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Monday, 6 August 2012

Some Thoughts on Philanthropy

As many of you know, I recently rode in a charity ride around the Cabot Trail in Nova Scotia. The organisation I supported, Coast to Coast Against Cancer Foundation, raises money to provide support services for children living with and beyond cancer. During my brief adventure I spent many an hour contemplating the place of philanthropy in modern health care. Here are some of my thoughts.

Going into the ride I was sceptical. I've recently become increasingly more leery of philanthropy as I've gotten older. For the most part this has to do with the fact that philanthropy is largely becoming the stand-in for the social welfare system. The broader trend over the past decade in Canada has been that public subsidies for health care have decreased, despite legal protection in the Canada Health Act. Provinces, and more recently the Federal Government, have made significant cuts to public services, health care included. These cuts make services less affordable and ultimately ensure that the quality diminishes over time. The claims are then made that public systems are inefficient in order to justify more privatisation. The cycle continues such that the social welfare state is in a serious retreat in all of Canada. This is part of the neoliberal model, an ideology designed to free up markets even further.

The difference between subsidised public health care services and a private system is that private health care is for profit. In Canada there has been steady growth in private-for-profit operations which are fee-for-service, meaning that people are paying for health care out of pocket. This is significant because it shifts the burden from broad (taxpayers) to narrow (users). Moreover, the profit imperative means that society is paying more for healthcare when it is privatised than when it is nationalised. This is best evidenced by the fact that the United States spends significantly more money on health care than Canada - our public system is more efficient.

The importance of this background is that it sets a particular context: health care costs in Canada are rising. This, of course, is happening when the quality of service is consistently being called into question. What's worse, there is much talk about our aging population, the so-called apocalyptic demography. In this context of health care needing saving, philanthropy is largely becoming an answer. In Canada various organisations operate as charities: the MS Society of Canada has several bike rides, the Canadian Brest Cancer Society has Run for the Cure events, the Heart and Stroke Society has a lottery, and various Children's Hospitals have pledge drives. Large organisations that once relied on public funds are now expanding their staff in order to get access to more resources. Effectively, this means that these organisations are becoming more inefficient without public support as they now need to become larger and more bureaucratic.

The reason why this system works, however, is because it removes the burden presumably from everyone. People aren't forced to support health care; instead they have choices. They can choose to support or to opt out, and more than that, they can also pick exactly what causes they want to advance. The results are predictable - instead of money being allocated by government departments based on perceived need, people are choosing for themselves and the most flashy campaigns are the benefactors. By virtue of being more affluent, these organisations can also afford to invest in more and better fundraising. The cycle continues and it is marketing like any other private service.

The rationale here is important, and it brings me to the Coast to Coast Foundation. The organisation was formed about a decade ago and provides support services. Unlike the other charities I listed, Coast to Coast does not provide treatment and it does not finance research. Nonetheless, it fits under the umbrella of care because it helps to support children and their families. Coast to Coast doesn't actually provide services that were ever part of the public mandate. As such, what the organisation does is, effectively, auxiliary to the system. Coast to Coast is not undermining public health care, nor are they promoting privatisation by way of philanthropy.

Nonetheless, I made some observations. Most of the participants for the ride were from Ontario (myself included). I was riding in the Maritimes, so this is obviously a long way away. Part of the reason why many people rode was because they wanted the experience of biking the Cabot Trail, so tourism or having a personal challenge was an impetus for many participants - something that a taxpayer doesn't get when they support public systems. Almost all of these Ontarians, and in fact many of the Maritimers as well, were comparatively wealthy. I don't mean this to disparage: they are the type of wealthy that are successful in the private sector as senior managers and business owners. These people work hard and are looking for a meaningful way to give back to the communities around them. And it makes sense - those with wealth have extended networks of peers that they can draw donations from. I see that, for each participant, the ride is personally meaningful. There is a sense of connection from volunteering time and resources to share with those in need. This is amplified by the fact that what they are doing is entirely voluntary. Participating in a charity event allows those who are fortunate to feel that the position they hold in society is just: they are leveraging their privilege for the betterment of society. While I do agree that what they are doing is noble, I can't help but think of how much more effective it would be if people were simply levied more taxes.

Philanthropy is not going to disappear: it's a lucrative industry in Canada where many people make a good living. That said, it comes off the backs of a sustainable public health care network. What's ultimately important is that the notions of "crisis" in health care are largely overstated. More importantly, the problems with our system are not the result of some inherent disadvantage in being public but instead the direct result of privatisation. Crisis is manufactured by reforms that put profits before people, but there are very successful public relations campaigns out there dedicated to making us believe that public systems are "luxurious" or a "privilege". Health care is a right and Canadians need to organise around infrastructure that protects citizens from an outrageous financial burden.

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