The COVID-19 pandemic is pushing an already ailing public health system to the brink. Meanwhile, capitalists are taking advantage of the situation to enrich themselves. It is high time to expropriate these private health-care parasites.
The health-care system is reaching the breaking point
While the peak of the second wave seems to have passed, the public health network remains under extreme stress. At the time of writing (late January), there were 1,426 hospitalizations for covid in Quebec, 212 of which are in intensive care.
The situation is such that doctors fear having to apply the “patient prioritization protocol,” a euphemism for letting some patients die. One doctor working in a Montreal hospital, Dr. Stanley Vollant, even said, “I’m already living through the worst-case scenario of choosing patients. Yesterday, I decided to let a 92-year-old die because there was no more room in the intensive care unit.”
This critical situation is happening while health-care workers are already exhausted after 10 months or more of fighting the pandemic. The psychological distress of health-care workers was recently highlighted by the tragic suicide of a doctor in Granby.
In order to relieve the health system, public health authorities have had to offload operations. Some patients are being sent for surgery elsewhere and operations are being postponed. There is already a backlog of 140,000 surgeries. Several types of semi-urgent and non-urgent surgeries are being postponed, such as colon cancer screening, specialized outpatient clinic visits and (non-pediatric) kidney transplants from living donors.
According to Dr. Horacio Arruda, Quebec’s public health director, “the impacts are huge and will be felt for months, if not years, due to the backlog of waiting lists. […] Unfortunately, some patients may suffer the consequences.”
For example, a report from the Ministry of Health estimates that 4,119 cancer cases in Quebecers went undiagnosed between March and July, due to offloading. If this does not result in immediate deaths, the long-term consequences are serious. “We’re living on our credit cards right now, debts are piling up and it’s going to cost us as a society,” says Dr. Martin A. Champagne, President of the Association of Hematologists and Oncologists of Quebec.
The situation is serious, and the covid vaccine will not be falling from the sky to save us anytime soon. Only 2.35 per cent of the population has received the first dose of the vaccine. In addition, the manufacturer Pfizer has announced that it will slow down distribution, forcing the provincial government to reduce its vaccination targets.
While the public network is overflowing, entrepreneurs are taking advantage of the situation to line their pockets.
The vultures circle
This is the case with the Olive app, the “Netflix of health,” which was launched during the pandemic with great success, with the help of an accommodating article in the Journal de Montréal. A $15 monthly subscription entitles you to “unlimited teleconsultations, prescriptions, medical certificates, and access to the emergency call centre.”
Olive is not the only “telemedicine” company to have benefited from the pandemic. Dialogue, Canada’s largest telemedicine company, was reportedly serving 300,000 Canadian patients working for 600 companies as of January 2020. By July, it was serving 5 million Canadian patients and 25,000 employers.
It was also recently revealed that public health institutions have had to contract out surgeries and rent operating rooms from private clinics. Hospitals had already started contracting out operations to private clinics in 2016, but COVID-19 has accelerated what was previously only a pilot project.
The Chirurgie DIX30 clinic is one of those that have been able to take advantage of the pandemic. Radio-Canada reports that “the offices of Chirurgie DIX30 are vibrant these days. The construction and fitting-out of two new operating rooms are nearing completion. Rooms that will be used for the public network … The company recently won a $22.5 million contract with the Central Montérégie CISSS [regional public health care authority] for the provision of surgical intervention services.”
The CISSS states in an online document: “This contract with Chirurgie DIX30 inc. will allow us to increase the speed of treatment and thus compensate for the delay in surgical activities caused mainly by covid-19 and, consequently, reduce the risk of endangering the lives of our patients.”
To give an idea of the magnitude of the acceleration, hospitals had contracted $44 million worth of operations to private clinics between the launch of the pilot project in May 2016 and January 2019. Since the pandemic began, they have contracted more than $82 million worth.
The shortage of nurses and orderlies triggered by the pandemic also presented a golden opportunity for opportunistic capitalists in employment agencies.
