¹ On ‘social cohesion’ see, for example, J. Jenson, “Mapping Social Cohesion: The State of Canadian Research” (Ottawa: Canadian Policy Research Networks, 1998) [hereinafter “Mapping Social Cohesion”] especially at 29–39; P. Bernard, “Social Cohesion: A Critique” (Ottawa: Canadian Policy Research Networks, 1999).

² Blendon, R. J. and Taylor, H., “Views on Health Care: Public Opinion in Three Nations” (1989) 8:1Health Affairs at Exhibit 4.Google ScholarPubMed

³ Canada Health Monitor, 1995, cited in The Economist Intelligence Unit, “Profile - Canada healthcare struggles with its five principles” (1998; 1^st quarter) EIU Healthcare International at Figure 4.

⁴ See, for example, Gee, M., “Health care is No. 1 concern: poll” The [Toronto] Globe and Mail (7 February 2000) A5Google Scholar, reporting on an Angus Reid poll that listed medicare / healthcare as the top issue for 55%, with education / schools a distant second at 23%, and taxes / tax reform / GST third at 19%. See also “Important issues” Toronto Star (1 July 2000) K2, reporting an Ekos poll listing health care as the most. single issue facing Canadian governments over the next five years, according to 25%, well ahead of level of taxation, unemployment, debt and public finance, and education, each at 7%. An earlier Environics poll had found that “extra money” should go to job creation projects (31%), health care (25%) and reducing taxes (9%), reported Greenspon, E. and Winsor, H., “Spending increase favoured: poll finds” The [Toronto] Globe and Mail (23 January 1997) Al, A8.Google Scholar

⁵ National Forum on Health, “Values Working Group Synthesis Report” Canada Health Action: Building on the Legacy, vol. II, Synthesis Reports and Issues Papers (Ottawa: Minister of Public Works and Government Services, 1997) at 5.Google Scholar

⁶ Canada Health Care Survey (Montreal: Merck Frosst, 1999) at 3.

⁷ “Mapping Social Cohesion” supra note 1.

⁸ Ibid. at 38.

⁹ Quoted in “Mapping Social Cohesion” ibid. at 4.

¹⁰ Canada Health Act, R.S. 1985, c. C-6.

¹¹ By contrast, the Clinton proposal for universal health care in the United States in the early 1990s took the form of a draft bill covering 1370 pages. It was difficult for all but the most dedicated policy wonk to understand in its entirety, while providing ample grounds for opposition from numerous quarters.

¹² See for example Voelker, R., “Activist Young Says ‘Gathering Storm’ Will Propel a Single-Payer Movement” (1997) 280 JAMA 1467.Google Scholar

¹³ Of late, the majority of Canadians opposed to queue-jumping has actually risen, despite (or perhaps because of) cuts to publicly-funded services. In response to the statement: “Individuals should be allowed to pay extra to get quicker access to health care services,” 55% disagreed while 34% agreed in November 1996. By December 1999, 61% disagreed while 29% agreed. Ekos Research Associates, “Canadian Values in Health Policy,” (Paper presented to the Centre for Health Economics and Policy Analysis (CHEPA) conference, June 2000) [unpublished].

¹⁴ Marsh, L., Report on Social Security for Canada (Toronto: University of Toronto Press, 1975)Google Scholar [first published 1943] at 10.

¹⁵ Andrews, C., Profit Fever: The Drive to Corporatize Health Care and How to Stop It (Monroe ME: Common Courage Press, 1995) at 90Google Scholar, citing Rolde, N., Your Money or Your Health (New York: Paragon House, 1992) at 7.Google Scholar

¹⁶ Calculated from Canadian Institute for Health Information (CIHI), National Health Expenditure Trends, 1975–1998 (Ottawa: CIHI, 1998)Google Scholar Tables A.1 and A.2. The data on public spending by province / territory in current dollars are presented in Table B.3.1.

¹⁷ Priest, L., “Gloom about health care widespread” The [Toronto] Globe and Mail (3 February 2000) A4.Google Scholar It should be added, however, that according to the Canadian Healthcare practice of PricewaterhouseCoopers, 92% of those who actually used the health care system in late 1999 and early 2000 were satisfied. This semi-annual survey was formerly known as the Canada Health Monitor. PricewaterhouseCoopers, News Release, “Canadians Satisfied with Health Care; Concerned about Home Care and ER Waits” (1 November 2000).

¹⁸ Donelan, K.et al., “The Cost of Health System Change: Public Discontent in Five Nations” (1999) 18:3Health Affairs Exhibit 2.Google ScholarPubMed See also Coutts, J., “Canada no longer enjoys image as Shangri-La of medical care” The [Toronto] Globe and Mail (27 October 1998) A12.Google Scholar

¹⁹ Ovenden, N., “Canadians gloomy about the future of health-care system” Ottawa Citizen (1 March 1998) A3Google Scholar, reporting on an Angus-Reid poll.

