| |
MOST
NATIONS proclaim a passionate love of equality. And, most nations do little
to prove it. Canada is not most nations.
One of our basic operating principles is to use public policy in unique
and daring ways to ensure and promote practical, day-to-day, equality.
Medicare was our best example. No one single public policy instrument
ever did more to let us live up to our equality ideal.
But, as we desert and diminish Medicare we desert and diminish our commitment
to equality for all. No one knows this better than Canadians with disabilities.
Thus, the campaign to respect, restore and expand Medicare is, for them,
not just about better medical care. It is also a campaign to respect,
restore and expand the equality of Canadians with disabilities.
A giant step backwards
Statistics readily show us that it's the most vulnerable citizens of our
society-people with disabilities and seniors-who benefit the most from
our Medicare system. After all, they are less likely to have the financial
resources to access the growing for-profit element of health care in Canada.
Since the inception of Medicare, Canadian society has become much more
inclusive of, accessible to, and accepting of, people with various types
of disabilities. However, the growing gaps and privatization of our Medicare
system mean less access to health support services for seniors and people
with disabilities and represents a step backwards in their struggle for
equality.
This is seen mostly within the community and continuing care sector of
our health system. The irony of this situation is that preservation and
expansion of this sector of our public health system not only promotes
equality, it makes good economic sense.
No money for the new model
The problem with respect to inadequate access to health support services
in the community has existed for decades but reached a crisis point in
the mid-1990s when provincial governments began to restructure health
care in Canada. The health care buzz words of 'closer to home' health
care and the 'continuing care model' of health care were to be heard in
every jurisdiction across the country, giving rise to the closure of close
to 300 hospitals and the elimination of thousands of acute care beds in
the last decade.
Unfortunately, when it came to implementing a community-based health care
model, our politicians failed to provide adequate infrastructure and resources
to community care-the less expensive preventative side of our health care
system. The result has created an overburdened Medicare system that provides
less equal access for persons with disabilities and seniors.
Canada's ability to promote equality should be measured by the degree
to which our most vulnerable citizens can fully participate in all aspects
of society. An important vehicle to achieve this is through the provision
of a range of public services that supports the integration and participation
of our disadvantaged citizens. Most of these services support and form
a community-based health care system.
Paul Martin pulls the plug
Around the time that health care was being restructured across the country
towards a community-based model of health care, our federal government,
through its war on the deficit, cut back on its funding of health care
and eliminated its funding for the many services that support a community-based
health care system. The biggest single factor in this regard was the 1995
federal budget of former Finance Minister Paul Martin, which reduced federal
funding for health care and eliminated an important public policy instrument
that promoted greater equality in Canada-the Canada Assistance Plan (CAP).
CAP would have also gone a long way in providing financial resources to
support a community care model of health within Canada.
CAP
was a federal/provincial fiscal arrangement dating back to 1966 whereby
the federal government provided provincial governments with fifty cents
for every dollar they spent on community-based health and social services.
These federal '50¢ dollars' provided provincial governments with
a significant incentive to expand services and programs to allow our more
vulnerable citizens, like people with disabilities to fully participate
in the lives of their communities.
The support services funded under CAP included such programs as home care,
homemaker services, attendant care and respite care. CAP also contributed
to the costs of medical and assistive devices that allowed seniors and
people with disabilities, to be integrated and fully participate in society.
These inexpensive people-oriented services not only improved their quality
of life, they helped keep them out of long-term care institutions and/or
hospitals. Without CAP funding and no recognition under the Canada Health
Act, these services now lack stability and can be changed or eliminated
at the drop of a hat. As a result, the real-life needs of many people
with disabilities are being ignored.
A half-million short changed
It's estimated that more than one million Canadians with disabilities
need help with one or more everyday activities-but over half of those
persons are not getting the help they need. There are many examples where
provincial governments across the country have slashed, privatized, and/or
downsized a range of services that would have greatly supported people
with disabilities in overcoming barriers to participating fully in daily
living, including economic and social activities.
Since the elimination of CAP, provincial governments have failed to provide
adequate funding for the necessary support services to sustain a community-based
health care system. Private expenditures on community-based services have
increased by almost 200%. The increased demand for health support services
has greatly outstripped the increases in public spending.
