The horizon is not so far as we can see, but as far as we can imagine

A Story About How Health Care Privatization Happens

So, as many readers know, I got cancer. (I’m fine. It’s treated, I won’t die of it (3% chance some years out), though I’m on hormone blockers (moderately nasty as an adult) for as much as another year.)

Anyway, I got cancer while Covid was on, so a lot of my visits were virtual, or just phone calls, unless they really required my physical presence. Three month followups: usually by phone. Faster for the doctor; faster for me, all good. But the last time I went in the waiting room was packed. I waited for hours, and the nurse apologized “the government won’t let us do followups by phone (or virtually) any more.”

Oh. Weird. Made no sense to me, but governments do stupid things all the time, and despite how I make my living I didn’t think about it much. (Doctor’s visits tend to focus my mind elsewhere.)

Ontario’s been in a deepening health care crisis for a couple decades at least. In a lot of cities, if you don’t have a family doctor, it’s essentially impossible to find one. If your current doc retires, too bad. Toronto, the largest city, is the worst. So lots of clinics sprung up, and you’d go to one of them when you got sick. They started offering virtual visits even before the pandemic.

All of this was covered by public health: you never paid for any of it. The provincial plan is called OHIP, and it’s still a sacred cow.

A spokesperson for the Deputy Premier and Minister of Health, Sylvia Jones, told CTV News Toronto, “It is against the law to charge for OHIP-covered services. If the ministry finds that a person has paid for an insured service or some component of an insured service, there is a mechanism in place for the ministry to ensure that the full amount of the payment is returned to that person. Ontarians who believe they have been charged for an insured service should contact the ministry by e-mail at or by phone (toll-free) at 1-888-662-6613.”

On Wednesday, Ontario Premier Doug Ford said he doesn’t want patients paying out of pocket for medical expenses.

“We also need to be clear, Ontarians will always access the healthcare they need with their OHIP card, never their credit card,” said Ford.

Sounds great, eh? The principle is that if it’s covered under the government plan physicians who take any money from the plan at all can’t charge: you’re either fully private or in the system. This is supposed to be true across Canada, and for a long time it almost always was. (Except in Quebec, where they use ethnic pride to allow extra lots of corruption. See “Brexit” for a recent high profile Anglo version of this.)

But about the same time I was sitting on my ass needlessly the Ford government in Ontario also changed another regulation: OHIP would no longer pay for virtual visits to clinics (or in a clinic with a telepresence doctor) if there hadn’t been a physical examination by that clinic or doctor in the last year.

THUD. People go to clinics because they don’t have a relationship with a family doctor. If they had a physical exam every year there’d be a relationship: that’s what family doctors do. Those “regular checkups”.

Have you seen the kicker?

If OHIP doesn’t cover it, then you can charge for it. Since virtual visits with doctors and clinics who haven’t phsycally examined you are not covered, they can be charged for.

Meanwhile, Galen Weston, probably the most influential and powerful Billionaire in Ontario, who owns both the most supermarkets (where he has clinics) and the biggest drug store chain (Shopper’s Drug Store, which he was allowed to buy a few years ago), had rolled out a virtual visit service. Don’t know how well it was doing, but I do know that the public health care line you call to be told what to do is now referring people to services like it.

It’s called Maple. Here’s the current pricing.

In my entire life I have literally never paid for a doctor’s visit. Not once. Not ever. Not even a virtual visit with an online clinic last year before this new regulation so I could renew some meds.

But this isn’t covered any more, so it’s legal.

And that’s one of the mechanics of stealth-privatizing healthcare.

Note that while it’s hard to get a family doctor, it’s a growing problem and most people still have them, so this is a boiling frog issue: a majority of people won’t be affected. Yet. And most people can afford $80. But this is how you do it, step by step.

And in a certain way, it’s a BIG step, because as I say, I’ve never paid. Neither have most Canadians. If I need healthcare I may have to wait sometimes (though usually not more than a couple hours), but it’s free.

This is a strike against that. You get people used to paying for some services and slowly expand which ones and pretty soon you’re paying for a lot more. Another similar step was to allow pharmacists to renew most prescriptions: but it isn’t a covered service and they can charge for it. Only $15, but I’ve never paid for a prescription in my life either. And phone renewals of prescriptions with doctors aren’t covered either, so most of them are now charging for them, though that’s been true for a while.

Step, by step. Meanwhile, under-fund the system, overwork doctors and nurses and technicians and make the quality of care worse and worse. Over decades don’t train enough doctors or nurses to start with, then use Covid to decrease supply even more and push doctors and nurses out of the public system into the private system where they don’t have to work 12 hour+ shifts over and over and aren’t expected to get Covid over and over. (In one previous visit three of the four radiation oncologists were out with Covid, another longer wait, because we refuse to ventilate, HEPA filter, use UV light and mandate N95 masks rather than cloth ones.)

