Privatization of health care in New Brunswick, “creeping” insidiously in 2016, reached full “gallop” by 2022. And the pace continues to increase. This trend is well documented by a New Brunswick Health Coalition report and more recent sources cited below.
Coverage of the mounting turnover of publicly funded critical health care services to the private sector is being misdirected by the corporate media, and its long-term consequences all but ignored. In New Brunswick, this is especially ominous as virtually all newspapers are owned by the right-leaning Postmedia network (and formerly by Brunswick News Inc., owned by the descendants of the late local billionaire, K.C. Irving).
The privatization trend in New Brunswick
Health care privatization’s most ardent facilitator has been the current Progressive Conservative administration of Premier Blaine Higgs, in power since 2018. A man of his (prognostic) word, Higgs forewarned us of this likely outcome in 2022.
This year, Higgs and company have stepped up the pace of health care giveaways under the veil of “public-private partnerships.” The latest two P3s have seen the management of a pilot program for the treatment of a major depressive disorder awarded to a for-profit health management company, and a purportedly enhanced prescription drug-monitoring program awarded to a for-profit health care technology firm. The latter deal, announced with some fanfare, was not critically interrogated by the corporate media, albeit with some exceptions.
Trends have beginnings. The recent amplification of health service outsourcing by the provincial Tories builds on a foundation laid by the provincial Liberals in the late 1990s and expanded by them through the first two decades of the 2000s (click here for the full list of privatized or otherwise offloaded New Brunswick health care services).
Since 1997, 24 of New Brunswick’s health care services have been surrendered to, or partnered with, private companies and organizations by successive Liberal and PC governments, incrementally weakening our public health care system. Most of these services (if extant at the time) were previously administered as New Brunswick Crown Corporation agencies and/or, beginning in 2008, by New Brunswick’s public sector health authorities Horizon Health Network (anglophone) and Vitalité Health Network (francophone).
By far the most-rewarded beneficiary has been Medavie. Medavie Health Services, together with Medavie Blue Cross, are private, not-for-profit companies under one corporate umbrella, Medavie. Medavie now manages seven essential health care services in New Brunswick, including the ambulance system, drug program, extra-mural services, and NB Health Link.
The Higgs administration’s turnovers of health care services to private companies and organizations—twelve and counting during their seven years in office—have a distinctive stamp. In contrast to the foregoing Liberal governments of Frank McKenna, Shawn Graham, and Brian Gallant, which largely favoured one company (Medavie), the Higgs government has awarded service contracts and agreements to a swath of for-profit (10 in number) and not-for-profit (2) companies.
As a result of Liberal and PC administration tag-team outsourcings, much of the health care system in New Brunswick is now literally incorporated by Clinidata Inc. (1 service), Accreon Inc. (1), Medavie Health Services (7), Shannex (1), Intrahealth (1), CPI Card Group (1), Medavie Blue Cross (1), New Brunswick Medical Society (1), Maple (1), Acadie-Bathurst Ophthalmology (1), Beal University (1), Oulton College (1), Canadian Health Labs (1) WINMAR Hamilton (1), Miramichi Cataract Surgical Centre (1), Edmundston Medical and Surgical Eye Centre (1), Canadian Health Solutions Inc. (1), and Leap Orbit LLC (1).
“So what?” The shaping of attitudes towards privatization
To many, this trend is not alarming. Legions of New Brunswickers and other Canadians—including many not situated to benefit personally from health care privatization—wholeheartedly embrace its proponents’ talking points. These people will need some powerful convincing to think otherwise, as claims about businesses being better at delivering services ring true to many, reflecting widespread cynicism about “inefficient” and “costly” government bureaucracies.
Generally under-appreciated by the public is the subversive role that conservative and libertarian public opinion influencers have had in denigrating and vilifying government in general, beginning in the 1970s. That so many buy into these anti-government narratives is testament to the success of long-standing, unrelenting lobbying and influence peddling by right wing think tanks. Repeated again and again, the talking points on health care privatization that originate from these think tanks are essentially always the same. To paraphrase the New Brunswick Common Front for Social Justice, proponents of privatization assure the public that:
Private sector awardees can deliver better health care services, because they are inherently more efficient and innovative than government bureaucracies and, furthermore, can deliver both better services and, at once, lower costs for both the government and taxpayers. To assuage the skeptical, a kicker sometimes thrown in is that the awarders (enabling government officials) should promise to monitor and evaluate the former public sector services that they have given away.
