Understanding the Changes in the Canadian Healthcare System

“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”

— Noam Chomsky

The quote above is a textbook contextual analysis. In any industry, during such changes towards privatization, those who adapt fast will survive.

Here are my small two cents, as we try to understand the profound changes that the Canadian healthcare system is undergoing, under a historical light.

PART I

The name of the game in the upcoming government-funded healthcare system in Canada is "hybrid" - part public, part private - as in many other countries.

Most government-funded organizations will have to find ways to partially privatize in terms of revenues.

90% (or more) of smaller organizations won't make it. The money will be concentrated in bigger hospitals, private clinics, medical insurance and private healthcare plans.

Healthcare will of course still be funded, and practiced for free in hospitals, such as in ER, Day Surgery, illness specific, lab exams, etc., mostly for low-income Canadians. So it will still be a partially funded healthcare system. Middle and upper classes will gradually migrate to private healthcare plans.

PART II

There is always a trade-off in these processes, between advantages and disadvantages.

One advantage is that trillion-dollar multinational consortiums of hospitals, for example, have the firepower to acquire state-ot-the-art technology to their facilities worldwide. With the next robotic-AI disruptive technology ready to enter mainstream, this is an absolute advantage.

One example of disadvantage is when private healthcare corporations choose to cut corners in quality and quantity of services due to pressures on their ROI, projected margin of profit, taxations, etc. Or when healthcare management gets so distant from patients that they start seeing patients as just a number.

PART III

As the human mind tries to find solutions to new circumstances, many wrong and right decisions are made at the same time.

There is no final right, wrong, or ideal situation in any reality. Reality is messy, and each of us must find our moral compass and directions, as we navigate it.

There is reality, period: what is decided to be done to confront the demands of our times, and the good and bad consequences of our decisions.

There is no ideal decision. No magic bullet. As things are in real life, in general even best decisions and situations come with a price to pay.

And there is no bad decision or bad situation that does not come without some benefit, such as getting out of that mistake with more experience for the next time.

How to draw the moral line, when weighing the trade-off of good and bad consequences of our imperfect decisions?

This depends on the choice you have made about who you want to be.

A war general and statesman, for example, tends to choose ruthlessness, and to justify the sacrifice the few for the sake of the many.

A healthcare healer from the heart tends to sacrifice themselves for the sake of their many patients.

And then there are those who choose to sacrifice the many for the sake of the few.

Only you can decide who you want to become in the end.

PART IV

To give some historical context and clarity to the process of gradual privatization of the Canadian healthcare system, here are a few observations based on personal experience.

Please take time to look back at the third wave of the globalization process, consolidated between the 60's and the early 2000's. That's half a century ago.

Those of you who participated in it, know it was a crushing and merciless process. Countless smaller companies were bankrupted, bought out, taken over, merged, etc. Remember...?

Any privatization comes with change management and its good and bad consequences.

We are living through a similar process in Canada.

Healthcare funding was frozen around a couple of decades ago for small agencies, and of course inflation and competition will force them automatically into inexistence.

This is how a gradual defunding process works.

Because I lived through the globalization period as a young adult, I can't help perceiving the new wave of healthcare privatization in Canada as déjà vu in a smaller scale.

I tried to share this memory a few times here in Canada in the last 10 years, but very few people seemed open to listening.

PART V

The third wave of privatization and globalization happened mainly due to the growing demand of production to sustain the explosion of the world population, which soared from 2 billion people around 1928 to around 8 billion now, i.e., the number of mouths to feed on the planet quadrupled in the last 100 years.

This demanded unprecedented production, profits, debt and reinvestment, or else.

The alternative was billions of people in hunger and misery, dying before being given any chance to survive. Then crime, violence, civil unrest, wars, you name it, at an unprecedented level. And so it happened.

Back then, to increase global production, the industrial and corporate worlds had to implement the first international standards of quality, the ISOs, so that global production and processes would be within a range of consistency and quality, to facilitate global trade, remember?

One negative trade-off consequence of increasing supply of energy to meet the soaring demand of production was, as you know, the rapid increase of CO2 levels in the atmosphere, and global warming causing climate change.

