Keynote speech, "Who Killed Health Care?", by Holly Dressel

from the Green Party of Canada Convention on March 1, 2009

at Pictou, Nova Scotia, Canada.

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We could spend this time talking about health care policy, and this book has a lot of the most basic guidelines to help you do that. To sum up the latest research, our system needs more general practitioners and nurses and community hospitals. That's called primary care, and with it comes a much greater emphasis on prevention—things like making sure people are eating and exercising, reviewing full family histories, taking the time to work with them individually on health issues, and especially, making sure that poisons like processed foods and toxins aren't finding their way into their bodies. With these additions to what our system already provides, all the big studies now coming out of the World Health Organization and the UN are showing we can go on funding single-payer health care that will cover everybody, for a very long time.

But in fact I can't talk about all that, even though it's so hopeful and fascinating, because our single-payer health care system is in a terrific crisis. It's being attacked by big money, international banks and financial institutions, an entire ideology skewed towards privatization, which has infiltrated every single political party except the Greens and the NDP. This conscious, concerted attack is so relentless and dangerous that today I'm going to explain first of all why our health care system is worth every ounce of your devotion, who is responsible for the attacks on it and how those attacks play out. Finally, I will provide you with a lot of ammunition to combat it, most of which you can find right here, in this book. You want to be a real political party that can give Canadians intelligent, popular policies in things like education, foreign affairs and health. Here's your chance to get informed about the one issue that is dearer to Canadian hearts than any other.

I'm going to start with a chart (Chart 1).

Trends in Age- and Sex-Specific Mortality Rates This was taken from one of the most fundamental public health textbooks used in this country, Public Health and Preventative Medicine in Canada. These are official Health Field Indicators, and the charts and statistics used to achieve them are directly from Health and Welfare and Statistics Canada.

It's hard to read the numbers, but this side represents deaths per thousand people. This is the time-line, beginning in 1951 and ending in 1998. This one is Infant Mortality, this Age 1-14, etc. etc. The dark line is males, the light, females.

Now this one isn't very useful because deaths in this age category are skewed by the high rates of accidents; and this one, is age 65 plus, which is also skewed by the high rates of natural decline and death. But look at all the others. You can see the deaths steadily going down here, because it was the 1950s, the decade when better surgical techniques, and especially antibiotics, were added to the medical lexicon of cleaner water and better nursing to gradually lower the death rate over the entire modern world. Notice the group that no society can afford to lose; its most productive members, adults between 25 and 64. Deaths went down for the first decade of good surgery and antibiotics for adults. See? But then they leveled off. This book is also a complete history of hospital care in Canada, and it makes it clear that the reason for that, among adults, was the ballooning costs of treatments and hospitalization at that time. We still had a U.S.-style, two-tier, private health care system in the 60s, and although more cures and treatments were available, they were too expensive for most Canadians to access. There's a long section of the book, called "Medical Bills," that details this period. And that's why there was in irresistible impetus to public, single-payer health care. Citizens were absolutely clamouring for their right to have their lives saved by drugs and treatments that were out there, but not available because of cost.

So the mortality rate didn't improve, for anyone, after that first flush of new technology in the 50s. But then...there's a visible break in the deaths, so they plunge downward again quite suddenly. Anyone who works with graphs knows that's quite an exciting thing—few variables make such dramatic difference in outcomes that you get a sharp break instead of a gradual incline in a chart like this. It looks like a broken branch; it really caught my eye. And if you look at the other charts, you'll see that they have similar spots in them, even the 65+, just less immediately obvious.

Let's see; what year was that, that deaths throughout the Canadian population suddenly plunged downward? Oh, yeah. It's 1971. That's the year that Medicare, single-payer health care was implemented throughout the country. Look at this spot in particular.

So, all the political parties, mark you—I mean the impetus came from the NDP, but it was the Diefenbaker conservatives who voted most of it in. In 1971 it became national policy. And look what happened. Canadians got access to health care, because they were all paying into it and that system, like any form of insurance, allows more people at any given moment to access it. And the country's mortality rate plummeted. Look; in 1969-70, well over 2.3 males per thousand, and over 1.2 females were dying. By 1981, the men were under 1.8 per thousand and the women only about 0.8. In mortality statistics, an entire point drop like that is huge. Even among old people, look at what happened in 1971. For males, from over 6.7 per thousand, down to under 6, in a decade. That's access to heart treatment, largely.

