bill shows more clearly than anything is that many, if not most, of the political elite no longer care whether they are carrying out the wishes of the electorate, and barely pretend that we are any longer a democracy. The prime minister promised before the 2010 election not to introduce any "top-down reorganisations" of the NHS; to say he, Andrew Lansley and Nick Clegg lack an electoral mandate for the bill is an understatement. It is also an understatement to say that they have not told the truth about the bill's intentions, and that they have reduced Department of Health statements, such as its latest so-called MythBuster document, to a level of brazen mendacity that demeans a once great office of state. The principle seems to be that if an official lie â&#x20AC;&#x201C; such as that the bill does not imply privatisation â&#x20AC;&#x201C; is repeated often enough, most people will feel it must be true. And by using existing powers to abolish PCTs and set up "pathfinder" so-called GP consortia, and making arrangements with foreign private companies to take over NHS hospitals, the government has also pre-empted such debate as MPs are inclined to have. The Conservative MP Dr Sarah Wollaston, who originally denounced the bill, now says that changes have already gone too far to oppose it any further â&#x20AC;&#x201C; a remarkable statement of political impotence. Medicare's 50th Anniversary

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The bill will end the NHS as a comprehensive service equally available to all. People with limited means will have a narrowing range of free services of declining quality, and will once again face long waits for elective care. Everyone else will go back to trying to find money for private insurance and private care. More and more NHS hospital beds will be occupied by private patients. Doctors will be divided into a few who will become rich, and many who will end up working on reduced terms and with little professional freedom for large corporations (the staff of the hospitals that are being considered for handing over to private firms will have noted that the firms in question want "a free hand with staff"). The costs of market-based healthcare – from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multimillion pound executive salaries, dividends and fraud – will soon consume 20% or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) are remotely resourced enough, or empowered enough, to prevent the decline of care quality and the scale of financial fraud that the bill will introduce. What we are witnessing is the completion of a project begun some 25 years ago to restore healthcare to private enterprise. The key players have not been MPs but private healthcare companies and consultancies like McKinsey and KPMG. The war has been waged by the lavish corporate funding of pro-market thinktanks – the quiet subversion of some of those, like the King's Fund, that are still rather quaintly described as "independent" – and the deep penetration of the Department of Health and Labour's senior ranks. No countervailing argument has come from pro-public thinktanks, because none exists with resources equal to the task. And how many MPs have actually read through the bill they are in the process of endorsing, or even the explanatory notes that accompany it? The one serious obstacle to the bill's promoters has been the impact of social media: 38 Degrees, Facebook, expert bloggers and tweeters. Along with the million-plus people who work for the NHS, a steadily growing portion of, especially, younger voters, have been exposed to a different narrative and see through the spin. At the moment most of them may be more cynical than politically active. But if the bill becomes law and the reality begins to be felt in people's daily lives it is this counter-narrative that will make sense. MPs – and now the Lords – would be well advised to ponder the implications of this.

The World Health Organization's ranking of the world's health systems. Tuesday, September 13, 2011 Source: WHO World Health Report - See also Spreadsheet Details (731kb) The World Health Organization's ranking of the world's health systems was last produced in 2000, and the WHO no longer produces such a ranking table, because of the complexity of the task. See also: Preventable Deaths By Country

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See also: Healthy Life Expectancy By Country See also: Health Performance Rank By Country See also: Total Health Expenditure as % of GDP (2000-2005) See also: Main Country Ranks Page Rank Country 1 France 2 Italy 3 San Marino 4 Andorra 5 Malta 6 Singapore 7 Spain 8 Oman 9 Austria 10 Japan 11 Norway 12 Portugal 13 Monaco 14 Greece 15 Iceland 16 Luxembourg 17 Netherlands 18 United Kingdom 19 Ireland 20 Switzerland 21 Belgium 22 Colombia 23 Sweden 24 Cyprus 25 Germany 26 Saudi Arabia 27 United Arab Emirates 28 Israel 29 Morocco 30 Canada 31 Finland 32 Australia 33 Chile 34 Denmark 35 Dominica 36 Costa Rica 37 United States of America 38 Slovenia 39 Cuba 40 Brunei 41 New Zealand 42 Bahrain 43 Croatia 44 Qatar 45 Kuwait Medicare's 50th Anniversary

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46 Barbados 47 Thailand 48 Czech Republic 49 Malaysia 50 Poland 51 Dominican Republic 52 Tunisia 53 Jamaica 54 Venezuela 55 Albania 56 Seychelles 57 Paraguay 58 South Korea 59 Senegal 60 Philippines 61 Mexico 62 Slovakia 63 Egypt 64 Kazakhstan 65 Uruguay 66 Hungary 67 Trinidad and Tobago 68 Saint Lucia 69 Belize 70 Turkey 71 Nicaragua 72 Belarus 73 Lithuania 74 Saint Vincent and the Grenadines 75 Argentina 76 Sri Lanka 77 Estonia 78 Guatemala 79 Ukraine 80 Solomon Islands 81 Algeria 82 Palau 83 Jordan 84 Mauritius 85 Grenada 86 Antigua and Barbuda 87 Libya 88 Bangladesh 89 Macedonia 90 Bosnia-Herzegovina 91 Lebanon 92 Indonesia 93 Iran 94 Bahamas 95 Panama 96 Fiji 97 Benin 182

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98 Nauru 99 Romania 100 Saint Kitts and Nevis 101 Moldova 102 Bulgaria 103 Iraq 104 Armenia 105 Latvia 106 Yugoslavia 107 Cook Islands 108 Syria 109 Azerbaijan 110 Suriname 111 Ecuador 112 India 113 Cape Verde 114 Georgia 115 El Salvador 116 Tonga 117 Uzbekistan 118 Comoros 119 Samoa 120 Yemen 121 Niue 122 Pakistan 123 Micronesia 124 Bhutan 125 Brazil 126 Bolivia 127 Vanuatu 128 Guyana 129 Peru 130 Russia 131 Honduras 132 Burkina Faso 133 Sao Tome and Principe 134 Sudan 135 Ghana 136 Tuvalu 137 Ivory Coast 138 Haiti 139 Gabon 140 Kenya 141 Marshall Islands 142 Kiribati 143 Burundi 144 China 145 Mongolia 146 Gambia 147 Maldives 148 Papua New Guinea 149 Uganda Medicare's 50th Anniversary

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150 Nepal 151 Kyrgystan 152 Togo 153 Turkmenistan 154 Tajikistan 155 Zimbabwe 156 Tanzania 157 Djibouti 158 Eritrea 159 Madagascar 160 Vietnam 161 Guinea 162 Mauritania 163 Mali 164 Cameroon 165 Laos 166 Congo 167 North Korea 168 Namibia 169 Botswana 170 Niger 171 Equatorial Guinea 172 Rwanda 173 Afghanistan 174 Cambodia 175 South Africa 176 Guinea-Bissau 177 Swaziland 178 Chad 179 Somalia 180 Ethiopia 181 Angola 182 Zambia 183 Lesotho 184 Mozambique 185 Malawi 186 Liberia 187 Nigeria 188 Democratic Republic of the Congo 189 Central African Republic 190 Myanmar

Solutions Within Medicare Tuesday, September 13, 2011 Nurses for Medicare

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There are better solutions for a sustainable Canadian health system that reflects Canadian needs. Improvements are needed in the health system to make it more sustainable, but these improvements need to be made within the public funding framework. Health system reform requires greater accountability with respect to the health-care budget – in other words, stronger business cases to justify spending and greater emphasis on outcomes. • New models of care that use a multidisciplinary, team-based approach can improve access to care and better utilize existing human resources. The Capital District Health Authority in Halifax has started a new program using a collaborative team of nurses and fee-for-service physicians. After six months, the teams estimated a 52 per cent increase in the number of patients scheduled for appointments each hour and a reduction in wait times for the next appointment from 1-2 weeks to the next day (Smith, 2007). The Alberta Bone and Joint Health Institute’s “new approach to hip and knee replacements” has reduced the average wait time between consultation and surgery from 290 working days to 37 days, all within the publicly funded system (Canadian Health Services Research Foundation, 2008). • A wider adaptation of the queuing theory in the health system would increase through-put and reduce wait times. Around the globe, the queuing theory has been used in in-patient facilities, outpatient clinics, physician offices, public health units, facility and resource planning, emergency preparedness planning, mental health care, long-term care, pharmacy services and inventory control (Singh, 2006). The Saskatoon Community Clinic is using the “Improved Access” queuing model, which has reduced wait times from 36 days for a complete physical or eight days for a regular appointment to two days for most kinds of appointments (Larson, 2006). Recent survey results have shown that almost 90 per cent of respondents received an appointment at the clinic within their requested timeframe (private communication, Ingrid Larson, 2008). The Saskatchewan Surgical Care Network is using a provincewide surgical patient registry as part of an initiative to reduce wait times. Both of these models are being used within the publicly funded system. • A greater emphasis on strategies that promote healthy living and prevent chronic disease will reduce the demand for health services. In Canada, chronic disease accounted for approximately 89 per cent of all deaths in 2005 and at least 67 per cent of all direct health-care costs (World Health Organization [WHO], n.d.; Conference Board of Canada, 2004). According to WHO (n.d.), at least 80 per cent of cases of premature heart disease, stroke and type 2 diabetes and 40 per cent of cancer cases in Canada “could be prevented through a healthy diet, regular physical activity and avoidance of tobacco products.” Investment in a best practice approach to chronic disease prevention management that is population-based, patient-centred and focused on health promotion, disease prevention and disease management “has the potential to realize annual benefits of $1.6 billion in avoided health-care costs”

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(Morgan et al., 2007). Expanding the use of innovative technologies will improve health care and enhance the productivity of the health-care workforce. River Valley Health in New Brunswick has incorporated telehealth into its home care program, resulting in improved clinical responsiveness through daily monitoring: a study showed 85 per cent fewer hospital admissions and 55 percent fewer visits to the emergency department among people enrolled in the program (Canadian Home Care Association, 2006). Telehomecare, as it commonly referred to, reduces the frequency of home care visits that nurses need to make, thereby improving their productivity (Canadian Home Care Association, 2008).

References Canadian Health Services Research Foundation. (2008). Evidence boost: Manage waits centrally for better efficiency. Ottawa: Author. Retrieved September 23, 2008, from www.chsrf.ca/mythbusters/html/boost13_e.php Canadian Home Care Association. (2006). High impact practices. Ottawa: Author. Retrieved September 11, 2008, from www.cdnhomecare.ca/media.php?mid= 1744 Canadian Home Care Association. (2008). Integration through information communication technology for home care in Canada: Final report. Ottawa: Author. Retrieved September 10, 2008, from www.cdnhomecare.ca/media.php?mid= 1840. Conference Board of Canada. (2004). Understanding health care cost drivers and escalators. Ottawa: Author. Larson, I. (2006). Improved access at the community clinic. Focus: Saskatoon Community Clinic, 42(2), 2. Retrieved September 9, 2008, from www.saskatooncommunityclinic.ca/pdf/2006-summer-focus.pdf Morgan, M.W., Zamora, N.E., & Hindmarsh, M.F. (2007). An inconvenient truth: A sustainable healthcare system requires chronic disease prevention and management transformation. Health Papers, 7(4), 6-23. Singh, V. (2006). Use of queuing models in health care. [Unpublished paper.] Available at http://works.bepress.com/vikas_singh/4 Smith, Patsy. (2007). Nursing in your family practice: A program for physicians. Preliminary qualitative findings. Halifax: Capital Health Primary Care. World Health Organization. (n.d.). Facing the facts: The impact of chronic disease in Canada. Retrieved September 9, 2008, from www.who.int/chp/chronic_disease_report/media/impact/en/index.html

Dying is no laughing matter Wednesday, September 14, 2011 Nurses Say Letting Uninsured Patients Die Is No Laughing Matter Following Abhorrent Audience Cheers at CNN-Tea Party Debate

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National Nurses United September 13, 2011

The nation’s largest representative of registered nurses today expressed revulsion at the cheering by some audience members in the CNN-Tea Party Republican debate Monday night at the prospect of letting a sick person die just because they do not have health insurance. Prompting the outburst was a question from CNN’s Wolf Blitzer to Rep. Ron Paul about whether medical care should be provided to a hypothetical, uninsured 30-year-old man who lapsed into a coma, to which Paul responded, “that’s what freedom is all about, taking your own risks.” When Blitzer then asked, “Are you saying that society should just let him die?” a number of audience members erupted into loud cheers of “Yeah!” and laughter. National Nurses United said the gruesome reaction from many in the audience is a reminder of the growing collapse of civil society in America, and the need for more humane policies. One such step would be to expand Medicare to cover all Americans so that no one has to be in danger of losing their life because they are uninsured. Nor is it an academic question. Nearly 45,000 deaths in the U.S. every year are associated with lack of health insurance, according to a study this year by Harvard Medical School and Cambridge Health Alliance published by the American Journal of Public Health. “It was stunning. My first reaction is how far have we degenerated as a society?” said NNU Co-President Jean Ross, RN who said she was watching the debate. Ross called the reaction antithetical to the very essence of nursing. “Everything we do is geared toward preventing illness, and getting people well. If no one cares whether our patients get well, what are we doing advocating for them and fighting for them?” A broader question, says NNU Executive Director RoseAnn DeMoro, is “one of national identity: Do we have — or even want — a country, a nation of common purpose and support — or just a collection of amoral individuals?” NNU Co-President Deborah Burger, RN said the idea of “deciding whether someone deserves medical treatment based on their pocket book is abhorrent. Does that mean we should take someone off life support if they are in an accident just because they are Medicare's 50th Anniversary

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uninsured? For nurses that would be unconscionable, and should not be part of any society I want to be in.” “Healthcare should be a right for everyone, not just a privilege for the few, a point nurses would debate with anyone,” said Ross. Ross said she was also disturbed by Paul’s comment about “freedom.” “Abandoning people is not freedom,” said Ross, especially those without the resources to buy increasingly expensive private insurance. "That isn’t what I hear from my patients or their families.” Strikingly, the audience cheers came just hours before the release Tuesday morning of new Census Bureau data showing the number of uninsured Americans this year rising by another 900,000 to 49.9 million people. Concurrently the Census Bureau reported a huge leap in the poverty rate, one reason so many people are without health coverage as insurance premiums alone have doubled in nine years. “Most people feel that when someone is hurting or down on their luck, you take care of them,” said Ross. “Many of those I’ve cared for who are in their most dire circumstances have said to me that they feel fortunate because there are some who are worse off than they are. There is still a lot of empathy and sympathy for others in this country.” “Most of us, other than the most wealthy, are just are one illness away from bankruptcy and lack of health insurance,” said DeMoro. “Nurses do not regard lack of wealth or personal misfortune as a handicap or an excuse to withdraw needed and appropriate medical care. Nor should that ever be acceptable in a just and humane society.” National Nurses United, with 170,000 members, is the nation’s largest union and professional association of nurses. NNU is holding a national convention this week in San Francisco that will also feature a major rally on Thursday, September 15 of 1,000 RNs calling for a tax on Wall Street to raise revenue for Main Street reforms of jobs, healthcare for all, and freedom from hunger and homelessness.

Saskatchewan CCF Election Program, 1960 Wednesday, September 14, 2011 Saskatchewan CCF Most notable in the 1960 election was the promise to introduce province-wide medicare. When the CCF won the election and proceeded to fullfill their promise, the doctors commenced their infamous strike in 1962.

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Britain: The Health and Social Care Bill and the Negation of Democracy Thursday, September 15, 2011 By Colin Leys New Left Project September 12, 2011

In voting for the third reading of Andrew Lansley’s Health and Social Care Bill last week MPs voted to replace the NHS as a public service with a system of competing businesses – foundation trusts, social enterprises and for-profit corporations. The government’s claim that the Bill does not mean privatisation is plainly specious: the truth of the matter is to be found in what Lansley’s health minister, Lord Howe, told a meeting of private health businessmen on the day the Bill was approved. He said it presented ‘huge opportunities’ for the private sector, and noted that commissioners of health care would be barred from favouring NHS providers. The truth is also to be found in the government’s leaked plans to hand over the management of NHS hospitals to private companies, and in the current and promised large-scale opening up of NHS work to ‘any qualified provider’. Lord Howe reiterated Tony Blair’s dictum that it doesn’t matter who provides care, so long as it is free to the patient. What this does is to treat as irrelevant everything that follows from introducing market dynamics. The basic fact about health care is that high quality care depends on a sufficient ratio of skilled staff to patients, whereas in the long run profits can only be made by reducing the skill-mix (to lower the wage bill) and cutting staff ratios. The resulting decline in care quality is already evident in privatised long term care and home care, and is now beginning to be seen in community health services and GP services. Once NHS trusts have to compete with for-profit companies they will be forced to follow suit. The erosion of quality will be reinforced by two other powerful factors: a) the cuts being imposed in the NHS budget, leading to the withdrawal of some services and the scaling back of others; and b) rising costs due to marketisation. The costs of market-based health care – from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multi-million pound executive salaries, dividends, fraud, and numerous layers of regulation – will eventually consume 20 per cent or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) is remotely resourced enough, or empowered enough, to prevent the decline of care quality or the scale of financial fraud that the Bill will introduce. Medicare's 50th Anniversary

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The effect will be that people with limited means will be offered a narrowing range of free services of declining quality, and will once again face lengthening waits for elective care. To get high quality and more comprehensive care people will have to pay for private insurance and private care, if they can afford to. More and more NHS hospital beds will be occupied by private patients, further reducing the resources available for free care. Fixed personal budgets, like those already given to people for social care, are to be introduced for a growing range of chronic conditions, allowing those with resources to top up their allocations while leaving the rest to make do with ‘basic’ NHS provision. None of this is wild speculation. It is either already happening or announced or readily foreseeable on the basis of current policy. To deny that the Bill means privatisation and the end of the NHS as a comprehensive service equally available to all is like denying that the earth is round. The fact that MPs have nonetheless endorsed the Bill reveals something more serious than an ideological blind spot. It shows that they don’t really care that they are flouting the wishes of the electorate. Cameron promised categorically that there would be no further top-down reorganisation of the NHS, but is pushing through a reorganisation that amounts to a destruction of it, against the known wishes of a large majority of voters. Governments, we are told, must often take unpopular decisions. But this is not some incidental measure. We are talking about something fundamental to what, for more than half a century, has played a key part in making Britons equal citizens, and Britain a civilised and humane country. If democracy doesn’t mean that governments have to respect public opinion on something as important as this, what does it mean? It is no less depressing that the Department of Health has been reduced to peddling more and more brazen lies, such as its‘Department of Health Myth Buster’ document, published to coincide with the Third Reading debate. The principle seems to be that that if an official lie – such as that the Health Bill does not mean privatisation – is repeated often enough, most people will feel it must be true. Democracy depends on voters having trustworthy information. If we cannot trust departments of state, run by public servants, to tell the truth, who can we trust? But most depressing of all is the failure of any organisation to mount a serious defence of the NHS. To call Labour’s opposition to the Bill weak is to give it too much credit. The NHS was Labour’s greatest social achievement. To have made no serious effort to defend it now ranks as one of the greatest, and at first sight one of the most puzzling, political betrayals in modern British history. The immediate reason evidently lies in the fact that New Labour prepared the NHS for privatisation, as Conservatives like to point out, and failed to be honest about it. But Miliband was elected leader on a promise to break with the legacy of Blair and Mandelson. Why would he not then break with the legacy of Milburn, Reid and Hewitt, their faithful water-carriers in relation to the NHS? And why have the unions, and the medical and nursing professions, not mounted a sustained and serious campaign to defend the NHS? The reason lies, I think, in a broader pathology. At every level we see an anxiety to conform – not to be dubbed ‘unrealistic’, ‘out of touch’, ‘difficult’, ‘radical’, ‘ideological’, ‘leftist’, ‘Old Labour’; a prevailing unwillingness to challenge the dominant discourse and the forces that underpin it. I don’t know about MPs, but so many professional leaders and managers, and many ordinary rank and file too, seem more afraid of being seen as out of step with the establishment than as having failed to stand up for what they believe in, or what their constituents want. There is a profound lack of confidence and independence. Any attempt to account for this must include two obvious factors. One is the power of market forces, strongly felt but most of the time unacknowledged. People know, without wanting to think about it too closely, that the power of the financial markets, which lies behind the power of corporations like United Health and McKinsey, is ultimately driving 190

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policy. They feel that when all is said and done it is, really, just quixotic to stand up for any policy that may be said to be at odds with what Blair and Mandelson liked to call the ‘new reality’. The other factor is the near-disappearance of collective organisation and action. People feel alone. If we take a stand, who will support us? Certainly not our party leadership, or our department head, and possibly not even our union. Instead we are all too liable to be marginalised and even punished. And so no clear, principled challenge is made to the tightening grip of market forces by those in a position to do so. The one encouraging qualification to this is the impact of the new social media: 38 Degrees, Facebook, expert bloggers and tweeters. Along with the million-plus people who work for the NHS a steadily growing portion of, especially, younger voters, have been exposed to a different narrative on the destruction of our social infrastructure, and not least the NHS. They see through the spin. At the moment most of them may be more cynical than politically active. But if the Bill becomes law and the reality begins to be felt in people’s daily lives it is this counter-narrative that will take hold, and cynicism will give way to anger. Eleven years ago, in the autumn of 2000, I summed up the prospects for the NHS as follows: It is not difficult to foresee that [the NHS] is destined to reach a point when resistance to privatisation has been sufficiently weakened and disheartened, and the market forces surrounding it [have been] sufficiently strengthened and emboldened, that further, more radical measures will become practicable. The conjuncture of a pro-market government and an economic downturn… would provide the context. The link between medicine and science… would be displaced by the link between medicine and profit. (Market-Driven Politics: neoliberal democracy and the public interest, p. 207) It’s usually nice to be proved prescient. On this occasion I just feel angry, and not only about the impending loss of the NHS. But I don’t believe the electorate will remain pacified indefinitely. Events will force a change.

Why the US health industry wants to raise the Medicare eligibility ... Thursday, September 15, 2011 By Joan McCarter Daily Kos September 12, 2011

Last week the American Hospital Association's lobbying for a hike in the Medicare eligibility age made news. The primary motivation expressed then was to attempt to stave

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off deeper provider cuts that would hurt them in exchange for benefits cuts. That's a big part of it, but of course the larger issue is much more straightforward: profit. The Health Leadership Council, a consortium of 47 health industry leaders including Aetna, Pfizer and the Cleveland Clinic, endorsed today to raise Medicareâ&#x20AC;&#x2122;s eligibility age from 65 to 67, phasing in the change by two months annually. Raising Medicare's eligibility age is one proposal in a four-part package of Medicare reforms up for vote, including creating a new exchange-like marketplace and increasing the cost-sharing for seniors who earn more than $150,000. You can read the full proposal HERE. There's a pretty simple explanation for why hospitals and some insurers would favor raising the eligibility age: Hospitals receive higher payments from private insurance than they do from Medicare. The payments that hospitals receive from private insurers are 28 percent above the break-even point for providing treatment, according to a recent report from the Blue Cross Blue Shield Association. Medicare pays only 91 percent of what it costs a hospital to provide care.[...] "At this point we're dealing with a situation where, if something raises money and it's not raising money from me, than its not a bad thing," says Ian Spatz, a senior adviser on the health care industry at the law firm Manatt. "If it's something that's not directly cutting you, that's better." The pushback on the policy proposal, rather, is likely to come from other stakeholders. States, employers and seniors would all suffer if the Medicare eligibility rules were changed. It would shift about $11.4 billion in new costs to those parties while saving the federal government only $5.7 billion, according to the Center on Budget Priorities and Policy. Since it's always worth repeating, yes, the on-paper savings for the federal government are $5.7 billion. And the costs for everybody else, $11.4 billion. But that's money in the providers' and insurers' pockets, so no wonder they're cheering this idea.

Report makes the case for Phamacare Friday, September 16, 2011 Canadian Health Coalition

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Download the groundbreaking new report, The Economic Case for Universal Pharmacare . The report lays out the formula for a Pharmacare program that not only offers coverage to all Canadians, but could save up to $10.7 billon in annual spending. The study includes an in-depth analysis of significant cost-savings through various scenarios, and has garnered the endorsement of eminent doctors, economists and researchers. The only thing in the way is lack of political leadership. Click here to download the report

The Public Voice for Medical Care Insurance, Issue #2 Saturday, September 17, 2011 Medicare: A People's Issue Issue number one HERE. As the struggle for medicare escalated to the doctor's strike in Saskatchewan, citizens supporting medicare started their own publication to counter the expensive ads and commercials launched by the KOD. Initiated through the Saskatchewan Federation of Labour, "Public Voice" was issued four times in July of 1962. Below is the second issue of the Public Voice.- NYC

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Tea Party campaign manager died for lack of private health insurance Saturday, September 17, 2011 Public Values September 13, 2011

Ron Paul, true to his word, though revelation comes after debate. Paul: Kent [literally] poured every ounce of his being into our fight for freedom. September 14, 2011: According to Ron Paul, churches, not governments or employers, should take care of the sick and dying, writes Wil Longbottom of the Daily Mail. After Paul's campaign manager died of complications from pneumonia, uninsured, we learn that Paul's last presidential nomination campaign did not provide its staff with medical coverage. "Ron Paul's former campaign manager died from complications caused by pneumonia because he couldn't afford health insurance, it has emerged. The details surrounding the 2008 death of Kent Snyder were revealed hours after the Tea Party candidate indicated he did not agree with free state health care for the poor. Mr Snyder, 49, died on June 26, 2008, with hospital costs totalling $400,000 after he became ill with viral pneumonia. The bill for his care was sent to his mother, who was unable to pay, and so a website was set up by friends to secure donations. Mr Paul's election campaign did not provide workers with medical insuranceâ&#x20AC;Ś" For the complete article, please click here.

International Health Workers for People Over Profit Monday, September 19, 2011 Visit their website HERE.

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Parliament needs to address Canadaâ&#x20AC;&#x2122;s drug problem Monday, September 19, 2011 Canadian Health Coalition September 2011

The Canadian Health Coalition is calling on the House of Commons Standing Committee on Health to conduct hearings into, and report on, the regulation and marketing of pharmaceuticals in Canada. ELEVEN QUESTIONS THAT REQUIRE ANSWERS AND ACTION 1. Why are adverse drug reactions among the leading cause of death in Canada? 2. Why has Health Canada prepared draft legislation to weaken drug safety regulation and speed up drug approvals without producing evidence that drug safety will not be adversely affected? 3. Why are Canadians paying 30% more for patented drugs than the OECD average? 4. Why is the government of Canada negotiating a trade agreement with the European Union (CETA) that would extend data exclusivity for brand-name drugs and further increase excessive prices annually by $2.8 billion, when the industry has failed to deliver on its promises to perform research and innovation in Canada? 5. Why does Health Canada allow direct-to-consumer advertising of prescription drugs with cross-border US ads that are illegal in Canada, and 'made-in-Canada' reminder ads, including ads for drugs Health Canada has issued safety warnings about? 6. How are public drug insurance plans performing in terms of access, costs, and evidence-based formularies? How many Canadians are uninsured or underinsured? 7. Why does Health Canada permit the illegal promotion of off-label drugs to physicians? Medicare's 50th Anniversary

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One consequence of this is doctors prescribing dangerous antipsychotics to young children with no clinical evidence of safety or efficacy. 8. Why is there no accountability for prescribing practices of health care professionals in most jurisdictions in Canada? 9. Why has Health Canada continued to maintain high levels of secrecy in drug regulation when both the U.S. and the European Union have instituted more open regulatory procedures? 10. Why does the majority of the budget of Canadaâ&#x20AC;&#x2122;s drug regulator (Therapeutic Products Directorate) come from the industry it is supposed to regulate? 11. Why does the Marketed Health Products Directorate receive less than 1/3 of the resources as the Therapeutics Products Directorate and the Biologics and Genetic Therapies Directorate?

Attack on New Zealand health system Monday, September 19, 2011 By Stuart Jeanne Bramhall People First June 19, 2011

Wikileaks has revealed that the US is collaborating with Big Pharma to pressure New Zealand to abolish PHARMAC. PHARMAC was established in 1993 to contain prescription costs. It is a world-renowned state agency and is currently exempt from World Trade Organization (WTO) anticompetition rules. All this will change if our National-led government proceeds to negotiate a Trans-Pacific Strategic Economic Partnership with its US and Asian trading partners. The power of bulk purchasing A single agency that purchases medications for millions of people has the power to pressure pharmaceutical companies to cut costs. This is one situation where market 196

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competition does lower prices, as multiple manufacturers producing virtually identical drugs compete to sell their products to PHARMAC. Medications on PHARMAC’s approved list are subsidized, so patients pay only $3 for each prescription. The formulary consists mainly of generic drugs, where they are available, and brand name drugs where the manufacturer has agreed to a volume discount. If a drug company won’t agree to a discount, its drug doesn’t appear on the PHARMAC formulary. Pfizer has refused to discount the price of its antidepressant Zoloft. Because patients must pay the full cost of a Zoloft prescription, it’s rarely prescribed in New Zealand. There are exceptions. If medical research indicates that a new, non-discounted drug fills a clinical need, it will be included on the formulary as a “special authority” drug. That means the prescription will be subsidized only if the doctor fills out a “special authority” form certifying that the patient meets specific diagnostic criteria and has failed to respond to one or two comparable drugs on the formulary. The envy of the world Thanks to PHARMAC, New Zealand, unlike most of the industrial world, has been able to limit the growth of prescription costs to the rate of inflation – despite a significant increase in demand. Not surprisingly, PHARMAC’s formation was followed by near constant litigation from drug companies, so that legal costs accounted for 18 percent of its budget in the early years. The drug companies charge that New Zealand is failing to pay its share of research costs, which is a pretty self-serving claim, given the record profits the pharmaceutical industry reported in 2010 (averaging more than 15-20 percent of revenues), the billions devoted to marketing identical “me-too” drugs, criminal penalties for fraudulent business practices and exorbitant CEO salaries. The Trans-Pacific Strategic Economic Partnership threatens to do what the pharmaceutical industry could not - open New Zealand to escalating drug costs and booming profits for the private sector.

Stuart Jeanne Bramhall is a retired American physician living in New Zealand.

Prelude to a Strike Tuesday, September 20, 2011 Medicare: A People's Issue As Saskatchewan entered 1962, the positions dividing the protagonists in the Medicare debate had hardened to the point where reconciliation seemed a dim hope. The government stood behind the Medical Care Act and its universal government funded insurance plan. The College of Physicians and Surgeons refused to cooperate or Medicare's 50th Anniversary

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negotiate until the act was changed. The doctors claimed that the Act would give the government a monopoly on the purchase of medical care which would intern interfere with their freedom to give the best possible service to their patients. The College proposed that patients should be covered by private insurance companies and that the poor would have their premiums paid by the province. In an attempt to reach a compromise, the two sides met in April. The meetings ended in failure. The month of May brought a new phase in the debate with both sides launching media campaigns. The government lauded the benefits of the universal plan while the doctors warned of a mass exodus of the health care professionals. Petitions and counter-petitions were circulated. Groups such as the Keep Our Doctors Committee (K.O.D.), the Free Citizens Association (F.C.A.) and the Committee for Medical Care (C.M.C) formed and held rallies throughout Saskatchewan. The Council of the College of Physicians and Surgeons met with the government in a last ditch attempt to ward off the strike at the end of May. Though the government offered to make substantial compromises, they refused to acquiesce to the doctors' demand of suspending the Actâ&#x20AC;&#x2122;s July 1 implementation date.

Practicing Revolutionary Medicine in Cuba and Venezuela Thursday, September 22, 2011 By Don Fitz MRzine September 22,2011 A review of Steve Brouwer's Revolutionary Doctors: How Venezuela and Cuba Are Changing the World's Conceptualization of Health Care. New York, Monthly Review Press, 2011. 245 pp. $18.95. Book excerpt HERE.

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As Venezuela becomes the first country to reproduce the Cuban medical model on a massive scale, it is doing so in ways that are unique in both form and process. Steve Brouwer's Revolutionary Doctors is essential reading for anyone interested in the transformation of medical systems at a cost vastly less than in the US and other overdeveloped countries. Readers knowledgeable of developments in Cuba and Venezuela as well as those first learning about them can learn from Brouwer's insights into how medicine intertwines with national and international politics. Revolutionary Doctors builds upon the growing body of information about medicine in Cuba. Some of the best recent writings include Linda Whiteford and Laurence Branch's Primary Health Care in Cuba (2008) and John Kirk and Michael Erisman's Cuban Medical Internationalism (2009). Together, the three works show how the Cuban model grew by responding to a series of contradictions. The first was the enormous disparity in the quality of medical care between rich and poor, urban and rural, and light-skinned vs. dark-skinned Cubans that characterized the island in the 1950s. The revolutionary government immediately devoted itself to increasing the number of hospitals throughout the island. Expansion of the access to medical care during the 1960s presented a new contradiction. The best medical care would be preventive rather than hospital-based reaction to disease. So the 1970s saw the introduction of polyclinics, which provided preventive care in the form of inoculations and education for 20,000-40,000 residents. (Brouwer points out that they now serve 40,000-60,000, p. 69.) Cuba was probably the first country in the world to recognize that clinics, though invaluable, do not create the close contact between health professionals and patients that are essential for genuine preventive care. In the 1980s the Family Doctor Program began Basic Health Teams (BHTs), which are a doctor and nurse pair living at the small medical office, or consultorio, in the community they serve. The most revolutionary concept of Cuban medicine is family doctors being responsible for everyone in a defined geographical area. Unlike the first three contradictions, that of the 1990s was 100% external in origin. The fall of the Soviet Union, the crash of the Cuban economy, and embargo bills that passed

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the US Congress left the island with much less energy, food, and medicine. Hardships were extreme: young men lost 25% of their caloric intake and nutritional deficits lead to 50,000 cases of optic neuropathy. But Cuba trained four times more doctors during this decade than it did during the 1970s. Amazingly, rates of infant mortality continued to fall (pp. 63-65). Polyclinics and consultorios had become so much a part of Cuban life that the island was able to weather the economic storm.

Haiti: A Cuban doctor treats patients at a mobile clinic The fifth contradiction was Cuba's understanding that socialized medicine could not be realized in one country alone. Though international medical humanitarianism spanned 50 years of revolutionary change, it was the first decade of the 21st century when it grew by leaps and bounds, with international medical brigades responding to crises throughout the world and over 20,000 students from 100 countries coming to Cuba for free education to become doctors. The Cuban concept of medicina general integral (MGI, comprehensive general medicine) defines the Family Doctor Program put into effect in the 1980s. Building close doctorpatient relationships means seeing patients in the morning at the consultorio and making home visits in the afternoon. The Venezuelan Barrio Adentro (inside the neighborhood) program is likewise based on this concept of medical professionals living in the same communities as their patients. Its foundation was laid with the October 2000 agreement signed by Fidel Castro and Hugo Chavez which included Venezuela's pledging oil and other goods and Cuba's providing human resources: teachers, agronomists, and medical professionals (p. 81). Though 17 of 24 million Venezuelans had no regular access to medical care when Chavez took office in 1998, in 2003 the first wave of 2000 Cuban doctors arrived to help extend care to every corner of the country. By 2009, 14,000 Cuban doctors had participated (p. 89). Like the Cuban MGI model, the Venezuelan MIC program (medicina integral comunitaria, comprehensive community medicine) begins by recruiting thousands of students who go to medical school for six years. They observe doctor/patient interactions beginning with their first year. In addition to treating people in their communities, the MIC program trains doctors in village settings. Some Venezuelan students are mothers and Brouwer describes one who began medical school at 71 years of age (p. 131). Barrio Adentro I began in 2003 with a massive expansion of neighborhood consultorios populares. In 2004, the Chavez government initiated Barrio Adentro II, which supported the mushrooming consultorios populares with a system of Clinicas Diagnosticas Integrales (CDIs, Comprehensive Diagnostic Clinics). CDIs have a variety of specialists,

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analytic equipment, and treatment alternatives not available at neighborhood settings (p. 87). The following year saw the introduction of Barrio Adentro III, which attempted to overhaul Venezuela's complex maze of hospital systems. In 2007, Barrio Adentro IV began the construction of specialty hospitals (p. 91). One of the most striking differences between health care metamorphoses in Cuba and Venezuela is their time frames. Each major shift in Cuban medicine marked a decade. A year was devoted to corresponding modifications in Venezuela: 2003, 2004, 2005, and 2007 for initiating Barrio Adentro I-IV. Brouwer notes the inevitable conflicts and problems which accompanied such rapid transformation. It is not surprising that a course which took decades to chart can be recreated much more rapidly. But it is not obvious that its stages may be reversed in the process of recreation. It took three decades for Cuban medicine to evolve from focusing on hospital care and polyclinics before hitting upon the MGI concept of the Basic Health Team. Once the Cubans realized that a doctor-nurse pair living in the community should be the cornerstone of community health, the Venezuelans used it as the beginning point of the Barrio Adentro program. After massive expansion of consultorios populares as their first step, the Venezuelans built more clinics to strengthen neighborhood health and then overhauled their hospital system -- they modified their medical systems in an order opposite to what Cubans had done. Of course, many other differences affected conversions of health systems in the two countries. With 11 million residents, Cuba has a much smaller population on an island which the US yearns to isolate. When the vast majority of naysayers departed from Cuba, it was able to develop a cohesive approach to health care. Venezuela, by contrast, has the continued presence of large anti-revolutionary forces using the media they control to issue shrill denunciations of any progressive change.

