I. Principle of the New Green Alliance and Medicare.
The New Green Alliance is a new Saskatchewan political party formed in 1998.
It is affiliated with the Green Party of Canada and has fraternal links with
similar parties in Australia, New Zealand, and Western Europe.
Members of the New Green Alliance formally endorse and subscribe to a basic
set of principles. Among them are the following which are most appropriate
to the question of government policy on the health of our citizens:
Social and Economic Justice. We believe in the right of every person of working
socially useful and environmentally sustainable work, access for every person
education and health care, as well as adequate food, clothing and shelter.
Participatory Democracy. All citizens must be able to directly participate
as equals in
the environmental, economic and political decisions that affect their lives.
Co-operation and Mutual Aid. We believe in the concept of a co-operative rather
competitive human society.
Decentralization. We must return power and responsibility to individuals, communities
and regions. We must encourage the flourishing of regionally based culture,
a dominant mono-culture. We must have a decentralized democratic society with
political, economic and social institutions locating power on the smallest
scale that is
efficient and practical. We must reconcile the need for community and regional
determination with the need for appropriate centralized regulation in certain
II. Structure of the Commission on Medicare.
The Commission on Medicare was appointed by the government of Saskatchewan
on June 14, 2000. Kenneth J. Fyke was appointed as the sole commissioner. We
did not agree with the structure of the Commission:
(1) It was designed to be an insider review of the medicare system by a professional
health civil servant and administrator.
(2) The staff was drawn primarily from the Departments of Health and Finance.
(3) No public hearings were held.
(4) The questionnaire which was circulated to households, and used to direct
the focus group meetings, was highly structured and the options present to
participants was designed to lead people in a particular direction.
(5) The time line for the commission was too short to do a complete job.
(6) The central focus of the terms of reference and the subsequent report was
need for greater efficiency and for cost reduction.
Our preference was for a different kind of commission with a different mandate:
(1) A broad inquiry on what was needed to promote good health and health care
services for all of the people of Saskatchewan.
(2) A commission that represented our society, including women and Aboriginal
(3) Public hearings around the province.
(4) A commission independent of the Departments of Health and Finance.
(5) The use of social scientists who with expertise in the broad area of health
Most people are well served by the present medicare system. Recent public opinion
polls show that the great majority of people believe they have receive good
treatment when ill. It is our belief that the Commission should have focused
on problem areas within the Saskatchewan system. This would have included:
(1) The health of Northern people and their health services, with a particular
the Aboriginal population.
(2) Health services in rural areas.
(3) How to improve the health of low income people.
(4) The growing numbers of elderly people and their needs.
(5) The impact of health care "reforms" on women as the primary
III. Position of the New Green Alliance.
Prevention promotes wellness
When the NDP was elected in 1991 it proclaimed that there would be
reforms in the health care system in Saskatchewan which would emphasize "wellness." Most
people believed that this would mean an emphasis on the prevention of
illness. That was the common sense response. But that is not what
we got. We have
a system which continues to concentrate on providing cures to people
who are sick or injured.
There is an enormous body of evidence available that demonstrates that poverty,
inequality, status, employment, and work environment are the key factors in
determining good health. The report of the Fyke commission mentions this briefly
in Chapter III but offers no strategy for dealing with the core problem. To
the New Green Alliance, this must be the central focus of any health policy
based on wellness.
Beginning in the 1960s, Dr. Michael Marmot, director of the International Center
for Health and Society at University College London, began the Whitehall I
study of the health of British civil servants. This classic study revealed
that the higher the job classification, the lower the rate of death, regardless
of the cause. Inequality is the most important factor in determining health.