I have quipped before that I’m very glad I got cancer now, because in 10 years I’m not sure I’d be able to get care. The system now is creaking, but it still more or less works if you’re really sick. But the real money in privatization is market pricing for the truly desperate, like people who have cancer.

One final point: these people make their fortunes, literally, by making you sick and making it more likely you die. That’s what they do. They are your enemies, wherever they are because anyone who is taking active steps which make it more likely for you to die, to not get healthcare you need or to become impoverished or homeless is your enemy if anyone is. We just pretend they aren’t our enemies, mortal enemies, in fact, because they operate through the system by the rules; rules they made.

More on that later.

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The Red Queen’s Race, Neoliberalism & Why Healthcare Is Being Privatized


Know Thine Enemy


  1. marku52

    Welcome to health care, US style. It won’t get better. Sorry to hear it.

    I just finished KSR’s “Ministry of the Future”. It’s about a mostly successful program to deal with climate change. Part of it involves terrorism against the rich (and some middle income). in one action, 60 passenger planes are brought down on the same day by drone swarms. Commercial aviation dies that day. So do private jets.

    Interesting idea, and the program wouldn’t have worked without similar other actions

  2. Dan Lynch

    No, I had not been aware you had cancer, Ian. Glad to hear your prognosis is decent.

    Agree with everything. Stepping back and looking at the bigger picture — the tension between capitalism and socialism — it seems inevitable that in any jurisdiction, one economic system will eventually drive out the other. They’re not compatible.

    If I were king, I’d have a mixed economy. I’d let capitalism cater to discretionary items like shampoo and potato chips. Capitalism is very good at making shampoo and potato chips (but prone to monopolistic pricing if left unregulated). I’d let socialism handle public goods like infrastructure and essential not-so-discretionary things like health care and education. Let the two systems exist side by side, with each doing what it does best.

    But in the real world that doesn’t work because money is power and the capitalists end up with most of the power, so there goes your democracy, and no matter how much money and power the capitalists have, it’s never enough, so they have to expand, expand, expand, and grow, grow, grow.

  3. StewartM

    Let me first say that I’m sorry I didn’t give to your fundraising this year. I’m right fine now, but my company is having a downsizing next month, so I’m in wait-and-see mode in regards to spending until I find out if I still am employed in a month.

    The Canadian experience made me think of a Youtube I watched the other week:

    As long as you allow capitalism to exist, especially a form that allow billionaires with outsized political influence, ‘backsliding’ is always likely. No one individual should ever own enough wealth to influence democracy in any meaningful way. Even more, no one individual should ever be “independent”; dependency on others is what really enforces and rewards kindness to others. Hunter-gatherers show that everyone behaves best when they know that they need everyone else.

  4. Willy

    Dan Lynch makes sense especially about the mixed economy thing. But I’m hoping that he isn’t being too nuanced for the mob.

    I’ve seen the USA medical business get “boiled frog” from one of American Dream small family friendly private practices, to one of MBA-domination megacorporate greed which cares nothing about the Hippocratic Oath.

    You’d think that in a truly free and capitalistic society there’d be services available at every possible level and that the best values and competencies would always win, because the mob is smart.

    But I’ve learned that the mob is not smart. The mob is easily suckered by emotion and can take a very long time to figure out grifts and scams.

    I’ve tried to simplify, that it’s the successful psychopaths who’ll conquer the world if we let them, and that the end result will not be of value or competency for the mob. But I was defeated by nuance. Nuance thinks that everybody has a nuanced guy inside of them just waiting to get their nuanced freak on. But I think they’re wrong. I think the mob is always just gonna always be the mob, and we need to strategize accordingly.

  5. Joe

    The depth of capitalist indoctrination is truly surprising. A few years ago in the states my girlfriend was training to be a doctor. As she was most of the way through pre med and on track for med school she applied to med schools. Soon after in the mail arrived completely unsolicited copies of investors buisness daily the New York Times and various glossy magazines advertising lifestyles cruises vacations etc. She was pre med- itativley being groomed to be a rich person. Attitudes and all.

  6. Eric Anderson

    @Dan Lynch and Willy:
    There’s a name for that. It’s called Democratic Socialism. It’s what Canada “tries” to do. The compromise between capitalism and communism. The “democratic” part is the participatory process by which the people choose how much of “their” society they want to allow individuals to own. But as you also intimate, Dan, the trick is instilling in the populace that every billionaire is policy failure. The trick is to get them to hate concentrations of wealth. We began losing this thread with the coordinated blitz orchestrated by a lawyer named Lewis Powell. See his memo here:

  7. Ché Pasa

    When my health began to fail, I learned how much I’d been taking for granted. Still learning. For a while last summer, I could not sit up, stand or walk, with or without assistance, and I was utterly dependent on hospital staff to meet my needs, keep me cleaned up, and — face it — keep me alive.