What the privatizers in this ghastly, heartless Harper government will say is, oh that was then; today, we can't afford that kind of thing. We need to vary our system, introduce public/private partnerships, fully private clinics and so forth. That will be better for all of us. I mean, just look how long you have to wait for services; you'll be happier and healthier and the system will be in the black. Probably some of you will think: that does sound reasonable. I even thought so when I began this book. I had so little knowledge of health care back then my mind was wide open. But I was able, because of a grant, to do research for four solid years. I learned a lot.

Let's start by looking at cost and mortality rates. That's a great way to see how you're doing, and we have all those stats.

Comparison of US and Canada for infant mortality, life expectancy, and per capita spendingThe one country on earth that's nearly all private is the U.S., so it makes a great control example to assess the effects of privatization. It really is partly public of course; there's U.S. Medicare, which these days serves the huge majority of that population. Still, their private component is the largest in the civilized world. OK. Here's infant mortality rates, the key way you figure out how a country's doing, because they measure not just whether babies are well-delivered and cared for, but how the mother was cared for, what her nutrition was like and so forth. They're still considered the gold standard for figuring out healthy a given population is. Canada's infant mortality rates are 4.7 per thousand, very respectable in world wide terms, 23rd out of 225 countries assessed, but in the highest quarter, right after Japan, Finland, Norway and Sweden, in the company of the Netherlands, Luxembourg, Australia and Denmark. So not bad at all. Where's the privately-funded U.S.? The worst infant mortality rate in the industrialized world, 7.1, a national scandal. Its immediate neighbours in that range are Croatia and Lithuania. This rate is higher than Taiwan's or Cuba's, and higher even than the poorest state in India, Kerala. The last two countries, by the way, may be grindingly poor, but they have all-public, single-payer health systems.

Well, health results for a private system aren't too great. But how about costs? If you don't care so much about overall survival of all levels of the population, but you're focused on money savings and efficiency, as we're repeatedly told a private system would be, then the savings should be enormous, somehow making up for all those extra deaths. The dark line here is per capita spending. That's the U.S. That's Canada. I know many of you have heard about this, but it's just stark in a chart like this. This is close to $6,000 per person—versus, oh, half that for us. Here is life expectancy in the U.S. and Canada. It's around 80 for both sexes combined in our country, the supposedly expensive, inefficient one. In the U.S., it's under 77. Three years means a lot in mortality stats, and again, it puts the U.S down among some very poor company. We have 6.5 people dying per thousand over all. The U.S. has 8.4. For the age group 45 to 64, twice as many Americans will die in that age group than Canadians. And they'll pay twice as much per capita for the privilege. We know they aren't very different from us culturally, economically or genetically. The only real difference is the private health care system on the one hand, and the public on the other.

Comparison of life expectancy and per capita spending on healthHow do Canada and the U.S. stack up internationally? This chart is really fun (Chart 3). The black squares are per capita spending, and the grey towers are life expectancy. As you can see, the U.S. is down with Costa Rica, Chile and Portugal in life expectancy; but while only Denmark spends up to half the U.S. rate, the other countries in this range are getting what they pay for. Cuba's mortality rate is the same as the U.S., but for about $500 a person, or 12 times under the U.S. Canada, over here, is in the company of France, Spain and Singapore in longevity levels, and although much higher than Spain and Singapore, is still getting better bang for the buck than any other country in the world except for Sweden and Japan! I mean, guys, is this a terrible, worthless, broken system that needs to be immediately scrapped because it's such a mess? These stats are recent—the fall of 2006. We're third in the world for economic efficiency in terms of health results for our population.

But I can hear you saying: yes, but I went to the hospital recently and had a horrible experience—waited six hours and didn't get my wrist or throat or whatever attended to. Or I have a relative who needed an expensive treatment in Saskatchewan, and she couldn't get it, the line-ups were too long, she had to pay a private clinic to get diagnosed! Or what about those horrible wait-times for cancer treatments just a few years ago, with people being sent down to the states for chemo because the system was too backed up in Quebec and Ontario? What about the sheer level of over-work anyone with relatives who are health care workers is all too aware of? Doctors fed up with schedules and responsibilities that are impossible? Operating Rooms that are so badly organized or under-funded that you can wait two years for a new hip or a knee?