(Marmot, 1996; Kawachi et al, 1999; Berkman, 2001; Daniels et al, 2000)
Numerous subsequent studies have reached the same conclusion. A recent
study by the CPRNs Health Network concluded that "among factors that influence
health over a person's lifetime, the health care system, itself, is far less
significant than the social environment. Measures of health status, like mortality,
morbidity and self-assessment, all vary according to socio-economic measures
like education, social class, occupation and income." People's health
status "closely parallels their socio-economic status, regardless of the
quality of the health care system available to them." (Glouberman
et al, 2000)
There is good research on the effects of racism on African Americans. We
suspect that these findings would also be relevant for the case of racism against
Aboriginal people in Saskatchewan. Those experiencing racism suffer larger
and longer-lasting increases in blood pressure than when faced with other stressful
situations. Social exclusion, residential segregation and other expressions
of institutional racism magnify the impact of low socioeconomic status. (Geronimus
et al, 1996; Krieger and Sidney, 1996; Krieger, 2000)
Yet across Canada, including Saskatchewan, government taxation and spending
policies have focused on cut backs to social programs coupled with reduced
taxation on corporations and those in the higher income brackets. As Statistics
Canada (March 2001) recently reported, this has resulted in greater income
and wealth inequality in Canada. A new study by Andrew Heisz at Statistics
Canada has found that low income intensity rose by 10% over the period from
1993 to 1997. Saskatchewan has the highest infant mortality rate of any Canadian
province. This is one of the most widely used standards of determining poverty
and inequality. Unfortunately, the elimination of poverty and inequality has
been a low priority for our provincial government for the last two decades.
And there are no recommendations for change in the Fyke report. (Raphael, 2000;
A good system of prevention is the only way to reduce the costs of medicare
while improving the health of Canadians. Ironically, wealthy Western governments
are starting to look seriously at Cuba to see how a poor country can maintain
a healthy population while spending relatively very little on a health care
delivery system. The infant mortality rate in Cuba is lower than the United
States (or Saskatchewan) and life expectancy is the same as in the industrialized
West. Yet on a per capita basis they spend a fraction of what we do on a medical
In October last year, a team of specialists from the British Department of
Health and 100 general practitioners went to Cuba to see what they could learn.
They concluded that Cuba's success was due to a combination of healthy food,
adequate housing for all, the absence of automobiles, and neighbourhood clinics
with adequate nurses and doctors.. Family practice stresses prevention. Rural
people have access to the same levels of care and support as urban people.
An extensive, affordable child care system and universal K-12 education is
very important. Children in child care services and elementary schools are
fed the equivalent of two meals a day. (Boseley, 2000)
In August 2000 Dr. Carolyn Bennett, Liberal MP and professor of family and
community medicine at the University of Toronto, made a similar tour of Cuba.
She reached the same conclusions. The Cuban health care system was less expensive
and better than that in the United States, she argued, because of its emphasis
on prevention and the elimination of absolute poverty. (Bennett, 2000)
The necessity of good air, water, food and housing
Good health also depends on a good environment. People need clean air, good
water, nutritional food, and good quality housing. The New Green Alliance
would put a greater stress on these factors in an attempt to prevent illness.
Here in Saskatchewan we believe we have good air. Our smaller communities have
less air pollution, and the wind blows away the smog from our vehicles. This
gives us air which is much better than in the larger urban centres. Yet Environment
Canada's list of the leading atmospheric polluters includes fertilizer producers,
food processing plants and feed lots in Saskatchewan. When farmers are applying
herbicides and insecticides, our air quality declines. (Ewins, 2001) In 2000
Agriculture Canada tested rainwater across Alberta over the summer and found
herbicide traces in all samples. Some samples showed 2,4-D at 53 parts per
billion, which is one half the Health Canada guideline for drinking water.
We have much more to worry about when it comes to our water. A 1997 Canada-Saskatchewan
Green Plan study found high levels of nitrates in most of the wells tested
in this province. Pesticides were found in 10% of the wells in the Kindersley
area and 45% of those in the Outlook-Davidson area. A 1998 study by the National
Hydrological Research Centre in Saskatoon found herbicide and insecticide residues
in all 21 farm dougouts they tested.
Of course, we are much more aware today of the problem of safe drinking water
in Saskatchewan, following the North Battleford disaster. The Safe Drinking
Water Foundation in Saskatoon insists that testing for water quality in rural
Saskatchewan and the North is inadequate. Furthermore, simply adding more chlorine
can add to the problem, for when chlorine is combined with organic acids it
produces trihalomethanes (THM) which are cancer-causing agents. (Peterson,
2001; O'Connor, 2001; Silverthorn, 2001)
Ontario, Quebec and Alberta have also been struggling with the problem
of ground water contamination from intensive livestock operations. We may
be facing that
problem here. Livestock manure run off was the cause of the Walkerton,
Ontario disaster. As John Lawrence, director of the National Water Research
stressed in a talk in Saskatoon recently, we have got to look at intensive
livestock operations "as basically industrial process plants instead of
farms." Excrement from large hog barns, spread untreated over the land,
contains not only nitrates and phosphates but copper, nickel, and manganese
used in feed supplements, as well as parasites, bacteria and viruses, including
salmonella, campylobacter, e.coli, cryptosporidium, giardia, cholera, streptococcus
and chlamydia. (Duckworth, 2001; "Big Farms", 2001; Thu and Durrenberger,
Good health depends on good, nutritional food. The New Green Alliance would
argue that the most nutritious food is that which is fresh and grown locally.