Meanwhile, companies and professionals all over the world had to sustain dogged determination for excellence in quality, long hours of most excellent hard work, real competence, real preparedness, stamina and resilience, not to be overtaken by their international competition. And international rivals were very real and well prepared, in this race to survive in the global market.

In this context, the workforce had to demonstrate and sustain lots of physical energy, excellent health, total focus on superior production, competence, preparedness, ongoing training and specialization, attention to quality and to detail, the highest standards of work ethics, and absolute loyalty to the company's directions, their team, their production and results.

Those who made a long career out there in the past 50 years, survived and achieved all that.

PART VI

Unfortunately, this came in a time when most former colonies of the Western European countries, by now politically independent for some centuries, were rebelling against the continued historical economic dependence and wanted to build national self-determination, in a world that was changing from the power of nations and colonial monopolies to the power of multinationals and a multinational financial system.

If you remember it, this was a period during which monopolies were highly criticized for their complacency, sense of entitlement, and inefficiency. The word of the day was deregulation, and back to free market and free competition, to increase quality, efficiency and production. And may the best man win.

And then it was a complete, epic comedy of errors.

PART VII

As my grandmother used to say, when the small bells toll, it is because Big Bell has already tolled.

Cultural change and beliefs trickle down to the mainstream through time. In general, when everybody in the mainstream finally hears about, understands, and believes in the cultural paradigm of decades ago, that paradigm has already passed, and become obsolete.

And that's what happened then.

Local monopolies and local unions did not have the vision to adapt to the new reality. They kept sustaining the old colonial tension between privileged monopolies and the aspiration to national economic self-determination.

Both sides stayed entrenched in the old values, mores, and practices of the paradigms of national monopolies and national self-determination, while the world order was changing fast in front of their eyes - but they could not see it.

So what happened is that both sides became a stumbling stone to companies trying to enter or to survive in the new multinational competition to feed billions of people and keep the world turning.

Consequently, both sides were gradually disempowered and lost their battles one by one. They could not survive the test of reality.

Multinationals would close their factories where monopolies, unions and the workforce wouldn't cooperate. They would move their plants and jobs to countries with more fiscal incentives and greater freedom of imposing the new production rhythm to the local workforce.

The brutal truth was - you do not achieve success in satisfying the monstrous hunger and demand to grow and build infrastructure, logistics, distribution of food, clean water, housing, sanitation, health, education, safety, goods and services to 8 billion people in a little less than 100 years, in a culture of laziness, arrogance, low production, gossip, machinations, incompetence, imprecision, unpreparedness, disloyalty, emotionality, indiscipline, mutiny, individualism, and self-entitlement.

What happened, inevitably, was the global race for efficiency, production and solutions which, on its turn, triggered the socially invisible massacre of the less advantaged and the vulnerable during the global economic war, remember?

Hundreds of thousands of workforce who believed in their unions, in liberating themselves from colonial monopolies, and in their rights to autonomy, etc., were laid out overnight, and there followed unemployment, misery, family migration to bigger cities, to live under subways or in slums, and survive on precarious casual employment and informal work.

This brought a massive number of disempowered angry males in many countries, going into alcohol, drugs, gangs and crime, insanity and suicide, to escape their sense of powerlessness and social emasculation.

Managers responsible for keeping this merciless pace of production were sick and tired of trying to convince their workforce that, at that point, it was a question of survival.

The world was indeed in a state of global economic war, and as in every wartime, sacrifices had to be made. The alternatives were: to work that hard to provide the basic needs to a population in explosion, or to have no work at all for the majority.

A lot of managers during that time had a heart attack or stroke at around 50 years old and died, remember? I lived through it all. They became casualties of the economic war themselves.

I had so many graduate and post-graduate students working as middle or top managers of these multinationals, who would train for Ironman, jiu jitsu black belt, marathons, triathlons, and other fitness programs, to stay as fit as the proverbial Spartans. They did that because they had seen their less fit colleagues go down before 50 years old.

PART VIII

The Canadian healthcare system is just a little late historically, around half a century behind in the transformational process that already happened all over the world in other industries. The change is starting to catch up with healthcare now.

One possible consequence I really fear is the trust Canadians put in unemployment insurance and welfare, as the new order settles in.

