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Health care provided publicly is the only fiscally sustainable way to fund high quality health care. CUPE Manitoba believes it is crucial that the federal government modernize, reinvest in, and expand, the present public health care system.

The Canadian Union of Public Employees (CUPE) in Manitoba represents 24,000 members who work in health care, social services, municipalities, libraries, schools and other public services. We welcome this opportunity to present to you our views concerning the state of health care in Manitoba and Canada.

In our presentation today, we are asking the Commission on the Future of Health Care in Canada to recommend to the federal government to:
  1. continue and increase public funding of health care in Canada;
  2. enforce, don’t open, the Canada Health Act;
  3. promote the 24/7 Community Clinic Model;
  4. implement a national home care program similar to Manitoba’s public.
Health care should be for people – not for profit – otherwise the quality of the health care system diminishes while the costs increase uncontrollably. In Canada, the Canada Health Act previously ensured that our health care system was public. Recently however, the federal government has not enforced the Canada Health Act. Manitobans were lucky that the Manitoba government did enforce the Canada Health Act when they passed Bill 25. Manitoba is also lucky to have publicly run community health clinics. However, these public clinics need to be expanded in order to accommodate around-the-clock health care service. In Manitoba, a previous government, experimented with a private home care program. It failed and the private home care company left the province. Manitoba still has a public home care program that should be the model for the entire country.

1) Continue and Increase Public Funding of Health Care in Canada

Health care is less expensive when it is funded through a public system. In a public system, there are no funds spent on profits, less spent on administration (including advertising and bill collection), and less room for fraud. The public system has the advantage of greater public accountability and transparency.

Medicare, our single-payer national health insurance system, is but one example of how Canadians save by using economies of scale to bulk-purchase health care.

In fact, when private [or personal out-of-pocket] health care spending and public [government] spending are added, Manitoba has been spending less on health care (per person) than many provinces for a long time. Why? Because the health care system in Manitoba has been more public than many provinces, for a long time.

Health Care Spending Per Person: An Ontario/Manitoba Comparison

Public spending per person $2,874.89 (CIHI1)1998Public spending per person$2,873.34 (CIHI)
Private spending per person $955.91 (CIHI)1998Private spending per person$773.31 (CIHI)
Total spending per person $3,830.801998Total spending per person $3,646.65


1: Canadian Institute for Health Information (CIHI) National Health Expenditure Database. (Most recent figures are 1998; 1999; 2000, 2001 figures are forecast only).

In a more public health care system, Manitoba was spending $184.15 per person less than Ontario in 1998.

The Alternative Federal Budget2 outlines how the federal government can afford the public health care system. The federal government logged a $17.1 billion surplus in fiscal 2000-2001, the largest federal surplus ever, even as Canada’s economy was weakening. During April to September of this fiscal year – Canada accumulated another $13.6 billion in surplus funds.

CUPE Manitoba believes that costs for public health care will increase as a result of an aging population, inflation, an increasing population, and to a certain extent, because of the high cost of new technology. If proper prevention programs and a primary care focus are created, the need for new and expensive technology, which is mainly used for acute care problems, is lessened. If proper generic drug legislation is passed, drug costs are lowered. If health care is delivered publicly, the overall cost is kept manageable.

CUPE is asking the federal government to increase the federal government share of provincial health care expenditures to 25% over the next five years.

Public health care is high quality when that health care system is funded properly. If, at any time, there are problems in a public health care system – quality or otherwise - public accountability and transparency requirements mean changes in a public health care system can be made. For-profit health care companies are accountable to their shareholders. For-profit health care companies are not accountable to hospital boards or elected members of a provincial or federal parliament which is the case in a publicly funded and administered health care system.