Food loses its nutritional value when it is stored and transported for long
distances. It loses nutritional value as it is processed. Of particular concern
to us is the use of hormones to promote growth in beef, the widespread use
of antibiotics in feeds to promote growth of poultry and other animals, and
the feeding of rendered animal wastes to domesticated livestock who are normally
vegetarian. We see no benefits to farmers or consumers from the introduction
of genetically engineered foods.
People living in Northern Saskatchewan have more severe health problems than
the rest of the Saskatchewan population. One of the causes of this situation
is the lack of good food at affordable prices. Whereas the provincial government
ensures that the cost of alcoholic beverages is the same in the North as it
is in the south, they have been unwilling to take action to provide food for
the same price. We could look to Mexico to see how basic food was distributed
to low income people through a system of state-owned stores in low income neighbourhoods.
We would shift government support from industrial agribusiness to ecological
farmers who produced for a local market. (See Bonanno et al, 1994; Goodman
and Redclift, 1991; Magdoff et al, 1998; Goodman and Watts, 1997)
Good housing is fundamental to good health and wellness. This has been
widely recognized for some time. (See Shlay, 1995) It was a focus of attention
the Golden report on low income housing and the homeless in Toronto. The
connection with health is very evident: "people who are homeless or living in sub-standard
housing are at much higher risk for infectious disease, premature death, acute
illness and chronic health problems than the general population is. They are
also at a higher risk for suicide, mental health problems, and drug or alcohol
addiction." (Golden, 1999)
When asked to comment on why Saskatchewan has the highest infant mortality
rate of all the provinces, Pat Atkinson, Minister of Health, said it was due
to poverty in the north and particularly among Aboriginal people. Clay Serby,
when he was minister in charge of housing, said that the province needed around
40,000 new residences for low income people. Both have admitted that poor housing
and overcrowding are a major problem in Northern Saskatchewan. But very little
is being done to solve this serious problem. This should be a priority area
for the Saskatchewan government.
Additional services are needed
There are other important issues which are not really recognized by the Report
of the Commission on Medicare. The whole issue of mental health is ignored.
There is no mention of the health status of people who are incarcerated in
the Saskatchewan penal system. The issue of the health of the Aboriginal
community is marginalized.
The National Forum on Health, which reported in 1997, called for the creation
of a national pharmacare program and affordable home care. Unfortunately, the
new Social Union, so strongly supported by former premier Roy Romanow, now
makes it nearly impossible for the federal government to introduce these federal-provincial
programs, strongly supported in public opinion polls. The Forum also called
for a national child care program and an integrated program to eliminate child
poverty. (Gray, 1997)
There is also a need for a dental program and an insurance program for vision
care. Many low income people do not have coverage under union contracts, work
plans or private insurance programs. A recent Statistics Canada survey found
that only 46% of the Saskatchewan population visited a dentist over a one year
period, well below the Canadian average of 60%. Cost is the major barrier.
For the medicare system as a whole, prescription drugs take about 15% of spending
on health, behind only the costs of hospitals (32%) and above the cost of physicians
(14%). The cost of drugs has been increased because of the changes to the Patents
Act following the implementation of the North American Free Trade Agreement.
Generic drugs are on average are priced around 50% of the cost of protected
brand drugs. Unfortunately, the Fyke Commission dodged this important issue.
We believe it is necessary for the province of Saskatchewan to take on the
monopoly drug corporations. Profits for these corporations are very high --
in the range of 18% to 27% of revenues. Their spending on research and development
(6.5% to 19.8% of revenues) is far less than they spend on advertising and
marketing (15% to 39% of revenues). Furthermore, much of their research is
paid for by governments, universities and private foundations. (www.phrma.org)
We believe that the Saskatchewan government should follow the lead of Brazil
and South Africa and become the purchasing agent for the provincial medicare
system. This includes searching the world for the lowest prices.
