The Battle of Medicare is not over

 

(The following article is from the May 1-15/2005 issue of People's Voice, Canada's leading communist newspaper. Articles can be reprinted free if the source is credited. Subscription rates in Canada: $25/year, or $12 low income rate; for U.S. readers - $25 US per year; other overseas readers - $25 US or $35 CDN per year. Send to: People's Voice, 706 Clark Drive, Vancouver, Canada, V5L 3J1.)

 

By Akif Akalin

 

Health has always been a sensitive issue, open to debate and sparking many controversies. It has long been taken as a personal trouble instead of a social issue.

 

In ancient societies, people considered illnesses to be punishments from Gods. Even though enlightenment brought an end to this idea, health continued to be seen as a personal problem until sociologists began connecting illnesses to society.

 

At the end of the 19th century, Emile Durkheim demonstrated that "suicide is more than just an individual act of desperation". In 1845, Frederick Engels had already stated that "society in England daily and hourly commits what the working-men's organs, with perfect correctness, characterize as social murder, that it has placed the workers under conditions in which they can neither retain health nor live long."

 

However, social thinkers preoccupied with health sociology have always had a dilemma in addressing social determinants of health. Whenever these issues are addressed, there emerges a problem: inequalities. Finally, in the midst of the 20th century, the World Health Organization (WHO) defined health as not only the absence of disease, but also as a condition of complete physical, mental and social well-being.

 

At the beginning of the 21st century, ironically enough, Marxist analyses in health sociology rose from the grave in Canada, which was ranked first in the world on the United Nations Human Development Index between 1995 and 2000. The most important reason is the over forty-year experience of Canadian Medicare.

 

It has long been thought that inequalities in health were due to lack of access for some to quality health care. Canadian experience has disproved this idea, because significant inequalities in health stubbornly persist despite Canada's renowned Medicare system.

 

The other reason to rethink social determinants of health is that the belief that differences in health behaviours (tobacco use, diet, physical exercise) would have a major impact on health has proven wrong (Raphael, 2004).

 

Finally, researchers have refocused on social determinants, such as income, education, or employment, to explain inequalities in health. Among these factors, income is especially important, because it is also a determinant of early life, education, employment and working conditions, quality of housing, and food security.

 

Researchers have shown that income is a prime determinant of premature mortality from a range of diseases. They also have shown that poverty constitutes a major health problem. One Canadian study found that men in the top 20 per cent income bracket live on average six years longer than those in the bottom 20 per cent. There are significant differences between low-income and high-income families in terms of mortality rates for the four leading causes of death: tumours, respiratory track diseases, circulatory system diseases, and accidental injuries. Infant mortality rates are also high in low-income families.

 

Another Canadian study found that people who are unemployed have more mental health problems including distress, anxiety and depression. Women with higher levels of education are more likely to have normal birth-weight babies. Children who are exposed to insecure, violent or chaotic environments can end up with an adult brain that secretes excessive stress hormones when faced with stress. This hinders adults' ability to cope well with difficult situations, and also makes it harder for their body to physically fight disease (Canadian Health Network, 2005).

 

This evidence shows that health is not merely a medical concept, it is something far bigger and more comprehensive than medical science. Rather than leave health to medical professionals, we must produce a new prescription to the sick: first, overcome income inequalities.

 

As a social institution, health care cannot be exempted from the general production relations of a society. The rules that are in effect in general must be in effect in health care.

 

According to the Program of the Communist Party of Canada, "The economic system in which we live is capitalism. Under this system the means of production are predominantly privately owned; the capitalists operate their factories, banks and offices, mines, forest operations, transport and service industries in order to extract profits."

 

According to Marx, everything has to be commodified in capitalism because "the wealth of [capitalist] societies ... presents itself as an immense accumulation of commodities, its unit being a single commodity."

 

Therefore, health care is commodified by capitalists in order to make profit. Once something is commodified, income becomes the principal determinant to buy it, and income inequalities determine its distribution among people. Since vast income inequalities are inherent in the capitalist system, there is no final solution to the health inequalities Canadians suffer until capitalist relations are replaced by an egalitarian one. However, it is possible to improve health by defending and developing Medicare, which is a publicly financed, privately delivered insurance plan.

 

Before Medicare, health care had been commodified in Canada, bought and sold in the market. Under capitalism, one's suffering is the other's profit. To make profit, capitalists need markets in which they trade and invest. Whenever their markets are limited, they begin crying. In our case, Medicare meant a closure of the Canadian health market for capitalists.

 

That is why the pharmaceutical industry, insurance companies, and Canadian Medical Association proclaimed war against the adoption of Medicare. The ferocious "Battle of Saskatchewan" took place in the summer of 1962, when many physicians went on strike against Medicare. The Battle of Saskatchewan was not won easily. Premier Tommy Douglas had to invite British physicians to the province, but the people of Canada finally won the battle to extend Medicare across the country.

 

Today, Medicare is once again threatened by neo-liberalism. Every day we see newspaper headlines with stories of insured services such as chiropractor or optician services being delisted, with news of private, for-profit clinics and hospitals, with warnings of physician and nurse shortages, with repeated posturing by federal and provincial governments, each accusing the other of funding shortfalls.

 

One of the firmest opponents of Medicare is the Fraser Institute, which advocates a system in which public medical insurance would cover only catastrophic illnesses. The C.D. Howe Institute and the Canadian Council of Chief Executives have also influenced governments to abolish Medicare.

 

One famous opponent of Medicare, Leonard Peikoff, says that socialized medicine is impractical because it is immoral. Referring to the U.S. Declaration of Independence, he argues that according to the Founding Fathers, Americans were not born with a right to a trip to Disneyland, or a meal at McDonald's, or a kidney dialysis.

 

Such arguments reveal a fear that Medicare could be a Trojan horse of egalitarian ideas in society. Therefore it must be destroyed as soon as possible to secure profits.

 

For-profit private health care has exploded in Ontario. King's Medical Center of Toronto has become the largest and most luxurious private facility in the country. The pharmaceutical industry, insurance companies, and the Canadian Medical Association are seeking revenge, and free trade agreements are pushing Canada to abolish Medicare.

 

But despite these attacks, there are physicians who put public health before profit, and in November 2004, Canadians voted Tommy Douglas the greatest Canadian of all time. Recommodification of health care will not be easy. The battle of Medicare has not ended yet.

 

Akalın, A. (2005). The Battle of Medicare is not Over. People’s Voice, 13 (8): 6 – 7. 1 – 15 May 2005. Vancouver.

 

A Worker’s Speech To A Doctor

 

We know what makes us ill.

When we are ill we are told

That it is you who will heal us.

For ten years, we are told

You learned healing in fine schools

Built at the people’s expense

And to get your knowledge

Spent a fortune.

So you must be able to heal.

Are you able to heal?

When we come to you

Our rags are torn off us

And you listen all over our naked body.

As to the cause of our illness

One glance at our rags would

Tell you more. It is the same cause that

Wears out

Our bodies and our clothes.

The pain in our shoulder comes

You say, from the damp; and this is also

The reason

For the stain on the wall of our flat.

So tell us:

Where does the damp come from?

Too much work and too little food

Makes us feeble and thin.

Your prescription says:

Put on more weight.

You might as well tell a bullrush.

How much time can you give us?

We see: one carpet in your flat costs

The fees you earn from

Five thousand consultations

You will no doubt say

You are innocent. The damp patch

On the walls of our flats

Tells the same story.

 

Bertold Brecht