Cuban doctors in Venezuela Despite these differences, there are many parallels between revolutionary medicine in Cuba and Venezuela, beginning with doctor-nurse teams living in areas served. As in countries throughout Latin America, established physicians were highly reluctant to practice medicine in poor barrios or rural areas. The revolutionary government needed to train thousands of doctors who would themselves go to areas most in need, as Che Guevara said, "immediately and with unreserved enthusiasm to help their brothers." The beginning point of revolutionary medicine is a new generation of doctors motivated by revolutionary consciousness. These doctors work, not to become wealthy, but because they find their efforts rewarding and meaningful for their patients' lives. This concept is empty rhetoric at corporate medical schools that churn out doctors

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who glare in hostility at physicians willing to live in impoverished communities. Governments in both countries quickly increased spending on medicine in the poorest areas, resulting in rapid reductions in infant mortality and infectious diseases and increases in life expectancy. These improvements could only occur because Cuba and Venezuela realized that improving medical care presupposes simultaneous improvements in literacy, education, and housing. US doctors not seeing patients until they are sick is symptomatic of "sickness-based" medicine. When Brouwer described statistical charts on the walls of a consultorio popular in Venezuela, I remembered the same types of charts I saw in a Havana consultorio. Charting behaviors that need to change reflects the "wellness-based" medicine of doctors who are familiar with their patients because they interact with them informally throughout the year (p. 97). The US is now moving toward destruction of Medicare and programs which are essential for healthy living (such as Social Security), as international financial Scrooges continue to demand "austerity" approaches that sacrifice the health of entire nations on the alter of bank security. Brouwer describes an alternative in Venezuela which is truly revolutionary because patients are anything but passive recipients of a benevolent government: Each neighborhood of 1,500 to 2,000 people that wanted a Cuban doctor to serve them was expected to organize a committee of 10 to 20 volunteers from the community who would commit themselves to finding office spaces, providing sleeping quarters, collecting furniture and simple fixtures and feeding the medical providers. (p. 84) Venezuela is now emulating Cuba's example of training doctors from other countries at its medical schools (p. 140). If the Cuban MGI model morphs into MIC in Venezuela, what new concepts will be born in countries of Latin America, Africa, and the Caribbean? We can be sure that they will not rely on expensive technologies of Western "sickness-based" medicine. We also know that they will not be static repeats of Cuba or Venezuela but dynamic recreations of medicine for the cultures they serve.

Don Fitz is editor of Synthesis/Regeneration: A Magazine of Green Social Thought, which is sent to members of the Greens/Green Party USA. He produces Green Time TV in St. Louis. A version of this review appears in the October 2011 issue of Z Magazine. See, also, Don Fitz "The Latin American School of Medicine Today: ELAM" (Monthly Review 62.10, March 2011).

U.S. Health Insurance Cost Rises Sharply, Study Finds Tuesday, September 27, 2011 By REED ABELSON and NINA BERNSTEIN New York Times September 27, 2011 Major health insurance companies have been charging sharply higher premiums this year, outstripping any growth in workersâ&#x20AC;&#x2122; wages and creating more uncertainty for the Obama administration and employers who are struggling to drive down an unrelenting

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rise in medical costs. A study released on Tuesday by the Kaiser Family Foundation, a research group, showed that the average annual premium for family coverage through an employer reached $15,073 in 2011 â&#x20AC;&#x201D; 9 percent higher than in the previous year. And even higher premiums could be on the way, particularly in New York, where some companies are asking for double-digit increases for about 1.3 million New Yorkers in individual or smallgroup plans, setting up a battle with state regulators. The higher premiums are particularly unwelcome at a time when the economy is sputtering and unemployment is hovering at about 9 percent. Many businesses cite the cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans. The cost of family coverage has about doubled since 2001, compared with a 34 percent gain in wages.

Read more HERE.

The threat to health care from a â&#x20AC;&#x2DC;grey tsunamiâ&#x20AC;&#x2122; is a myth Wednesday, September 28, 2011 By Kimberlyn McGrail Troy Media September 21, 2011

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You’ve heard it before: the boomers are aging and jeopardizing our health care system by the sheer number of them swanning into their golden years. Sounds right – except it isn’t true. Let’s check the evidence: the older you are, the more likely you are to use health care services. This is a fact, but it does not necessarily follow that the coming bulge of boomers will bankrupt the health care system. Study after study in Canada over the last 30 years shows that aging is an issue, but it exerts only a small and predictable pressure on health care spending (less than one per cent annually from 2010 to 2036). More recent research shows that increases in utilization – how many and how often Canadians use health services – are twice as important as aging in increasing costs year by year. In other words, while population aging does increase costs, the kinds and amount of services provided to people in every age group are a far more important factor. How and why are these changes occurring? Increased visits to medical specialists, lab tests increasing costs The “how” is easier to answer. In a recent study published in the journal, Healthcare Policy, my colleagues and I looked at spending on physician services over a decade and found two major trends. One is that people are seeing a larger number of doctors overall. In particular, they are being referred to specialists more often. Even more significant is the increased use of diagnostic testing: people are being sent for far more lab tests, CAT scans and other imaging services. For example, about 6 per cent more of the population in B.C. had lab tests in 2006 compared to 1997; that is an additional 260,000 people being referred for laboratory services – a hefty additional cost to the health system. There is no reason to think BC is different from other provinces in this or any other trend. The second trend we found is that these increases themselves increase with age. That is, the percentage increase in doctor visits, specialist referrals and laboratory testing are all higher at older and older ages. By 2006 nearly half of people aged 65 and over saw at least one medical specialist

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during the year, saw at least one surgical specialist, had at least one imaging service, and three-quarters had at least one lab test. This is why the topic of aging and its impact on the system is so complex. The fact that populations are aging exerts only a small pressure on the system, but the fact that the system keeps changing so that more services are directed to everyone, particularly older people, compounds the problem. More care is not always better care The questions of “why” the system is changing in this way, and even more importantly, whether these changes are actually improving health and quality of life, are far more difficult to answer. Did more diagnostic procedures detect new conditions, increase the accuracy of diagnosis, alter care management, keep chronic conditions in check and improve patient outcomes? That is, do more tests keep us healthier and living longer? Or is all this testing simply a response to the wider availability of the technology itself, a kind of defensive medicine, “standard practice” – or even the outcome of seeing many different doctors (who may all feel they need to ‘do’ something)? Further, were increased referrals to medical specialists necessary, or the predictable outcome of a poorly organized and overly-burdened system of primary care? Unfortunately, we don’t routinely collect information on diagnostic outcomes and quality of life in health care so these questions are sometimes difficult to answer. But there are some important general cultural facts at play. We like new things and we seem to have a general assumption that if something is good, then more of it is better. New tests, screening devices and procedures are invented and we expect that they will be adopted immediately into the system. But we too often forget that care itself comes with certain risks – all drugs have sideeffects, many forms of imaging expose us to radiation, surgeries may have complications, even the fact of being diagnosed with a chronic condition can have a negative effect on people’s outlook on life. There is plenty of research to show that more use of specialist services, tests and imaging do not necessarily create better outcomes. More care is not always better care. Matching innovation with improved health outcomes People who need care should absolutely receive what they need. The trick is in defining and understanding that need. There is a lively ongoing debate about whether earlier and earlier screening, detection and labeling actually improves quality of life and outcomes for patients. The fact is, we don’t often know. We need better ways of measuring the outcomes of increased diagnostic testing beyond our now somewhat crude measurements of morbidity (the number of people with a specific disease) and mortality (the number who die of the disease). In other words, we need to put our efforts toward tracking more subtle changes in health and quality of life over time, particularly given that much of our health dollars are now spent in addressing chronic health issues. Medicare's 50th Anniversary

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It is time to shift the conversation from finger pointing at boomers to a much broader discussion about technology , the value and potential dangers of increased diagnostic testing, and whether we are getting value for money from our ever increasing utilization of health services.

Kimberlyn McGrail is Expert Advisor with EvidenceNetwork.ca and an assistant professor at the University of British Columbia and associate director of the UBC Centre for Health Services and Policy Research. EvidenceNetwork.ca is a comprehensive and nonpartisan online resource designed to help journalists covering health policy issues in Canada.

Improving Saskatchewan Health Care Thursday, September 29, 2011 CUPE Saskatchewan Division September 27, 2011 Saskatchewan is moving towards more privatized delivery of health care. We're using forprofit surgical clinics; privatized long-term care and adding private diagnostics like CT scans. By voting for a candidate who wants to strengthen Health Care rather than privatize it, you might be VOTING FOR YOURSELF.

Click to enlarge

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HANDOUTS -- Improving Health Care

60 UK hospitals facing closure due to PFI debt Saturday, October 01, 2011 Public funds to be taken out of NHS to support private deals. Public Values September 22, 2011

England's National Health Service (NHS) is set to suffer cutbacks as hospital closures put extra strain on the system, reports Daniel Martin of the Daily Mail. Trusts operating hospitals are unable to pay debt accumulated through the private financing [PFI=Private Funding Initiative] of building the hospitals.

"Hospitals could be forced to close as they buckle under the huge debt left behind by private finance initiative deals, the Health Secretary warned yesterday. Andrew Lansley said 22 NHS trusts are facing major financial difficulties because they cannot afford to repay huge annual fees for building work carried out under Labour. In some cases, the repayments account for a third of their entire budget â&#x20AC;&#x201D; putting pressure on finances and threatening front-line patient services. Mr. Lansley said Labour had left the Health Service with an 'enormous legacy of debt'â&#x20AC;Ś" For the complete article, please click here.

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Former Albertan doctor with public and private system experience fa... Saturday, October 01, 2011 Politicians pushing privatization not doing their jobs. Public Values September 23, 2011

Dr. Robert Ross Dr. Robert Ross is well qualified to pass judgment on the private, forprofit delivery of health care, having experienced systems in Canada and the USA. Returning to Canada to care for an elderly parent allows Dr. Ross to compare systems and offer unconditional support for public health care. He writes in the Edmonton Journal. "It is said that one measure of a society's evolution is how it cares for the old and infirm. On this measure, my home province fails miserably. I have just returned from the Canmore Hospital where my father was admitted with a fractured hip. He is 94 years of age, still relatively mobile and of comparatively sound mind so I don't expect miracles, but I do want enough hospital staff to physically help with care when he is in severe pain and requires my assistance just to transfer from bed to chair, or use a commode while maintaining some degree of dignity..." For the complete article, please click HERE.

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T.C. Douglas' December 1959 Speech Saturday, October 01, 2011 Medicare: A People's Issue

“If we can do this – and I feel we can – then I would like to hazard the prophecy that before 1970 almost every other province in Canada will follow the lead of Saskatchewan.” - Tommy Clement Douglas, Provincial Affairs radio broadcast, 16 December 1959

As the 1950s drew to a close, Saskatchewan stood at a crossroad. Funding of medical care was a mixture of direct patient physician payment, public programs or voluntary and commercial plans. The CCF, first elected in 1944, had consistently advocated universal health care, yet only one of the province’s health regions had successfully implemented such a plan. They would soon be looking for their fifth mandate from the people and felt the time was right to make the final push. On 16 December 1959, Premier Douglas speaking in a dramatic provincial affairs radio broadcast, outlined his party’s health care policy. Douglas outlined the five principles on which CCF medical care would be based: • A portion of the cost of the program would be paid directly by the people on a prepayment basis. • There would be universal coverage-everyone would have to join. • There must be high quality of service. • This must be a government-sponsored program administered by a public body responsible to legislature. • The plan must be in a form acceptable both to those providing the service and those receiving it. Douglas also announced the creation of a ten-member Advisory Planning Committee on Medical Care. Three persons would represent the medical profession, three the government, three the public and one the University of Saskatchewan College of Medicine. The health care issue would dominate Saskatchewan politics for the next two years. The CCF would win the election and pass the Medical Care Act which would create a crisis culminating in the “Doctor’s Strike” of 1962.

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Saskatchewan Doctor's Strike settled - Time magazine 1962 Monday, October 03, 2011 Canada: Condition: Fair Time Friday, Aug. 03, 1962

After it was over, Britain's Lord Taylor, a bluff Labor Party peer and an architect of the British National Health Service, last week gave Saskatchewan a doctor's order. "This province has had a major operation," said he. "I prescribe for it absolute rest." The major operation was the settlement of the bitter, 22-day strike of Saskatchewan's doctors, who closed their offices rather than practice under the Socialist government's new compulsory medical insurance scheme. Largely mediated by Lord Taylor, the settlement let each side claim moral victory. The government won the doctors' agreement to North America's first comprehensive, taxsupported state medical insurance plan. But by their stubborn fight, the doctors won modifications in the plan removing what they had feared as political controls over the practice of medicine. In the key concessions, Saskatchewan's Premier Woodrow Lloyd made clear that the doctors could practice inside or outside the scheme, agreed to let the province's two major doctor-operated voluntary insurance plans continue in business, and expanded the doctors' representation on the medicare plan's governing commission. The weary Taylor hailed the agreement as a model for what he hopes will come to the rest of Canada and the U.S.â&#x20AC;&#x201D;and, following his own prescription for a rest, headed off to fish in the seclusion of northern Saskatchewan.

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The Coming Battle: Healthcare Privatization and the Ontario Election Wednesday, October 05, 2011 By Doug Allan Socialist Project Bullet October 5, 2011

In the past, capitalists had given many aspects of healthcare a pass in Canada and Ontario. There was a general preference to leave medicare intact from the lower costs it provided employers, especially in export sectors like auto, that gave Canadian companies a cost advantage. But, with the shifting balance of class power and the turn to an â&#x20AC;&#x2DC;age of austerityâ&#x20AC;&#x2122; in the midst of the economic crisis, this has changed. With cuts to public healthcare set for the post-election period in Ontario whatever the electoral outcome, that balance is poised to change again with further attempts to privatize and marketize the healthcare system. The 1990s: Origins of Healthcare Privatization In the early 1990s, delivery of healthcare in Ontario by for-profit businesses had been centred in the long term care and ambulance industries. Even hospital support services were mostly publicly delivered. Public insurance sufficed for hospital and physician services. During the hard right government of Conservative Mike Harris, there was a significant development of for-profit long term care facilities. The Harris government also embarked on two other major attempts to privatize healthcare: [1] the creation of public-private partnership (P3) hospitals where for-profit corporations would finance new hospital facilities and operate the hospital support services, and [2] the establishment of for-profit diagnostic clinics for MRIs and CT scans. Long running community-labour campaigns led by the Ontario Health Coalition helped to delay the expansion of for-profit diagnostic clinics. They also limited the privatization of support services in P3 (public-private partnership) hospitals, even while the private Medicare's 50th Anniversary

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financing for these hospitals continued unabated. As well, with the assistance of a union campaign, for-profit delivery of ambulance services was mostly abolished. The latter was accompanied by a dramatic improvement in the pay and prestige of paramedics, along with the quality of Emergency Medical Services. The Role of International Capital in Healthcare Privatization International capital played a major role in the various privatization ventures, with the expertise on privatization of British corporations from the Margaret Thatcher era most evident. Carillion, a British P3 corporation won a major role in the first two projects started by the Harris government, massively expanding its role in Canada. The role of international capital has been a major theme in recent healthcare privatization initiatives across Canada. In British Columbia, the election of the business government of Gordon Campbell in 2001 led to one of the biggest privatizations in Canadian history. Support work performed by thousands of employees at healthcare facilities was contracted out. The work went largely to foreign based transnational corporations. Indeed, following complaints about superbug infections, the Vancouver Island Health Authority tried to dump its transnational housekeeping contractor earlier this year, but Compass hung on to its $50-million, fiveyear deal by buying Marquise Group, the company chosen to take over cleaning at several Island facilities. “It's always a bit disconcerting when you set a contract with one company and another company buys them,” observed Joe Murphy, vice-president of the health authority's operations. The consortia for a new, massive P3 hospital in Montreal is entirely foreign: Innisfree, a British based firm which is one of the largest investors in hospitals around the world; Laing O'Rourke Canada Ltd., a British based construction firm; OHL Construction Canada Ltd., a Spanish construction and services groups; and Dalkia, a large French company that provides facilities management services to more than 5,000 hospitals around the world. Dalkia has also recently built a plant in Ontario to sterilize hospital surgical instruments through a subsidiary of one of its subsidiaries. Canadian capital has been forming its own interests in privatization, but these national capitals have historically had less P3 experience than competing foreign corporations in the healthcare sector. The long term financing aspect of the deals particularly disadvantage Canadian companies, whose relatively smaller size weakens their ability to secure financing at favourable rates. These changes are bringing powerful international capitalist interests to the healthcare industry in Canada, but also providing a foundation for Canadian capital to grow and develop their own agenda for internationalization. So, for example Bombardier, a relatively large Canadian corporation, lost its position as the favourite for a £1-billion Crossrail train contract when the government moved to fund the deal through a P3. The problem? Bombardier's German based competitor, Siemens, has better access to financing than Bombardier. “A large company like Siemens will be able to borrow the money to undertake a project of this kind,” Tony Travers, director of the Greater London Group at the London School of Economics, warned. Indeed, Siemens's superior financial power is thought to have been a factor in their victory over Bombardier for a recent Thameslink deal that caused Bombardier to announce it would lay off 1,400 workers at a British factory. Certainly foreign corporations are often the winners of major healthcare privatizations so 212

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far in Canada: think of Carillion, Compass, Sodexho, and Aramark. Likely, the giant foreign trans-nationals will have a marked ability to push for and capitalize on new major privatization initiatives. A significant point – if the openings for privatization become more widespread. But more P3 activity in Canada will also help some Canadian capitalists in the healthcare sector gain additional productive capacity and financial expertise and linkages to compete more successfully. The internationalization of capital is a key dynamic to healthcare sector restructuring and it bears close watching in Canada. Privatization of Clinical Services While in the past, the privatization initiatives had steered to less controversial quarters, the privatization of surgical and diagnostic services has come more to the fore. For example, Sacre-Coeur hospital in Montreal has moved 6,000 surgeries to the private business RocklandMD since 2008. In this case, however, the private surgical clinic is not just performing a few minor surgeries. Instead it is performing breast cancer operations, bariatric surgery, orthopaedic surgery, etc. RocklandMD claims to be able to perform a broad range of day surgeries, “from the simplest to the most complex, in various specialities and within very short times.” In contrast, the Toronto Star has noted that the Quebec Health Insurance Board reprimanded a Rockland MD for charging patients fees for use of medical equipment, facilities and support staff in contravention of the Canada Health Act. This is a new and troubling level of healthcare privatization in Canada. The thin edge of the wedge is usually to start with support services, minor operations or tests. The corporations are now pushing to go well beyond that. Physicians have been a factor in these developments, with the Ontario Medical Association leading the calls for an expansion of private surgical and diagnostic clinics. The doctors have actually already achieved enormous increases, driving up their OHIP funding since the Liberals got in power by just under $6-billion – an astonishing 87 per cent increase! That one line-item increase alone accounts for a significant portion of the total increase in healthcare spending in Ontario. But more came through special funding for private clinics, or “Independent Health Facilities.” The Conservatives explicitly called for the expansion of private clinics in the 2007 provincial election, to little electoral avail. The Liberals declined to make such a call and opposed the for-profit CT and MRI clinics established by the Harris government. In fact, the private clinics have seen an 82 per cent increase during the Liberal regime. Outgoing Liberal Health Minister Deb Matthews responded to the latest demands from the doctors for more funding for the private clinics by saying: “We're not opposed... We support the need to deliver services in the community. That's why we have a lot more dialysis, for example, out of hospitals. It's really all about getting the right balance.” As these clinics expand the fragmentation of the healthcare system grows and the problems of recruitment and retention of professional staff at public facilities increases. Privatized Payments for Healthcare With the development of for-profit clinics, we also get a push for new revenue to increase profits. This often means user fees – or what the World Health Organization refers to as by far the major obstacle to progress toward universal coverage. Medicare's 50th Anniversary

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The MRI and CT private clinics established by the Progressive Conservatives were founded on this idea, as are many of the private clinics popping up around the country. Many private clinics are introducing user fees, some quite ingenious to get around legal obstacles (e.g. $100 for a glass of orange juice – I kid you not). As corporations get in on this action, they will likely prove much more formidable backers of this than the physicians alone. Ontario Leads the Way Contrary to pro-privatization myth-makers, Canada is not a backwater of socialized healthcare akin to Cuba. About 29.8 per cent of Canadian healthcare expenditure comes from private (rather than public) payments. That's a lot of user fees for those without private insurance. In fact, Canada rates 18th out of 26 developed countries reported by the Canadian Institute for Health Information (CIHI). Other measures also bear this out. Private healthcare payments account for 3.1 per cent of the Canadian GDP, tied for the fourth highest percentage of the 26 countries reported by CIHI. In fact, Canadians make the third highest payments for private healthcare services in the world ($1,216 in 2008). No surprise, Ontario has higher private payments than any other province both as a percentage of total healthcare expenditures (32.6 per cent of total healthcare expenditures) and in total cash payments per capita ($1,841 per person). For total cash payments, that's 50 per cent more than Canada as a whole.

A Perfect Storm? Increased costs for Canadian public healthcare are a pale echo of the increased costs in the motherland of privatization, the USA. Americans have faced 113 per cent premium increases for employer-based plans over the last ten years (a 108 per cent increase for the employers’ share and a 131 per cent increase for the workers’ share of those premiums). While the Ontario Ministry of Health and LTC got significant funding increases over the last ten years, those increases fall well short of this enormity. A 113 per cent increase would have forced Ontario to come up with an additional $11-billion this year alone. Americans now face an average premium for family coverage of $15,073 (U.S.) annually. U.S. private insurance now also provides less comprehensive coverage: “Without any real national discussion or debate, there's a quiet revolution going on in what we call health insurance in this country,” Drew Altman, president of the Kaiser recently told the Washington Post. “Health insurance is becoming less and less comprehensive. ... And we expect that trend to continue.” And with the increased costs, fewer employers even offer healthcare insurance: it's now down to 60 per cent from 68 per cent a decade ago. In fact 12.6 million Americans fell off of employer-based plans over the last decade, with a drop of 1.5 million in 2010 alone. Nevertheless, the increased costs in Canada have been significant, with 6 per cent annual increases in federal payments in the current ten year deal for the Canada Health Transfer and an average 6.6 per cent annual increase in Ontario for the Ministry of Health and LTC funding over the last ten years. And there are significant service problems: dramatically increased wait times for long 214

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term care, 10,000 people on wait lists for home care, sky high hospital bed occupancy, back-ups in emergency rooms, ambulance offload delays at overcrowded emergency rooms, and, when it all backs up, code zeroes (when there are no ambulances available to respond to 911 calls). Ontario has significant provincial deficits and the prospect of more economic troubles is clearly possible. The response of the Ontario government, like other Canadian governments of a wide variety of political stripes, has so far been to turn to austerity and squeeze provincial funding after the October election. The widely accepted plan is to eliminate the provincial deficit by 2017-18. A few months ago, the Auditor General reviewed the Liberal healthcare funding plan for the next two years and reported that those increases would average 3.6 per cent annually. This is much less than previous years (about half) and the Auditor was openly sceptical that the government could implement this without significant healthcare cuts, even with a wage freeze. Hospitals for example â&#x20AC;&#x153;may have little alternative but to cut services.â&#x20AC;? For an auditor, these are strong words. But even this dismal projection may prove optimistic. Buried in the costing of their electoral program, the Liberals have determined that they won't even meet this level of funding. They will only increase healthcare funding by 3.6 per cent next year. The year after that the increase will fall to 2.86 per cent, a decline of 0.74 per cent. This will mean the loss of $360 million dollars in healthcare funding annually. The two-year average annual increase will be 3.2 per cent rather than 3.6 per cent. The Liberal four year increase would also be about 3.2 per cent annually, based on figures in their costing document. For the Conservatives, the increases would be about the same. This contrasts with promises from the federal government to increase their transfers for healthcare by 6 per cent annually for the same time period. That's almost double what the province would put in (and much closer to the actual cost pressures facing healthcare).

However, when you consider the increasing federal transfers for healthcare will actually pay for almost half of the provincial funding increase, the money for healthcare actually raised by the province would only be about 1.6 per cent. In other words, the federal government percentage increase is almost four times the increase that would come from money raised by the province. Somehow, Stephen Harper is now far more generous to public healthcare than Dalton McGuinty. Medicare's 50th Anniversary

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Sectors outside of healthcare will do much worse in Ontario. According to the Auditor General, the funding plan of the Liberal government would see a sharp reduction in overall spending increases (from 7.2 per cent over the last eight years to 1.8 per cent for the next two). That's quite a tumble, to a level of increase that is much less than the government's inflation forecast. Healthcare would get the largest increase and education, post secondary education training, and social services would see some nominal increases. But other areas will receive absolute cuts: Justice would be cut 1.8 per cent annually and all other programs would be cut 5.6 per cent annually.

And the Future? Privatization problems abound, not just in the USA. The British Health Secretary was forced to admit recently that 60 hospitals were on the “brink of financial collapse” as a result of their public-private partnerships. The costs of the British P3s are now going up by almost a quarter, just as the government restricts healthcare spending, forcing cuts to hospital services. In Ontario, the failure of a P3 long term care scheme in Windsor almost single-handedly drove a crisis backlog in the hospital system. In Britain, long term care homes were privatized but the recent circumstances scuppered the largest private chain (with 752 homes and 30,000 residents) passing the real risk of privatization not to the private sector but on to the elderly and infirm residents. Despite these privatization problems, the immediate prospects look grim for defenders of public healthcare. The Liberals have set up the Drummond Commission to report on public services. Of course, the Commission will not report until after the election. It would be a shock, however, if Donald Drummond, an ex-Bay Street banker, does not recommend cutbacks and privatization. A number of factors confront us, as citizens and unions, in the coming battle over healthcare restructuring: • The decline in public healthcare services. • The prospect of a spending squeeze and more service cuts after the provincial election. • The growing strength of transnational corporate power in the Canadian healthcare market, and the efforts by Canadian capital to strengthen their competitive position in the sector. • The attempts by the capitalist class and the most affluent to obtain preferred – often private – access to healthcare and the likelihood that this response will intensify as public healthcare declines. These will all likely mean more serious push to privatize healthcare after the Ontario election, whatever the precise political make-up of the new government. In this age of austerity, the future is not friendly, at least in the short run. But the healthcare sector is one area where anti-austerity and anti-privatization struggles can gain significant traction from the strength of union organization and the vibrant community coalitions that have already formed.

Doug Allan writes regularly on healthcare, the public sector, class, and collective bargaining in Leftwords for the Ontario Council of Hospital Unions/CUPE web site. Resources: 216

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• • • •

Global Crisis, Fiscal Restraint and Public-Private Partnerships with Dr. John Loxley Book Launch: Power in Coalition with Amanda Tattersall and Natalie Mehra Starving Healthcare with Colin Leys and Natalie Mehra Morbid Symptoms, Health Under Capitalism with Colin Leys, Pat Armstrong, Roddy Loepky, Dr Andy Coates, and Natalie Mehra

Lifespan shorter in USA than other developed countries Friday, October 07, 2011 LeftWords October 6, 2011

World Bank data suggests that the United States has a lower life expectancy compared to the other major developed economies. Canadian life expectancy is now (2009) 2.5 years longer than in the USA. In 1960, before the development of Canada's public medicare system, the difference was a little less, 1.3 years. Indeed, the USA has fallen behind its long term nemesis, Cuba. Cubans now live 78.9 years, a couple of ticks more than the U.S. lifespan of 78.7 years. In 1960 (at the beginning of the Cuban revolution) Cuban's lived 5.9 years less than Americans.

Leftwords: Defending Public Healthcare Friday, October 07, 2011 Healthcare News & Opinion by Doug Allan for The Ontario Council of Hospital Unions/CUPE Visit the site HERE.

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The state of single payer in the states: Saskatchewan a model Sunday, October 09, 2011 By Joan McCarterFollow Daily Kos October 4, 2011

Last week, Daily Kos asked Governor Brian Schweitzer about his plan to pursue a single payer health system for the state, modeled on the system pioneered by Saskatchewan Province in Canada. "Montana has a population of 990,000 people," he explains. "Saskatchewan has a population of 1,050,000. Their average age is about the same average age of Montana. They're about 10 percent Indian, we're about 7 and a half percent Indian. The other ethnic groupsâ&#x20AC;&#x201D;they're a mirror image of us.... So we have the same ethnic population, we're farmers, we're loggers, we're miners, we're oil developers.... They, in Saskatchewan, live two years longer and have lower infant mortality."[...] "We have an $8 billion health care industry in Montana right now, and 50 percent of it, or $4 billion, is coming directly from the federal government," he continued. "That may be enough so that we can get the rest of Montana in it. We turn to the rest of Montana and say to them we've got this $4 billion, and we're taking care of all these people, and now we've run the rates and if you want to pay into this system, here's how much it's going to be. If you don't want to buy into that system, you don't have to." "If you want to pay twice as much for Blue Cross and Blue Shield and have their 218

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accountants lie to you," the governor said, "you just stay right where you're at. But I think they'll knock our door down." Schweitzer's plan requires waivers from the federal government primarily for Medicaid, but potentially for all federal health systems. Schweitzer wants to include Medicare, Medicaid, Indian Health Services, SCHIP, VAâ&#x20AC;&#x201D;all federal health systemsâ&#x20AC;&#x201D;to pool that $4 billion to set up a public option. He'd like to implement this program as soon as possible, so he is not waiting to see what the outcome of the various legal challenges to the Affordable Care Act will be, or for the provision of the law that allows states to apply for waivers to set up their own systems rather than the standard ACA exchange. Since Montana's Republican-controlled legislature refused to pass legislation to set up the exchange, as required by the law, Schweitzer's plan could be the kernel of a federal-state partnership under the law. Two other states have innovative single-payer plans that are well-developed, while a handful are in the "still talking about it" stage, and one has abandoned its efforts. Vermont and California are the furthest along, and Connecticut has backed off a public option plan that had been in the works for years. Vermont has established Green Mountain Care, a bill actually signed into law. There are still critical details, like how the program would be financed, to be worked out. This is where the Schweitzer model might come into play, and could be a sort of ideological reversal of the Republican answer for all programsâ&#x20AC;&#x201D;a block grant. Using all federal health care dollars spent in Vermont, or Montana, as a lump sum to finance a public health system, with the option for people with private insurance to buy in, is a smart solution. They're looking at using the funds offered in the ACA to assist states in building the health insurance exchanges. Vermont is seeking a waiver to pursue the single payer system and not have to run a separate exchange. As the law stands now, they can't get that waiver until 2017. Democrats in both chambers of Congress have introduced legislation to move that date up to 2014, legislation which President Obama supports, and in fact has included in his jobs plan. For Vermont, the big question is whether there's any leeway for the administration to grant waivers ahead of what's allowed in the ACA for the system to be implemented. Vermont's success in this, in turn, could help clear a path for Montana. California has made substantial legislative progress toward setting up its own single payer program, with a block of "two-year" bills that will both ready the state for the 2014 implementation of the ACA, and lay groundwork for a single payer system, a bill which is also slated to be considered next session.

The Future of Medicare by Tommy Douglas Sunday, October 09, 2011 Canadian Health Care Coalition

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"We can’t stand still. We can either go back or we can go forward. The choice we make today will decide the future of Medicare in Canada." The following text from a 1984 speech of my father is in response to Premier Klein and others who would have us believe that Tommy Douglas had a limited vision for the future of Medicare. He saw much further than most governments in Canada today. - Shirley Douglas, Spokesperson Canadian Health Coaltion The Future of Medicare There’s not any doubt at all that the present Medicare program in Canada is in serious danger of being sabotaged. One danger is extra-billing, which is growing and which has meant only one thing: that we are rapidly developing two types of people in the health care field–those who come under the general program and whose care is paid for out of government funds, and those who pay “a little extra” to doctors who want a little extra. If that goes on, the percentage they will pay in extra billing will increase from year to year, so people will get to the place where they are saying, “I’m paying almost as much in extra billing as I pay through taxes.” Let’s scrap this plan. Otherwise, you’re going to have a situation in which some doctors will only want patients who accept extra billing, and they will be the most competent doctors and the most proficient surgeons. Thus, after a while, the people who will not accept [or cannot afford] extra billing will have to go to the less competent doctors and less competent surgeons, and you’re right back where we started when we fought for Medicare. The well-to-do who can afford it will have one standard of health care, and those less fortunate will have to accept a lower standard of health care. Surely we’re not going back to a system in which the quality of care patients receive depends upon their financial capacity to pay. Any free country that talks about the democratic process and allows extra billing to become the general rule is denying the basic principles of the democratic process. The other danger to our present system is the premiums which are being levied in some

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provinces. In Ontario, for instance, a widow with three children has to pay $500 or $600 in per capita taxes. What a ridiculous situation! You don’t pay for education on a per capita basis. Surely, if we provide education as a right, we ought to provide health care as a right, irrespective of income. I’m telling you that, unless those of us who believe in Medicare raise our voices in no uncertain terms, unless we arouse our neighbours and our friends and our communities, we are sounding the death knell of Medicare in this country, and I for one will not sit idly by and see that happen. I helped to establish the first Medicare program in Canada, and even at my age I’ll trek this country from the Atlantic to the Pacific to stop Medicare from being destroyed. Even if we get rid of extra-billing, however, and even if we get all Medicare costs paid out of government revenue, we will not yet have tackled a more important problem. And that is how to reorganize a health care system that is lamentably out of date?

We have to move increasingly toward care through clinics. We’ve got to provide financial inducement for doctors to form clinics and go into clinics, whether they are paid on a salary or a fee-for-service basis. We have to locate these clinics in or close to hospitals, so that people will have ready access to diagnostic and treatment facilities. Let’s not forget that the ultimate goal of Medicare must be to keep people well rather than just patching them up when they get sick. That means clinics. That means making the hospitals available for active treatment cases only, getting chronic patients out into nursing homes, carrying on home nursing programs that are much more effective, making annual checkups and immunization available to everyone. It means expanding and improving Medicare by providing pharmacare and denticare programs. It means promoting physical fitness through sports and other activities. All these programs should be designed to keep people well–because in the long run it’s cheaper than the current practice of only treating them after they’ve become sick. It seems to me that this is the task that lies before us, and I suggest to you that programs of this kind can be organized under Medicare and that we have an obligation to see that such a program of prevention is instituted. We can’t stand still. We can either go back or we can go forward. The choice we make today will decide the future of Medicare in Canada.

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Healthcare-NOW! Supports Occupy Wall St. Movement Wednesday, October 12, 2011 By Healthcare-NOW! October 12, 2011

In 1,368 cities across the country and around the world, people are standing up to the top 1% who collectively have more wealth and power than the lower 99% of the population. These occupations are self-sustaining communities focused on creating a space for free and open dialogue and action on the issues–from healthcare to education to unemployment–that plague the 99%. Healthcare-NOW! endorses the occupation movement and urges all who can to join them, bringing the message of improved Medicare-for-all as a solution to the crisis of inequality in wealth and in health. We’re being told by the Super Committee and other politicians that our already too modest safety-net is bankrupting us, but the reality is that Wall Street is bankrupting us. Social Security, Medicaid, and Medicare are not the problem. Instead of being cut, they should be maintained and strengthened. Single-payer, improved Medicare for all, like H.R. 676, would save millions of lives and reduce healthcare spending by $400 billion per year. We need to take the single-payer healthcare message to the occupations, as is happening already in many cities (New York City, Denver, Washington, DC, Philadelphia). We need to make sure that improved Medicare-for-all is on the lists of demands.

Careworker testimonies: the privatised future of the NHS Friday, October 14, 2011 By Marienna Pope-Weidemann Counterfire Friday, 14 October 2011

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Marienna Pope-Weidemann spoke to NHS care workers battling the disastrous reablement scheme that puts market imperatives ahead of the needs and interests of the most vulnerable in our society.

