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 the less likely to have the financial resources to access the growing for-profit element of health care in Canada.
The growing gaps and privatization of our Medicare system, however, means less access to health support services for seniors and people with disabilities and represents a step backwards for in their struggle for equality. This is seen most within the community and continuing care sectors 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.
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-1990’s when province began to restructure health care. 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 province giving rise to the closure of hospitals and the elimination of hundreds 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 an adequate infrastructure and resources to community care – the less expensive preventative side of our health care system. The result has created an overburden Medicare system that provides less equal access for persons with disabilities and seniors.
Newfoundlands’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.
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.
Around the time that health care was being restructured across Newfoundland towards a community-based model of health care, our federal government, through their war of the deficit, cut back on its funding of health care and eliminated its funding for the many support 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 elimination of CAP has affected the lives of persons with disabilities disproportionately to other Canadians since the national standards of CAP ensured that they had access to many of the vital services that relied on for independent living in their communities.
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. Although spending on community-based services has increased, most of that spending has come from private sources such as the Janeway Telethons, Dream Homes, Daffodil Place, Health Care Foundations etc.. The increased demand for health support services has greatly outstripped the increases in public spending.
Amidst high taxes, the generosity of the corporate world and consumers in this province has helped to ease the need for community services, unfortunately it's not enough. We have not even begun to grapple with the more devastated issues in health care for the disabled and senior community, home care, equipment, housing, drugs, human rights and much more.
It’s estimated that more than twenty thousand persons with disabilities need help with one or more everyday activities but over two thirds 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.
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 assertive 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 eliminated.
This instability in funding for these vital support services has greatly attracted ‘for-profit’ interests and thus spread the growth a two-tier health care. The growth of ‘for profit’ private services in community health will always hit hardest at those with the lowest incomes 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.
For people with disabilities, the goals of Canada’s Medicare system should be to assure equality of opportunity, full participation, independent living, and economic self sufficiency. A health care system that is 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 1600’s.
Newfoundlands Medicare system needs to be revamped and strengthened through the development of provincial standards to ensure that it doesn’t continue to discriminate against people with disabilities. There are many essential health support services that are unavailable or unaffordable to thousands of NL'er 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)
- 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.
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 provincial government would go along way to promote better health outcomes, greater equality and independence for NL'ers with disabilities, and ensure our public universal health care system is strengthen, sustainable and equitable.
Brudder
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