For example, Agence emploi étudiant inc. [Student Employment Agency Inc.] began to operate in the health field with the onset of the pandemic. By September, it was already doing business with some 30 institutions, including public institutions, which were paying it millions of dollars for recruiting about 700 health care workers.
La Presse explains how this type of agency took advantage of the crisis to get rich on the back of the public network. “Unlike those who participated in a tender months or years ago, these agencies negotiated their rates in the middle of the crisis, when there was a glaring shortage.”
It should be noted that these agencies are likely among those most responsible for the outbreaks in long-term care homes in the spring, having moved their employees from one facility to another.
An existing phenomena
It is precisely because the public health-care system is overflowing that the private sector thrives. A glance at history shows that opening up to the private sector has always been the flip side of the coin to the deteriorating public system.
Workers fought hard to win a public health-care system in the 1960s and ’70s. However, capitalist governments, both Liberal and PQ, soon began to try to claw back the concessions won by the workers. Not only is public coverage expensive for the state, but health care represents a huge potential market. Through disinvestment, job cuts, bed and hospital closures, and reductions in insurance coverage, governments opened the door to the private sector.
This trend has accelerated sharply in the last 20 years. The data clearly shows this. The number of physicians in Quebec not practicing in the public system has risen from 50 in the early 2000s to more than 800 in 2019. There are more than 500 private clinics in Quebec, whereas there were only a handful at the beginning of the millennium.
The (counter-)reform of Health Minister Gaétan Barrette in 2015 was a big step in this direction. We explained at the time that “the ruling class is preparing for privatization … First of all, the cuts in personnel, the work overload imposed on employees … constitute a deliberate sabotage of the system … The incorporation of doctors, the end of public coverage of certain types of care, and the legalization of private coverage … the transfer of patients to [associated medical clinics], all this is aimed at quietly pushing medicine out of the public system and eventually softening the transition to the private sector. Soon the big companies will only have to bend over and pick the system up like a rotten fruit.”
This trend has continued since and has created the conditions for unscrupulous entrepreneurs to thrive in the midst of the pandemic.
For example, the government actively encourages personnel placement agencies, imposing terrible working conditions on nurses employed by the public system. Unbearable working hours push nurses to leave the system en masse and work for agencies that offer them more flexibility—and which then send them back to the public system, after having taken their share at taxpayers’ expense.
Get the private sector out of the health-care system!
Québec solidaire (QS) recently revealed that private clinics continue to offer plastic surgeries, such as buttock augmentation and liposuction. The party therefore called for the requisitioning of private clinics. Manon Massé said she “invites Mr. Legault to mobilize all private reinforcements before our hospitals break down.”
Indeed, as Massé asks: “Why is it still possible to have a private Brazilian butt lift, but some cancers are no longer diagnosed and many treatments are delayed in the public?” Québec solidaire also called for the nationalization of private long-term care homes in September, a few months after we did.
There is no doubt that the private sector should be requisitioned to fight the pandemic. All private clinics, long-term care homes, and laboratories should have been expropriated to be used in fighting the pandemic from the beginning. Massive reinvestment in health care would also have been necessary after years of cuts.
The QS proposal is therefore a step in the right direction. But it also raises the question of why anyone should even accept the existence of a private network. Capitalists in the private network will always try to further erode the public network, even if it means sabotaging it to do so. Not to mention that with every economic crisis, governments cut public spending and impose austerity, which further weakens the public health-care system. Requisitioning the private sector is absolutely necessary, but the public health-care system remains in poor condition because of Liberal and PQ austerity.
More fundamentally, the public health-care system will never be safe under capitalism. It is a huge potential market for capitalists. As long as we live in a society, capitalists will always seek to get their hands on it—and recurring economic crises, and the austerity that accompanies them, will always provide the perfect opportunity to turn health care over to the private sector. As the pandemic has amply demonstrated, profits take precedence over health for the big bosses who dominate our society. It is high time to take economic power out of their hands.