CANADIAN HEALTH CARE

Some excerpts from the inimitable Mark Steyn

Roy Romanow justifies the state's monopoly on health care on the grounds that "Canadians view Medicare as a moral enterprise, not a business venture." Well, if they do, they're very mistaken. Medicare isn't a moral enterprise: what's moral about removing a citizen's responsibility for his and his dependents' health care and entrusting it to the state? If free citizens of advanced, wealthy economies are not prepared to make provision for their own health care, what other basic responsibilities are they likely to forgo? Socialized health care redefines the relationship between the citizen and the state. Even if it worked - even if it wasn't a decrepit, SARS-spreading sinkhole - it would still be bad in its softening effect on the citizenry.

But, of course, it doesn't work. In April this year, Gerald Augustin of Riviere-des-Prairies, Quebec went to the St. Andre medical clinic complaining of stomach pain. He'd forgotten to bring his Medicare card, so they turned him away. He went back home, collapsed of acute appendicitis, and by the time the ambulance arrived he was dead. He was 21 years old, and he didn't make it to 22 because he accepted the right of a government bureaucrat to refuse him medical treatment for which he and his family have been confiscatorily taxed all their lives. Clinic director Rouslene Augustin says it's the policy to refuse all patients who don't have their cards with them. No big deal, he wasn't anything special, no-one in her clinic even remembers giving him the brush.

A few years back, when my little boy was a toddler, I had to rush him to Emergency at the Children's Hospital in Montreal. They asked for his Medicare card. I didn't have it. The missus usually has it with her, and she was out, and we don't usually think to shuffle it back and forth between us all day. So the receptionist said we'd have to go away and come back later. In all my experience of American, British, French, Swiss, Austrian and other health care systems, I'd never heard such rubbish. I had my card. He's my dependent. What would cause her to think he didn't have a card or wasn't entitled to one? And, given that the cards are generated by a computer anyway, why isn't there a database of current card holders? Well, I kicked up a fuss, swore like Paul Martin reacting off-mike to a Gary Doer soundbite, and, after ten minutes of yelling, they agreed to see the kid. Perhaps if M Augustin had done that, he'd still be alive.

A year or so later, south of the border, another child had a fall on Thanksgiving and had to go to hospital for a couple of stitches. We pulled up at the door, the boy was taken to the examining table, and while they were looking at him the nurse handed me a release form to sign, giving them permission to treat him. Only after they'd looked at him and calmed him down and everything was underway did they suggest I saunter along to the desk to fill in the paperwork. Whatever the particular deficiencies of America's or any other health service, any system that requires the operators to respect you as a client rather than tolerate you as a ward of the state is, in Romanow terms, more "moral".

In a soft culture, the only hard power is wielded by bureaucrats - the fellows who told M Augustin that no matter what pain he was in they weren't going to see him. But, what's fascinating to me is that, no matter how inept the nanny state is, no matter how bad the health care system gets in reality, Canadians are still unwilling to give up on its utopian virtues - universal lack of access, equality of non-care. We believe it's more moral to take poor government health care than to make arrangements for our own.

The Canadian system is supposedly designed for the weakest in society - the unfortunate person who needs medical treatment but, without the state, would have difficulty gaining access to it. But, by treating all of us as the weakest in society, the state softens us - and softens itself. When health care is the government's responsibility, it becomes its principal responsibility. Imagine if we had as many high-profile conferences on national security as we do on health. But we don't. Because the minute you make government the provider of health care, you ensure that, come election time, the electorate identifies health as its number one concern. Thus, in a democracy, the very fact of socialized health care seduces government away from its prime responsibility - the defence of the realm.






HISTORY SHOWS THAT BETTER MEDICAL CARE IS POSSIBLE

This article starts out with a comment on the recent Australian elections. The Labor Party's Mark Latham had promised to institute "Medicare Gold" -- a policy to give people over 75 first place in the queue (line) for medical services

Apparently Mark Latham informed the first meeting of caucus since the election that Medicare Gold is to remain Labor policy. This was a mistake - the sooner Medicare Gold is forgotten the better. Medicare Gold should be contrasted with the golden age of medical care, the years before the Whitlam government socialised the system.

There were no waiting lists then, hospitals did not turf out patients before a proper convalescence and costs were closely monitored. Most people had insurance, the government looked after pensioners and doctors did a vast amount of pro bono work.

Contrast that with the situation today. Hospital waiting lists are lengthening, the NSW Government has just abandoned a complex and unnecessary system of hospital administration it had installed at great expense, while the community remains concerned about the unusual number of deaths in hospitals. A man was left bleeding outside Sydney Hospital - next door to Parliament - because doctors and nurses refused to help.

As with transport, water and electricity and other infrastructure, efficient management of the public hospitals seems to be beyond at least some of the state governments. No wonder the NSW Premier engages in such distractions as the Kyoto Protocol - a federal issue if ever there was one - or keeping the Governor out of Government House, changing Crown land into State land, and removing the politicians' Oath of Allegiance. Now he is trying to hand the hospitals over to the Commonwealth. He no doubt would want to keep those golden rivers flowing from the GST which Mr Howard, at great political risk to himself, gave the ungrateful state governments.

Under Mr Latham's retained policy, anyone over 75, even a multi-millionaire not in any urgent need, may jump the queue at a public hospital. (Queues of course are an inevitable feature of socialised medicine.) This recalls those earlier "reforms" of the 70's to provide aged pensions and free university education without any regard to need. Neither lasted for long, but long enough to do damage. The universities have never fully recovered....

Instead, we should gradually expose the health market to the beneficial effects of competition. At the present time, with most health costs paid by government, there is little control and no incentive for suppliers to compete about price. And entry into the medical profession, especially as a specialist, is still too restrictive. The move of nursing to the universities was an error. Entry should be through an apprenticeship, with graduate programmes available to those nurses who wish to specialise later in their careers.

The idea that health, or the universities, should be isolated from the rest of the economy, and provided "free" by the government is a concept which can never work. It is, will always be, both a bottomless pit for the taxpayer, while never being able to provide the level of service which citizens in an advanced society deserve. It will be said that health is different, but we leave other necessities to the market, for example cars, homes, and food. Imagine if the government levied us so that some agency could provide us with the cars, food and homes it decided we deserved. There is no need to imagine the waiting lists, the waste and the quality that would result. Just look back to the wonderful achievements of the USSR.

Health care needs a competitive market. The role of the government should be to ensure that a safety net exists for the needy, the markets for health products and services and for health insurance are competitive, and that there are a range of insurance providers, including mutual insurers. Above all, government should see that we are able to insure against calamities, at reasonably competitive premiums.

Of course it is difficult to change a system that is already in place, especially one in which so many political ideologues have vested interest. But we do not need the government to take our money to pay for the occasional visits to a GP, just as we don't need it to tax us to pay for visits to the dentist or the grocer, and for visits from the plumber or the TV repairer. And by insisting that all the health and health insurance markets are more competitive, not only can we return to the golden age of health care we had in the 70s, we can improve it.

More here


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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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