All that is carefully and completely and honestly faced and dealt with in this book. Wait times in particular are complex, and local, and vary with time and frankly how good the particular managers are. We don't have time to deal with them in detail here. Please get the book. It's all there. Again, we go on wide stats, not individual anecdotes, because it's how most of us get cared for that's the most important thing; some cases will fall through the cracks in any system. Again, Canada has a very respectable wait-time rate worldwide. It's inexcusable to have to wait too long for a cancer diagnosis, say, and when that happens the place it happens in must be reamed over and improved. The point is, there have now been many national and international studies on our wait times, and they simply do not happen across the board, or the way the media portrays them. Terrible national wait times, as one exasperated researcher put it, "a zombie idea," one that just won't die no matter how many facts and studies are arrayed against it. In fact, the only place our wait times are consistently worse than the privatized U.S. is not in heart surgery or cancer treatment or any of those really vital things, but in so-called "elective" care, which is everything from mole removal to cataract removal or a new hip or knee. I know if you have a bad hip, like Elizabeth did, it sucks to wait months and months for a new one and it can destroy your hope for a successful outcome. That's the one spot we're a little worse than the U.S.; but at the same time, E got her hip in months, which is average. The horror stories, thank heavens, are statistically rare. And all those Canadians do get their hip...for nothing. A poor person in the U.S. who can't even think about the expense of a hip or knee arguably has an infinite wait time. But those people aren't included in U.S. wait time statistics, which are in fact skewed to include only the people who can afford this care, which costs them thousands of dollars out of pocket—while Canada's wait times include—everyone.

But I want to explain to you, in the time we have left, why the single-payer, Canadian health care system, although still delivering these amazing stats, which more people should know about, and which we should be SO proud of, is so widely perceived here at home as a broken-down failure. That's a snow-job. By and large, our media draws most of its statistics from the Fraser Institute, honest, check the sources of all those heart-rending "wait time" stories...which is a right-wing think-tank which makes no secret of its bias towards "market-based," ie., profit-making, alternatives and solutions. When you crunch the Fraser Institute numbers against the real numbers from stats Canada they claim to base their findings on, you'll find a lot of serious manipulation and outright rigging. Check the book, I'm not the only person to have looked into this.

But there's more than media laziness involved in how poorly we understand what we have and where the real pressures on it are coming from. We have to go back to the mid 1990s, where this book is set. I took as a case study the Queen Elizabeth Hospital in Montreal, which was suddenly and apparently irrationally closed in 1995, to the everlasting outrage and grief of its staff and its patients. This was an exemplary, community-based hospital in every way, in the black, the birthplace of dozens of important medical breakthrough, including the invention of modern anesthesia. It was still doing pioneer work right up to the day it was closed. Its staff is still distraught, over ten years later, and there isn't one who feels they ever found, or could hope to find, a better place to work. But in investigating why this paragon was closed, I discovered something that most Canadians are blissfully unaware of. 21percent of ALL our hospital beds were closed in the years between 1994-97. Hospitals were closed, amalgamated or downsized by the hundreds, right across this country at that time.

Here in Nova Scotia, the process was muddied by a 1999 election in which the Tories claimed hospital closures were due to the Liberal government's need to bail out the Sysco steel mill in Sydney, the famous tar ponds. Four separate Halifax community hospitals were merged into a single one, the Queen Elizabeth II, with predictable effects on service. In Quebec, where the city of Montreal alone lost seven hospitals, there were the usual accusations of language favouritism—even though four of those hospitals were French. Saskatchewan lost 52 rural hospitals, a situation from which the province had never recovered. In 1995, the same year Montreal's hospitals were summarily closed, Toronto lost four of its most prized institutions, the Wellesley, the Salvation Army Grace, Riverdale and Runnymede, and just about every other hospital in the city was subjected to violent restructurings costing yet more beds. This was just before Conservative Premier Mike Harris' 1995-98 bloodletting of health care province-wide, which cost Ontario another 7,000 beds. Alberta closed "the biggest North American hospital to ever shut its doors," as Maclean's put it, the 100-year old queen of the city, the Calgary General. This 700-bed giant had so many supporters even after it closed its doors that the city actually blew it up in the face of the protesters in 1998. To this day, Calgary is the only large city on the continent without a downtown ER! B.C. and Manitoba also lost thousands of beds.

Everywhere we were told that this was the new face of medicine: more out-patient centres like Quebe's CLSCs, shorter hospital stays. Most of those centres didn't materialize or are horribly under-staffed, of course. And the other excuse, that health care costs were "ballooning," "out-of-control," threatening entire provincial budgets, is simply not true. In Alberta, for example, they were going up by a modest 1 percent a year! They were not "skyrocketing" or spiraling as the government claimed, and their increases could have easily been handled if the province hadn't been lavishing tax breaks and infrastructure programs on heavy industries like oil and hogs. I could go on, but you get the picture. No matter where you delegates hail from in this country, you have reason to feel betrayed and angry when it comes to health care. And the fact is: all the devils that haunt our system today, the acute health care shortages, the seasonally crowded ERs, the huge wait-times, got really bad right after these massive bed closures that were not done for the reasons given, and which, up until now, have never been properly acknowledged and assessed.