The impact of the NDP government's reforms
The cut backs to the provincial pharmacare program have been very hard
on many people. For example, low income seniors are paying more of
the cost for prescription
drugs than any other province. Those on GIS here pay on average $460
a year for prescriptions. Quebec is second at $360. ("Province's Seniors," 1999)
There is also the issue of the writing of prescriptions. It is alarming to
learn that the number of children being prescribed Ritalin has increased ten
fold over the 1990s. It is astonishing to learn that the number of prescriptions
written for antidepressants in this province has increased from 349,000 in
1998 to 419,400 in 2000. There is something fundamentally wrong with our society
and the sickness care system when the answer to health and wellness problems
is to put everyone on drugs. (Warick, 2001)
The New Green Alliance strongly supports the community clinic approach to providing
health care services. They provide the integrated approach recommended by the
Fyke Commission, and they can include holistic medicine. This form of delivery
of services has proven to be less costly than individual practice by doctors.
The key to success of the community clinics is that they are co-operatives
run by their members. We believe that local, community control should be promoted
whenever feasible. Primary health services are best provided by community clinics.
In our opinion, they are preferable to individual private practice, doctor-owned
walk-in clinics or regional clinics owned and operated by the provincial government
or their subsidiaries, the health districts.
Today, the health care delivery system is run by the government. Physicians,
nurses and health care workers have input into the system through their representative
organizations. But the general public who pay for and use the system have little
influence over how the system operates or its basic principles. The New Green
Alliance advocates the creation of an ongoing, funded, representative, overview
committee that would allow the citizens as a whole to have a say in how the
There is a widespread concern today in Saskatchewan over the health care reforms
that were introduced by the NDP government in the early 1990s, and in particular
the role of the health districts. Some of those concerns are as follows:
(1) The new changes were driven by the goal of cutting costs rather than creating
a new system to improve the health of people.
(2) The abolition of 500 local health boards and their replacement by 32 appointed
health district boards was a dramatic move towards more centralized control.
(3) The new health districts have no control over revenues or budgets.
(4) The new health districts have encouraged the introduction of privatization
of local services.
(5) The new health districts have resulted in different health services offered
in different areas of the province.
(6) The new health district system resulted in the Dorsey Report and the denial
of the democratic right of workers to choose their own trade unions.
(7) There is less local public participation in the health care system under
the new reforms built around the health districts.
The general thrust of the Report of the Commission on Medicare is to continue
this system and to promote even more centralization of power. For people living
in rural Saskatchewan, there will be even less control over the health care
Kenneth Fyke is concerned primarily with creating a "more efficient" way
of delivering the present system of treating sickness and injury. The goal
is to hopefully be able to cut the budget for health care by 30 to 35%.
This, in our opinion, is the fundamental problem with the approach of the
First of all, the proposals involve a shifting of health care costs from the
public area to the private sector, particularly the family, and more particularly
to women, who are the primary care givers. In rural areas, more costs will
be shifted to families.
Furthermore, this approach ignores the importance of family, friends, community
and history to the health and well being of human beings. It reflects the general
shift in social services away from the Keynesian welfare state with its fundamental
policy that good health care and social well being are citizenship entitlements
in an advanced, industrial society. It is a rejection of the modern Keynesian
goal of lifting the burdens of family care giving from women and putting more
of these burdens in the public sector. It reflects the new dominant ideology
We live in an agricultural economy. The urban centres in this province benefit
greatly from agriculture as finance and agribusiness interests take most of
the income earned by farmers for their labour. Wealth flows from rural areas
to urban areas. The New Green Alliance believes that the urban sector of the
province can afford to give back some of that wealth to the rural areas in
the form of good government services.
Financing the health care system
The basis for the position of the Commission on Medicare is that health costs
are rising fast and that this trend cannot be maintained. The mandate asks
the Commission to investigate this area, but it has not.
The data here is very clear. Health care spending in real terms (discounted
for inflation, in $1986) stood at $1,200 million in 1991, the last year of
the Progressive Conservative government of Grant Devine. The budget was cut
by the new NDP government and did not surpass the spending of the Devine government
until 1998. (See Appendix)
Health care costs as a percentage of the provincial gross domestic product
stood at 6.4% in 1991. They fell to a low of 5.1% in 1997 and have risen slightly
to 5.3% in 2000. Thus, as a percentage of our GDP, we are certainly not spending
too much on medicare, and it is not rising. (See Appendix)
The main problem for the government is the decline in revenues. Provincial
revenues as a proportion of the provincial GDP have fallen steadily from 24.9%
in 1991 to 19.0% in 2000. This reflects the reduction in resource revenue taxes
and taxes on corporations and small business, reduction in wealth taxes, and
reduction of income taxes on those in the higher income brackets. You cannot
maintain the same levels of services if you are going to reduce taxes. (See
It is for this reason that the New Green Alliance has taken the position that
we should maintain the progressive tax system of the Keynesian welfare state.
