2003 August Speech International Forum on Privatization of Public Services

Les Steel, President of the Alberta Federation of Labour, August 2003 (Oslo, Norway)

Good morning and thank you for the warm welcome.

As you've already heard, my name is Les Steel and I'm president of the Alberta Federation of Labour.

For those of you who've never been to Canada, I'd like to start my presentation this morning with a quick geography lesson.

Canada, as you know, is the big, cold country that sits at the top of North America. It stretches from the Atlantic Ocean in the east to the Pacific in the west and the Arctic Ocean in the North.

Alberta is in the western half of the country. It's where the prairies meet the Rocky Mountains.

Alberta is the petroleum capital of Canada. It's home to the Calgary Stampede. And it's where Wayne Gretzky first made his name as a hockey star.

Of course, we're not all Gretzkys. Most Albertans - like most Norwegians - have to work for a living. And that's where the AFL comes in.

Our federation represents 41 Alberta unions and 120,000 unionized workers in both the public and private sectors.

Like unions here in Norway, our first priority has traditionally been to protect and improve working conditions for our members.

But over the past ten years or so, our attention has turned to a much broader fight.

In particular, we've been engaged in a battle to preserve many of the core social programs that previous generations of Canadians fought hard to establish.

So far, our biggest fight has involved our national public health care system, which we call Medicare.

Canadians cherish Medicare. It's one of our proudest achievements - and it's something that many Canadians hold up as a defining characteristic of our country.

But despite the overwhelming support that Medicare consistently receives from the public, for most of the past decade it has been threatened with death by a thousand cuts.

And nowhere in the country has the attack on public health care been more focused and more determined than in Alberta.

Since the election of 1993 which brought the current Conservative government to power in Alberta, our provincial health system has endured unprecedented budget cuts; massive lay-offs and a growing number of attempts to privatize services.

The good news today is that many of the worst cuts have been reversed - thanks in large part to public protests organized by unions and other community groups.

But we're still dealing with a serious shortage of hospital beds and a chronic shortage of trained health care workers.

Even more significantly, our provincial government hasn't retreated when it comes to privatization. Despite widespread public opposition, they've handed over huge swathes of our health care system to the private sector - and they're continuing to chip away at the foundations of everything that's left.

That's why I'm here this morning.

I'm here to talk about our experience with so-called market-based health care reforms. I'm also here to talk about our campaigns to reverse the cuts and stop privatization.

Most importantly, I'm here to share with you a few lessons that we've picked up along the way - lessons that might prove useful in your campaign to protect the public health care here in Norway.

Making comparisons between nations is always a tricky thing - especially when those nations are on different continents, and have different cultures, languages and histories.

Comparison can also be tricky when you're talking about something as complex and dear to our hearts as health care.

But despite the distance and all other things that separate us, I think there are at least two reasons why our experience in Alberta has relevance here in Norway.

The first reason is that, if you think about it, Norway and Alberta actually have a lot in common.

We both know what cold winters are like.

We both have a lot of land and relatively few people.

We both have abundant petroleum resources that have strengthened our economies and given us the ability to pay for high-quality social programs.

And, at least for the moment, we both have tax-financed health systems that guarantee our citizens access to quality care when they need it and regardless of their ability to pay.

So, in many ways, when we compare health care in Alberta with health care in Norway, we are comparing apples with apples, not apples with oranges.

The second, and probably more important, reason why I think our experiences are relevant here in Norway is that they are hardly unique.

The truth is that Canada is not the only country that swallowed the bitter medicine offered by advocates of market-based health care reform.

Neo-liberalism has been a wave rolling across the globe for more than twenty years now.

Like a virus, it started with Margaret Thatcher in Britain in the seventies. Ronald Reagan allowed it to spread to the U.S in the early 80s. And in the late 80s and early 90s it took hold in places like New Zealand and Canada.

In many ways, the fact that the privatization wolf is only knocking on your door now is a testament to your good sense and the strong foundations you've built for your public health system.

When I look back on the past ten years of struggle that we've had in Alberta and compare it to the privatization onslaught that has taken place in other countries since the late 70s, the thing that strikes me is how similar the experiences have been.

Whether it's Canada, Britain or New Zealand, it seems that the privatizers have followed roughly the same three steps to push their agenda.

The first step has always involved fear-mongering. In particular, the privatizers attack the credibility of the public sector and sow doubts about its efficiency, its affordability and its ability to provide quality service.

In Alberta, our government spent years trying to convince people that our public health care system is unsustainable.

Despite irrefutable evidence to the contrary, they told Albertans that costs were spiraling out of control. They said health care was swallowing an ever-increasing share of the provincial budget. And they warned that the aging population would bankrupt the system.

As recently as two years ago, our provincial premier was telling every reporter who would listen that the cost of Medicare in Alberta had doubled and that drastic measure needed to be taken to "save the system" from itself.

This kind of fear mongering led naturally to the second step. After manufacturing a crisis and attempting to convince people that a huge problem exists, the market boosters presented the solution - and surprise, surprise, it happened to be the market.

For conservatives, privatization is the cure-all. Markets, they say, will reduce cost, improve efficiency, and increase choice for patients. They even go so far as to say that privatization can help save public health care by "relieving pressure" on the public system.

In Alberta, as in other jurisdictions, the government moved very quickly from bad-mouthing the system to parceling out pieces to the private sector.

The first things to go were the so-called secondary services in hospitals, like the laundry, janitorial and food services.

But our government wasn't content to stop there. They also handed over almost all hospital laboratory service to for-profit companies. And they actively encouraged entrepreneurs to set up private surgical suites to perform things like cataract surgery and private diagnostic imagining services that charged patients between one and three thousand dollars for things like MRI and CT scans.

