Episode Transcript
Episode 32: Smith and Carney May Destroy Socialized Medicine / Nikolas Barry-Shaw
Matthew Remski: Hello everyone, my name is Matthew Remski and this is episode 32 of Antifascist Dad Podcast. It's called Smith and Carney May Destroy Socialized Medicine with journalist Nikolas Barry-Shaw. You can find me on Bluesky and Instagram under my name and I'm on YouTube and TikTok as AntifascistDad. And the Patreon for this show is AntifascistDadPodcast where subscribers get early access to a second episode every week. It's usually a coda or reflection on the main feed interview in which I fill in some history and theory and tie up loose ends. And it's available simultaneously to the main feed episode. So that means right now, and if you subscribe you support the show, and if you can't afford to subscribe I thank you anyway. And you should know that those second episodes per week are released to the wild in a few weeks time because I don't hold everything back here.
I also want to direct listeners to the link in the show notes to order my new book, it's called Antifascist Dad: Urgent Conversations with Young People in Chaotic Times. It is out now.
In this episode I talk with journalist Nikolas Barry-Shaw from Montreal about how Alberta's Bill 11 constitutes a radical privatization of Canada's socialized healthcare and how it's being driven primarily by insurance industry lobbying. Manulife, Canada Life, and Sun Life helped draft the legislation through government working groups, while doctors, unions, and the public were excluded. Now the bill enables a two-tier system, fast lanes for the insured, slow lanes for everyone else, and it's written broadly enough to privatize virtually anything. Now Premier Danielle Smith, who came to right wing politics through corporate lobbying, has openly discussed what is necessary for Bill 11 to go through, which is scrapping the Canada Health Act, which ensures healthcare coverage for all citizens regardless of ability to pay. And so far the Carney government is accommodating her, making no moves to enforce the act. And this is partly due to pipeline politics, partly due to his own ties to the asset management world that the insurers inhabit. So that's the 101 on the interview. We'll get to that in a moment.
But I just want to say by way of introduction that if you've been following along, I've done a lot of ranting recently about the vapid, trite, cornball Canadiana culture buttons that Mark Carney has been banging on like whack-a-mole for this year in office as he pretends to steer the country out of Trump's way and beyond the horizon of the international rules-based order of predatory capitalism. Because at every turn it's absolute bullshit. His elbows-up hockey talk, having a skate with the Oilers wearing number 24. That's the 24th prime minister. Isn't that cool? Introducing Joni Mitchell at the Junos as the singer who drew the map of Canada, as he said, and benefiting from Mitchell being elderly and I guess checked out enough with regard to Canadian politics that she goes ahead and says this.
Joni Mitchell: I haven't been here in many, many years, but I'm so glad to be here tonight with our wonderful Prime Minister. We are so fortunate to have him. I'm living in the States and you know what's happening there.
Matthew Remski: Oh, but Joni, do you know what's happening here? After the event, the Prime Minister's office released their social media summary quote, the world needs more of Canada, which of course is this signal of friendliness, dependability, camping grit in the frozen north which is now melting. It's so sad. But maybe Joni can write a polar bear song. Also apologizing, apologizing for apologizing. And let's not forget Mike Myers, Catherine O'Hara, Seth Rogen, Martin Short.
But underneath the bumf, what Carney is delivering is an American regime of austerity, executive power grabbing, shitting on First Nations consultations, the scrapping of environmental protections to ramp up pipeline and data center construction, and the promise to triple military spending, ostensibly to protect our southern border, but in reality to be a lapdog participant in American empire. And just this past week, after months and months of touring the world to broker deals with more stable right wing regimes like India, he just indicated that the country is open to considering greater economic integration with the US under the CUSMA agreement in upcoming negotiations.
So Mark Carney is the guy who will sell you a ticket to a syrup-on-snow event in the Eastern Townships where the sugar man pours out the hot maple taffy onto a sheet of hardened snow and the kids swarm in with popsicle sticks. And while they're chewing the sweet and picking their teeth, Carney leads the group on a tour of the sawmill next door, which will devour the sugar bush in a few years.
I want this picture to be really vivid because all of these tropes of Canadian culture, all very white, sentimental, wholesome, have little to nothing to do with any actual material support that people who live here experience on a daily basis. And if you need some proof that none of these vibes are actually Canadian per se, it's really staring you along with four million Instagram followers in the eye. Anyone north of the US border who has seen the videos of Old Time Hawkey one hundred percent believed that this dude was Canadian. This is the well-hello-buddy guy who makes ASMR comfort food over a winter campfire or in his camper van.
Old Time Hawkey: Well hello buddy. Please join us for movie night featuring Labyrinth and my famous baked mac and cheese.
Matthew Remski: So during that movie night his dogs Donnybrook and Kris Draper are looking on. So he's cooking using this 1970s Cathrineholm enamelware and the glow of movies from the 1980s and cartoons on VHS light up all of the plaid interiors.
Old Time Hawkey loves hockey, but he lives in the Michigan Upper Peninsula. Now I was born in the Upper Peninsula of Michigan. My dad is American from Detroit and my mom Canadian from Windsor. We wound up north because of Vietnam and the air base my dad was stationed at. But from three years old I've lived in Toronto, and from a young age I've been baffled about the supposed cultural differences between the two places. And now I can say that the only thing that distinguishes the two countries is the degree of socialist commitment enshrined in the Canada Health Act.
There's nothing abstract or vibes-based about it. Doesn't matter who your folk singers are or whether you've got ketchup-flavored potato chips that have turned your fingers red when you were a kid on this side of the border. Since 1972, the year after I was born, all provinces have provided guaranteed socialized medicine. It has been imperfect in terms of regional and class and racial access. It has not covered basic health needs like prescription medicine, dental, or mental health care. But it has created a general moral sense that in this place and with regard to the frailties of the flesh, we do not let each other die over money. We'll still fuck each other over through private property, rents, and wage theft. But healthcare has stood as a line of social commitment in the sand that no one has wanted to cross except for the real capitalists who have fought socialized medicine from the beginning and are now winning.