When we talk about privatization, then we are talking about multinational private groups buying and taking over the healthcare market share in Canada. Which means we will be in the international world of profit and competition, as it happens everywhere else.

Healthcare businesses will be demanded to be efficient and lucrative, and their workforce qualified enough to please and retain their paying client, because it is the client that ultimately pays for their life.

Clients do not pay the workforce to do workplace politics, play princess and king to one another, hold unproductive meetings and spread coffee break gossip. Clients pay the workforce to give them excellent services at a better price.

The pressure is already on, and frontline healthcare staff in the trenches of this war are feeling it the most, with an impossible workload laid on the shoulders of underfunded, understaffed, underpaid, and overworked employees.

In the private multinational competition, workforce advances their careers if they are highly productive and please the paying client by giving them total quality in services. That was, and is, the goal and final fruit of privatization: better quality, better prices, more paying clients, more profit.

PART IX

Although taxpayers are the paying client of a government-funded system, and should receive the same excellent services for what they pay, most top government officials around the world do not welcome anymore having the added headaches, expenses and workload caused by direct administration of their funded businesses, and having to constantly deal with bloated public services workforce, structures and expenses, inefficiency, and the sense of self-entitlement to public money that often happens in public services.

Governments can outsource it through privatization, and still receive the influx of taxes from the public and private businesses without the administrative workload of directly managing the finances and operations of publicly funded services.

This was and is the worldwide choice and decision made by most Western nations half a century ago, that shook the foundations of the Western world first, then spread up to the ends of the Far East, causing momentous geopolitical changes such as the fall of the USSR, and communist countries like China creating their own economic model and solutions to face the competition in a global market.

The politico-economic decision for globalization profoundly influenced and marked all our lives, in one way or another.

PART X

Fast-forwarding to present times, the world out there is now at the fourth and fifth waves of globalization, with the USA and China as the new geopolitical tension and economic polarization, at the cusp of another disruptive technology and a new paradigm shift, that will take the now globalized and interconnected world due to the Internet and satellites to the next unimaginable level: the end of human workforce and the beginning of the robotic-AI era.

This will happen if, and only if, humanity is lucky enough to sustain the transition from globalization based on human workforce to the robotic-AI workforce, in the middle of climate change, unprepared leaders, peoples with insufficient education, widespread misinformation, primal emotional reactions, and weapons of mass destruction.

The new momentous trade-off humanity is facing from now on is: the global end of human slavery and heavy exhausting labour (which would take humanity to a completely different direction) versus the price vulnerable human beings will pay for this transition.

If we survive all that, I greatly fear it will still be over a massacre, with the gradual end of the global human workforce.

There are many voices in favour of a universal personal income to all the billions of people who will gradually lose their jobs, until their generation passes away, but this still remains to be seen.

Theoretically, casualties of this next paradigm shift, might include not only the human workforce of billions of people, but might unfortunately pass first through the particular sacrifice of the alleged "surplus" of ageing people in the so-called developed countries of our generation, among other vulnerable sectors of society, during this transition.

As it happens on this sorrowful planet and with our species, it seems that we do not know how to create progress and civilization peacefully and equitably to all, in harmony with nature.

Historically, progress has always come at the expense of the weaker: the poor, the sick, the old, widows, women and children, the unborn, the vulnerable and the helpless. It has always been the weaker who paid the price of civilization, built over the blood of millions.

This time, if we repeat the pattern, I fear it might be over the blood of billions.

I pray we can find a better way soon.

PART XI

This unfortunate confluence of factors directly impacts gerontology and palliative care, especially during a time of defunding and privatization. I don't want to extend myself here talking about ageism, for the sake of clarity, so I'll just say that humanity might be contemplating one of the biggest moral scandals and dilemmas of our century: how we are going to treat this generation of elderly people.

For the first time in the known history of evolution of our species, we got to a demographic inverted pyramid of populational age, where in many countries we have more ageing citizens than children.

"Developed" countries did not react fast enough to this reality, which consequently became a huge challenge in our present times. These countries share some common issues, and are contemplating three major "solutions":

a) an underfunded healthcare system in change management towards privatization providing insufficient progressive and palliative care to their ageing population;

b) euthanasia in the insufficiency or absence of proper progressive and palliative healthcare;

c) elderly abandonment in a culture of social invisibility of the elderly, and social silence.