When up to 2,000 protesters joined UK Uncut and blocked Westminster Bridge for two hours on Sunday, they were seeking to stop a bill which will be the last nail in the coffin of our National Health Service. This is just the latest legislative Frankenstein from this government. We’ve been descending down this slope for years. NHS care workers have been trying to stop waves of privatisation drowning their department since 2007. In many respects the new bill represents a monolithic expansion of the spirit of structural adjustment. In Middleton, for example, the so-called ‘re-ablement scheme’ promised to save the council £8.5 million: about as much as it costs us to run each of the Eurofighter Typhoon bombers in Afghanistan for three days. According to the Department of Health, the introduction of the scheme in care for the elderly was part of a new ‘Putting People First’ approach. It defines re-ablement as the ‘timely and focused intensive therapy and care in a person’s home to improve their choice and quality of life... so they achieve their optimum stable level of independence with the lowest appropriate level of ongoing support care.’ Re-ablement, which occurs during the transition from hospital care to the home, can go on for up to six weeks, though care workers are often re-directed before then. So what does this NHS service look like four years later? And does it tell us anything about what we can expect if the new Health & Social Care bill is passed? I spoke to Rebecca Hoving, a care worker for over 15 years, who said: “This is a financial move. It has nothing to do with care quality. The aim of this seems to be to cut patients off as soon as possible and either leave them to their own devices or channel them through a private care company.” Before these reforms, care workers were responsible for providing holistic and individualised care, usually after being approached by and consulting with the family. They performed simple tasks like pouring the kettle and helping someone into bed. They also administered medication and maintained constant written and verbal communication with supervisors and families, which brought a sense of security to patients, seeing the same faces every day. Most care workers seemed to view this as an effective system of accountability and collaboration – not qualities the free-market approach has been noted for. While re-ablement is a free service, its primary function is to encourage ‘self-sufficiency’ Medicare's 50th Anniversary

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by re-routing patients to private care companies; in practice, the service prefers private companies ‘on their books’. As things stand today, paying for private care can often be cheaper than coughing up the required subsidies to continue NHS care, leaving poorer patients with no real choice. Staff turnover is rapid in the private sector, hindering the development of patient-carer bonds which help ensure the incentive to provide a high standard of care. Before being channelled into the private sector, patients are presented with the option to purchase ‘reablement equipment’, which someone who clearly never studied psychology or cared for a disabled person thinks substitutes the routine, interaction and consistent care provided by the old service. It is generally assumed that the private sector provides higher standards of care. I spoke to one Bupa employee whose experiences working with the elderly for the past couple of years suggests this is wrong. She reported having worked as an assistant in a Bupa care home for three months before receiving any training, and was given no training on managing challenging behaviour or how best to behave towards different patients for the first eighteen months. She reported that accountability and record-keeping is often lax, and that family members who raise concerns are generally demonised by the staff. She said: “Management is very much absent, they never come in contact with the patients, which leads to the promotion of people not suited to senior positions. They’re not the most caring of people.” She reported that it is not uncommon for residential carers to work for minimum wage along with the assistants. Since so little training is apparently required, this seems unsurprising, but attempts to verify this with Bupa led to my being hung up on. Rebecca Hoving says: “The scheme doesn’t re-enable anyone. There’s no therapy, no holistic care at all. We’ve been taken out of that role. Any caring input must be secretive, we can’t even write it down. Supervisors have become policemen. They don’t visit my patients, but they tell me I’m not allowed to put Mr. Abbot’s socks on for him anymore. Watching a man in his eighties, riddled with arthritis in his legs and shoulders, lying on a bed in great pain, struggling to get his socks on, is not outside the purview of a care-worker. To me, that is a great indignity to the patient, who desperately needs the community support work we used to provide. We’re being used to suck patients into the private sector. I did not sign up for this. I am a care worker; now they ask me not to care.” As early as January this year, the Tory ministers were admitting there would be ‘no limits’ on private care firms invading the system under their reforms. This expansion has now exploded into the public consciousness, but the way such structural adjustment impoverishes the most vulnerable members of our families and communities has been observed in the developing world for decades. What will be more immediately obvious, however, is the erosion of the cohesive and vital relationship between the patients and the professionals, once charged with their care but now with cost-cutting. Because salesmen embellish, elaborate, even lie; if they don’t, they go out of business pretty quickly. That is how the market operates. 224

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After my interview with Rebecca Hoving, I was contacted by another young care worker who wanted to share his story. “There was an elderly woman I used to visit when I first started working here, before the re-ablement scheme. I used to go there most nights to help her go to the bathroom, replace her incontinence pad and put her to bed, since she couldn’t raise her legs. When I was assigned to re-ablement, someone else was assigned to her. I met her daughter recently, who told me she passed away recently, after a long period of deep dissatisfaction with the private care company she’d been encouraged to go to – the supervisors always get ruffled when a patient wants to choose a different company. There’s definitely pressure there. It turns out they weren’t changing her incontinence pad, which caused painful sores. Perhaps more important is the psychological effect of neglect like this. She lost her selfconfidence, and when you do this job long enough you learn that that can be the difference between life in death. I wouldn’t be surprised if it contributed to her decline. I’ve been so angry about it... but we’re unemployed unless we toe the line.” That’s something which has been reported up and down the country. Those fighting to keep day centres open or taking action against re-ablement are being actively discouraged from attending community meetings. Unfortunately, this institutional policy has forgotten that once upon a time, medical professionals were encouraged to prioritise the interests of their patients over everything else. But that’s not dynamic, competitive market thinking: it’s just compassion and common sense. And there’s no room for that kind of outdated nonsense in the new NHS. All names have been changed for anonymity. Marienna is running in Monday's elections for NUS conference delegate at the School of Oriental and African Studies (SOAS) in London. Her manifesto can be found here.

Tommy Douglas on Future of Medicare (1983) Friday, October 14, 2011 Clip from his Speech to the 50th Anniversary NDP Convention. Tommy Douglas was present at the Regina Convention that founded the CCF. At the 50th Anniversary Convention in 1983, he delivered what many consider his greatest speech. Those present cheered him for over 20 minutes.

Tell Canada to "Show Up" for health Monday, October 17, 2011 Africa Files October 17, 2011

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Action Requested: The Government of Canada is currently refusing to send Ministerial representation to a crucial global health conference taking place in Brazil, from October 19-21, 2011. The World Conference on Social Determinants of Health is a gathering of over 100 member states of the United Nations, and will be attended by heads of state and Ministers of Health from around the world — all coming together to discuss key national and global measures to improve health and well-being around the globe. Please add your name to a new online petition calling on Canadian Prime Minister Stephen Harper and the Government of Canada to "show up" for health by ensuring that Canada’s Minister of Health attends and participates in the conference. CJW Act By: 19 October 2011 Sponsor: Health for All Target: Prime Minister, government officials Action Site: http://www.gopetition.com/petitions/tell-canada-to-show-up-forhealth.html Other Contact Info: n/a African Charter Article #16: Every individual shall have the right to enjoy the best attainable state of physical and mental health. (Click for full text...)

Introduction to “Sick and Sicker” Monday, October 17, 2011 By Susan Rosenthal Solidarity is the Best Medicine

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“What does it mean to strive for health in a sick society run by psychopaths?” After 35 years of practising medicine, I found myself asking this question. This wasn’t the question I asked at the beginning of my career. I began by asking, “How can I help Jane Jones and Sam Smith?” For decades, I immersed myself in the details of people’s miseries until, gradually, I saw a pattern emerge – an exploitive and heartless system was making people sick, the medical system was blaming them for being sick, and funding agencies were moaning about the cost of caring for the sick. I had wanted to be an agent of health, but I had become an agent of damage control for an utterly damaging social system. In the following essays, I share the information that led me to conclude that human sickness is a product of sick social relationships and human health is a product of healthy social relationships. A profit-driven society needs an ever-expanding medical system to contain the damage it creates. We can do more than debate the best way to contain this damage, we can eliminate it. We can build a health-generating society that provides everyone with the means to a healthy life, including a healthful environment. This is now possible, but the profit-motive stands in the way. Our health, our lives, our environment and our future depend on replacing divide-and-rule capitalism with a cooperative socialist society. This can happen only if the majority organize to fight for it and build it. These essays provide some of the ideas needed for that fight.

"Reducing income inequality in the United States would save as many lives as would be saved by eradicating heart disease or by preventing all deaths from lung cancer, diabetes, motor vehicle crashes, HIV infection, suicide and homicide combined.

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Even greater benefits would flow from eliminating class inequality entirely."

CONTENTS • • • • • • • • • •

Introduction Inequality: The Root Source of Sickness Engels and the WHO Report Mental Illness or Social Sickness? The Myth of Scarcity The US and Canada: Different Forms of Medical Rationing The Fight for Medicare in Canada Assembly-Line Medicine Health Care or Damage Control? The Lessons of Chile

To purchase by personal check, contact the author

Canadian Government "missing in action" at global health meeting Wednesday, October 19, 2011 CACHCA October 19, 2011

The World Conference on Social Determinants of Health got underway today in Rio De Janeiro, Brazil, with visible concern from Canadian and global delegates regarding the absence at the conference of Ministers from Canada's federal government. Over 60 Ministers of Health, including U.S. Secretary of Health and Human Services, Kathleen Sebelius, prioritized participation in the global meeting, deeming it a critical stage on which to demonstrate commitment to local, national and global action in improving health around the world. CACHCA Board Member and lead representative at the Rio conference, Jack McCarthy, described reactions on the ground in Brazil: "There is a clear sense of disappointment and frustration here from Canadian delegates and our global partners that the Government of Canada has turned its back on this global gathering. On the one hand, it is exciting and encouraging to see Ministers of Health gathered from countries around the world, while on the other hand it is very troubling and quite embarrassing that Canada's Minister of Health and her government colleagues are conspicuously absent." McCarthy noted the shared sense of frustration that Canadian delegates at the 228

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conference are dealing with in trying to explain the lack of Ministerial representation on the part of Canada: "Canadian delegates are at a loss for words, quite frankly. Global delegates are inquiring about Canada's absence when our country has, in the past, taken a lead on global cooperation related to action on health, including a critical role in bringing the WHO's Commission on Social Determinants of Health into being. We're left holding the bag, ourselves wondering why our federal government has decided to turn its back on the health of Canadians and on the global community." The three-day world conference got underway this afternoon with addresses from Brazil's President and Minister of Health, the Director-General of the World Health Organization and other leaders who welcomed delegates and declared the conference officially open.

The death panels are already here Wednesday, October 19, 2011 What happens when drug shortages spike? You hope to get lucky, like me By Mary Elizabeth Williams Salon October 17, 2011

Bad news, right-wing nutjobs – it turns out that getting sick is not just a problem for those freeloading, uninsured socialist troublemakers. With drug shortages on the rise – and other countries tightening the reins on treatment coverage – who lives and who doesn’t won’t be determined by politics but by the frightening economics of supply and demand. A piece last month for the Wall Street Journal highlights the problem: Severe shortages of chemotherapy drugs, antibiotics and nutritional supplementation are leading to limited treatments and have caused “hundreds of clinical trials to be stopped.” Drug shortages have tripled in the last six years. And with a new high of 213 different drug shortages this year, patients with life-threatening conditions like high blood pressure, breast cancer, Kaposi’s sarcoma and leukemia have been affected.

Read more HERE.

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Happy Birthday Tommy Douglas! Thursday, October 20, 2011

Tommy Douglas Remembered- CBC Friday, October 28, 2011

Why Healthcare Reform Matters to Occupy Wall Street Sunday, October 30, 2011 By Healthcare-NOW! October 25, 2011 By E.D. Kain for Forbes â&#x20AC;&#x201C;

Nearly every country in the developed world has some form of universal access to health insurance. The glaring exception to this rule is the United States. As a proponent of free markets, I find this to be a glaring failure on the part of American policy makers and business leaders. 230

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So we see Occupy Wall Street rallying for healthcare reform, where healthcare workers ”joined the Occupy Wall Street protesters Sunday to rally for health care reform, and tourists continued to funnel in and out of Zuccotti Park to witness the demonstrations for themselves” featuring ”speakers demanding significant health care reform across the country.” This is a natural and frankly long overdue reaction to the way capitalism works – and doesn’t work – in America. Beyond the inherent humanity of providing services for those who cannot provide them for themselves, the purpose of safety nets is to enable capitalism. Without a mechanism to stabilize the human cost of market failure, public opinion will turn against a market economy. People will clamor for command and control, for stability, for guaranteed wages and price freezes – for disaster, if truth be told. Many would argue that the problem with our system is that it’s not a system of safety nets, but rather a system of entitlements for the middle class. This sort of thinking is basically pity-charity liberalism. The idea that we should slash back all services to simply cover the poor in order to save money may sound good on its face, but the lack of universality makes these poor-only programs politically vulnerable. Medicaid faces the chopping block before Medicare because it is largely a pity-charity program geared toward the poor rather than the broad middle class. Just as importantly, the nature of healthcare costs lends itself to large risk pools. A singlepayer healthcare system works so well because there is one very large risk pool with an enormous amount of bargaining power. You can’t match that bargaining power in a fragmented system like the one we have, comprised of myriad regional insurers with de facto monopolies over their area. Of course, the problems with our healthcare system gouge much deeper than that, and there are many ways you could improve upon the status quo. Some combination of market reforms to loosen up the supply and increase access to providers, coupled with a single-payer insurance framework or even a system of HSA’s and universal catastrophic would be a major leap forward. In any case, the lack of universal access to healthcare in this country actually hampers business. It makes capitalism more risky for workers, and the cost of healthcare weighs down workers and businesses. The economic cost is huge, and makes American firms less competitive and American workers less secure. Occupy Wall Street protesters demanding a change to this abysmal system are right. It’s long past due. As more firms shed benefits – such as Wal-Mart – this issue becomes even more important.

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Pay attention, because medicare is about to change Sunday, October 30, 2011 By Jo-Ann Fellows Daily Gleaner October 18th, 2011

In 2014, the current agreement on medicare between the federal government and the provinces will expire, and a new agreement will be required. Significant amounts of money will be involved, and the shape of our health-care system for the next few years will be determined. There is general agreement in Canada about what the new health-care system should contain. The problem will be in "transforming" our current system to get to the new one. The new system must accommodate the advances continuously being made in medical science. We must move from a "sickness" system, where diseased and injured patients are treated, to a system where keeping people healthy predominates. We must move from a hospital-based, acute-care system, with primary care being delivered in family doctors' offices, to a narrowing of the scope of hospitals and a considerable enlargement of primary care being delivered in the community. This care will be delivered by various agencies, including community care centres, augmented doctors' offices and clinics. As well as making referrals, these organizations will assist the patient in the management of chronic disease, and contribute to encouraging good health. There will be tremendous resistance in making these changes. Hospitals will resist, as well as some physicians. There are many with a vested interest in the current system. Making these changes will take courageous leadership. It would be impossible to over232

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emphasize the political and administrative skills that will be required. We need people to think about the provision of good care first, and their own interests second. The public will have to be alert so that they can assist in this transformation. The amount of money presently being spent, with an adjustment for inflation, is sufficient to pay for the new system. If you are going to add services, then cuts will be required in the old system. The transformation should be revenue neutral. At the moment, the cost of Canada's health-care system as a percent of GDP is higher than that of a number of European countries, and their systems are better than ours. As part of the up-grading of our system, we need a national prescription drug insurance plan, and we should add a dental plan. We need to revolutionize the way we deliver longterm care, and to strengthen home care. A better source of rehabilitation between the hospital and the home is also required. There has always been a gap in our system for this service. Remember that these improvements must be made with current funding provided by both the federal and provincial governments. The new funding from the federal partners is already promised to be increased by six per cent annually, as a result of a promise made by the Conservatives during the recent election campaign. We need a revitalized system. The status quo is not acceptable. Too much funding is going to the wrong things. There is no other way to achieve an accessible, fair, equitable and high quality health-care system. Canadians place great value on their health-care system. The public will have to exert pressure on all the governments to facilitate this decision-making process. Once agreement is reached, it will take a highly skilled and dedicated group of administrators to drive these changes, with support from all the players in the health-care system. Basically, we need to decide on the shape of medicare for the next few years. The federal government has been waiting for the provincial elections to be completed, in order to determine the players in this negotiation. The public should pay close attention to these discussions.

Jo-Ann Fellows is a writer with an interest in health care. She lives in Fredericton.

The subtle contours of the new medicare debate Tuesday, November 01, 2011 By Thomas Walkom Toronto Star Nov 01 2011

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Get set for the next round of fighting over medicare. The battle lines will become clearer as we approach the 2014 date when Ottawa has to renegotiate its health deals with the provinces. But the contours are already emerging. First, expect a more subtle dispute. In the past, Canadian medicare battles have been waged over the Canada Health Act, the federal law that effectively bans private funding of most physician and hospital services. Ten years ago, anti-medicare forces argued that Canada’s health-care system just wasn’t working and that only the addition of a second, private tier of medicine — funded through private insurance — would solve the problems. This time, expect most critics to pay at least lip service to the Canada Health Act. In part, that’s because Canadians are viscerally attached to medicare and will reject anything that sounds like U.S.-style medicine. Even Prime Minister Stephen Harper, at one point a rock-ribbed opponent of universal medicare, now lauds the Canada Health Act But in part, the change has occurred because most analysts now accept that two-tier medicine doesn’t save any money overall and, indeed, usually costs more. As economists Don Drummond and Derek Burleton wrote in a TD Bank study last year, adding a private tier simply shifts the cost of health care from people’s taxes to their wallets. This time around, the debate promises to focus more narrowly on so-called market reforms. With provincial governments pleading poverty, the fight will centre on whether governments should try to raise more revenue for health care or cut costs. The revenue-raisers are, in general, a modern version of the old user-fee crowd who argue that patients should pay an out-of-pocket price every time they see a doctor. Most studies show that user fees don’t work, but the idea persists. The more modern version is to have individual patients pay for a portion of their treatment through special income tax levies. That’s what Drummond and Burleton suggest and what Quebec Premier Jean Charest tried last year before public opposition forced him to back down.

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The cost-cutters are a disparate group. Drummond and Burleton resurrect the idea of having provincial governments use their combined buying power to winkle better deals from multinational drug firms. That’s a valid idea but it usually falters when the drug companies threaten to pull their investments. Toronto physician and consultant Michael Rachlis has long argued that better organization significantly lowers health-care costs. A paper released this week by the University of Toronto’s Mowat Institute expands on this theme. Written by Will Falk, Matthew Mendelsohn and Josh Hjartarson, it makes the point that even when such change occurs, health-care pricing has not kept up. Factory-style methods of surgery in areas like cataract treatment, for instance, allow physicians to process far more patients than they could a decade ago. Because doctors are paid a fixed, per-procedure rate, this has boosted their incomes dramatically. The Mowat paper argues that such physicians should get less pay. How exactly this would happen is unclear. The Mowat paper hints at introducing market mechanisms such as auctions into the system. Britain did something similar when it required doctors and hospitals in its public National Health Service to form trusts that competed with one another and with private health firms. Critics in that country say these changes are paving the way for full-scale privatization of British medicare. But in Canada, there has been little discussion so far of what happens when faux markets are created in health care. As things heat up, expect more.

2014 Health Care Accord action preparations Tuesday, November 01, 2011 Council of Canadians November 1, 2011 The Council of Canadians, with pro-public health care allies, is organizing a citizens’ agenda and rally in Halifax, Nova Scotia when the provincial and territorial health ministers will be meeting to discuss the 2014 health care accord, November 24th-25th. PRESS CONFERENCEon the need to protect, strengthen, and extend Medicare. WHEN: November 24th, at 10:00am. WHERE: Location to be announced. Featuring: • Council of Canadians Chairperson, Maude Barlow • Canadian Health Coalition National Coordinator, Michael McBane • Nova Scotia Citizen’s Health Care Network (NSCHCN) Chair, Kyle Buott • Canadian Federation of Nurses Union President, Linda Silas • CAW President, Ken Lewenza • CLC President, Ken Georgetti PUBLIC FORUMon the next health care accord WHEN: November 24th, 6:30pm. WHERE: Saint Andrews Church (corner of Robie & Medicare's 50th Anniversary

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Cobourg, Halifax) The event, co-hosted by the Council of Canadians and the NSCHCN, will feature a keynote address by Maude Barlow, Chair of the Council of Canadians, followed by short presentations on innovation in the public health care system by health care workers Linda Silas, CFNU and Elizabeth Ballaston, Chairperson of the Health Professionals Secretariat. The remainder of the evening will focus on the creation of a 2014 Citizensâ&#x20AC;&#x2122; Agenda where Nova Scotians will advocate for what they want in the next health care accord. RALLYto protect public health care WHEN: November 25th, 12pm. WHERE: Victoria Park (Spring Garden Rd and South St) The rally will take place across the street from the Health Ministersâ&#x20AC;&#x2122; meeting. The rally will be to support the call to protect, strengthen and extend Medicare in the 2014 health care accord. For More Information: Adrienne Silnicki, Health Campaigner, Council of Canadians, 902.422.7811, asilnicki@canadians.org Dylan Penner, Media Officer, Council of Canadians, 613.795.8685, dpenner@canadians.org Twitter: @CouncilOfCDNs, #2014HealthAccord

Health as if everybody counted blog Sunday, November 13, 2011 CHC Check out the new Health as if everybody counted Blog. The Blog is written by Ted Schrecker, a population health researcher with the University of Ottawa.

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Federal health funding promise ends - for now Monday, November 14, 2011 By Doug Allan Leftwords November 14, 2011

Federal Finance Minster Jim Flaherty has indicated that there is no promise to increase the Canada Health Transfer (CHT) to the provinces by 6% per year beyond the first two years after the ten year accord expires in 2014. The public won the promise for the two years during the election -- but that's where it ends, for now. More bad news: the Globe and Mail reports that newly re-elected Saskatchewan premier Brad Wall wants to tie federal funding 'to health care "innovation," a term sometimes used to describe increased private-sector involvement.' Wall wants to create more conditions for his province to receive federal funding, it seems. Meanwhile, the federal government doesn't much bother to ensure that (in exchange for federal funding) the provinces stick to the five principles of the Canada Health Act that guarantee universal, comprehensive, accessible, portable, and publicly administered health care.

The health-care sky is not falling ! Monday, November 14, 2011 By Dr. Michael Rachlis Toronto Star November 11, 2011

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Last week, the Canadian Institute for Health Information (CIHI) released the latest figures on the country’s health spending. It provides a cool analytic antidote to a heated political issue. Health costs are not out of control. And the report’s findings remind us that the real issues have little to do with money. Almost every day some politician or pundit declares that provincial health-care spending is massively out of control, eroding government’s ability to fund everything else. Our roads are full of potholes, our kids can’t do long division, and it’s all the fault of a rapacious health-care system. Several reports have suggested that health spending will inexorably rise to 70 or even 80 per cent of provincial government program spending in the next 10 to 20 years. The CIHI graph of provincial health-care spending over time draws a very different picture from that portrayed in our public debate. Health spending was fairly steady at 33 per cent of program spending during the early and mid-1990s. After 1997, it rose rapidly to 39 per cent of program spending in 2003 before plateauing there until 2008. It has been falling since. Provincial health-care costs decreased from 39.3 per cent of program spending in 2008 to 37.7 per cent in 2010. In Ontario, the decrease was even more startling, from 45.5 to 40 per cent. Of course, governments increased non-health-care spending during the recession as welfare, employment insurance and other costs rose. But CIHI forecasts provincial health-care spending will fall this year as a share of GDP from 7.8 per cent to 7.5 per cent. It would be nice if those who spew fire and brimstone about rocketing health costs would read the annual CIHI reports. Then maybe we could get onto the three big issues that get little or no media attention. First, we don’t have to spend a lot more money to the fix the system. Most of health care’s problems — from long wait times to inadequate follow-up of chronic illness — are due to antiquated, provider-focused processes of care. The remedy — a high-performing, patient-friendly system. And, contrary to the ill-informed Canadian chin-wag consensus, this shouldn’t mean higher costs. To quote the 2001 Saskatchewan health-care royal commission, “better quality care almost always costs less.” For example the referral route from family physicians to specialists has not changed fundamentally since the professional model was created during the Middle Ages. In Canada you can wait months to see a spinal surgeon. But 90 per cent of patients referred to Ontario spinal surgeons don’t need to have surgery. They may need physical 238

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therapies, medication, counselling or acupuncture. But they don’t need surgery and very few of them should even be seeing surgeons. The solution? In Hamilton, 20 psychiatrists are working part-time with more than 100 family doctors, 80 mental health counsellors and dozens of other professionals. Urgent questions for the psychiatrists are answered immediately by cellphone. The psychiatrists also drop into the family practices every week or two where they see patients directly, discuss other cases with staff, and generally raise the already high standards of mental health delivery. It’s well past time to change the practices of other Canadian specialists. All medical specialists and their teams should be working more closely with primary health-care practices. No Canadian should wait longer than a week for elective specialist input into her case. Second, we should be spending more public money if it remedies private market failures. Justice Emmett Hall’s 1964 royal commission recommended public insurance for physicians because it would cover everyone and cost millions less to administer than a private system. The same argument holds for drugs, long-term care and home care. Finally, we need to resuscitate our shrinking public sector. Health care increased its share of the public pie from 1997 to 2008 largely because government cut the size of the pie by axing other programs. The feds eliminated the National Housing Program in 1993 and Ontario social assistance recipients have seen their inflation-adjusted incomes fall by 40 per cent since 1995. These policy debacles have made a lot of people sick and applied pressure to hospitals and other health-care organizations. According to the latest figures from the Department of Finance, from 2000 to 2010 Canadian governments cut their incomes by 5.8 per cent of GDP, the equivalent of $94 billion. If we had cut taxes by only half that amount, all governments could be out of deficit by 2012. Or we could afford to pay for first-dollar universal pharmacare, long-term care and home care, as well as regulated child care for all parents who want it, free university and college tuition, 20,000 new social housing units a year, and a hike in the Canadian Child Tax Benefit to $5,000 per child. Our health-care system is affordable. To make it sustainable, we need to complete Tommy Douglas’s vision for medicare by changing the way we deliver health services. Let’s set aside the shroud-waving about rising costs and refocus on redesigning the delivery system. Medicare remains as sustainable as we want it to be.

Dr. Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.

National Health Insurance vs. Public Health Insurance - 1953 Tuesday, November 15, 2011 Medicare: A People's Issue The Health Services Review, Dec 1953. Published by the State Hospital and Medical

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League (Regina, Saskatchewan) urging more action on establishing public medicare.

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Why Canadians Should Fear Two-Tier Tuesday, November 15, 2011 By Brianne Kirkpatrick Public Policy and Governance Review November 10, 2011

Over the past few months we, as a city, a province, a state, and a people, have been distracted. We have been busied by an economic crisis. Keeping up with Rob Fordâ&#x20AC;&#x2122;s vision for Toronto. Swept up in the largest social movement our generation has seen in support of Occupy Wall Street. But there are other interests at work and other dialogues to which to listen. 240

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Health care, I argue, is an issue deserving constant vigilance. To look away from it for a moment is to relinquish that moment to another interested party – one that, if left unchecked, could seriously damage the quality of health care we receive in this country. Universal health care is a symbol of Canada, both to its citizens and to its global audience. ‘Universal’ is an assumption that has become natural to Canadians. But what does universal really mean? How is the Canadian health care system universal? The answer to my former question is obvious to most. Universal could mean that everyone has equal access to health care in Canada, no matter their resources. Why is it a good thing? Because people who wouldn’t be able to afford health care have access to quality care. And to quote the common phrase, without our health, we have nothing. The latter question is slightly more complicated to answer. First, let me take issue with the title, “Canadian health care system.” Discourse around the Canadian health care system is misleading. It is not so much ‘Canadian’ as it is a series of 10 provincial systems. There is no real national standard, nor the political will to formulate such at present. The Canada Health Act is vague. Violations go unfound and unpunished. If you consider that there are at least 49 surgical clinics selling medically necessary services in Alberta and BC combined[1], the ‘wild west of health care’ seems an apt name. So how is the Canadian health care system universal? It simply isn’t[G1] when you consider the health care alternatives that do not meet the strict definition of equal access. The number of private health care businesses has been growing in Canada since the 1990s, including a private for-profit surgical and diagnostic industry that emerged in the early 2000s.[2] In addition, more and more Canadians are turning to Complementary and Alternative health care, amounting to a 2006 estimate of $5.6 billion spent out-of-pocket on visits to providers of alternative medicine[3]. Enough Canadians seem to have formed opinions from pop culture, ie. Denzel’s 2002 performance in John Q, or heard cringe-worthy stats (like while the U.S. spends nearly twice as much per person on health care as Canada, more than 45 million people have no health care coverage at all[4]) to put the argument for privatized health care on a shelf. Enough Canadians, but not all. Terence Corcoran, in his October 4th article, “Nurse, Get Me An Entrepreneur”[5] presents a purely ideological argument for privatized health. In Corcoran’s world, health care is ‘socialized’, doctors are ‘victims’ and facts are absent. Privatize health care and the entrepreneurs will flock to innovate, says Corcoran. Set aside your bleeding heart moral argument and accept that the health industry is just like any other business – open-market competition will make it thrive. Aside from explaining to Corcoran that innovation does exist in public health care[6], I would point out that in a competition, someone always wins while someone else is sure to lose. How does this make sense for our health? Is it acceptable for a clinic to happily count its monies at the expense of patients suffering down the street? When it comes to health, it shouldn’t be business – it should be personal. It’s the well-being of our families, our communities, our population. Collaboration, not competition, is the key to healthy innovation to be shared by all. But the Corcorans of Canada remain heard. And perhaps it is the polite Canadian in all of us who listens, and the most generous of all whom offers an ‘institutionalized Medicare's 50th Anniversary

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ambivalent’[7]compromise: let two-tiered health care be the solution. Those who seek to privatize argue that this ‘compromise’ frees up resources in public health care. That opening the system up to more private funding is the only way to remedy escalating costs of care. Those in favour of public health care may agree or disagree. But most may not be equipped to debunk the fallacy. It certainly can sound appealing to let Canadians who can afford to pay, pay, and allow those who cannot pay to reap the benefits of a lightened public system. But reality doesn’t work that way[8]. To begin, it is unlikely that throngs of wealthy Canadians will race to shell out cash for the same service they could get for free publicly. Further, the private tier would take a disproportionate amount of resources out of the public system to provide faster service, pushing the public system to service almost the same number of patients with far less resources. Finally, we must remember that private health services are highly dependent on employer-sponsored benefit packages, which are subsidized with almost $3 billion in taxpayer money each year[9]. In other words, private investment does not get taxpayers off the hook for healthcare funding[G2] . A compromising compromise indeed. It can also sound appealing to increase private investment in our system. Again, I question how private investment, which comes strapped to single-minded focus on producing a return for investors, makes sense for the health care industry. If the current trends were to continue, private health care business would open up in urban, densely populated areas, cherry-pick the ideal patient (read – ignore difficult patients who need care the most), and sell services patients may not need[G3] . In Andrew Coyne’s recent talk, “Why we [the media] always get it wrong”, he lamented our reliance on the United States for policy learning and suggested looking elsewhere. I couldn’t agree with Mr. Coyne more. Australia, for example, has many lessons to teach, having expanded private health insurance in the same way Canada often considers. Now we can observe how Australian patients are struggling with longer public wait lists, higher overall costs, and unequal access to care[10] – but can we learn? In the UK, attempts to create a market for primary health care via private financing initiatives (what this side of the Atlantic terms “public-private partnerships”) shifted power away from government and practitioners alike[11] and have ultimately been a deemed a failure. Instead of infusing more money and resources into the system, PFI-funded facilities had less capacity and were subject to overly expensive contracts, among other ills[12]. As of September 2011, 12 million patients were threatened as 60 hospitals teetered on the brink of financial collapse due to costly PFI schemes[13]. But at least the UK is open and honest about their two-tiered system. In Canada we have preferred to ignore the twenty-year trend, and with a lack of admission comes a lack of research, knowledge, and regulation; a lack of regulation that may be responsible for the recent infection alert at a ‘non hospital’ (read- likely private) clinic – an embarrassment that made the BBC headlines[14]. It is time to reach a consensus that universal health care is not a result of bleeding heart voters and purely ‘socialized’ medicine. Universal health care is the best system to provide quality health care for all in both an economic and social sense. But it needs government support through policy and practice. The bad news: the Federal Cash Transfer Program, in its current state, offers little recourse for direct violations of and loopholes found in the Canada Health Act. But the good news is that the two-tier trend is 242

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recent and thus reversible. Thus, in solution-speak I observe a crucial need for strict, federal standards regarding our not-so-universal health care system; robust regulation to protect our system from the problems plaguing our commonwealth comrades in Australia and the UK; a level of care to which provinces should be compelled to reach. And to the screaming provinces I say…relax. Relâchez. Smart, protective health care regulation is not interference – it is leadership. It is your health and mine. And we can no longer afford to be distracted.

Brianne Kirkpatrick is a candidate for the 2013 Master of Public Policy from the School of Public Policy and Governance at the University of Toronto. Her primary research interest concerns bridging the gap between conventional and complementary and alternative medicine. _____________________________________________________ [1] Mehra, Nathalie. Eroding Public Medicare: Lessons and Consequences of For-Profit Health Care Across Canada. Canadian Doctors for Medicare. P. 43. [2] Mehra, Nathalie. Eroding Public Medicare: Lessons and Consequences of For-Profit Health Care Across Canada. Canadian Doctors for Medicare. P. 14. [3] Esmail, Nadeem. “Complementary and Alternative Medicine in Canada: Trends in Use and Public Attitudes, 1997-2006.” Vancouver, BC, Canada: Fraser Institute, 2007. P.4. [4] Council of Canadians. “Protecting Public Health Care.” Viewed October 22 at [5] Article viewed October 4th, 2011 at [6] Ontario Hostpital Association. (2006). Inspiring health care innovation: Policy ideas for ontario’s health care system. Toronto, ON, Canada: Ontario Hospital Association. [7] Tuohy, Carolyn. Policy and Politics in Canada. Philadelphia: Temple University Press, 1992. [8] Canadian Doctors for Medicare. Bottom 10: Practices to Avoid in Health Care Transformation. P. 2. [9] Canadian Doctors for Medicare. Bottom 10: Practices to Avoid in Health Care Transformation. P. 2. [10] Shrybman, Steven. “Defending Medicare: A Guide to Canadian Law and Regulation.” Cupe. 2008. P. 10. [11] Miller, Emma et al. “The Market for Primary Care.” BMJ. Vol. 35, No. 7618. September 8, 2007. Pp. 475-477. [12] Atun, Rifat A and Martin McKee. Is the Private Finance Initiative Dead? BMJ. Vol. 331, No. 7520. October 8, 2005. Pp. 792-793. [13] NHS hospitals ‘crippled’ by PFI Scheme. Viewed October 28, 2011 at < Medicare's 50th Anniversary

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http://www.telegraph.co.uk/health/healthnews/8780363/NHS-hospitals-crippled-by-PFIscheme.html> [14] Canada Clinic Infection Alert. Viewed October http://www.bbc.co.uk/news/world-us-canada-15343972.

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[G1]When you consider health care alternatives that do not meet the strict definition of equal access. [G2]The current approach is for employers to look for ways to reduce these benefit costs ie., pensions [G3]This occurs with public system given that specialized health care will be found in major urban centers. You can still form an argument that public system is better prepared to address the distance health care challenge.

Health care activists gather in Halifax for meeting of health minis... Tuesday, November 22, 2011 NUPGE News November 22, 2011

When provincial and territorial health ministers meet in Halifax, Nova Scotia this week to discuss the upcoming federal health accord, they will be greeted by community and labour activists with a clear message about what should take place in this round of negotiations. The federal health accord expires in 2014 but discussions across the country have already begun. Government's have been sounding the alarm saying that health care is unaffordable, yet at every turn they provide corporate tax cuts thus reducing government revenue.The National Union of Public and General Employees (NUPGE) has produced Here they go again, a pamphlet which spells out how the federal transfers work and why investment is needed. 244

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To further demonstrate that there are better choices than to cut programs and services or reduce funding, the Canadian Health Professionals Secretariat (CHPS), a national advocacy body representing 70,000 unionized professionals who deliver the diagnostic, clinical, rehabilitation and preventive services that are essential to timely and quality care, will be meeting in Halifax on Nov. 24 and 25, to coincide with the ministers' meetings. CHPS is working with local and national organizations to ensure a strong presence in the city to pressure the ministers to maintain their commitments to the Health Accord and invest further in Canada's universal health care instead of walking away from their responsibilities. On Nov. 24, health care experts will host a public town hall meeting to highlight many of the health care innovations and will provide an opportunity for the public to develop its own priorities for this round of federal/provincial/territorial negotiations. The next day, Nov. 25, a noon-time rally will be held in Victoria Park (corner of Spring Garden Rd. and South Park St.) to demonstrate to the ministers that public health remains a high priority for Canadians. According to James Clancy, NUPGE President "the principle of these transfers is that every Canadian should have equal access to services regardless of where they live. This promise of universal health care and social and public services defines our society." "We need to work together to force them to put people before tax cuts and excessive corporate profits. We need to invest more money to keep that most prized jewel of Canadians â&#x20AC;&#x201D; Medicare â&#x20AC;&#x201D; strong." More information: Here they go again: Less sharing, more inequality Event information: 2014 Health Accord

New Nanos Poll: Canadians want more federal investment in health care Thursday, November 24, 2011 NUPGE News November 23, 2011 As Canadaâ&#x20AC;&#x2122;s Ministers of Health prepare to meet in Halifax a new Nanos poll finds nearly 90% of Canadians want to see the Harper government invest more in health care with a focus on the recruitment of health care professionals.