The drive for increased profits usually leads to poor quality health care. In the U.S., The National Kidney Foundation found that the percentage of people on dialysis who die each year was higher in the United States (in its for-profit health care system) than in any other industrial country.3 In the journal Med Care in 1997, it was argued that Canadian dialysis patients’ outcomes are better, and costs are lower, than for comparable patients in the U.S.4

2) Enforce, Don’t Open, the Canada Health Act

The Manitoba government has set a positive example by purchasing a previously private health care clinic – The Pan-Am Clinic. At the clinic, out-patient surgical procedures are performed. Since its purchase in September of 2001, the clinic has reinvested more than $100,000 in what would have been profits of the formerly private clinic. Surgeries have been increased which has attracted an upper-extremity surgeon back to Winnipeg to work at the Pan Am Clinic.5

Manitoba has also passed legislation that prevents for-profit clinics from operating on a 24-hour basis through Bill 25. Corporations and many governments are seeking to open up the $86 billion Canadian health care market to private for-profit health corporations. Protecting not-for-profit hospitals needs to be a priority. The federal government must also ensure that health services are not on the agenda at any future trade talks.

In Manitoba, involvement of the private sector in the centralized hospital food system of the Urban Shared Services Corporation (USSC) was a disaster. The USSC went grotesquely over budget. The plans developed by the private sector did not meet the needs of Winnipeg hospitals. A new plan had to be developed.

Ambulance services are also an integral part of the public health care system and should be funded and administered as such. Funding of ambulance services under the Canada Health Act will ensure financial support, consistency in delivery, standards, administration, and accountability throughout the province and country. Opportunities for medical access in rural communities by citizens should include expanding the scope of practice for paramedics including physician-delegated authority as a means to control costs and improve delivery of health care in these communities.

3) Promote the 24/7 Community Clinic Model

There are community, publicly-run health clinics or health centres in Manitoba. These clinics see patients who would otherwise go to higher-costing health care services for care. Examples are Klinic Community Health Centre, Mount Carmel Clinic, Women’s Health Centre, Nor’West Co-op Health Centre, the MFL Occupational Health Centre, the Village Clinic and the Misericordia Health Centre which has an Urgent Care Centre and Health Links. Some of Manitoba’s present health clinics should be expanded to a Community Clinic Model for primary care, which includes multidisciplinary teams of health care providers on salary, available 24 hours a day, 7 days a week. Sufficient staffing levels will be needed.

Community clinics should consider expanding publicly funded and delivered health care to include: nurse practitioners, dentists, physiotherapists, psychologists, registered massage therapists (and orthotherapists), naturopaths, other “alternative” health care providers and treatments, and allied health professionals, as deemed necessary.

We do not want to, however, replicate the HMO model from the U.S. with their problems of denying care to truly sick patients (capitation and rostering).

4) Implement a National Home Care Program Similar to Manitoba’s Public Home Care System

The model for home care in the country is Manitoba’s home care system. Manitoba has a publicly funded and publicly-run, home care system. Everyone has access to home care, if they need it, and publicly run means one central administration. The federal government could initiate a national home care program that each province implements. The absence of a home care system that is an integral part of a public health care system endangers the continuity of patients care, placing an unfair burden on family members, particularly women and increasing financial strain. Privateers are looking to make huge profits from home care, exploiting low paid workers. The federal and provincial governments should cooperate on a public home care program governed by a Community and Home Care Act, modelled on the same principles as the Canada Health Act.


In our presentation today, we are asking the Commission on the Future of Health Care in Canada to recommend to the federal government to:
  1. continue and increase public funding of health care in Canada;
  2. enforce, don’t open, the Canada Health Act;
  3. promote the 24/7 Community Clinic Model;
  4. implement a national home care program similar to Manitoba’s public home care system.
2. Alternative Federal Budget 2002, Economic and Fiscal Statement (Dec. 6, 2001), Canadian Centre for Policy Alternatives.

3. New York Times, Dec. 4, 1995, front page.

4. Med Care 1997: 35:286 in For Our Patientes, Not for Profits, Center for National Health Program Studies, 1998, p. 90.

5. “Operating time lures surgeon to Pan-Am” Winnipeg Free Press, March 1, 2001.

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