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Wednesday, August 25, 2010

Having Your Health Care and Eating It Too

I want a mansion, a yacht, a swimming pool, oh, and free health care:

Canadians aren't keen to pay more out of their own pockets to help the country cope with rising health-care costs, nor are they calling for governments to pump more money into the system. Instead, a majority of Canadians think efficiencies should be found in the existing system, with not a penny more thrown in the pot.


The majority of Canadians, 61 per cent, said focusing on finding more efficient ways to deliver health care is their preferred option, while 28 per cent said a bigger piece of the tax-dollar pie should be devoted to health care, which could mean cuts in other government services.

Only 11 per cent said the best way for governments to address rising health-care costs is to provide more opportunities for Canadians to pay out of their own pockets for services, effectively expanding a network of private facilities to offer those services.

Waste! That's the problem! If only we could stop waste then health care would work perfectly! Centuries ago critics of the King would, fearing accusations of treason, blame the King's "evil advisors." Waste is the modern version of the "evil advisors" ruse. Rather than criticizing the system - the most sacred of Canadian sacred cows - politicians and ordinary citizens blame waste. It is as controversial as complaining about the weather. It is also as pointless.

There is, contrary to public perception, no waste in health care. How? Because waste is a relative term. Every dollar spent in an organization is spent on someone, by someone. The receiver of a comfortable salary, or plush contract, certainly doesn't consider his cash flow to be waste. His supervisor probably doesn't consider it to be waste either. The more people, and the more money, someone supervises the more important, and usually better paid, is the supervisor. We all know waste when we see it, but what we do is never waste. This is true of any large organization. In placing health care under ultimate state control, the problem is made worse because the spending has now become politicized. 

Politicization transforms once relatively straightforward economic decisions over staffing, and resource allocation, into political battles. Try firing nurses? Premier Smith is against health care! Try reducing the number of medical administrators. Minister Jones is against health care! The same voter who complains about "waste" is often the same voter who will believe, with little hesitation, the hysterical calls about government "cut backs." Every dollar government spends comes with its own army of vested interests. With socialized health care those vested interests carry about them a halo of altruistic purity, summed up with the holy words: "We heal the sick!" 

The politician, knowing he has little real power to correct the situation, is left consoling the public with platitudes about "patient focused care" and "doctor empowerment." You cannot have patient focused care when the system is not, in any real way, accountable to the patient. Don't like your doctor? Try finding a new one. Don't like the local clinic? Try finding another one without the crowded waiting room. Don't like medications being proscribed? Try obtaining alternatives. So long as it is government health care, it will be bureaucrat focused care. Complaining about waste is simply a convenient evasion.

Posted by Richard Anderson on August 25, 2010 | Permalink


You guys should stop complaining cuz one the health care we have now isnt as good as it was supposed to be. also the law has just been signed give it a try u guys are too hard on democrats they went to college and we voted for most of these people.so if u want to say u have the right to choose tell that to ur congress men or state official. as for obama people are just tryin to make it look like america made a mistake he has done things to help us and we had a full 8 years of a terrible president and i will be so as happy as ever when a obama fixes bush's mistakes. You can find full medical coverage at the lowest price from http://bit.ly/9fDY7U . obama has to put up with the world judging his every move and trying to fix the mess we are in we are lucky anyone wants to be our president. STOP COMPLAINING AND GIVE HIM A BREAK. i wanna see one of yall do what he has done. some people are just so ignorant.

Posted by: blackwood | 2010-08-25 4:42:28 AM

Uh, Blackwood? The post is about CANADIAN healthcare, not US politics.

Posted by: Nothing New Under the Sun | 2010-08-25 6:09:06 AM

Another excellent post, Publius.

The essential economic problem with socialized medicine is that, unlike service provision in a free market, price signals largely do not exist. Therefore, resource allocation must necessarily be chaotic and "inefficient". No extra layer of bureaucrats whose task it is to promote efficiency will ever change this.

The poll indicates that John Q. Public, for the most part, simply does not "get it" when it comes to Medicare. When you price a good at zero, demand effectively becomes limitless. Government budgets, however, are not limitless. This conflict inevitably results in line-ups, rationing, delays, budget cutbacks and lengthy waits for treatment. Ultimately, this situation will not improve until John Q. Public understands that medical care is neither a right nor an entitlement.

Posted by: Dennis | 2010-08-25 7:42:09 AM

Ontario's government monopoly on health insurance now consumes 65 cents of every ONTARIO tax dollar. The ban on private health insurance was introduce in 1969, by the Progressive Conservative government of the time. Premiums for the new government monopolized health insurance system took the form of a new tax: the provincial income tax, which was introduced the same year, by the same Progressive Conservative government.