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A poll conducted by Nanos Research on behalf of the National Union of Public and General Employees (NUPGE) and the Canadian Health Professionals Secretariat (CHPS) finds Canadians want the Harper government to invest more in health care and address shortages of health professionals. “The poll shows Canadians still see health care as their first priority and want the Harper government to invest more in the system,” said NUPGE’s National President James Clancy. “Corporate tax cuts are not a priority for Canadians, funding their health care system is.” “More than 88% polled Agree or Somewhat Agree that the federal government should invest more in health care with strong support for either a five year or 10 year federal funding agreement for the next health accord.” Canadians also felt a greater investment was needed to recruit more health professionals. “People understand that timely and quality health care delivery requires an adequate supply of skilled health professionals,” said CHPS co-chair Mike Luff. “They ranked the recruitment of health professionals as their top priority and it's a clear sign that they don't believe governments are doing enough in this area.” Clancy hopes the Harper government listens to the wishes of Canadians when it comes to supporting health care. “Canadians value their public health care system. They want to see the federal government invest more and improve the public system we have.” The random telephone survey of 1,202 Canadians 18 years of age or older was conducted between November 16th and 21st. The margin of error for a survey of 1,202 respondents is plus or minus 2.8 percentage points, 19 times out of 20.

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How Sustainable is Medicare? Thursday, November 24, 2011 CCPA September 2007 A Closer Look at Aging, Technology and Other Cost Drivers in Canada’s Health Care System By Marc Lee There is little to suggest that health care costs will spiral out of control as Canada’s population ages, says a new study released today by the Canadian Centre for Policy Alternatives. The study, by CCPA-BC Senior Economist Marc Lee, finds that population aging is only a small contributor to rising health care costs, and that the system can be maintained and even enhanced without breaking the bank. “There is no demographic time bomb waiting to go off in our health care system,” says Lee. The study finds that: • Over the past decade, the impact of population aging on health care spending was only 0.8% per year. • To keep current service levels and accommodate for future population growth, aging, and inflation, health care expenditures must rise by 4.4% per year. This is very affordable in the context of reasonable economic growth. • If economic growth rates in the future are consistent with those over the past decade, health care spending as a share of the economy (GDP) will actually fall over the next 50 years. • By dedicating the same proportion of new economic output to health care, not only will there be enough money to pay for existing services (even after population growth, aging and inflation), there will still be enough for modest expansion of services. “The real challenge for future health care expenditures comes not from an aging population but the costs associated with new health technologies, such as new surgical techniques, diagnostics, prescription drugs, and end-of-life interventions” Lee says. “We’ll have to decide how to weigh the benefits of new innovations against their costs. And those decisions are best made in the context of a public system.”

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Click image above for PDF

Support for public health care soars Thursday, November 24, 2011 Canadian News Wire November 24, 2011

An overwhelming 94-percent of Canadians support public - not private, for-profit solutions to making the country's healthcare system stronger - with an equal number of Conservatives flying the banner for public health care.

A new poll conducted by Nanos Research, released on the eve of National Medicare Week (Nov. 27- Dec. 3), revealed the soaring Canada-wide support, up nearly 10-percent from a similar poll conducted a little over a year ago. Support has risen to a record 94percent, from a strong showing in August 2010 of 86-percent, underlining that more than nine in ten Canadians support public solutions to making public healthcare stronger. "There are two issues at play here," Nik Nanos, President of Nanos Research, noted. "First, healthcare continues to be a top issue of national concern for Canadians. The second point is that right across the board, regardless of political affiliation or other demographics, support for public solutions in health care has increased over the past three years." The new poll was commissioned on behalf of the Canadian Health Coalition (CHC) and surveyed 1,202 Canadians between Oct. 20 and 24, 2011. The results are considered 248

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accurate within 2.8 percentage points, 19 times out of 20. The results were good news for the CHC, a national organization that advocates for the protection and expansion of Canada's public health system, who said the polling results should serve as a loud wake up call to the Harper government. "Canadians are looking for federal leadership to protect and improve the public health care system," said Michael McBane, national coordinator of the CHC. "With the 2004 Health Accord up for renewal in 2014, the federal government needs to work with provinces and territories to make healthcare - and a renewed 10-year plan - a top priority. The current government's lack of leadership, combined with a history of abdicating its federal healthcare responsibilities along with its penchant for turning its back on enforcing national standards and compliance with the Canada Health Act are all causes for concern," said McBane. As a result, the CHC will be carrying its message to 100 parliamentarians on December 1, seeking their support to protect and improve Medicare. As well, the CHC has planned an evening symposium for Nov. 30. Secure the Future of Medicare: A Call to Care will feature keynote speaker Roy Romanow, chair of the Commission on the Future of Health Care in Canada, Andre Picard, senior health reporter and others who will discuss the future of Medicare in Canada.

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Arguments for state medicine in Saskatchewan (1943) Thursday, November 24, 2011 Petition for Rights and a Bill of Health By the State Hospital and Medical League Prince Albert, Saskatchewan 1943

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Published and presented just before the election of Tommy Douglas's CCF in 1944.

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Advocates call for higher taxes to pay for health care Thursday, November 24, 2011 CTVNews.ca Thu Nov. 24 2011

The federal government needs to increase its funding to the provinces to pay for health care programs, and they should raise taxes to do it, a group of medicare advocates is telling the country's health ministers meeting in Halifax. Maude Barlow of the Council of Canadians says the federal government should commit to a 10-year health transfer plan with the provinces that would see a six per cent increase in funding annually. "At the moment, the Harper government is only committed to 2016, so we are very concerned that they have no intention of carrying it beyond that," Barlow told a news conference Thursday. Barlow added that the Canada Health Act must be better enforced so that it's used to stop private health care services from eroding the system. Barlow also wants to see health care coverage include dental care, pharmacare and continuing care. The ministers are meeting in Halifax to discuss how to reform and pay for health care after the current health care accord expires in 2014. Federal Health Minister Leona Aglukkaq will join the ministers on Friday evening. The federal government is currently providing $27 billion to the provinces this fiscal year for health care. That amount is slated to rise six per cent a year for the next four years.

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But the provinces provide the bulk of the funding -- often at the expense of other programs and their general fiscal health. This week's meeting is considered an early step in the health care spending decisionmaking process. Talks will continue next month among provincial and territorial finance ministers and culminate with a gathering of premiers in January. The talks come as the federal government looks to cut spending across a number of ministries -- and at time of growing concern about the rapidly rising costs of health care.

The dangerous myths about medicare Friday, November 25, 2011 By Thomas Walkom Toronto Star November 25, 2011

With medicare talks underway again, two pervasive health-care myths need be cleared up and one warning given. First, medicare isn’t about to be bankrupted by the elderly. That’s a common misconception, spurred by the fact that baby boomers — those born between 1946 and 1964 — are nearing retirement. In both political and media arenas, this particular myth is treated as unshakeable truth, creating fears that doddering boomers will monopolize virtually all health-care dollars. But as figures released this month by the Canadian Institute for Health Information (CIHI) demonstrate, such fears are grossly exaggerated. The government-funded agency calculates that the aging population has only a “modest” effect on medicare spending — in large part because, thanks to social programs like old age security, Canadians over 65 are healthier than they used to be. Indeed, as with most people, the most expensive medical care in an elderly person’s life usually occurs just before the point of death.

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The institute doesn’t dismiss out of hand the role of aging. It just points out that other things — such as wages paid doctors and overall population growth — are far more important in determining health-care costs. Second, medicare costs in general aren’t spinning out of control. This is an even more pervasive media myth, spurred on by doomsayers who argue that health-care spending, if unchecked, will soon consume entire provincial budgets. In part, this misconception results from the fallacy of extrapolation — the assumption that past trends must inevitably continue. It reminds me of a prediction, made before the invention of the rotary dial phone, that by 1960 all North American women would be working as switchboard operators. That turned out to be false. As physician and consultant Michael Rachlis pointed out in this newspaper, so has the myth of the voracious health budget. The CIHI report explains why. It notes that governments cut back health-care spending growth severely during the recession of the early 1990s, then — because of public pressure — reversed themselves later on. As a result, provincial government health spending did accelerate. But by 2003 the growth rate had levelled off. In the last two years, it has slightly declined. All of this is important because governments now are starting to debate — again — what to do with medicare. The current federal-provincial deal on cost-sharing expires in 2014. A meeting of health ministers in Halifax on Friday officially marked the beginning of the next round of negotiations. Last time, the focus was on reducing wait times and restoring services that deficitburdened governments had slashed during the ‘90s. This time, if the Ontario is any indication, governments are likely to focus on systemic reforms that allow them to save money. So here’s the warning. No government is likely to attack medicare head on. They’ve learned that this is political suicide. But as Don Drummond, an influential economist charged with recommending ways for Ontario to save health dollars, noted in a recent report for the Conference Board, the laws regulating medicare are remarkably flexible. They do permit, for instance, the private delivery of publicly funded health services. Most physicians are already private entrepreneurs. My guess is that governments will be looking at ways to privatize even more — from hospitals to specialty clinics — all within the medicare umbrella. In theory, this could work out. Or, as in Britain today, it could undermine the very nature of the public health-care system. The devil will be in the details. If you care about 252

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medicare, this is a good time to start paying attention.

Medicare gets a rough ride in Regina (CBC 1962) Friday, November 25, 2011 CBC Broadcast Date: July 11, 1962 On July 11, the doctors strike peaks. Media reports talk of possible violence and leaders on both sides call for calm. Medicare opponents from around Saskatchewan gather at the provincial legislature in Regina, including some with lynched effigies of Premier Lloyd and Tommy Douglas. Crowd estimates vary from 10,000, as claimed by the rally's organizers, to one government official's claim that he could get more people out to a picnic. Police put the number at around 4,000.

ClickHEREto view. Select video 6.

2,550 bankruptcies filed daily in US because of unpaid medical bills Friday, November 25, 2011 MyPeace TV In fact,one recent survey estimated that 72 million,or 41 percent,of nonelderly adults have accumulated medical debt or had difficulty paying medical bills in the past year.A full 61 percent of those with difficulty were policyholders with ridulous copays/deductibles. 75% of people who have filed for bankruptcy due to unpaid bills were in fact underinsured. Because we have managed to match last years bankruptcies filings (in just 8 months) 2550 people daily file for bankruptcy.These stats are based on reports filed U.S. Department of Health and Human Services report, â&#x20AC;&#x153;Insurance Insecurity: 9/16/09

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Find more videos like this on MyPeace.TV

UK: The abolition of the NHS. That’s what is happening. Friday, November 25, 2011 Allyson Pollock and David Price Our Kingdom 24 November 2011 In a speech on exports and growth on 10th November 2011, David Cameron went “offscript” and revealed his government’s true agenda for the NHS. Standing in front of a Union Jack banner and the slogan “START UP BRITAIN” the Prime Minister told his audience of small and medium enterprise people at the BFI on London’s South Bank: “We have a growth review, led by the Chancellor and the business secretary, which ensures that every minister has to come to the table with proposals to cut regulation in their departments and come up with ways of helping business in their sector, helping them to grow.” Then he said: “From the Health Secretary, I don’t just want to know about waiting times. I want to know how we drive the NHS to be a fantastic business for Britain.”

He really said that. It’s here on video: “I want to know how we drive the NHS to be a fantastic business for Britain.” That same week Hinchingbrooke Hospital became the first NHS Hospital to be franchised to a large for profit health care company — Circle. The NHS is already big business and some of the costs are there for everyone to see. (Much is hidden). The NHS is haemorrhaging public funds to hundreds of companies through a range of services, legal, accountancy, catering cleaning, PFI and health care. For the last two decades government policy has been to divert billions of pounds of NHS spending to for-profit corporations, including the multi billion pound PFI debt programme. Inflation-proofed PFI payments absorb around 15 per cent of hospitals’ budgets and the figure is rising. No wonder facilities must close, staff are being sacked and patients turned away. These sources of profit have not always existed. Viewing the English NHS and other European health systems as unopened oysters of profitable opportunity, corporations in the USA and Europe have worked long and lobbied hard to open public health care systems to the market. Ten years ago, the United States trade delegation put it like this: “the US is of the view that commercial opportunities exist along the entire spectrum of health and social care 254

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facilities, including hospitals, outpatients, clinics, nursing homes, assisted living arrangements, and services provided in the home.” Today market predators want more than NHS funds. Claiming, as they have always done, that buying from them will save public money, corporations now want the concession to charge and sell private health care to NHS patients and introduce charges for health care and private health insurance.

Politicians have offered no answer to the patient protests and ‘save our hospital’ campaigns that commercialization has generated so far. Protest will escalate as the new policy hits home. So, just as Europe’s bankers have got a technocrat to destroy Greece’s public sector, including its national health service, English politicians are distancing themselves from the fall-out from NHS privatizations by vesting responsibility in a handsoff board. Commercial interests and right wing ideology lie behind the Health and Social Care Bill (the “secretary of state Abdication Bill” as David Owen, a former health minister, calls it). The Bill abolishes the Secretary of State’s duty to provide comprehensive health care and dismantles the bodies created to deliver it. In their place it introduces the structures and systems of patient and service selection and patient charges. Not patient choice but choice of patient will be the order of the day. All of this is unpacked in a series of briefings for the Lords by health professionals. In a two-pronged approach, public health services are transferred from the NHS to local authorities with the functions of both so poorly defined as to bring utter confusion to patients’ and citizens’ rights. The scene is set for a re-run of the transfer in the 1990s of long-term care responsibilities to councils when funding was privatized through means testing and charges. Worse: it’s returning to pre-1948. Not everyone will be covered for all services in the new “NHS”. The government has gone to great lengths to ensure that the newly created commissioners of NHS services (the so-called clinical commissioning groups, CCGs) do not have responsibility for comprehensive care for all residents in one geographical area. Instead the commissioning groups will able to recruit patients from GP lists across the country. This is not patient choice. It is commissioning groups choosing patients and purchasing what the commissioning groups deem to be the appropriate NHS cover. Selection will be the name of the game.

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David Nicholson, chief executive of the NHS Commissioning Board, made this absolutely clear when he advised patients to shop around across the country for their GPs based on the range of services offered. (See briefing number 4: clauses 3, 4, 6 & 7). Clever informed middle class patients may be able to shop around for the best choice of health plans and services, just as some now do for utilities. But there is no guarantee of success, as anyone who tries to navigate electricity, gas, telecom and rail providers know. And try making a complaint! The information is too dense and complex, and the costs too high for the average person to understand what is on offer from complex health care packages. Patient choice is the great con. Patients wonâ&#x20AC;&#x2122;t choose. They will be chosen on the basis of their risk profile. Many of the health care companies now active in the UK manage financial risk by placing time limits on care, introducing cost deductibles, copayments and restrictions on the number of GP visits, hospitals visits, operations. All are commonplace in private health insurance. They are the spectre of what is to come if the Health and Social Care Bill is passed. The only hope is the House of Lords. So far peers have signalled general dissatisfaction with ill-specified transfers of fundamental ministerial powers. Lords Owen and Hennessy tabled an amendment that made precisely this point and although it was defeated it helped put other peers on notice that forensic examination of the Bill was needed on constitutional grounds. With all party agreement on 3rd November the House of Lords agreed that Clause 1, which sets out the duties of the Secretary of State, would be paused and taken off the floor of the house for further deliberation until the Bill returns to the House at the Report stage. It is Clause 1 that severs the duties of the secretary of state to his people to provide and secure comprehensive care. (See our briefing here). Clauses 4, 6, 7, and 10 give extraordinary discretion to the new corporations with powers to select patients and services. The next few weeks are critical for the Lords. It is up to health professionals and the medical colleges to help them unpack the Bill and follow the amendments as the Lord scrutinize and debate the Bill clause-by-clause through the committee stage. Peers are taking this Bill seriously and giving it the scrutiny that the coalitionâ&#x20AC;&#x2122;s majority prevented in the Commons.

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The NHS will be abolished if the Bill is passed in the Spring. Were that to happen our immediate task would be to draft a short bill to restore it. The briefings show that the structures and functions crucial to protecting our comprehensive health care system are being systematically dismantled. The analysis goes to the heart of what is needed to restore the NHS and it goes to the heart of the governmentâ&#x20AC;&#x2122;s lack of candour about the true purpose of its reforms.

About the authorsDavid Price is a senior research fellow at Queen Mary, University of London.Allyson Pollock is professor of public health policy and research at Queen Mary, University of London and the author of NHS plc, on the privatisation of our health care under New Labour.

Tommy's Heirloom: A backgrounder and screenplay Sunday, November 27, 2011 MEDICARE AS POLICY: Context for Tommyâ&#x20AC;&#x2122;s Heirloom

This essay surveys the story of how medicare legislation was developed for the province of Saskatchewan and took effect on July 1st, 1962. Through the case study of Saskatchewan medicare legislation, a screenplay [by Stephanie Gan] complementary to this essay develops the following more general themes: the process of policy development and the roles played by politicians, experts and civil servants; the nature of good policy; medicare in Saskatchewan as precedent Medicare's 50th Anniversary

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and as continuing legacy.

â&#x20AC;&#x153;It is most necessary for any government that those in charge of various departments shall be competent and capable of absorbing new ideas and techniques. No matter how good legislation is, if those in charge of administering it are unsympathetic or incapable of a new approach, little good will come of it.â&#x20AC;? These words belong to Tommy Douglas, the man voted to be the Greatest Canadian in 2004 for the social agenda his party, the Cooperative Commonwealth Federation, brought to Saskatchewan and Canada. The credit is well-deserved.

Read more HERE.

Medicare turns 30 Sunday, November 27, 2011 By Malcolm Taylor, PHD. CAN MED ASSOC J 1992; 147 (2) An assessment from 20 years ago...

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Romanow fears 'patchwork-quilt Canada' health care Sunday, November 27, 2011 By Kevin Scanlon CTVNews.ca Nov. 27 2011

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Former Saskatchewan premier Roy Romanow warns that pushing provinces to raise funds for their own health-care systems would create a "patchwork quilt Canada" of health coverage, with the have-not provinces losing out. In the wake of a two-day meeting in Halifax this week that laid the groundwork for a new health accord, Romanow spoke to CTV's Question Period about the dangers of cutting back on federal funding. "It would be the end of a national program of medicare," he said. The Canada Health Transfer, created under the Liberals in 2004, expires in 2014. In this fiscal year, Ottawa will send $27 billion to the provinces for health care and that figure is expected to climb by six per cent annually. When the national medicare program began in 1965, Ottawa paid half of the provinces' health care costs. But now, it covers less than a quarter of the costs. Former Reform Party leader Preston Manning said the time for talking about the future of health care is over because today's model is fiscally broken. "The current system can't be financed," the head of the conservative Manning Centre said. "We need fundamental changes in how health care is organized. I'd like to see more flexibility â&#x20AC;Ś allow provinces to experiment with various systems." Manning, who said the universality of health care could be maintained while experimenting with a blended system of public and private health care, pointed out that many European countries have already gone to mixed systems. Romanow, who in 2001 headed a royal commission on the future of health care, said the public system is more efficient than a blend of public and private care. He cited the United States where health costs are 15 per cent of the gross domestic product, far below Canada where it is 10 per cent.

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"The notion of private and public is a bit of a mistaken debate," he said. "The evidence is very, very clear that the core provision of health services is more effectively done through the public model." The Halifax meeting of provincial and territorial health ministers with their federal counterpart Leona Aglukkaq was short on details when it concluded on Friday. But Aglukkaq did say any funding discussions would be left to the premiers when they meet with the prime minister early next year.

Health Care Poll Results Monday, November 28, 2011 Canadian Health Coalition November 2011

Open publication - Free publishing - More medicare

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Canadaâ&#x20AC;&#x2122;s never-ending medicare fight Tuesday, November 29, 2011 By Thomas Walkom Toronto Star Nov 29 2011

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The most depressing element of Canada’s on-again, off-again medicare debate is its repetitiveness. The country is forced to fight the same battle again and again. It’s as if our political elites learn nothing. I was reminded of that this weekend when Reform Party founder Preston Manning showed up on CTV’s Question Period to — again — make his pitch for two-tier health care. The ostensible reason for his appearance was that Ottawa and the provinces are again talking about how to share medicare costs. Manning has been pushing two-tier medicine since 2005. That’s when he and former Ontario premier Mike Harris wrote that Canada’s medicare system should be replaced by a narrowly defined scheme focused on catastrophic illness and financed, in part, by user fees. All other health care would be paid for privately. Few paid much attention to Manning then. The country had just gone through a bruising debate over medicare during which the kind of ideas he was flogging were thoroughly discredited. Any number of studies have demonstrated that so-called single payer public insurance systems like Canadian medicare are more efficient than two-tier schemes — for the simple reason that they avoid the paperwork costs involved when physicians have to track and bill large numbers of private insurers. And user fees? Even a Senate committee that had been warm to the idea of charging patients each time they saw a doctor changed its mind when faced with the evidence. By deterring sick patients from getting early treatment, user fees end up costing the health system more. But the real problem with two-tier medicine, as former Saskatchewan premier Roy Romanow noted on the same CTV show, is that it simply shifts costs. Private-pay medicine may save governments money. But it provides no net savings to citizens who end up paying out of pocket for the same or worse health care. Manning made much of the fact that Quebec’s government devotes proportionally less of it provincial budget to health —30 per cent of program spending as opposed to about 40 Medicare's 50th Anniversary

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per cent in Ontario. He appeared to attribute this to the fact that Quebec, unlike Ontario, allows physicians to opt out of medicare and bill patients privately. But the real reason why the Quebec government spends less in proportional terms on health care is that it spends more in absolute terms on everything else. Provincial government program spending per capita in Quebec is $11,457. In Ontario, the figure is $9,223. What’s more, health care spending in total — including both private and public medicine — takes a bigger bite out of the Quebec economy. The Canadian Institute for Health Information calculates that total health spending in Ontario represents 11.9 per cent of the province’s gross domestic product. In Quebec, the comparable figure is 12.4 per cent. All of these statistics point to the same thing: shifting health care costs from the public to private sphere is no solution. If politicians want to deal seriously with the issue of rising costs, they will have to move beyond this sterile preoccupation Yes, other countries have two-tier systems. But they don’t necessarily do any better. The Germans, Dutch and French, all of whom are praised by two-tier fans, spend more of their gross domestic product on health care than we do. Surely it’s more productive to build on what we have — a successful, publicly funded, universal health insurance system that covers doctors and hospitals. It could be improved or even expanded. But it works. That’s why Canadians keep fighting for it. Over and over and over again.

More Canadian public health coverage needed: Romanow Wednesday, November 30, 2011 By Bradley Bouzane Postmedia News November 30, 2011

Roy Romanow told a symposium on the future of medicare Wednesday that a number of health matters — including home care and the out-of-pocket costs for prescription drugs — should be included in the public system to ensure all Canadians get the services they 262

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need. The former Saskatchewan premier and chair of the 2002 Commission on the Future of Health Care said Canada's public health-care system maintains clear advantages over a privatized system, but insists more work is needed to provide more complete care. "We must lay the groundwork now for including catastrophic drug costs, at least, and bring aspects of home care, long-term care and access to advanced diagnostic services — the areas of fastest rising costs — under the umbrella of public funding," Romanow told the symposium, which was organized by the Canadian Health Coalition. "Otherwise, costs will continue to escalate — without restraint and with relentless abandonment of those in need." He said that Canada's spending on prescription medication "now outpaces that of most other (Organization for Economic Co-operation and Development) countries." In his speech Wednesday, Romanow also addressed the issue of lengthy wait times in Canada, saying that a strategy is needed to cut the delays. This month, the OECD released a health report to gauge the efficiency of health systems around the world. It noted that Canada ranked among the worst of all OECD countries in terms of wait times. Romanow's appearance at the symposium comes a week after the federal government and officials from the provinces and territories began talks on changes to the 2004 Health Accord, which is set to expire in 2014. He said there are "two fundamentally competing visions" for how the future of health care in Canada will look. He said one view — that of a private system — sees health care as a "commodity," while insisting the public system is "grounded on the Canadian values of fairness, equity, compassion and collective action." National expansion of community health centres — with the assistance of new money from the federal government — would be one method to improve upon the current Canadian system, Romanow said. A national home-care strategy would also help alleviate some of the burden placed on hospitals, he said, by allowing more Canadians to receive treatment in their own homes instead of inside a hospital, when that level of monitoring is not always necessary. Romanow also stressed the need for better integration of health-care providers at various levels in order to improve health-care delivery in Canada. "We need to break down traditional barriers among health-care providers and reform the local delivery of health care through more efficient and effective integration." He said maintaining the status quo for Canadian health care just won't cut it and said the system must evolve to deal with its current burdens. "After all, we are not fighting to preserve a 1960s health-care system," he said. "We are fighting to build a modern and sustainable health-care system that meets today's needs." Medicare's 50th Anniversary

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The Canadian Health Act Friday, December 02, 2011 Purpose

The Canada Health Act aims to ensure that all residents of Canada have access to necessary health care ona prepaid basis. The purpose of the Canada Health Act is to establish criteria and conditions in respect of insured health services and extended health care services provided under provincial law that must be metbefore a full cash contribution may be made. Criteria 1. Public administration. The health insurance plan of a province/territory must be administered and operated on a non-profit basis by a public authority accountable to the provincial/territorial government. 2. Comprehensiveness. The plan must insure all medically necessary services provided by hospitals and physicians and, where permitted, services rendered by other health care practitioners. 3. Universality. The plan must entitle 100 percent of eligible residents to insured health services on uniform terms and conditions. 4. Portability. Residents are entitled to coverage when they move to another province/territory and when they travel within Canada or abroad (with some restrictions). 5. Accessibility . The plan must provide reasonable access to insured hospital and physician services on uniform terms and conditions. Additional charges to insured patients for insured services are not allowed. No one may be discriminated against on the basis of income, age, health status, etc. Conditions

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1. Provision of information. Provincial/territorial governments are required by regulations to provide annual estimates and statements on extra-billing and user charges. They are also required to voluntarily provide an annual statement describing the operation of their plans as they relate to the criteria and conditions of the Act. This information serves as a basis for the Canada Health Act annual report. 2. Provincial recognition of federal contributions. Provincial/territorial governments are required to give public recognition of federal transfers. Provisions on Extra-billing and User Charges 1. Extra-billing for an amount in addition to any amount paid or to be paid for an insured health service by the health care insurance plan of a province. 2. User charge for an insured health service that is authorized or permitted by a provincial health care insurance plan that is not payable, directly or indirectly, by the plan, but does not include any charge imposed by extra-billing. Penalty Provisions 1. Mandatory financial penalty for extra-billing and user charges. Direct patient charges are subject to dollar-for-dollar deductions from federal transfer payments. 2. Discretionary financial penalty for non-compliance with the five criteria and two conditions. Financial penalties will reflect the gravity of the default.

Source: Health Canada, Canada Health Act Annual Report, 1997-98 Access the full ActHERE.

Fighting to Build Health Care Saturday, December 03, 2011 Canadian Autoworker's Union November 30, 2011

CAW activists from right across Nova Scotia took part in a public rally to strengthen and

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extend Canada's Medicare system. Assistant to the President Deb Tveit and Director of Health Care Katha Fortier joined in the Halifax rally, along with activists from a number of other unions, coalition partners, and concerned citizens on November 25. The rally was held at the city's Victoria Park, across the street from where Canada's health ministers were meeting for first discussions on what the 2014 Health Accord should look like. The Accord sets the amount of money that will be transferred to the provinces for health care, and the conditions under which they will receive funding. Tveit said that the outcome of these ongoing discussions will affect the Canadian health care system for years. "Recent polling indicates that 94 per cent of all Canadians support public solutions to strengthen Medicare and this Accord represents our opportunity to push this issue with the Harper Conservatives to expand our current system to include national pharmacare and continuing care outside of hospitals." Speakers included Maude Barlow, Chair of the Council of Canadians, and Sean Meagher, Executive Director of Canadian Doctors for Medicare. Both argued that Medicare is sustainable and that we should use this opportunity to expand public services and clamp down on privatization, indicating that a public system always results in better patient outcomes.

Health care not a ‘commodity’ Saturday, December 03, 2011 By Roy Romanow Toronto Star Dec 03 2011

The following is an excerpt from a speech this week in Toronto by Roy Romanow, former premier of Saskatchewan and commissioner on the future of health care, to the Canadian Health Coalition:

Today, an overwhelming majority of Canadians believe in a vision of medicare that is rooted in our narrative as a nation — a vision that sees health care as a “public good” and a right of Canadian citizenship.

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But there are others, with a different vision — one that sees health care as a commodity. One that believes that markets should determine who gets care, when and how. That’s why, now more than ever, we need to engage and mobilize Canadians in the fight to secure and expand medicare. Now, more than ever, we need to reaffirm the original vision of a truly comprehensive public health-care system that provides a continuum of services and includes a universal program of home care, long-term care and pharmacare. We need to embrace comprehensive policy solutions that tackle root causes instead of surface symptoms; that bring about systemic changes instead of quick fixes; that promote long-term benefits, instead of short-lived gains. We need to root ourselves and our work in the values that have shaped this great country: fairness, diversity, equity, inclusion, health, safety, economic security, democracy and sustainability. Now, more than ever, is the time to recapture the moral and political strength to see ourselves in our own place, in our own time, informed by our own values, and within our own actual narrative, as an independent nation, worthy of the respect of a world that needs an even better Canada. In doing so, we shall once again put our nation’s policies on track and resume the task of building an even greater Canada.

Swift Current Led the Way in Saskatchewan Saturday, December 03, 2011 Medicare: A People's Issue

The first region in Canada to combine public health with medical care, the Swift Current Health Region or Health Region #1, would play a key role in the development of Medicare in Saskatchewan. Medicare's 50th Anniversary

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The practices, experience and innovations developed there from the mid-1940s through the 1950s formed the basis of the provincial medicare legislation of 1961. This was a complete program of medical and hospital services. Payment to physicians was made on a fee-for-service basis. Patients could choose the doctor they wanted and the system was administered by an independent nonpolitical committee. Beginning operation in July of 1946, the initiative for its formation came from the local level and was ratified by the voters of the region. In the subsequent years other innovations followed such as a comprehensive childrenâ&#x20AC;&#x2122;s dental program and the formation of the first Regional Hospital Council. Why did it begin in Swift Current? A number of factors coalesced to make it the ideal area for medicare reform and experimentation. The 1944 election of the CCF government under the leadership of T.C. Douglas, created an environment where medicare reform was supported at the provincial level. One of their major platforms was the implementation of a socialized medicine plan. In addition, the area had been hit hard by the drought and economic depression in the 1930s. This had led to a community heavily reliant on the municipal doctor system for the delivery of its medical care. When calls for a new hospital arose, the community looked to a cooperative solution. Though the system was popular in the Swift Current area, it was met with trepidation elsewhere. A similar plan was easily defeated in 1955 when put to a vote in the Regina Rural and Assiniboia-Gravelbourg areas. The most vocal opponent was the Saskatchewan College of Physicians and Surgeons. The lines between the government and college were becoming deeper as time progressed. The confrontation would come to a head in the Doctors Strike of July 1962.

Health care, E.I. dominate Atlantic premiers conference Monday, December 05, 2011 Atlantic Canada's premiers are calling on the federal government to increase health transfers, leave employment insurance alone and let more skilled immigrants come to Canada. By QMI Agency December 5, 2011

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Newfoundland and Labrador Premier Kathy Dunderdale hosted P.E.I Premier Robert Ghiz, New Brunswick Premier David Alward and Nova Scotia Premier Darrell Dexter at the 20th annual Council of Atlantic Premiers in St. John's on Monday morning. Health care dominated the talks because the current federal-provincial deal expires in 2014. The feds will provide $27 billion to the provinces for health care this fiscal year, which covers about 20% of the provinces' health costs. The premiers want the feds to increase that to 25%. "Growth in the federal Canada Health Transfer contribution is not keeping pace with provincial health-care cost pressures," the premiers said in a statement issued after their meeting. "The agreement should include additional funding that respects and reflects jurisdictional health priorities." The premiers also called on the government to ignore suggestions made by a think-tank in November to change Canada's employment insurance formula. The Mowat Centre for Policy Innovation suggested EI requirements should be the same in all provinces so all taxpayers get the same bang for their buck. "We need a program that treats all Canadians equitably regardless of where they live, just like other signature programs that form the foundation of the Canadian national social safety net," Matthew Mendelsohn, director of the Mowat Centre, said at the time. "The current EI program responds well to the challenges faced by rural economies and is designed to take into account the differing economic circumstances in regions throughout the country," the premiers said. Implementing the think-tank's policy suggestions "would undermine the ability of the EI program to respond to distinct differences between regions," they added. Finally, the premiers called for an end to caps on the Provincial Nominee Program, which helps fast-track the immigration process for skilled workers and entrepreneurs. "In order to support regional labour market needs, particularly in light of changing demographics, it is imperative that there be growth in the recruitment and retention of immigrants for Atlantic Canada," the premiers said.

The Nerve! Saskatchewan private clinic director resigns Wednesday, December 07, 2011 LeftWords Wednesday, December 7, 2011

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The Medical Director of Saskatchewan's new for-profit surgical clinic has resigned. It turns out he is ALSO the head of the Surgery Department at Regina General Hospital -and has been for the last 11 years. The brains behind the Health Region sees no conflict of interest. DUH! But having the Director wear two hats in this situation is an obvious conflict of interest, Suzanne Posyniak, a spokesperson for the Canadian Union of Public Employees, told the CBC.. "How can you be responsible for ensuring that the hospital is doing the maximum number of surgeries in house, fully using all of its own infrastructure, and at the same time managing a for-profit clinic that needs business from the region to turn a profit?" Posyniak said. "You could tell this story to anyone and they would roll their eyes and think 'Duh â&#x20AC;Ś of course this is a problem,'" Posyniak said. With the Health Authority denying a conflict of interest in such an obvious case, I have to wonder if there are not more conflicts.

The private clinic still plans to start surgeries in February.

Videos: Secure the Future of Medicare Wednesday, December 07, 2011 Straight Goods Highlights from "Secure the Future of Medicare: A Call to Care" organized by the Canadian Health Coalition.

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A keynote address by Roy Romanov, Q.C, Chair of the Commission on the Future of Health Care in Canada and comments by several panelists about threats to Medicare recorded by Samantha Bayard for Straight Goods News at the Chateau Laurier on November 30, 2011.

Bungled trade deal will hurt health care system Wednesday, December 07, 2011 NDP motion demands study of real impact of botched trade negotiations on health care costs NDP December 7, 2011

Canadians are concerned about the consequences of the Canada-EU Comprehensive Economic and Trade Agreement (CETA) for the public health care system and the everrising cost of prescription drugs. Unfortunately, the Conservative government has allowed little study into the real impact of CETA on Canadian families. New Democrat MPs on the committee, Health Critic Libby Davies (Vancouver East), Deputy Critic Anne Minh-Thu Quach (Beauharnois—Salaberry), MP Dany Morin (Chicoutimi—Le Fjord) and MP Djaouida Sellah (Saint-Bruno—Saint-Hubert), are demanding the Standing Committee on Health examine the impact of a potential CanadaEU free trade agreement. The MPs have presented a motion that will be tabled this afternoon. “We know that a trade agreement promoting deregulation is a threat to our public health care system. If government procurement is included in this agreement, some health services may even be privatized,” said Davies. “Since 2009, Conservatives have been negotiating a trade deal with the EU behind closed doors and have refused to disclose what it will cost Canadians,” said Brian Masse (Windsor West), the Official Opposition critic for International Trade. “Conservatives must Medicare's 50th Anniversary

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release the details of the agreement and protect the interests and health of Canadians.” Quach added she is concerned about the consequences of the agreement on prescription drug costs. “Europe wants to extend the length of drug patents by at least 3 years, which would increase the cost of drugs and delay the entry of generic drugs onto the market,” said Quach. “This will further drain already stretched health budgets.” New Democrats are urging the Conservative members of the committee to agree to this study so Canadians can understand how this agreement will impact them and their health, before the agreement is signed.

Canada’s health care system is affordable Thursday, December 08, 2011 But to make it sustainable, we need to change the way we deliver services Troy Media December 8, 2011 Recently the Canadian Institute for Health Information (CIHI) released the latest figures on the country’s health spending. It provides a cool analytic antidote to a heated political issue. Health costs are not out of control. And the report’s findings remind us that the real issues have little to do with money. Almost every day some politician or pundit declares that provincial health-care spending is massively out of control, eroding government’s ability to fund everything else. Our roads are full of potholes, our kids can’t do long division, and it’s all the fault of a rapacious health-care system.

Health spending actually falling Several reports have suggested that health spending will inexorably rise to 70 or even 80 per cent of provincial government program spending in the next 10 to 20 years. The CIHI graph of provincial health-care spending over time draws a very different picture from that portrayed in our public debate. Health spending was fairly steady at 33 per cent of program spending during the early and mid-1990s. After 1997, it rose rapidly to 39 per cent of program spending in 2003 before plateauing there until 2008. It has been falling since. Provincial health-care costs decreased on average from 39.3 per cent of program spending in 2008 to 37.7 per cent in 2010. In some provinces, like Ontario, the decrease was even more startling, from 45.5 to 40 per cent. In Saskatchewan, costs fell from 37.2 to 34.7 per cent while they actually increased in Nova Scotia from 42.4 per cent to 47.2 per cent

Of course, governments increased non-health-care spending during the recession as welfare, employment insurance and other costs rose. But CIHI forecasts provincial health-care spending will fall this year as a share of GDP from 7.8 per cent to 7.5 per cent.

