Doug Ford's Cute Health Care Privatization Game

The Ontario goverment has manufactured a crisis in health care and their solution will further enrich their well-connected friends.

By Ryan McGreal

Posted January 18, 2023 in Blog (Last Updated January 18, 2023)

Doug Ford is playing a cute game to muddy the water around health care privatization, but it helps to understand how the structure of Canadian health care helps him.

When we talk about public health care in Canada, what we mean is that the state pays for insured health care services, not that the state provides them. Canadian health care is a monopsony - one payer, many providers - rather than a monopoly.

In Canada, family doctor's offices, clinics, specialists and so on are private businesses that provide care to people and then bill the government. Even 'public' hospitals are independent corporations with boards of directors.

Contrast the UK National Health Service, which is almost entirely directly state-run. British doctors are employees of the NHS, not independent contractors or private business owners who bill the government.

So, Ontario already has a private model of health care delivery, albeit with a public payer. In addition, doctors and clinics are already allowed to charge their patients money for non-insured services, which further muddies the waters.

Ford is exploiting this hybrid model by allowing private clinics that operate for profit to take on more surgeries that are normally performed in hospitals. This is not inherently a bad idea, but as with everything Doug-related, the devil is in the details.

For one thing, the decision happens in the context of Bill 124, which the Ontario Superior Court has already ruled as unconstitutional and which is making it impossible for hospitals to attract and retain nurses.

The government knew that bill 124 is damaging the ability of hospitals to provide care, as their own internal analysis demonstrates. Yet they passed it anyway and are still appealing the court decision that ruled it unconstitutional.

So the decision to shift more procedures - and particularly the easier, more profitable ones - from hospitals to private clinics needs to be understood in the context that the government's own policy knowingly manufactured the hospital crisis this move is intended to alleviate.

When it comes to health care, profit must be understood as pure waste - that is, money that goes into the health care system but is not used to provide health care. Profit means there is less money to provide care - and especially, care that is more complicated or expensive.

When private clinics are able to peel off the easy surgeries, that actually raises the average complexity and cost of the surgeries that must remain in hospitals. To the extent that public funding is diverted from hospitals to private clinics, this will have the effect of making the hospital crisis even worse.

If Canada had a fully public system - public funding and public delivery - then it would be easier to make these allocative decisions for the benefit of the system as a whole without cannibalizing one part of the system to feed another part.

It is entirely reasonable to suspect that the Ford government is manufacturing this crisis in health care - and it absolutely is a manufactured crisis - in order to soften the public for further privatization to enrich their well-connected friends.

We know how things turned out after Doug Ford's mentor, Mike Harris, turned long-term care over to private, for-profit businesses: seniors suffered worse quality of life and worse health outcomes while the investors (including Harris himself) benefited.

When seniors in for-profit LTC facilities died at appallingly high rates during COVID, Doug Ford responded not by investigating what went wrong but by rushing to pass a new law to shield the owners from liability for their negligence!

Meanwhile, he just broke his election promise not to touch the Greenbelt so that he could force the rezoning of protected land in order to give a windfall profit to his property speculator friends - many of whom conveniently bought properties right before he changed the rules.

He absolutely does not deserve any benefit of the doubt regarding his intentions toward the broader health care system, and anyone who is telling you not to worry is gaslighting you.