TORONTO — An Ontario minister says her history of railing against Canada’s health-care system with talking points used by right-wing Americans is old news. But critics say her ideology is outside the Canadian mainstream and raises questions about her handling of the COVID-19 pandemic.
For years, Ontario’s Minister of Long-Term Care Merrilee Fullerton, an Ottawa-area doctor, wrote a popular blog calling for increased health-care privatization. She said that “government monopoly health care” is what Canada has in common with North Korea and argued that our governments here will soon start encouraging people to be put to death.
“You’re talking about some discussion back years ago with medically assisted death,” Fullerton said Monday when asked about her comments by HuffPost Canada. “That discussion has been had.”
She did not directly answer another question about whether she believes the long-term care system would also benefit from more privatization.
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“I think this is about making sure people get the care they need when they need it. And that’s definitely what we’re doing in long-term care,” the minister said.
Pandemic thrust homes into spotlight
Ontario’s long-term care ministry, which Fullerton took over in 2019, relies heavily on private operators. Now that COVID-19 has devastated Ontario’s long-term care facilities — killing 1,959 residents and at least 8 staff — Fullerton is facing calls to make the entire system public.
Fullerton called it “a knee-jerk reaction.” She and her Progressive Conservative colleagues voted it down.
“We’ve spent a great deal of time and effort to understand the issues ... It needs to be better thought-out than what they’re proposing,” Fullerton said.
Homes are required to return most of the government funding they receive if it goes unused, she added, “so there’s not a lot of profit there.”
‘Bastard orphan’ of Canadian health care
The question over public versus private ownership is bubbling up because of how COVID-19 outbreaks have played out, Dr. Samir Sinha told HuffPost Canada. He’s the director of geriatrics at Sinai Health and the health policy research director of Ryerson University’s National Institute on Ageing.
Research found that for-profit homes had larger, more deadly outbreaks than homes run by municipalities and non-profits, he said.
About 60 per cent of Ontario’s homes are owned by for-profit companies, but they all receive public funding, according to Dr. Sinha, including about $122 a day per resident for accommodation and care.
“How did we get ourselves here in the first place? … We never included it in the Canada Health Act back in 1966,” he said, referencing the federal law that lays out which health-care services the provinces must provide without cost to the patient.
“That was our original sin. And as a result, because it’s kind of this bastard orphan of the health-care system … we’ve been underfunding our long-term care system.”
Dr. Sinha said that ownership isn’t the most important conversation for Ontarians to have about long-term care.
“I think there’s a deeper issue at play … our system is just grossly underfunded.”
He pointed to research that suggested Ontario needs to inject $1.8 billion more into its $4.3-billion long-term care system.
He also said that homes run by municipalities or not-for-profits often invest their own money or fundraise to improve their care.
If the government significantly increases funding, holds all homes to a higher standard and still finds that for-profits struggle to provide the same level of care, then it will be time to re-evaluate their role, he said.
‘The entire country convulsed’
But the idea of nationalizing all for-profit homes may be a popular one.
An Angus Reid Institute poll in May found that two-thirds of Ontarians said they support the idea of nationalizing long-term care homes. The poll was conducted shortly after the military was called into Ontario and Quebec facilities, when images of bodies being removed from homes dominated the news.
“This was a period of time where we were learning about what conditions were like in private for-profit care facilities in places like Ontario and Quebec,” Shachi Kurl, Angus Reid Institute’s president, told HuffPost.
“... I think the entire country convulsed and recoiled.”
The May poll only asked one question: do you agree that “long-term care facilities should be nationalized” or “long-term care facilities should NOT be nationalized,” Kurl noted. So it would be important to ask more questions and see what people think of allowing for-profits to keep operating under stricter rules.
“I think it’s something that is worth taking a second look at,” Kurl said. “But I would say that unequivocally, what you found with the main data, is that Canadians were really reacting very strongly to what they were seeing and hearing and were horrified by it.”
Canada’s ‘deep consensus’
There is “an extremely broad and deep consensus” in Canada that people should have equitable access to health care, longtime advocate Natalie Mehra, executive director of the Ontario Health Coalition, told HuffPost. The minister’s views, prior to taking office, were “very far out,” she said.
“This was a physician who was lending her name and her weight to opposing public health-care reform in the United States and using Canada as a bad example,” Mehra said.
Before politics, Fullerton long called for a hybrid public-private health-care system, which she said would end the “rationing” of patient care and doctors’ incomes. The blog where the Kanata—Carleton MPP shared her views has been deleted. But it’s still accessible through Internet Archive.