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It would be nice if those who spew fire and brimstone about rocketing health costs would read the annual CIHI reports. Then maybe we could get onto the three big issues that get little or no media attention. First, we don’t have to spend a lot more money to fix the system. Most of health care’s problems – from long wait times to inadequate follow-up of chronic illness – are due to antiquated, provider-focused processes of care. The remedy? A high-performing, patientfriendly system. And, contrary to the ill-informed Canadian chin-wag consensus, this shouldn’t mean higher costs. To quote the 2001 Saskatchewan health-care royal commission, “better quality care almost always costs less.” For example the referral route from family physicians to specialists has not changed fundamentally since the professional model was created during the Middle Ages. In Canada you can wait months to see a spinal surgeon. But 90 per cent of patients referred to Ontario spinal surgeons don’t need to have surgery. They may need physical therapies, medication, counselling or acupuncture. But they don’t need surgery and very few of them should even be seeing surgeons. The solution? In Hamilton, 20 psychiatrists are working part-time with more than 100 family doctors, 80 mental health counsellors and dozens of other professionals. Urgent questions for the psychiatrists are answered immediately by cell phone. The psychiatrists also drop into the family practices every week or two where they see patients directly, discuss other cases with staff, and generally raise the already high standards of mental health delivery. It’s well past time to change the practices of other Canadian specialists. All medical specialists and their teams should be working more closely with primary health-care practices. No Canadian should wait longer than a week for elective specialist input into her case. Second, we should be spending more public money if it remedies private market failures. Justice Emmett Hall’s 1964 royal commission recommended public insurance for physicians because it would cover everyone and cost millions less to administer than a private system. The same argument holds for drugs, long-term care and home care. Finally, we need to resuscitate our shrinking public sector. Health care increased its share of the public pie from 1997 to 2008 largely because government cut the size of the pie by axing other programs. For example, the feds eliminated the National Housing Program in 1993 and Canada’s spending on early childhood programs is the lowest of any OECD country. These policy mistakes have made a lot of people sick and applied pressure to hospitals and other health-care organizations.

Redesign delivery systems According to the latest figures from the Department of Finance, from 2000 to 2010 Canadian governments cut their incomes by 5.8 per cent of GDP, the equivalent of $94 billion. If we had cut taxes by only half that amount, all governments could be out of deficit by 2012. Or we could afford to pay for first-dollar universal pharmacare, long-term care and home care, as well as regulated child care for all parents who want it, free university and college tuition, 20,000 new social housing units a year, and a hike in the Canadian Child Tax Benefit to $5,000 per child.

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Our health-care system is affordable. To make it sustainable, we need to complete Tommy Douglasâ&#x20AC;&#x2122;s vision for medicare by changing the way we deliver health services. Letâ&#x20AC;&#x2122;s set aside the shroud-waving about rising costs and refocus on redesigning the delivery system. Medicare remains as sustainable as we want it to be.

Dr. Michael Rachlis is an Expert Advisor with EvidenceNetwork.ca and a health policy analyst and an associate professor at the University of Toronto. EvidenceNetwork.ca is a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada.

History of Health: Why is it important? Thursday, December 08, 2011 By James Low Executive Director Museum of Health Care blog September 2, 2011 Jane and John Smith born in Portsmouth Village, now a neighbourhood of Kingston, Ontario, in 1810 and 1812 respectively had a life expectancy of forty years. Jane and John Jones born in Kingston in 2009 and 2011 respectively look forward to a life expectancy of eighty years. What accounts for this striking difference?

Multiple, often interrelated, factors have contributed. Understanding the factors accounting for this transition identifies the health and health care issues that need to be protected in our health care system. An example is the occurrence of waterborne infections. From its first appearance in 1832 until 1873, cholera aroused fear in British North America and United States. In June 1832, cholera was raging in Kingston. By August there had been 212 cases of which 78 had died. The cholera epidemic in Kingston and district counted 200 burials that year. Cholera recurred in 1834 and was responsible for 274

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approximately 200 burials near Kingston by the end of August. Cholera continued to return in successive waves. In July 1849, cholera was in most of the cities and towns in the province and in June 1854, cholera was reported to be bad in Kingston. At the same time the community experienced annual outbreaks of typhoid fever with a significant mortality. The cause and transmission of cholera was not known until, based on studies of cholera epidemics in London in 1849 and 1854, John Snow surmised that the poison was released from infected feces that contaminated the water supply. Later, during a study of the cholera outbreak in Egypt in 1883, Robert Koch demonstrated the cause to be the bacillus, Vibrio cholerae. Similarly, in 1856, William Budd concluded that typhoid fever was an alimentary disease due to fecal contamination of water and milk. Eberth and Klebs identified the cause of typhoid, a gram negative motile bacillus, Salmonella typhi, in 1880. Although the importance of clean water and sanitation was now recognized, it was some time before the needed infrastructure and practices were established in urban and rural communities. In Kingston, mortality due to typhoid fever continued until 1930. Public health initiatives have achieved regulation of water and sanitation in most communities in Canada. However the system requires vigilance. The Walkerton, Ontario outbreak in 2000, which is highlighted in the online exhibition â&#x20AC;&#x153;Death in a Glassâ&#x20AC;?, acts as a reminder. Cholera in Haiti demonstrates how a breakdown of water distribution and sanitation can lead to a recurrence of cholera epidemics. Worldwide waterborne infections continue to be a major issue, with the United Nations reporting that one child dies of waterborne infections every 8 seconds . The maintenance of universality of health care in Canada and elsewhere is being challenged due to the cost. Clearly, the provision of clean water and sanitation are high priorities that must be maintained.

World Youth Study Medicine in Cuba Friday, December 09, 2011 Cuba Debates Sept. 13th, 2011

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More than 20,000 youth from Latin American, African and Oceania countries are currently training in the Medical Sciences universities of all Cuban provinces. The 2011-2012 school year officially began on Monday at the Latin American School of Medicine (ELAM), located at the outskirts of Havana, with an enrollment of about 2,300 foreign students. This is the 12th academic year of this institution, founded in 1999 by an initiative by the leader of the Revolution, Fidel Castro. Previously, the center graduated about 10,000 physicians. “You, students, as Fidel Castro stated, have to be trained with the quality of our physicians, with a high scientific-technical, humanist, ethic and solidarity formation, ELAM Rector Juan Carrizo repeated to the new students. According to Granma newspaper, after the earthquake that devastated Haiti in January 2010, about 250 volunteers from 28 countries trained in such educational center went there to assist that Caribbean people.

The Problem with Profit-Driven Health Care Friday, December 09, 2011 Canadian Doctors for Medicare What does the evidence say about private, for-profit health care? It’s not what you think. Having more private, for-profit clinics reduces access to care

Private for-profit clinics drain the limited supply of doctors and other health professionals from the rest of the health care system, lengthening waiting lists and reducing access[1 Private for-profit clinics also use up needed resources scheduling unnecessary procedures, reducing the services available to other patients requiring medically necessary procedures.[2] Private, for-profit clinics contribute least where the need is greatest Private, for-profit clinics often “cherry-pick” the healthiest patients, who are easiest, and

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cheapest, to treat. [3] Patients, who are very sick, and no longer profitable to treat, are often referred back into the public system, putting added stress on public resources.[4] For-profit clinics tend not to serve unprofitable markets like remote and rural communities, Aboriginal communities, marginalized urban populations, and those needing complex chronic care and emergency care. They focus on affluent populations in urban centres, who face the lowest barriers to care. [5] Private, for-profit clinics aren’t as good for you and they cost taxpayers more. The evidence shows that private, for-profit health care produces worse patient outcomes than non-profit care, and they order more unnecessary tests and procedures. [6],[7],[8] Private, for-profit clinics conduct these unnecessary procedures at the taxpayer's expense, and tie up physician resources that could be used on medically necessary procedures. Criteria for effective health care delivery There are four important criteria in determining an effective health care delivery model. Private, for-profit delivery doesn’t stack up. 1. Equitable access to medically necessary physician and hospital services: The need to turn a profit means that accessibility can suffer, as private clinics exclude very sick patients or patients who need complex care and are too expensive to treat. 2. High quality care: Making a profit can compromise quality – it means that all of a clinic’s resources aren’t being put into optimal care for patients. 3. Delivery of effective, clinically indicated services: The need to make a profit can push private clinics to order tests and procedures that aren’t medically necessary. 4. Effective planning and integration of health care: Increased competition between private and public delivery is inefficient – it’s harder to coordinate, it’s less accountable, and it’s less effective at delivering an integrated continuum of care. Evidence shows that more private care does not increase efficiency or access. __________________________________________________________

[1] Duckett, S. J. “Private care and public waiting.” Australian Health Review; 29(1): 8793. 2005. [2] N Ivers, M Schwandt, S Hum, D Martin, J Tinmouth, N Pimlott. A comparison of hospital and nonhospital colonoscopy: Wait times, fees and guideline adherence to follow-up interval. Can J Gastroenterol 2011;25(2):78-82. [3] Perry, Joshua E., A Mortal Wound for Physician-Owned Specialty Hospitals? The Legal and Ethical Prognosis for Market-Driven, Entrepreneurial Medicine in the Wake of 2010 Health Care Insurance Reforms (May 13, 2010). [4] Perry, Joshua E., A Mortal Wound for Physician-Owned Specialty Hospitals? The Legal and Ethical Prognosis for Market-Driven, Entrepreneurial Medicine in the Wake of 2010 Health Care Insurance Reforms (May 13, 2010). Medicare's 50th Anniversary

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[5] Vaithianathan R. 2004. “A critique of the private health insurance regulations.” Australian Economic Review;37(3): 257-70. [6] Journal of the American Medical Association, 2002; 288:2449 [7] N Ivers, M Schwandt, S Hum, D Martin, J Tinmouth, N Pimlott. A comparison of hospital and nonhospital colonoscopy: Wait times, fees and guideline adherence to follow-up interval. Can J Gastroenterol 2011;25(2):78-82. [8] New England Journal of Medicine, 1997, 337:169

Saskatchewan's Health Services Planning Commission, 1944–50 Saturday, December 10, 2011 Encyclopedia of Saskatchewan

The Health Services Planning Commission (HSPC) was created in November 1944 to serve as a central health planning and advisory body to the new Co-operative Commonwealth Federation (CCF) government of T.C. Douglas. The CCF had come to power in 1944 with the intention of creating a comprehensive system of socialized health services in Saskatchewan. Under the leadership of Douglas and the HSPC, the new government was to realize much of its goal in its first term in office from 1944 to 1948. The Commission had been one of the “recommendations for immediate action” made by Dr. Henry E. Sigerist, professor of Medical History at Johns Hopkins University and recognized expert in public health and “socialized medicine,” whom Douglas had recruited to conduct a review of health conditions in the province and to make recommendations that would serve as an outline for the government for future reform. By 1944, Saskatchewan had already seen several innovations in Health Care such as municipal doctor and union hospital schemes, which collectively allowed a large number of people access to pre-paid hospital and medical care. These ideas, and others, had evolved over time as a result of local initiative, not of a central government plan. The Department of Public Health had focused primarily on public health activities and not on planning a comprehensive public health, medical and hospital scheme for the province. A small Commission allowed for a concerted effort to transform the system. Douglas staffed the Commission with reform-minded individuals instead of relying on the more traditional Department of Public Health. The Commission was, in some ways, a continuation of Sigerist’s work, with the initial three members—C.C. Gibson, an

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experienced hospital administrator, T.H. McLeod, economic advisor to the government, and Dr. M.C. Sheps, secretary and member—each having served in some capacity with Sigerist’s survey. Selection of a permanent chairperson for the Commission did not occur until 1946, when Dr. F.D. Mott, former Assistant Surgeon General for the United States, assumed the role. But the Commission did not wait for a chairperson to begin; the reforms came quickly and the list was impressive. The Commission proved instrumental in launching a series of initiatives including a program of medical and hospital care for residents receiving various forms of social assistance (January 1945); division of the province into health regions to deliver public health and preventative services (launched in 1945); plans for these same health regions to provide hospital and medical services (by July 1, 1946, Weyburn, Health Region No. 3, had a full hospitalization scheme, and Swift Current, Health Region No. 1, had complete medical and hospital care); development of a model contract (including full medical and preventive care) and financial support for municipal doctor plans (1945); a system of grants to support hospital construction (March 1945); construction of a new medical school and a university hospital (begun in 1946); efforts to attract and retain needed health care professionals; the launch of the Air Ambulance Service (1946); and, of course, the implementation of Saskatchewan Hospital Services Plan on January 1, 1947, providing the first provincewide, universal, pre-paid hospital insurance plan in Canada. By 1948 the HSPC was increasingly occupied with administration of its many reforms. At the same time, the CCF determined to slow the pace of social reform and concentrate on economic matters. The need for a compact planning body focused on health reform had diminished, and on April 1, 1950, the operational programs of the HSPC were moved to a reorganized Department of Public Health. The Commission reverted to its original role as a planning and advisory body, and continued to exist until 1963—but in a much diminished capacity, and without the influence or importance it held from 1944 to 1948. The HSPC had its detractors, in particular the organized medical community who would have preferred an “independent commission,” and its plans were sometimes modified or postponed (for example, plans for local health centres based on salaried physician practices were not implemented); but between 1944 and 1948, the HSPC had provided the government with advice and programs needed to eliminate many of the hardships evident in 1944 and to set the stage for the next major reform, Medicare, which would come more than a decade later.

'Sicker' Canadians most in need of health care, but cost a barrier ... Monday, December 12, 2011 Huffington Post December 12, 2011

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Although the article below doesn't mention it, the information below clearly points to the need for a national pharmacare plan. - NYC. Canadians with chronic conditions are frequent users of the health-care system, but a new report shows many experience considerable difficulty getting the medical treatment they need. So-called sicker Canadians most of whom are age 50 or older have one or more of seven chronic conditions: high blood pressure, heart disease, cancer, diabetes, joint pain or arthritis, chronic lung problems such as asthma or chronic obstructive pulmonary disease (COPD), and mental health problems such as depression or anxiety. Those who are chronically ill are among the highest users of health services: they are more likely to be hospitalized, have surgery, visit emergency departments and take prescription medications. But cost can be a major barrier to accessing that care, says the Health Council of Canada, citing results from the 2011 Commonwealth Fund International Health Policy Survey, which included almost 4,000 Canadians. Almost a quarter of respondents who rated their health as fair or poor reported skipping a dose of medication or not filling a prescription due to the cost, compared with just 10 per cent of other Canadians, the survey found. The council said that one-in-four ratio is significant because 90 per cent of sicker Canadians take at least one prescription drug, while 54 per cent take four or more medications. As well, about one in eight said they have skipped a recommended test or followup treatment due to cost concerns, compared to just five per cent of those without chronic health problems. The experiences of patients with chronic conditions can tell us a lot about the quality of the health-care system as a whole and the progress we have made, council CEO John Abbott said in a statement Monday. The data here tells us we need to be concerned that there are many Canadians who still cannot afford treatment of their chronic conditions.

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"We need to address this immediately, because medications that prevent complications from chronic disease are vital in contributing to better quality of life for individuals, and reduced health-care costs for the system. Almost 60 per cent of those with ongoing health concerns have below-average household incomes, making it difficult to afford certain types of care and medications. Secondary costs such as paying for transportation to appointments, child care and lost wages from time away from work can also present obstacles to care, the Health Council said. In fact, 12 per cent of sicker patients reported not visiting a doctor due to cost concerns, compared with just four per cent of other Canadians. Over a quarter of health-care services are paid for through private sources, either out-of-pocket by patients or through private insurance. The survey also found that this group of patients fares worse when it comes to coordination of care. People with chronic conditions are likely to see multiple providers and specialists, yet many said they didn't always receive help from their doctors office in coordinating that care. About half of patients had to wait a month or longer to see a specialist, while almost onequarter said test results or medical records were not available when they arrived for their appointments. The survey showed sicker Canadians felt less engaged in their health care compared with others in the country. Overall, 36 per cent said their doctors didn't explain their health concerns in an easily understood manner and 45 per cent felt they did not get enough time with their physician. Its important that doctors know my medical history and are up to speed on my health results, said Frank Austin, a stroke survivor and patient advocate. There needs to be improved communication among health-care providers so that time is not wasted and the risk of errors in my care is reduced. Still, there were some positive results from respondents with chronic conditions: more had a regular doctor or clinic for care 96 per cent versus 86 per cent of the general population. They also found it easier to get care after-hours or to get an appointment with a doctor the same or next day. While such results are promising, the council said much improvement is needed. The report recommends a number of ways to eliminate cost barriers, including increasing use of alternatives to face-to-face visits, such as telemedicine, email and phone consultations. To improve co-ordination of care, widespread use of electronic medical records in Canada would reduce costs and improve efficiency, the council said. The 2011 Commonwealth Fund International Health Policy survey involved about 19,000 randomly chosen adults from 11 countries, who were interviewed by telephone between March and June. The survey included 3,958 Canadians.

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Romanow’s 50-year fight for medicare Tuesday, December 13, 2011 For former Saskatchewan premier Roy Romanow, the Canadian health-care system speaks to Canadian values and cannot be treated as a commodity, writes Tim Harper By Tim Harper Toronto Star Tue Dec 13 2011 Also read Roy's reminisces HERE.

Roy Romanow is 72, though he hardly looks it. He has earned the right to sit this one out, but, of course, he can’t. As the future of health care in Canada elbows its way onto centre stage in 2012, the former Saskatchewan premier will be marking 50 years of fighting for a publicly administered, single-payer health-care system in this country. This is a man who drove Tommy Douglas across Saskatchewan on the NDP icon’s final provincial campaign. He dates his conviction on the sanctity of public health care to the doctors strike of 1962, when almost 90 per cent of the physicians in his home province withdrew their services to protest Douglas’ medicare plan. As a university student, Romanow fought against the KOD (Keep Our Doctors) rallies in Saskatchewan, a tumultuous period in Canadian history. “Very early on in my thinking, I came to the conclusion that the most efficient and most ethical form of delivery is predicated on the assumption that we are all together on this short journey in life and we owe it to each other to look after each other the best that we can,” he said. “For me that was the crossing point. Half a century ago.’’ When we sat down to chat recently, we determined it had been eight years since our last meeting, but we shared a laugh in the realization that despite that lapse of time, we were again talking about the same subject.

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What else would it be? It’s just in the Romanow DNA. He has readied himself for one more battle. For Romanow, the Canadian health-care system speaks to Canadian values and cannot be treated as a commodity. But whether they see it his way or not, the players are setting their negotiating lines in advance of the expiry of the existing 10-year accord in 2014. The Conservatives have promised 6 per cent increases in health-care transfers to the provinces through 2016, but appear prepared to rein in that figure thereafter. There are reports that Finance Minister Jim Flaherty will tell his provincial colleagues at a meeting in Victoria Monday that he wants future increases tied to economic growth, something which could cut Ottawa’s contribution in half. Prime Minister Stephen Harper has essentially sent the same signal and Health Minister Leona Aglukkaq on Tuesday would say only that the $27 billion spent by Ottawa will be increased in a way that is “balanced and sustainable.’’ There have also been suggestions that 1 per cent of the 6 per cent in increased transfers might be mandated for aboriginal health. Atlantic premiers have called for Ottawa to provide 25 per cent of their health spending, a return to the formula put forth by Romanow in his landmark health-care study nine years ago. Saskatchewan’s Brad Wall has lamented that too much time is spent on funding debates instead of delivery. Liberal interim leader Bob Rae said Tuesday that tying health-care funding to economic growth is “just wrong.’’ In fact, Rae says, if economic growth slows, it puts more pressure on the health-care system. Under the proposed Ottawa scheme, says NDP deputy leader Libby Davies, good years will mean sustainable health care, but the bad years will mean, “sorry, you are out of luck.’’ Former Liberal deputy prime minister John Manley told The Hill Times this week that growing health-care costs for the provinces meant less funding for education, transportation and environmental regulation. So, the debate is underway and will eventually crowd out all else, because health care is still the number one issue with Canadian voters. But Romanow, half-a-century on, says it will never end. “Every time you think you have instituted reform,’’ he says, “along comes a new invention, a gamma ray or some new pill. I don’t see the debate going away. Medicare's 50th Anniversary

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“Some see things being better delivered through government, others not. “Why not have an ideological debate about it?’’ That is precisely the next big national debate and it’s about to take off.

Universal health care: If Cuba can do it, why can’t the USA? Friday, December 16, 2011 By Mike Lado People's World December 15 2011

What's Cuba got that we don't? A good universal health care system. Despite the valiant attempt of the Affordable Care Act passed in March 2009 and signed into law by President Obama to fix health care, about 50 million Americans remain uninsured, and another 25 million remain under-insured, trapped in limited-benefit and high-deductible health plans. There are also 26.5 million Americans with heart disease. There's an autism epidemic that affects 1 in 100 children being born. For many parents the treatments they need for their children aren't even covered by insurance. The poor cannot afford health care so they end up waiting until they are so sick they wind up in the emergency room driving up waits and costs for everyone through no fault of their own. Rates of lack of insurance amongst Latinos, African Americans, Native Americans and other minorities are appalling. Most progressive Democrats agree the Affordable Care Act does not go far enough in ending the nation's health care woes. So how can we fix this mess while putting the bogus insurance industry out of business and curbing bloated pharmaceutical industries? The simple answer is a universal health care system that works. Many opponents of a universal system point to supposed government waste and abuse along with a massive health bureaucracy. There's a way to avoid that. I look to Cuba as a model for us to follow.

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A recent conversation with an American medical student studying at Cuba's renowned Latin American School of Medicine provided me with some key facts. The basic health care system in Cuba, she said, starts at small neighborhood clinics staffed by a trained nurse and a doctor. The doctor or nurse in charge of the station typically lives above the clinic in a small apartment so they are available even when the clinic is closed. This doctor is a primary care family doctor who serves as the health care frontline. He or she handles all basic health care such as checkups, immunizations, and health questions. For situations requiring a specialist or medical tests the next stop is the polyclinic. The polyclinic is basically a centralized medical office where specialists are located and diagnostic tests are carried out. Cuba has more than 400 polyclinics around the island. Things such as X-rays, ultrasounds, dentistry, and other health specialties are handled at the polyclinic. At the polyclinic emergencies can be handled that do not require overnight stays. So fractures, sprains, and other urgent care situations can be treated there. This removes the need for everyone to show up at a hospital emergency room at the slightest sign of trouble. Hospitals in Cuba are truly for treatment of life-threatening emergencies and conditions. They come in all shapes and sizes. Ambulances can transport patients who are too ill to move themselves to either a Polyclinic or hospital depending on the emergency. The best part of Cuban medicine in my opinion is that alternative or complimentary medicine is part of the free universal health care the government provides. Alternative treatments like acupuncture have come to the island. It it's not limited to a select few patients. Alternative medicine is used at all three levels of care! Doctors and nurses along with alternative treatment providers such as acupuncturists work with their patients and each other to coordinate care successfully. It's amazing. Even with the discriminatory U.S. economic embargo against them, Cubans have built a modern medical system in which every citizen is able to have quality care at no cost to themselves. Something Americans lack. How could a Cuban-style health care system work here in the United States?

Despite the valiant attempts by progressive Democrats to pass a universal health care system, we got the less-than-ideal Affordable Care Act that still leaves several million uninsured people.

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In part one of this series, I described how Cuba does a miraculous job of having a successful health care system despite the U.W. embargo she faces. In addition to hospitals Cuba has an island-wide network of neighborhood medical stations and specialty polyclinics that reduce reliance on emergency rooms for care. Now onto the million-dollar question: would such a system work here in the States, and how? I've tweaked the system a bit to adjust to our current structure of government. The first level of care, based on the Cuban system, would be a municipal medical clinic. Each town or municipality of over 1,000 people would be served by a clinic staffed by nurses and physician assistants. So don't we have this like the Cubans do? As KaiserEDU.org notes, the United States is facing a critical shortage of primary care physicians in medicine. Most medical students saddled in debt go to high paying specialties instead of primary care. It would take some time to train all those new physicians to fill the gap. In the interim we can use nurse practitioners and physicians assistants to fill the void. NPs and PAs can work alone or under the supervision of a doctor. They both have prescribing rights and are just as qualified as doctors to deliver basic care. In a Cubanstyle system a doctor would be assigned to a set of clinics to oversee operations with the NP or PA supervising a nursing staff directly as needed. These medical stations would cover primary care such as physicals and immunizations. The next level up is a polyclinic. I suggest one polyclinic per county or county equivalent. In Cuba polyclinics generally serve several tens of thousands of people. In our big cities and larger counties more than one polyclinic will be needed to cover people. At the polyclinic people should be able to see a doctor who's a specialist, receive diagnostic tests, dental and optical care, outpatient surgeries, and treatment for urgent care scenarios. Finally, the hospitals. These would be used in case of life threatening emergencies. The more we reduce the need for a hospital emergency room through the polyclinic, the less people will show up at the hospital sick. A successful health care system that covers all for free must be well financed and have some kind of democratic control. So who's going to pay for all this? Well first we can start by jacking up taxes on the rich and big corporations. Strengthening the progressive income tax system is a must for a good health care system to be successful. A successful taxation system that places the burden of cost on the people who can afford to pay allows every citizen to receive free, quality health care without having to turn the entire nation upside down searching for a way to finance such a system. Now the nitpicky part: who gets to control the system? In my plan the people do. On the local level I propose that every county elects a democratic assembly of health care workers, professionals and patients who oversee the day to day operation of the county polyclinic and local clinics. There should be regional assemblies as well for control over hospitals affiliated with a major university or medical school. Abortion should be legal and on demand at a polyclinic for women who choose it. HIV/AIDS treatment and testing should be free and available for all who need it, including post-exposure prophylaxis treatment. Fertility treatments for women who are unable to 286

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conceive should be available. Local medical clinic staff should be trained to be sensitive to the needs of all patients and should set their personal beliefs aside when it comes to the needs of a patient.

Let there be no blackout of health Friday, December 16, 2011 Saskatchewan CCF Circa 1942/43 Medicare: A People's Issue A pamphlet published by the CCF in Saskatchewan leading up to their victory in 1944.

Open publication - Free publishing - More canada

US Doctors Support OWS Because Wall Street Is Occupying Health Care Saturday, December 17, 2011 Physicians for a National Health Program

We support Occupy Wall Street because the private health insurance industry exemplifies the OWS movement’s central tenet: its unchecked corporate greed tramples human need. We support OWS because economic and social inequalities make our patients sick. Low wages, high unemployment, inadequate education, unhealthy food, unaffordable housing, unsafe jobs, a polluted environment, and a lack of access to affordable health care breed death and disability. We support OWS because health care is a human right. We reject a system that forces us to treat patients differently based on their insurance and the treatments they can “afford.” We support OWS because we believe in evidence, and evidence shows us that profitdriven health care decreases access, raises costs and lowers quality. It’s unhealthy for Medicare's 50th Anniversary

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the 99%; only a few corporate executives, bankers, and lobbyists benefit. We support OWS because our political leaders, held hostage by corporate money, reject evidence-based health policies such as a single-payer reform that would save both lives and money. We support OWS because the health care economy â&#x20AC;&#x201C; like the overall economy â&#x20AC;&#x201C; has ample resources to take care of 100%, but those resources are siphoned off by profitdriven corporations in the interest of the 1%. We support OWS because we took an oath to do no harm, and our corrupt political and economic systems are harming us all. We support OWS because we are hopeful that we can change our society

Stats make U.S.-style health care a tough sell Sunday, December 18, 2011 By Terry N. Champion Edmonton Journal December 18, 2011

Statistics for 2009 compiled by Harvard Medical School and the U.S. Census Bureau show that, in the insurance-dominated U.S. healthcare system, 45,000 Americans died because they had no health insurance; 922,819 Americans went bankrupt because of medical expenses; 50,700,000 Americans have no health insurance. The comparable figures from the Canadian health-care system are zero, zero and zero. Which health-care system would you rather have? Americans have been frightened by insurance industry lobbyists into resisting universal governmentfunded health care for over 100 years, portraying Canadians as flocking south across the border to obtain proper medical care in the U.S. We must counteract the lobbyists who are attempting to move our health care toward a system where those of us who are in good health would qualify for expensive insurance premiums while millions of our fellow citizens could end up with no health coverage at all. And don't think our taxes would be reduced accordingly. The money would be spent elsewhere. Insurance company bureaucracy adds over 20 per cent to the cost of U.S. 288

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health care, with no value added. Tommy Douglas enunciated Canadian values when he said "people are more important than profits." What can we do to preserve and improve our health-care system? Support organizations that are working on our behalf, such as Seniors United Now and Friends of Medicare. Seniors United Now has a documentary film, The Health Care Movie , that every Canadian should see. It was researched and produced by a Canadian-American couple. And let our elected officials know that we want no part of U.S.-style health care.

Commissioner on public service reform recommends nation-wide privat... Monday, December 19, 2011 Public Values December 7, 2011

In a press conference at the Ontario Legislative building, the Ontario Health Coalition warned the McGuinty government not to accept recommendations that include cuts and privatization of hospital and health care services. Don Drummond, a former bank executive appointed to head this government's Commission on Public Service Reform, has used the enhanced platform afforded him by McGuinty to become a spokesperson recommending health care privatization across Canada. In the last year alone, Drummond has been involved as an advisor, spokesperson and author of numerous reports on health care reform. In every report to date, Drummond has participated in recommending health care privatization, something the Finance Minister and Premier promised would not be part of the Commission's mandate. He has repeatedly called the Canada Health Act "irrelevant" though it protects Canadians from user fees for their hospital beds and services. The Canada Health Act has been used to force the repayment of patients who have been charged illegal fees through extra-billing and user fees. "The McGuinty government has no mandate whatsoever to privatize health care. They have run three elections with the promise to protect and improve public health care," noted Natalie Mehra, coalition director. "We are deeply concerned about Drummond's

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repeated exhortations in favour of private for-profit hospitals and clinics. The evidence shows poorer quality and higher costs in private clinics. For-profit privatization of hospitals and clinics leads to two-tier health care: one system for the rich and poorer access to care for everyone else. We have researched virtually all private clinics that have emerged across Canada and we found that the vast majority of private for-profit clinics charge extra user fees to patients and sell two-tier health care to the rich even in violation of the Canada Health Act, while reducing access to care in our local hospitals." "The public does not support the idea that a corporation should make profit from a person suffering with cancer," added Derrell Dular, board member of the OHC and Managing Director of the Older Canadians Network. "Handing the control of our health care institutions to for-profit corporations means that profit-taking comes at the expense of quality care and drives up costs. It violates deeply-held values of Ontarians." He also warned about hospital cuts. "Every round of hospital cuts for the last 15 years has been accompanied by more for-profit privatization. Seniors have been hit hard as increases in home care and long-term care have never kept pace with hospital cuts. We now face serious waiting lists for nursing homes and inadequate home care where the impact of for-profit ownership and control are also evident. The for-profit companies have lobbied for changes that give them more money with less strings attached, standing in the way of improvements in care." "Today we are issuing a warning. We will strongly oppose any so-called 'reform' that leads to the privatization of our health care system," concluded Ms. Mehra. "Fair and equal access to health care relies on building capacity and improving the democracy and quality in our public health care system. Privatization would destroy this potential." The coalition released a backgrounder listing Don Drummond's involvement in health care reports over the last two years. The backgrounder and an open letter to the Minister of Finance can be accessed at www.ontariohealthcoalition.ca.

How poor nations prop up Canadian health care Monday, December 19, 2011 Toronto Sun Dec 18 2011

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Dr. Isaac Odame Consider it the great brain robbery. Canadians have for years been quietly stripping poor nations of a precious commodity — their doctors, nurses and other health professionals. In fact, Canada is prominent among poachers of medical talent from other countries, especially from developing nations where this talent is desperately needed and in lamentably short supply. Other major offenders include the United States, Australia, the United Kingdom and Saudi Arabia. Exactly how much they gain, and what poor countries forfeit, is impossible to tally. But a new Canadian study manages to put a dollar figure on at least a portion of our windfall and the developing world’s loss. It’s a sobering result, one that cries out for more ways to repair the damage that we cause. Researchers studied nine sub-Saharan nations and found they spent almost $2.2 billion training doctors who subsequently left for Canada, Australia, the U.S. or Britain. All nine, including Uganda, Zimbabwe and Ethiopia, are struggling to cope with AIDS and a host of other ills that together kill millions of Africans every year. Meanwhile, the four rich countries eagerly attracting the brightest and the best have saved $4.5 billion by training fewer of their own doctors and taking physicians from these sub-Saharan nations. “It’s a great way to build your health-care system,” Ed Mills says with a grim laugh. The University of Ottawa professor headed the study published in the British Medical Journal last month. He warned that health and stability in African countries is being undermined. That’s bad enough. But what Mills discovered is just a fraction of the brain drain benefiting Canada. He didn’t count the many doctors who have come here but failed to find work in their field. He examined the loss from only nine countries — not all of Africa or all the Third World nations from which Canada draws medical expertise. And he didn’t consider gaps left by departing nurses, pharmacists and other professionals. As Canadians, we like to think of ourselves as a caring and generous people. And we are. But the ugly fact is we’ve been stripping life-saving medical talent from the very places that can least afford to have these skilled professionals slip away. That carries a human toll. “Sometimes I struggle with why I left Ghana,” says Dr. Isaac Odame, at Toronto’s Hospital for Sick Children. “You sit here. You’re consulted. You’re a leader of some repute. You’re helping children. And you know that, back home, children are dying needlessly.” As he speaks his hands cradle a small globe — a clear glass sphere the size of an orange engraved with the world’s continents. He says it reminds him of the global nature of health care and the need to give something back to the poorest on the planet. To that end, Odame has been instrumental in creating a program training nurses in his homeland. With an infant mortality rate 10 times higher than Canada’s, Ghana had no certified pediatric nurses to care for its 8 million children. Not one. To change that, Sick Kids and the Canadian International Development Agency are Medicare's 50th Anniversary

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investing $3.5 million to train 140 nurses specializing in caring for children. Selected for their leadership skills, they are to train others. The goal is to create up to 1,500 pediatric nurses in Ghana over the next 10 to 15 years, certainly saving lives. “This needs to happen through all sub-Saharan Africa,” says Odame. And he’s right. A few other Canadian centres have launched similar efforts, but these are rare and often of limited duration. CIDA has spent an average of about $38 million annually since 2006 on projects boosting access to trained and equipped health workers. It’s better than nothing, to be sure. But to put that in perspective, Mills showed that Canada gains almost $400 million just by attracting doctors from nine African nations. Aggressive steps should be undertaken to share more of our health-care expertise with countries in dire need. It’s only fair since we take much of it from them. The Hospital for Sick Children has found a way to send help back, and other hospitals and regional health authorities should do likewise. There’s no lack of expertise. According to new figures from the Canadian Institute for Health Information, 16,700 of this country’s doctors — 24 per cent — were trained abroad. That’s a huge pool of talent with international experience. And there’s no shortage of good intentions. Dr. Habtu Demsas, a family physician in Selkirk, Man., has gone back to his Eritrean homeland three times at his own expense to voluntarily deliver care. He has gradually become discouraged by lack of outside support and a grasping local bureaucracy. “My intention was to open a clinic and serve,” he says. “But it’s not happening.” Federal authorities could help by creating an agency specifically to act as a clearing house for health-care professionals, like Demsas, eager to share their skills abroad. It would link them to areas most in need, help with paperwork and logistics, and provide some funding. There have been calls for such an agency in the United States and it’s an area where Canada could take the lead. We would all be better for it. Hard-pressed developing nations would receive life-giving aid, and Canada’s health professionals would return with new perspectives and better diagnostic and treatment skills, honed under extreme conditions. “It’s never one-way. It’s always of mutual benefit,” says Odame of Sick Kids. He leans forward and peers over the top of his glasses, giving his words special intensity. “It changes you. People come back and say this has been the most transformational experience that they’ve had.” That’s worth pursuing by Canada as a whole. With a bit of effort we can transform from a society largely absorbing others’ medical expertise to one that also gives much back. In doing so we’d be keeping faith with our own best aspirations.