Canadian culture, as it has developed, is unsuited to protect socialized medicine. At the root of this unpreparedness are deep streams of anticommunism, beginning with the RCMP killing two workers marching in the 1919 Winnipeg General Strike and then continuing in 1936 with Prime Minister Mackenzie King making it illegal for Canadian Communists to travel to Spain and fight against Franco. After the war, anticommunism went low key and implicit. In 1959 the John Diefenbaker government canceled the Avro Arrow, the country's homegrown fighter jet. Now these days, those who remember it remember a nationalist tragedy of engineering genius sacrificed to American pressure. But what was that American pressure? It was the need to fully integrate all of our hardware with US continental defenses against the presumed Soviet threat.
In 1980, I was nine and Terry Fox started his run across the country. He was so stubborn and ornery and also innocent. I remember the newscasts where they showed his bleeding foot and then the stump of his amputated leg after a ten-hour day of running on the snowy TransCanada. We loved him so much. But what was the spectacle telling us? It was telling us subtly that fighting against and maybe overcoming disease is essentially a solitary journey. And of course, for those who are suffering it, it is. But this erased the notion, or at least put it on the back burner, that cancer research or healthcare itself might be a collective political project rather than a charity marathon. Fox's individual heroism blotted out systemic analysis with a wave of sentiment. That was medicine to the Cold War liberal. And amidst it all, the remnants of the Canadian socialist tradition that fought for and won Medicare. The modern NDP has spent decades preemptively distancing itself from socialist language, even removing the word socialism from its constitution in 2013. Now the bright hope is that Avi Lewis, the new NDP leader, ran explicitly on a program of bringing socialists back to the center of the NDP. And he won.
So in the absence of socialist education in this country, which is the only thing that would really help people see this clearly, we have culture, the feeling that healthcare is just part of our wholesomeness, the way we do things. It's a lifestyle and a mood. We knew that when Gord Downie of the Tragically Hip was dying of that brain tumor, he and everyone poorer than him would get the same care in the same hospitals. And that's because we would all chip in. And he paid that back to the social good with songs like Wheat Kings and later his Secret Path project about Chanie Wenjack, which was explicitly about colonial violence. But these cultural moments always seem to absorb the political stakes into emotional catharsis. It wasn't in Gord Downie's makeup to stand on stage during his self-eulogizing concert and say to the country, I have been cared for in this bodily suffering by a socialist medical system and I hope that long after I'm gone you will fight to preserve it. That wasn't his style. He was an artist and he approached things indirectly. And that's fair enough.
Today, ironically, I think the nation is now treating its socialized medicine with the same sentimental regard paid to Joni Mitchell, who will stand beside Mark Carney and say that you're lucky to have him. But at the same time we're also concerned that she's old. She won't be with us too much longer, and we're wondering when we'll watch Carney pull the plug.
Nikolas Barry-Shaw is a writer and researcher living in Montreal. He's the author of Paved with Good Intentions: Canada's Development NGOs from Idealism to Imperialism. He's the trade and privatization campaigner for the Council of Canadians. And it was his articles in The Breach — one is called Pandora's Box: Danielle Smith and Insurance Giants Unleash Attack on Healthcare, and the other article was written with Saimi Desai, it was called Danielle Smith Admitted She Wants to Throw Out Canada's Public Health Care Law — that really fleshed out this issue for me. So he joins me now to run through how Alberta's Bill 11 is the tip of the spear into the heart of Canadian socialized medicine. Now, in the coda to this episode, which is now up on Patreon but unlocked here in a few weeks, I offer a few reflections on the personal and existential importance of socialized medicine and why Tommy Douglas, its founder here in Canada, viewed it as a Trojan horse for socialist values.
Nikolas Barry-Shaw, welcome to Antifascist Dad. Thanks for taking the time.
Nikolas Barry-Shaw: Thanks for having me on.
Matthew Remski: So I think the background here with Bill 11 involves some generalized antagonism toward public health that's emerged in a couple of strange ways. Like I did a piece for the Globe and Mail a few years back on Danielle Smith's fondness for the wellness industry coming out of the pandemic. So, you know, tonic water and hydroxychloroquine for what ails you and a lot of antivax dog whistling. And I argued that this was all part and parcel of a neoliberal ideology that reduces healthcare to consumer choice, amplified by a kind of institutional distrust and wellness industry growth. And I'm wondering if this has been a cultural factor fueling these current privatization drives.
Nikolas Barry-Shaw: I think there is definitely a kind of shared root of hyperindividualism that's there, that's present in both the antivax kind of take-control-of-your-health type of movements, alternative health movements, and the neoliberal ideology. That's the school that Danielle Smith comes out of, definitely. And I think we saw that in your work with Conspirituality, just underlined that. Certainly in the pandemic that was really helpful for me and other people puzzling over what the heck was going on with these yoga moms teaming up with neofascist types around the convoy. So yeah, I think that is one of the big roots there. But in terms of Danielle Smith and the push for privatization, I would say the more relevant part of her biography is the fact that before she became Premier, she was president of a corporate lobbying firm called Alberta Enterprise Group, one of the largest business lobby groups in the province. I think that's really where the energy and the drive for privatization is coming from. Because despite the grip that the right has over the province at a political level and at a media level, we could say people still tend to support public healthcare. They do, even Albertans. And when it gets attacked, they're actually pretty upset. And so that's kind of, I guess it's good to start on a hopeful note because there has been a fair bit of backlash. And that was something that I talked a bit about in this Breach piece about Bill 11 that I did recently and that I think is encouraging and I hope it will grow because even in kind of deep, deep UCP areas, people are kind of coming out of the woodwork and looking at this two-tier healthcare bill that they're facing and they're saying we're going to end up losing with this. So yeah, I think with all of these privatization pushes, my sense is that the neoliberal ideology has always been something that really gripped the elites. It gripped the people in the media. It gripped obviously the corporations who are the ones who funded it and designed it and propagated it through the think tanks that they fund. But Danielle Smith is a total product of that whole world and that political project. But it doesn't have deep roots. Certainly for things like healthcare privatization, it doesn't have deep roots. There's not some popular movement for privatizing healthcare that is driving this forward. It's really coming from corporations and in this case, I would say the insurance companies.
Matthew Remski: And that's why she's sort of ideally positioned as a lobbyist, right? She has to really sell this to the public.