The Liberal government, just swept in 1995 in a massive voter reaction against the pro-American, pro-privatization, NAFTA policies of the Tories, had Paul Martin as its Finance Minister. He presided over the worst blood-bath carried out against a hospital-care system in human history—I mean it. No other industrialized country has ever closed so many beds so precipitously. Canada is now a popular subject for dozens of UN, World Health Organization and other international studies, I discovered, probing what happens to a health system that is gutted so violently. We can tell you. Through the no less than heroic efforts of its workers and its supporters, the huge mass of Canadian people, it has managed to live on, but it has a lot of new problems. And when Liberals and Conservatives tell you this system is unviable and has to change—because it's public, that's the reason it doesn't work well—you have to tell them that the only reason it's having problems is that they intentionally gutted it in the mid-90s and continue to undermine it every chance they get, against the wishes and needs of the Canadian populace, and despite the fact that it's still one of the best systems on earth!

Do I have proof of all this? Oh my, yes. My biggest shock in doing this book is that a decade after the fact, no one had put all the facts together, no national CBC or print reporter had even noticed that this wasn't a provincial matter. We are blinded by the idea that health care is totally under the aegis of a province, so federal policies can't effect it. If you don't consider transfer payments, of course that's true. And that's exactly how the feds did it. They cut the payments so the provinces had to scurry around and cut the hospitals. And the reason why the Liberals betrayed the country and their own policies? Because they were ordered to do so from on high. Who's higher than the feds in Canada? Well, the same international finance banks that have so recently plunged the entire world into recession. So naturally, the Canadian government did exactly what they said.

Let's look at the proofs.

People don't want to believe there's an international conspiracy of rich bankers, and I don't want to tell you that there is either, because you'll think I'm looney; I would if I were you. Unfortunately, I have full proof, a complete paper trail that there was and is an international effort to push public health care programs towards privatization. The wedge to do so is the huge debts many nations owe to these huge financial institutions. Sorry. I was just as surprised as you are. I got this proof through your current leader, Elizabeth May, although at the time she gave it to me, we had no idea it covered the health care crisis in this manner. As head of the Sierra Club of Canada, Elizabeth, along with the Halifax Initiative, an umbrella group of environmental NGOs, went through access to information to get hold of details on Canada's international debt. They were trying to figure out why the Liberals went back on every single election promise they made in 1995 and delivered a budget identical to what the Mulrooney Tories might have presented. In other words, why it doesn't any longer make any difference who you vote for; the policies are always the same, and they favour big money and small government.

Maybe that'll change if we can get rid of Harper's brand of give-the-country away politics, but Obama in the White House or not, for us it's still business as usual. So we got hold of the "1994 IMF programme for Canada." I hope you all know this, but definitions are helpful. The IMF, the International Monetary Fund, is not a bank, but how it functions is to negotiate how a country not paying its debt back fast enough should restructure its economy in order to meet its obligations. Think an Enforcer for a loan shark. So what happened in the 1980s under Mulrooney is Canada, like a lot of other countries, borrowed a vast amount of money on the international market in order to fund various programs, infrastructures like roads and dams and construction, and in the case of many political parties, pork-barrel schemes for themselves. They were encouraged to do so exactly the same way poor people were encouraged to take out sub-prime mortgages over the past few years. Oh, don't worry, you can pay it back!

Well, like a lot of other countries in the world—Rwanda, Russia, Brazil, Great Britain, and so forth—we couldn't. So in the early 90s the banks decided to get testy and send the IMF. The IMF then implements a program of what they term "structural reform" in the debtor country's economy. That's a pretty straightforward term, and it means that the new economy should be structured the way the IMF and the other Bretton Woods financial institutions like the World Bank and the WTO consider to be fiscally responsible and profitable for the creditors, the big banks. That is, government should shrink, and business should grow. First of all, it told the newly-elected Liberals that in their creditors' suggestions for re-structuring, and I quote, "Virtually no area of federal spending has been left untouched." Here is what, among other things, the IMF demanded of our country: less money to veterans and First Nations through "rationalizing the delivery of transfers or tightening access to benefits." They demanded cut-backs to ViaRail, the Canadian Mortgage and Housing Corporation, the National Film Board and the CBC. Only one of these institutions is still very functional today, the CBC, and it's under great duress. But most importantly, they demanded that transfer payments to the provinces be cut, and its helpful list includes: health care, old age benefits, equalization payments and educational subsidies. "Cuts in health transfers to the provinces," it wrote, "especially Ontario and Quebec..." would encourage "greater efficiencies or cost recovery in the health sector." What they mean by cost recovery is repayment of your debt to us, not more efficient service to the public.