Finance Ministers Debate Health Care Monday, December 19, 2011 By Adrienne Silnicki Council of Canadians December 19, 2011

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Jim Flaherty, Bank of Canada Governor Mark Carney, and provincial finance ministers are meeting in Victoria last night and today to discuss health care transfer funding. Although few details have emerged, Ontario Finance Minister Dwight Duncan has said that it’s been made clear that the 6 per cent escalating transfer that was negotiated by the former Liberal Federal government will not be continued past 2016, despite Jim Flaherty’s April 9th election campaign promise that it would. Instead a variety of options have been suggested including tying funding to growth in the economy- which is currently forecasted at about two per cent per year. As Bob Rae has pointed out in several news stories, tying health care spending to different economic indicators which are not connected to the problems we face in home care (like the cost of technology, or higher expectations of quality) seems pretty random. What most stories have failed to highlight, is that it’s downright dangerous to leave health care funding in such an unpredictable state. What happens when we fall into the predicted economic recession? If our GDP isn’t growing, then we will not be investing in health care? When Canadians are losing their jobs and their benefits due to a recession, our government will cut back our public health care services? Cutting public services, especially the ones that we need when we’re most vulnerable is just irresponsible. Fiscal restraint is important, finding savings in our public health care system through innovation is the right way to go, and science-based evidence shows that public health care is cheaper and safer than private, so it seems that we should be investing more now in population appropriate, public health care. Yet our government is telling provinces to bring in more private health care and reduce their spending overall. At the same time, the Federal government is negotiating a new trade agreement with the European Union (CETA) that will increase Intellectual Property Regimes on drugs making them more expensive for all of us and delay our ability to access generic drugs. In other words the Harper government is increasing the cost of health care for us, giving more of our money to large multinational corporations, and decreasing their share of health care payments to the provinces. More money for them, less money and less health care for you. Sound fair? We don’t think so either. And we’re not alone. Several provinces are also crying foul. The Atlantic provinces who have been meeting together in advance of the 2014 health care accord, met again last week to discuss the percentage of expenditure the Federal government is currently contributing to the provinces for health care. When Medicare was first introduced the split was 50-50. Now, the Federal government contributes 19 per cent of the health care expenditure in Newfoundland and Labrador, 20 per cent in Nova Scotia, and 23 per cent in Ontario. It takes stable and predictable funding to create and implement thoughtful social policy. If provinces are not given this type of funding, and are instead left to predict possible GDP revenue, how are they to implement or expand much needed care programs like home care and long term care? Alberta’s Finance Minister may think that having a “fair share” of health care isn’t

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important, but it is to Canadians. That’s why we have health care in Canada, and it’s the job of the Canada Health Act to ensure that every Canadian has the same quality and level of care across every province and territory. It’s time the Federal government stepped up and performed its job. We need adequate, predictable funding for the provinces and national care standards set by the federal government so that all people have care in Canada from cradle-to-grave. Dear Flaherty, enough passing the buck already- it’s time to be accountable to Canadians.

Fraser Institute report on wait times flawed Monday, December 19, 2011 By Don McCanne, M.D. Senior Health Policy Fellow Physicians for a National Health Program 15 December 2011 A critique of Waiting Your Turn: Wait Times for Health Care in Canada - 2011 Report, by Bacchus Barua, Mark Rovere and Brett J. Skinner, Fraser Institute December 2011

"This edition of Waiting Your Turn indicates that waiting times for elective medical treatment have increased since last year. Specialist physicians surveyed across 12 specialties and 10 Canadian provinces report a total waiting time of 19.0 weeks between referral from a general practitioner and receipt of elective treatment." - Fraser Report The Fraser Institute has released its 21st annual report on wait times for health care in Canada. This report is used widely to condemn Canada's reliance on their single payer medicare program for the financing of health care. It helps to fulfill the Fraser Institute's libertarian agenda of advocating for privatization of their health care system. Today's comment takes a critical look at this report. The findings in the report are based on the solicited opinions of Canadian physicians. Questionnaires were sent to 10,737 of the 68,000 active Canadian physicians. Of these, 1,696 physicians responded (15.8% response rate). Distributing these responses amongst the 12 specialties and ten provinces results in single digit tallies for 63 percent 294

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of the categories, and often only one physician falling into a given category. For instance, only one specialist in internal medicine represented the views of all internists in the province of Prince Edward. Besides questioning whether these numbers are adequate to represent the views of all Canadian physicians, there are two other factors that may have skewed the results. As an enticement to return the questionnaires the physicians were given the chance to win $2000. Physicians with an entrepreneurial mentality - those who more likely favor privatization of health care - might be more favorably inclined to try for this reward. More altruistic physicians who really care about the problem of queues might be insulted by this attempt to buy responses with a prize. A great many Canadian physicians strongly support their medicare program and oppose the current efforts to privatize both the delivery system and the health insurance system. These physicians are acutely aware of the agenda of the Fraser Institute and would be much less likely to cooperate in their biased studies. Thus it is unlikely that the sampling truly represents the views of mainstream Canadian physicians. Another important consideration is that this study was heavily weighted toward elective surgeries. Emergency conditions were not included. Patients in Canada have excellent access when a true emergency exists. So this study is not looking at acute, urgent conditions. Instead, this study was looking more at patients with chronic conditions which are usually managed over a long period of time, sometimes for a lifetime. Yet the authors imply that the disorders for which they are treated began at a single point in time in the generalist's office. In reality, when the physician and patient decide that it is time to consider more options for managing a chronic problem, often a decision is made to obtain a specialist's consultation. These are not emergencies so a routine appointment is scheduled. Except for a few specialties, most of these appointments are within a reasonable time interval. Once the patient sees the specialist, more time is consumed for appropriate comprehensive evaluation of the problem before a decision is made on definitive management. Again, these time intervals are mostly reasonable. Once the decision is made to schedule the elective surgery or other procedure, then excessive waiting times can be more objectionable. But how long are these waiting times? The specialists were asked what a reasonable waiting time was for their given procedures, and how long their patients had to wait. With the exception of plastic surgery and orthopedics, most waiting times were very close to those that the specialists considered to be reasonable. (Internal medicine was also an outlier for endoscopy and non-urgent angiography.) The Fraser report is very deceptive because they add to the time between scheduling a procedure and completing a procedure the time for the routine request by a generalist for Medicare's 50th Anniversary

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a consultation, and the time for the specialist to complete the full evaluation before deciding on the specific management. If you separate these out, most of the intervals are quite reasonable. The 19 week wait reported by Fraser has little meaning, since it does not represent the time between scheduling a procedure and completing it. The much more credible study from the Canadian Institute for Health Information confirms that Canada is doing quite well in delivering care within medically recommended wait times.

"At least 8 out of 10 Canadian patients are receiving priority area procedures, such as hip replacements, cataract surgery and cancer radiation treatment, within medically recommended wait times, according to a new study from the Canadian Institute for Health Information (CIHI). The study provides the first comprehensive national picture of how long Canadians wait for care in priority areas as compared with evidence-based benchmarks of acceptable waits" This does not mean that there are no problems. There is a very major problem, and it is political. Conservative politicians who currently control much of the government would like to privatize the health care system. Their approach is to abandon their role as stewards of the health care system, deliberately allowing longer queues to develop. Then the public is told that the only way to fix these outrageous delays that are killing people is to turn to the private health care markets in order to bypass the queues. As this view gains traction there is greater support for what amounts to a two-tiered system - the best of care for the relatively wealthy, and an under-funded public program for the masses. Sound familiar? Only we're far ahead of them in fragmenting our system.

Dr. Norman Bethune documentary Tuesday, December 20, 2011 National Film Board of Canada This feature documentary is a biography of Dr. Norman Bethune, the Canadian doctor who served with the loyalists during the Spanish Civil War and with the North Chinese Army during the Sino-Japanese War. In Spain he pioneered the world's first mobile blood-transfusion service; in China his work behind battle lines to save the wounded has made him a legendary figure.

Harper government attacks public health care Tuesday, December 20, 2011 By James Clancy NUPGE News December 20, 2011 "Once again, the Harper government has shown that it prefers to dictate rather than negotiate," said James Clancy, NUPGE National President. "Their unilateral decision to cutback billions of dollars in health transfer payments will have serious negative consequences in terms of the accessibility and quality of health 296

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care across the country."

The National Union of Public and General Employees (NUPGE) says the announcement by federal Finance Minister Jim Flaherty on the Canada Health Transfer (CHT) further demonstrates the Harper government's disdain for democracy and a total lack of leadership on health care. At a meeting of Finance Ministers from across the country, Flaherty announced that the federal government would extend the 6 per cent escalator clause, part of the 2004 Health Accord, for the CHT only until the 2016-17 fiscal year. After that, until at least 2024, annual increases in the CHT will be tied to nominal GDP growth. The Ontario Department of Finance projects that the Harper government's decision could remove as much as $36 billion in support for health care across the country. NUPGE National President James Clancy criticized the Harper government for acting unilaterally rather than working in partnership with the provinces to improve health care. "Canadians want the federal government to work in partnership with the provinces not dictate terms and conditions," says Clancy. "Where was the consultation and negotiations? How are the provinces health care needs and priorities reflected in this announcement?" Clancy also said the announcement shows a total lack of commitment and leadership by the Harper government when it comes to the top public policy issue for most Canadians. "There's no doubt that this announcement means the removal of billions of dollars from the health care system and that's going to have serious negative consequences for the accessibility and quality of care that Canadians receive," says Clancy. "This is the exaxct opposite of what Canadians want - they've repeatedly said they want a stronger federal role and greater federal investment in health care, not less," says Clancy. "And the reality is that the federal government could afford to make a much bigger investment in health care if it stopped spending billions of dollars on corporate tax cuts, new fighter jets and federal mega-prisons." "In addition to more investment, Canadians want the federal government to work with the provinces to fill in the gaps in the continuum of care. They want to see new programs and services in the areas of home care, long term care, prescription drug coverage (pharmacare) and mental health," said Clancy. Medicare's 50th Anniversary

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Why the Harper funding diktat endangers medicare Tuesday, December 20, 2011 By Thomas Walkom TheSun.com Tue Dec 20 2011

For medicare, the federal governmentâ&#x20AC;&#x2122;s new health financing ultimatum is a clear and deliberate step backward. By scaling back cash contributions to provincial medicare plans, it will gradually and inevitably destroy Ottawaâ&#x20AC;&#x2122;s ability to enforce the Canada Health Act. By tying these contributions to the vagaries of the overall economy, it will make it harder for provinces to forge long-term health-care strategies. And by cutting back health spending during slump periods, it will remove money and jobs from health care precisely at those times when they are needed most. Most provincial governments were furious when federal Finance Minister Jim Flaherty formally unveiled his non-negotiable scheme Monday. Justly so. The new plan from Prime Minister Stephen Harperâ&#x20AC;&#x2122;s Conservatives threatens to undo key medicare gains that Canada has made in the past eight years. To understand those gains, we have to understand what medicare is. It is a national public health insurance scheme administered and partly funded by the provinces. The only incentive for individual provinces to adhere to national standards set out in the Canada Health Act is that doing so allows them to get cash from Ottawa. But since its inauguration by the Liberals in 1968, medicare has been under attack from those who think the federal government has no business in health care. 298

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Indeed, it was a Liberal government that, in 1977, first devised a way to gradually extricate Ottawa from what had been a 50-50 cost sharing arrangement with the provinces. The Liberals did so by first tying annual federal health transfers to the ups and downs of the economy. Like Flaherty, they explained this as a cost-saving measure More important, they began to count any tax room ceded to the provinces as part of their health contribution. The use of these so-called tax points allowed successive Liberal and Conservative governments to gradually reduce the actual cash they transferred to provinces. By 2002, Ottawa was contributing only 18 per cent of the public cash going to medicare. An increasingly unenforceable Canada Health Act was on its way to becoming a dead letter. This is why Roy Romanow’s 2002 Royal Commission into health care recommended a boost in federal cash contributions. And it is why the federal-provincial health accord two years later was so important. That accord eliminated any linkage between federal health transfers and economic growth. More important, it committed Ottawa to put more real cash into medicare. Thanks to that accord, the federal government’s cash share of health-care funding has gone back up to about 25 per cent. Flaherty’s new plan very carefully doesn’t mention the accounting fiction known as tax points. But even so, the Conservative arrangement would eventually return the country to where it was in 2002 — with Ottawa putting little into medicare and the federal government losing all ability to enforce national standards that Canadians accept as given. Think of this as stage one. Stage two has not yet been announced. But it is intriguing to see that Ottawa still wants to continue talking to the provinces about health, even as it insists that the main topic of contention — money — is non-negotiable. What will they talk about? My guess is “flexibility.” Having warned the provinces that he plans to eventually starve them of cash, Prime Minister Stephen Harper can now tell the premiers that he’ll turn a blind eye if they try to make up this shortfall through creative solutions — even if such solutions (delisting of all but core services? user fees?) run directly counter to the letter and spirit of medicare.

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Passive-aggressive Tories tackle health funding Tuesday, December 20, 2011 By Karl Nerenberg Rabble.ca December 20, 2011

In the 1960s, when Canada’s universal healthcare system first got underway, between 40 and 50 cents out of every dollar provinces spent on health care was federal. The rest came from the provinces’ own coffers. Today the federal figure is around 21 per cent; the rest, nearly 80 per cent, is provincially collected money. It is not the same for every province. For British Columbia, for instance, the federal contribution is less than 15 per cent. And the federal figures do not include equalization payments, of which some can be assumed to go to healthcare. What is clear, though, is that there has been a fairly steady decline in federal participation in health funding over the years. The federal spending power When the Pearson government of the 1960s went about reproducing Saskatchewan’s universal healthcare system throughout the country, it used the lure of federal money to entice the provinces. The original idea was that medicare would be a fully cost-shared program. Health, of course, is entirely within provincial jurisdiction. How the federal government gets involved is through the federal “spending power”. Although neither the BNA Act nor any other constitutional document mentions it, the federal government is deemed to have the right to spend in areas of provincial jurisdiction. In the case of healthcare, the federal government did not use its spending power until the mid sixties. During that period, the NDP-supported minority Liberal government was engaged in a large scale expansion of the Canadian social safety net.

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The big pieces of that expansion included: enhanced unemployment insurance; regional economic development programs; the Canada (and parallel Quebec) pension plans; the Canada Assistance Plan, through which the federal government leveraged provincial social welfare and social assistance spending; and the universal, public health insurance program. Some of these programs were entirely federal. But a great deal of this social expansion required federal-provincial cooperation, and over time, the federal government sought to get away from 50/50 funding arrangements. It wanted to limit the growth of federal spending in healthcare and other provincial fields. However, the federal government still made use of its spending power to foster national standards and equal access to services throughout the country. Taking on "extra billing" and other corrosive practices The Trudeau government’s Canada Health Act of 1984 is the quintessential example of federal muscle flexing. The federal health minister of that time, Monique Bégin, used the Act to put a stop to practices such as “extra billing” which were eroding the universal healthcare system. By the early 1980s it had become almost impossible to have surgery in most Ontario hospitals, for example, without agreeing to pay an “extra” fee to the anesthesiologist. There was an effective “closed shop” in Ontario. In order to practice, virtually all anesthesiologists had to agree to “extra bill”, to impose fees on patients over and above the provincial fee. The Canada Health Act put an end to that practice. The Act enunciated five main principles for healthcare throughout the country: public administration, comprehensiveness, universality, portability and accessibility. More important, the Act had teeth. It provided for financial penalties, in the form of reduced federal transfer payments, for provinces that broke the rules. Wait times reach near crisis proportion When the Chrétien government radically slashed health transfers to the provinces in 1995 it did not get rid of the Canada Health Act. But that cost-cutting exercise, coupled with growing demand for health services, had significant negative impacts on the healthcare system. One of the most troubling of those negative impacts was the increase in wait times for essential treatments and services. As a result, in 2004, when the health funding arrangement was renewed for 10 years, with 6 per cent per year annual increases in federal transfers, the provinces and federal government agreed to take on the wait-times problem. The two levels of government agreed to reduce wait times in five priority areas: cancer Medicare's 50th Anniversary

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treatment, cardiac care, diagnostic imaging, joint replacement and sight restoration. And the provinces agreed to accept common benchmarks to measure how well they were succeeding. Seven years later, this seems to be a case in which federal-provincial shared goals have been effective. By 2010, a Canadian Institute for Health Information (CIHI) report showed that a large majority of Canadians were receiving treatments in the five areas within clinically recommended time frames. Unilateral federal funding decision; no joint undertakings Now, the current Conservative government has put a new, non-negotiable funding proposal on the table. It will continue the 6 per cent increases for a few years (until 2017), then will peg increases to economic growth, regardless of any potential increase in needs due to an aging population or other factors. But this time there is no effort to put joint federal-provincial goals on the table, as we had in 2004. Finance Minister Jim Flaherty has made vague statements about the provinces making efforts to manage healthcare more efficiently and finding ways to reduce costs, and thatâ&#x20AC;&#x2122;s about it. There is nothing wrong with seeking to deliver healthcare more effectively and at lower cost, of course, and there are many ways to do that. One of those is through the use of electronic health records (EHR). As a country, we are still way behind the curve on EHR, despite the millions already invested. The federal governmentâ&#x20AC;&#x2122;s contribution to the EHR effort is Canada Health Infoway, a federally funded agency designed to assist and encourage provinces and the technology industry in their efforts. Another way to reduce costs is through improved service delivery systems. The federal government also funds a body that works in that area: the Canadian Health Services Research Foundation. It trains healthcare managers in evidence-based strategies and facilitates sharing across jurisdictions of best practices and experiences. And there are other significant federal health investments, such as CIHI and CIHR (the Canadian Institutes for Health Research), the entities that deal with health statistics and fund basic scientific research on health matters. A passive-aggressive approach? Taken together these all are part of the federal governmentâ&#x20AC;&#x2122;s contribution to the national healthcare system. Their work could actually make a difference and help cut healthcare costs. None were created by the current government and it is not at all certain that the Conservatives will be interested in supporting all of these federal efforts. There are signs that at least some are in danger. 302

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The current Conservative approach to the whole area of health has always seemed somewhat passive aggressive. Many Conservatives are on record as favouring a much increased private sector role in healthcare. Later this week we’ll look at what the Fraser Institute proposes. It seems to be lurking in the background of current Conservative policy. However, the Harper government knows there is not much appetite in Canada for an American-style, private enterprise health system. Not yet, at any rate. Do the Conservatives hope that by putting the healthcare system on a diet, and doing little to invest in improved service delivery, they may be able to build a groundswell for the private sector option? And we haven’t even talked about the so-called “population health” issues -- the impact of poverty, inequality, pollution, diet, exercise and stress (among other factors) on healthcare and health outcomes. We will have to leave that for another day… À bientôt!

Saskatchewan's Medical Care Insurance Act 1961 Tuesday, December 20, 2011 Medicare: A People's Issue

Throughout 1961, the proposed medical care plan remained the top political issue in Saskatchewan. To fulfill its promise of consultation, the government created the Advisory Planning Commission on Medical Care, mandated “to study and report upon a medical care insurance program for the province and on the public need in other fields of health.”

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The former President of the University of Saskatchewan, Dr. W.P. Thompson, was invited to act as chair. It was an onerous job, made especially difficult by the attitude of the medical members of the committee. 49 briefs of more than 1,200 pages were submitted by individuals and groups from across the province. In September of 1961 the Committee produced an Interim Report which recommended: • Universal coverage for all residents. • Comprehensive benefits based on residence, registration and payment of personal premiums with additional finances to be drawn from general government revenues. • Utilization fees. • Fee-for-service payment. • The creation of a commission responsible to the government to administer the plan. Despite continued opposition from the College of Physicians and Surgeons, the Douglas government used the report as the basis of the Medical Care Insurance Act, which it passed in a special sitting of the legislature. Ten days before the Act was to be given Royal assent, Douglas turned over the reins of government to the steady but less than charismatic former Minister of Education, W.S. Lloyd. Douglas’s decades’ old dream of a universal medical care plan seemed complete as he left provincial politics to run for the national leadership of the newly-created New Democratic Party (NDP). The Act was set to become law on July 1, 1962. Two camps, the government in one and the doctors in the other, took uncompromising positions that would eventually lead to crisis and strike.

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Bad medicine: Harper's prescription for privatization Medicare Wednesday, December 21, 2011 By Jesse McLaren Rabble.ca December 21, 2011 304

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The Harper government has announced a new funding arrangement for Medicare, which after 2016 will be tied to economic growth in the nominal GDP. According to one estimate, this will translate into $21 billion in cuts to health-care funding over 10 years. By unilaterally imposing health-care funding cuts on the provinces, the Harper government is putting its own brand on a familiar prescription for privatization: scapegoat Medicare, ignore private health costs, pretend you don't have any money, and then cut public health care to encourage privatization. 1. Scapegoat Medicare Immigration Minister Jason Kenney, fresh off his attack on Muslim women, was the first Tory to open the campaign against Medicare -- scapegoating it for cuts to social services. Suddenly a public education advocate, he claimed that public health-care costs are soaring and devouring provincial budgets. Kenney stated that, "For some of the provinces, if they continue in that trajectory, there will be nothing left for education, for universities, for anything else." This is a common myth, repeated by the corporate media, that manipulates statistics created by decades of Tory and Liberal cuts at both federal and provincial levels. The relative rise in provincial health-care budgets is a statistical effect from greater cutbacks elsewhere. According to the 2011 report, "Neat, plausible and wrong: the myth of health care unsustainability" by Canadian Doctors for Medicare (CDM):

"The change in share of provincial budgets is not primarily due to increased health care spending. It is the result of decreases in other provincial spending to accommodate political decisions to cut taxes â&#x20AC;Ś Deep cuts in federal transfers to the provinces in the mid-1990s were compounded by provincial tax cutting policies in the latter part of the decade, causing significant reductions in total provincial budgets. Provincial revenues have fallen almost $30 billion since 1997, causing decreases in other government program spending through cuts to education, social services, and municipalities â&#x20AC;Ś It is tax cuts that have 'crowded out' these priorities, not Medicare." 2. Ignore private inefficiencies Overall health costs have increased, but it's crucial to differentiate between public and

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private. While Medicare costs have been constant and sustainable over 30 years, overall health costs have increased -- from those sources not covered by Medicare. As the CDM report explains: "The real cost driver is precisely the thing that critics of Medicare tout as the solution: private health care. Currently 30% of all health spending is in the private sector, up from 24% in 1975 â&#x20AC;Ś the overall cost of care has been driven most significantly by the rising cost of pharmaceuticals." If we want to control rising health care costs, we need to control the profit-driven private sector, federally and provincially. It's estimated that developing a universal public pharmacare program could save $10 billion annually. But federal governments have refused to make this "efficiency." Meanwhile a year ago the B.C. government slashed funding for the Therapeutics Initiative -- an independent evidence-based review board that helped promote safe and affordable pharmaceuticals. 3. Pretend there's no money While ignoring the heightened costs of private medicine, the Tories are using the economic crisis to justify cutting public health care, claiming there's no money to cover it. According to Finance Minister Jim Flaherty, "We all realize that public finances relate to revenues and we can't pretend that we can spend money that we don't have." This ignores massive tax cuts, bank bailouts and military spending sprees. While the new health plan could cut $21 billion from health, the Tories gave a $69 billion bank bailout, are wasting $220 billion on tax cuts, and have been going on a military spending spree -from $30 billion fighter jets, to $25 billion warships -- as part of a $490 billion military plan. 4. Cut the public to promote the private But the Tories don't want to debate the spending priorities of the 1 per cent, so they've chosen to unilaterally impose cuts to the provinces, to encourage privatization. According to Health Minister Leona Aglukkaq, "This investment also provides the opportunity to put the divisive issues funding behind us to allow us all to focus on the real issue -- how to improve the system so you can ensure timely access to health care when needed." In other words, the government is trying to bury the question of federal funding -- which initially comprised 50 per cent of Medicare's funding -- in order to starve the provinces and encourage "timely access" through privatization, a strategy many provincial governments are happy to oblige. Occupy Medicare This passive-aggressive approach is similar to Harper's campaign against abortion: claim to "not open the debate" while imposing cuts anyways. But this is based on a position of weakness: an overwhelming majority of people support public health care, the legacy of a grassroots movement that won Medicare and continues to defend it. Public health care is not a divisive issue: it unites us, as do other issues. The funding is there, not only for public health care but for all the social determinants of health: income and social equality, housing and food security, education and a clean environment. But to occupy health and health care, we need to move beyond the 1 per cent world of tax cuts, bank bailouts, military spending and profit-driven medicine.

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The Thompson Committee (1960–62) and Saskatchewan Medicare Wednesday, December 21, 2011 By C. Stuart Houston Encyclopedia of Saskatchewan

Dr. W. P. Thompson The Advisory Planning Committee on Medical Care consisted of twelve members: its Chair, Dr. W.P. Thompson, recently retired as president of the University of Saskatchewan; Beatrice Trew and Cliff Whiting (representing the people of the province); Drs. J.F.C. Anderson, E.W. Barootes, and C.J. Houston (College of Physicians and Surgeons of Saskatchewan); Dr. I.M. Hilliard (College of Medicine); Donald McPherson (Saskatchewan Chamber of Commerce); W.E. Smishek (Saskatchewan Federation of Labour); and Dr. V.L. Matthews, former Health Minister T.J. Bentley, and Deputy Minister of Public Health Dr. F.B. Roth (the last three representing the government of Saskatchewan). John E. Sparks served as the non-voting secretary. Six of the twelve members were medical doctors. The committee received its instructions on April 26, 1960, and deliberations began on May 9. The committee held 23 meetings for a total of 43 days; it conducted 33 public and 7 private hearings, analysed 50 study documents, and received 1,226 pages of documentation in 49 briefs. Teams of committee members visited health care programs in Australia, New Zealand, Great Britain, Holland, Norway, Sweden and Denmark. The committee was instructed to report to Walter Erb, Minister of Public Health, on “the extent of public need in the various fields of health care as related to a medical care program,” following the broadest possible interpretation. They studied in detail the doctor-sponsored plans (GMS and MSI), municipal doctor plans, the plan for public assistance recipients, as well as existing mental health, cancer and tuberculosis programs. The interim report, issued on September 25, 1961, recommended that health services be developed in a coordinated way, that physicians be paid on a fee-for-service basis, with use of modest “utilization fees” of $1 for a first office visit and $2 for a home visit, and that the program be administered by an independent commission who reported to the Minister of Public Health. Such a plan was estimated to cost close to $20 million per year. Walter Medicare's 50th Anniversary

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Smishek appended a 17-page minority report, in which he argued the case for a system with salaried physicians and for making the Minister of Public Health directly responsible for its administration. The three representatives of the College of Physicians and Surgeons appended a 3.5 page minority report, signed also by Donald McPherson, recommending a less ambitious and less expensive plan which included a selective aid program for those not covered by existing plans, at an estimated cost of $3.6 million per year. They added that mental health services and rehabilitation facilities required attention before an all-inclusive plan was introduced. Between this interim report and the final report, momentous events took place. The CCF government passed the Saskatchewan Medical Care Insurance Act on November 17, 1961, and four days later appointed William Gwynne Davies, former executive-secretary of the Saskatchewan Federation of Labour, as Minister of Public Health. This appointment, from the doctors’ viewpoint, was the equivalent of raising a red flag in front of a bull. The health plan was slated to begin on April 1, then was postponed to July 1. The doctors began the “23-day doctor’s strike,” which they termed a work stoppage, on July 1. Lord Stephen Taylor persuaded both sides to moderate their positions, and the Saskatoon Agreement was signed on July 23; this agreement was adopted into law at a special session of the Legislature on August 2. Meanwhile the department operated with Dr. Vince Matthews as acting Deputy Minister from June 30, 1962 to September 1, 1963-at which time J.G. Clarkson was appointed Deputy Minister. One week later, Allan Blakeney, a man whose integrity was recognized by most doctors, took over the ministry. It was an anti-climax when the final report of the Thompson Committee was submitted on September 26, 1962: it added useful data and details, but was now, after the fact, an interesting document for historians to ponder.

Four comments on Harper's attack on health care Thursday, December 22, 2011 Is Money Enough? The Meaning of 6% and Flaherty’s Health “Plan” By Armine Yalnizyan Progressive Economics Forum December 21st, 2011

As Christmas presents go, this one was a shocker: Over lunch on Monday, cashstrapped Finance Minister Jim Flaherty promised provincial and territorial finance 308

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ministers he’d increase federal funding for health care by six per cent each year for the next five years. No strings attached. No negotiations. A done deal. With a catch. Read more HERE. Attacking our health care is un-CanadianThe Citizen December 21, 2011

The agenda for the federal Conservatives with regard to health care transfer payments is quite simple. They want to force privatization of our health care system by starving it of the funds it needs to keep going. Read more HERE. Leading Canada's public healthcare to the free-market guillotine By Stefan Christoff Rabble.ca December 22, 2011

National discussion in Canada on the Conservative government's new healthcare financial ultimatum, a take-it-or-leave-it-style proposal, largely revolves around myths. First that financing alone is key to securing a sustainable public healthcare system and second that free-market economic winds will provide sustainable guidelines, via GDP, for viable future government healthcare financing. Read more HERE. Feds walk away from health care reform Council of Canadians December 21, 2011

The Harper government let down millions of Canadians this week by effectively walking away from the opportunity to craft a 2014 Health Accord that brings real reform to our health care system. Read more HERE.

Health Minister’s ‘what would Tommy do?’ rationale misses mark Wednesday, December 28, 2011 By Robert Matas Globe and Mail Dec. 28, 2011

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“I’m not certain Tommy Douglas had in mind free parking when he talked about universal publicly funded health care,” Health Minister Mike de Jong says in a year-end interview in the Vancouver Sun. Tommy Douglas is a library in Burnaby, a collegiate in Saskatoon, a street in Côte SaintLuc and a townhouse development in Toronto. Corner Gas fans know the politician who introduced universal publicly financed medicare to Canada as the advocate for free coffee refills. “You’re not in Toronto any more, Lacey, with your grande-mocha-dappo-loppafrappochinos,” Brent said during an episode in the first season. “This is Saskatchewan. Tommy Douglas fought the federal government for free refills on coffee.” And now Health Minister Mike de Jong is mocking the suggestion that Mr. Douglas’s legacy could stand for something more: free parking at hospitals. His comments came in response to a question about an editorial in the Canadian Medical Association Journal by Rajendra Kale. The editorial proposed free parking as an important step for patientcentred health care. The editorial maintained that parking fees amount to a user fee in disguise. The fees may interfere with a clinical consultation, compelling a patient to cut short a visit in order to avoid a parking ticket or additional charges. The impact is felt especially by patients undergoing regular dialysis or chemotherapy and parents with sick children. Hospital administrators and politicians say the money – about one per cent of hospitals’ net revenues – is a valuable source of funds for health care. But the fees are an additional source of stress for patients and are, for all practical purposes, a barrier to health care, the editorial says. Mr. Douglas did not make speeches about parking fees but he spoke about medicare. He responded to the most common criticisms during a special session of the Saskatchewan legislature in October, 1961, when his government brought in the Medical Care Insurance Act. Health-care services “should be the inalienable right of every citizen of a good society,”

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Mr. Douglas said. Measuring medical care just in dollars was “sheer nonsense,” he said. “When we’re talking about medical care, we’re talking about our sense of values. Do we think human life is important? Do we think that the best medical care which is available is something to which people are entitled, by virtue of belonging to a civilized community?” As for paying the bills, Mr. Douglas said around two-thirds of the cost ought to be raised by taxes related to ability to pay. Flat taxes that bear no relationship to ability to pay should be kept as small as possible, he said. Requiring a means test to qualify for health care was humiliating, he said. He believed that most people were willing to pay for medicare, providing the cost was spread equitably on the basis of ability to pay. “The only ones who are likely to oppose it are those who fear that they will have to help those less fortunate than themselves,” he said. No one should be exempt from paying, he said. “Even if we could finance the plan without a per-capita tax, I personally would strongly advise against it,” Mr. Douglas said. “There is a psychological value in people paying something for their [medical] cards. It is something which they have bought; it entitles them to certain services. We should have the constant realization that if those services are abused and costs get out of hand, then of course the cost of the medical care is bound to go up.” By invoking Mr. Douglas, Mr. de Jong has set a new benchmark for medical care in B.C. He could now be expected to ask, “what would Tommy do?” when confronting any health-care issue. Based on that measure, Mr. de Jong was mistaken in using Mr. Douglas to back up his views on parking fees. Mr. Douglas appears to have indicated that the charges, as an unavoidable part of health care, should be paid through taxation, not user fees.

Saskatchewan's municipal doctors: A forerunner of the medicare syst... Saturday, December 31, 2011 By C. Stuart Houston, MD CAN MED ASSOC JOURNAL 1994

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jurisdiction in Canada to employ municipal doctors and municipal hospitals, and the only province where the system was widely adopted. Why and how did Saskatchewan come to lead North America in introducing these important milestones on the road to medicare? One answer lies in the cooperative spirit that developed as a way of coping with the exigencies of rural life. Communities came together for barn raisings and, later, to build skating rinks and curling rinks. Extending this spirit of cooperation to the provision of health care was a natural outgrowth, especially since people widely scattered in a new land had a hard time finding medical services.

Read more HERE. (pdf)

Saskatoon Community Clinic celebrates 50 years of medicare Saturday, December 31, 2011

Click image above to enlarge

Meet the new 1%: healthcare CEOs replace bankers as America's best ... Monday, January 02, 2012 No bankers in top 10 of America's best-paid executives, but those in charge of healthcare and drugs firms are in the money By Dominic Rushe guardian.co.uk 14 December 2011

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Joel Gemunder, CEO Omnicare "earned" $98 m. Pity Wall Street's bankers. Once the highest-paid bosses in the land, they are now also-rans. The real money is in healthcare and drugs, according to the latest survey of executive pay. There are no bankers in the top 10 of this year's GMI survey of CEO pay. In fact, they have been out since 2007, when Goldman Sachs boss Lloyd Blankfein competed for the top slot with Richard Fuld, boss of soon-to-be-bust Lehman Brothers, and Angelo Morzillo, head of Countrywide, once the largest sub-prime home loan firm. With the bankers still recovering from their tussle with hubris, old age and infirmity were 2010's boom businesses – at least in terms of pay. Leading the pack was John Hammergren, chief executive of McKesson Corporation. The firm's 52-year-old chairman, chief executive and president took home $145,266,971 in 2010. McKeeson is probably the biggest company you've never heard of. Headquartered in San Francisco, the company is the largest pharmaceutical distributor in North America, distributing a third of the medicines used in the US. McKeeson's sales topped $112bn last year. Hammergren's next closest rival was Joel Gemunder, outgoing boss of Omnicare, where he had been president since 1981. Omnicare is a pharmacy company that dispenses drugs in nursing homes – among other services – and had sales of $6.15bn last year. When Gemunder started at the firm it had sales of $150m. His 2010 total pay package was worth $98,283,242. CVS Caremark, which operates 7,000 pharmacies across the US, awarded chief executive Thomas Ryan $68,079,823 in 2010. Caremark's share price was $71.70 on 1 May 1998, when Ryan joined the firm, and ended 2010 at $34.29. Ronald Williams, boss of health insurance giant Aetna, made $57,787,786 in 2010. Another recipient of a golden goodbye, Williams made $50.4m on his stock options last year. Williams is one of the US's most prominent African American business leaders, and has campaigned against healthcare reforms that would have introduced a governmentbacked public insurance option to compete with private insurers. Since he became CEO, Aetna's stock price declined by 70%.

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Unsung Heroes of Health Care Show: CBC Radio Monday, January 02, 2012 By Dr. Brian Goodman White Coat, Black Art CBC Radio, Nov. 11, 2011

When you think of hospitals, you probably picture places staffed by nurses and people like me. The image is far from complete. There are countless others who toil in healthcare's shadows. They have job titles like service assistant, lab technician and respiratory therapist. Explaining what they do can be hard to do at cocktail parties. But make no mistake: these are people who look after you with skill and compassion. And sometimes, they mean the difference between life and death. This week, we walk in the shoes of the unsung heroes of health care. We tell their stories - doctors and nurses need not apply. I visit a hospital where I meet a professional who keeps your breathing when seconds count. I talk with a clinic receptionist who cheers you up as you wait nervously for test results from your doctor. I chat with a case manager who - more often than not - finds a way to keep seniors and others with chronic illness and disability living at home. We also meet a hospital employee who stayed at her post at the hospital when others were fleeing for their lives. To listen now, download the podcast.

Doctor: Health care can survive baby boomer 'tsunami' Wednesday, January 04, 2012 CTV News Video HERE. January 4, 2011

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The growth of Canada's labour force will slow to a crawl over the next two decades as an increasing number of baby boomers leave their working days behind, according to a projection by Statistics Canada.The growth of Canada's labour force will slow to a crawl over the next two decades as an increasing number of baby boomers leave their working days behind, according to a projection by Statistics Canada. Canada's aging population has been called a "tsunami" that could eventually swamp our public health care system, but a health care expert says the true threat is an inability to adapt. Dr. Michael Rachlis, a medical doctor and analyst, believes that aging and ailing baby boomers won't break the public purse in the coming years. Indeed, much of his analysis is directed at calming skittish policy makers who fear that health costs and aging baby boomers are on a collision course. "It's not a tsunami, even though it's been called that," he told CTV's Power Play from Toronto on Tuesday. "It's more like a glacier. And you don't get run over by a glacier unless you haven't moved." Instead, Rachlis is an advocate for what Tommy Douglas called "Second Stage Medicare," which is essentially a patient-friendly system of health delivery focused on keeping people out of hospitals. While some experts believe that health costs will rise to 70 or 80 per cent of provincial budgets in the next two decades, Rachlis believes that actual health spending has decreased. He points to a recent report from the Canadian Institute for Health Information that suggests health spending has actually fallen over the past three years, since public expenditures have also sunk. Accordingly, Canadian policy makers and officials shouldn't panic about crumbling health infrastructure, but should work to stretch the dollar as the population ages. Think of it as acting strongly before illness strikes rather than reacting to patients' symptoms after the fact, said Rachlis. "It's not the aging population that's the crisis, it's the inappropriate way that the health care system deals with everything that leads to those problems," he said. Medicare's 50th Anniversary

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In the past, Rachlis has assailed the referral system as antiquated, and he believes that Canadians wait far too long to see specialists. Rachlis notes that specialized doctors should work much more closely with primary-care doctors and general practitioners. If they did, more Canadians would be spared hospital trips and costs would go down in the long run. Last month, Finance Minister Jim Flaherty laid out a new plan for federal transfer payments, but some critics have said the spending schedule gives the provinces too much leeway in how transfer dollars are spent. "It looked like the federal government was just throwing its arms up and saying, ‘We can't do anything with this, we're just going to leave it to the provinces,'" Rachlis said. But a similar issue occurred during the previous Liberal government, and health dollars were used to pay doctors and nurses more money rather than to spur innovation, he added. Though there is growing awareness about the effectiveness of preventative and community-based medicine, Rachlis said that governments still haven't been able to reform the system enough. "We still have not found a way to engineer the politics to get us there."

