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Monday, December 07, 2009

"Medtario"

Kelly McParland introduces a new word to the Canadian lexicon:

The Fraser Institute issued a study last week reporting that Ontario's government will spend more than half its revenue on health care next year. New Brunswick will follow soon after, and four more provinces will pass the 50% mark in the next 20 years.

The Institute favours privatized medicine and would like to see Canada adopt private-sector solutions to the problem of runaway costs.

It would seem, though, that once a province is spending the majority of its money on one service, it takes on many of the aspects of a private operation, but without the choice, quality or efficiency. 

In other words, Ontario has a state controlled health care system, with a provincial government attached. This is, oddly, a hopeful sign. When common sense and reason cannot persuade people, sometimes disaster can. There is little point in rehashing the pros and cons of Medicare. It is a command economy version of health care. Like every command economy in history, it's a ticking time bomb. Sooner or later it will either implode or be replaced. The whole premise of socialized Medicare is that the laws of economics do not apply to one particular sector of the economy, health care. Like a parallel universe where gravity only works within a legally defined area. 

The general public is kept loyal, or at least not too discontented, by fear of the alternative. The Soviets did this too. Images of the alleged Dickensian nightmare that is the United States. If you think things are bad here, comrade, they're much worse in America. The nightmares are a reality in America, as they are here. Crude caricatures of the American system - which seems to be the only alternative we are allowed to discuss - mask its complex reality. The anecdotes, the pious homilies to the memory of Tommy Douglas, the cries of Canadian identity as waiting list, are not the point. Medicare is a cult. Its adherents, willing or not, are not interested in facts and logic. The Fraser Institute has been valiantly denouncing Medicare for three and a half decades. The Canadian Right, to varying degrees, has been critical for just as long. The task is harder than trying to tell people their God is dead. We are trying to tell them their God is the Devil. Until the Medicare Moloch gets ready to consume them completely, it's a call they are unlikely to heed. 

Posted by Richard Anderson on December 7, 2009 | Permalink

Comments

Publius writes: "The Fraser Institute has been valiantly denouncing Medicare for three and a half decades. The Canadian Right, to varying degrees, has been critical for just as long."

With the greatest respect: neither is true. Years ago, I contributed to the Fraser Institute. It then came out with a health care publication in which it set out a plan to *save* tax-funded healthcare. And, it appears, its publication last week sets out to do the same. Consider the following quotations from the Fraser Institute publication page to which the above post links:

“Unless provincial governments can devise a better way to finance health care, they will be forced to either hike taxes, expand rationing of medical goods and services, or make extensive cut backs in other government programs.”

A pro-capitalist, anti-collectivism institute would never so imply that the government *should* "devise a better way to finance health care". It should EXIT the field entirely. That the Fraser Institute is *not* advocating the demise of tax-funded health care becomes clear in its list of "recommendations":

"* encourage the efficient use of health care by requiring patients to make copayments for all publicly funded medical goods and services they use;"

"copayments"? No. If the Fraser Institute opposes socialized medicine, it ought not to be implying that the government be a co-payor.

"* relieve cost pressures facing the public health insurance system by legally recognizing the moral right of patients to pay privately (out of pocket or through private insurance) for all types of medical goods and services, including hospitals and physician services, as is currently allowed for access to prescription drugs;"

That's a half measure. So long as the public continues to be taxed for health care, most will have been deprived of too much money to *exercise* the "moral right of patients to pay...".

"* shift the burden of medical price inflation onto the private sector by allowing providers to charge patients fees in addition to the government health insurance reimbursement level;"

If such a thing were done *without* also getting rid of the tax-funding of health care, health care costs would end up costing Canadians an even greater percentage of their income. And, no doubt, those without the "ability to pay" the fee would end up with a subsidy, such that an increased percentage of the tax-funded health services would be allocated to those who lack an "ability to pay". In the long run, at least 100% of the actual cost of the services one consumes would be paid by the extra fees, yet the patient would continue to pay the same amount (or a greater amount) as taxes spent on *other* peoples' health care.

"* create incentives for cost and quality improvements by permitting both for-profit and non-profit health providers to compete for the delivery of publicly insured health services."

That one is just plain stupid. It is already the case that the physicians paid with OHIP are private sector businesses. If they want to run "non-profit", they simply have to charge less. If, on the other hand, "non-profit", in this context, is being used as a synonym for "tax-subsidized", then: what's the point, from the taxpayer's perspective?

The Fraser Institute page ends up with this remarkably fascistic suggestion:

"Skinner suggests that Canada follow the example of Switzerland or the Netherlands, where the government is not responsible for providing health or drug insurance. Instead, individuals in those countries are required by law to purchase comprehensive health insurance in a regulated, pluralistic private-sector market, and the government provides low-income subsidies so that everyone can afford coverage."

