Myth 1 «We can’t afford to pay for a public system.

2. Myth 1 «We can’t afford to pay for a public system.

3. Are you sure? : • Over the last 20 years the proportion of money spent on health costs has grown only slightly – from 6.3% to 7.3%. So, health care isn’t costing more. In 1981, Quebec directed 22% of its revenues towards medical services and hospitals. In 2000, that number dropped to 18%. • The public system costs less for individuals and collectively than a private health care system. On average, the Swedes spend 2 825$ per year on health; each Canadian 2 998$ while each American spends 6 402$ !

4. • In the drive towards a 0 deficit, and a change in policy that has seen lowered taxes since 2000, Quebec has lost more than 5 billion dollars annually, almost the equivalent of what is missing in the health care system. • The cost of medication is rising at a rate of 15% per year and represents 18% of health care costs. Medication takes up more room in the budget than doctors and nurses together. The pharmaceutical industry asserts a lot of influence about what/how medicine is prescribed. The Quebec government has refused to control costs in this area. In fact, the length of time pharmaceutical companies can maintain their patents has been extended to 20 years = no no-name brands.

5. Government choices have lead to cuts in the health care system.

6. Myth 2 An aging population is going to lead to an explosion in health care costs. 

7. Fact The number of seniors in Quebec will double in the next 25 years.

8. However… • We have head that there will not be enough workers to support dependents such as seniors. This increase in number is partiallyoffset by a general decrease in the number of people younger than 18 years (fewer number of dependents overall.) • Western society has witnessed a slow progression (not a sudden jump) in these proportions (increasing aging population and decreasing numbers of younger members). • These demographic changes have led to an increase of 1.8% in public health expenses between 1981 and 1991. It is projected that this increase will be maintained over the next decades until 2026. This number does not qualify as an explosion in costs.

9. The population is living longer, but in better health. In general people have increased health care needs in the last 5 to 10 years of their life. They do not automatically need more when they turn 65. It is a gradual increase. • More and more people are continuing to work past retirement, and will therefore continue to pay income taxes. Beyond their continuing financial contribution, if you consider the other ways these people will save costs, in terms of providing family support and volunteering, the number added to the public treasury could be measured in the billions of dollars in industrialised countries. We must stop thinking that all seniors are dependent on government support and that aging means disability and poverty. • Aging itself is not responsible for the increase in costs, the largest amount is due to other causes, such as the increasing use of medication in our society.

10. Because the increase will occur slowly over time, the aging population will not mean an explosion of costs in the health care system.

11. Myth 3 Private systems are more efficient and perform better than public ones.

12. Measured how? • According to an American study; private, for profit, hospitals spend more than one third of their budget on administration costs (34%). Private insurance companies spend approximately 20% on administration costs. • The RAMQ manages approximately $4 billion worth of programmes with administrative costs = 2% of the total budget. • Studies have shown that, in reality, private services are generally of a lower quality because companies must maintain a profit margin. (In order to keep personnel salaries can’t be reduced, so cuts must be made elsewhere, like in the type of care.)

13. Also, the need to be profitable can influence clinics to prescribe regimens that may not be useful in the treatment of patients. One study in British Columbia observed that patients in a private system underwent surgical interventions even though this course of action was questionable. • Overall, almost a quarter (23%) of all money spent on health in the United States is wasted, according to a large employee organisation… (because of higher administration costs, second opinions, product development, advertising, unneccesary medical interventions…)

14. • Rising health costs are due principally to an increase in the cost of medication and technology (from 37% of total health care costs in 1980 to 55% in 2005) while at the same time the amount given to hospital services and medical salaries dropped from 63% in 1980 to 45% in 2005. • • In the United States, where there is no public health care system, almost 50 million Americans, or 16% of the population, are left to fend for themselves. • In 2005, the United States spent 15,3 % of their GNP on health care costs, almost double that of the average developed country (9,9% in Canada, 9,2% in Sweden).

15. In the end does the private health care system really cost less than a public one? Not sure.

16. Myth 4 The system isn’t working because there are too many people who abuse it.

17. The Facts According to research done by a Montreal group, le Carrefour departicipation, ressourcement et formation, it is very difficult to prove abuse of medical and hospital services. And, assuming it could be verified, it is just as difficult to identify the culprits.

18. So what is behind this argument? • • This argument is based on discrimination and prejudice and is used in all public sectors to justify changes to accessibility. Arguments for cuts in welfare to fines for failing a course in CEGEP all come from the same line of thinking. • According to the Conseil de la santé et du bien-être du Québec, visits to the doctor are initiated by patients, all other medical interventions (and resulting costs) depend on the judgement of health professionals. Ultimately then, the costly « abuse » depends on the decisions made after the patient arrrives in the office, something not controlled by patients.

19. Even in systems where the patient must pay for a portion of the costs of a trip to the doctor, the number of persons who could be considered « abusers » is not reduced. What does happen though, is that those with less money do not seek medical attention and consequently risk worsening their condition. Not only is their right to health care denied; should they need to seek care, the cost is a deterrent.

20. It is impossible to prove individual abuse of the health care system: this allegation is discriminatory and serves to deny the right to health care.