Preserve Medicare Wednesday, January 04, 2012 By Anne Morris Salmon Arm Observer January 04, 2012

MP Colin Mayes tells us that the federal government is reviewing the Canada Health Accord and that the current health-care system “is not sustainable.” He says that “solutions, whether they are tied to private delivery or public delivery,” need to be found (Dec. 21). This should raise a red flag for Canadians who value our public Medicare system. Canada’s current Health Accord expires in 2014, and the federal government is preparing 316

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for negotiations with the provinces and territories on a health-care accord for the future. Private interests are lobbying to expand for-profit health services for the wealthy. The Harper government wants to oblige by convincing Canadians that our current system is unaffordable and that increased privatization is the answer. But two-tier health care has been proven to increase costs and also wait times for those of us who can’t afford private health care. Furthermore, if private for-profit hospitals are permitted in Canada, American HMOs will rightly claim that under the North American Free Trade Agreement, they too have a right to establish themselves in Canada. Do Canadians want American-style health care? I think not. The federal government can afford a well-funded, enhanced public health-care system if it chooses to do so. Cancelling the planned purchase of 65 F-35 stealth fighter-bombers, would free up $30 billion to invest in health care over the coming years, and cancelling the planned tax cut to corporations would yield another $6 billion. A recent report from the international Organization for Economic Co-operation and Development, (cited in the same issue of the Observer), states that income inequality in Canada is rising, and that it is not market forces but federal and provincial government policies that are increasing this inequality. Medicare is an equalizing force in Canadian society in that it is designed to provide quality care to everyone, regardless of income status. Let’s keep it that way by saying ‘no’ to the Harper government’s smoke and mirrors campaign to persuade us that Medicare is unaffordable.

Health care belongs to all Canadians Thursday, January 05, 2012 Williams Lake Tribune January 05, 2012 Editor:

Residential care and Medical Service Plan fees, hikes, and the introduction of convalescent care fees have added to the financial burden of seniors. In many respects we are back at the beginning when Tommy Douglas began the Medicare's 50th Anniversary

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campaign against privatization and had the vision to make health care a public service for all, regardless of their income. It is time to revisit the original principles of the Canada Health Act. In September 2004 the federal Liberal government announced a 10-year action plan on health. This accord expires in two years, and one has to ask what has been accomplished. The action plan was based on principles of universality, accessibility, portability, comprehensiveness, and public administration. It promised access to medically necessary health services when they are needed, based on need, not ability to pay. From my vantage point as a retired person, I would have to say not much, if anything, has improved. We have federal and provincial governments that have been silent on the encroachment of privatization in health care. Assisted living and residential care has been delivered to the private, for-profit sector in a disproportionate ratio to publicly funded models of care, which has left many seniors and disabled unable to afford care. Provincial health ministers and Leonna Aglukkaq, minister of health for Canada, meet in Victoria Jan. 16-17, 2012 to continue their discussion of the 2014 Health Care Accord. Health-care advocates will also gather to make their point that the health-care system under discussion belongs to the citizens of Canada. It is important that all citizens begin now to inform themselves of the issues and join their voices with other advocates about what the future of health care in Canada should and can be. We need to do this for ourselves, but more importantly for future generations. Let us not disappoint. Audrey MacLise Chair of the Seniors Advisory Council of Williams Lake and Area

Medicare in Saskatchewan: A nation building event Friday, January 06, 2012 Coast Reporter January 6, 2012 Editor:

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While I agree with Keith Maxwell (Coast Reporter letters, Dec. 30) in the general sense that commemorating historical events is important, I differ with him on the choice of raising the profile of the War of 1812 to the exclusion of other events. The War was between the U.S. and Britain and occurred when the Americans perceived a British weakness given a war in Europe. It was the first, but far from last, American imperialist adventure. No one “won”, but there was a clear loser. The Native people lost the opportunity for an autonomous indigenous region in the British colonies, and the conflict opened the way for the genocides carried out in the American West. It may also be asked why other milestones are not given equal status. The year 2012 marks the 175th anniversary of the rebellions in both Upper and Lower Canada. The 1837 rebellions were the Occupy movements of the day and paved the way for responsible government and the formation of Canada. It will also be the 50th anniversary of both Medicare in Saskatchewan and the opening of the TransCanada Highway — clearly nation building events. The only explanation for glorifying 1812 is the Harperite desire to “remake” the Canadian culture into the type of jingoistic, militarist cesspool we see in other countries. C’mon MP Weston: explain how a colonial war is more important than responsible government, health care and a major breakthrough in linking the country’s transport system.

Paul Johnston, Roberts Creek

The assault on universalism: how to destroy the welfare state Friday, January 06, 2012 Martin McKee and David Stuckler BMJ December 20, 2011

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Martin McKee and David Stuckler watch aghast as American examples are followed to destroy the European model of the welfare state Christmas is a time to count our blessings, reflecting how they came to be. For people living in England this reflection is more relevant than ever, as the coalition government paves the way for the demise of the welfare state. This statement will be seen by many as reckless scaremongering. The welfare state, not only in Britain but also throughout western Europe, has proved extremely resilient. How could any government bring about such a fundamental change? To answer this question it is necessary to go back to the 1940s, when Sir William Beveridge called for a national fight against the five â&#x20AC;&#x153;giant evilsâ&#x20AC;? of want, disease, ignorance, squalor, and idleness.His call secured support from across the political spectrum. Although he sat in the House of Commons as a Liberal, his plans were implemented by a Labour government, and continued under successive Conservative ones. The reasons for such wide ranging support varied but, for many ordinary people, the fundamental role of the welfare state was to give them security should their world collapse around them.

Read more HERE.

Medical bills cause 62 percent of American bankruptcies Friday, January 06, 2012 By Joan McCarter Daily Kos Thu Jan 05, 2012

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A study released Thursday [pdf] by the American Journal of Medicine finds a huge increase—nearly 20 percent—in medical bankruptcies between 2001 and 2007. Sixty-two percent of all bankruptcies filed in 2007 were tied to medical expenses. Three-quarters of those who filed for bankruptcies in 2007 had health insurance. Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001. […]

In 2007, before the current economic downturn, an American family filed for bankruptcy in the aftermath of illness every 90 seconds; three quarters of them were insured. Since 2001, the proportion of all bankruptcies attributable to medical problems has increased by 50%. Nearly two thirds of all bankruptcies are now linked to illness. How did medical problems propel so many middle-class, insured Americans toward bankruptcy? For 92% of the medically bankrupt, high medical bills directly contributed to their bankruptcy. Many families with continuous cover- age found themselves underinsured, responsible for thou- sands of dollars in out-of-pocket costs. Others had private coverage but lost it when they became too sick to work. Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another

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quarter do so within a year. Income loss due to illness also was common, but nearly always coupled with high medical bills.

Note that this is data from 2007, before the great recession began, meaning the picture has likely become more bleak in the last five years. Also discouraging is the evidence that just having health insurance is no magic bullet. Costs for prescription drugs, hospitalizations and the need for chronic care for conditions like multiple sclerosis, diabetes, heart disease and psychiatric illnessesâ&#x20AC;&#x201D;even with insuranceâ&#x20AC;&#x201D;were the most frequent causes for medical bankruptcy, with hospital costs leading. The Affordable Care Act will address some of these issues, but certainly not all. Health care reform that gets at the biggest drivers of costs still has to be addressed. It won't happen in the current political climate, not with a Republican-controlled House and a Senate in paralysis because of the minority's obstruction, not to mention an extremely robust health care industry lobby.

Your Right to Health : Saskatchewan CCF (1960) Sunday, January 08, 2012 Medicare: A People's Issue

Open publication - Free publishing - More ccf

Tommy Douglas on YouTube Sunday, January 08, 2012 NYC

Visit the Tommy Douglas YouTube pageHERE.

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Harper's hands-off stance a threat to health-care system, unity: Ro... Sunday, January 08, 2012 By Mark Kennedy Postmedia News January 8, 2012

OTTAWA — Prime Minister Stephen Harper must join Canada’s premiers at the negotiating table to discuss medicare reforms or the country’s public health-care system will grow weaker, medical privatization will spread and national unity will be imperilled, says Roy Romanow. The former Saskatchewan premier, who led a royal commission on health care a decade ago, made the comments in an exclusive interview with Postmedia News. Romanow said he is worried the Harper government has adopted a deliberate strategy to leave health care to the provinces — possibly to foster the development of more private, for-profit medical companies. His concerns come as premiers are poised to meet in Victoria next week for a special health-care summit, and as Harper maintains his distance over direct involvement in the first ministers’ talks.

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“The prime minister has to roll up his sleeves, he’s got to get in there, he’s got to articulate the values of the country — which I believe are as strong, if not stronger, than when I was around as a royal commissioner,” said Romanow. He said that his commission found that Canadians viewed health care as a “social good” and that the national medicare system should be built on that foundation. But Romanow expressed anxiety at signs coming from the federal government. In December, federal Finance Minister Jim Flaherty surprised his provincial counterparts at a meeting in Victoria by unveiling a non-negotiable long-term funding plan that falls short of what some provinces had hoped for. Federal health-care transfers will continue to increase by six per cent until 2016-17. After that, increases will only be tied to economic growth including inflation — currently roughly four per cent — and never fall below three per cent. Romanow said it appears the federal government doesn’t plan on adopting a leadership role in medicare reform. He said Flaherty has no apparent intention of using money as a bargaining chip to ensure provinces attempt to reform the system — a reflection of the prime minister’s view that “open federalism” should involve less federal meddling in how provinces run their healthcare systems. “To say, ‘Goodbye and good luck’ could be the beginning of the end of a reformed modern-day functioning health-care system,” said Romanow. “If that argument is advanced, we have a prescription for a patchwork-quilt series of programs by the provincial governments based on their fiscal capacity. “It will mean more privatization in more provinces, or some combination of private and public. It will be a very much weakened fabric of national unity without Mr. Harper’s direct involvement.” Romanow, a longtime New Democrat, said he doesn’t want to “be political” in his criticisms of Harper’s approach to federalism “But I just feel very, very strongly about this. “Where is it that this country was predicated on the notion that there is such a watertight set of compartments that there’s no intermingling on key issues? Medicare needs Ottawa at the table.” “This is a very big turning point in the making of the federation.” Romanow was appointed by then-prime minister Jean Chretien in 2001 to study medicare. The next year, he delivered a report concluding the system was financially sustainable if the federal government gave billions more to the provinces for health care on the condition they implement reforms in areas such as home care, primary care and pharmacare. In 2004, Paul Martin’s government struck a 10-year accord to give provinces billions in 324

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extra cash, but Romanow said it came without the necessary strings attached for reform of the system. In last year’s election platform, Harper’s Tories declared they were committed “to a universal public health-care system and the Canada Health Act, and the right of provinces to deliver health care within their jurisdictions.” The party promised to “work collaboratively” with provinces to improve wait times for medical services. “In our discussions we will emphasize the importance of accountability and results for Canadians.” “In the spirit of open federalism, when renewing the Health Accord we will respect the fact that health care is an area of provincial jurisdiction and respect limits on the federal spending power.” In a recent TV interview, Harper said it’s up to the provinces to find the “solutions” to a better health system. “This government will ensure that there continue to be increases in health-care transfers,” said Harper. “We’ll do it over the long term at a level that’s sustainable, but a healthy growth.” He said some provinces are already starting to slow the growth of health spending “and they’re the ones who are going to have to really come up with the solutions on healthcare delivery.” The premiers will hold their health-care meeting Jan. 16-17. There are no immediate plans for them to also meet with Harper. Harper is more likely to work individually with them — for the time being — to foster health-care reform. Federal Health Minister Leona Aglukkaq has told provinces she is ready to work on a common plan to measure how well the health system is performing. Romanow said Harper must get involved himself. “You need the prime minister there. This is a test of leadership right across the board from the premiers, but I think primarily for the prime minister.” Romanow said Harper’s interpretation of how the Constitution spells out responsibility for health care to provinces is wrong. He said there is a long history of federal prime ministers — dating back to Conservative John Diefenbaker and Liberal Lester B. Pearson — using the federal spending power to help build a national health system. Romanow said only the federal government can provide the leadership to set programs and standards. “There’s a question here of federalism and Canadian citizenship. Do we want to have the Medicare's 50th Anniversary

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possibility of disparate regions in the country?” “This is a question now of how you build the country. It’s federalism. It’s Canadian unity. And programs such as medicare define what it means to be a Canadian.”

Crisis in care: Ontario pioneers the privatization of long-term care Thursday, January 12, 2012 By Justin Panos Briarpatch magazine Nov 1, 2011

A pill trolley rattles urgently as it makes its rounds in one of Ontario’s many long-term care homes. The support worker pushing it looks visibly exhausted, while a nurse practitioner moves stressfully under the imperatives of time and patient needs, tending to the unwashed, unshaved, undressed, unturned and unfed. Ontario’s long-term care homes, which provide 24-hour nursing services to chronically ill residents who require some form of basic assistance for daily living, suffer intolerably from an understaffing crisis. As the pioneer of privatized care in Canada, Ontario has opened the doors for a corporate takeover of long-term care homes, resulting in chronic understaffing by profitseeking multinational providers. Those in Ontario with the good fortune of longevity must brave the consequences of this increasingly corporate care. For residents, this means that staff are so busy as to be unreachable. Meanwhile the owners – the corporate directors and proprietors of the homes – continue to extract a profit, a vital portion of which is public money funnelled from government subsidies urgently needed for patient care. In an effort to counter this deliberate understaffing, a coalition of forces – unions, residents and their families – have been principled in their calls for an enforceable 326

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average of 3.5 hours of care per resident. Ontario is the only province without such a law. The currently triumphant opposition is the corporations whose profits are based on the ability to keep staffing levels as close to zero as possible. Despite the understaffing crisis, multinational providers such as Extendicare, whose workers reported 36 understaffed shifts in one month, have no scruples about advertising themselves to investors as an asset that “generates strong cash flow” – cash flow derived from public money that ought to be allocated for long-term care staff. Long-term care is a burgeoning market across Canada. This is particularly true in Ontario, with over 75,000 long-term care residents. Of these residents, 75 per cent of whom are women, 73 per cent have a form of dementia, 72 per cent need assistance with mobility and 86 per cent have some degree of incontinence. The need for reliable and safe levels of staff clashes irreconcilably with the imperative of a corporate provider to expand its quarterly earnings. Ontario’s long-term care sector is now the most corporatized in the country, with six multinational corporations having secured 76 per cent of the market. Staffing levels in Ontario rank below all provinces save for B.C. The connection between privatization and understaffing is neither spurious nor shocking. The making of Ontario’s long-term care market During the recession of the early 1990s, the debt obligations of the Ontario government became intractably high. As part of sweeping cutbacks in public services, Bob Rae’s NDP government began to delist the services provided by hospitals, which are covered under the Ontario Health Insurance Plan. The ground watered by Rae quickly bore fruit for multinational real estate investment trusts, looped and linked as they were with Ontario Conservatives in the 1996 election. In exchange for lavish contributions to their campaign, the Tories began the process of contracting out services as recommended by the Health Services Restructuring Commission. The three corporations that gave donations in excess of $22,000 – Extendicare, Central Park Lodges and Leisureworld – received roughly 40 per cent of the contracts by 2001. Thus began the conversion of Ontario’s long-term care homes into coveted commodities and the diminishment of staff to boost the profitability of these assets. In 1994 there were 74.4 registered nurses per 10,000 people; by 1999 there were 67.6. The corporations that made seemingly low bids for contracts did so only under the stipulation that they could cut their staffing levels to recoup profits. Then-premier Mike Harris erased the legislation that required a minimum of 2.25 hours of care per resident, ensuring that profits would rebound sufficiently. Ontario Premier Dalton McGuinty, appearing more benign than the Tories, was elected on the grounds that he would reverse the Tories’ assault on the public sector. Yet the Liberals have actually managed to contribute less to Ontario health care than their Tory predecessors. Between 2003 and 2007 health-care spending increased by 30 per cent, whereas between 1998 and 2003 the same indicator increased by 43 per cent. In 2007 Premier McGuinty finally appeared to be honouring his health-care promises and tabled Bill 140, which become the Long-Term Care Homes Act in 2010. After three years Medicare's 50th Anniversary

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of ostensibly fruitful consultations with a vast number of unions and advocacy groups like the Ontario Health Coalition, the McGuinty government had everyone convinced that a minimum of 3.5 hours of care would find life in black letter legal code. Yet the chief consultant for the provincial government, Shirley Sharkey, abruptly abandoned the minimum standard and advanced toothless and non-binding guidelines, which the corporate community has blithely ignored. Sharkey and Premier McGuinty disregarded the near-universal calls for minimum standards of care, as the resolution to the understaffing crisis was entirely contingent on an amendment to Bill 140 that would give the public the power to set staffing standards. The real crisis in provincial health care finances The understaffing crisis in Ontario’s long-term care homes is bred in the bone of privatization. Based on the assessed needs of a home’s residents, the government provides a per diem subsidy, which currently stands at $152.94 per resident per day for services. Government funding goes into four envelopes in each private or public home: staffing, food, services and accommodations. The accommodations envelope is the only envelope from which a corporate home is not obliged to return to the government any unused funds. In other words, every unused dollar in this envelope is rendered into profits. Managers, then, seek to move costs, like incontinence supplies, into other envelopes to free up potential money for profit. Such managerial manoeuvres require approval by regulatory bodies, such as Ontario’s unelected Local Health Integration Networks, which are composed of Liberal and corporate patronage appointees. The cozy relationship between corporations and public officials makes this a much simpler affair than it ought to be. Without a legislated standard, this sort of double-dealing with envelopes is as unpreventable as it is dangerous. The consequences of corporate care in Ontario are felt by both residents and workers. Residents who suffer from cognitive impairments, making language and social connections and abstract thought difficult, register their frustration against the first hurried staff member who eventually gets around to tend to their needs. One York University study, “Out of Control: Violence Against Personal Support Workers in Long-Term Care,” found that nearly half of all staff can expect to be assaulted at least once a day. Ontario is the pioneer of this style of “care,” where exploitation of staff and neglect of residents thicken the dividends for corporate owners. Other provincial governments are, frighteningly, beginning to follow suit. But as nurse-to-patient ratios grow unsustainably high, front-line caregivers, along with the Registered Nurses’ Association of Ontario, CUPE, the Ontario Public Service Employees Union and the Ontario Health Coalition, have entered into a struggle to stop corporate providers from misappropriating public money for private profit. Central to their campaign is the call for a minimum standard of 3.5 hours of daily care per resident, without which corporate providers face no imperative to provide adequate staffing. This battle goes beyond the elderly. Since even the sprightliest of us will invariably face the trials of aging, we ought all to be concerned with restoring accountable, publicly 328

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provided long-term care across Canada. Justin Panos has worked as a researcher for CUPE Ontario and the Centre for Research on Work and Society at York University. He writes a political column for www.wrgmag.com. Justin lives near High Park in Toronto, where he can be found wandering about.

Ottawa needs to fix medicare Friday, January 13, 2012 By Stan Rice The StarPhoenix January 13, 2012

Rice is a retired pharmacist and health-care administrator, who has experience in developing a drug formulary for the Saskatoon Community Clinic.

Prime Minister Stephen Harper stated in a year-end interview that it's up to the provinces to fix the problems with medicare. Yet lack of federal coordination and guardianship means that more and more Canadians lack access to comparable services in primary health care, prescriptions drugs, home care, rehabilitation and long-term care. Harper's unilateral action on future federal funding indicates that Ottawa no longer will take any responsibility for ensuring that all Canadians receive universal quality health care. He went on to say that the provinces must do something, because the current system is unsustainable. This is a curious statement that shows the PM either isn't aware of, or chooses to ignore, the true cost of health care in Canada. From 1975 to 2009, medicare spending - on hospitals and doctors' services - has remained stable at between four per cent and five per cent of GDP. At the same time, the cost of services not included under the Canada Health Act have risen to seven per cent from three per cent, led by the cost of private drug plans at an average of 15 per cent annually. The biggest impediment to progress in implementing the 2004 Health Accord has been the withdrawal of the federal government from the essential role of national co-ordination in health-care policy. Medicare's 50th Anniversary

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The Harper government never misses an opportunity to note that health care is a provincial responsibility and to avoid accountability for its important roles in health care, including use of federal spending power to achieve health objectives for the good of all Canadians, aboriginal health, food and drug safety, and the enforcement of the Canada Health Act. It is unfortunate that Harper cares so little for our public health-care system that he ignores the feelings of most Canadians. A recent Nanos poll indicates that support for the public health system has risen to 94 per cent in October of 2011 from a high of 90 per cent year earlier. Canadians expect our federal government to take a leadership role. The one area where the leadership vacuum is most damaging is in pharmaceutical management. Federal policies that govern the approval, pricing and marketing of prescription drugs are a failure. As a consequence, millions of Canadians are not receiving safe, effective, appropriate and affordable medication. When the 2004 health accord was negotiated, pharmaceutical costs were the fastestgrowing segment of health-care budgets. It is not surprising, then, that pharmaceuticals management was such a major focus of the agreement. What is surprising is the decision of the Harper government to walk away from national pharmaceutical management. The Health minister denied in front of a Commons committee that an agreement on pharmaceuticals was ever in the accord. For the record, the National Pharmaceutical Strategy in the 2004 Health Accord, found on Health Canada's website, promised action on catastrophic drug coverage, establishing a national drug formulary, strengthening the evaluation of drug safety and effectiveness, improving prescribing habits, and international parity on drug prices. It is difficult to overstate the damage to people and to medicare caused by Ottawa walking away from a key element of the accord - namely nationwide solutions to concerns about safety, accessibility and affordability of prescription medicines. Some of the resulting consequences are deaths from inappropriate use of pharmaceuticals; millions of Canadians lacking affordable access to pharmaceuticals; and drug costs being 30 per cent above the international average. In addition, the Harper government is working in the opposite direction by negotiating a trade agreement with the European Union, which could increase the cost of prescriptions by $2.8 billion a year and introduce draft legislation that weakens drug safety. It is perverse for the Conservative government to encourage excessive growth of pharmaceutical costs and abusive marketing practices, and then pass on the bulk of the cost and damage to provinces, territories, employers and individuals. You can't claim to be concerned about rising health-care expenditures, claim that it's a provincial responsibility and then forget about your responsibility to control the fastest growing component in health costs. A groundbreaking research study for the Canadian Centre for Policy Alternatives concluded that a universal public drug plan would save Canadians up to $10.7 billion a year. The dramatic savings are achieved by various measures that include eliminating 330

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some subsidies, using competitive purchasing, assessing new drugs more rigorously, improving prescribing practices; and revising industrial policies related to drug prices something that's entirely within federal jurisdiction. Politicians no longer can hide behind the excuse that universal public drug coverage is too expensive. We can save lives, cover everyone and save money. Canadians cannot afford not to have universal pharmacare.

Harper's Health Transfer Plan Offloads Costs to Provinces: Budget O... Friday, January 13, 2012 By Heather Scoffield The Canadian Press January 12, 2012

OTTAWA - Parliament's budget watchdog says the new health-care funding formula will slowly reduce Ottawa's support for medicare, but it will also put the federal government on a solid fiscal footing for the future. The trouble is the provinces will have to shoulder a growing health-care burden over the long run and they can't afford to do that without cutting spending elsewhere or raising taxes. Kevin Page, the parliamentary budget officer, crunched numbers from the federal government's recent announcement on how health care will be funded until 2024. He projected costs and revenues out to 2040-41. In his report released today, Page found that Ottawa's promised cash transfers will keep pace with projected increases in provincial health spending until 2016-2017. But after that, Ottawa's funding will be tied to expansion of the economy. Increases will likely average 3.9 per cent annually, compared to the previous six per cent, the report forecast. That means Ottawa's share of provincial health-care funding will fall to an average of about 18.6 per cent for the coming two decades from about 20.4 per cent today. It will Medicare's 50th Anniversary

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continue to slide significantly after 2035 if the policy persists. As a result, Ottawa's debt burden will decline steadily, the report said. The federal government will have some room to cut taxes or increase spending and still maintain fiscal health. The provinces, however, will find their debt rising and some jurisdictions will have to increase taxes, cut spending or both in order to stay on track. The report comes as the premiers prepare for a crucial meeting on health-care financing in Victoria starting Sunday. They will attempt to figure out how provinces should deal with health care after suddenly being handed a funding formula from the federal government last month. Finance Minister Jim Flaherty announced increases in funding with no strings attached â&#x20AC;&#x201D; signalling a federal step-back from health-care policy-making and a slow erosion of federal funding increases. In another report released today, a coalition of health associations said federal and provincial leaders need to confront the deterioration in the health-care system, clarify their roles and then get to work fixing things. The Health Action Lobby of 34 national health organizations polled leading health-system experts and compared Canada's regime to others around the world. They found a consensus on what the problems in Canada's health care system are, as well as general agreement on how to fix them. But they also found a lack of political leadership at both the federal and provincial levels.

Health Care Accord: Provinces must take the lead Friday, January 13, 2012 Health centres to Canada's First Ministers: "Collaboration can't wait. Let's achieve Second Stage of Medicare together." CACHCA January 13, 2012

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The association representing Community Health Centres (CHCs) across Canada is again urging federal, provincial and territorial leaders to focus on collaboration and innovation to improve health care and Canada’s overall health system. On the occasion of the upcoming meeting of Premiers from across the country in Victoria, BC, this week, the Canadian Alliance of Community Health Centre Associations (CACHCA) is calling on the federal government to take its seat alongside the provinces and territories in negotiating a meaningful health accord for Canadians. In the meantime, the association is urging the Premiers to use their time together in Victoria to carry this process forward, focusing on collaboration and priority-setting in health care across the country’s jurisdictions. Speaking from Halifax, where she directs the North End Community Health Centre, CACHCA Chairperson, Jane Moloney, grounded the association’s recommendations in reference to the spirit of collaboration and common-purpose that gave birth to Medicare fifty years ago. “It was discouraging to see the federal government recently declare itself irrelevant – no more than a bank machine – in an area as vital to the lives and identity of Canadians as health care,” Moloney noted. “That is certainly not the spirit that sustains Medicare, nor is it a view held by the overwhelming majority of Canadians, including health providers and organizations across the country that are all pleading for federal and provincial leadership in this area.” “Collectively, we are urging our federal government to sit down with the provinces and territories and to work collaboratively in improving standards for access, quality and person-centred care across Canada. Medicare was birthed through collaboration and common-purpose. Only by renewing commitment to meaningful collaboration, as we did in negotiating the 2004 Health Accord, will we improve health care for Canadians and achieve Tommy Douglas’s vision for the Second Stage of Medicare. It is essential that health transfers to the provinces be coupled with commitments and targets around key areas such as access to community-oriented primary health care services.” Moloney underscored the longer-term vision for our health system that was recommended by Medicare’s founders and which remains to this day a powerful, but

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unfulfilled vision. Tommy Douglas and others cautioned Canadians that establishing a publicly-financed and administered health system – solving the insurance and money issue – was only “stage one” of the process. They urged Canadians to begin building toward the “second stage” of Medicare by reforming and improving the actual delivery of services, placing greater emphasis on preventing illness and ensuring more appropriate, timely treatment when it is actually needed. CACHCA has joined a myriad of other Canadian organizations in urging the provinces and territories not to allow the federal government’s recent decision to sit out health care planning to derail discussions about achieving this vision for Canadians. “We’re at a crossroad with Medicare and it is more critical now than ever that the provinces and territories commit to common actions and priorities for all Canadians. The federal government has unparalleled potential to move jurisdictions toward positive change, and toward the Second Stage of Medicare. However, until the federal government decides it is ready to play its part, it is imperative that the provinces and territories continue the process themselves, working to identify common priorities, solutions and targets.” For its part, CACHCA has committed to working with the provinces and territories to identify ways that health system innovations such as community-oriented, person-centred primary health care services can be extended to more Canadians. “Community Health Centres and our association have decades of experience to contribute and we are ready to play our part, working with governments to implement the local health care solutions that Canadians want and deserve. We can all do better, and we’re going to have to work together to do so.”

Labour calls for Premiers to stand up for healthcare Monday, January 16, 2012 FEDERATION OF LABOUR PRESIDENTS Monday, January 16, 2012

The Presidents of the Provincial and Territorial Federations of Labour are calling on Canada’s Premiers to reject an irresponsible Federal Conservative “plan” for healthcare. In an open letter from the labour leaders to the Premiers, attending a meeting of the

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Council of the Federation in Victoria today, the Premiers are asked to stand up and support Canada’s most important social program: universal healthcare. “We believe, as many Canadians do, that the Harper Government’s December announcement is an abdication of its responsibility,” said Larry Hubich, President of the Saskatchewan Federation of Labour. “Our letter to the Premiers is a call for true leadership on healthcare - leadership that we are not getting from Ottawa.” As the Federation Presidents outline in their letter, the Harper Government has proposed significant cuts to healthcare funding, beginning in 2017. The announced cuts come after the federal government made the decision to ignore the issue of establishing a new Health Accord, the latest of which is set to expire in 2014. “In a style that has become typical of the Harper Government, the provinces are going to be handed a take-it-or-leave-it decision without any meaningful dialogue whatsoever. If Prime Minister Harper is not willing to play a leadership role in securing the future of the healthcare system, then the Premiers need to make a stand on behalf of Canadians, on behalf of the values upon which our nation and our healthcare system are founded.

Why medicare needs Ottawa Monday, January 16, 2012 ROMANOW, SILAS and LEWIS From Monday's Globe and Mail

The federal government has signalled its intention to reduce its role in shaping medicare to writing cheques. This would complete a 35-year journey that began in 1977, when Ottawa first capped its financial contributions to the provinces. At its peak, Ottawa’s share of publicly financed health-care spending reached 41 per cent. Today, its cash contribution is just over 20 per cent. The provinces run health care and have traditionally welcomed federal cash transfers with few strings attached. So what’s wrong with Ottawa’s self-imposed exile – is it not merely recognition that it has no legitimate role in shaping how the system develops? Not in our view. Writing cheques and walking away from the duty to improve medicare is not only a retrograde step that endangers health care and the economy, it also reveals a vision of an increasingly shrivelled and parochial federation, where governments look inward and the whole becomes a pastiche of increasingly isolated parts. Medicare's 50th Anniversary

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Here are seven reasons why a strong federal presence in health care is vital to Canada: Successful nations are built on unifying infrastructure. Think railways and the TransCanada Highway, seamless telecommunications networks, the armed forces, regulatory and judicial processes. Health care is a level up in importance because health is a fundamental precondition for full participation in society. A high-performing nationwide public system contributes enormously to the economy. Businesses don’t have to design and fund complex health plans for their employees. Workers don’t have to worry that taking a job in another province will compromise their health care. Only leadership from Ottawa can guarantee a common set of programs and standards and ensure that program enhancements are available to all Canadians. The 2004 health-care accord acknowledged that Canada’s public coverage of prescription drugs is not up to international standards. Ottawa must insist on improvement and put its money behind it. The intelligent use of health information is the key to improving access, quality and efficiency. Analysis and comparison are the midwives of improvement. Canada’ healthintelligence network is unco-ordinated, sluggish, incomplete and fragmented, a clumsy hybrid of paper and electronic records from which anything useful emerges slowly and at great cost. Both leadership and investment from Ottawa on an unprecedented scale are essential to creating high-quality, standardized information that improves clinical practice, policy and accountability. Provinces can’t transform their systems on their own regardless of how much money they spend. The politics of health care are simply too fraught, and the vested interests too powerful, to effect large-scale change. Even worse, the jurisdictions routinely engage in unconstructive bidding wars for personnel and are whipsawed by vendors, such as pharmaceutical companies, that exploit their isolation and vulnerabilities. Ottawa should play a major role in creating a more collegial and co-operative federation that overcomes obstacles to reform and bargains more effectively in the public interest. Ottawa could do a great deal to reduce the redundancy and bureaucracy in the system. A great example to emulate is the common process for reviewing the cost-effectiveness of drugs that both eliminated duplicate efforts and the confusion caused by multiple reports. Similarly, the whole area of professional credentials and regulation could be greatly simplified and standardized, with Ottawa promoting and brokering change. Something is wrong when it’s more difficult for some professionals to get licensed in another province than it is for a Polish nurse to get a job in Liverpool. Canadians deserve to know more about where the system succeeds and where it fails. Because Ottawa is not held as politically accountable for health care as the provinces, it’s the ideal mirror to and conscience of the overall system. It shouldn’t only invest in and codesign the health-information infrastructure but also mine that asset to report on how well the system performs, and promote a culture of openness and transparency where independent researchers and health-care providers can do the same. Ottawa must proudly stand up for single-payer, not-for-profit health care and ensure that its financial contributions reinforce this commitment across the country. Several provinces have turned a blind eye to blatant violations of the Canada Health Act, and Ottawa has stood by in indifference. The country needs to know where its government stands on the 336

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basic character and values of medicare. If the federal government abdicates, Canadian health care will be increasingly fragmented and costly, and two-tier medicine will grow not because the public wants it but because Ottawa allows and perhaps encourages it. Giving up on medicare is in a sense giving up on the Canadian values that have knit us together. There is more to leadership than writing cheques.

Roy Romanow, a former premier of Saskatchewan, wrote a royal commission report on health-care reform in 2002. Linda Silas is president of the Canadian Federation of Nurses Unions. Steven Lewis is a veteran health-policy analyst.

Romania rebels as health care threatened Monday, January 16, 2012 By Stef Newton CounterFire January 16, 2012

Thousands of protesters waving flags sing the national anthem, ‘Awaken thee, Romanian!’ among burning trash cans and broken windows. No, it’s not historical footage of the 1989 Revolution, but the fourth consecutive day of protests against the Romanian government’s austerity measures. It all kicked off when Deputy Health Minister Raed Arafat, a widely popular Romanian physician of Palestinian origin, resigned in opposition to a draft healthcare reform bill that represented a partial privatisation of the healthcare system.

The protests began on Thursday, with a solidarity demonstration in support of Arafat that took a violent turn. Riot police used tear gas against protesters, who responded by throwing bricks and Molotov cocktails at them. Protesters chanted ‘Down with the thieves! One solution, another revolution!’ and lit candles for heroes of the 1989 rebellion, a series of riots that marked the end of Nicolae Ceausescu’s regime. On Friday, president Traian Basescu withdrew the healthcare bill, but protests continued and spread across the country, as people jumped at the opportunity to express their anger about various issues, including public sector wage cuts, reduced benefits, increasing youth unemployment, higher value added tax and widespread corruption. Medicare's 50th Anniversary

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Leaders of the Social Liberal Union, a Romanian political alliance between three opposition parties (the Social Democratic Party, the National Liberal Party and the Conservative Party) condemned the violence, but urged people to take to the streets to overthrow Basescu and the Liberal Democratic Party. Public response to this was, however, extremely negative: a chorus of ‘We hate parties! LDP, SDP, you are all the same to me!’ rang in the centre of Bucharest, Romania’s capital city. Sunday saw the most violent protests since the 1990s, with thousands demonstrating in 34 counties and increasingly brutal clashes with the riot police. In Bucharest alone, there were 247 arrests and more than 30 injured. The people called for Traian Basescu to resign, 4 years after he became the first president in Romania’s history to be suspended from office and 2 years after his controversial re-election amidst allegations of electoral fraud and general outrage. The national media blamed ‘football hooligans’ for ‘hijacking’ an otherwise peaceful protest, a move reminiscent of the biased reporting during the 1989 Revolution, but the message is clear and cannot be written off as ‘mindless violence’: Romania is awakening, and joining the global movement against austerity.

