~ BY SEAN GRIFFIN

When the Canadian Labor Con-

| &ress’ ‘‘SOS Medicare’ campaign

_ Opens with a national conference in
_ Ottawa November 4, it will have
_ before it a task that in recent mon-
ths has become desperately urgent
_ —Tescuing a comprehensive health

Care system that is in danger of be-

| ing dismantled less than a decade
_ 4fter it was made universal.

“Organized labor is increasingly

| alarmed by the mounting assault on
_ Canada’s medicare program —
_ Whether by budget limitations, im-
Position of deterrent fees, physi-

Cian’s withdrawal from our public

3 health insurance programs or extra
billings,” the CLC warned in a

bulletin announcing the Congress

| campaign.

‘| &Nterprise think-tank Fraser

 Yincial

fn SU
a

The International Woodworkers

_ Of America added to that this week

With a pledge to play a leading role

M labor’s program ‘‘to defend -

_ Medicare against governments of

_ the far right and against members

_ Of the medical profession for whom

} €coming even wealthier is more
_ lMportant than the access of Cana-

dians to medical care.”’
Regional IWA president Jack
Unro commented, ‘‘There are

~ damn few working people who will

Not join us in a fight for continued

UNiversal medicare.”’

And working people will have to

Tally to the defence of medicare —

Or the squeeze on provincial health
budgets and ‘‘opting out’ of
Medical plan by doctors has already
feached a crisis in Ontario and
threatens the same in other pro-
vinces.

Perhaps most indicative of the

| degree to which universal medicare

has been challenged is a recent book

Published in Vancouver by the free

In-

Stitute, entitled The Health Care
usiness,

Written by economist Ake Blom-
Qvist, it calls for a dismantling of
the present. system. of subsidized
Public health insurance ‘and its

» teplacement by a premium financed

health insurance scheme available

| through either the private or public

Sector.

Blomqvist also advocates that
Present financing arrangements for
hospitals be scrapped and replaced
-Y a system ‘whereby hospitals
Would be entirely dependent for
their Tevenue on fees for service to

Paid by individuals or by public
Or private insurance.”’

Blomqvist — and the business

- Community, for whom his book was

Produced — ‘see it, the principle
“Pon which the medicare system is
‘ased, that the best available care

Ould be excessible to all, is too

-fostly and should be abandoned in

ves of providing a ‘‘minimum
®vel”” of care for all.
f © cost, of course, is the major
ator. Governments and the cor-
Porate sector have long been rankl-
by the rising costs of health care
bs the changes in federal govern-
‘ent cost-sharing as well as the pro-
back governments’ budget cut-
7% S$ have been in direct response
Corporate pressure.

aut Only does business want to
=| its hands on the substantial
h Unts of money now allotted to
a th care but the multinational in-
meee firms also want back into
big health insurance delivery
Uni Ness, from which, as a result of
Versal medicare, they have been

Ut excluded for several years.

‘ 29 surprisingly, both Blomqvist
Mich Taser — Institute director
* ee Walker, in an introduction
© book, point favorably to the
Wheret. handling of Autoplan —
liabil, y the compulsory third party
oie, Msurance is only available
gh ICBC while private in-
aus been allowed back in to
hid . . -
SUrance. for the optional in
to omavist’s study was intended
Rover an academic voice to the
dism, Ament-business clamor to
if elle the medicare system. But,
ding ee it shows just how
Tous — and expensive — it

Hh

| seo

ALL YOUR MOANING AND GROANING MERELY STEMS
FROM “AN ACUTE APPENDICITIS WITH A FEW

OTHER COMPLICATIONS... HARDLY THE THING
REQUIRING IMMEDIATE

HOSPITALIZATION . ...

~

ake,

Medicare: labor action
to save our health care |
is more urgent than ever

would be if Canada were to follow
the example of the U.S., now the

only: major-country. which does:not-,

have a comprehensive medicare
system. .

According to Blomavist’s
figures, for example, the per day
cost in U.S. hospitals is $128, com-
pared to Canada’s $96, indicating
that the private ‘‘market’’ system
for which the author argues, has
not kept costs down. Blomavist
himself concedes, ‘‘. . . the U.S.
system in fact appears to have been
somewhat more expensive than the
Canadian one.”

He also concedes that as a result
of the often prohibitive cost of ob-
taining medical insurance, ‘‘a not
insignificant part of the U.S. low-
income population continue to have
little or no health insurance protec-
tion, and undoubtedly there are
some people who suffer ill health
for which they are not being
treated, for financial reasons.”’

Medicare is suffering
open attack by medical
associations and covert

attack by some
provincial governments

More ominous are the statistics
cited on child mortality and life ex-
pectancy which show that
minorities in the U.S. have substan-
tially higher rates of child mortality
and lower life expectancy than
white Americans — and the relative

disparity has not changed since the ©

1950’s. The U.S. privately-based
medical insurance system has made
minorities the victims of its in-
evitable inequities.

But although the U.S. system
makes medical care prohibitively
expensive for working people,
many Canadian doctors look en-
viously to the U.S. where private in-
surance firms have not put the
restrictive pressure on physicians
fees that provincial governments
have in this country.

Already, as a result of what they
claim are ‘‘unrealistic” provincial

_ fee schedules, many doctors in both
Ontario and Alberta are extra-

billing their patients for amounts
over and above the schedules of
fees. In Ontario, about one-fifth of
the provinces doctors have ‘‘opted
out’? of the Ontario Health In-
surance Plan in order to get both
the medicare fee and an extra
amount from the patient. (Accor-
ding to the provincial medicare
legislation in Ontario, doctors, in
order to extra bill, must opt out and
then bill the patient directly for the
whole amount although the patient
can be reimbursed by OHIP for the
amount stated in the fee schedule).