²⁰ Sullivan, P., “Focus groups confirm that MDs, public differ on role of private health care” (1996) 154 Canadian Medical Association Journal at 1247–48.Google Scholar

²¹ Graves, F., “Canadian Health Care: What Are the Facts? An Overview of Public Opinion in Canada” Liberty Health et al., Access to Quality Health Care for all Canadians: Proceedings of a National Health Care Policy Summit (Ottawa: Canadian Medical Association, 1996)Google Scholar [hereinafter Access to Quality Health Care] at 17–18.

²² G. Scott, “Post-Summit Communications with the Media: The Text of the Statement by the Summit Moderator, in Access to Quality Health Care supra note 21 at 65–66 [hereinafter “Post-Summit Communications”].

²³ “Rationale for a Summit” in Access to Quality Health Care supra note 21 at 7.

²⁴ It is worth noting that the “Summit” was co-sponsored by the CMA, along with Liberty Health, MDS Health Group Limited, and SHL Systemhouse. Among the 50 or so who were invited were the Chairs, CEOs and Presidents of Bell Canada Enterprises, Hewlett-Packard Canada, Trimac, Medisys, Biomara, BC International Power, and Stelco, along with senior Vice-Presidents from Alean, Nestlé Canada, and CP Rail.

²⁵ “Post-Summit Communications”, supra note 22 at 65.

²⁶ Ibid. at 67.

²⁷ I am of course borrowing the term from Ken Battle. See his “The Politics of Stealth: Child Benefits under the Tories” in Phillips, S. D., ed., How Ottawa Spends, 1993–1994 (Ottawa: Carleton University Press, 1993) 417 at note 32Google Scholar, where he points out that making significant public policy changes by technical means without voter knowledge or consent is not new, but that the Mulroney Tories did so extensively and “in a deliberate, calculated manner that definefd] their style”. See also his (writing as Gratton Gray) “Social Policy by Stealth” (1990) 11:2 Policy Options.

²⁸ For an elaboration of the forms sketched here, see Armstrong, H., Armstrong, P. and Connelly, M. P., “The Many Forms of Privatization” (1997) 53 Studies in Political Economy 3.CrossRefGoogle Scholar

²⁹ Canadian Institute for Health Information, (January 2000) CIHI Directions ICIS at 3.

³⁰ This line of argument is nicely made with regard to arts funding in Drainie, B., “We pay the piper, but they call the tune” The [Toronto! Globe and Mail (21 December 2000) A19.Google Scholar

³¹ Naylor, D., Private Practice, Public Payment (Montréal: McGill-Queen's University Press, 1986)Google Scholar; Rekart, J., Public Funds, Private Provision (Vancouver: UBC Press, 1993).Google Scholar

³² Hon. Jim Wilson, “Notes for Remarks for Community Care Access Centres” Toronto, 25 January 1996. As the then Minister of Health for Ontario, Wilson was announcing the establishment of the community care access centre (CCAC) system.

³³ National Forum on Health, supra note 5 at 19.

³⁴ This metaphor is drawn from the influential US book by Osbome, D. and Gaebler, T., Reinventing Government: How the Entrepreneurial Spirit Is Transforming the Public Sector (New York: Penguin, 1993)Google Scholar c. 1. It is reflected in the language of Ontario's (then) Minister of Health, who stated that her Ministry was shifting “in emphasis from being a service provider to becoming a system manager.” Hon. Elizabeth Witmer, “Message from the Minister” Ontario Ministry of Health Business Plan 1998–1999, online: Government of Ontario http://www.gov.on.ca/MBS/english/press/plans98/moh.html (accessed 6 June 1998).

³⁵ This care is not being sent back home, for the acuity levels now being coped with at home were never previously cared for there. Our grandmothers did not work IV equipment or clean shunts. See Armstrong, P., “Closer to Home” in Armstrong, P.et al., Take Care: Warning Signals for Canada's Health System (Toronto: Garamond Press, 1994) 95.Google Scholar

³⁶ MacKinnon, D., “Safeguarding Patient Care: Submission to the Federal Standing Committee on Finance” (Ontario Hospital Association, 16 October 2001) [unpublished] at 30–31.Google Scholar

³⁷ Ontario Ministry of Health, News Release Backgrounder, “Long-Term Care Services in Ontario” (6 September 2000) put the 2000–01 budget for the province's 43 Community Care Access Centres (CCACs) at “over $1.1 billion in annual funding,” an increase of $439 million since 1995. Almost all of this amount goes to home care, as does much of the additional $190 million the province allocates each year to long-term care community agencies such as local cancer societies and meals-on-wheels organizations.

³⁸ It is close to half as much in the broader category of “other health expenditures” reported by the Canadian Institute for Health Information (OHI), a category that includes such items as transportation (ambulances), public health and health research as well as home care. CIHI has announced that it intends to break out home care as separate (public and private) expenditure categories, but has not yet done so. See CIHI, “Preliminary Provincial and Territorial Government Health Expenditure Estimates” (Ottawa: CIHI, 2000).

