Legal Abstractions and For-Profit Delivery

The categories we use to make sense of the world structure how we act.

In his April 17th column Andre Picard, the health reporter for Toronto’s Globe and Mail newspaper, repeated one the most misleading justifications for more for-profit health care: most of the system is already private.  After all, as Picard points out, many family physicians are self-employed and almost all hospitals are private, albeit non-profit, corporations.  To equate public hospitals and family physicians with for-profit corporations, like Gamma-Dynacare, the Gambie Surgical Center, and the AIM Health Group, is to bury your head in legalistic sand. The result is Picard’s implicit support for the Wildrose’s health policy, one of the most pro-corporate in Canada.

Sure hospitals are not public in the sense of directly part of the public sector, but that is how people see them: as part of the public system.  More important, that is how they are treated by governments. The wide spread use of regional health authorities, regulations on transparency, wait time goals, inclusion in Freedom of Information and Sunshine laws and directives on what services hospitals can provide, are among a plethora of ways hospitals are treated as a part of the public sector.

For-profit corporations are treated differently and act differently. Freedom of Information laws protection their business confidentiality so we do not have the same access to quality measures, how the public money we pay them is spent, or information on investment decisions. Private corporations are allowed to lobby to protect and expand their interests.  These interests include finding more income opportunities either by removing health care from public coverage so that there is more private payment, or increasing the number of procedures and fee-for-service payments they receive from public insurance.  Both of these are often opposed to the public interest yet these companies are allowed to use public money to lobby for their own interest against the public interest.

For-profit companies also use their profits to pay shareholders and reinvest as they see fit, often in more private health care.  Money saved in the public system is returned to the public coffers. There is also a higher rate of fraud among private, for-profit corporations.  In the United States over four billion dollars was collected in fines for health care fraud in 2011.

When all is said and done the use of for-profit companies within public health care is not similar to using public non-profit providers, no matter how much regulation we have.  To say they are all private is to confuse profit making with public interest and encourage more private profit taken out of health care dollars for no benefit.

Instead of using legalistic abstractions which see a more privatized system it would be more helpful to use the real world experience of patients and health care providers. Currently about 70% of our system is publicly financed, lower than most other developed nations.  We could start by increasing the number of services that are publicly covered.

The vast majority of our essential medical services, laboratory and diagnostic services being the notable exceptions, are delivered by public, non-profit institutions. Many doctors, while legally small business people, essentially pay themselves a salary and work primarily for the benefit of their patients. The trend we need to be concerned about is the increased use of for-profit corporate chains providing primary care.  These often rip-off doctors and ill serve their patients.  The growing use of these corporate clinics is a development we see more clearly when a key dividing line in health care delivery is between for-profit corporations and a variety of public and non-profit providers.  This is a distinction that serves us better in improving health care than abstract legalisms.

The link to Andre Picard’s article is

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