At the same time all this was happening, our government laid the ground work for more sweeping privatization by introducing legislation that would pave the way for investor-owned hospitals.

In many ways, this piece of legislation - which the government had the nerve to call the Health care Protection Act, or Bill 11 for short - was the straw that broke the camels back. After years of going reluctantly along with the government, Albertans finally started to protest. The Bill was eventually passed, but not before we organized the largest demonstrations in our province's history.

That leads us to the third step. When confronted with large scale public opposition, privatizing governments often start playing games with language.

The point here is for the privatizers to reassure the public and hide their true intentions.

This is where we're at right now in Alberta. Our government now says that it was misunderstood. They say they never really wanted to privatize health care. Instead they say they've merely been looking for alternative funding mechanisms. Or they say all they want to do is build partnerships with the private sector to deliver services within the public system.

The problem with all of this is that it's just new wrapping on the same old package. Public-private partnerships may not be quite the same thing as the wholesale privatization that exists in the United States - but it's still privatization.

So far, we in Alberta have had some successes and we've had some failures when it comes to dealing with our government's privatizing agenda in health care. As I mentioned earlier, many of the deepest spending cuts to our public system have been reversed, largely as the result of the many protests organized by unions and our partners in the community.

After years of rapid decline, we are now spending as much on a per capita basis on health care was we did in 1993. It may not sound like much, but from our perspective, that's a step in the right direction.

We've also succeeded in rolling back some privatization initiatives. For example, after running a high-profile public campaign exposing how private MRI clinics were blocking access to quick diagnosis for seriously ill Albertans, the government agreed to buy more MRI machines and run them within the public system. They even agreed to reimburse hundreds of people for the MRI and CT scans they had to pay for in the private system.

Another success we've had has more to do with what hasn't happened than what has. Two years ago, the Alberta government released a long-awaited study called the Mazankowski report which outlined plans for taking privatization in health care to the next level. In particular, it called for caps on the amount of public insurance people could have - and it opened the door for the introduction of American-style private health insurance.

The good news is that the government has not moved towards implementing either of these recommendations. In fact, even though the Mazankowski report was billed as the government's blueprint for health reform in the 21st century, almost none of it major suggestions have been acted upon.

The reasons for this are mainly political. The government has simply failed to convince Albertans to that further privatization is either prudent or desirable.

So what can you here in Norway learn from our experience in Alberta?

I think there are three lessons.

The first is don't give up without a fight.

In many ways, the deck was stacked against us in Alberta.

Historically, ours has been the most conservative province in the Canada. And Albertans like to think of themselves as free enterprisers - so you might think they would all be won over by free market argument.

But what we discovered is that even conservative voters can be persuaded of the benefits of public health care and the pitfalls of privatization. But it doesn't happen overnight - and it doesn't happen without effort and planning.

The second lesson that we learned is that there is no stronger weapon than the truth.

The advocates of privatization can sound pretty slick when they talk about the magic of competition and incentives.

And they can be persuasive when they list all the supposed weaknesses of the public system.

But private health care has a track record - and it's not a particularly impressive one.

So every time they ran down the public system and extolled the theoretical virtues of privatization, we answered back with facts.

When they implied that costs in the public sector were spiraling out of control, we showed that they we in fact stable.

When they said the private sector was cheaper and more efficient we presented evidence from around the world that it was more expensive and less efficient.

When they argued that privatization would improve access for patients, we demonstrated from experience that the opposite was true.

The good news for those of us who believe in public health care is that the verdict on privatization is in. It's been tried and it's failed. Those are the facts.

In many ways, the arguments in favour of privatization in health care are like the arguments used by the U.S. government to justify war in Iraq - they have the ring of truth, but once you scratch the surface, they have no substance.

The bottom line is that both public and private health care have a track record - but don't assume that everyone know it. As advocates of public health care it's up to us to put the good news on the table. If we do, the facts we speak for themselves.

The third and final lesson that can be taken from the Alberta experience is to involve the broader community.

Unions in our province made a decision at the beginning of our campaign to swallow our organizational pride and work in coalition with churches, seniors citizens, students and other groups in the community.

It was an important decision for us, because by ourselves, the government could afford to ignore us. But they couldn't completely ignore the other in our coalition.

This will be true here in Norway. The bigger tent you build the more power you will have politically.

Having said all that I'd like to conclude today by saying how optimistic I am about the prospects to preserving public health care in your country.

Conservatives may control your parliament today - and they may be toying with some free market notions. But it's going to be hard for them to make the case for privatization.

We now have more than 25 years of experience from around the world showing that privatized health care actually costs more and delivers less.

We're also now living in a post Enron world. Given all the examples of corporate wrong-doing that have come to light over the past few years, it's going to be harder than ever to convince people that it make sense to entrust our health to the private sector.

Here in Norway you also have the advantage of prosperity. Thanks to your oil reserves - which, by the way you've managed much better than ours in Alberta - your conservatives cannot argue that public debt is a problem and they cannot realistically claim that your health system is unsustainable.

From where I stand, the real danger for Norway may be complacency. You have a strong tradition of social responsibility; you have all the facts on your side and you have the resources to afford high quality health services. But don't under-estimate the privatizers - they have a product to sell and they can make it sound like the answer to all your problems.

The trick for you is to prick the private balloon and let the hot air out. You have to shine a bright light into the dark corners of any and all private health care proposals. And you have to expose these proposals for what they really are - self-interested sales pitches.

Based on what I've seen at this conference so far, I'm confident you will be up to the challenge.


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