³⁹ For example, a maximum of 80 hours of homemaking (personal support services) are allowed in the first month, and a maximum of 60 hours in every subsequent month. Ontario Regulation 386/99, made under the Long-Term Care Act, 1994, “Provision of Community Services” (filed 6 July 1999), Section 3(1). Similar caps apply to nursing services.

⁴⁰ Calculated from Ottawa-Carleton Community Care Access Centre, “2000–01 Budget” (March 2000), Exhibit 9, Community Therapy Services - Divestment.

⁴¹ Using a less conservative approach, Ross Sutherland estimates that $247 million is wasted annually by Ontario's CCACs on contracting out and competitive bidding. R. Sutherland, with assistance from S. Marshall, “The Costs of Contracting Out Home Care: A Behind the Scenes Look at Home Care in Ontario” (Ottawa: Canadian Union of Public Employees, 2001) at 19.

⁴² Braverman, H., Labor and Monopoly Capital: The Degradation of Work in the Twentieth Century (New York: Monthly Review Press, 1974) at 303.Google Scholar

⁴³ If the goal is managed competition among fully integrated services, from home care to tertiary care, an enrolled population of 500,000 to 750,000 is required to make each competing organization viable. This would mean that in Canada competition would be possible only in Toronto, Montréal and Vancouver.

⁴⁴ Polanyi, K., The Great Transformation (Boston: Beacon Press, 1957)Google Scholar [first published 1944] at 141.

⁴⁵ Hon. Jim Wilson, Minister of Health, letter of 30 May 1996 to Ontario Home Health Providers, Canadian Red Cross Society (Ontario Division), Victorian Order of Nurses (Ontario), Ontario Community Support Association, and Saint Elizabeth Health Care.

⁴⁶ Ontario Ministry of Health, “Provincial Requirements for the Request for Proposal Process for the Provision of In-Home Services, Supplies and Equipment” (May 1966) at 1.

⁴⁷ Bueckert, D., “Victorian Order of Nurses faces bleak future” Toronto Star (28 December 2000) A3.Google Scholar

⁴⁸ “Olsten says it's facing another billing probe” Financial Post (25 January 2000) C2. See also Handelman, S., “What Alan Rock Isn't Saying” Time (14 February 2000) at 40Google Scholar; YahooFinance website on 27 November 2000.

⁴⁹ Miller, A., “Nashville, Tenn.-Based Healthcare Firm Agrees to Pay Fine for Government Fraud” Atlanta Journal and Constitution (15 December 2000Google Scholar). HCA agreed to pay SUS95.3 million in fines and penalties and to plead guilty to 14 counts of defrauding government health care programs.

⁵⁰ Medline, E., “Ontario cancels dialysis clinic deal” Ottawa Citizen (3 May 1996) C1.Google Scholar See also the series of front-page articles on National Medical Care, a for-profit firm controlling over 20% of the entire US market, by K. Eichenwald in The New York Times (4–6 December 1995).

⁵¹ The wording of this pre-qualification criterion is that potential contracting agencies must “[h]ave no material legal cases pending or in the recent past”. To satisfy itself on this score, the CCAC asks in its template RFP the following questions: “Within the last five (5) years has the Agency or its Predecessor Organization, or any organization with which it is associated within the meaning of the Income Tax Act, or any of its officers or directors: a) been bankrupt or been subject to any other insolvency proceeding; b) been found guilty of any criminal offence; or c) been the subject of any civil proceeding based upon fraud, misrepresentation, criminal conduct or negligence? Is the Agency (or any of its officers or directors) presently subject to any such insolvency, criminal or civil proceeding?” Ottawa-Carleton Community Care Access Centre, “Request for Proposal for the Provision of Medical Supplies and Equipment” July 2000, at S-3. The same wording appears in the subsequent School Therapy and In-Home Speech Therapy RFP and is to be included in further RFPs.

⁵² The concept of ‘contract government’ is insightfully addressed, in the context of British universities, by Dominelli, L. & Hoogvelt, A. in “Globalization, Contract Government and the Taylorization of Intellectual Labour in Academia” (1996) 49 Studies in Political Economy 71CrossRefGoogle Scholar, especially at 74–78.

⁵³ Commission d'étude sur les services de santé et les services sociaux (Commission Clair), Solutions émergentes (Québec, 2001); Fyke, K.J., Commissioner, Caring for Medicare: Sustaining a Quality System (Regina: Government of Saskatchewan, 2001)Google Scholar; Commission on the Future of Health Care in Canada (Romanow Commission), appointed 3 April 2001, to report by 30 November 2002; Canada, Standing Senate Committee on Social Affairs, Science and Technology (Kirby Committee), “The Health of Canadians - The Federal Role” 2^th Session, 36^th Parliament, to report by 30 June 2002.