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Ford's Bill 60 will gut public hospitals

Michelle Robidoux

April 13, 2023
Premier Doug Ford's Bill 60, sweeping legislation that will dramatically accelerate the destruction of public healthcare in Ontario, is being rammed through at lightning speed.
The bill, which has already passed second reading, is being pitched as the solution to the backlog of surgeries in Ontario by vastly increasing the number of private for-profit surgical clinics and diagnostics. In fact, far from relieving pressure on public hospitals the bill will worsen critical staffing shortages. It will expand already widespread upselling to patients, as investors seek to maximize profit. And all of this will take place with even less oversight than currently exists for private clinics.
The backdrop to Bill 60 is the criminal underfunding of the healthcare system by the Ford government and its predecessors. Ontario has the lowest levels of beds and healthcare funding per capita in the country. As the Ontario Council of Hospital Unions stated in a 2021 report, low levels of beds are a marker for low levels of staffing: "If Ontario hospitals had the same staffing as hospitals in the rest of Canada, there would be 45,000 more hospital employees in Ontario." Low hospital funding and few beds means hospital patients are discharged more quickly. Ontario has the shortest length of stay in Canada. It is in this context of an underfunded and overstretched public health system that Bill 60 has been offered up as a 'solution' to the crisis.
Staffing crisis
Ontario is facing the worst hospital and healthcare staffing shortage in memory. The combined impacts of COVID and deliberate wage suppression by the Ford government through Bill 124 have left healthcare workers exhausted and demoralized. Not only does Bill 60 not provide relief to frontline workers who are struggling every day under crushing workloads, it will aggravate the situation by siphoning staff from public hospitals to work in the proposed new private clinics. 
At the Ottawa Hospital's Riverside campus, private corporation Academic Orthopedic Surgical Associates of Ottawa Inc. is operating an after-hours surgical clinic privately within the hospital, using the hospital's operating rooms, supplies and hospital staff. This shows that there are not two different pools of staff that will work in parallel – there is a single under-resourced pool of staff that the private clinics will draw from.
Private clinics will poach workers away from the public system because they won’t fall under legislation that deliberately underpays and creates intolerable pressure on staff. Despite claims by Minister of Health Sylvia Jones that applicants for these new licences would be required to submit staffing plans meant to “protect our public hospitals and to ensure that they are not in any way impacted”, there are no teeth in this process, and no indication of how an applicant would be rejected if their staffing plan fails to ensure public hospitals are not impacted.
Ramping up profit
Profit for investors in private for-profit clinics will come from cream-skimming less complex cases, concentrating the most complicated cases in public hospitals. It will also come from upselling patients, which is already happening. 
A 2017 report by the Ontario Health Coalition documented the proliferation of user-fees in private clinics and surveyed patients about the fees they were being charged. The report found that patients were afraid to voice complaints about extra user-fees, not wanting to cause tension with the physician prior to surgery. Some were told the extra user-fees were required in order to receive better quality care or safer care. Some feared not being able to get appointments or receiving worse or even unsafe care if they did not pay. 
Bill 60 will only make this situation much worse.
No oversight
Bill 60 does not include any protection against corruption and conflict of interest. Considering the close ties between the Ford government and private sector investors, this should be a great cause for concern. The process for inspecting private for-profit clinics, if there is one, is left to regulations made by the Ford Cabinet, after the legislation is passed. 
While public hospitals are subject to the Public Hospitals Act, currently private clinic inspection reports are contracted out to a third party, so are not liable to Freedom of Information laws and other mechanisms of accountability which apply to public hospitals.
Concerns about cost-cutting and poorer outcomes for patients in private clinics not subject to the oversight that covers public hospitals are not misplaced. A recent study published in The Lancet, looking at the privatisation of public services in the National Health Service in England, found that "Private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services."
Bill 60 was pitched as the only means available to clear the backlog of surgeries that have been delayed. But there is another way to deal with this backlog without further incursions of profit-taking into our public system: use existing surgical infrastructure and personnel to expand surgeries within the public system. In hospitals across the province, there are operating rooms that are not being used, in some cases that are closed, because of a lack of funding and staff. 
Instead of sitting on $1.25 billion of unspent healthcare funding as he is currently doing, Ford could use those funds to schedule more surgeries at night or on weekends, invest in the public system, and pay healthcare workers what they deserve. Instead of fighting public sector workers in the courts around Bill 124, they could respect the court decision that found it unconstitutional.
Instead of properly funding the public system to provide healthcare based on need, Ford is going to divert public money to private institutions to profit off of the sick and vulnerable. But across the province people are mobilizing to defeat this move and to reach out to those who have been swayed by Ford's claims that there is no alternative to privatization. This is vital work to shore up the support for public medicare, which though strong, is being eroded by this deliberate starving of the system.
Even when Bill 60 passes, there will be multiple battlegrounds as the reality of this wholesale attack on public medicare becomes clearer. Such battles have been fought in the past, and we will have to organize in every community to challenge this grab for public funds by Ford and his corporate buddies.
Join the fight to save public healthcare! See the Ontario Health Coalition for details on how to get involved:
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