Social Policy in Ontario

Many of us watched in bewilderment as U.S. President Barack Obama struggled to enact a health reform plan that fell far short of what Canada achieved 40 years ago.

What was so controversial about the idea that every American deserved access to health care? Why would anyone defend a system that forced people into bankruptcy to pay their hospital bills? How could Congress block what an overwhelming majority of voters wanted?

Today, we’re not as smug as we were then. Health costs in Canada are rising at an unaffordable rate. Advocates of private insurance, private hospitals and private health-care services are making inroads. Medicare no longer feels impregnable.

This was the backdrop as Dennis Rivera, the behind-the-scenes organizer who built the coalition Obama needed to win his health-reform battle, came to Toronto this week to tell the inside story and offer a bit of advice.

Rivera, who chairs the million-member health division of the Service Employees International Union (SEIU), spoke to the Economic Club of Canada. His main focus was America’s roller-coaster journey from Obama’s inauguration to last month’s landmark health reform bill. But he also came to thank Canada “for blazing a path to universal access before anyone else,” and to share a few thoughts about the future of medicare north of the border.

“We share common enemies,” he said, pointing to demographic and cost pressures. “We have to keep reinventing health care.”

Rivera is not a household name in Canada. In fact, he is not a high-profile figure in the U.S. He prefers to work behind the scenes, brokering alliances, building support, creating a movement.

Nor does he fit the stereotype of a union boss. The 60-year-old Puerto Rican labour leader is soft-spoken, politically sophisticated and superbly connected. He is willing to compromise, prepared to make common cause with former enemies and unashamed to settle for second best, if it means progress.

“We (the SEIU) wanted a single-payer health-care system like yours,” Rivera told his Toronto audience. “But it was too big a step to take. We had to build the largest coalition possible. We knew the White House needed a group that wouldn’t quit and wouldn’t splinter.”

So Rivera set broad goals. He negotiated deals with unlikely partners such as Wal-Mart, the American Medical Association and the pharmaceutical giants. And he made painful sacrifices (under Obama’s plan, some SEIU members will lose their jobs). “Our bill got smaller and smaller. We kept losing things in a spirit of making it happen.”

The legislation that Obama finally signed on March 23 is not what he hoped for. But it is the breakthrough the country needed, after 100 years of failed attempts to extend medical care to every citizen.

Acknowledging that Canada is decades ahead of his country, Rivera was reluctant to apply the lessons of the American health-reform drive here. But, to strengthen the hand of medicare proponents, he did offer a few guiding principles for straitened times:

• Look for ways to reduce health-care costs. The survival of the system is more important than the preservation of every existing program.

• Listen to the people. Americans and Canadians have said for years they’d rather be cared for at home than in a hospital or long-term care institution. It makes sense to move in this direction, politically and economically.

• Use every available tool. A national drug purchasing program would be an obvious one.

• Look at the big picture. Don’t focus solely on your own interests.

It was clear Rivera considers Canada’s challenges manageable, compared with the gargantuan task of overhauling the U.S. health-care system.

But it was also clear his country has a stake in our success. If we can’t sustain medicare, the beacon goes out.

< http://www.thestar.com/opinion/editorialopinion/article/812462–goar-health-care-advice-from-south-of-the-border >