By Adam Sakiyama and Daniel Tarade (first published by Socialist Action on Jan. 26, 2023)
Well folks, he’s done it again. Ontario Premier Doug Ford retrieved the major tool in his toolbox: privatization. This time, Ford brandishes privatization to hammer on the nail that is the province’s healthcare system. As reported by the CBC last week, “Ford and Health Minister Sylvia Jones are planning to make an announcement next week on expanding the number and range of surgeries performed in independent health facilities outside of hospitals.” Independent health facilities are generally for-profit clinics operated by the private owners.
Ontario’s Conservative government first proposes to expand the number of cataract surgeries to be performed at independent facilities, followed by other “non-urgent, low-risk and minimally invasive” procedures. By 2024, private clinics will be allowed to even perform hip and knee replacement surgeries. The expansion of private healthcare represents a dangerous attack on socialized medicine and the tenet that everyone deserves access to quality healthcare independent of their ability to pay for it.
While Ford argues that individuals will be able access private clinics without paying out of pocket (the government promises to pay these costs just as it pays for publicly-owned clinics), healthcare advocates make clear that this move further erodes public health care.
One danger with a mixed public-private healthcare system is that for-profit clinics focus almost entirely on “lighter-care profitable patients.” Those who need complex care will have to rely on publicly-owned healthcare institutions, who cannot turn away “less-profitable” patients, and will suffer the most, under our under-resourced, over-burdened system. Remember, Ford’s government will be giving millions directly to for-profit clinics, which is money that otherwise would go to our public system. As more money is put into private clinics, the most vulnerable among us, who cannot access private clinics, will be left with an even more underfunded public system.
Another massive issue with for-profit clinics is that in addition to siphoning money away from our public system, they also siphon away staff. Investment into private clinics leads to greater under-staffing in our public institutions as both private and public sectors seek to hire the same workers. We see this at play with our mixed public-private mental healthcare system. A resident in Ontario can see a psychiatrist, psychologist, or social worker for free if they are offered in government-funded hospitals, clinics or agencies, but with a lack of funds for public mental healthcare, most practitioners operate in the for-profit sphere, where they can pick and choose the most-stable, least-complex, and wealthiest clients while the rest of us are left waiting months for access to public services. The same reality awaits all of us if we continue to expand private healthcare.
We must contend with the obvious contradiction in for-profit healthcare. A for-profit corporation prioritizes profit accumulation, above all. Whether providing healthcare or selling luxury watches, every for-profit corporation treats their business as a profit-generating machine. While the masses of workers and oppressed people generally agree that ill people should not be gouged by greedy corporations, the Ford Conservative government clearly condones gouging. A December 2021 report from the Office of the Auditor General of Ontario found that “the Ministry [of Health] has no oversight mechanism to prevent patients from being charged inappropriately for publicly-funded surgeries.” The Auditor General found that for-profit clinics “misinformed [patients] of their right to receive standard cataract surgery free of charge through OHIP,” which led to manipulative up-selling and extra charges. For a private clinic, up-selling of medically unnecessary procedures and services represents another avenue to bolster the bottom line — profit in their pocket. Anything beyond profit is secondary, which constitutes a violation of the basic oath each doctor takes to “first, do no harm.” All procedures come with some risk and if a procedure is not necessary outside of its ability to generate profit for a corporation, then this up-selling is clearly at odds with basic principles of medical practice.
In Ontario, we see many examples that prove profit matters more to for-profit healthcare providers than the health and even life of their patients. The Ontario Science Table released a report in January 2021 showing that for profit long-term care (LTC) homes had Covid-19 outbreaks with nearly twice as many residents infected and 78% more resident deaths compared with non-profit LTC homes. Both for-profit and publicly-owned non-profit LTC homes charge residents the same fee and receive the same financial support from the government. So why do for-profit homes see their residents die at a higher rate, especially during Covid-19? To maximize profits, they cut costs. For example, even though Ontario provides a fixed per diem of $103.88 per resident for nursing and personal care to both for-profit and publicly-owned non-profit LTC homes, for-profit corporations pay their healthcare workers less and hire disproportionately more casual and part-time staff to avoid paying benefits. This results in residents at for-profit LTC homes receiving fewer hours of daily care than those at non-profit LTC homes. As the Ontario Health Coalition notes, “for-profit facilities have fewer services and provide lower comfort and security, which increases residents’ stress levels.” Despite equal public funding for both for-profit and non-profit LTC homes, the former takes some of that cash and puts it into their pockets while the latter puts everything towards care for residents.
Let us be clear: healthcare is a fundamental human right. Any move to restrict access to healthcare on the basis of individual wealth is exclusionary and a form of class warfare. Privatization of healthcare only serves to further widen the societal gap between the capitalist and lower classes. It disproportionately harms the most vulnerable among us.
The Ontario Government should not look to profitability as a motivator for funding public services. There are critical supports an individual needs to participate in a happy, healthy society. Healthcare is a primary one.
If Ford is truly interested in ameliorating the province’s healthcare crisis then the funds he’s willing to invest in private for-profit clinics should go towards supporting the public healthcare workers who were already struggling, rather than letting them drown. We need to properly invest in our public healthcare system. Not only will funding our public healthcare system cost less than subsidizing for-profit care, it will also result in better care and healthier communities.