Saturday, September 10, 2016

The Gravest Challenge

Single-payer health care in Canada is under threat, brother! Whatcha gonna do?

If my childhood was all about Looney Tunes and Transformers, my adolescence was dominated by WWF (now WWE) pro wrestling. While Randy "Macho Man" Savage was my favorite WWF star of the late 80s - my mother preferred "Ravishing" Rick Rude - like so many others I was a diehard Hulkamaniac.

Yes, Hulk Hogan. While he'd be eclipsed as a wrestling star by "Stone Cold" Steve Austin, and as a Hollywood star by Dwayne "The Rock" Johnson, Hogan - that pill-tanned, pot-dishing, chemically-enhanced orange superhero - carried pro wrestling on his shoulders from its salad days of Rock 'n Wrestling to stadium-packed Wrestlemanias.

Who could forget his legendary matches with Andre the Giant? The titanic title-for-title bout against the Ultimate Warrior?

His rocky but electric relationship with the Macho Man?

Those of us with fond memories of the Hulkster at the height of his popularity might not know (or care - it is pro wrestling after all) that Hogan's star, and the WWF's by extension, was fading fast in the early 1990s. His main event match at Wrestlemania VII, originally slated to take place in the 100,000-seat L.A. Coliseum, was moved to the medium-capacity L.A. Sports Arena due to poor ticket sales. The NBC Saturday Night's Main Event specials were cancelled due to flagging ratings. And Hogan was a poster child for the steroid scandals that nearly brought the WWF to an end. A leaner, faster, less "enhanced" roster of talent was waiting in the wings, and the fans' love of Hogan came under increasing strain.

One of the elite up-and-comers at the time was Mark Calaway, better known as The Undertaker. Advertised at just under 7 feet, Undertaker was taller than Hogan, just as strong, but far more agile and versatile in the ring. In contrast to Hogan's prima donna reputation, Undertaker quickly became one of the most respected men in the locker room, revered to this day. Unstoppable and undefeated, Undertaker's meteoric star power led to the only place it could: one year after his debut, Undertaker was booked in a big-money showdown with Hogan for the WWF title. At the November 1991's Survivor Series show, it was to be the Hulkster's "Gravest Challenge".

Okay, why the recap of 25 year-old WWF angles? For one thing, I had to try and top my post on the Gong Show from last month, and you never know where inspiration will turn up.

More importantly, the Gravest Challenge to Hulk Hogan is as good as any analogy for Medicare in Canada these days. In some ways, Medicare today is a lot like Hogan was in the early 1990s: a beloved icon, still performing well some of the time, but losing much of its sheen and failing to please the owners the way it once did.

Of course, Medicare is now facing its own set of grave challenges, this time in the courts. There's little point in going over the specifics of Dr. Brian Day's lawsuit. Real journalists have already done that, and there's no shortage of debateanalysis, and opinion out there as to whether private health insurance would be a good or bad thing for Canada.

The travesty, of course, is that we never should have reached this point as a country. The Supreme Court of Canada struck down the ban on private insurance in the landmark 2005 Chaoulli decision, but the implications of the ruling were restricted to Quebec.

(Everything that happens in Quebec applies only in Quebec, except for the infamous "WWF Montreal Screwjob" that forever changed pro wrestling, but I digress.)

Even before Chaoulli reached the Supreme Court, though, the federal and provincial governments had well-grounded legal opinion that a lack of timely care would put Medicare on trial for its survival:

 - Thus, in the Committee’s opinion, the failure to deliver timely health services in the publicly funded system, as evidenced by long waiting lists for services, is likely to lay the foundation for a successful Charter challenge to laws that prevent or impede Canadians from personally paying for medically necessary services in Canada, even if these services are included in the set of publicly insured health services. - 

The passage is from The Health of Canadians - The Federal Role, more commonly known as the Kirby Report. Together with its contemporary, Building on Values: the Future of Health Care (aka the Romanow Report), governments were reminded quite forcefully that the Canadian public continued to treasure single-payer health care, but as it was (and remains) structured, court challenges were inevitable without fundamental reforms put in place.

Kirby was largely ignored, sadly ironic given that it was by far the more comprehensive report. Romanow, of course, became a bludgeon for the provinces to extract health care money from the feds. The result was the 10-year "Fix for a Generation" that funneled billions upon billions into provincial coffers. Canada bought a hell of a lot more health care, but whether it bought reformed health care is very much open to interpretation. 

There's still time before Dr. Day and friends go before the Supreme Court, and the merits of the case have yet to weighed. Assuming the case will get to the Supreme Court, however, and based on the outcome of Chaoulli, there are really only three plausible scenarios for Medicare As We Know It in Canada.

1. Governments act like a deer in the headlights, despite 15 years of warnings. The Court strikes down the various provisions of the Canada Health Act and provincial laws that enshrine single-payer health care. Some form of private pay is legalized for non-emergent but "medically necessary" services, ushering in an Australia-ish insurance or cash-pay "second tier". Medicare As We Know It is put out of the misery that so many claim it's in. 

2. The Court makes a measured decision, punting things back to legislators. Governments cobble together a series of half-measures, practice restrictions, and targeted investments - not unlike Quebec's Health Insurance Act amendments that allow private insurance for long-wait-list surgeries (joint replacement and so on) - to keep most of Medicare intact. Medicare will be a "Frankenstein" social program - functioning poorly, but patched together enough to satisfy the Court and maybe get a party re-elected.

3. Governments make a monstrous investment in health care capacity, spending whatever's necessary to uphold a "timely access guarantee" mandated by the Court. What that might look like will have to keep for a later post, assuming that's what the public wants and is willing to pay for.

I have no idea how this will all unfold. I have my own thoughts on what I would do if appointed Czar of All Health Care in Canada. That too will have to keep for a later post.

But getting back to the Hulkster, it's worth noting how the Gravest Challenge turned out for him. He lost. He lost, and a good chunk of the crowd erupted in cheers when it happened (just past the 16:00 mark)...a result unheard of for the WWF's mega-star babyface.   

Then again, after floundering for a few years with ever-declining popularity (and size, presumably due to a major scaling back in the steroids), Hulk Hogan reinvented himself, coming back leaner, meaner, and more popular than ever.

The overhauled Hulk Hogan ushered in pro wrestling's New World Order, kickstarting a boom in the industry's popularity unmatched by anything before or since. Could the same thing happen to Canada's health care system? Food for thought, brother.

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