Crawl Across the Ocean

Monday, March 06, 2006

That Didn't Take Long

Just in case you thought the 'typical' pro-privatization arguments I was trying to refute in my last few posts were straw men or not representative of what people argue, Lysiane Gagnon has a column in the Globe (subscriber only but you're not missing much, you can probably find it using google news if you must see it) today which, while misleading the public, serves nicely to illustrate what I've been talking about in the last few health care posts.

The article is sort of about how Alberta's plan for no holds barred two tier care is better than Quebec's plan for some holds barred two-tier care, but mainly it's just a recitation of pro-privatization talking points.

First off, the ritual invocation of Europe:

"Throughout Western Europe -- including social-democratic countries such as France and Sweden -- physicians can work for both the public and the private sectors as long as they respect certain quotas that ensure priority is given to the public sector."

No mention, of course, of how European countries which have a parallel private system do so in the context of an overall health system which covers a higher percentage of health costs publicly than ours does, but to be fair, if the point is only that it is possible for a social democratic country to have two tier care, then I guess it is fair enough, as far as cherry-picking goes.

"Quebec will pay for patients to have surgery in private clinics (in the province or anywhere else in North America) if the public system cannot accommodate their needs within six to nine months after a specialist's diagnosis. This will hugely increase the taxpayers' burden.

Alberta, on the contrary, considers the present system financially unsustainable (a sound analysis if one looks at the numbers), and wants more private money to be injected in the system. It will encourage patients who can afford it to buy private insurance to have cataract surgery and knee and hip replacements in the private sector."

You see, if the province pays for it, it is a 'huge increase in the taxpayers burden', but if people pay the same amount (or more) themselves, this is 'an injection of private money into the system'.

Let me say it one last time: it doesn't matter what shell it is under or whose hands it passes through, money spent on health care is money spent on health care.

Also, note the bold assertion that if 'one looks at the numbers', the system is 'financially unsustainable'. Well I've looked at the numbers, I've even put a few of them in colourful chart form, and it doesn't look unsustainable to me. True, I don't analyze numbers for a living (wait, never mind) - true, I'm not a health care expert but I just don't see how spending an extra percent of GDP on health every decade or so is so unsustainable.

I guess it's true that the cost of the system might be unsustainable if provinces refuse to raise taxes, but this is akin to saying that a private system would be unsustainable if people refused to pay any money for private medical procedures. We will never be able to provide infinite health care, of course, so there will always be rationing based on some criteria, just as there is for every other product or service we consume, but that's just the way it is - it's not a reason to make the system more public or more private.

There's lots more silliness in the article, but I don't have all day, and I just wanted to highlight the parts which directly illustrate my point from the last few posts. Maybe a legitimate case can be made for a two-tier system, but I haven't seen it yet. Scaremongering about 'unsustainable costs' just brings to mind the recent battles over Social Security in the United States. And if you want to convince me of anything, I don't recommend working from the George Bush persuasion tactics playbook.


  • "Maybe a legitimate case can be made for a two-tier system, but I haven't seen it yet."

    It's about the freedom - i.e. freedom to spend our money on whatever we please, including health services.

    All of your economic/fairness/etc arguements ignore the fact that by imposing single-payer health care on the public, personal freedom has been harshly curtailed.

    Perhaps that's okay with you. Perhaps freedom is an acceptable sacrifice upon the altar of efficency in your mind... but to me, enforcing a single-payer system is not worth that cost.

    By Blogger Andrew, at 4:05 AM  

  • Unless, of course, you can't afford the private system because you are ill, or because you can't make enough money to afford it because your spouse is ill and you have kids to take of.

    In which case, with a full-blown private system sucking scarce resources out of the public system, your freedom becomes severely curtailed.

    A public system maximizes freedom for the most people. A two-tier system maximizes freedom for the monied.

    By Blogger Mark Richard Francis, at 9:37 AM  

  • I guess in some ways I see it being like the prisoners in the prisoner's dilemma demanding the freedom to be able to rat one another out and go to jail for 10 years.

    In other ways I see it being like a man in a lifeboat demanding the freedom to row to safety without first stopping to pick up any of his fellow passengers.

    I certainly sympathize with the deisre to have the freedom to make dumb/selfish decisions, I just think the tradeoff favours a single payer system in this particular instance.

    Similarly, many drivers probably consider rules requiring them to stay on the road, stick to one side of the road, obey the speed limit, obey all signs and traffic signals, etc. etc. to be a sharp curtailment of their freedom. But we enforce these rules nonetheless, because the costs of not restricting freedom exceed the benefits of greater freedom in this instance.

