Inequality in care exists
Government has failed to provide an adequate social safety net
Thank you for your editorial Tackling two-tiered health care in Canada, Feb. 4, based on the Canadian Medical Association Journal (CMAJ) article on the problem of poverty and its effects on peoples’ health.
The CMAJ did not use the term two-tier in their editorial because Canada does not have a two-tier health-care system. What we have is a public health-care system based on the five principles of the Canada Health Act – universal, accessible, comprehensive, portable and publicly administered. Everything in the hospital and the doctor’s office is free to all Canadians, from the poorest to the richest citizen. Few countries in the world have such a system. In contrast, a two-tier system allows doctors to extra bill patients or charge fees for patient services. This is contrary to the Canada Health Act. Unfortunately, many profit-seeking individuals and businesses try to undermine our system by spreading false information.
Forces that want to privatize our universal system include Dr. Brian Day and his Cambie Clinic. At the moment, his case is in the British Columbia Supreme Court.
Dr. Day’s privatized surgical clinic is trying to introduce a two-tier system. They are billing their patients and the B.C. government for the same service – a clear violation of the Canada Health Act. The B.C. Health Coalition, Canadian Doctors for Medicare and others including physicians are opposing them.
The CMAJ is concerned about the fraying of Canada’s social safety net (SSN) established after the Great Depression of the 1930s. We Canadians worked together to weave the social programs into our safety net. We were determined never again to experience the devastation and indignity brought by the Depression. We wove together a social system intended as a concrete commitment to equality. Over the years the programs included national health care, old age security, family allowance, unemployment insurance, training, labour policy, pensions and welfare. These programs were intended to include everyone, and contribute to a sense of a distinctive national identity.
Although far from perfect, the SSN reduced inequality and injustice in Canada. Regretfully, different governments shamelessly shredded the SSN and in so doing, unravelled much of the social fabric of our nation. With this shredding, poverty grew with every shameful cut to social programs.
In this process, programs and services were delisted from our public health care system (Medicare) although its founders intended a Phase 2 that included the items mentioned in the CMAJ editorial – prescription drugs, mental health counselling, home care, dental, physiotherapy and related physical services to name some.
Those without private insurance plans or high enough incomes cannot afford to payout-of-pocket under a privatized system. This is where the inequality exists as the CMAJ notes.
The journal also emphasized the importance of the social determinants of health – 12 in all, including income level, housing, food security, education opportunities, employment and working conditions with decent pay, adequate housing, race and gender equality, mental health care and social supports that ensure a healthy lifestyle. When these are lacking, people get sick as the CMAJ notes.
It laments the fraying of the social safety net and therefore the extent of poverty and its accompanying health effects. The fact that governments failed to provide an adequate social safety net, is not a failure of Medicare. Sadly, Canada has slipped to last place among comparable countries in spending on social programs. The CMAJ rightly points out that failure to assure a strong social safety net amounts to discrimination against those in poverty. In relation to health care, the inequalities consist in what is not included in the Medicare system; not in what is currently there. Universal Pharmacare is at the top of the "missing programs list.” Problems in our health-care system stem mainly from lack of government funding.