Canadian Review of Social Policy (CRSP) / Revue canadienne de politique sociale (RCSP)

Riches, Graham

Workfare: Ideology for a New  Under-Class, edited by Eric Shragge

Clavette, Huguette

Nouveau Brunswick

Brown, Bev

Newfoundland and Labrador

Boychuk, Gerard

English

Canada West Foundation, "Where Are They Now?": A Critical Assessment

Nutter, Richard W.

Round- Up/Tour d'Horizon 
been estimated that the annual cost to society per problem gambler ranges 
from $18,600 to $56,000. 
The problem with VLTs in particular is their ubiquity. They are easily 
accessible, located in bars and restaurants throughout the province, and their 
accessibility contributes significantly to increasing the incidence of problem 
and pathological gambling. Black quotes L.L. Desjardins, Chairperson of the 
1996 Manitoba Lottery Policy Review Working Group, as follows: 
I believe that VLTs are responsible for the majority of gambling problems 
in this province. They are referred to as the "crack cocaine of gambling." 
( P  10) 
This crack cocaine of gambling, Black argues, is no economic boon for Man- 
itoba, despite the claims of the provincial Conservative government. On the 
contrary, it is a costly public health menace, adversely affecting the lives 
of tens of thousands of Manitobans - and disproportionately lower-income 
Manitobans - while producing no net economic benefit for the province as a 
whole. The CCPA-Mb. study concludes by calling for the elimination of VLT 
gambling in Manitoba. 
NOTE 
1. The study by Err01 Black, The VLT Controversy: Economic Boon or Pub- 
lic Health Menace? A Primer on Vadeo Lottery Terminals, is available from 
the CCPA-Mb. office. Phone: (204) 943-9962; fax (204) 943-9978; e-mail cc- 
pambQpolicya1ternatives.ca. 
Alberta Richard W. Nutter 
University of Calgary 
The most pressing social policy issue in Alberta today is a bill to give the 
Alberta Minister of Health the power to approve private, for-profit hospitals. 
Bill 37 was introduced in the Spring session but died on the Order Paper. 
However, the Klein Government appears set to reintroduce and pass this bill, 
thereby paving the way for private, for-profit hospitals. This is a national 
issue because, under NAFTA, approving one private, for-profit hospital in 
Alberta means that private, for-profit hospitals must be approved everywhere 
in Canada. 
Three arguments are made to support private, for-profit hospitals. These 
arguments appear reasonable and are believed by some on purely ideological 
grounds, but systematic data do not support them. 
1. It is falsely claimed that private, for-profit hospitals are more eficient and 
more cost effective. Two sets of data are relevant to this false claim: 
No. 42,1998 131 
a. A t  the microlevel: Private, for-profit hospitals are not more efficient 
and cost effective than public hospitals. Two of numerous studies 
demonstrating this fact are: Canadians Stoddart and Labelle (1985) 
demonstrated publicly financed and administered hospitals were more 
cost effective; and Woolhandler and Himmelstein (1997) found that 
US private, for-profit hospitals spent more on administration than US 
non-profits, and spent twice as much (25%) as Canadian hospitals 
(12%) on administration. 
b. A t  a macro level: Private, for-profit hospitals increase the overall 
amount of money spent on hospital services if current service levels 
are maintained. The National Forum on Heath shows that increas- 
ing reliance on the private medical sector leads to increased overall 
costs. Comparing the US and Canada before and after Medicare was 
introduced (1971), shows our system, which provides universal cov- 
erage and a very high quality of service, is much less expensive than 
theirs, which provides only partial coverage. Evidence from all OECD 
countries shows that publicly funded and administered medical care 
is more cost effective than mixed public-private systems. 
2. It is falsely claimed that the addition of private hospitals to our system 
will reduce the pressure on  our public system. It is argued that as a nation 
we cannot afford to spend more on hospitals, but if those who can afford 
it pay for their own care in private for-profit hospitals, the pressure on 
the public system and waiting lists will be reduced. This argument has 
two major flaws: 
a. If the wealthy paid for their own care from private, for-profit hos- 
pitals and current funding to the public system was maintained to 
reduce waiting lists and improve services, then a larger, not smaller, 
proportion of the total economy would go to hospital care. If funding 
for the public system is not maintained, it deteriorates, as the NHS 
has in Britain. 
b. When the well-to-do get their care from private hospitals, either paid 
by themselves or by employer-supplied insurance, they are loath to 
pay taxes to support a public system they no longer use. The US and 
Britain illustrate this political/economic truism. 
3. It is falsely claimed that private, for-profit hospitals will increase choice 
for both physicians and patients. Two kinds of choices are spoken of: 
a. Medical choices: In both Britain and the US insurance companies and 
HMOs are severely limiting the choices of physicians and patients. The 
US Congress is debating a "Patients' Bill of Rights" to protect against 
a system increasingly focussed on profits rather than patients. Not 
only have individual middle-class Americans lost LLchoice", but they 
have lost any chance to control the quality of care they receive. 
132 No. 42, 1998 
Round- Up/Tour d 'Horizon 
b. Values choices: The claim is that the individuals have the right to 
choose either public or self-funded private hospitals. The liberty of the 
individual should not be constrained by the collective good. However, 
affluent Canadians already have the liberty to buy private hospital 
care in the US or Britain. Therefore, we don't need a two-tiered 
system in Canada to satisfy the libertarian ideal. 
The Values study of the National Forum on Health found most Canadians 
favour social justice choices that enhance the good of the community as a 
whole. Recent data indicate only one in ten Canadians favour a two-tiered 
system. Unfortunately, many of that one-tenth of Canadians favouring a two- 
tiered appear to be in the Klein Government cabinet and caucus. Therefore 
it is very important that everyone who cares about our current system be- 
come active in stopping this potential destruction of our medical/hospital care 
system. 
No. 42, 1998 


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Workfare: Ideology for a New Under-Class, edited by Eric Shragge