The Fight to Save Ontario Hospitals

In Toronto on the weekend of January 30-31, 200 representatives attended a “Strategy Summit on Ontario’s Planned Hospital Cuts, Downsizing and Restructuring” convened by the Ontario Health Coalition. The OHC includes more than 400 labor and community groups that are committed to defending and improving the publicly-funded, publicly-administered health-care system.

The Summit was called in response to planned health-service cuts that will affect every hospital in the province. If the cuts go through, Emergency Departments will be closed, local birthing services will be eliminated, hospital departments and beds will be lost, paramedical and support services will be privatized and fees for hospital patients and visitors will be increased.

The goal of the meeting was to organize a province-wide campaign to prevent the loss of these essential services. The first order of business was to counter the lies that justify the cuts.

The Cuts are Not a Response to the Economic Recession

Back in 1994, the Ontario government presented its plan to transform the medical system into a cash-cow for the private sector.

“To have the effective launching pad it needs, the health industries sector must expand its share of its own home market. Steps must be taken to ensure that, as in other countries, the domestic market supports the development of globally competitive companies.”1

One of these steps was to scrap regulations that ensured a minimum level of daily care for nursing home patients. Major cuts to funding and services followed.

The cuts were so unpopular that the Conservative Party was voted out of office in favor of the Liberal Party, which has betrayed its election mandate by planning this round of even deeper cuts.

In 2006, before the recession began, the Liberals passed the Local Health System Integration Act to dismantle the public hospital system under the guise of “integration.” The province was divided into 14 geographic areas, each of which was assigned a Local Health Integration Network (LHIN) with the power to cut and reorganize regional medical services.

Economists warn that health-service cuts will deepen the effects of the recession, because every lost hospital job will cause another job loss in the community. Moreover, increased wait-times for medical services will cost the province billions more dollars in lost work time and productivity.

The Cuts are Not About Improving Hospital Efficiency

Our hospitals are not being cut to make them more efficient, but to boost the profitability of the private sector.

Ontario hospitals are the most “efficient” in the country. Between 1981 and 2008, the hospital share of the Ontario health budget fell from 52 percent to 37 percent. Ontario has fewer funds for health and social services because the government has chosen to support corporate profits instead.

Because of low corporate tax rates, only 15 percent of Ontario’s GDP goes to government funding, compared with 17 percent for the rest of Canada. As a result, Ontario has the lowest per-capita government expenditures: $6,905 in 2007 compared with $8,692 for the rest of Canada.

Hospital cuts facilitate the movement of medical services (and funds) from the public sector to the private sector. This is accomplished in a two-step process. First, government funds hospitals below the level required to match the rate of inflation and population growth. (Currently, half of Ontario hospitals are in deficit, and 70 percent are expected to be in deficit by next year.) Second, hospitals are forced to cut services to balance their budgets.

By Canadian law, medical services provided in hospitals must be publicly funded and provided free of charge. Once these services leave hospital, they can be taken over by the private sector and sold to those who can pay for them.

The Cuts are Undemocratic

Instead of matching health dollars to the needs of the population, the population is expected to sacrifice its needs to budget mandates. There is no way to achieve this democratically.

According to the Ontario Ministry of Health,

“The [LHIN] legislation places significant decision-making power at the community level and focuses the local health system on the community’s needs.”

In fact, the LHINs are staffed by government appointees who are not elected and not accountable to anyone but the Ministry.

Small, local hospitals are built and maintained by dedicated community fund-raising. They are vital to the economies of their areas, providing jobs and helping to attract new industry. These hospitals are scheduled to be closed, despite the protests of the people who built, maintain, work in and rely on them.

The Ministry of Health has required all hospitals to sign “Hospital Accountability Agreements,” that compel hospitals to cut services to meet restricted budgets. Those that don’t “agree” have the cuts imposed.

Hospital CEOs who protest the cuts have been fired and replaced by government-appointed supervisors. Community-elected hospital boards that reject the cuts have been dissolved and replaced by government-appointed managers. Communities that protest this lack of democracy have been told that hospitals are too large and complex to be run democratically!

These Cuts Will Kill

Most small and rural hospitals are scheduled to be closed. These hospitals are critical for providing timely care in outlying areas. Additional travel time to larger hospitals can mean the difference between life and death.

Patients need social support to recover, and local hospitals provide easy access to family and friends. If these hospitals close, families will be forced to travel to larger centers to see their loved ones. No provision has been made to assist in this travel, so low-income families will be unable to visit at all.