The promises are tall but alluring, by design. The last intends to reassure the public that the handovers may not be permanent if they don’t work out—but examples of monitoring and cancelling such outsourcings, once surrendered to private capital, may be harder to find than hens’ teeth. And the remaining promises and rationalizations have been demonstrated, repeatedly, to be bunk.
The health care privatization “debate” on the national stage
On the national mainstream and corporate media stage, however, such bunk enjoys respectability, and “debate” over the merits and demerits of health care privatization is often framed in an uncritical, if not wholly biased, manner. Typically, there is a lack of pushback against or fact checking about claims of the purported benefits of health care privatization. Often these transactions are presented as noble, creative solutions for “saving” a health care system that is on the ropes—especially when the awarded company is a not-for-profit.
Disproportionate national coverage has focused of late on Ontario Premier Doug Ford and his administration’s “bold and innovative solutions” to the province’s struggles with health care delivery. Ford and his Health Minister, Sylvia Jones, are repeatedly seen offering assurances that patients will always be able to access medical services using their OHIP (Ontario Medicare) card, not their credit card, as the privatization march moves forward in his province.
These assurances relate to Ontario’s turnovers, ongoing and planned, of health and surgical services to private capital. An added salve is Ford’s claim, in league with Liberal Prime Minister Justin Trudeau, that these outsourcings are in keeping with the Canada Health Act.
This disingenuous claim should infuriate most Canadians, given our overwhelming fondness, across party lines, for Tommy Douglas, the “father of Medicare,” and for the system itself, in which access to health care is based on need, not money.
A recent exposé by The Breach focused on Ford’s assault on public health in Ontario, narrowing in on three purported advantages of privatization: that it will 1) save money, 2) cut down on long wait times, and 3) boost capacity. The verdict reached was that all three claims are myths, unsupported by evidence. To the contrary, privatization was found to raise costs, worsen wait times, and deplete the public system of essential health care workers, leading to its degradation.
Independently, the organization Canadian Doctors for Medicare recently produced a policy primer on claims advanced by proponents of privatization, singling out four such claims: 1) private pay alleviates wait time in the public system, 2) private, for-profit ownership of health care facilities leads to better health outcomes, 3) private financing makes health care more “efficient”; and 4) we cannot afford publicly funded health care.
Evidence for these claims was found to be lacking. Indeed, 1) wait times are reduced only for those who can afford to pay, likely worsening wait times overall; 2) the profit motive does not incentivize high-quality care—quite the opposite; 3) single-payer health care systems spend less on administrative costs, which means more money for direct patient care; and 4) present affordability challenges stem from having to spend privately for health services not covered by Ontario’s system. The solutions lie in improving the system, not dismantling it.
Although focused on Ontario, both the critique published by The Breach and the Canadian Doctors for Medicare primer speak to privatization initiatives across Canada and especially to those in New Brunswick, where many of Ford’s arguments for privatization are stridently advanced in parallel by Premier Higgs.
The fundamental problem with privatization of government services
Reactions to these handovers by New Brunswickers and other Canadians are impacted by prevalent, overly simplistic notions about “good” versus “bad” corporations. One such notion is that outsourcing to not-for-profit private companies is necessarily less problematic, ethically, than turning over services to profit-driven companies.
What is missing from this ethical elevation of not-for-profit companies is the recognition that when components of a health care system are contracted out to any private company or organization, the citizenry and their elected officials lose the power to direct these “lost” components of the system in ways that meet public needs, rather than the desires of those in charge of the private organization taking over the service.
This truth applies equally to services handed over to not-for-profit entities, whether they be administered as part of a vast nation-wide health services company like Medavie, or by a province-wide professional organization of physicians such as the New Brunswick Medical Society.
“Follow the money”— if only!
What is needed to get to the bottom of the privatization push is, of course, the “follow the money” principle. Who benefits, or stands to benefit, from turning over essential health delivery services from the public sector to any private company or organization, for-profit or otherwise?
Of course, no one can ever know (except for the players themselves) what has gone on behind closed doors with these handovers of the management of New Brunswick’s medical services, whether to Medavie, the New Brunswick Medical Society, or the myriad other companies and organizations that presently manage critical health services in the province. Indeed, in the absence of whistleblowers stepping forward, following the money in New Brunswick or elsewhere in Canada can be difficult to impossible, for reasons outlined in the New Brunswick Health Coalition’s 2022 report:
Our first source of information on the delivery, quality and cost of privatization should be the annual reports from different government departments. Unfortunately, they do not provide enough detailed information to allow the public to assess the impact of these privatized deals.