    And they did. This was in a privatized health care system, with privatized Medicare Advantage health care insurance coverage. I have no complaints about my treatment or coverage. I expected a huge co-pay bill, but that didn’t happen. My co-pay was just over $2000 which was cut in half by insurance’s financial assistance office, and is being paid off in monthly installments.

    My long stay in the rehabilitation hospital with daily physical therapy re-learning to do basic things like sitting, standing, walking, dressing myself, bathing, etc….cost me nothing at all.

    I hear the horror stories about privatized health care, and I believe them. Yet, I have not personally experienced such horrors, and I’m learning not to take that for granted. My fortunate situation could change at any moment. And there wouldn’t be a lot I could do about it.

    I’m convinced that any health care system will have its horror stories. Nursing homes, for example, have become poster children for the worst of US health care. Even if you can pay enormous sums to be looked after and treated, nursing homes are filled with suffering and neglect. They are chronically understaffed, what staff they have is grossly underpaid and overworked, and patients are too often the last priority behind making sure that investors are richly rewarded.

    That’s where the whole health care infrastructure appears to be headed in Britain and Canada and pretty much everywhere that “investors” are allowed to rule the system. Obviously the health of the population should be a primary public priority, but obviously it is not. Far from it. A less healthy and lively population appears to be the priority of “investors” who only want to extract as much money from the system as they can before it all collapses.

    My excellent treatment in a private hospital, indeed, two private hospitals, paid for through private Medicare Advantage insurance — which of course depends on government Medicare payments — seems like a fluke. I don’t take it for granted any more than I take for granted my ability to sit up, stand and walk — albeit unsteadily — these days. By next year, who knows, None of this may be likely or possible.

    That’s a very rational concern or fear, and the trouble is we can’t do much about it. The system is feeding on itself and once that starts, it seems to me that it has to be replaced in its entirety. With what though? How?

    We haven’t figured that out.

  8. Trinity

    Yes, my latest growing concern is how coordinated they are in implementing these changes, between nations. They appear to be running experiments and comparing notes.

    Reports from Davos suggest this is true. They no longer recognize any national boundaries because their wish is to abolish them and establish global control. That makes a nation a term used to describe an area on the surface of the earth, nothing more.

    One article I read (and unfortunately didn’t save) said that 38% of US Americans are deferring healthcare, almost four in ten,

  9. Eric Anderson

    The evil genius of the ACA was simply to fund the insurance companies through government dollars. So, it’s kind of a socialist system that shovels money into capitalist pockets. Thus, the inflation of costs due to the middleman. But hey, bigger GDP amiright? Keep the capitalist class mollified, amiright?

  10. Willy

    We haven’t figured that out?

    I’ve figured it out. You live like a mountain man. Alone, yet free. Self-reliant, yet cautious. Eat right, exercise, and stay out of trouble.

    But then there’s everybody else.

    Most everybody else knows that something is wrong with the world. We could warn them. Tell our little stories. For example, I’ve seen my in-law’s best buddy, a medical MBA CEO, turn his latest little clinic into a money extraction racket per the latest MBA handbook. His clinic currently rates 1.6 stars (of 5), because of honest patients willing to tell their little stories.

    We could teach them how to self-diagnose. We could discuss other medical resources, like naturopathy or even chiropractic. As for the latter, while I think chiropractic mostly woo quackery, I did get my sciatica diagnosed and healed with good therapy advice, when MDs wanted “more tests”.

    Maybe if you’re an entrepreneurial sort who also wants to benefit society, then come up with low cost easy to use methods which circumvent big medical/pharma. Your body does after all, usually prefer for the most part to heal itself than kill you, as big medical/pharma wants you to believe.

  11. Stirling S Newberry

    How to make anything live forever.

  12. Ché Pasa

    The problem I see, Willy, is that everybody has an opinion about everything and has the means if not necessarily the desire to publish and spread that opinion. This makes every opinion take on added weight, especially, it would seem, contrarian opinions; whatever pwns the libs or runs contrary to the mainstream consensus is therefore elevated, even if it has neither utility nor even coherence. Our ruling elites saw the value of the state of affairs some time back and are quite happy with the results. Atomization of the masses so they can’t/won’t identify with one another and thus take action against their overlords.

    We can see the process in action by the fierce resistance to unionization currently under way by so many employers. But there is so much more than that. It doesn’t mean the lower orders can never win, but it does mean that victories are much harder than they should be and what is won is much less than hoped for.

    At one time, our ruling class seemed to have an instinct to self-preservation. That allowed a few of them to show a bit of social conscience and now and then to serve the People. Blame Marxism and the Soviet Union. Well, that period is over. Isn’t it?

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