Nikolas Barry-Shaw: If you're a billionaire or you're a large corporation and you want to hire someone to push your interests, you're going to hire the most sincere advocates. They're going to be the people who are going to sell what you're doing the best. And it's been a multidecade project of developing a cadre of people who can go out there and connect with people and make arguments for things like privatizing healthcare to a broad audience, which wasn't the case before. And that's how Danielle Smith kind of got her start as a young leadership kind of trainee and intern with the Fraser Institute, coming through the Calgary School of Neoliberalism and getting trained up and becoming a radio talk show host and so on. And so I think that's kind of where the interests and the passions kind of meet.
Matthew Remski: So let's talk about interests and agencies that are playing a leading role. And I think we have to start with the insurance companies because we've got Manulife, Canada Life, and Sun Life who have all updated their Alberta lobbying registrations around the time that Bill 11 is being drafted. And they've described themselves as key partners with a government working group. So let's just start by establishing how large are these companies and what do they want? To whom are they responsible? What do they stand to gain?
Nikolas Barry-Shaw: Like a lot of industries, Canada's insurance industry is a kind of cozy oligopoly. It's three companies in a trench coat. Manulife, Sun Life, and Canada Life basically dominate the market for private health benefits, kind of extended workplace health plans. Between them they control basically two thirds of that market in Canada. It's a $66 billion market, I think, as of 2025. But it's kind of restricted because of the way that Canadian healthcare is structured. It's restricted to stuff that falls generally outside of the umbrella of Medicare. So we're talking about mental health, we're talking especially about prescription medication, which is I think one of the issues that the Council has campaigned to bring under the umbrella of Medicare over many years. And it covers things like vision and dental. And so that's kind of the space in which these companies are operating in Canada. They have a lock on the market, but they would like a bigger market. They would like to be covering other kinds of healthcare. And since the pandemic especially, I've been reading a bit of what they say to the industry press and what they say at their gatherings to each other when they're in their corporate safe space. And they're very open about it. They say the healthcare crisis is an opportunity for us. People can't see a family doctor. They're worried about going to the ER and waiting 17 hours to be seen. They're worried about all these things. This is an opportunity, we can offer more products, we can expand into the fissures that are opening up in the healthcare system because of decades of underfunding and because of the really devastating impact that the pandemic has had on the workforce in healthcare and on the healthcare system in general. And so they see an opening here. And I feel like with Bill 11, it's kind of that next step, where rather than just going into the cracks, they're actively putting a wedge into the crack and they're trying to drive it home. And Danielle Smith is really the hammer that is driving that wedge home.
Matthew Remski: It really gives the picture of the mixed economy as really vulnerable in the sense that we can work for decades and decades and decades to build up some kind of robustness in public health, in socialized medicine. And there is this set of corporate vultures that are sitting just on the nearby ledge waiting for any kind of stress on that system to dissuade people from their democratic instinct to support it and to sort of capture whatever market they can from it. It's really kind of incredible. In a way, we're talking about a crisis point of this bill really ushering in a two-tiered system, but that was just kind of waiting to happen for a long time, wasn't it?
Nikolas Barry-Shaw: Absolutely. And I think, I guess I should say out loud for your listeners, I'm going to hold up a book, Tommy Douglas and the Quest for Medicare in Canada, which is this tome of a book. It's 900 pages, but I've been reading it slowly. And one of the things that comes out clearly there is that from the get-go, from the 40s onwards, Medicare, public healthcare in Canada has always had three opponents. Big business, organized medicine, and the insurance companies. And they've always fought against it. And doing some of this research, I've been reading old speeches by Tommy Douglas, and there was one from '84 where this is shortly before he died. But it was at the beginnings of the first attack when the system stopped expanding and you had provinces trying to bring in user fees and kind of the first initiatives at trying to chip away at this very popular public healthcare system. And Tommy said to a meeting, he said, we can either move forward or we can move back. We can't just stand still.
Matthew Remski: Because he's looking at it as a war. It's a class war, actually.
Nikolas Barry-Shaw: Absolutely. And I think it's a multigenerational thing and it's happening over these long timescales. And that's the ability to identify who we're up against. I was kind of shocked to see that the insurance companies were always there because I found when we're doing fights against privatization, we haven't paid enough attention to the insurance companies and we haven't named them as our adversaries in a lot of these fights often enough. Often we're going after the politicians. And the politicians are definitely guilty of a lot of this stuff. But they have donors, they have people they speak to, they have advisors that they're getting from the insurance industry often. And so we really need to map that out better and highlight that better. I think there is a really fundamental tension between providing healthcare in a way that is meeting people's needs versus providing healthcare as a profitable service. And those two logics are just so in tension that you really are kind of forced to have one win out over the other. And if one starts to take the advantage, it's going to kind of spiral.
Matthew Remski: But Nicholas, we do have this thing called the public-private partnership and it should be able to balance these two tensions and come to some sort of detente or agreement. Don't you believe in that?
Nikolas Barry-Shaw: Yeah, we can sit around with the construction firms and the bankers and sing kumbaya and yeah, the healthcare system will get better. No, I don't believe that. We've had cycles over the last couple of decades where healthcare has, certainly 1995 and the mid-90s was a cycle, the first really big cycle where there was both at the provincial and the federal level huge cutbacks. It was absolutely devastating what happened in the mid-90s and the healthcare system hasn't really recovered from that. But there is a recurrent cycle of like, okay, these big cutbacks in the mid-90s, the system kind of starts careening towards a crisis point. Politically it becomes untenable. The governments have to do something. They announce a reinvestment, but then that reinvestment is like billions of dollars on the table. And so the P3 thing is like, that's where, well, okay, if you're going to reinvest, you're going to make sure a good portion of that flow is going to go into our pockets. And I think that once we start understanding the ways in which not only is it underfunding, but with each kind of cycle of cutting funding and then reinvesting, our governments both at the provincial and the federal level have been favoring these private interests that are latching onto the body of our healthcare system. That's when we start to understand why we're at such a low point now.