We should also move in the direction of restoring the taxes and royalties on
resource extraction industries. In this respect, our taxation policies are
similar to those we had in the province during the NDP government of Allan
In an economy fundamentally based on agriculture and the extraction of natural
resources, we cannot provide good social services, including health care services,
unless we are willing to tax the resource industries.
IV. Specific proposals from the Commission on Medicare.
The New Green Alliance endorses a number of the major proposals from the Commission
(1) There is no need for health care premiums or users fees. These are regressive
taxes that are unnecessary. Alternatives revenues are available.
(2) Continued commitment to the five principles of the national Medicare system:
comprehensiveness, accessibility, universality of coverage, public administration,
(3) The need to look at the fee for service system and doctor's incomes. Why
is it that doctor's incomes in Saskatchewan are 36% above the national average
and higher than those in any of the four western provinces? (See CIHI data
(4) We need research on special prairie health problems, especially those associated
with living in the North and rural areas.
(5) We support the team approach to medical services, using the Saskatchewan
Community Clinic model.
(6) Telephone service can be helpful but it is no substitute for good, local
(7) The quality control proposals have some merit but must involve patient
and general public participation.
The public and the media has focused its attention on the proposal of the Commission
on Medicare to reduce the number of rural hospitals, eliminate hundreds of
acute care hospital beds, and consolidating the rural health districts into
9 or 10 larger units.
The New Green Alliance does not have a formal policy on the health care districts.
Our policy is set at the Annual General Meeting, and we try to reach a consensus
on all major issues. But there is a consensus among our members and supporters
that the present health care district system is not working and is unacceptable
as it stands, for the reasons cited above.
Perhaps a majority of our member favour the abolition of the health districts.
This is the position supported by the majority of Saskatchewan adults, as reflected
in recent public opinion polls. It was the position taken by Chris Axworthy
in his campaign for the leadership of the NDP. It is widely believed that it
was his position on health districts that made him the preferred candidate
among voters in general as well as NDP voters.
There are a number of members of the New Green Alliance who believe that the
present system of rural health districts should be retained, but only if they
are transformed. They must have adequate funding. There must be local, democratic
control. They cannot just be the managers of the provincial government which
is off loading its responsibility for cutbacks onto local boards with appointed
members. People in rural Saskatchewan have also witnessed the loss of front
line health workers and their replacement by more administrators. We know full
well that this has angered people in rural areas. As the Commission reports,
there is little local interest in the health boards. People see them as having
no real control over important matters.
In conclusion, as you can see the New Green Alliance has a perspective on wellness
and health care services which is quite different from the general thrust of
the Report of the Commission on Medicare.
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Principles of the New Green Alliance attached.
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A-8. Table from Canadian Institute for Health Information.
(1) $185,454 is the average that a Saskatchewan family doctor bills the provincial
health plan. The Canadian average is $177,589. This is the third highest in
Canada, behind Ontario and Prince Edward Island.
(2) $252,570 is the average amount a Saskatchewan specialist bills the provincial
health plan. The Canadian average is $239,322. This is the third highest in
Canada behind Ontario and New Brunswick.
Table I. Health Care spending in Saskatchewan, 1991 - 2000.
Spending as a percentage of provincial Gross Domestic Product has declined
from 6.4% in 1991 to 5.4% in 2000.
Table II. Saskatchewan Provincial Revenues, 1991 - 2000.
Provincial revenues as a percentage of provincial Gross Domestic Product have
fallen from 24.9% in 1991 to 19.0% in 2000.
Table III. Saskatchewan Resources and Royalties. Average Annual Figures $millions.
Royalties and taxes as a percentage of resource sales have fallen from 26.3%
during the Blakeney government to 9.9% during the Romanow government.
-Resource revenues as a percentage of total provincial revenues have fallen
from 32.6% during the Blakeney government to 10.2% during the Romanow government.