Stop me if you’ve heard this one before. Our publicly-funded, not-for-profit health- care system is described as being in crisis and unsustainable. A privileged few will come forward with their scheme to magically save the system by selling services that have been developed and sustained by public money to affluent buyers.
The purported goal is share Ontario’s knowledge, expertise, and skills in order to alleviate human suffering while tapping into pools of cash that will invigorate our deficit-weakened, poised to crash system. The marketing spin is that everyone wins—the folks from abroad are healed and Ontario’s faltering health-care system is given new life thanks to fresh financial transfusions. Not coincidentally, by transforming a public good into a commodity, the invisible hand of the market boosts those privileged few even higher up the ladder of financial reward and power.
Yes, this mix of commerce and care is fabulously innovative until Kevin Donovan of the Toronto Star, the Auditor-General, and the Standing Committee on Public Accounts start to unpack the many ways that ORNGE betrayed the public’s trust. It might be tempting to blame just a few bad pieces of fruit such as CEO Dr. Chris Mazza, whose most recent yearly income from ORNGE included $1.2 million in loans in addition to a secret salary of $1.4 million. Or the seven executives considered “high performers” who had their MBAs paid for by ORNGE at a total cost of more than $600,000. Details of these and more significant operational failures are widely documented but the logic that drove the ORNGE fiasco may be found in Mazza’s testimony to the public accounts committee: “The mandate of ORNGE, that started back in 2006 and went through four cabinet ministers and two deputy ministers, two associate deputy ministers and three assistant deputy ministers—always had to generate revenue outside the tax base in order to improve the sustainability and improve the infrastructure of the systems in Ontario, which were, in the view of those who built the systems in 2006, not sustainable.”
This is the same rationale that Toronto General Hospital, Princess Margaret Hospital and Mount Sinai Hospital use in defense of their treatment of non-urgent patients from outside of Canada -- based on their ability to pay. Bryce Taylor, director of the international patient program at the University Health Network, explained to the Ottawa Citizen “that revenue generated from foreign patients can actually benefit local patients in an era of tight budgets.” The revenue involved can be significant. A Kuwaiti woman, for example, was admitted to the McGill University Health Centre for cardiac surgery at an estimated cost to the Kuwaiti government of around $200,000. So, why then, would the Québec Minister of Health, Réjean Hébert, state that “Québec is not open for medical tourism.”
Ontario’s registered nurses value access to health care as a human right and public good. Profiting from human suffering by offering preferential hospital services based on ability to pay rather than need is ethically suspect as is evident by all those campaign photo-ops where politicians promise during elections that OHIP cards will trump credit cards. Splitting already scarce human resources between a public system and a parallel, for-profit system will erode the quality of our public health-care system. If there is extra operating room capacity, extra beds, and abundant numbers of surgeons, anesthetists and RNs (which is news to us!) for discretionary health care for revenue-generating patients from outside of Canada, why aren’t those resources being directed to Ontarians on surgical wait lists and those lying on stretchers along ER hallways awaiting beds?
Will Ontario’s Minister of Health, Deb Matthews, stand up, and pledge as her Québec counterpart has that: “Ontario is not open for medical tourism”?
Chief Executive Officer
Registered Nurses’ Association of Ontario