Eighty per cent of Canadians agree that our health-care system is in crisis. It has been gradually worsening for decades as a result of chronic underfunding and understaffing, but since the COVID-19 pandemic began three years ago the struggling system is under even greater strain. There is a growing anger and frustration among the general population at the state of health care today and many provinces are gradually privatizing health-care services under the guise of “addressing the crisis”. As patients and health-care workers suffer, everyone wants to know who is to blame. The federal Liberals tell us the provinces are not doing enough, while the premiers want us to think it’s the feds that aren’t pulling their weight. So who is really to blame for this mess?
Haggling over health transfers
To address the current crisis premiers are demanding the federal government increase the Canada Health Transfer, a sum of money the federal government gives provinces to spend on health care. The Canada Health Transfer sits at $45 billion for this year, but the provinces want it increased by at least $28 billion a year. This is a bold ask. It would mean increasing the transfer by more than five times the amount the federal Liberals promised in their last election campaign.
However, at the same time, many provinces have been gradually privatizing health care, which makes it doubtful that this money will not find its way into the coffers of private companies. In response to the demand for more money, Justin Trudeau has said, “We’re going to be sending more money, but we need to see real change, real results.” In exchange for more funding, he is asking provinces to set up data collection systems to prove that they’re using the money to fix their broken systems. Provinces would need to prove that the additional funding is resulting in a reduction in wait times, more Canadians being matched with a family doctor, and other metrics. A meeting was organized in November to get the federal and provincial health ministers together and agree on an action plan. Talks broke down when the federal government refused to say how much money it would give provinces for meeting its conditions, and the provinces refused to commit to meeting the conditions without being given a dollar amount!
Either our elected leaders have worse conflict resolution skills than a bunch of toddlers, or neither side was negotiating in good faith. Either way, more than two months later, the federal government has not boosted its funding and the provinces have not set up a system that would hold them accountable. Nothing has been solved. The Canadian Medical Association, which represents doctors across the country, put out a statement expressing its disappointment. The Canadian Nurses Association used stronger language in their statement, expressing that they are appalled at the lack of progress: “The lack of results and finger pointing is not what nurses expect, leaving them wondering if their governments have their back.”
Privatization has made the crisis worse
Over the years, as a so-called solution to the problems of our health-care system, many provincial governments in B.C., Alberta, Ontario, Newfoundland and Labrador, and Quebec have privatized various health-care services. As medical wait times and ER wait times reach record highs, right-wing premiers are using the present impasse to justify further privatization. Earlier this month Doug Ford unveiled his plan to expand private clinics in Ontario. If Ford gets his way, these clinics will be allowed to do “non-serious” surgeries like hip and knee replacements and cataract surgeries. This means almost 50 per cent of surgeries in the province are being outsourced to private, for-profit clinics! Some have called this move the biggest shift in Canada’s health-care system to happen in generations; in other words, the biggest privatization.
The current premiers in Alberta and Quebec are also openly in favor of more privatization. Depending on how Ontarians react to Ford’s scheme, if the backlash does not result in the fall of the Doug Ford government, right-wing premiers across the country may conclude that they too can privatize a wide range of health-care services and get away with it.
According to Ford, outsourcing to private clinics “will allow additional capacity at the hospitals to do the serious surgeries.” Ontario’s College of Physicians and Surgeons says it previously explained to the Ford government that this move will actually accomplish the exact opposite, increasing wait times for more urgent hospital-based care. More investment in private clinics will mean less investment in hospitals and worsening staff shortages. Ford and his health minister have yet to explain how diverting funding into the private sector will shorten wait times and improve care overall.
The reality is that giving public money to private clinics is a waste of health-care funding. Instead of the government paying for just the cost of delivering health-care services, it will have to pay for the cost of these health-care services and profits for the owners on top of that. That is money that would be better spent on solving the staff shortage by hiring more nurses and doctors and paying them well. We can look to our neighbors to the south to see how expensive health care can get when it is in private hands. A 2020 study showed that U.S. hospitals charged an average of $417 for every $100 of costs they incur! The more we expand the role of the private sector in health care, the less care we actually get for each dollar of public money spent. The only people that stand to gain from privatization are the health-care profiteers that own these private facilities.
When Ford made his announcement earlier this month, many Twitter users called on Justin Trudeau to stop him by making a ban on privatization a requirement for provinces that wish to receive additional funding through the Canada Health Transfer. Unfortunately Trudeau has referred to Doug Ford’s privatization scheme as “innovation”! While Trudeau’s statement would come as a surprise to some, it is totally in line with the Liberal track record of the last few decades, with Liberal premiers doing their fair share of health-care privatization. Liberal governments in Ontario, B.C., Nova Scotia, and Quebec have outsourced health-care services or invested in private-public hospitals.
