Commentary by Andy
Stevens, 2/13/19.
At the end of January, a
rather smugly proud Gov. Gavin Newsom of California and a feisty Mayor Bill de
Blasio of New York appeared on U.S. national news on the same night, the former
to announce free “guaranteed health care for all Californians” and the latter,
free “universal health care” to all New Yorkers.
The United States is
talking about trying Canadian-style socialized medicine. I’ve been a fairly
contented user of Canadian socialized medicine my entire adult life, and I know
a lot of good people in the system. But I’m also a public critic of it, due to
its expense, delays, and limitations, but especially because there’s simply no
moral justification for the forced socialization and policing of health care in
a free society.
Ideologically speaking,
no socialized medicine scheme can succeed for long, because the very principles
and deceptions by which it is justified lead to its downfall. Canadian
socialized medicine is near the end of a long process of consuming itself both
ideologically and financially. So, in what follows, I offer a few warnings to
our U.S. friends.
Lies About ‘Free’ Health
‘Insurance’ - When it comes to
government-controlled, single-payer health care, the word “free” is an
illusion. So is the word “insurance.” Nothing is free—although it may be
prepaid for you by someone else. The province of Ontario, where I live, has an
“Ontario Health Insurance Plan” (OHIP). It’s a well-meaning Ponzi, or “pay-go,”
scheme, as economists say, because there is no insurance, and never has been.
Money is simply taxed from mostly younger working people and doled out for the
health care of mostly older sick people. In Ontario, 10 percent of the
citizenry (mostly seniors) consumes 77 percent of all health care.
Socialized Medicine Is
Very Expensive. Canada’s state-controlled system is per capita among the most
expensive in the world ($6,839 for every citizen in 2018). But it rarely gets a
B from international agencies ranking national health care systems. A 2017
Commonwealth Fund study of 72 metrics of health care in 11 nations ranked
Canada third from the bottom. The United States ranked last, which is an irony,
because the United States has the best medicine and medical science in the
world, but not the best medical delivery system.
A further irony, when
comparing medical spending, is that there is no particular connection between
national health care spending and the health of citizens. Many countries, such
as Japan, spend as little as half of what Canada spends (and a third of what
the United States spends), but their citizens are no less healthy, and often
more so.
Canada and the United
States each spend about 7 percent of GDP on public health care. The rest of
Canada’s roughly 11 percent total, and the United States’ 17 percent total, is
private. Canada’s program is publicly administered, but privately delivered
under strict state controls. The difference in the totals is because American
citizens are still free to spend as much of their own money as they wish on
additional private health care and insurance, whereas Canadians aren’t.
Individual doctors and medical institutions in many provinces of Canada are
subject to prosecution and serious fines for providing private care in
competition with the public system. You could say Canadians are health care
prisoners.
Canada’s Experience - Canada
formalized its socialized health care program with the Canada Health Care Act
of 1984, which insisted on provincial compliance with certain “principles” of
the Act, such as universality and accessibility. The federal government then
offered massive cost-sharing subsidies—a form of fiscal bribery—to all
provinces in exchange for coast-to-coast compliance with the principles.
Provinces found in breach have been docked millions of dollars.
The act made Canada,
along with North Korea and Cuba, one of the few countries in the history of the
world to outlaw private medical care (though North Korea and Cuba have recently
dropped the ban). Ontario can issue fines of up to $25,000 to individuals and
hospitals found guilty of queue-jumping (although, as I shall point out, there
is lots of that). This calls for a lot of inspectors and surveillance.
Medical Police - Canada’s once-free physicians soon realized
their entire profession was going to be overseen by—there’s no other word for
it—medical police. There would be strict state control and scrutiny of fees,
fines for contraventions of the act, and queries from government inspectors
about the “reasonableness” of additional treatments or referrals to
specialists.
My own general
practitioner (GP), a good and caring man, has remarked to me often, when I
inquire about possibly being allowed a certain additional treatment, “Well, I
don’t suppose that would be an abuse of the system.” He means that, in my case,
he’s decided that it’s justifiable to spend scarce public money on me (and that
he’ll be able to defend his decision if questioned by the medical police). So
you see, he’s not just my doctor. He’s my medical master and gatekeeper.
eSnooping - All
physicians in Canada used to swear on the Hippocratic Oath to maintain strict
physician–patient confidentiality. But administratively speaking, that has
evaporated. Poof! From the start of Canada’s socialized system, any citizen’s
private medical file could be seized and reviewed by a medical officer of the
state—perhaps your neighbor down the street? They have the right to open your
file and inspect the private details of your reflux, your cancer, your
hemorrhoids, your gall-bladder surgery, your erectile dysfunction, whatever.