Matthew Remski: It's so difficult too to have this be legible within just regular democracy. Because I'm thinking about, I'm not as familiar with Canadian healthcare policy and history as you are. But when you talk about austerities in the mid-90s, I kind of have an impression of what you mean, but also it's a little bit vague to me. And I'm thinking that if it's vague to me, that for most people we're talking about how they might have noticed longer wait times or it was harder to make an appointment for this or that, or it was harder to see a specialist, or they heard a story from somebody in their family who was having trouble getting a prescription filled or something like that. And we're talking about small changes over time that are the result of these sort of trickle-down austerity programs that are hard for any individual to see given how vast the systems are. But the privatization drive, the drive towards more and more capital capture, always moves faster than the capacity we have to understand it, it seems, or to see it play out in real time.
Nikolas Barry-Shaw: Yeah, I mean, I think that's partly just on us, people who are defending public healthcare and who care about it and know that it's just such a fundamental part of the welfare state that we need to defend. We need to get better at kind of telling that story. It's one of the reasons I'm happy to be on the show to talk about it because I think it is fundamental. The metaphors, we're always looking for metaphors to express it. I think it was Armin Yelnyazan who had an article about privatization and healthcare and was comparing it to a tapeworm, which I think is great. It's exactly what's happening, which is whether it's P3 hospitals, whether it's privatized long-term care homes, it's kind of worming into the system and leeching off of its vitality. I mean, I like the metaphor of leeches. Whether it's private clinics or diagnostic MRI clinics that are privatized, it's like every time there's a problem with the public healthcare system, there's long wait times, there's overcrowded ERs and so on. The kind of the medieval neoliberal doctors of our political class and the media class say, well, we got to put another leech on, let's attach another leech. And so by this point, 30 years later, we're staggering around, our bodies covered with these private sector leeches that are pulling the vital fluids from our healthcare system. The actual people doing the work, the nurses and the other healthcare workers, the orderlies, the secretaries, the janitors, everybody, they're running on fumes. And then the answer is always, oh, well, we need more leeches. It's like, yeah, it's not going to work.
Matthew Remski: And it's not just that the leeches are a symbol of privatization, but I think Smith and her Robert F. Kennedy Jr. buddies would say the leeches are actually good for you. They're cleaning up the system, they're purifying impurities and so on. Yeah, so that's a good metaphor. Okay, so we've got this bill with heavy insurance company influence. Now, were you able to track specific policy provisions in the bill directly back to input from the insurers?
Nikolas Barry-Shaw: Yeah, I should say, for this article in The Breach, the thing that I jumped on, that I was like, okay, I have to write about this, was when I found a document from the Canadian Life and Health Insurers Association, which is basically the main lobbying front group of the insurance industry, obviously dominated by again the big three, Canada Life, Manulife, Sun Life. And it was a pre-budget submission to the Alberta government, but it kind of read like a love letter to the Smith government. They just were effusive in their praise of Bill 11. They said this proves that the government in Alberta understands that we are key partners in healthcare now. And thanked Smith for giving them time to weigh in on the technical side of the bill. Said even that the Smith government had created a working group within the government of industry representatives. Somewhere in the Alberta government, there are officials sitting down on a regular schedule with people from the insurance industry working out the details of this policy which is about to go live. The bill was passed in December, but it hasn't been enacted yet. They have regulations that need to put it into effect. And so that's kind of the stage where we're at. But just this level of involvement in policymaking, especially when you consider how excluded basically everybody else was from this bill, is quite shocking. And I just felt like this has to be written about and highlighted because it hadn't been covered anywhere else and yet it was a public document. It was there for anyone to see.
Matthew Remski: Well, there's a public document, but just sort of like a freedom of information question for you on the reporting level is, those meetings are taking place in some conference room, maybe within the parliament or somewhere else. Are there minutes kept? Are those meetings on the books? Like, are they supposed to be public and recorded?
Nikolas Barry-Shaw: I'm sure they are. I'm sure there's a paper trail here. I am also sure, having spoken to people in Alberta who regularly do Freedom of Information requests, that it will be exceedingly difficult to get their hands on them. I think it should still be done. I'm not an investigative journalist. I'm a researcher. I'm a pretty good researcher, but I don't have those skills. But I would love to see an investigative journalist dig into this more because there definitely are those documents. And even just showing how often those meetings are happening and things like that, even if the whole thing is blacked out, I think that would be a public service to Albertans and to Canadians at a time when you have a government that's just in the process of trying to tear down the whole public healthcare system.
Matthew Remski: So we've got private insurers, industry professionals, who are meeting with government officials in black-box rooms consulting on technical implementation of Bill 11. Doctors are part of the population that are shut out of the process. But what are Alberta doctors saying about Bill 11 in general?
Nikolas Barry-Shaw: When the legislation was finally kind of leaked in draft form in November, the Alberta Medical Association kind of came out and said, we weren't even consulted. We had no idea this was coming. It's going to radically change how the public healthcare system works for doctors. And they obviously said, well, the international research, as anyone who does healthcare system research knows, is not very favorable to this. It's not actually going to solve our shortage of surgeons and doctors, and it's not going to solve the pretty severe problems that Alberta's healthcare system is facing. Just kind of pointing out the obvious. That's really striking because sometimes you do have at least organized medicine sometimes in favor of privatization. They see that their members might benefit. In this case, even the doctors were shut out. So obviously unions, healthcare workers, the broader public, nobody was consulted about this bill other than insurance companies. And this is a piece of legislation. It's 296 pages long. It makes changes to five different bills. It's a really radical rewriting of how healthcare works and how private insurance functions in the province. And it was done basically with zero oversight and input from anyone other than the insurance companies.
Matthew Remski: Okay. Turning to the doctor's perspective, you mentioned in the big Tommy Douglas book that professional medical associations have often been antagonistic to public health in Canada. And just as a general question, when you have institutions that represent doctors in a province who want to have input on the pathway of privatization and they're speaking on behalf of their members, how does anybody ever justify the sort of adherence or their commitments to the Hippocratic oath if they know that outcomes for public health generally decline when the pathway goes towards privatization? Like, how do they square that circle?