The elimination of CAP has affected the lives of persons with disabilities
disproportionately to other Canadians. The loss of the national standards
of CAP meant the loss of any assurance of access to many of the vital
services they relied on for independent living in their communities.
CAP ensured that the sharing and caring values of Canadians formed a part
of our country's overall prosperity.
CAP also provided a strong signal that the state had a collective responsibility
for the associated costs related to an individual's disabilities.
The 'for-profit' sharks close in
This instability in funding for these vital support services has greatly
attracted 'for-profit' interests and thus spread the growth of two-tier
health care.
The growth of 'for-profit' private services in community health will always
hit those with the lowest incomes hardest, resulting in less access to
health care services for them, compared to those who can afford to pay
directly for health care.
People with disabilities are disproportionately poor, and as a result
their access to health services will decrease as a result of increased
fees and privatization.
Choking on the cost of drugs
The same can be said about access to drugs that many people with disabilities
need to ensure their health and well-being. As with health support services
in the community, Canadians with disabilities need to have affordable
access to drugs.
The spiraling costs of drugs as well as the de-listing of many drug therapies
for people with disabilities by provincial governments, are undermining
many of the advances that the disabled community has made in terms of
independence, equality and full participation.
Drugs are the fastest growing single cost of our entire health care system.
While a majority of Canadian workers has access to drugs through private
insurance, the same cannot be said for the majority of Canadians with
disabilities. They don't have access to a private drug plan and are being
denied proper access to drugs as a result of many provincial governments
increasingly de-listing medications and introducing co-payment plans.
If we are committed to community-based care that promotes health, then
we must have a national pharmacare plan. Such a program would not only
ensure greater access and equality, it would provide an overall savings
to Canada's health care system.
Welcome to the 17th century
For people with disabilities, the goals of Canada's Medicare system should
be to ensure equality of opportunity, full participation, independent
living, and economic self-sufficiency.
A health care system that increasingly relies on private financing results
in the opposite-it creates unequal access. In fact, private sector involvement
in our health care system only forces people with disabilities to rely
more on the old 'charity' model of care-a model that emphasizes dependence,
segregation and transfers the costs of disabilities away from the state
and towards families and charitable organizations.
The disability rights community strongly objects to this model as a throwback
to the old British Poor Laws of the 1600s.
Three priorities to get us started
Canada's Medicare system needs to be revamped and strengthened through
the development of additional national standards that ensure it no longer
discriminates against people with disabilities.
There are many essential health support services that are unavailable
or unaffordable to thousands of Canadians with disabilities. While these
necessary supports are diverse, the most widespread and acute needs relate
to three areas:
-
personal support services of all kinds (such as self-directed attendant
care, home support services, sign language interpretation, communication
supports, and support workers);
-
assistive devices and supplies (such as mobility aids, hearing aids
and other communication aids, incontinence supplies, home oxygen, etc.);
and
-
prescription drugs and related health needs (such as special diets).
A priority for improving our Medicare system should be a coordinated
plan involving the Federal/Provincial/Territorial governments in each
of these areas.
Such a plan must be developed in consultation with disability rights
activists, to ensure that Canadians with disabilities are guaranteed
these supports.
Four fundamental principles
The
fundamental principles that should form the basis for this type of plan
are:
-
Health support services made available to all Canadians regardless of
type of disability, age or geographic location.
-
Health support services provided on an equal basis to all, regardless
of their residential or living arrangements. In particular, persons
living independently or with families and other caregivers in the community
should be eligible on an equal basis with persons living in residences
and institutions.
-
Health support services provided based on national standards applicable
to Provinces and Territories, and be portable across jurisdictions.
-
Access to health support services not restricted by user fees or co-payments.
These
principles are essential for cementing the link between equality, full
participation and health care. By incorporating home care, other health
support services and Pharmacare into the Medicare system, the federal
government could go a long way in promoting better health outcomes, greater
equality and independence for Canadians with disabilities, and ensuring
that our public universal health care system is accessible, sustainable
and equitable.
This
paper was prepared by the CLC Disability rights Group
November 2002
|
