Wasting Away: The Undermining of Canadian Health Care

Paul G. Thomas is a professor of political science at the University of
Manitoba, and the co-author of Canadian Public Administration:
Problematical Perspectives.

The thesis of this provocative and valuable book is that Canadian
governments are cutting back on health care in ways that reinforce the
medical model, involve greater reliance on the private sector, and shift
responsibility for care to individuals, especially women. The political
economy perspective applied in the book sees the provision of health
services as the result of a power struggle among producer groups, with
the patients’ interests taking second place.

The information presented in the book is derived from official reports,
the medical and social literature, and more than 100 interviews with
health-care providers. The authors begin by challenging the prevalent
assumptions that the determinants of health are biological rather than
social and that professional medicine is scientific and offers a
guaranteed cure for every known biological disorder. They go on to argue
that public funding of hospital and medical services over the past
several decades has done little to shift the focus away from the
curative model and toward prevention. Today, instead of redistributing
resources into prevention, governments are promoting
corporate-management models within health institutions, privatizing
service delivery and the financing of health care, and
deinsti-tutionalizing patients into the care of communities and families
that lack the resources and supports to cope. Such cost-cutting measures
are transforming our universal medicare program into a discretionary
two-tiered model based on financial capability.

The authors offer no neat policy or organizational “fix,” but
insist on the need to build a new system founded on various principles
that are too often falsely represented as dichotomies rather than as
complementary requirements.