Harper’s plan would kill medicare in Canada Monday, January 16, 2012 The Harper government has set in motion a strategy that will lead to the unravelling of Canada’s national health system. All Harper has to do is nothing. By abdicating the essential federal responsibilities in health care, the system will fragment on its own into 14 separate pieces. By MICHAEL MCBANE The Hill Times Jan. 16, 2012

There is a deficit of political leadership in health care, especially at the federal level. Prime Minister Stephen Harper stated in a year-end interview recently that he had no idea how to secure the future of health care in Canada. Instead, he said it is up to the provinces to find “solutions.” Harper’s recent unilateral, non-negotiable decision on the future of federal health financing stunned provinces. It seems the federal government intends to limit its role to signing blank cheques with no strings attached and no accountability. If rumours on the Hill are true, once the current arrangement expires Harper may replace cash transfers 338

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entirely with tax credits. The Harper government has set in motion a strategy that will lead to the unravelling of Canada’s national health system. All Harper has to do is nothing. By abdicating the essential federal responsibilities in health care, the system will fragment on its own into 14 separate pieces. In order to understand the implications of abandoning federal responsibilities in health care, it is important to identify what they are, especially since the Harper government never misses an opportunity to say that health care is a provincial/territorial responsibility. The federal role in health care is very clear and well described on Health Canada’s website. The federal government is a funder, and transfers more than $40-billion a year to provinces and territories for health care. In addition to health-care cash transfers, the four most important federal duties in health care are: 1. guardian of the national standards in the Canada Health Act; 2. regulator of pharmaceuticals, medical devices and food; 3. Health-service provider to First Nations and Inuit communities; and 4. catalyst for innovation and best practices. First, as guardian of national standards the federal minister of Health is supposed to ensure that provinces and territories are in compliance with the Canada Health Act and are not allowing queue-jumping, extra-billing or user-fees for medically necessary services. The act also says no Canadian should face a financial barrier to care—regardless of where they live or work. Increasingly flagrant violations of the law are occurring and are well-documented. The federal government plays dumb as patients and the sick are exploited or denied access to essential services while wealthier Canadians jump the queue. Second, as a regulator, Health Canada is responsible for health protection, including the safety of products (food, pharmaceuticals, medical devices, natural health products, consumer products, cosmetics, and chemicals). When the federal government performs these duties poorly, the consequences for Canadians and their health-care system are dire. Currently, the federal government is fighting multi-billion dollar lawsuits for regulatory negligence. Poor regulation of drugs is making people sick and killing thousands of Canadians annually. This regulatory negligence also puts enormous strain on provincial and territorial health care resources. Third, as a service provider, the federal government is the fifth largest in the country. Health Canada provides basic primary care services in approximately 200 remote First Nations communities, home and community care in 600 First Nations communities, and support for health promotion programs in Inuit communities across four regions. Where is the federal plan to adequately meet the health-care needs of aboriginal people in Canada? Also missing in action. Fourth, Health Canada is a catalyst for innovation, a funder, and an information provider in Canada’s health system. It works closely with provincial and territorial governments to develop national approaches to health system issues and promotes the pan-Canadian adoption of best practices. The narrative of the Harper government—that health care is not its responsibility—is Medicare's 50th Anniversary

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simply untrue. If there is indeed no federal role in health care, why does the federal minister of Health have 12,000 employees and an annual budget of $4-billion? Harper’s abdication of health care is also at odds with the values of the vast majority of Canadians. A Nanos poll released in December shows support for public health care in Canada at 94 per cent. It is time for the federal government, on behalf of all Canadians, to perform its legal duties and get back to the table with provincial and territorial counterparts and work together to secure the future of health care in Canada. With Canada’s growing and aging population, federal leadership is needed more than ever. An excellent place to start is better regulation and management of pharmaceuticals. It is perverse for the federal government to encourage excessive growth of pharmaceutical costs and abusive marketing practices, and then pass the bill on to provinces, territories, employers and individual Canadians. You can’t tell the provinces and territories that health care sustainability is their problem when it’s federal policies that allow the pharmaceutical industry to drain billions of dollars out of their health-care budgets. The Health Council of Canada observed that advances in pharmaceutical management policies are integral to overall health-care renewal, since drugs are the second-highest spending area in the Canadian health-care system. The reality is federal pharmaceutical management is a failure that threatens the integrity and sustainability of all aspects of the health-care continuum, including primary, hospital, home, and continuing care. A groundbreaking study done by Marc-André Gagnon concluded that a universal public drug plan would save Canadians up to $10.7-billion annually. The dramatic cost savings are achieved primarily by just four measures, including eliminating subsidies, bulk purchasing, more rigorous assessment of ‘new’ drugs, and improved prescribing practices. Politicians can no longer hide behind the excuse that a universal drug plan is too expensive. It would not only save taxpayers billions annually, it would save lives and provide medically necessary medicines to every Canadian in need—many of which who currently have no coverage. Canadians can’t afford not to have a pharmacare program. Nor can Canadians afford the current deficit in federal leadership in health care. To paraphrase Tommy Douglas, our parents and our grandparents worked and fought and suffered to get us medicare. We’re not going to let anybody take it away, including Prime Minister Stephen Harper.

Michael McBane is national coordinator of the Canadian Health Coalition in Ottawa. www.healthcoalition.ca

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A prescription for health care reform: think integration & coll... Monday, January 16, 2012 By Iglika Ivanova Progressive Economics Forum January 16th, 2012

This morning the CCPA released a new report (co-authored by yours truly) that looks at the thorny issue of health care reform in BC (and Canada) and identifies some practical, evidence-based strategies that have been successful in improving quality of care and controlling costs in other jurisdictions. The papers comes out at a time when all Canadian provinces face significant pressure to reduce the rate of growth of health spending while continuing to improve access and quality of care but when there is no agreement on the specific changes needed to ensure that public healthcare dollars are more efficiently utilized. As a result, individual provinces are experimenting with a variety of reforms. In BC, the two major policy options being introduced are an activity based funding (ABF) model for hospital surgical procedures; and an integrated model for caring for people with chronic conditions and complex needs in the community. Though both of these are formally priorities of the Ministry of Health, ABF is receiving the vast majority of the financial resources and technical expertise. Our paper raises serious concerns that the current preoccupation with reforming hospital funding is simply too narrow to effectively address BC’s most pressing health care challenges, many of which have roots outside the hospitals (in our inadequately funded community care system). This is why we titled our report Beyond the Hospital Walls: Activity Based Funding Versus Integrated Health Care Reform. The current focus on ABF is a reflection of the conventional, hospital-centric model of health care that our system was built on. While this worked well to meet the health care needs of Canadians in the 1960s, it’s outdated in the 21st century when chronic disease management — which is better handled in the community, not the hospital — is increasingly becoming a pressing concern. But what’s worse is that ABF is not just a distraction from the real problems in our health care system: it may actually reinforce the silos and fragmentation within the health care system, hindering efforts to improve overall system integration and coherence (this stand in the way of priority #2). This is why jurisdictions where ABF has been in place for a number of years are increasingly looking to move away from it towards funding mechanisms that incentivize integration across the system (among hospitals, family doctors and community care services like long term care and home support). The paper outlines a strategy for health care reform that is timely, practical and evidencebased, and that will address the root causes of problems in our health care system. Our Medicare's 50th Anniversary

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review of the international evidence on health systems reform suggests that the best performing systems are the ones that have developed mechanisms to collaborate and share accountability across services and providers. The key to their success is understanding the patient experience across the continuum of diverse health services the patient needs at any one time. High performing health systems are organized in a way that allows providers to be jointly accountable for providing cost-effective care in whichever venue is medically appropriate – the patients’ home, the family doctor’s office or the hospital. There are many examples of how this can be done, both internationally and from our own backyard (Northern Health Authority is a leader in this area). All that’s needed is for the BC government to show leadership, look at the evidence, and actually implement the initiatives that have proven successful province-wide. We hope that Canada’s Premiers’, who are currently meeting to discuss health care in Victoria, find a way to avoid getting bogged down into narrow issues like hospital funding reform and engage in a broader discussion of how to improve quality, increase access and ensure the cost effectiveness of the overall health care system.

Canadians want feds to play strong role in health care: poll Tuesday, January 17, 2012 BY MARK KENNEDY POSTMEDIA NEWS JANUARY 16, 2012

A strong majority of Canadians believe the federal government has an "important" role to play in the country's health-care system and to ensure provinces are accountable for the money spent on medicare, according to a new poll. The national survey by Ipsos Reid was commissioned by the Canadian Medical Association, which represents the nation's doctors. It was released as the premiers gather in Victoria for a two-day meeting to discuss the health-care system. Prime Minister Stephen Harper is not at the meeting, but his Conservative government has announced billions of dollars in long-term medicare payments that fall short of what the provinces had wanted, but which carry no conditions on how the funds are spent. Among the poll's findings:

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- 97 per cent of Canadians think the federal government's responsibility for the Canada Health Act is important. In return for receiving federal money, provinces must adhere to the principles of medicare as outlined in the Act. Those principles include accessibility to services, universal availability, and portability from province to province. - 70 per cent say they are "worried that without accountability to the federal government, provinces will have no incentive to achieve health care efficiencies." - 88 per cent are worried that "without national standards, Canadians will have different levels of health care depending on where they live." - 74 per cent believe that health care is a shared responsibility between the provincial and federal governments. Few believe it is solely a provincial (13 per cent) or federal (11 per cent) responsibility. - 56 per cent are not confident that the premiers will be able to agree on a plan to improve health care in Canada. - 69 per cent "strongly agree" that they would encourage their premier to "adopt a series of principles that make the health-care system more concentrated on the needs of the patient." The telephone poll of 1,000 Canadian adults was conducted Jan. 4-9. With a sample of this size, it has a margin of error of 3.1 percentage points, 19 times out of 20.

Many struggle to pay for prescriptions Tuesday, January 17, 2012 BY ANDRĂ&#x2030; PICARD Globe and Mail Monday, Jan. 16, 2012

One in four Canadians who do not have drug insurance are unable to afford to take their prescription drugs as directed, a new study shows. And, over all, one in 10 Canadians struggle to pay for their drug treatments, even if the have public or/and private insurance, according to research published in Mondayâ&#x20AC;&#x2122;s edition of the Canadian Medical Association Journal.

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That means, practically, that millions of patients fail to fill or refill prescriptions, or skip doses to cut costs. “These levels of non-adherence are something to be concerned about,” Michael Law, an assistant professor at the Centre for Health Services and Policy Research at the University of British Columbia, said in an interview. “When people don’t take their meds, there are, potentially, higher costs in other parts of the system,” he said. The findings are based on data from 5,732 respondents in Statistics Canada’s Canadian Community Health Survey. The data show that 9.6 per cent of Canadians did not take a prescription as directed because of the cost. That included 26.5 per cent of those without health insurance reporting not being able to afford their prescription drugs. According to Statscan, 82 per cent of Canadians have drug insurance, but the survey did not distinguish between public and private plans. Dr. Law said there are several reasons that patients fail to take medications as they are directed to do by health professionals: They don’t like the side effects, they are forgetful, they feel they are no longer necessary, and so on. But he said lack of affordability is one of the chief reasons and it is important to understand the extent of the problem because “it’s amenable to policy action.” In this case, Dr. Law said, the obvious solution is to ensure that everyone can afford necessary prescription drugs. There are several ways of doing so, including instituting universal drug insurance (pharmacare), lowering drug prices, subsidizing drug costs, or targeting programs at those who are unable to pay now. “You want to be careful and thoughtful about who you make policy for so you meet the needs out there,” he said. The study shows that those who have the most difficulty paying for their drugs are patients with chronic conditions that entail recurring drug costs. Low-income citizens also struggle, even if they are insured. (This because insurance often has co-payments or deductibles, or does not include dispensing fees.) While Canada has universal public insurance for hospital and physician services, public prescription drug coverage tends to be limited to seniors and people on social assistance. (Quebec is the only province where all residents have drug insurance; low-income residents are covered by the state, but others must purchase it from private insurers.) “Lack of universal drug coverage is a glaring hole in medicare,” Dr. Law said. Danielle Martin, a family doctor at Women’s College Hospital in Toronto, said she routinely sees patients who cannot afford their drug treatments, and they tend to be the working poor. “It’s the taxi drivers, nannies and restaurant employees who often fall through the cracks,” she said.

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Dr. Martin, who is also president of the group Canadian Doctors for Medicare, is a staunch advocate for pharmacare, or adding prescription drugs to the services paid for by medicare. “Providing prescription drugs for free is not only the right thing to do, it also makes economic sense in many situations. A small cost outlay can sometimes prevent higher costs in the future,” she said. She cited a study in the New England Journal of Medicine showing that routinely providing medications to all heart-attack patients resulted in more people taking needed medications and having fewer complications. Dr. Martin said the fear that universal public drug insurance is unaffordable is unfounded. “A national pharmacare program would save money and improve economic efficiency,” she said. Canadian spent $26.1-billion on prescription drugs in 2010, including $4.6-billion out-ofpocket, according to the Canadian Institute for Health Information.

On the outside looking in: Indigenous peoples excluded from premier... Wednesday, January 18, 2012 By David P. Ball Rabble.ca January 18, 2012

Is there a link between the tar sands pipelines, the premiers' health conference, and Indigenous rights?

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As Canada's premiers and territorial leaders met in Victoria this week to discuss the future of health care -- after the Conservative government pulled back from its medicare role -- no attention has been paid to Indigenous peoples at the talks. All that came out of the meetings were strong words towards Ottawa, and plans to set up working groups on finance and "innovation." But rabble.ca spoke to two First Nations advocates outside the meeting who said they were outraged by the lack of Aboriginal consultation around the health-care talks. United Native Nations of B.C. president Lillian George -- from the Wet'suwet'en First Nation in northern B.C. -- and Jerry Peltier, former Grand Chief of Kanesatake Mohawk Nation (near Oka, Quebec), said that all levels of government failed in their obligation to consult and include Indigenous people. Especially, they argued, when it comes to health care. Here's their conversation with The Left Coast Post today.

DAVID BALL: It seems like, for all their talk yesterday, (the premiers) are not really taking a position challenging the federal government. What's your response to the last couple of days here? LILLIAN GEORGE: I'd be lying if I said I was happy with the outcome. Unfortunately, what I'm seeing here is government again doing what they choose to do, working in isolation, without involving Aboriginal people. It's important that we have a place at the table, particularly regarding health. Health is a huge concern for all Aboriginal communities, and right now they're not asking us any questions or seeking our input. We weren't invited to this meeting. Yesterday, the premier mentioned Aboriginal peoples -but there's nothing today. What I'm hoping is when they set up the health innovation working group -- I'm hoping the premiers of PEI and Saskatchewan will see to it that Aboriginal organizations are at the table. But when it comes to developing health initiatives, there has to be representation from Aboriginal people across the country. DB: What about you, Jerry? JERRY PELTIER: I'm sort of disappointed at the media itself. I think the Aboriginal issue has been a very big issue over the last couple of months since what happened in Attawapaskat in northern Ontario, where they had to bring in the emergency Red Cross to help that community. At that time, First Nations issues were at the top of the media's list. This gave the mainstream media the opportunity to ask questions of the premiers and the chair: Why wasn't the Aboriginal leadership invited to this very important meeting taking place here? As for the announcement this morning -- setting up a working group on innovation -- there's been no attempts made to even reach out to Aboriginal health providers, so that we can have our input into how this negotiation on health care should function... I feel disappointed that no questions were raised by mainstream media about Aboriginal issues. DB: Why should Indigenous people be at the table? Why in particular? JP: Well, for us, why is it important for Indigenous organizations to be at the table? Number one, health for First Nations is a treaty rights issue. And secondly, health matters affect all Aboriginal peoples, no matter which political stripe they're on or whose turf 346

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they're on. If you look at our situation from coast to coast to coast -- the living conditions - everything is holistic, everything affects our health. Whether we live in a nice home environment, or whether we don't. Whether we lack running water. All these issues affect our health. LG: When we talk about the issue of health, it includes environment, employment, housing, clean drinking water, issues of Aboriginal women and children. All those are connected to health -- they have a huge impact on the whole health of Aboriginal Canadians across Canada. If you look at any urban centre across Canada, you'll find a Downtown Eastside. The Aboriginal people are homeless, they're living on the streets, a number of them now have HIV/AIDS -- they can't go back to their home communities. What happens to them? They end up living on the streets. That really goes to show you that the Canadian health-care system as it stands right now isn't working for Aboriginal people. There need to be changes made in the health-care system itself -- the way that Aboriginal people are treated when they go to emergency rooms. I'll give you an example: my cousin went to a hospital in Vanderhoof (B.C.) -- he was out skydiving and started having chest pains. His voice got slurred, he wasn't walking properly, and when he went to the emergency room in Vanderhoof hospital -- they just assumed he was a drunk, another drunk Indian. He was having a heart attack. It's things like that -- the stigma they put on us, that we're all low-income families, we all live on welfare, if we have a status card we get everything for nothing, everything's free -- that is the furthest thing from the truth. Mainstream society needs to understand that... We need to be working together to change the health-care system to make it acceptable. The whole lack of doctors, nurses and treatment that even I've seen Aboriginal people getting in hospitals is deplorable. They don't have the cultural relevance to deal with Aboriginal people in hospitals right now. Aboriginal elders who need to go into home-care situations, there's none available specifically for Aboriginal people. They won't go into a regular nursing home because people there don't understand them. DB: These weren't constitutional talks, but they were talking about the future of Canadian health care -- between the federal and provincial governments. Do you find it surprising that you weren't consulted? Particularly in light of the fact that previous attempts at rebalancing the federal-provincial relationship have hung on the words of Indigenous people. I'm thinking of (Manitoba MLA) Elijah Harper -- this isn't exactly a constitutional talk, but it's about the future of health care. It's a substantial federal issue. LG: Government always talks about buzz-words like accountability and transparency -and yet they've shut the door on us. Not only on health issues, but on several other issues. That's why Jerry and I are here -- to find out what's going on, and for people like yourself to do interviews, to let Canadians know that Aboriginal organizations weren't invited here... We're on the outside looking in, while they make decisions on health care that affect us. JP: There's only one issue: at all other talks the federal government and provincial premiers have -- whether it's on education, the economy, whatever issues that have an impact on our communities -- we have to be at those tables. It took a Supreme Court ruling to force both governments and also private industry to recognize the duty to consult. The international community must understand -- it's nice for the Canadian government to say, 'We're having discussions with Aboriginal groups on all matters that affect the Aboriginal people of Canada.' I think, that's quite far from the truth. If you look Medicare's 50th Anniversary

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at the (United Nations Declaration on the Rights of Indigenous Peoples), it took a while for the Canadian government to accept that. For us to move forward with what's in those rights -- and the health issue is one of those rights -- it's an important element, the premiers have to understand that. What do we do now? We're going to consult with our national organizations, but what's our next step? Do we continue to try to sit outside looking in as these discussions take place? Or do we take a progressive move and set up our own forums? But we'd need money to do that. Is the federal government going to fund that? I don't think so. Will the corporations -- that are taking millions and millions and millions of dollars of resources from our Aboriginal territories -- fund it? I don't think so. So we'd need to look for international funding to make it happen. DB: You hear a lot about the health impacts people worry about with projects like the pipeline, the tar sands, the Taseko mine (on Tsilqotin First Nation territory) -- all of these projects have health impacts because Indigenous peoples live downstream, often in remote areas. How do you see that relating to discussions around health? LG: If the pipeline goes through, it's going to go across all the territory of British Columbia. The whole northwest part of British Columbia is going to be affected. That's where our people go to get traditional medicine. That's all going to be gone. A part of that happened when they did all the clear-cutting in B.C. And I'm sure it's happened across Canada as well. But the fact is that traditional medicines are what a lot of us use. If that pipeline goes through, and heaven forbid there's a spill, it's going to have a huge impact not only on our traditional medicines, but the whole livelihood of Aboriginal people in that whole area -- to hunting and fishing. It's not just about medicine, but about food source as well. If you don't have proper food to eat -- the government is often spouting off about healthy eating and healthy lifestyle -- well, a lot of it is what we live on, our wild meats and fish. If that pipeline goes through, it will have a huge impact on where the game goes, and what happens to the fish. If anything disrupted that whole ecosystem, it would have a huge impact on Aboriginal people. JP: I should say, we're not against development. We're not against creating job opportunities for Aboriginal peoples or Canadians as a whole. However, we've got to look at the balance. Is it going to affect our traditional way of life? If all of our traditional food source is contaminated or destroyed, and we've got to rely on so-called mainstream food sources which are getting very expensive, a lot of our members can't afford that. You try to go to a healthy lifestyle using non-Aboriginal food sources, a lot of our people can't afford it. DB: Much like how organic food can be very much a white privilege, right? LG: Yeah, it's unbelievable. A small loaf of organic bread is like $7. They want us to eat healthy? Even buying whole wheat bread is expensive. I remember my mom going to the bakery and buying day-old bread because it was cheaper, and it was always white bread. We couldn't afford brown bread (laughs). It's things like that, little things that people take for granted every day. DB: So you're talking about the bigger context of health, and here they're talking about the very basic aspect of the health-care system. LG: They have to look at more than just the basic health-care system, because if it's just the basic system then we wouldn't be fighting so hard to be here. For us, it encompasses it all -- it's a holistic view of health. That's the way we were raised, to look at everything. 348

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You can't just fix one part of something and expect everything else to fall into place. It doesn't work that way -- you have to fix it all. That's the one thing that we would like to see happen, and that's one of the main reasons we're pushing so hard to be at the table. It's important that our voice is heard. DB: I was reading a study on First Nations communities [3], in which communities that had both educated youth about traditional culture, and also been part of some kind of action or blockade to defend their lands, were healthier as a whole -- there were fewer suicides and less alcoholism. What are the factors in a healthy community? LG: Absolutely, it's important that youth are involved. Right now, with everything about health care, you hear on the news about Ecstasy. You can buy an Ecstasy pill for $5 and now it contains a toxin that could be killing youth. Suicide is huge in Aboriginal communities across Canada. Why is that? Because there's nothing to do, there's no outlet for their energy. To be involved in sports is expensive. Then there are problems in the whole family structure, and that goes back to residential schools. Families didn't know how to parent properly, because they lost that when they were taken from their communities. It's that whole history, going back that far, as to why youth have turned out the way they are today. Even today, people have to move to an urban centre to go to school. DB: Jerry, I have a question. You were Grand Chief of Kanesatake, right? When was that? JP: From 1990 to 1997. DB: So you were there for the Oka Crisis? JP: I was the one that helped defuse the Oka Crisis. I was in there, involved in the crisis in our community. DB: How do you see a link between healthy communities and self-determination? You experienced that first-hand. JP: Self-determination -- or what we call our sovereign rights -- includes running our own health institutions, our own education institutions, and our own financial institutions. We happen to be fortunate to live in an area that is close to a major city, but at the same time far enough so that we can do our own thing the way we want to do it. But certainly, that's one of the areas we were fighting for when Canada repatriated its constitution. We talked about self-determination and how we want to move forward, and to make sure our communities move in a way that our ancestors fought for. DB: Do you feel that your exclusion from these meetings and others like them is an example of colonial attitudes on the government's part? JP: It's always been there, and will continue to be there. That's what I think about the Aboriginal peoples and our elders in the past -- they had a lot of patience. I think it's going to be the next generation that's going to carry the fight. We went through this in the constitutional debates -- I was involved from 1982 to 1987, I was one of the chief negotiators for the First Nations of Quebec -- we knew that we can't change this colonialist mentality overnight -- we have to work at it. We've gotta use their court system to fight it. There's cases we win; there's cases we lose. But we continue to persevere.

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LG: We were successful in Delgamuukw (the historic 1997 B.C. Supreme Court case recognizing Aboriginal title), on the territories that I'm from. That was a huge win for Aboriginal people, on and off reserve. Half of my family live on reserve, half live off. You know, it's the pride we have within ourselves. I never identify myself as an Aboriginal woman. I identify myself as a member of the Wet'suwet'en Nation, the Big Frog clan, and then I'm also the president of the United Native Nations of B.C. It's the identity that gives me the pride -- for me, at least -- I think that's what's lost for a lot of the youth now, they don't know where they belong. Before you know where you're going, you need to know where you come from. JP: In fact, we just met one here this morning. LG: Yes, we did, as a matter of fact. A young man just found out which Aboriginal nation he came from. JP: He was one of the security guards for the premiers. LG: He just found out what community he's from, but he had no idea because he'd been adopted. DB: Does that give you hope? JP: Oh yeah! (laughs). LG: Absolutely. In the words of Chief Dan George, 'We endeavour to persevere.' We will continue moving forward. Sometimes we take one step forward and three back, but we keep on going.

The future of Canada's health care at stake: Maude Barlow warns of ... Wednesday, January 18, 2012 By David P. Ball Vancouver Observer Jan 17th, 2012

The health care discussions by premiers in Canada is about more than about just funding, Council of Canadians national chairperson Maude Barlow warns. It's about the very future of public health care in Canada itself. 350

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“We have to get the story to the Canadian people,” she said. “A lot of people don't actually realize that what this means, if the government does this, is the end of a federal role in medicare.” For decades, Barlow has been a well-known Canadian advocate and commentator – on everything from stopping free trade agreements to declaring access to water a human right. But public health care has always been one of the 64-year old activist's hot-button issues. The veteran national chairperson of the 100,000-member strong council, sporting a “Medicare” button on her grey suit jacket – sat down with the Vancouver Observer outside a pivotal meeting of the country's provincial and territorial leaders, who are deliberating on a new national health accord as the current one expires in 2014. “We're looking at either extending, deepening, recommitting to our health care system, or perhaps the beginning of the end of it,” she told the VO. “Canadians need to know those are the stakes here. “Stephen Harper has never liked public health care, he's always said it belongs to the provinces, its their responsibility. He would go totally private, I'm convinced, if he could. But he can't, because 94 per cent of us think the private system is not the one for us. He can't do it through the front door – he has to do it by pulling the rug out from under the provinces and let them do the dirty work.” Barlow said she was surprised and pleased that even B.C.'s premier, Christy Clark, who had initially praised the federal Conservatives, changed course and announced the premiers were unanimously opposed to finance minister Jim Flaherty's unilateral decision to change Canada's health funding formula. “The one thing we've been saying is we need to have an agreement with all the premiers – we want to have one unanimous front,” Barlow said. “We were really nervous that wouldn't happen. “We're pleased they've taken this first step – but we're hoping they'll up the ante if they have to.” Confronting the Conservatives So what, exactly, would upping the ante look like? For Barlow, a confrontation with the Conservatives seems at this point inevitable. Premier Clark said she believes Prime Minister Stephen Harper can be convinced to back down. But will the premiers' unity hold out to the bitter end? “I think there's going to be confrontation needed before this is over,” Barlow said. “Let's remember that Stephen Harper and Jim Flaherty acted in a unilateral way in destroying a tradition of negotiation, and bringing in this unilateral statement. “If you want to talk about confrontation, they started a confrontation that is now going to have to escalate.”

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And the Council of Canadians believes that Harper can be forced back to the table – but it won't just take consensus among the premiers. Citizens, Barlow argued, need to get involved in pushing their leaders to support medicare. “It's clear from the polls – whether they're left, right or centre – Canadians actually want (our leaders) to support health care,” she said. “The prime minister has said this is done, but there's no such thing as a done deal. “All of the premiers – and the extreme majority of Canadians – don't want this. He's going to have to listen.”

Will any government stand up for medicare? Wednesday, January 18, 2012 By Thomas Walkom The Toronto Star January 18, 2012

Think of the current impasse between Ottawa and the provinces over medicare funding as part of a long game. On one side is the Canadian public, which overwhelmingly supports the publicly funded, universal health insurance system known as medicare. On the other are the federal and provincial governments, which, for a variety of reasons (some political, some ideological), find medicare a bother. They are reluctant to spend the money that a successful health system requires — and even more reluctant to raise the taxes that would fund it. In normal times, the two levels of government simply squabble over who pays how much. The provinces want Ottawa to pay more so they can pay less, and vice versa. The gun to their heads, in such normal times, is public opinion. While few like to pay 352

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taxes, polls show that the vast majority of Canadians value medicare dearly. And when the public senses that its elected governments are endangering the national health-care system, it tends to react badly. But these are not normal times. That’s why the premiers’ attempt this week to pressure Prime Minister Stephen Harper into amending his diktat on future federal medicare transfers failed so badly. First, the economic slump makes all governments even more reluctant to spend money. Ontario Premier Dalton McGuinty can hardly complain about federal stinginess when Ottawa’s take-it or leave-it offer — a reduction in future health transfer growth to a minimum of 3 per cent annually — matches Queen’s Park’s own projected spending cutbacks. Second is the Harper factor itself. Canadians gave a parliamentary majority last year to a federal Conservative government that is deeply suspicious of medicare. True, Harper has not tried to ditch the Canada Health Act, the federal statute governing medicare. His government even continues to enforce it in some manner. Since the Conservatives came to power in 2006, Ottawa has levied $335,568 in fines against provinces — mainly British Columbia — that failed to abide by the conditions of medicare. But the principles behind Canadian medicare are an offence to Harper’s brand of conservatism, which, in its purest form, is often better expressed by the Prime Minister’s ideological soul mate and sometime co-author Tom Flanagan. Writing in The Globe and Mail this week, political scientist Flanagan attacked the very idea of Ottawa spending money in areas of provincial jurisdiction like health. He lauded Harper for moving “incrementally” towards a more classic form of federalism, where aberrations such as national medicare would not exist. Programs like medicare, Flanagan wrote, “create the illusion for both levels of government that they are spending something less than 100-cent dollars” and thereby lead to more debt. All of this suggests we are in for a grim few years on the health-care front. Don’t expect the Harper government to attack medicare directly. It’s too popular with voters. But what we can expect is a hands-off approach from Ottawa, which, when coupled with federal transfer cutbacks, will encourage cash-strapped provinces to search for more privately funded alternatives — from user fees to private-pay clinics. Quebec has taken a couple of false starts down this route, including an attempt to introduce user fees for patients that would have put it in direct conflict with the Canada Health Act. British Columbia is already happily breaking federal law by allowing some Medicare's 50th Anniversary

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clinics to extra-bill patients. Ontario is talking vaguely of massive structural change. In this segment of the long game, it’s not clear that any government at any level is willing to speak up for medicare and for the vast Canadian public that cherishes it.

Harper’s health scheme will mean ‘Goin’ Down the Road’ for Maritimers Thursday, January 19, 2012 BY NICK FILLMORE Canadian Dimension January 19th 2012

By dramatically changing the health care funding formula, is Prime Minister Stephen Harper showing little concern for the future of the Maritime provinces? The Health Accord “deal” that Harper practically threw in the face of the provinces and territories this week, not only cuts health funding for all the provinces starting in four years, but threatens to further widen the growing standard-of-living chasm between the “have” and “have not” provinces. As their meeting ended in Victoria on Tuesday, the premiers vowed they will pressure the Conservative government to change the least equitable aspects of the so-called take-itor-leave-it “agreement”. But what if the sometimes stubborn Harper government refuses to give much ground? All citizens of the Maritimes – not just the governments – would have good reason to vehemently protest the new agreement because the provinces that would likely lose the most in the long term are Nova Scotia, New Brunswick and Prince Edward Island. Increase in cost of living If the 2016-17 part of the agreement goes into effect, the cost of living will increase in the Maritimes, and this will be another blow to the region’s problem of too many people leaving to live elsewhere in the country. Parliamentary budget officer Kevin Page said in his evaluation of the agreement that, by

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going to the GST-based formula, the Conservatives plan to download onto the provinces perhaps as much as $31-billion by 2024. Future federal payments will be based largely on the growth of each province’s GDP — the gross domestic product: the market value of all goods and services produced within a province during a year. The Royal Bank has predicted GDP rates for the provinces for 2012 and if by chance, these increases were to be the same in the period starting 201617, the four western provinces would receive health care expenditure increases roughly double those for the Maritime provinces. Projected GDP increases for have provinces for 2012: B.C. 2.3 per cent; Alberta 3.9; Saskatchewan 4.2; and Manitoba 3.2. Projected GDP increases for the Maritimes: 1.8; New Brunswick 1.8; Nova Scotia 1.6; and P.E.I. 1.9. The result will be that once again many more millions of dollars will go to the already rich western provinces compared to payments to the Maritimes. This means huge additional costs for the Maritimes and, combined with other factors, could be the straw that breaks the camel’s back in terms of more people making the tough decision to move to a more affordable part of the country. A comparison of some facts about have-not Nova Scotia and have-province British Columbia indicate why thousands of people already leave the Maritimes. Unemployment rate: Nova Scotia 7.8 per cent (plus thousands discouraged from being listed) British Columbia: 7 per cent. Conclusion: it’s much harder to get a job in Nova Scotia. Consumer Price Index: Nova Scotia food: 135.9 B.C. food: 126 N.S. Shelter 132.2 B.C. shelter: 114.5 Overall index: Nova Scotia 124 B.C. 117.5 It is quite a bit more expensive to live in Nova Scotia. Average hourly wages (mostly skilled): N.S.: $20.57; B.C. $23.51 (Employees earn on average $3 more an hour in B.C., but live more cheaply.) Because of these and other factors, Nova Scotia already experiences a serious exodus of people. A TD Bank report in January 2011 said that during the years 2007 to 2010, Nova Scotia’s net loss of people to other provinces was 4,640. Incidentally, during the same period, 43,568 people moved from some part of Canada to British Columbia. Unfortunately, with Nova Scotia having to shoulder the additional health costs in a very few short years, it is likely that many more people will be tempted to go west, leaving the province with too small a population base to develop as it would like. And if this were not enough, the Harper government may want to make additional changes that would further damage the financial picture for the Maritimes. For decades federal governments spent billions-of-dollars supporting economic development in poor parts of the country in an attempt to maintain some semblance of equality of opportunity and standard of living across the country. Medicare's 50th Anniversary

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Big change with Harper in command But there is now a dramatic change in the attitude in Ottawa. For Stephen Harper it all comes down to, you guessed it, right-wing ideology. Tom Flanagan, a former Harper mentor, embraces the return of “classical federalism” to Canada: “In the Canadian context, the revival of classical federalism is an essential part of classical liberalism (i.e. neoliberalism), with emphasis on smaller government, lower taxes and balanced budgets,” Flanagan wrote in The Globe and Mail. “It is good news that Stephen Harper’s Conservative government is now moving incrementally toward both classical federalism and classical liberalism.” The Harper government believes that what happens in the marketplace should decide the fate of our country. So, if it is “bust” in P.E.I. when it’s “boom” in Saskatchewan, people should move west. That’s the law of the marketplace. The neo-liberal ideology being implemented by the Conservatives may mean they will also want to fiddle with equalization payments: money transferred to the less prosperous provincial governments “to provide their residents with public services that are reasonably comparable to those in other provinces, at reasonably comparable levels of taxation.” Nova Scotia, one of the provinces that receives the most under the concept, will receive a transfer payment (under the Atlantic Accord) in 2011-12 of $1.268-billion – a huge amount of money for the province. Perhaps luckily for the Maritimes, the concept of transfer payments was enshrined in the Constitution in 1982, but this will not stop the Harper government from trying to compensate for the payments in one way or another. If Harper gets his way in bringing a near-total market-driven economy to Canada, we could very well end up with a two-tier country — one for the rich and one for the poor.

Secure the Future of Medicare: A Call to Care Friday, January 20, 2012 Canadian Health Coalition January 2012

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Medicare's 50th Anniversary


Health care in Canada is a fundamental right without distinction of race, gender, age, religion, sexual orientation, political belief, immigration status, and economic or social condition. Organizations representing millions of Canadians will mobilize to defend this right and to ensure that the following principles shape the direction of the Health Accord renewal: The recognition of the highest attainment of health as a fundamental right throughout life and the necessity of preserving public health through active measures of promotion, prevention, and protection including such determinants as housing, food safety, income, education, environment, employment and peace.

The recognition that many Aboriginal people have a poor health status and a high burden of disease. The current system is failing and requires a transformation of the relationship between Canada and its Aboriginal people to find solutions together. The Aboriginal people must be at the First Ministers discussions on the Health Accord as these solutions involve all levels of government. The recognition of health care as a public good for which no financial barriers must be erected. We affirm the need for a system of public health care which is organized on the basis of public administration, public insurance and the delivery of services on a public, not-for-profit basis. Opposition to any commercialization and privatization of health care. Therefore the federal government must negotiate a general exclusion of health services and health insurance from all trade agreements. The need for the federal government to fully assume its responsibilities in respect to health, particularly by securing the adequate and predictable federal health transfers and enforcement of the Canada Health Act. The reaffirmation of the original vision of a truly comprehensive public health care system for Canadians providing a continuum of services. The next steps are the expansion of the public system to include a universal Pharmacare plan, a system of home and community care, long-term care, and a strategy for mental health. The need to move towards a community-based, multi-disciplinary team approach to the management, organization and delivery of services, especially in primary care. Levels of services must be sufficient so that the burden of care does not fall on families, mainly Medicare's 50th Anniversary

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women. An accountable health care system through democratic participation and transparent governance at all levels. The recognition that health care workers are critical to the effective operation of the health care system and that decent wages and working conditions are essential to high quality care. We come together to commit to ensuring that governments throughout Canada renew their commitment to protect and expand Canada’s public health care system to meet the present and future needs of all people living in Canada, based on the principles (public administration, universality, comprehensiveness, accessibility and portability) and conditions (no extra billing or user fees, or queue-jumping) of the Canada Health Act. Regard