By Miranda Schreiber
At the intersection of College St. and University St. in Toronto, six hospitals crowd together over five blocks. Although they are public institutions, most of their various departments are named by both speciality and private donor. In fact, nearly every center for care, research center, ‘wellness gallery,’ and atrium - even the nearby medical school - bears the name of its wealthy Canadian financier. Papered onto bus stops and the temporary barriers around construction sites are hospital fundraising campaigns, sometimes containing the stories of patients who feel particularly served by a given institution. Testaments to the power of private capital are everywhere.
In many ways this philanthropic basis of public healthcare is a virtually unquestioned aspect of the Canadian system, which is partially dependent on sporadic ‘gifts’ of millions of dollars from the highest echelons of the capitalist class. Major hospitals repeatedly characterize such events as generous, rather than reflective of the system that causes much of the sickness they spend their time treating. The Canadian situation is an example of the limits of public services under fundamentally capitalist conditions, the ways that the super-rich rule even ‘socialized’ systems.
Like many other kinds of capitalist infrastructure, the public healthcare system is useful to Canadians. However, it was designed to serve profit, not working people. An institution that has existed since the 1960s, it is easy to forget that it was not a gift from the government, a sign of an enlightened national character, but a concession from the capitalist class. Public healthcare did not simply appear due to a moment of moral clarity on parliament hill, it was demanded.
The history of Canadian medicine reveals this. Capitalist expansion onto Indigenous land led to the state-sanctioned destruction of food systems and smallpox epidemics; Indigenous nations were coerced into signing treaties in the midst of famine, allowing material resources to be expropriated by the settler state. [1] The Canadian government’s refusal to meet basic treaty obligations facilitated the spread of tuberculosis in substandard living conditions on reserves and in residential schools, internment camps where thousands of Indigenous children perished. [2] [3] Since its founding Canada’s existence as a capitalist colony has been contingent on the spread of disease. [4] This was simultaneous with the attempted destruction of Indigenous medicine and healthcare.
After the first world war, the Canadian settler population became increasingly conscious of class warfare as their economic exploitation accelerated, frightening the capitalist class. “It seems strange now but at the time the possibility of a socialist or communist revolution was a viable threat to the ruling classes everywhere internationally,” says Tyler Shipley, author of Canada and the World. Revolutions in the USSR and Latin America revealed the possibility for working people to seize the means of production. As Alex Birrell explains on the podcast Unmaking Saskatchewan, the rapid spread of infectious disease among settlers led to grassroots organizing for the purposes of establishing public clinics in rural Saskatchewan for the treatment of diseases like tuberculosis. [5] In the 1930s during the depression, farmers who could not pay off medical debts unionized and formed the Farmer’s Labour Party, demanding social security and socialized medicine from the provincial government. [6] Even while farmers faced starvation due to drought, the medical establishment - specifically insurance companies and regulatory bodies representing urban doctors with wealthier patients - resisted public clinics from their inception, fearing a reduction in profits. [7] As Birrell explains on the podcast, “We had to drag the government around and force them to care, force them to act.” The first medicare bill was dramatically diluted by representatives of the medical establishment and commerce, so that “moderates won the battle over what medicare would look like….it was a victory built to be moved to the right.” A more comprehensive medicare plan was rejected in favor of one that placed more power in the hands of physician regulatory boards and industry.
Socialized healthcare in Canada came about at a time of capitalist crisis, as a concession, and so an aberration, of a fundamentally exploitative system that has required human deprivation from its beginning. As Shipley explains, the creation of Canadian healthcare, along with the rest of its social welfare system, stove off revolutionary activity and permitted the social reproduction of labor, offering enough care and security primarily to keep people looking for work. In the sixty years since medicare was passed, this Canadian social security net has been slowly stolen away, as the very forces that resisted public healthcare in the first place have reclaimed the infrastructure they reluctantly handed over to the working class. Over six decades, although more rapidly since the 1980s, the Canadian state has cut back government services and civil service employment while transferring power to private capital in the mass sale of public infrastructure and increases in tax breaks. [8] [9] Public health has been targeted at two ends: in the destruction of the resources that keep people healthy, and the sale of aspects of the healthcare system to private industry. Since 1985, housing and public sector pensions have been consistently clawed back, drug companies have been permitted to monopolize pharmaceutical drugs over generic brands, and thousands of civil service jobs have been eliminated while unemployment insurance has been cut. [10] [11] Grants to advocacy groups supporting the environment, Indigenous people, women, and children have been slashed, and occupational safety training programs have been defunded along with health and welfare grants. At the same time, the wealthy have received massive tax breaks and government shares in transportation, universities, colleges, and communications have been sold off to private ownership.
The healthcare system is whatever remains after this attempt to maximize surplus profits, which has only hastened in the last several years. This is what explains the absurdly common event in Canadian healthcare in which a person who does not have a house is sent back out into freezing temperatures after receiving a free medical procedure. It clarifies the government decision to offer citizens care for ears but not for eyes, and a free patient-intake interview but not free medicine. There is no moral justification for this with the explanatory power of class analysis.
The story that healthcare makes Canada extraordinary is circulated in the media, in textbooks, and in political rhetoric. Another story we are often told is that people who can’t work but need healthcare are responsible for social misery. Patients are chided for ‘poor lifestyle choices’ and ‘wasting government resources’ by a healthcare system that effectively resents having to treat them. Predominant leaders in healthcare continue to collaborate with the philanthropists who are responsible for increasing homelessness and poverty. These multi-millionaires and billionaires have stolen from the public once through the theft of surplus value and the destruction of the public welfare state, and again in an evasion of just taxation. They donate to hospitals to expedite exploitation, not to end it; it’s just PR and a tax write-off. Representatives of commerce who are price-gouging groceries during a housing crisis like Galon Weston sit on hospital boards, claiming the system. [12] They name every medical building in their image.
Notes
[1] Clearing the Plains pg 24-29 (More in depth chapter 5, chapter 9)
[2] Clearing the Plains pg 27
[3] https://globalnews.ca/news/9432774/saddle-lake-cree-nation-residential-school-investigation-report/
[4] Clearing the Plains pg 24-29 (More in depth chapter 5, chapter 9)
[5] Unmaking Saskatchewan
[6] Ibid
[7] Ibid
[8] https://www.sfu.ca/~mcohen/publications/Polecon/dismantl.pdf
[9] Stephen McBride and John Shields, Dismantling a Nation: Canada and the New World Order (Halifax: Fernwood, 1993), Table 2.4.
[10] Stephen McBride and John Shields, Dismantling a Nation: Canada and the New World Order (Halifax: Fernwood, 1993), Table 2.4.
[11] Federal Budgets 1985 to 1995; Canadian Council on Social Development, Canada's Social Programs are in Trouble, (Ottawa 1989);
[12] https://sunnybrook.ca/team/member.asp?m=948&page=4071
