The Shotgun Blog
Thursday, September 29, 2005
Separation of state . . . and health care
Paul Tuns describes a libertarian argument, here, against the Canadian single-payer system for health care.
There's another way to look at public regulation, delivery, and funding of health care . . . a Burkean conservative, institutional argument.
I'd like to see the separation of health care and the state, so that hospitals and clinics become legally free-standing institutions, and so the profession of medicine isn't coerced by having to either come into the single-payer system or stay out altogether.
I've written at some length about alternatives to the current system on my blog, under the heading Canadian Health "Care" 'one,' 'two,' and so on. Something that's been forgotten is the contrast between what happened in Saskatchewan v. Alberta when the single-payer system was brought in.
When the single-payer system kicked in, hospitals and physicians were flooded with patients needing bones reset that had never been set, boils burst, and on and on. When people in Saskatchewan couldn't afford health care, they went without, and so when the universal, single-payer system came in, there was a huge pent-up demand for health care. But Alberta had a hybrid system:
- Alberta had government-run health units to which people could come for immunization, eye and ear tests, and many of the things that people now take to the emergency ward
- Every Albertan was required to have medical insurance; if someone couldn't afford insurance, the Alberta Gov't had a very inexpensive non-profit insurance option;
- Hospitals were free-standing, municipal institutions locally governed by self-perpetuating boards or Christian charities likewise governed by self-perpetuating boards;
- Physicians and surgeons ran their businesses and governed their profession much as lawyers still do.
When the single-payer system was imposed on Alberta by the federal gov't, THERE WAS NO PENT-UP DEMAND FOR HEALTH CARE.
It's time to disestablish health care. It's time for separation of health care and state.
Posted by Russ Kuykendall on September 29, 2005 | Permalink
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The more private and the less public, the better health care you will get. If you must have public health care, the smaller the jurisdiction which is running the service, the more efficient it will be. But private is always better.
I don't know exactly what was going on in Saskatchewan, but I have a feeling that being considered some kind of national bread basket has tended to make that province a really big, flat welfare trap. The CPR, the free land, the Crow Rate, the Wheat Marketing Board, and so on. Whereas I'll bet that Albertans were mostly left alone to raise their cows and pump their oil. Consequently, economic activity in Alberta - including health care - would tend to be developed on more rational, market-driven lines; whereas Saskabushians would tend to always look to the government to give me land, give me a branch line, give me crop insurance, lance my boil, etc.
Posted by: Justzumgai | 2005-09-29 7:45:31 PM
Alberta (and northeastern B.C.) had homesteading -- believe me, that land wasn't "free." Alberta had the Crow Rate, which during the '30s had the unintended consequence of making transport of beef on the hoof more expensive than what stockmen got for their cattle. Alberta's been subject to the Canadian Wheat Board since its institution. The UFA bought mineral rights from Alberta landowners through the '20s while trying to obtain the 1930 constitutional amendment that gave the Gov'ts of Alberta, Sask, Man, and B.C. title to all Crown land within their borders except for the National Parks. What made the development of Alberta's oil patch such a roaring success was Ernest Manning's creation of a system of oil leases and royalties that is, still, a model for oil fields development around the world. Ernest Manning prioritized public spending to health care in the manner I've already described, to education, and to building infrastructure.
Saskatchewan put teachers on a very small wage on which it was almost impossible to survive, it had no non-profit option for health insurance, and it tended not to invest in highways. I'm not here to defend what T. C. Douglas did. I think the Manning model is far and away preferable. But the Manning model was not a radical individualist, unfettered free enterprise solution. In the Manning model, gov't was limited, but gov't had a role.
Posted by: Russ Kuykendall | 2005-09-29 8:20:35 PM
I want you to consider a different means by which to provide Canadian Healthcare The health care system needs reformed, of that there is no doubt. But as we look to reform of this socialist system we are constantly told, by the left, of the danger of moving to a U.S. style health care system. This is perceived by the public to be the right wing alternative.
Not only have the left created the system of health care we have but they have successfully created the right wing system that we should fear. For this I blame the right because the right has never created its own right wing option. We continue to provide right wing change that we offer to the public to try and make a socialist system work. If the left can’t make a socialist system work how can the right?
I do agree however that private hospitals are not the answer. They will treat the rural communities unfairly because multiple hospitals that could compete will not be an option. As well, even in urban areas, if you had 5 private hospitals only 3 of them will be any good but because all can not go to three hospitals the other two will be able to provide substandard care for the same price and get away with it.
The healthcare system we have resembles the way the railroad functions. It is a government monopoly. It has all of the characteristics of a monopoly. You have no choice but to use it, you have no choice but to fund it and it will damn well tell you how it intends on treating you. I believe that with a fundamental change to the system it can operate more like our highway system where the taxpayer owns the system and health care providers work within a publicly owned infrastructure
The proper way to establish a workable right wing health care option is to create an element of competition at the physician level not the hospital level. In other words the tax- payer should own the hospitals and pay for their maintenance (keep them clean and the shelves stocked) but hire no doctors or nurses. We have private clinics throughout the country and the expansion of this should be encouraged and promoted. These clinics would provide us with all the medical care we need through a health care policy that they would create and offer to the public to acquire our support.
With out hiring doctors or nurses the government can give us our money back to use to purchase a health care policy from the clinic of our choosing. That policy must meet a minimum standard established by the government. This way we only have to pay for the doctor’s expertise not profit for a hospital. If a hospital visit is required we can offer the use of our publicly owned hospital to all doctors free of charge. After all we (the taxpayer) own the hospital. The Doctors would remit a portion of our individual contributions to a Medical Association that would allow the doctors access to specialists paid for by the Association.
No more payment to doctors for writing prescriptions and no more herding people through like cattle just to make a dollar.
The hospital staff would consist of an administration and maintenance staff and those could be employed directly or contracted.
As well I strongly believe that the ambulances should be run from the hospital by the administrator and not privately. Presently we pay qualified paramedics to sleep at the station waiting for an emergency to develop. If we are going to pay for their service anyway they should be deployed at the hospital where these trained paramedics could man the emergency room 24 hours a day.
If you have any questions about these ideas please feel free to contact me at your convenience. At the very least I would ask you to pass this idea on to your listeners for discussion.
Thank You and keep up the great work!!!
3918 52nd Street
in the future.
Posted by: Dwayne Hill | 2005-09-29 9:02:43 PM
It's the ethics of a government only system that bother me - the government decides whether you live or you die. Scary thought!
I recall reading an op ed piece in the Globe about public health care in Cuba. To me, it sounded dreadful. In effect, the health care unit spied on its "clients" and made sure they were brought to heel whenever they stepped out of line (example given - women missing their period). The author condoning this system is now a Liberal Cabinet minister.
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