Nikolas Barry-Shaw: I don't think they do. I think people like Dr. Brian Day, who runs Cambie Surgeries, they just try to say that the public system is terrible and it needs to be torn down. And that's kind of their perspective. They just paint a picture that is entirely black of the public healthcare system. I think the medical associations are a little more nuanced in their position, but they will sometimes come out in favor of privatization. I think their main preoccupation is to protect the power of doctors in the healthcare system. I do want to point out that there are associations of doctors who are fully in favor of a public healthcare system. Canadian Doctors for Medicare. Here in Quebec, I'm based in Montreal, there's the Médecins Québécois pour le Régime Public, which is a similar organization. They don't want to slag doctors across the board. There are definitely many of them who have really stepped up and used their voice and their credibility as doctors to fight to defend the public healthcare system. And that's super important. But oftentimes the professional bodies have been kind of hostile to anything that would kind of limit the power of doctors within the healthcare system. And the example I think of here in Quebec, at one point there was a community group that was calling for opening a clinic in Maisonneuve-Rosemont, which is like a working-class neighborhood of Montreal that doesn't have very good healthcare services. There was a debate over, well, why aren't there doctors willing to work at this clinic? Some people were suggesting, well, maybe doctors should be obliged to work in these underserved areas. And one of the heads of the professional association of doctors in Quebec came out and said, oh, that would be like the Soviet Union.
Matthew Remski: Well, I mean, maybe. And there's the question of, like, what are we doing here? Is there a way that we can possibly circulate folks through high-need areas in ways that work and that actually fulfill our commitments to each other? Yeah, I mean, it's very easy to sort of immediately go into red scare territory, isn't it?
Nikolas Barry-Shaw: Absolutely. And I think that was present throughout the whole history of the fight for Medicare, which was, if we build this system then the next thing to go is doctors' ability to care for patients and make professional judgments and we'll all be slaves of the state. That was there from the get-go, from the 50s and 60s onwards. And so yeah, it's not surprising when you know that history to see it come back even when it's in this kind of miniature form when there's a little debate about, hey, we need better staffing at this clinic. The thing pushing in the other direction is that the medical profession has feminized and so there are way more female doctors, people who are often shouldering the double burden of housework and social reproductive work at home as well as a very taxing professional job. And so that has had an impact of opening up a significant number of doctors to the idea of maybe we don't want to be entrepreneurs who build a private practice because of all the paperwork that comes with that. And maybe we should be public servants and we should be professionals that are salaried and work for the government. That was one of the big compromises of Tommy Douglas's achievement in Saskatchewan, which was they did keep doctors as basically kind of private businesses within a public system. But it is extremely laborious and kind of fee-for-service is not the easiest way to go about things. And to connect this to Bill 11, that's something that has been interesting for me to read, is in the insurance industry press they talk about, for doctors this is going to mean a ton of paperwork. Now they're going to be adjudicating claims, not just billing the government, which is a relatively predictable thing for every surgery you do and so on. Now you're going to have to be figuring out, okay, well is this person in the private or the public sector? Is there insurance covered? Who's the first payer? And we know where that goes. And that goes down the route of the US system where insurance companies are playing just a huge role in life and death decisions around people's care. And that's a very scary prospect. And I think it should be scary even for doctors who might be otherwise tempted to support privatization because it will mean just a big bureaucratic mess for everyone.
Matthew Remski: It's such a paradox because with the feminization of medicine and the feminist implicit principles that would come along with that, we have this powerful and pro-social demographic who understand what care work means. They understand because they do it. They understand what social reproduction means. As you say, they're probably going to be inclined towards the protection of the public system because they don't want the added bureaucracy of entrepreneurship. And yet because they are also doing the lion's share of social reproduction, it's going to be an additional burden on them to try to fight for this. So I just wanted to point that out. It's just like labor upon labor upon labor.
Nikolas Barry-Shaw: It would be nice if the problem would fix itself on its own. Getting involved in political organizing is always kind of like an extra thing on top of having kids and a job.
Matthew Remski: The phrasing around Bill 11 is that it creates flexibly participating physicians who can charge patients privately while simultaneously billing Alberta's public insurance plan. So what does that actually mean with something like a non-urgent procedure like a hip replacement or something that you schedule? It's not critical, it's not acute. Because I just don't understand how the double billing process works. Is the idea that Alberta will be billed in decreasing increments until the surgery is just not covered at all and all of the funding stream switches over to the private stream?
Nikolas Barry-Shaw: There are a few changes that are not entirely clear yet, because the regulations. And this is actually one of the scariest things about the bill, that because of the way it's written, it opens the door to anything being privatized. So the Smith government has been saying, don't worry, this is a really small change. We're just going to do it for low-acuity patients. These simple surgeries, cataract surgeries, knee surgeries, hip surgeries, and that will go into the dual practice, having surgeons one foot in the public sector, one foot out. That's the only thing that's going to change. But the way the law is written, it could be family doctors tomorrow, and that could change just through an administrative decision of the government. They wouldn't even have to change this law. So they have the power to privatize any part of the healthcare system down the road. So that's just the first thing to understand. How the private insurance will work for these surgeries that would be done in a private clinic and insured by private insurance, it's not clear. It seems to be that there's like a private-payer-first principle in the bill so that your insurance would pay and then the public sector might top up or might not. This is not clear to me and certainly the insurers have talked about how unclear this is. But what is clear is that the Smith government is lying when it says this is a small change. That is not true. This is a tremendous, huge change in how healthcare works and how deeply into the system private insurance is. And we see this happening already with existing changes. So one of the first changes that preceded Bill 11 was the Smith government was promoting these private surgical facilities. And this is done in other provinces. Ontario is doing this too, where they have private surgeries doing publicly funded surgeries for things like cataracts. And so there's this surgical center in Calgary that after Bill 11 came out, they said, okay, if you're on the public wait list and your surgery is being covered by the government, with us, a private clinic, that's okay. But with Bill 11 coming into force, you may be able to skip the line. And so stay tuned and write to us if you're at all interested, if you have the money, if you have the insurance. I think whatever changes are happening, this is the real change that is happening, which is they're creating a fast lane and they're creating a slow lane.
Matthew Remski: Right.