What few people recognize is that the government has continued to ensure that it raises enough *progressive rate* income taxes (personal income tax, health premium, employer health tax, corporate tax: all are income taxes) to pay the cost of health care. Income taxes being amenable to progressive rate structures, they are the taxation manifestation of the "from each according to his ability, to each according to his need" principle espoused by Karl Marx. In Ontario, this principle has been paraphrased: "Health care based upon need, rather than on ability to pay". Same thing.

Rather than describe the socio-economic effect of such a policy, I refer you to a North American application of it from someone who lived through it in Lenin's Russia, Ayn Rand:

"We thought it was good. No, that's not true, either. We thought that we were supposed to think it was good. The plan was that everybody in the factory would work according to his ability, but would be paid according to his need…
"None of us knew just how the plan would work, but every one of us
thought that the next fellow knew it. And if anybody had doubts, he felt guilty and kept his mouth shut—because they made it sound like anyone who'd oppose the plan was a child killer at heart and less than a human being. They told us that this plan would achieve a noble ideal. Well, how were we to know otherwise? Hadn't we heard it all our lives—from our parents and our schoolteachers and our ministers, and in every newspaper we ever read and every movie and every public speech? Hadn't we always been told that this was righteous and just?
"We're all one big family, they told us, we're all in this together.
"It took us just one meeting to discover that we had become beggars—rotten, whining, sniveling beggars, all of us, because no man could claim his pay as his rightful earning, he had no rights and no earnings, his work didn't belong to him, it belonged to 'the family,' and they owed him nothing in return, and the only claim he had on them was his 'need'—so he had to beg in public for relief from his needs, like any lousy moocher, listing all his troubles and miseries, down to his patched drawers and his wife's head colds, hoping that 'the family' would throw him the alms. He had to claim miseries, because it's miseries, not work, that had become the coin of the realm—so it turned into a contest among six thousand panhandlers, each claiming that his need was worse than his brother's.
"But that wasn't all. There was something else that we discovered at the same meeting. The factory's production had fallen by forty per cent, in that first half-year, so it was decided that somebody hadn't delivered 'according to his ability’…They voted which men were the best, and these men were sentenced to work overtime each night for the next six months. Overtime without pay—because you weren't paid by tune and you weren't paid by work, only by need.
"It didn't take us long to see how it all worked out. Any man who tried to play straight, had to refuse himself everything. He lost his taste for any pleasure, he hated to smoke a nickel's worth of tobacco or chew a stick of gum, worrying whether somebody had more need for that nickel. He felt ashamed of every mouthful of food he swallowed, wondering whose weary nights of overtime had paid for it, knowing that his food was not his by right, miserably wishing to be cheated rather than to cheat, to be a sucker, but not a blood-sucker. He wouldn't marry, he wouldn't help his folks back home, he wouldn't put an extra burden on 'the family.' Besides, if he still had some sort of sense of responsibility, he couldn't marry or bring children into the world, when he could plan nothing, promise nothing, count on nothing.

"But the shiftless and the irresponsible had a field day of it. They bred babies, they got girls into trouble, they dragged in every worthless relative they had from all over the country, every unmarried pregnant sister, for an extra 'disability allowance,' they got more sicknesses than any doctor could disprove, they ruined their clothing, their furniture, their homes—what the hell, 'the family' was paying for it! They found more ways of getting in 'need' than the rest of us could ever imagine —they developed a special skill for it, which was the only ability they showed.

"God help us, ma'am! Do you see what we saw? We saw that we'd been given a law to live by, a moral law, they called it, which punished those who observed it—for observing it. The more you tried to live up to it, the more you suffered; the more you cheated it, the bigger reward you got. Your honesty was like a tool left at the mercy of the next man's dishonesty. The honest ones paid, the dishonest collected.
"What was it we were supposed to want to work for? For the love of our brothers?…Love of our brothers? That's when we learned to hate our brothers for the first time in our lives. We began to hate them for every meal they swallowed, for every small pleasure they enjoyed, for one man's new shirt, for another's wife's hat, for an outing with their family, for a paint job on their house—it was taken from us, it was paid for by our privations, our denials, our hunger. We began to spy on one another, each hoping to catch the others lying about their needs, so as to cut their 'allowance' at the next meeting. We began to have stool pigeons who informed on people, who reported that somebody had bootlegged a turkey to his family on some Sunday—which he'd paid for by gambling, most likely. We began to meddle into one another's lives. We provoked family quarrels, to get somebody's relatives thrown out. Any time we saw a man starting to go steady with a girl, we made life miserable for him. We broke up many engagements. We didn't want anyone to marry, we didn't want any more dependents to feed.