Emergency Rooms will become even more congested. The cuts of the mid-1990s (dubbed “the Harris cuts,” after the Premier at the time) eliminated many hospital and chronic-care beds, making it more difficult to transfer patients out of Emergency.

Before the Harris cuts, Ontario’s ERs were moderately congested 9 percent of the time and severely congested 0.5 percent of the time. After the cuts, they were moderately congested 23 percent of the time and severely congested 6 percent of the time.

The backlog in Emergency Departments is not caused by too many people using ERs irresponsibly, but by sick, injured and elderly people needing beds that aren’t available. Patients can spend hours, even days, in the ER waiting for a hospital or chronic-care bed while lying on uncomfortable stretchers in the hallways of a noisy, trauma-filled environment.

ER staff suffer high rates of burnout, and turnover is high. Regular conflicts erupt between ambulance paramedics bringing new patients and ER staff who cannot cope with the demand.

Combine overcrowded Emergency Rooms, hospitals filled to capacity, and cuts to cleaning staff and you have a perfect breeding ground for deadly hospital infections like SARS, MRSA and C. Difficile.

The medical system has no surplus capacity to handle an epidemic or mass trauma event. And this is before the coming round of cuts that have been described as “Harris on steroids.”

The Problem is Not a Lack of Money

While the government squeezes hospital budgets, it is going hundreds of millions of dollars over budget to establish private “P3″ (public-private-partnership) hospitals.

The 2008 Provincial Auditor’s report found that the total cost of one P3 hospital was $300 million more than it would have cost to build and operate the hospital publicly.

Despite public disapproval of P3s and their higher costs, the province plans to build more of them, because P3s are a convenient conduit for transferring public funds to the private sector.

As OHC organizer Natalie Mehra points out,

“[T]he only advisors that the government listens to are those who come from the P3 industry – the financiers, law firms, service privatizers and giant construction firms who directly benefit from the exorbitant costs of this privatization policy.”

What Will it Take?

The dismantling of Ontario’s public hospital system has provoked major protests across the province. Public rallies and marches, petitions and thousands of letters to the editor have condemned the cuts. There have been a few small victories – some hospitals kept open, some services saved – but not nearly enough. It was clear to everyone at the meeting that much more will be needed.

There were many suggestions of how to fight back. One was to try to convince the government and the LHINs that their “restructuring” plans are medically unsafe, economically unsound and inappropriate for a recession. The OHC has collected a mountain of evidence that this is so.

Unfortunately for us, the government doesn’t care about these things. It serves a business class that is locked in a fierce competition for profits, and ensuring those profits is all that matters.

Another strategy was to mobilize people in numbers large enough to “inflict political pain” on the ruling Liberal party. Suggestions included town hall meetings, mass leafleting and postering, door-to-door campaigning, media events, letters to the editor, rallies, marches, demonstrations and civil disobedience coordinated across the province. This is definitely doable. Since the OHC was launched in 2003, it has organized a province-wide network of activists.

A few voices proposed hospital strikes and sit-ins. These suggestions were not taken up, despite the many union representatives at the meeting. Decades of defeats and compromise have produced widespread demoralization among workers. Nevertheless, the power of organized hospital workers, backed by patients, families and community groups, is our best hope for winning this fight.

The future of our public medical system is at stake. In order to mobilize the forces necessary to stop the cuts, we must convince them that it is possible to put people before profit.

  1. Cited in Fuller, C. (1998). Caring for profit: How corporations are taking over Canada’s health care system. Ottawa: Canadian Centre for Policy Alternatives. []

Susan Rosenthal is a socialist, retired physician, union member, and the author of Sick and Sicker: Essays on Class, Health and Health Care (2010), and Power and Powerlessness (2006). She recently launched ReMarx Publishing. She can be reached through her web site or by email: susan@susanrosenthal.com. Read other articles by Susan.

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  1. rosemarie jackowski said on February 3rd, 2009 at 1:27pm #

    Medical care in US hospitals is also on the decline. There is new system of ‘hospitalists’ that are endangering the lives of patients. A ‘hospitalist’ is a doctor employed by the hospital. His purpose is to keep the patient’s real doctor out of the loop. This recently almost cost a beloved relative her life. The ‘hospitalist’ discharged my relative – an otherwise healthy 97 year-old- who had pneumonia. The patient was on an intravenous antibiotic which was needed for 2 more days. The ‘hospitalist’ was signing orders to discharge the patient prematurely – could have cost her her life. Family intervention prevented the tragedy. There are many cases like this. God help anyone who is admitted to a US hospital without someone to act as a medical advocate and challenge the system.