February 27, 2006

Canadian Health Care Held Hostage: Will Conservatives Free It?

Even the New York Times now agrees that Canada's much-vaunted socialist health-care system is "faltering."

Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.

Not only is the system breaking down, it is beginning to be supplemented -- and eventually supplanted -- by a return to a private health-care system. This is happening in classic "boil the frog" fashion, with little steps here and there. But unlike, say, the creeping centralization in the United States, Canada is experiencing creeping privatization... a good and necessary change for our neighbor to the north.

The Times opens with a long anecdote about Canadian Dr. Brian Day, who operates a private hospital in British Columbia, in open defiance of Canadian healt-care laws. His Cambie Surgery Center charges patients money for treatment, just as an American hospital would do. However, even there, most of the hospital's income is legal; many of the public hospitals have begun referring patients to Dr. Day. However, Day plans to open other centers in other provinces... and he has already been threatened with legal action by the provincial government of Ontario:

Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court.

"We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Dr. Day is not being reckless in his eagerness to go to court: the Supreme Court of Canada already ruled months ago, in a case in Quebec, that the country's ban on private medical care is unconstitutional when it interferes with the ability of patients to get treatment (though by a narrow 4-3 decision). Since the decision was based upon the Quebec Charter of Rights, not the Canadian Charter of Rights and Freedoms, it does not necessarily apply to any other province; the same justices split 3-3, with one justice making no decision, whether the ban violated the Canadian as well as the Quebec Charter.

The Quebec government reacted by saying it would apply immediately for a stay of between six months and two years before the decision takes effect, given the chaos it could cause in the delivery of medical services in Quebec.

Intergovernmental Affairs Minister Benoit Pelletier said the province would consider using the notwithstanding clause in Quebec's constitution as an alternative to abiding by the court's decision.

But it's the first crack in the northern ice. Besides trying to sidestep the Supreme Court of Canada's decision, Quebec is also trying to resolve the underlying problem -- which it recognizes at last as a problem. From the New York Times article:

In response [to the ruling], the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.

Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court.

One Vancouver-based company launched a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics — in Toronto, Ottawa and London, Ontario — next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI tests are opening around the country.

In an interesting parallel with socialist arguments against school vouchers in America, socialist defenders of "free" health care in Canada warn that allowing private clinics will "drain the public system of doctors and nurses." This is tantamount to an admission that doctors, nurses, and patients are unhappy with the current system, though of course defenders of the status quo don't recognize that is what they are saying. Similarly, Americans who attack vouchers because students will flee the government schools are in fact making a wonderful argument for vouchers: they implicitly admit that when parents are allowed to "vote with their feet," they opt for capitalism over socialism.

Much of what is driving the surreptitious (or at times, openly defiant) move towards a market in health care is the utter failure of the socialist model to deliver services in a timely manner. That is, the surgeries don't run on time. Waiting periods between initial consultation and treatment can run months or even years, causing many Canadians to bolt south to American hospitals to buy privately what they cannot beg from their own government.

But such stop-gap measures will not satisfy Canadians for long, I suspect. The capitalist impulse is strong, for the simple reason that the laws of the market are not just idealistic yearnings; they are laws of economic nature that cannot be evaded. Socialism can control the price but not the cost of goods and services; and eventually, somebody has to pay the difference between the two. In Canada, as in the United States, that piper-payer is inevitably the middle-class taxpayer.

But equally inevitably, such taxpayers demand they get their money's worth. And when the government proves incapable of delivering it, even Canadians will overcome their Eurocentric revulsion of dirty capitalism and opt for what works over what is flattering to a narcissistic altruism.

Now Dr. Day says he is considering building a full-service private hospital somewhere in Canada with a private medical school attached to it.

"In a free and democratic society where you can spend money on gambling and alcohol and tobacco," Dr. Day said, "the state has no business preventing you and me from spending our own money on health care."

That sounds like an American talking. Perhaps someday, Canadians will not see that as a mortal insult.

Hatched by Dafydd on this day, February 27, 2006, at the time of 4:54 PM

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The above hissed in response by: KarmiCommunist at February 27, 2006 7:07 PM

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