How did all these opponents of two-tier health care miss it popping up everywhere around them?

Posted on September 26, 2016 in Health Delivery System – Full Comment
September 26, 2016.   John Robson

Oh, here’s a surprise. Canada has multi-tier health care. Who saw that coming? Or rather, who didn’t see it already here? And the answer is a surprising number of intelligent, informed, passionate, completely wrong people.

When you suggest loosening the stranglehold central planning has on our health-care system, you risk being called an “ideologue.” It’s a curious term, widely used in the pejorative, even insulting “I am principled, you are stubborn, he is ideological” sense of someone wilfully impervious to evidence or decency. And in this context it implies that we free-market ideologues (or “fundamentalists”) insist on applying cold abstract rigid principles to health care at the expense of genuine human values.

Now I could go on at some length about whether lengthy waiting lists for indifferent care at socially unaffordable prices really foster genuine human values. But right now I want to concentrate on something a bit different, namely the widespread failure to see what is in front of our noses by people who spend much time and effort accusing their intellectual opponents of precisely that failing.

Last Wednesday’s National Post had a thorough front-page story on the way public hospitals in Canada and public workers’ compensation systems routinely, even proudly, let certain categories of patients jump the queue and pay doctors extra to treat them early because, duh, incentives matter. And I ask why anyone is surprised, and where they’ve been all these years.

‘Preferential treatment’: Injured workers getting fast-tracked surgery, sometimes within 10 days
More than 20 years ago, in the March 1993 Fraser Forum, I asked why it wasn’t news that Quebec premier Robert Bourassa sought cancer treatment in the United States. A month later, I noted that York Central Hospital was turning its CAT scanner off for most of the day for people because it had no money to run it, then turning it back on for dogs whose owners could pay. And in an April 1994 piece, “Requiem for a Nobody,” I described a man who died on a waiting list (for a hip operation, but the stress got him) and mentioned that there was a special clinic for elective surgery for senior Ottawa bureaucrats, whose existence was only unearthed through a Freedom of Information request by the National Citizens’ Coalition.
In that sense the Post article shouldn’t have been necessary. But it was, and it was commendably detailed. So where have the advocates of socialized medicine been? And what’s with sounding the alarm about “two-tier” health care with all this hidden in plain sight?

In the article some such advocates were quoted as being outraged. But for the most part they’ve been carrying on, including in their thunderous warnings of potential ruin if we had such a system, as though it were not happening. How can this be?

One is entitled to different opinions on the fact that Canada has multiple health-care tiers. But not to different facts.

First, there’s the public system. Then there’s the ability of the rich, or desperate, to seek treatment abroad. Or to access private care in Canada (it’s not illegal to buy or sell it, just to sell insurance of publicly provided services or to work as a doctor in the public and private systems at the same time). Then there’s preferential access for the well-connected. How long do you think a provincial premier, or even an opposition backbencher, will spend on those waiting lists the Fraser Institute, among others, has been so diligent in exposing over many years? Or a professional athlete, elite businessperson or pundit? Or a doctor? Again, duh.

So how can people so ostensibly outraged at privilege and in favour of the common person be unaware that our system is so skewed? Or uninterested in it? And how can they denounce “two-tier” medicine, when we have at least four major tiers and lots of minor ones inside it, including famous politicians getting treatment at private for-profit clinics?

At this point there would be poetic justice in my resorting to the all-purpose peremptorily dismissive term “ideologue” to describe them. But it would be unconstructive. Indeed, it was hurled back and forth by supporters and opponents of the Romanow Report that, you may be excused for having forgotten, saved health care in Canada 14 years ago. And the hurling didn’t get us any further than the report.

So I will content myself with saying there’s nothing wrong with having an ideology, which is just a fancy or abusive term for thinking systematically. What’s bad is having the wrong one. Like thinking central planning can work in Canadian health care, which not only leads intelligent, compassionate people to insist that it is working when it clearly is not, but to react with abuse rather than analysis when challenged.

Multi-tier health care is all around us. The question is: what are we going to do about it?

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