    By Blogger Declan, at 9:39 AM  

  • Another issue which I raised is the issue of money. There's no hard and fast rule in our society that says that those with the cash have somehow contributed more. Someone can make millions selling some useless, environmentally-damaging widget, while someone else can make nothing voluntering their time to clean the mess up.

    Would we give politicians special access to the second tier? Or pay for a great insurance package? I ask, because they don't make a huge amount -- they do well, but a serious illness could still set them back a ways fiscally. Yet, would it be fair to argue that they are less deserving speedy health care than some captain of industry or a mob boss?

    Wealth allocation is so illogical in our society, that it can't be a basis for allocating something as essential as health care.

    By Blogger Mark Richard Francis, at 11:31 AM  

  • You both write with the underlying assumption that two-teirs would deny services to users of the "lower teir". That's a faulty assumption.

    By Blogger Andrew, at 4:58 AM  

  • "That's a faulty assumption"

    How is that faulty?

    You and I have discussed many times how the shortage of doctors and nurses will mean that less doctors and nurses in the public tier.

    That means that wait times will be longer in the public system. That means the resources will be diverted to the private system and not be available to the public one.

    Doctors may end up forcing patients to sell their car or their house so they can afford faster medical treament in the private system. This is because they have a perverse incentive to keep wait lists longer and medical quaility lower in the public system - doctors will do this because they will get more money. This happened in the UK and in Australia, it will no doubt happen here, especially under the model Ralph Klein is proposing. Doctors won't care how you get the money, only that you do, so you can pay them. We already have doctors writing letters to the Ottawa Citizen looking forward to being able to make more money by working for a Copeman Clinic, so it will happen here.

    And in the end, the "lower tier" will have far longer wait list and poor quality or no services. See, its a perfectly valid assumption, based on good reasoning and precident from other, similar countires experience with this sort of thing.

    Mark is right - only people with money will afford that "freedom". We'll be back to a time where catastrophic illness leaves you destitute or you suffer for years with easily curable conditions because you cannot afford treatment. These were the reasons we got single-payer, healthcare in the first place.

    And what will that do for Canada? You will spend about 3 times more for procedures as you do now. You will spend more on insurance premiums, and get less in return. You may be denied coverage. It will cost you more money and you will get less services. But insurance companies, HMO and doctors will get very rich.

    And there will be a large underclass of people that can't afford medical care, who will suffer more than they do now.

    You are proposing medical care be doled out and prioritized based on ability to pay rather than medical need. Sorry, but that is just wrong. Its a fine way to ration cars and TV but not healthcare for Canadians.

    Sorry, but there is no "freedom" at all in any of this. And if we had decent wait times, there wouldn't be people wishing the "freedom" to buy their way to the front of the line. Your "freedom" to buy your way to the front takes away the freedom of someone who can't and pushes them back from the front.

    That't not freedom. That's elitism.

    Why not take some of that extra money you are so willing to spend on private insurance or private procedures and spend it on a modest tax increase so that everyne get through the line faster?

    By Blogger Mike, at 12:32 PM  


    Another glimpse into the future if Ralph's vision is followed.

    By Blogger Mike, at 5:56 AM  

  • I'd like to point out a factual mistake you made. You argued that taxes come out of our pocket, and thus are the same as private sector spending. Actually, the private sector is not synonymous with taxpayers, because it includes business.
    That said, if we could see businesses taking a stakeholder approach to their affairs rather than a shareholder approach, it might be possible to have them pay the (some?) costs of health care.

    By Blogger lecentre, at 7:23 PM  

  • Sorry, make that the private sector is not synonymous with individuals. I didn't mean to imply businesses don't pay taxes.

    By Blogger lecentre, at 7:24 PM  

  • Businesses are just people dressed up in different (legal) clothes. Any money spent by business is money that could have gone either to their owners, their workers, or their customers, so I don't really see a big difference either way.

    Personally, I like to keep business out of politics as much as possible, so I'd prefer that they don't pay for health care.

    By Blogger Declan, at 1:03 PM  

  • They may be dressed in different legal clothes, but they can't be considered the same. Consider GDP rising as salaries have stagnated. Business or government or both must have gotten the balance of the new money.
    Anyways, your post is in my roundup of moderate politics: the Moderate Circus of Canadian politics.

    By Blogger lecentre, at 7:29 PM  

  • Well, normally, I'd just say that if business or government got the money it would circulate on to people as they spent it.

    But with both business and government sucking up much of the economic growth to pay down (or at least stop increasing) their debts, to a certain extent the money is simply disappearing (or reappearing as increased consumer credit -> housing bubble, depending on your point of view), so perhaps some distinction can be made between people and business.

    Anyway, thanks for the link.

    By Blogger Declan, at 9:37 PM  

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