January 17, 2023

It is hard to understand how we got to this point of having Ford announce full government funded for-profit health care. Unless of course you have been paying attention.

Unlike the absurd narrative Canadians tell themselves about our health system, Canada does not have public health care. It has a monopoly public health insurance program that funds a multitude of public, P3, and private health care services. This is not an accident, it was designed this way to appease the medical doctor community who feared loss of their exceptional income status.

While this mix of private and public has mostly been non-profit care (because the funding formula only allows some net revenue to be taken), there is plenty of skimming going on.

Although, if "long-term care is health care" (it isn't, of course, because it is housing), then we have had government subsidized for-profit health care for a good long while.

What is the difference between non-profit and for-profit in the provision of health care? It really depends on how far up the investment tree you go on how you answer this question.

Non-profit care is mostly for-profit care pretending to be non-profit. The company that runs the service is non-profit, but everything else is for-profit and not government owned or run.

There is plenty of health care money funding a profit subsidy going on in the non-profit health sector in Canada. In fact, how we fund doctors' offices is basically for-profit care. These are businesses that take money from the government and seek to maximize returns—usually by underpaying staff and engaging in financial trickery on the buildings.

Though, it does feel different when Ford announces for-profit care.

And, it is different. Up to now, private capital has funded and profited from our infrastructure through P3s, our long-term care homes, our hospitals, our doctors' offices, our community clinics, our MRI machine offices, our medical devices, drugs, and patented health processes.

But, private capital has not directly benefited from the explicit actions of our doctors trying to fix us when our bodies or minds are broken.

This has now explicitly changed.

The new incentive regime is clear. The province is paying more to your clinic if it is for-profit. This is the end of non-profit care.

Private finance capital will now flow-in and build to take-up the profit subsidy the province is guaranteeing. The same as they did in Long-Term Care. Non-profits cannot compete as they have no capital (from profits) waiting to invest.

And, without putting too fine a point on it, the campaign against it is done. We have lost public non-profit healthcare.

Why do I say this? Because there isn't a single non-Communist political party promoting an alternative anywhere in the Western capitalist world. It is happening in every jurisdiction where there is public health care. The NDP, UK Labour, European Socialists, USA Democrats all have decided they need to go down this road.

It is not just about health services either, it is the new model of privatization of public services.

Capital thought Social Impact Bonds and finacialization of public services would do it, but that failure as debt gets more expensive means that capital have given up trying to hide it. They want wealth transfer and they are not shy about demanding it.

In some ways it is the last gasp of neoliberal reform of the public service just as this version of capitalism fails.

The new model is direct profit subsidies to keep companies and capital from collapsing. No longer cheap interest rates, but direct money into the pockets of capital. Governments want someone else to own it, run it, and they don't care how much it costs so long as they don't have to be bothered to be accountable for it.

And, they have all the money because we gave it to them through five decades of wealth transfer. Now we are going to pay them more in the absurd hope that they put that money to use how we need it. It will not work (as we have seen in the pandemic and climate response), but it is now the only policy left.

This is not even a new form of direct profit subsidy. Think of your health clinic as you would a car assembly plant. We want cars built here, so we tax working people and give that money to Ford/GM/Stelantis to employ people to make cars here. Then we do what we can to guarantee profits for their shareholders.

A true profit-public partnership.

In the end it will cost people their lives. Every time the government spends more money on production and services than it needs to by promoting private profit, money is cut somewhere else. In health care, this is seen at its most dramatic as people are denied care because of lack of funding.

There is one mild social democratic solution left.

We can demand our municipalities start publicly owned health companies to build the clinics and get paid the "profit" subsidy rate for provision of services. Then redirect those additional revenues back into more health services.

Municipalities may be the only level of government left that still run some public businesses and care about their populations not dying.

Sure, the federal government could do the same thing. There is nothing stopping a Crown company building community health clinics and operating them under this new "for-profit" payment system. Of course, that would be the nationalization of health care and no one is calling for that in Canada.

The real alternative is a true government health program. One that keeps profits out of the system, directly employs doctors and other health care support staff, and opens the flood gates to increase the number of doctors, nurses, and other health providers. And, builds a public ownership model of health products, drugs, intellectual property, and builds health infrastructure.

But, again, not even the health unions are calling for this.