In Alberta, some 37 percent of
doctors bill the provincial medical
plan for the stated fee and then bill
their patients for an extra amount.

In this province, doctors reluc-
tantly accepted the last increase
negotiated with the government by
the B.C. Medical Association but
since that time, the BCMA has been
campaigning for ‘‘patient participa-
tion’? in the payment of doctors’
fees. :

Dr. Mel Petreman, president of
the BCMA, said in an interview
with the Tribune last week that the
‘‘patient participation’’ was intend-
ed as an ‘‘escape valve”’, to relieve
the pressure created by the govern-
ment squeeze on fees. ‘‘We want to
avoid the kind of confrontation
that has taken place in Ontario,”’ he
said, adding that the present system
in B.C. was ‘‘among the very best.””

But if the patient participation
scheme is in response to the govern-
ment restriction on fee increases,
the BCMA — and the Canadian
Medical Association — also sup-
port the idea as a matter of princi-
ple. As Petreman put it, if patients
have to pay directly, it reminds
them that medical. care is “a
privilege”’ and that doctors are ‘‘en-
trepeneurs.”’

It is precisely that attitude and
the apparent preparedness of the
medical association to compromise
the universal accessibility of
medicare in order to maintain their
incomes that has aggravated the
present medicare crisis.

In fact, any form of extra billing

Jeads to a bréakdown of the fun-

damental principles. on _ which

‘medicare was built. As the CLC

has stressed, doctors have a social
responsibility to accept the
negotiated fee schedule and abide
by it. If the fees are too low — and
there is reason to suggest that the
$11 paid to a physician for an office
visit, for example, is unreasonably
low — then they. must put pressure
on governments, with public sup-
port, for a better deal.

If extra billing is allowed to go -

on, one economist warned, we may
end up with the kind of denuded
medicare that New Zealand has
been left with. There, according to
Malcolm Brown, writing in the
Canadian Consumer, the combined
pressures of doctors raising fees and
right-wing governments freezing fee
payment schedules has resulted in a
medicare system which pays only a
minor fraction of patients’ costs.

And whatever the amount of ex-
tra billing, or ‘‘patient participa-
tion’’, it stands in the way of low in-
come people obtaining medical
care. In Saskatchewan, for exam-
ple, according to a 1974 study, the
introduction of a $1.50 fee levied
against patients when they visited
their doctors — a so called ‘‘utiliza-
tion fee’? — resulted in an 18 per-
cent decline in the use of physicians
by the poor.

Questioned on that point, in rela-
tion to the BCMA’s bid for patient

participation, Petreman conceded
that he was ‘‘not aware that the
figure was so high.”’

But the BCMA president, like
others in health services, points the
finger of blame at the provincial
government.

“There has been a severe ration-
ing of health care delivery by the
government without any consula-
tion by those in the health
services,’” he charged, adding that
the Socreds ‘thave made some pret-
ty arbitrary decisions.”’

The result, he said, has been a
serious deterioration of health ser-
vices throughout the province.

Ever since the federal govern-
ment altered the dollar-for-dollar
matching grant system of sharing
medicare costs with the provincial
governments and replaced it with a
sysem of per capita grants and in-
creased provincial taxation power,
the provinces have been cutting
costs even more stringently. Some,
such as Ontario, have simply
pocketed some of the health money
and have arbitrarily cut provincial
health budgets.

The result has been a crisis of ma-
jor proportions, with hospital
closures, pressure for higher pa-
tients’ fees — and a disintegrating
medical insurance plan.

The federal government has lost
ome of its policing authority over
the medicare system because of the
change in cost-sharing agreements.
But in any event, Tories have shown
little commitment to the principles
of universal medicare, — and won’t
support them without a massive
public campaign.

The danger to medicare has also
prompted other groups to speak
out. Last month, a brief from the
Co-operative Union in Saskat-
chewan called for action to save
“Canada’s troubled health care
system.”’ .

“‘Medicare is suffering open at-
tack by medical’ associations and
covert attack by some provincial;

governments,”’ the brief declared. ib
“No ‘longer: are federal. health, ‘: ..»

dollars matched equally by the pro-
vinces; in some cases federal health
dollars are being diverted to other
uses. :

‘*Health care is again becoming a
privilege of the wealthy and not a
natural, equal right of all, Cana-
dians.”’

It called on the federal govern-
ment to maintain the four principles
of the 1968 medicare legislation,
namely comprehensive coverage,
universal accesibility, portability of
benefits and public administration,
and to make available ‘‘even more
generous cost sharing’’ for alter-
native health care, particularly
preventive programs.

It also. urged the provincial
governments to stand by the 1968
principles, to match the federal fun-
ding dollar for dollar and to
“refuse to refund any portion of
the fees of those practitioners who
fail to abide by the negotiated con-
tracts.”” :

The CLC campaign will be work-
ing with such groups as the Co-
operative Union as well as church
organizations, women’s groups,
pensioners and others.

“In spite of its shortcomings,
Canada’s medicare system used to
be one of the best in the world,” the
CLC declared in announcing the
call for a country-wide campaign.
“But unless we act fast, it will
disappear altogether.”

PACIFIC TRIBUNE—SEPTEMBER 14, 1979—Page 3