The other source of information could be the web sites and annual reports of the private companies involved. However, the private sector makes accessing information on how they are performing difficult, since most private company records are not available to the public.
Decades of chronic government underfunding
In the case of New Brunswick, how did our health care system arrive at its current state of dysfunction? Doctor and nurse shortages loom largest in discussions of our ailing, sometimes seemingly broken system. As elsewhere in Canada, many New Brunswickers do not have a family physician or a nurse practitioner and must access primary care via walk-in clinics and hospital emergency rooms, which, in turn, are understaffed.
A 2023 primary care survey by the New Brunswick Health Council reported that in 1997 (when privatization of health care services began), 93 percent of the province’s populace had a primary care provider. This percentage had diminished to 79 percent by 2023. Although government austerity and privatization are not entirely to blame for the failure to recruit the physicians, nurses, and other health care workers needed in the province, these survey results should dampen arguments that privatization can lead New Brunswick, or any Canadian jurisdiction, out of its health care crisis.
In New Brunswick, the essential, underlying cause of the health care crisis is longstanding government underfunding of health care, spanning both Liberal and Conservative administrations. Recently, the New Brunswick Medical Society (NBMS) criticized the Higgs government’s 2024 budget as woefully inadequate, denouncing it as “a budget for longer wait times.” The budget, as the NBMS observes, offers no chance of stabilizing—let alone transforming—the province’s failing health care system. Why is this? Decades of underfunding. Decades.
As Tracy Glynn has reminded us, when “[medical] services become inadequate, the private sector often steps in to fill and profit from the need.” In such surrenderings, however, this kind of intervention may seldom be merely opportunistic; most likely, cold-blooded agency and intention lurks behind the closed doors of the meeting rooms in which such arrangements are worked out. To paraphrase Chomsky, the standard technique of privatization involves government defunding or underfunding to make sure that services don’t work. Subsequently, people get angry, setting the stage for governments to hand over the underperforming services to private companies.
Mindsets and propoganda
Most New Brunswickers are justifiably angry about the failings of our health care system. And although such sentiments are widespread across Canada, the consequences of health services privatization for New Brunswickers may be more dire.
In a survey report issued last year by the Angus Reid Institute on political and demographic intersections of views on the privatization of health care, three “mindsets” were identified for analytic purposes: 1) Public Health Purists; 2) Private Care Proponents; and 3) Curious But Hesitant. The latter cohort was said to be “sympathetic to elements of both sides of the debate.”
Public Health Purists were identified as having the highest education levels and tended to vote NDP or Liberal, while Private Care Proponents tended to have higher incomes and vote Progressive Conservative. Those identified as Curious But Hesitant were more likely to have a high school education or less.
The latter cohort can be more meaningfully described as Vulnerable and Desperate—vulnerable owing to economic hardship and educational shortfall, and desperate owing to disproportionately higher levels of suffering and death due to challenges involved in navigating an ailing or broken health care system. In broken systems, the ability to “game” them depends on a person’s skill at being one’s own effective medical advocate. Surely Tommy Douglas never envisioned that who is served well and who is not should be determined by a person’s ability to game our national health care system at the local level.
Presently, depending on educational and economic circumstance and political persuasion, New Brunswickers are bracing for, eagerly awaiting, or confused about what another surge of privatizations will mean. The province’s Vulnerable and Desperate citizens may be particularly confused about what further health care privatization will mean for them, their neighbours, and society in general, and more predisposed to the influence of propaganda touting the benefits of shrinking government, getting out of the “business” of medical care delivery, and turning management and ownership to the more “efficient” and “creative” private health care sector.
The ability to evaluate propaganda is of significant concern, given New Brunswick’s 1) high levels of relative and absolute poverty relative to the rest Canada (see articles here and here); 2) relatively low levels of educational achievement; and 3) below-national-average literacy, numeracy, and problem-solving skills.
The Angus Reid survey lumps New Brunswick into a wider “Atlantic provinces” category, so using it in support of the proposition that New Brunswick’s citizens may be particularly receptive to propaganda about the benefits of further privatization of our health care system requires a caveat.
That said, one of the Angus Reid survey questions seems particularly salient: “Provinces are intentionally ruining public health care to make private health care look better.” Only 39 percent of Atlantic province respondents agreed, while 19 percent didn’t know or couldn’t say. Thus, 61 percent of Atlantic province respondents expressed disbelief or skepticism that their governments purposefully undermine public health care to pave the way toward further privatization.