"In the old days, we used to celebrate if somebody had a baby, we used to chip in and help him out with the hospital bills, if he happened to be hard-pressed for the moment. Now, if a baby was born, we didn't speak to the parents for weeks. Babies, to us, had become what locusts were to farmers. In the old days, we used to help a man if he had a bad illness in the family. Now—well, I’ll tell you about just one case. It was the mother of a man who had been with us for fifteen years. She was a kindly old lady, cheerful and wise, she knew us all by our first names and we all liked her—we used to like her. One day, she slipped on the cellar stairs and fell and broke her hip. We knew what that meant at her age. The staff doctor said that she'd have to be sent to a hospital in town, for expensive treatments that would take a long time. The old lady died the night before she was to leave for town. They never established the cause of death. No, I don't know whether she was murdered. Nobody said that. Nobody would talk about it at all. All I know is that I—and that's what I can't forget!—I, too, had caught myself wishing that she would die. This—may God forgive us!—was the brotherhood, the security, the abundance that the plan was supposed to achieve for us!"

- Ayn Rand, excerpt from "Atlas Shrugged" (1957)

Liberal, NDP, Progressive Conservative: all want health care to continue to be delivered on the basis of need, regardless of ability to pay. All of them found their party's respective policies on the horrific altruist code that dehumanizes every Ontarian, and that turns us against one another.

It's getting worse, quickly. As retired baby boomers continue constitute an increasing percentage of the populace, less money will be earned in the province, and health care expenses will climb up to and beyond 100% of Ontario tax revenues (if memory serves, when I was writing the 2007 Freedom Party of Ontario platform in 2005, health care was consuming 59 cents of every Ontario tax dollar). The signs are everywhere, and the most obvious is: Ontario is currently borrowing about $20B per year, half of which is to pay interest on a debt that is skyrocketing. Yet none of the elected MPPs dare propose ending the tax-funded government monopoly on health insurance.

Freedom Party of Ontario's morality is the opposite of the one upon which the Liberals, NDP, and PCs base their decisions. We regard every individual's highest purpose as the pursuit of his own happiness, and we reject the coercion inherent in the morality and policies of the Liberals, PCs, and NDP.

Due to recent changes in the law, FP Memberships can be purchased online using PayPal or credit cards. Contributions - by members and non-members alike - can also be made, online. If the current state of Ontario health care upsets you - as it does me - or if you simply find the above quotes passages from "Atlas Shrugged" to be disturbing and entirely plausible in today's Ontario, join, support, run as a candidate for, and/or contribute to Freedom Party today.

To JOIN: http://www.freedomparty.on.ca/members/join.htm

To CONTRIBUTE: http://www.freedomparty.on.ca/contributions/contribute.htm

Posted by: Paul McKeever | 2010-08-25 8:44:49 AM

Healthcare was socialised in Britain in the 40's. The course was maintained because socialist convention proclaimed several things to cover up the inadmissible truths; the greatest being that socialised healthcare would be efficient because every decision would be in the hands of experts, not the markets.
A generation of propaganda about the nature of the pursuit of happiness (through individual profit) and the usual claptrap about exploitation of the sick were enough to cow the proles.

They dutifully doffed their grimy cloth hats (clothes were still rationed) in abeyance to the notion of these experts, people with degrees that were cashing in on the notion of impartial administrators that had been fostered to present the image of British political hegemony(as opposed to cultural and economic trade) as 'a good thing'.

Now the administrators were home to stay, and how could they fail to produce a new paradise of enlightened patronage? Why, they would behave disinterestedly and make decisions based solely on clinical need.

But what kind of healthcare professional has no interest in his career?


The kind that prefers personal empires and power games to making money.

And so of course, laws were erected to govern the behaviour of these people, which was another way of saying that their word is law.

The politicians meanwhile went on saying that this institution was 'cherished'. They still do.

But one thing they don't parrot anymore is Ernest Bevin's allegation that costs would fall as people became healthier.

Another comforting fact about Bevin; he was in charge of conscripting men into the coal mines in WW2, where they suffered a greater death rate than the army, which had the distinction of millions of heavily armed Germans and Japanese trying to kill them, instead of one, disinterested social reformer.

Posted by: Simon O'Riordan | 2010-08-25 9:27:37 AM

It doesn't matter anymore that socialized health care doesn't always have a happy outcome or that there are no "repairs" within the constraints of the law possible, it will simply continue degrading over time. It has accomplished the goal of it's architects in lobotomizing the electorate. The vast majority of Canadians believe that they receive more out of the system then they put in and on this point, they are correct. Until the top 20% of tax payers read or re-read the above mentioned book and or do something about it (like shrugging) their altruism will support the slow and continual decline as opposed to a well deserved collapse. Who is John Galt?

Posted by: John Chittick | 2010-08-25 9:59:49 AM

Demand for healthcare in Canada (Ontario especially) and the UK is driven by mass migration, especially non-European in origin.

