Private Help For Public Healthcare Is A Cop-Out
The Saturday Huddle is a weekly column that features opinion, analysis and reflections on Huddle stories, podcasts and business news in the region. Trevor Nichols is Huddle’s associate editor, based in Halifax.
This week, the three Maritime premiers joined Ontario’s Doug Ford for a brainstorming session about how to fix the country’s crumbling healthcare system. They don’t appear to have formed any concrete plans but one solution at the front of all their minds is turning to the private sector.
Public healthcare is deeply important to many Canadians and the premiers’ vague suggestions of bringing in for-profit companies alarmed many. But, as Ford succinctly put it at a press conference this week: “The status quo is not working, folks.”
And boy, is he right.
Talk to any on-the-ground healthcare worker and you’ll quickly get a sense of just how fundamentally broken our system has become. Many of my friends and family are nurses and most of them say the same thing: they are chronically overworked and deeply, deeply underappreciated.
One, who’s been in the field for decades, used to love her job and take great pride in her work. Today, she’s completely disenchanted with the system and can’t wait to retire.
She’s an ER nurse who was working at a hospital near her home. Not long ago, management forced her to start picking up shifts at a hospital more than an hour away. It wasn’t an option, she says, it was an order, made under some kind of emergency provision in her contract.
She talks all the time about a completely dysfunctional system where management is wildly out of touch and appears to have no respect for her or her colleagues. I can feel sorrow and anger radiating from her when she talks about the career she used to love. And she is not an exception.
How many failures had to pile up over the years for our system to get to a point where a once-proud, veteran nurse is forced to drive more than an hour to clock in at a job she hates?
There’s no question our healthcare system is in deep, deep crisis. But opening the doors to profit-making enterprises is not the answer.
I’ve talked before about how dangerous it is to put vital public services in private hands – just look at the situation we’re in with Nova Scotia Power.
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Tim Houston and Blaine Higgs seem to be mulling using public money to pay private firms to offer things like minor surgeries. To be fair, that isn’t the same thing as handing a private firm control of a public service.
But Higgs evoking the practices he saw at Irving Oil as inspiration for the healthcare system should give anyone pause.
There are some fair arguments for why our public system can’t survive without private help. My colleague Derek Montague even argued recently that we already have a two-tiered system and pushback against expanding is disastrous for people’s health.
RELATED: Throw Up Your Arms, Two-Tiered Healthcare Is Here To Stay
But there’s an even greater danger if we start farming our healthcare out to private enterprise.
Private companies are literally structured to put profits above everything. When the health of their customers (and that’s exactly what people getting medical care will be to them, customers) is pitted against the company’s bottom line, the bottom will win.
Look at the difference between private and public long-term care homes during the Covid-19 pandemic. More people died in private-equity-run homes because they were “more aggressive in seeking to extract value from care homes and the people who live and work in them.”
But there’s a deeper and more fundamental reason we must resist putting our healthcare in the hands of these value-extracting enterprises: any money we give a for-profit company is money that’s not improving the public system.
Although those private companies would be providing desperately needed healthcare services, not all the money we give them would go to delivering that service – some of it will be kept as profit.
Private companies can usually deliver services more efficiently than the government. Higgs and Houston would likely argue that even if some taxpayer money is getting syphoned off as profit it’s worth it because a private company can provide services more cheaply than the government, so we’re still saving money in the end.
Even if that’s true (and there’s no guarantee it will be), there is something fundamentally wrong with taxpayer money that could be going directly into the healthcare system ending up in the pockets of wealthy shareholders.
Handing over swaths of our medical care to profit-seeking enterprises will also have irreversible, long-term effects on the system. Every time we give parts of the system to private companies we lose a certain amount of agency; we hurt our ability to control our own destiny.
Think again about Nova Scotia Power. Because our power generation is run by a private enterprise there’s very little the government can do to impact rates, performance, or infrastructure investment. Nova Scotians are beholden to the priorities of a private company whose goal is greater shareholder returns.
What happens, 20 years from now, when the private companies performing surgery on Nova Scotians don’t want to upgrade equipment, or want to cut in-hospital recovery times to save money? We’ll be at their mercy.
We’re facing an alarming healthcare crisis right now and it’s going to take a lot of brave ideas, tough decisions, and creative thinking to get us out of it. Instead, our leaders appear ready to take the easy way out, throw up their hands, and dump the problem on the private sector.
Not only is that a short-sighted solution, it’s a cowardly one.