Decades of underfunding
The privatization that is taking place in our health-care system today is the logical conclusion of decades of underfunding. After years of wait times getting longer and services declining in quality, politicians use the rhetoric that our “broken system” needs “innovation” to justify privatizing the system piecemeal. In reality public facilities would thrive if given the funding they need. Who is responsible for the underfunding?
At a press conference in November, Trudeau said “provincial governments say they don’t have any more money to invest in health care and therefore they need money from the federal government, while at the same time they turn around and give tax breaks to the wealthiest.” If we listen to Trudeau, right-wing premiers are responsible for the lack of funds in health care and the federal Liberals are already paying their share. Is this true?
Let’s look at Ontario, Canada’s most populous province under right-wing premier Doug Ford. In 2018 he cut $97 million slated for hospital beds. In 2019 he announced $1 billion in cuts to Toronto Public Health, and in the same year he cut $330 million in planned funding for mental health. These are just some examples of Ford’s cuts to health care. Additionally, in the fiscal year 2021-22 his government withheld $1.2 billion of the money earmarked for health-care spending, and in the first half of the 2022-23 fiscal year it has withheld $859 million. Ford complains about lack of funding but refuses to use the money already available to him to fund health care to fund health care. Over the same period his government also implemented Bill 124, which ensures that nurses cannot fight for an annual pay increase above one per cent. Ford’s attacks on frontline workers are further driving them out of the profession, exacerbating the labor shortage in health care. The situation in Ontario is not an exception in Canada, but the rule.
When Trudeau spoke out against right-wing premiers at his press conference, he spoke the truth. They are cutting health-care funding and contributing to the worsening state of public facilities. However, while the federal Liberals chastise premiers for their indiscretions they are hoping Canadians forget a very important fact: the federal Liberal Party is responsible for the biggest cut to our health-care system in Canadian history. Between 1995 and 1998, Liberal Prime Minister Jean Chrétien cut federal transfers to the provinces by $7 billion. Predictably, since the Chrétien days both the total number of hospital beds and the number of acute beds per 1,000 inhabitants has steadily fallen. The system never recovered from Chrétien’s cuts, but the Liberals don’t want to talk about that.
Where is the NDP?
Federal New Democratic Party Leader Jagmeet Singh has come out opposing Ford’s privatization and calling out Trudeau for his silence. “We already have a shortage of health care workers and Ford’s answer to this is to take people out of operating rooms and ERs in the public system and send them to private facilities,” Singh said. “How does that make sense?” In response Singh is calling on the Liberals to ban health-care privatization. While a ban would slow down the worsening of the crisis in health care, it would not actually fix it. The NDP should also call on the Liberals to reverse previous privatizations that both parties have carried out in Ontario and the rest of Canada, through the expropriation of existing private clinics and public-private hospitals. As long as these facilities are allowed to remain under private ownership, they will continue to suck up public funding and take health professionals away from the public system. Fixing our health-care system is more important than guaranteeing eternal profits for these parasites. As Doug Ford’s brother Rob was fond of saying, we have to stop the gravy train!
Additionally, the NDP should call on Trudeau to take bold action to solve the staffing shortage by providing free education for nurses, personal support workers (PSWs), and doctors. But this won’t get us the nurses and PSWs we need right now for the system to function well. In some hospitals, understaffing has gotten so bad they’ve had to temporarily close for days at a time! Frontline workers are leaving frontline work because of the poor pay and conditions, but these can easily be fixed. The NDP has already called on the Liberals to hire 7,100 nurses, but this alone does not go far enough to address the turnover rate which is the driving force behind the staffing shortages. Health-care workers are fleeing frontline work in droves because of poor pay and conditions. The NDP should demand that the Liberals significantly improve wages and conditions for frontline health-care workers to reduce turnover and solve the staffing shortage once and for all.
Now, whether the NDP puts bold demands on Trudeau or only demands the bare minimum, without sufficient leverage to back it up nothing will actually happen. At the moment the federal NDP actually has some decent leverage, they are propping up the Liberals through their confidence-and-supply agreement. If Singh breaks the agreement the Liberal government will fall soon after. Singh says he plans to leverage the agreement to get concessions, but according to an NDP insider the party has “no intention” of walking away from the deal while “still pushing for more”. As long as Singh continues to rely on empty threats alone to “push for more” from Trudeau, the Liberals will continue to ignore his demands. The NDP needs to be prepared to actually walk away from the confidence-and-supply agreement if its demands are not met. If leadership continues down this path of moderation and cooperation with the Liberal Party, the NDP will continue its descent into irrelevance.