Nikolas Barry-Shaw: And if you have any doubt as to which lane you're going to be in, it means you're going to be in the slow lane. I think people need to understand that if you're not one hundred percent sure that you are going to be the one in the fast lane, you're almost definitely going to be in the slow lane. And again, the insurance industry press is really clear about that. Really, really clear. They've been saying premiums are going to go up. Bill 11 means premiums for health insurance have to go up because if we're going to be obligated to cover this whole other sector of healthcare, and if we're going to be forced to include that in plans, you're going to have to pay more in insurance, like a lot more. And they said, well, one of the things that's going to happen is small employers and maybe even medium-sized employers, you're probably going to have to get rid of health benefits altogether because it'll just be too expensive as an employer to offer that to your employees. And they say to large employers, you might have to look at this again and reconsider the level of coverage that you're offering employees. And so I think that for me was really revealing. And having done campaigning around pharmacare, calling for a national public drug plan, sometimes people with insurance say, oh, I'm okay, I'm covered. I have work, I have a stable job, I have health benefits. And so I might even benefit from a privatized system because then that'll be covered and I'll get access to it. And it's like, yeah, but will you still have those benefits after this process plays out? Will you be able to afford the copayments? Will you be able to afford the insurance premiums? And everything we know from how these systems work and how the system down south in the US works, you're going to be paying a hell of a lot more than you're paying already. That's the process that's going to play out if this bill goes forward, is some people will get access to a fast lane and a whole lot of other people will get kicked into the slow lane.
Matthew Remski: There's a story in here about public communications and public perceptions that I just want to draw out because it seems to me, and I think with you knowing more about Tommy Douglas than I do, that public health, while it's difficult to champion within a capitalist society, it's based on a very simple principle of shared responsibility. And what you're describing now as the pie begins to be divvied up between public interests and private profit, and how the individual citizen is going to have to navigate and try to understand where they actually fit in and then will be told by their officials in various ways that, oh well, we had to do this because things were getting so complicated. There's a way in which this destruction of public health also seems to have something to do with a decline in public participation in shared knowledge or the capacity to all be on the same page. I mean, when I hear my American friends talk about how with the Affordable Care Act, they will go onto a website and look at the insurance exchanges to see what kinds of policies are on sale or on offer in their region according to what their pre-existing conditions are or whatever. The burden upon the individual to try to assess what the best choice might be for this kind of false offer of help, which is not universalized, it's such an incredible burden that the complication of that in itself probably depresses the capacity for people to think collectively.
Nikolas Barry-Shaw: I think the public healthcare system in Canada, as was defended by Tommy Douglas and the CCF and all the kind of anonymous workers and activists who fought for a public healthcare system, it was always based on the principle of you should have access to care based on need and not income. To the degree that we've won something, it's been we've moved towards that principle. And I think the achievement of public healthcare, Medicare in Canada, was absolutely tremendous and it's been enormously popular with people. So even if people don't understand all the ins and outs in the details, and actually a lot of people do because there are a lot of people who work in the healthcare system, just having people in your family who are healthcare workers often helps you understand it better. Even beyond that, just that principle has been so enormously popular with Canadians that it's become part of our kind of national psyche. And I feel like people like Smith and the corporate elites that back people like Smith, they've just been trying to drown that out and drill that out of people for a very long time because they understand that that principle is a threat to their whole system, their whole setup. It's like, what if we can produce healthcare, which is this enormously complicated undertaking, to have comprehensive healthcare provided to people on the basis of need, couldn't we provide other things to people on the basis of need as well? It's very uncomfortable if you're a corporation, if you're a capitalist, to look at this system and to see it function. And so it's not surprising that for the last 40 years they've just been trying to destroy it.
Matthew Remski: I think it expands out to, well, why is every socialist project in the global south torpedoed or couped by the CIA? If you do have a thriving public anything in a particular region, what are the other possibilities? That's got to be on their minds. We have something called the Canada Health Act that is supposed to rein in everything that's happening in Alberta right now. And health advocates wrote to Prime Minister Mark Carney on the 42nd anniversary of its signing because they had this pretty stark warning that this could be the last year for the Canada Health Act. And they wanted to remind him that Ottawa has the power to enforce it, and that would include blocking certain Bill 11 provisions and withholding health transfers if Alberta doesn't actually fulfill its commitment. So is federal enforcement politically viable? What would it look like? Why isn't Carney or the health minister actually doing anything to step in here, do you think?
Nikolas Barry-Shaw: On the first point, it absolutely is viable in the sense that the federal government does have the power to step in if it wanted to. So health transfers to the provinces are governed by the Canada Health Act. Alberta gets $6.6 billion a year from the federal government for its healthcare system, but that comes with conditions. It has to be a system that's public. Access has to be universal. It has to be single-payer. So things like physician services and hospital care, that has to be within the public sector and it has to be accessible to everybody. And if a province violates those conditions, as Bill 11 quite clearly does, the federal government has the power to step in and eventually even claw back those transfers. The hesitation some people have is, well, given the separatist movement in Alberta, is this going to fuel the fire and maybe the federal government should tread lightly. And I disagree with that on multiple levels. Certainly we should not be exchanging keeping Alberta for public healthcare. But I also know from speaking to people who live in Alberta and who are campaigning around this issue, they're saying bring it on. We would welcome healthcare becoming the number one issue as far as Alberta separatism goes because Albertans are not behind these healthcare changes and it would definitely weaken the separatist cause. If you're separating so that you can destroy public healthcare, that's not a winning case for their side. I don't think there are any good political reasons for why the federal government isn't intervening. I think it would be popular just politically with their own base. It was a clear commitment that the federal Liberals made to enforce the Canada Health Act in their election manifesto Canada Strong. And I think the explanation I see behind it is one, pipeline politics. Carney is busy doing these deals with Smith to build pipelines, be it east, west, north, south, any direction. They want to build pipelines together as well as data centers. There are those larger economic interests that I think mean that Carney is playing nice and doesn't want to step on any toes in Alberta. And I think the other thing is that Carney is a banker. He's from the world of asset management. And insurance companies have become these globe-spanning asset managers. They take money from us through premiums, through contributions from our workplace plans, and then they invest it all over the world. They have pension funds and other big investors like BlackRock. They are investing in toll highways, pipelines, privatized water infrastructure. So they're part of that world that Carney comes out of. And since he came into office, I've been following the business pages and they are on these trade junkets with the Carney government. In their internal meetings they're like, oh yeah, we're meeting with Carney, top Carney officials all the time. So they have this access. And healthcare advocates and unions I know have been trying to meet with the healthcare minister saying, can you do your job? Can you enforce the Canada Health Act? And she won't even give them a meeting. But she's met 41 times with the lobbyists of the insurance industry since this government took office a year ago.