The number of births to foreign-born women has increased over the past decade, despite a falling birthrate among British women. This has led to a £200 million increase in spending on maternity services for immigrant women, independent analysis claims[...]

BBC analysis shows spending on maternity services has increased from £1 billion in 1997 to £1.6 billion now, including £350 million spent providing maternity care for foreign born women.

This is in the face of a 44,000 drop in the number of births to British women, compared to a 64,000 rise in babies born to immigrant mothers.

The Office for National Statistics shows one in five babies is now born to immigrant mothers, up from around one in eight a decade ago.

Last week's Healthcare Commission review of maternity services identified high immigrant populations as a potential factor behind the poorer performance of many London trusts.

Posted by: Jim | 2010-08-25 4:57:45 PM

It was all good until the xenophobe showed up...

Posted by: Cytotoxic | 2010-08-25 7:07:06 PM

cyto: ding ding ding - we have a winner.

Posted by: Paul McKeever | 2010-08-25 8:26:26 PM

Jim, it would be interesting and pertinent to know the cost of abortions provided to British women, since your reference speaks of immigrant women increasing the cost of health care in the UK.

Actually the UK socialised health care is even more broke and broken than our own and the reasons for that have nothing to do with "immigrant" women. Mind you we are fast catching up although we started much later on the same path.

Posted by: Alain | 2010-08-25 8:41:26 PM


Cyto is right ... but your xenophobia seems to be affecting your judgment as well. Of course immigrants will be using the services offered to all Canadians. Then again, immigrants will be having more children, paying more taxes and hopefully this will cushion the blow from the impending social security disaster.

Posted by: Charles | 2010-08-26 5:22:39 AM


In any modern developed country the overwhelming majority of health care spending is directed toward those over 65. Since in Britain, as in Canada, this population (even with family reunification) is mostly white Old Stock, your argument doesn't hold up. Socialized health care is a bad idea that was introduced by Old Stock Canadians - as I mentioned above. Same in Britain. Or was Nye Bevan a foreigner? Please no silly Welsh jokes.

Giving birth is among the simplest things done in a hospital, for the obvious reason that it is natural. A doctor basically hangs around and makes sure nature takes its course, which it does about 90% of the time. If it wasn't that simple the human species would never have survived this long. Even a Caesarean section is cheap compared to open heart surgery, or a hip replacement.

As for the actual link you provide, it indicates visits to the doctor, not actual health spending. Scores of simple check-ups or prescriptions can cost far less than even a single surgery, in fact they save money by being preventative.

The differences can also be explained very easily by the fact that non-Europeans are younger and have bigger families than native Canadians, so yes parents with children tend to go to the doctor more frequently. Don't begrudge them, they'll be paying your pensions in twenty years time, because the Old Stock didn't reproduce themselves (and whose fault was that?).

You'll also notice that doctor visits fall dramatically for long-term vs recent immigrants. In other words, immigrants from the Third World aren't as healthy as Canadians and may need more visits to the doctor (even keeping in mind the demographic differences I mentioned earlier), but after a few years the divergence narrows considerably. It is very easy to blame someone else, but this is a problem as Canadian as snow.

Posted by: Publius | 2010-08-26 5:48:11 AM

Discussing this issue without commenting on the roles of various health unions and trade associations in deciding standards of practise and division of labor is a dead end street. Throw in the construction of new facilities and the role of "health care services" as "economic drivers" and you begin to understand how the road to hell is paved with good intentions.

Do you think it coincidental that the fastest spending increases are on drugs when the standard physician reference book, The Merck Manual, is published by a drug firm. Are you surprised to learn that on average 5 out of every six new drugs introduced are less effective and at least an order of magnitude more expensive than their patent expired predecessor?

Would it shock you to learn that the entitlement and defned benefit pension schemes do not entertain folks, on average, living beyond their best before dates...what do you think Wall St. thinks about that?

Like vested economic Keynesian orthodoxy, modern medicine orthodoxy persists in spite of overwhelming evidence that there are better ways to produce good results. I'm prepared to bet that bureaucrats and other with their noses firmly in the existing trough are disinclined to see change that puts them on the job hunt. To allude to a post above,"their need to keep slamming back six figures is great, even if their ability to do so is suspect."

If readers here are not familiar with the 1910 Flexner report they should do some reading...the blueprint for disaster we are now following was laid out a century ago by the same "philanthropists" who brought us the Federal Reserve system and market distorting, insider rigged Wall St. system. It is difficult for careful observers to not assume there is an end game in play.

As we see consumption taxes being introduced world wide (HST, VAT) as economies implode and the ranks of the unemployed swell, mere existance will still give the bloated carcass of the State the tools to suck what little wealth we have from us. Will governments cut spending? Will monkeys fly out of my butt?

Posted by: peter | 2010-08-26 10:04:59 AM

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