But it gets worse. Now
we have eSnooping. With recently updated electronic patient-record systems,
health inspectors can now do all their peeking into your once-private medical
history electronically. To reflect a little on such unlimited invasion of
intimate privacy by a government official is to feel a slow burn.
Canary in the Mine - Canada
is the canary in the mine for the United States’ socialized medical future. So
here’s what can be expected. Socialized medicine is in competition for public
funding with all other government services, such as roads, education, culture,
policing, and so on. When it began in Ontario in 1968, the OHIP program
accounted for about 25 percent of all expenditures.
There were lots of
warnings from skeptics that triage of patients and rationing of scarce
resources would soon begin, and government would be unable to control spending
due to unlimited demand from patients and gaming of the system by doctors,
nurses, specialists, technicians, medical equipment suppliers, and drug
companies. And because Canada had turned the illusory notion of free medical
care into a sacred “right,” no one would dare limit it. Whenever they try, as a
former premier of Alberta soon found out, “everyone’s hair lights on fire.”
Crowding Out in
Socialized Medicine - By 2017, the cost for socialized medicine in Ontario had
risen to 44 percent of all government expenditures, and it’s heading straight
for 50 percent. In a disturbing report on health care spending issued in 2012,
Don Drummond, chief economist of the Toronto-Dominion Bank, warned, “Things
will only get worse as health care eats up every other public service, like an
insatiable Pac Man,” and that it would rise to 80 percent by 2030.
Critics thought he was
exaggerating. But in terms of a province’s “own-source revenue” (total revenue,
minus federal subsidies and debt repayment), many provinces of Canada are
already very close to spending 80 percent of their own revenue on health care. As
U.S. political satirist P.J. O’Rourke warned long ago: “If you think health
care is expensive now, just wait ’til it’s ‘free!’ “
Long Waits - Dr. Brian
Day, a former president of the Canadian Medical Association, warned in a New
York Times interview<https://www.nytimes.com/2006/02/26/international/americas/as-canadas-slowmotion-public-health-system-falters.html>
in 2006 that “[Canada] is a country in which dogs can get a hip replacement in
under a week and in which humans can wait two or three years.”
Vancouver’s Fraser
Institute, a highly respected think tank, published an annual survey of 12
medical specialties in 2018. It revealed that, on average, specialist
physicians report a median wait time for medically necessary treatments of 19.8
weeks from referral by a GP to receipt of treatment.
<https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2018>
The wait from first
consultation to orthopedic surgery is the longest, at 39 weeks—10 months—and
from diagnosis to the start of oncology treatment, 3.8 weeks. For scans, it’s
4.3 weeks for a CT scan, 10.6 weeks for an MRI scan, and 3.9 weeks for an
ordinary ultrasound. The institute reports that, typically, more than a million
Canadians are wait-listed for medically necessary treatments.
Waiting for care is so
common that, in 2005, Canada’s own Supreme Court publicly warned the nation
that “access to a wait list is not the same as access to health care,” and that
in some serious cases—which are on the record—”patients die as a result of
waiting for public health care.” Citizens die because the government makes them
wait for health care. What kind of country admits such a thing without shame
and blushing? Toronto’s mayor describes the sad spectacle of patients languishing
in the corridors of overcrowded hospitals, as “hallway medicine.”
A Multi-Tiered System - Socialized
medical systems are never single-tier, as promised, or even two-tiered (that
publicly dreaded possibility). They are, in fact, and inevitably, multi-tiered.
First, there are several triage tiers—tiers within tiers—where patients wait
differing lengths of time, according to the severity of their illness.
Then, there are the
professionals, or even ordinary citizens, who just happen to know someone working
in the system—the big-name athletes; the big business people; the media stars;
the politicians; the police; the military brass; and, not surprisingly, doctors
and nurses themselves, who get immediate care from their own hospitals.