Matthew Remski: And so we're talking about, hypothetically, we have on a trade mission to India there are health insurance executives who are there to search for investment opportunities for our premiums, which is just an activity that has nothing to do with healthcare. I don't know how old you are, but I have this kind of early maybe grade school, high school memory of thinking that something like an insurance company was really just in one building and it took in the money and maybe it stored it in the bank and it made 3% or 5% interest like everybody else did and that it carefully watched everybody's sort of situation and it took in the claims and then it paid out as it needed to. But that's not what corporations really are anymore. Like the service is incidental to the wealth accumulation and the financial management stuff, right?
Nikolas Barry-Shaw: Yeah, I mean, that whole side of it I didn't even know until a couple of months ago when I started being like, okay, I need to understand insurance companies a little better. What the heck are these things? And yeah, I mean, they are global globe-spanning corporations and their CEOs are some of the highest paid people on Bay Street and they're trotting around the world looking for opportunities to invest. And I came across this TD Bank sheet which was really interesting. It was basically offering alternative assets for insurance companies to invest in. This is what TD Bank says to the smaller insurance companies that don't have this kind of knowledge in house, so they have to go to a bank. They have all their premiums and they want to invest it somewhere. And TD says, well, we got great opportunities for you in real estate and in public infrastructure. And the section on public infrastructure says explicitly, public infrastructure is great because it's publicly regulated, it's monopolistic, and you get a nice fat stream of revenue coming from it that's predictable and that won't get disrupted. It's just like, yeah, that's the direction we're going in. And we have Carney talking about airport privatization and the sovereign wealth fund, which just sounds like an excuse to chop up what's left of our public infrastructure and sell it for parts. And the insurance companies are a part of that now. Because I think your picture of the boring man maybe with a green visor in a small office building downtown that probably characterized insurance companies up until maybe the 90s, and then there was a big deregulation of insurance in the late 90s that completely transformed them.
Matthew Remski: I'll bring my last question home in a moment, but I just want to rant one more time, which is that I have some kind of policy with Sun Life, given that I'm self-employed and if I go down, we've got to do something. And I get their statements in the mail. I hardly look at them. I don't really know what they mean. I know that I've got some kind of coverage. And I'm just thinking about this corporation as being basically an investment firm that's just trying to make money however it can. And to think that the graphic design and the language that they use to describe how sort of generous and empathetic their services are and how they're going to take care of you if you get ill, when you know that you're going to have to fight for every penny, that even the effort that's put into sort of describing the service is probably this tiny portion of what they actually concentrate on. It's like a front or something like that. So I just wanted to, I don't know, I just want to complain about that.
Nikolas Barry-Shaw: I mean, it is worth complaining about because this is all stuff you don't need. You don't need a glossy brochure telling you lies about how nice they're going to be when you try to bring a claim. What you need is a public healthcare system that doesn't send you any glossy brochures and just provides you with the care that you need. And that's what we've had in various forms. It's been very incomplete. Certainly our public healthcare system should have, and initially going back to the 60s, they were talking about covering things like drugs, covering things like dental care, covering things like mental health. That's maybe a newer preoccupation, but we really need to think about all the ways in which the problems of the healthcare system are because it's incomplete, not because it's public. It's because we left so much out that we didn't get around to building in. And Tommy Douglas, from that same speech, that was his point. He was saying we can either go backwards or we can go forwards. And the way to go forward for him was precisely to expanding into those areas, going upstream, addressing the things that make people sick. Everything from sports programs to nutrition to housing and inequality. So very quickly, once you start thinking about people's health as a preoccupation for the public and for public action, then yeah, you do start getting into, well, why are people living in overcrowded apartments that are moldy and making them sick? Why are people doing jobs that are unsafe and stressing them out and burning them out, all that stuff? And then that's when you start to really see how healthcare can be a window into the injustices of our society. And if you were really serious about people's health, you would start coming up against these various interests, against bosses, landlords, insurance and so on. And so they want the opposite. The insurance companies want us to concentrate just on ourselves and our plan and to really focus down. And it makes for a very inefficient system on top of it all.
Matthew Remski: They want to send you a personalized brochure of services.
Nikolas Barry-Shaw: Absolutely. That logic of personalization is like they are trying to take the population and divide it up into profitable slices. They want every segment. And so that work, that's a tremendous amount of work, is to figure out, okay, well, you in your workplace, I mean, you have an individual plan, but if you were in a workplace, you would have a workplace plan. They're pooling the risks of these people. Okay, they need to figure out, okay, who's likely to need this expensive drug, who's likely to get diagnosed with diabetes, who's likely to be on long-term disability, and come up with some sort of actuarial model and say, okay, this is what your premium should be. All that work is useless other than in a capitalist frame. It's absolutely useless. And that's why in a public system, you cover everybody. You don't worry about any of that. You pool all the risks of everybody and you cover what's necessary. That's why the private healthcare plans have about 14 times the administrative costs of public plans, because they're doing all that extra work from the glossy brochure to the mathematical modeling of how likely people are to get sick, which is not useful other than as a way of dividing people up and saying, okay, well, you guys are too likely to get sick, you're too poor, you're too ill, and we're not going to cover you, and so we'll leave you out. That's how they make money.
Matthew Remski: It's incredible to think of how prescient Tommy Douglas is too about this notion of it's got to press forward, because in terms of democratic feasibility and public perception, if pharmacare gets covered, if dental care gets covered, if you can suffer in your mental health and you're able to go for an appointment and actually talk to somebody who will listen to you who's qualified, those become additional signs that you live in a society that cares for you. And the difficulty with which even Smith has in selling privatization in Alberta becomes that much harder. It becomes that much less attractive because there's more to lose. People feel really cared for with this stuff. And so if you add to it, you seal the deal.
