Introduction
Thousands of protesters attended a protest rally or demonstration in Toronto on May 30, 2024, starting at Nathan Phillips Square and ending in front of the Ontario Legislative Building, where Conservative leader, among others, was holding a session.
A similar protest rally or demonstration was held in September, 2023. It is difficult to determine whether there were more or less people at the rally or demonstration this time, but it was perhaps slightly less (but this could be wrong). Bus loads of union and community members from southern Ontario arrived to participate in the protest in addition to local union and community organizations on both occasions.
The protesters heard from various organizers and representatives, ranging from the executive director of the Ontario Health Coalition, Natalie Mehra, to the leader of the New Democratic Party (NDP) Marit Stiles.
Privatization of Public Health Services
The gutting of the public health services in Ontario ranges from the increased closure of hospitals and emergency rooms to the charging of healthcare fees at private clinics. The Ontario Health Coalition’s report Illegal, Unlawful and Unethical: Case Studies of Patients Charged for Medical Care in Ontario’s Private Clinics provides further information and examples. Thus, on page 5, we read:
The Most Common Violations of Public Medicare Laws in Ontario’s Private Clinics
From our in-depth case studies of eighteen patients who were charged for services in private clinics, the Ontario Health Coalition was able to identify several trends:• For-profit clinics violated the law outright and told patients that they had to pay for medically-needed surgeries. They did not tell them that there was an option not to pay, which is incorrect in any case, as they are not allowed to charge for an OHIP covered service.
• For-profit clinics flagrantly charged for preferential access to care for those who paid out of pocket. Patients were told that public cataract surgeries have a long waitlist and that they can decrease the waiting time by paying for the surgery. Note: the patient does not know if the length of the public waitlist is true and correct information or not. Often, we find they are being told waitlists are longer than they actually are.
• For-profit clinics withheld vital information necessary to make a voluntary, informed decision about health care services.
• For-profit clinics required patients to pay for add-ons not needed or covered by OHIP, such as upgraded lenses or diagnostic exams in order to get the needed surgery. The patient was told that a surgery, or any other service, cannot be performed unless they pay out of pocket for the add-on.
• Physicians or private clinic staff manipulated patients to pay for add-ons by saying that further tests are needed to get more accurate results for their surgery or that certain lenses provide better results than the OHIP lens. Patients reported that the education they received from the physician or facility feels more akin to a sales pitch rather than being therapeutic.
• The majority of the patients are elderly and vulnerable due to the lack of medical education about how urgent or non-urgent their case is, and what their rights are under public health care legislation in Ontario and Canada.
Several cases are presented, such as the one on page 6:
Case Studies: Violations of the Canada Health Act & the Commitment to the Future of Medicare Act
The following stories are of Ontario residents who are covered by OHIP and have been manipulatively upsold and/or extra-charged in private for-profit clinics.
Patient A
Patient A was referred to an eye clinic in Oakville for cataract surgery by his optometrist on March 1, 2022. He was going to be charged $250 to the clinic for two tests prior to the surgery, which he declined. However, he saw other people pay the amount as he waited for further tests. It was then recommended he get laser eye measurements because they produced better results, he was told. The measurements cost him $500. A further $330 was asked to be paid to the clinic if he wanted to get upgraded lenses that were not covered by OHIP. Despite being told that private clinics work faster than public hospitals, his surgeries were not scheduled until November 14 and 28 of 2023, one and a half years later.
The report also reads (page 3):
The Ford government is doing substantially nothing to stop the now-rampant out-of-pocket charges that the private clinics are charging patients. The evidence shows that for-profit cataract surgery clinics are frequent violators of the Canada Health Act and the Commitment to the Future of Medicare Act, yet the Ford government has increased their funding by a whopping 300 percent10 and is giving massive expansions to companies that are in breach of our Medicare laws. While claiming to the public that they will never pay with their credit card, only their OHIP card, the Ford government is actually doing the opposite. They are allowing unfettered user fees in the thousands of dollars for often-elderly patients in need of surgeries and tests. Charging patients for access to these health care services re-establishes the two-tier health care system that Medicare was designed to end in 1966. It must be stopped.