Key words: "required by law to purchase". Time to change the name from "Fraser" to "Fascist"?

The problem facing Ontario's health care system is this: it is tax-funded. Want to fix health care in Ontario? Eliminate tax funding, stop forcing people who do not want insurance to buy it, and end the prohibition on private sector insurers who could then compete against a state-owned, non-profit, voluntarily-funded OHIP system. Let the public vote...with their dollars.

And, of course: ignore the Fraser Institute, unless your goal is to replace communism with fascism.

Posted by: Paul McKeever | 2009-12-07 2:49:19 PM


Paul,

I said "denouncing Medicare," I didn't say they were doing it properly. Almost no one is. Medicare is the third rail of Candian politics. "Valiantly," because virtually no one else is doing it. Like dissidents in the USSR, points should be given just for showing up.

My point was that even the Fraser Insitute's proposals are considered "too extreme" for the contemporary debate. Your analysis is correct. I absolutely agree with the following:

"The problem facing Ontario's health care system is this: it is tax-funded. Want to fix health care in Ontario? Eliminate tax funding, stop forcing people who do not want insurance to buy it, and end the prohibition on private sector insurers who could then compete against a state-owned, non-profit, voluntarily-funded OHIP system. Let the public vote...with their dollars."

Only a small fraction of the electorate will support this in the near to medium term. We are not at the stage where a free market approach will even be listened too. My point was not regarding the Fraser Institute, but the attitudes of the electorate. Support for Medicare is not based on rational belief, but a cult-like mentality. Until that is broken, presenting new ideas - to say nothing of good ideas - will be virtually impossible.

Posted by: Publius | 2009-12-07 3:48:05 PM


Oh, don't get me wrong Publius: I understood your point, and I agree with you about the religious nature of the commitment to communized health care. My only criticism is in giving sanction to an organization that proposes fascism. In my view, to hold up the Fraser Institute as a force against collectivism is to harm the cause of individual freedom. In my view, the only way to change the public's view is by being honest and forthright, and by making the moral argument rather than a purely economic one. In other words: that it is morally wrong for the government to force me to pay for health insurance, whether for my own health or someone else's; that it is morally wrong for the government to punish a person for offering health insurance in exchange for the payment of premiums; that another person's hardship does not make it morally right for him - or the people he chooses to represent/defend him - to threaten to murder me if I refuse all of the government's efforts to obtain the money I have earned by honest trade.

Every law - from murder right down to spitting on a sidewalk - *implicitly* specifies a condition pursuant to which a police officer or sheriff can murder a person without facing any penalty. The person who buys and possesses a banned rap music record refuses to pay his fine, and finds a police officer at his door ready to put him in jail. He refuses to go. The police officer initiates the use of force in an attempt to seize him and take him to jail. The person uses force against the officer, defensively. The officer pulls out his gun and threatens to shoot. The person reaches into a drawer to pull out his gun to prevent himself from being killed. The officer shoots him dead. All perfectly legal. All because of an immoral law against the possession of, say, a 2 Live Crew album.

The law forcing people to pay tax into a common pot, 50% of which is then spent on health care, is a law that specifies that the person who refuses to pay not only can be murdered, but - if he is a person who refuses to sanction the immoral - *is* to be murdered.

The confusion comes in inserting a government between ones looting neighbour and oneself. Ask a person whether his neighbour should legally be able to shoot him dead if he refuses to pay for his neighbour's knee replacement. When - not if, but when - the person replies "of course not", ask that person if anything changes if the neighbour hires a hitman instead. When the person replies "of course not". Ask whether it matters if the hitman puts a gold crown on his head and says "I'm your king". When the person starts laughing, and continues to say "no", ask the person whether anything changes if everyone on his block votes to make the hitman king.

Then watch as they - disturbed at the revelation - switch the subject or make a red-herring argument like "Well police aren't hit men, and they don't wear crowns, and, besides, everyone in Canada votes, not just the few people on one block...so your analogy doesn't hold". But know that...they remain disturbed, even as they struggle for ways to forget what they've discovered.

Wash, rinse, repeat. Wash, rinse, repeat. Eventually, you will hear - as I did this week - that other people you've never met are using arguments you've made on a recent TV show.

Don't do the disservice of sanctioning those who try to win freedom without making the moral case against altruism. Altruism - not any particular economic issue - is at the root of collectivism (though irrationality is at the root of altruism, which is why I always say: "Advocate reason, and capitalism will take care of itself").

Posted by: Paul McKeever | 2009-12-07 6:08:44 PM



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