Nikolas Barry-Shaw: That's exactly what they're trying to destroy. I came across, doing the research for this, it didn't end up being in the Breach article, but before Smith became Premier of Alberta, she was doing a series of podcasts with the Fraser Institute and she had this long two-hour interview with one of the Fraser Institute hacks where they basically gamed out how they're going to destroy the public healthcare system. The two things that stood out for me there was, she was saying she wants healthcare to become like traditional insurance, where people have some skin in the game, where they have to pay user fees, where they take out private plans to cover themselves and their family, and it's just like car insurance for her. Sounds great. I think for anyone else who's dealt with insurance companies, they know that sounds like a total dystopia. The other thing she said was that, well, this is obviously going to require us to scrap the Canada Health Act.
Matthew Remski: She just said that. She just said that out loud.
Nikolas Barry-Shaw: She just said that in this interview. And so I might have an article come out about it pretty soon, hopefully. But it was just shocking. So this is back in 2021 and they're just gaming it out. They're just saying, yeah, well, if we want to do all these changes and we want to make health insurance function more like your car insurance where you have to take out your own plan, then yeah, we're going to have to basically toss the Canada Health Act out the window. Now of course they say Bill 11 doesn't do that. But you can see exactly what they're gearing up to do and they know very well what they're doing. And I think that reflects especially badly on the federal government which can't find the political spine. And hopefully we will be able to pressure them into doing it because there have been MPs that have been speaking out, but they really need to be put to shame and pressured into doing their job and enforcing the Canada Health Act and stopping and slowing down this kind of wholesale destruction that Danielle Smith is trying to bring to public healthcare.
Matthew Remski: The Canada Health Act as a phrase is taking on the quality of the international rules-based order in Carney's verbiage. We all knew it was a little bit fake or we knew that we weren't really going to support it when the time came. Last question is, I think we're talking about dominoes here because beyond Alberta there are provinces that are going to be vulnerable to copycat legislation. And so I'm wondering if you see signs that insurance lobbies are already laying groundwork elsewhere.
Nikolas Barry-Shaw: Absolutely. And I think we've already seen signs of where this could go if the federal government doesn't step in and doesn't start putting some sticks in the wheels of this kind of privatization bicycle. We heard from Scott Moe shortly after Bill 11 was unveiled saying we're looking at Alberta and we're really thinking about how we can do something similar with healthcare innovation. He likes it, he's thinking about it. They haven't made any moves yet, but I think Saskatchewan would be the obvious next domino to fall if that were to happen. I think Ontario for sure would be the next place because if there isn't this federal enforcement, then the more right-wing provinces that have obviously demonstrated their hostility to public healthcare will say, okay, well it's open bar, let's go, let's see how far we can go. And I think even for the provinces that do not currently have governments that are pushing these more aggressive forms of privatization, it's a big threat. And Matt Jones, who is one of the health ministers, Minister of Surgeries in Alberta, when they unveiled this legislation said Alberta is not an island, which is a hilarious thing to say on the face of it. But he was making a point about staffing and how he said Alberta competes with other provinces for recruiting physicians and we think this two-tier legislation, Bill 11, is going to help us recruit more surgeons to our province. And that is a pretty frank admission by the Smith government that they are trying to basically shovel the problem of their shortage of healthcare staff into the backyards of their neighbors, be it BC, be it Saskatchewan, be it any other province across the country. And I think that is a real risk, which is if this two-tier system gets off the ground, if you have insurers who feel confident because they know the federal government isn't going to step in, creating plans that cover what should be publicly insured care, it's going to create a pool of money, it's going to create momentum and it's going to start drawing in resources and surgeons and creating this sector and it's going to put pressure on healthcare systems across the country. So this is really, for me, people from the outside can look at what's happening in Alberta and be like, oh, it's Alberta, you know those crazy people with Danielle Smith as their premier. It's just an Alberta thing. And it's not just an Alberta problem, it's a Canada-wide problem. And it's really an existential threat to our public healthcare system writ large.
Matthew Remski: What's incredible is to think about how the next provincial elections are so decisive. Because if Moe stays in power for I don't know how long his term is, Ford's where he is for now. But everywhere else, whoever takes the reins in the next couple of years, the vultures are there. They're ready with the precedent being set, if Bill 11 is allowed to fly, to just continue the pattern. Do you see any hopeful signs though? Is there anybody who is making a dent either in terms of public perception or legislatively, who's doing really good work here?
Nikolas Barry-Shaw: I would say first of all, in Alberta itself, I think there's been a mobilization that we haven't seen against privatization in a long time and that's really encouraging. And I think it gives lie to the impression that Alberta is a monolithically right-wing province. It's not. These public programs are actually broadly popular even in places like Alberta. And Friends of Medicare Alberta and a lot of the healthcare unions that they're allied with have been mobilizing, organizing town halls across the province in the wake of Bill 11 being introduced and passed, and reaching out and bringing on board people who would not normally be involved in a fight against privatization, precisely because they live in a rural area and they understand that, oh man, if we let this go forward, is the small rural hospital that we depend on even going to be around if we move towards this kind of two-tier US-style system? And so I think that's incredibly encouraging. And I think for people like us who are outside of Alberta, we have a responsibility to mobilize and to put pressure on the federal government to step up and do their job. Because there has been a mobilization in Alberta. I guess I would give a shout out to the other healthcare coalitions as well. The Ontario Health Coalition, led by Natalie Mehra. They do amazing work. They're constantly fighting tooth and nail against Doug Ford's privatization moves. Here in Quebec I've been working with the Coalition Solidarité Santé as well, which is the local health coalition. So there is work that is happening and there is a pushback happening, but I think it needs to reach another level and I think we can do it, but I think it's going to be tough.
Matthew Remski: Nicholas, thank you so much for all of your research and your work on this file and yeah, solidarity.
Nikolas Barry-Shaw: All right, thank you, Matthew.
Matthew Remski: So thank you again to Nicholas for that great information. And that's a wrap for episode 32. But the coda for this episode is now up on Patreon. It's called What Tommy Douglas Knew and What We All Know About Socialized Medicine. And it's about what Danielle Smith and I think Mark Carney want us to forget, which is how socialized medicine makes us feel in terms not of coziness and culture and stuff like that, but in terms of raw security and baseline communal welcome and care, and most importantly, how it fosters solidarity between working people. So that's up now. And if you can't afford to support the show through this two-tiered podcast delivery system, I'll do a Tommy Douglas on that coda and release it to the wild before long. Until then, take care of each other.