Limitations of the Protest Rally and Report
Idealization of the Law and Lack of Critical Distance from its Ideological Function
From a socialist point of view, both the report and the protest rally has at least two major problems. Firstly, during the protest, the fact that Ford is breaking the law was mentioned several times, and the report also argues this. Although the left needs to use the law when possible to protect itself, it also needs to take a critical stance towards the law–and there was no evidence during the rally not only of the limitations of the law in protecting the interests of workers and communities in the context of a society dominated by a class of employers but also of the ideological function of law in co-opting workers and community members into such a society.
Idealization of the Public Health Sector
A second problem with the protest rally is the idealization of public health care (similar to the idealization of public education). It is the typical union attitude of the good public sector versus the bad private sector, which resonates only with certain sections of the working class (such as workers organized into unions) but certainly not with other sections. Although public funding of health care is certainly preferable to private funding since the poorer sections of the working class have access to health care, publicly-funded healthcare is hardly an ideal state to which socialists should strive.
Such idealization hardly advances the interests of the working class as a whole. Public health care needs to be criticized as well. Workers in the public medical sector, for instance, often are oppressed. From Barbara Briggs (1984), “Abolishing a Medical Hierarchy: The Struggle for Socialist Primary Health Care,” pages 83-88, in the journal Critical Social Policy, volume 4, issue #12, page 87:
GPs AND SOCIALISM
Socialists have traditionally argued for state control of key areas of the economy and of the provision of welfare services such as health and education. Socialist health workers have argued for general practitioners to become salaried employees of the Area Health Authorities, along with the ’ancillary workers’, instead of continuing to enjoy the independent self-employed status that they insisted on to protect their status when the NHS [National Health Service of the United Kingdom] was set up.
But the NHS, the largest employer in the country, has shared with nationalised industries the failure to demonstrate any evidence of ’belonging to the people’: because of the backing of the state it has proved a ruthless and powerful employer, keeping the wages of unskilled and many skilled workers also at uniquely low levels; time and again, union members seeking improvements in pay and amelioration of very poor working conditions have been defeated. Nor has the NHS shown any kind of effective accountability to its users. Public spending constraints have hit the NHS not only by causing a decline in working conditions and in the services provided, but also by imposing even more centralised planning priorities based on the need to save money whatever the cost.
Workers in the public health sector may not produce a profit directly, but they may perform surplus labour and indirectly increase profits for employers by reducing the costs of health care. From Charles Umney (2018), Class Matters: Inequality and Exploitation in 21st Century Britain, pages 108-109:
So, for people on the left, it is politically useful to sentimentalise ‘our’ NHS [National Health System, the public health system in the United Kingdom] (recall the tribute to it in the 2012 Olympics opening ceremony), but this sentimentality can also be a problem – as, arguably, is the left-wing fixation on what percentage of the NHS is being outsourced to the private sector. Quasi-privatisation has been a priority of successive governments, but it only benefits small segments of capital. The bigger issue, and the more important thing from capital’s perspective, is the need to apply intense budget pressure so as to lower the costs of the system as a whole.
…The main effect of the policy obsession with ‘competition’ and the market was not so much crony capitalism – i.e. a nefarious scheme to hand NHS services to mates in the private sector – but just plain capitalism: growing pressure on NHS workers themselves to produce more and more indirect surplus value to capital as a whole. This meant extracting
more work for less, and it is this obsession that defines working life in the NHS today as much as in Sports Direct or Amazon. NHS staff are harder to bully than those warehouse workers in some respects (since they are typically higher-skilled and more likely to be unionised). But in other ways they are easier to push around, since they tend to be very
squeamish about making too much of a fuss in the workplace because of their sense of duty.
Conclusion
The protest rally was indeed necessary to highlight the gutting of public health care by the Conservative Ford government. However, like the social-democratic left in general, the protest rally (and reports associated with it) idealize the law and do not even recognize the ideological nature of law. It also expresses a lack of critical distancing from the public sector, idealizing it and demonizing the private sector.
Such an approach reflects the general nature of social democracy–the humanization of the class power of employers (a.k.a. capitalism) at best, but never its abolition. With such an approach, we will never address the problems which we face on a daily basis–such as the power of the class of employers and the daily pressure to produce more and more under increasingly stressful working conditions. Nor will it address the back-and-forth movement of nationalizing some industries and privating others and vice versa. Unless the class power of employers, with its associated economic, political and social structures, is addressed head on, the problems we face will never be solved.
The Abolitionary 