21. Myth 5 We pay too much in taxes in Quebec.

22. The facts In 2005, taxes accounted for 36.2% of the GNP for 30 member countries in the Organisation for Economic Co-operation and Development; this percentagevaries greatly from one country to another, reflecting different political choices (50% in Sweden, 21% United States). Canada’s proportion is slightly lower than average, around 33.4%; this means that Canadians pay fewer taxes than the average industrialised countries.

23. What do taxes give a country? • The more that is accumulated through taxes, the better we are able to offer services for everyone. The taxes we pay finance part of the services we receive: health, education, daycare, roads, legal system, parental leave, assistance to individuals and familes, public health, environmental protection, public transportation, libraires, arts and culture, public security, international aid, national defence…None of us could afford to pay for all this based on a system of pay per service.

24. An April 22, 2005 article in La Presse noted that Quebecers, on average, pay $993 more in taxes per year than Ontarians. What does that get us? • Quebec drivers pay $130 in annual fees to the SAAQ, a collective provincial insurance plan vs $1123 in Ontario’s private insurance system. • Annual hydro bills for houses in Montreal is $1687 and $2943 in Ontario. • Statistics Canada shows that University fees in Quebec average $1900/yr in Quebec vs $4881/year in Ontario… Do Quebecers or Ontarians pay more for the same services?

25. The Quebec government must deal with a structural deficit. The current is not because of what has happened in the face of a crisis. We all know that budgetting requires the balancing of what is coming in with what is going out. Current expenses are higher than revenue. Since 2003, the government has chosen to reduce the amount of taxes paid by companies and individuals. The government numbers indicate a deficit of $5.4 billion dollars just for the 2009-2010 year. If we had this tax money, there wouldn’t be a deficit.

26. Because we don’t have that money, panic has set in! The government needs money! Their solution? Increased sales taxes: advantageous for a government preoccupied by the « fiscal burden » of the rich (and influential), to sharing the cost with everyone, including the most poor. Over the years, we have witnessed the art of transferring the responsiblity for government funding from companies and the most affluent to everyone. This is a regressive form of taxation as opposed to a progressive one in which the most affluent would pay proprotionally the same amount as the most poor.

27. Once state revenues are reduced, and a need to find a way to fund services is created, the argument can be made to move from universal accessibility to a fee for service system. This also moves us from a democratic principal in which everyone is treated equally no matter what their income, to a market-based system in which demand is based on those who have the ability to pay; while the needs of those who cannot afford to pay fade into the background. Government and businesses alike claim: The fewer taxes we pay, the better off we are. With less revenue coming in, we can’t afford public services, it’s simple math. Public services will continue to decline unless we speak out! • Ultimately, the decrease in taxation is most advantageous to those who are taxed at higher rates (and who can probably afford private services.)

28. There are many ways in which companies can avoid paying taxes: tax exemptions, tax reductions offered by the government, tax evasion, tax havens, etc. In 1950, companies and individuals made almost equal contributions towards financing government policies. The proportion of company contributions continues to decrease, dropping to 9 or 10.5%, depending on the source. • What do Quebecers think? According to a CROP survey done in January 2005, Quebecers would agree to an increase in taxes if the revenue generated would go towards public services. The study also revealed that Quebecers believe that lower and middle income earners pay too much in taxes and that those who have higher incomes, including companies, don’t pay enough.

29. It is important to remember that the amount of taxes we pay is related to the qualtiy and accessibility of public services.

30. Myth 6 A two-tiered system will help the public system work better.

31. Always? • By allowing doctors to have a mixed practice (alternating between the public system and working in a private clinic) the problem of lack of personnel is intensified in the public system. Doctors, nurses and other professionals working in private clinics are less available to fill public spots. Waiting lists for public services risk to increase, not decrease! • In Alberta, private clinics can offer cataract surgery. The wait time in the public system for this operation has doubled since doctors prefer to spend more time operating in private clinics they can earn more. In Manitoba, the wating time for surgeons who work only in the public system is 10 weeks vs 26 weeks for those who also work in private clinics.

32. The most expensive cases to treat stay in the public system since private clinics prefer to deal with cases with relatively fewer risks and therefore fewer costs. A medical team who has completed a complicated surgery will not perform a second one on the same day. Therefore, there is no reduction of wait times for complicated cases in the public system. • Only a small number of people can afford to pay the $11,000 cost of knee surgery or the $17,000 cost of heart surgery without going into debt. (In 2008, only 3% of Quebecers earned more than $100 000/year). The system would not be freed up to the extent we think. • In countries where the most affluent must pay for their health care, they are pressuring the government to no longer finance the public health care system with their tax dollars, which ultimately creates an erosion of public health care.

33. The presence of private clinics in the health care system has a negative impact, eroding the quality of the public system.

34. «All human beings are born free and equal in dignity and rights. »First article of the UN declaration of human rights Is this really true ?

35. I prefer to pay with my health card, not my credit card!

36. More reading • Canadian Centre for Policy Alternatives: Health Care, Limited – The Privatisation of Medicare. http://www.policyalternatives.ca/documents/National_Office_Pubs/health_care_ltd.pdf April 2008: Lies the Media Tell us Our media push relentlessly for privatized health care • No place for more privatization in health care says CUPE http://cupe.ca/media/No_place_for_more_pr • Médecins Québécois pour le régime public http://www.mqrp.qc.ca/position3.php