Finally, there’s anyone who lives close to the best hospitals and doctors
rather than hundreds of miles away. Unionized workmen get treatment for
injuries in a week because the government doesn’t want to get stuck with their
disability payments, while an ordinary citizen may have to wait for months.
When I first began
investigating the questions of medical tiers in Canada, I discovered that many
of Canada’s members of Parliament in Ottawa were walking down the street for
same-day medical care at a military hospital intended for soldiers only. That
was halted once the story broke. And I almost forgot: Statistics Canada reports
a huge tier of almost 2 million Canadian citizens who complain they have no
doctor because Canada is short on doctors.
Medical Tourism Booming
- There’s another very large Canadian tier engaged in medical tourism.
Thousands of Canadians—64,000 in 2018 that we know of, and surely thousands
more who aren’t telling—travel a long way to countries such as the United
States, Costa Rica, the Cayman Islands, Cuba, and South Africa for services
that are unavailable in Canada. People in this tier spend close to a billion
dollars per year in other countries, either because they are forbidden to spend
it for private care in Canada, or because the services, technology, or
specialists are not available here, or the pain and the wait are just too long.
Most shocking of all is
that many of the people engaged in these expensive medical jaunts are the very
politicians who write laws forbidding Canadians to spend their own money on
private medical treatment. Among them are two former prime ministers of Canada
(Joe Clark and Jean Chretien), two provincial premiers (Danny Williams and
Robert Bourassa), and we suspect other government ministers and elected
officials who aren’t telling. These people want private health care for
themselves, but not for the voters.
Private Clinics - Most
of Canada’s provinces have below-the-radar private clinics that operate in
contravention of the Canada Health Act. Medical police pursue them for years to
shut them down. Lawsuits follow. Some are shut down. New ones open up. More
medical police. And around it goes.
The same Dr. Brian Day
mentioned above has already spent $2 million in court fighting for the survival
of his private medical clinic in Vancouver. Even though, when citizens pay his
clinic for care, it reduces the government’s expenditures, the government is
trying to shut him down for ideological reasons. They argue that money in your
pocket shouldn’t determine the quality of care you get, even though the same
government doesn’t mind if money in your pocket determines the kind of condo,
or car, or bicycle, or food you buy. And they go silent when informed that
there would be a lot more money in everyone’s pockets if the government weren’t
taking so much of it in the first place.
The most recent private
initiative in Canada was to open private hospitals on Indian reserves, where
Canada’s laws against private medicine don’t apply. Health Canada reacted
sharply: Such private hospitals might be allowed, but only if they cater solely
to foreigners.
Foreigners Can Pay Cash
for Care - If you’re a foreigner, and have cash—money from outside Canada’s
socialized system—immediate health care is available to you for, say, a
surgical procedure today, for which a tax-paying Canadian may have to wait a
very long time. So let’s see now: A full citizen who has been paying taxes for
an entire working life for medical care is forbidden by law to use personal
funds to purchase the same surgery offered today to a foreigner for cash? That
seems very wrong.
Physicians Gaming the
System - And, of course, many physicians learn to game the system to keep their
earnings up. Good, honest folk, for sure. But only human. Lots of studies have
revealed that in any government-controlled health system with scarce resources,
physicians may be found engaging in “time shuffling,” “upgrading,” “injury
enlargement,” “ping-ponging,” “service splitting,” “phantom treatment,”
“assembly-line treatment,” and more. I didn’t invent these terms. They are easy
to find in the fevered calculations of health economists.
Veterinary Medicine for
Humans - Surely, the most damning moral fact about any socialized medical
system, however, is that it converts human medicine into veterinary medicine
for humans. Think about it. The machinery, medicines, and procedures used to
treat your pet dog or cat are the same as those used to treat you.
In a free and open
society, humans have a say as to how much and what kind of treatment they want
to purchase, or to insure themselves for, or to refuse. But animals don’t:
Animals have medical masters. Meanwhile, in a closed society with a socialized
medical regime, the quality, availability, and timing of medical services that
citizens are permitted to receive are dictated by their master, the state. It
follows that socialized medicine is veterinary medicine for humans. Is this
what Americans want?
William Gairdner is an
author who lives near Toronto. His latest book is “The Great Divide: Why
Liberals and Conservatives Will Never, Ever Agree” (2015). His website is WilliamGairdner.ca
http://williamgairdner.ca/
Norb Leahy, Dunwoody
GA Tea Party Leader
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