Review in the CCPA Monitor

A CBC newsman in a recent broadcast about health care asked his listeners why Canadians are so “obsessed” about the private versus public issue. Canadians are not obsessed at all. They are simply defending a system which embodies the values of equity and fairness, from which derives a system in which care is based on need not ability to pay. The barbarians at the gate are those who would profit from a shift from public to private, and they are not about to give up the siege. The Armstrong’s book is a timely, and powerful weapon in this defence. It succinctly and readably covers all of the bases. They start with the values on which our current system is based, detail the horror stories designed to discredit the system, and ask the relevant questions such as are the stories true and who stands to benefit or lose from a shift to a privatized system? An historical review traces the development of the system from the early initiatives in Saskatchewan, the Hall Commission, the passage of the Canada Health Act (CHA), and on to the end of the Harper regime. The chapter emphasises that our health care system was born in struggle and that it has taken place, and continues to take place, on many levels, from the streets to Parliament and legislative buildings. This is followed by a description of our current system including the five principles of the CHA. The case for a publicly funded and publicly delivered system of health care is eloquently presented, and is contrasted with the United states system. The book gives an honest critique of the current system. It carefully takes the reader to the conclusion that many of the problems facing the system stem from the parts that are already largely in private for-profit hands such as prescription drugs. It goes further to point out and exemplify ways in which wait times, and other issues which feature in the hyperbole of the critics, can be addressed within the public system. It also includes the case for expanding the present system, rather than contracting it. The fifth chapter, Reforming Primary Care singles out one particular difficulty in the current system. It contains a solid critique of the fee for service system, the predominance of solo family practice and the need for more salaried doctors, group practices and the more holistic multidisciplinary community health clinics. There follows a discussion of some issues such as sustainability and wait times, which currently dominate the health care discourse. The authors skillfully separate aspects of these issues which are genuine, and those which are panic-inducing hyperbole. It compellingly leads the readers to the conclusion that while some aspects of these issues are real, the marketplace solutions inevitably offered by opponents of the public system will not benefit the sick – only the private providers. They support their case by giving examples of how and where solutions have been found within the public system. The private versus public theme is threaded throughout every chapter, but it is also given a chapter of its own. It shows how each of the arguments put forward by the privatizers, has been discredited by the evidence and counterargument, only for the invaders to invent a new one, which is in turn demolished and so on. The chapter suffers somewhat from the lack of an acceptable typology of privatization (in this book and elsewhere in the literature). Even the usual distinction between privatization of delivery and privatization of financing, while exemplified, is not explicit. The result is an occasionally confusing smorgasbord of items. The final chapter, Strategies for Change, is a bit disappointing. It proposes policy changes which are implicit in the preceding chapters. It ends by exhorting readers to join organizations already in the front lines of defending and expanding our public system. However, the Armstrongs are not street fighters or political strategists. They are academics making their contribution to the struggle in the way they know best. Health Care is their latest of several works providing readers with ammunition with which to continue. The question raised by this last point is for whom is the book intended. I suggest that even researchers in the field will find an enjoyable refresher as well as an occasional gem amongst the ore of the familiar. However, the book is essentially a primer. It introduces content and uses language which should recharge the batteries of health care activists, as well as engage a huge swath of the population at present on the sidelines. To hope that it would be introduced into every high school classroom may be a fond one, but that is where, among other places, it should be. At the very least it should be on the reading list of every undergraduate student whose course work has even the remotest connection to health care.

— Pete Hudson for the CCPA



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