This belief is at once quintessentially Canadian (we tend to trust our public institutions) and worrisome. Worrisome, because such a degree of unwariness, in these economically mean times, sets the table for so-called “free market” ideologues and their public- and private-sector fellow travellers to plan and enact the degradation of the very institutions that keep the wolves from our doors.
Countering and reversing health care privatization
Education and effective communication strategies for reaching a broad spectrum of New Brunswick’s citizens are the keys to electing public officials who are committed to fully reconstituting and supporting our single-payer, publicly administered health care system.
With a provincial election looming, it will be easy for opposition parties to criticize Premier Higgs for the failures of his administration to fix New Brunswick’s chronic health care delivery crisis. He has a terrible record to stand on. But such criticisms will miss the mark if focus is directed only toward improvement of services per se.
Effective, transformative critique of Higgs and Ford and their like needs to engage the public in thinking about the root causes of the crisis, and why it is wrongheaded and futile to imagine that kicking the can down the road to private companies and organizations will lead us toward a well-functioning system.
Premier Higgs, it must be emphasized, is no pragmatist (though he presents himself as such to the press). His words and actions reveal, rather, that he is a true believer that “best practices” in delivering public services (health care or otherwise) can only be realized through hard-nosed “bottom line” business management practices, of the sort typically embraced by private companies. Such “free market” dogma, amplified if not originated by Ronald Reagan in the 1980s, has proven and continues to prove appealing to many Canadian Tories and other neoliberals. Governments that govern best, govern least, so that dreary austerity story goes.
Higgs and his confederates have without a doubt bought into this Reaganesque view about the proper role of government, and are likely incapable of questioning it critically. Therein—their very inability to question it—lies the danger of such a mindset to the health and functionality of our health care system.
Whither left perspectives and action in New Brunswick
Across the media landscape, both corporate and alternative, criticisms of the dysfunctions and chronic failures of New Brunswick’s health care system—from shortages of doctors, nurses, and support staff to the continuing tragic deaths of people in hospital emergency rooms, with patients dying even before they can be attended to—have largely lacked the critical focus that is needed. As for political leaders, so far none have indicated that they intend, in an appropriately radical fashion, to address root causes and corrective measures within a holistically integrated plan of action.
Although Liberal leader Susan Holt has taken a stand against further privatization of health care services, the elephant in her room is that her party gave birth to takeovers of health care services by private companies in the late 1990s, expanded them in the early 2000s, and again in 2017. “Can they be trusted?” is a legitimate concern—especially given the well-known propensity of Liberal administrations to “talk the talk” before elections and fail to “walk the walk” upon assuming power.
The provincial NDP and People’s Alliance parties, both currently decimated in terms of membership numbers and general influence, are virtually nowhere to be seen in the battle for New Brunswick’s health care system. This is a sad commentary, in and of itself, on the diminishing influence of left-of-centre and populist parties in the province.
The potential torchbearer for transformative change will be Green Party leader David Coon, who has declared health care to be “the big issue” in the upcoming provincial election. This is encouraging, especially given that the Green Party’s health critic, Megan Mitton, has issued warnings about the dangers of privatization. But declarations and admonitions are only a beginning. As yet, the Greens have not indicated if or how they intend to counter New Brunswick’s alarming health care privatization trend, or attempt to forge cross-party support for reversing the decades-long underfunding and weakening of our public health institutions.
What is needed: Adequate funding and de-privatization
In advance of the next election, what is needed is an integrated educational campaign about the fundamental reasons as to why our system is failing us: chronic underfunding of public health care together with giveaways of health services to private capital by previous and current provincial governments. The message needs to be communicated clearly and effectively as to why and how they are linked.
For decades, our public health system has been dying from a thousand paper cuts, and we’re mad as hell. Alarmingly, many among us have concluded that privatizers can somehow lead us out of our current morass. Focus must be concentrated on disabusing those who are “reachable”—as many of them as possible—of this fantasy.
Without the foregrounding of root causes, utilitarian piecemeal attempts at improvements to a weakened, degraded system are destined to failure. If decisive action is not taken against the privatizers and their enablers in government, then we are in grave danger of losing a vitally important part of what defines us as a decent society: a system in which one and all have access to quality health care.
Gary Heathcote is an Adjunct Professor of Anthropology at St. Thomas University, in Fredericton, and a supporter and occasional contributor to the NB Media Co-op. He is one of approximately 90,000 New Brunswickers without a primary care provider.
A version of this story was first published by the Canadian Dimension on August 7, 2024.