PART XII

Now allow me to turn your attention back to the question of personal behaviour and personal moral compass.

How can a healthcare professional navigate through these imminent changes?

Here are some pointers that might help the next generation working in healthcare, as they figure out which direction to take.

What I learned in my life is simple: be consistent! Determine inside you where to draw the line in terms of right and wrong for yourself, in a place that will keep you happy and in peace.

You are not a statesman, not a conquistador, not a psychopathic dictator. You are a healthcare provider.

Synchronize your moral code to a healthy, reasonable personal balance between happy personal life and feeling good with yourself about helping your patients and clients in the correct way.

In challenging moments, do not give up the moral compass you chose. Set the boundaries against toxic colleagues and toxic organizational cultures.

Protect your personal wellbeing with constant selfcare not to get burnout. Keep strong bonds of mutual love with close family and friends. This is most important.

Above all, focus on hope, empathy, honesty, humility and kindness. Help everyone you can out of a good heart and conscious decision.

Again, you chose to be a caregiver and healer out of your kind heart. You were not born a predator, a killing beast, an executioner, a psychopath, or any kind of ruthless killer. Being bloodthirsty, aggressive, or climbing the social ladder over the bodies of others is not your thing at all.

If you try to go against your innermost nature, you will commit an act of violence against yourself that can end in serious psychological or physical conditions, including living in deep remorse, trauma and chronic serious PTSD.

These simple timeless truths will help you find and stick to your goal and direction in the middle of the momentous changes you are and will be experiencing in your lifetime.

PART XIII

To recapitulate, it is important to understand that Canada is implementing the privatization of healthcare during a period of global momentous changes. The world is living through a new paradigm shift, with new disruptive technology occuring in the middle of a new climate change and mass extinction event.

Talk about bad timing and confluence of uncontrollable variables.

My personal feeling is that there is no point in trying to share what most people clearly could not bear hearing at this point.

I do not have the heart anymore, to cause gentle and vulnerable people to suffer more than they already do, for becoming aware of something that is absolutely beyond their control, or anyone's control.

As I always say, life is hard enough. We don't need to, and should not make it harder to one another.

I don't see people as statistics. I see people as living, breathing, scared, imperfect, vulnerable, lonely individuals in pain, sacred lives in need of hope, our care, compassion, and kindness.

As I turn 70 and contemplate what to do with the last quarter of my life, my decision is that I'll still try to do my part, my dear little best, to help and console people in the barracks of this war.

To my idealist colleagues in healthcare, I encourage you to remain as realistic dreamers. Ground on reality. Think about what is the best you can do with the reality you have. It will be tough. It will be messy. It won't be perfect. Do not fear doing your best! The world needs you.

A final word to those who sit and whine. Those who get discouraged and complain incessantly. Those who give themselves permission to "me, me, me" drama in the middle of so much pain and suffering.

Those who get angry and hotly criticize everything and everyone, and never consider their own imperfection and ignorance, or do anything to help.

Above all, those who try to capitalize and advance their petty personal agendas on the pain, suffering, sickness and death of so many human beings. Those working in healthcare, especially palliative care, who secretly congratulate themselves for being so smart and crafty, those who wave the flag of palliative care to terminal patients and their distraught families just to advance their careers and aspirations to power and wealth. Frankly, that's an all-time moral low in terms of personal work ethics.

Some really do not get that they are making everyone around even more miserable with their behaviour. Some really can't notice that everyone else is suffering in one way or another. It is cruel to lay an extra burden on the shoulders of people who already carry a very heavy cross. And all healthcare providers are carrying a very heavy cross right now.

If you are not part of the solution, you are part of the problem. And how I wish more of us became part of the solution!

I decided to keep the burden of awareness to myself. After retirement, I will still follow my mantra: shut up, pray, work, and help.

It is what it is. None of us can change the powerful waves of History but each of us can still decide how we will navigate these waters.

May you become a lighthouse and safe harbour to all those who meet you. And may you find your peace, at the end of each day, inside the citadel of your good heart.