... I would caution anyone in the U.S. not to adopt the system we have here.Minister Merrilee Fullerton
In 2013, Fullerton went on a radio show to warn Americans against adopting a universal single-payer system like Canada’s.
“We’ve had socialized medicine here since the ’60s,” she said. “People thought this would be a good thing.
“... I would caution anyone in the U.S. not to adopt the system we have here. We’re trying to change the system we have here.”
‘No death panel per se’
Fullerton said that Canadians feel an obligation to die for a health-care system that rations its services and treatments, borrowing a phrase from former U.S. vice-presidential candidate Sarah Palin to make her argument.
“There’s no death panel per se, but what we have is a system now that’s being value based … It’s almost to the point now where people are being given the idea they have a duty to die for the system,” she said.
“So we don’t have death panels but we do have people that are in charge of evaluating what service should this person be able to get, because the evidence shows it will only give them another six months or only another three months and on the basis of that, the government decides that you will or will not be able to get that care or that treatment or that procedure.”
Palin coined the expression “death panel” in 2009. It was called the “Lie of the Year” by fact checking website PolitiFact for falsely claiming that the Affordable Care Act would give bureaucrats the power to deny care to elderly people and people with disabilities. The act actually provided insurance coverage to about 32 million Americans by expanding Medicaid, requiring people to have insurance and requiring employers to cover their workers.
Some Republicans took the lie even further, claiming the bill would take Americans “down a treacherous path toward government-encouraged euthanasia.”
In the following years, Fullerton made similar claims about Canada’s system.
During the Ebola epidemic in 2014, she wrote that there were other, more pressing threats to Canadians than the disease: jihadists and politicians.
“We don’t seem to be ‘terrorized’ by the thought of politicians encouraging euthanasia as a way to deal with rising numbers of frail elderly or people with diseases we can’t fix. We don’t seem to be ‘terrorized’ by jihadists mowing down soldiers in parking lots,” she wrote. “Perhaps we should be. Maybe then we would take our collective heads out of the sand and respond in a meaningful way to the real threats that are more insidious, less immediate, but even more harmful to society and to individuals.”
A year later, she wrote a list of predictions for Ontario health care on her blog. The ninth one read, “Assisted suicide morphs into Duty to Die.”
If Fullerton really believes those things, “then the people in long-term care are really doomed,” Mehra said.
“Those statements are ghastly … They are factually untrue,” she said. “They feed into the most right-wing, radical propaganda against health-care reform in the United States … I think it raises serious questions about her judgment and her personal politics.”
Fullerton seems to be taking an “ideological approach” to responding to the pandemic, Mehra charged.
“There have not been improvements in regulation ... They have not improved accountability at any level.”
She noted that the government is moving to protect nursing home operators — and all other businesses — from COVID-19-related lawsuits.
“In the summer, there was an opportunity to regulate, to get measures in place to ensure when outbreaks started again, in a second wave, they would be nipped in the bud,” Mehra said. “None of that happened. No home has lost a licence ... including the very worst of them.”
Ontario did release results of a staffing study, which was launched in February, this summer. And on Monday, the province said it would recruit tens of thousands of new workers for the sector so that all residents get four hours of care per day by 2024/2025.
In response to questions about Fullerton’s past writings and Mehra’s view that it raises questions about her role, Fullerton’s press secretary sent a short statement.
“Our government’s priority and focus continues to be modernizing long-term care to improve quality of care and quality of life for our most vulnerable,” it said. “The long-term care sector has faced significant challenges as a result of decades of neglect. That is why we have worked tirelessly towards building a 21st century model that is resident-focused so that our seniors can get the care they deserve.”
NDP MPPs have been calling for Fullerton’s resignation since May, when the Canadian Armed Forces’ report on five hard-hit long-term care homes was made public.
Soldiers said that they found poor infection control practices, infestations of cockroaches, and in one case, saw a patient choke to death while being fed lying down.
“... It’s shocking that the Canadian Armed Forces needed to lift the veil, when Doug Ford and Merrilee Fullerton ought to have known about these horrific conditions, and did nothing to take the homes over,” Horwath said on Twitter.
“[Ford] has no choice to immediately require the resignation of Minister of Long Term Care Merrilee Fullerton.”
Ford has stood by his minister and she’s defended herself.
When Horwath recently asked the premier during question period why he hadn’t asked the minister to resign, Fullerton answered.
“Please don’t make it about me … It is about serving Ontarians.”