The IMF 1994 programme for Canada even says that we have too many people with post-secondary educations, and student bursaries should be cut, to be replaced by the student loans that now mean that graduating students owe an average of $20,000 for a BA. Finally, it hit health again. Please think about what the following statement means in terms of what happened at Walkerton two years later and what continues to happen with listeriosis and e.Coli today: "there would seem to be scope for rationalizing [that's their word for "privatizing"] the services of...

Chart 4. Hospital separations and admissions, Canada, 1976-1977 to 2002-2003 Response rates in Annual return of health care facilities...
Chart 4. Hospital separations and admissions, Canada, 1976-1977 to 2002-2003 Chart 5. Response rates in Annual return of health care facilities (HS-1 and HS-2 and Canadian mis database (CMDB), 1984-85 to 2002-2003
Hospital admissions, Canada, 1976-1977 to 2002-2003 Average inpatient days, canada, 1976-1977 to 2002-2003
Chart 6. Hospital admissions, Canada, 1976-1977 to 2002-2003 Chart 7. Average inpatient days, canada, 1976-1977 to 2002-2003

Oh yes, there's a big hole in every single one. In 1994-95. And Stats Can's explanation on its website for that hole is simple. "The health institutions across the country did not report their numbers that year." Funny, that. They had done so every year since 1976 (and actually for twenty years before that) and every year after that, from 1996 to 2003. That's reporting faithfully for more than 50 years. Except for 1994-95. They didn't respond because these institutions, the few that were left after the blood-bath, were in such crisis that they couldn't even fill out the most basic forms for who was admitted and who discharged, how much money they spent, and so on. These are the basics of any administration, any office. Can you imagine how chaotic and horrible things must have been for them not to file any reports for those years?

Share of hospital expenditures by selected...And look at the wonkiness following—from nice, even towers of expenditures, admissions and so forth, we get these staggers and wiggles as the institutions nearly crashed. Notice in particular that for twenty-five years, hospital admissions and separations (that includes deaths, you understand), were equal. Look at that. Look at 1996-2000. For four years, there were more deaths/separations than admissions. For the first time in the history of these statistics. It only evened out again in 2002.

And still, no one in Canada has done a real assessment of what this kind of meddling in a country's internal services can do. The only reason we still have a public health care system—is the health care professionals, who work heroically, as many of us know, to somehow keep things going—and the Canadian public. We have made it clear over, and over and over that single-payer, public health care for all is a primary political right that we don't want taken away. But they keep hammering at us, with the media, the Fraser Institute, cooked books, fallacious, zombie arguments, and we keep weakening and allowing private clinics and infringements of the Canada Health Act, and not taking to the streets like we should, to save one of the finest systems on earth.

Those of you who are candidates or who are involved in party policy, I implore you to buy this book for your campaign office. I'm not being venal. Elizabeth will tell you, those of us who write serious non-fiction don't make money out of book sales, or enough to mention anyhow. All the stats and arguments and lengthy footnotes are here; they mustn't go to waste. No one has had the time to amass them before this book. I still believe that lies cannot stand up to serious research, and this book is very, very thoroughly researched. Its intention was to become a tool for your use. I will present these findings to the NDP, too. Not to the liberals or conservatives, however, as there's no point. Get a copy, or get some central office to get one and make xeroxes of the information you need. But please use it! That's what it's for.

If you take nothing else away from this lecture, take this:

It's very hard to take care of sick people and old people. No matter how hard we try, some will die, some will be poorly served, in any health system. The Canadian health care system is, by and large, one of the best you can get on this whole planet, given the limitations of time, money and budgets that all humans must deal with. In the top five, people.

The reason it has problems and failures is NOT BECAUSE IT IS PUBLIC. Sometimes, local failures are due to cases of local mismanagement, which statistically are still better than the full system failure of for-profit health care. But most of the time these failures are due to a willful plan of undercutting and weakening the public system by forces outside the country that see health care as a bonanza for private interests. As long as our intention is to help sick people get well and guard the lifespans of citizens, that's what we'll get. If we change that intention to: oh, and make money for stockholders too, what do you think we'll get? We'll get what the U.S. has, a system that makes money for health corporations that that from the point of view of keeping their population healthy for less cost is thousands of times more broken than ours. The privatizers are destroying our citizens' democratic right to take care of each other. As you value your family's health and happiness—don't let them.