Labour movement must act
The most powerful force in Canada that can solve the health-care crisis is the working class, particularly workers in the health-care sector. These workers are bearing the brunt of this crisis, and as the backbone of our health-care system they have the biggest leverage of all: their labour power. Health-care workers could bring the federal and provincial governments to their knees if they go on strike and refuse to go back to work until these capitalist politicians commit to taking the bold measures needed to end the health-care crisis: good wages and working conditions, free education for health-care workers, a ban on healthcare privatization, and expropriation of existing private facilities.
Of course, such a strike will not happen spontaneously, but must be organized. Fortunately in Canada health-care workers enjoy high unionization rates. The Canadian Union of Public Employees (CUPE) alone represents more than 200,000 health-care workers, and thousands more are represented by other unions such as UFCW. Union leaders have put out statements expressing their disapproval of what is happening and providing suggestions for the government to take on board. Capitalist politicians have ignored these suggestions. Like Jagmeet, our union leaders need to start using their leverage! They need to put forward bold demands and begin organizing demonstrations to build momentum for an all-out strike. Health-care workers need to take matters into their own hands and demand their leaders act.
One of the most common arguments we hear against a strike in the health-care sector is that “patients will suffer”. Patients are already suffering and even dying. Earlier this week a Nova Scotia woman died in the ER after waiting seven hours to receive care. If we allow the crisis to worsen these incidents will inevitably become more commonplace.
Another common argument against strike action is that it is unethical to deny patients urgent care. Those who make this argument might be surprised to hear that health-care professionals, the people who dedicate their lives to helping the sick, agree with them! That is why during hospital-wide strikes such as a recent strike in New York, emergency rooms remain open. The only time emergency rooms close their doors is when they don’t have enough staff to function, a commonplace occurrence in Canada today. Dozens of emergency rooms have gone into what some call “disaster mode”, closing their doors for days at a time because they simply can’t provide the care patients need. Anyone who really cares about emergency rooms staying open should support a health-care workers strike as it is the only way to force governments to solve the crisis.
Labour leaders have already tried asking nicely, and they have also tried asking not nicely. Now is the time for action. Hundreds of thousands of health-care workers in Canada are unionized and there is no power greater than the power of the union. That power must be realized through mass strike action! Health-care workers in Britain are on strike right now because their health-care system is facing the exact same problems as ours. Just last week, 7,000 nurses at two hospitals in New York went on strike and won after just three days! They won a guarantee of better staff-to-patient ratios and compound pay increases of 19.2 per cent over three years. Here in Canada, nurses at the Maisonneuve-Rosemont Hospital ER in Montreal recently staged a wildcat sit-in strike and in a few hours forced the hospital administration to get rid of an abusive manager. Health-care workers in Canada can fight and win by joining their brothers and sisters in the U.K. and the United States on the picket lines.
New era of capitalism
If we do not stop them, Liberal and Conservative governments will continue to attack the health-care system until there is nothing left. These attacks are part of a general, decades-long process of dismantling the welfare state in Canada and elsewhere.
Under capitalism the existence of a welfare state and various protections for workers are the exceptions, not the rule, and we must vigilantly defend them. For hundreds of years workers in capitalist countries had next to no rights. The welfare state only formed after World War II, under very unique conditions and only in imperialist countries. Capitalism was experiencing its biggest economic upswing ever and workers were fiercely fighting for their rights. As soon as the workers movement receded and the economic upswing came to an end in the 1970s, capitalist governments began clawing back the hard-fought gains of that period on behalf of the capitalist class, and they have no intention of stopping.
Workers have fought and died for the benefits that we enjoy today including a public health-care system, but we are moving backwards and have been for decades. We need our leaders to act with a sense of urgency and mobilize the millions of workers in this country to fight back and win all that has been lost.
We cannot continue to go backward. We need to go forward to free pharmacare, free dental care, and free mental health services; well-funded, well-staffed hospitals and clinics; a 30-hour work week, and good wages for all health-care professionals. With a powerful labor movement we can do it. To ensure that the capitalists and their representatives in government never pull us backwards again, we need to overthrow them and run society under workers’ control and ownership.