It should come as no surprise that Accenture was represented at the August 11th "proponents meeting" for privatizing Medicare and Pharmacare, or as the Minister of Health Services calls it, "Health Benefits Operations Project, Public Private Partnerships & Alternate Service Delivery Projects". The full list of the meeting's attendees is available on the BC Bid website; it includes Accenture, Bell, EDS Canada, Fujitsu Consulting, Government Agents, IBM Canada Ltd., Info-Lynk Consulting Inc., Intria Items Inc., Manulife Financial, Myra Systems Corp, Pacific Blue Cross, Serco Group Inc., Sierra Systems Group Inc. and Telus. One of those companies may be operating BC's Medicare and Pharmacare by late next year.

There was a time when that kind of privatization would have been considered a violation of the "public administration", Section 8, of the Canada Health Act. It is yet to be determined whether the federal government has agreed to exempt BC from financial penalties that could result from its plan for a P3 to run Medicare.

The full minutes of the proponents meeting are available on the BC Bid website. They show that one proponent asked if Vital Statistics could be included in the "contract". Vital Statistics is the government agency that records births, deaths and marriages, maintains the registry of wills, and produces statistical reports (although those reports are late this year). A representative of the government answered "Well, I mean, all we can say is that it's open to the solutions that come forward. And if that's part of the solutions that's in the Ministry's long-term best interests in solving the issues that we've talked about, in terms of what was articulated a few minutes ago, then that will be considered as well. But that's just hypothetical." In plain English it looks like that answer means that everything is up for grabs.

No one asked why the government doesn't simply hire enough people to answer the phone and open the mail; staffing for MSP was reduced from 185 to 103 people - a 44% reduction. The government agent who attended the meeting came close. He asked whether the Ministry was ruling out face to face contact as part of the "solution". As part of its cutback agenda, government closed two walk in MSP offices. The Ministry answered the question by saying that "…we're looking for a new way to do business and we're looking for innovation. And we're hoping that through this joint solution definition process we'll be examining all options, which could include some face-to-face service."

Submissions for round one of the process to privatize Medicare and Pharmacare are due by September 8, 2003.

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July 30, 2003

Privatization of Medicare

The Campbell government is driven by blind ideology; having just backtracked on its scheme to privatize the Coquihalla, now it is moving to privatize Medicare. . A proposal has been put on the BC Bid website and a government news release and background paper have been issued which characterize the privatization as nothing more than "changing the approach to administering" MSP and Pharmacare.

The timeline for a decision on a winning bid puts the implementation after the next election. That means that the Campbell government will do nothing to solve current backlogs since they will be able to point to the privatization bidding process.

According to the 70 page bidding document, two finalists will be chosen, one of which will run Medicare. The bidding document doesn't even get the facts straight on the history of Medicare in BC. It claims that MSP was set up in 1965 (paragraph 1.3.3). An examination of that error reveals a lot about what is wrong with the Campbell government's scheme.

The British Columbia Medical Plan was established in 1965; MSP wasn't established until 1968 - there is an important difference. In 1965 BC had public hospital insurance but it did not have public medical insurance to pay the doctors. Medical Services Association, a private society established by the doctors, and CU&C Health Services Society, also a society but started by the credit unions and cooperatives, were the two primary insurers which provided medical insurance to pay doctors. There were also some for profit insurers but they played a minor role. The BC Medical Plan came into existence in 1965 as a government plan to provide medical insurance for people who were not covered by a private company or one of the two nonprofit societies. In 1967 the Medical Services Commission was established by the BC Legislature to regulate all of the health insurance schemes. When federal funding started in 1968, the for profit health insurers ended their medical operations and all coverage was provided by either BC Medical Plan or one of the two not for profit societies. In 1968 BC Medical Plan became the Medical Services Plan and by the early 70s it also took over the medical insurance operations of CU&C and MSA. The two societies, MSA & CU&C, continued in existence by providing dental insurance. They later merged in the 1997 to form Pacific Blue Cross. Ironically, Pacific Blue Cross will probably be one of the two finalists in the bidding to role the clock back 30 years. It was involved in the registration process for "Fair Pharmacare". The other finalist may well be a major US health insurer or a company like the one that is now running a major party of BC Hydro's operations.

The government's backgrounder claims that privatization is needed in order to upgrade services to the public. Anyone who has tried to phone MSP or Pharmacare knows the nightmare, and a response to a letter can take six months or more. In a fashion typical of the Campbell government, recall the failed computer portal exercise in the Premier's office, the government assumes that there is a technological fix to the service problems and that a private company can work such magic. Paragraph 2.1.1 of the bidding document says:

Maybe the government just hasn't budgeted enough to run the system. If that is the case, then the administrative mess will be transferred back to an insurance company but the problems will remain (complete with all the problems that come with new computer systems). Before government rolls the clock back to the days when MSA (that's an "A" not a "P") and CU&C ran part of the system while waiting for MSP to take over, it ought to determine what is causing the service problems. It is not the lack of a magical technological solution. It is a shortage of people to answer the phone and read the mail.

MSP and Pharmacare are nothing but public health insurance; it is not that there is an administrative component and some other component; the entire function is administrative. Insurance, public or private, is paper shuffling or the modern equivalent. The Campbell proposal will do what was originally banned under federal cost sharing - make the system largely private under contract to the government. What will be lost in the process is accountability. Read the legislative debate for the health estimates. Health Minister Colin Hansen and his junior minister sidekicks repeatedly refused to answer questions and told the opposition to talk to the people he appointed on the health authorities - those would be the people who refused to hold public meetings. How much accountability will there be for MSP and Pharmacare after the plans are run by a major US insurance company or Blue Cross? Does anyone believe that the Campbell government has considered the implications under NAFTA of privatizing MSP and Pharmacare "administration"?

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I know some of these things because I managed CU&C Health Service Society from 1979-1988.