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Tuesday, October 26, 2010

A Sacred Trust Revisited

A quarter century ago Brian Mulroney - I'm sure you all have fond memories of that name - rose to power, in part, by pledging that Medicare was a "sacred trust." In other words, contrary to what the choir invisible of Canadian opinion wanted the electorate to believe, the Boy from Baie-Comeau was no free market extremist. Nope, it was to be status quo for the hallmark of the post-Trudeau national brand, socialized health care.

Well, as the Brian's good friend Ronald Reagan liked to say, status quo is Latin for the mess we're in. Such a mess, in fact, that even the Brian is having second thoughts about the sacredness of Medicare:

It seems to me that, on health care for instance, we need to strike a better balance between the intrinsic value of universal coverage for basic medical service and the readiness, indeed the capacity, of Canadians to pay the necessary taxes to support the system.

A serious, adult discussion is called for, and I believe a blue-ribbon panel of medical and financial experts could provide a sensible framework for the debate and for the decisions needed. Not surprisingly, the fundamental assumptions on which Justice Emmett Hall based his recommendations for medicare almost 50 years ago have changed and we need to adapt accordingly.

Well, it's not exactly a barnburner at the Cato Institute. It is, however, a confession by a former Prime Minister that the system is broke. He didn't say that exactly, the Brian is too much of a politician not say anything exactly. "A serious adult discussion" sounds like code for more private involvement and "Canadians to pay the necessary taxes" sounds like a call take another one for the Medicare team.

The fanatical insistence that we must defend our single tier system, lest we become Americans free market cyborgs, is held to even when it is quite clear we no longer have such a system:

Saskatchewan Roughriders injured on the field enjoy a privilege few others in the province share: They can receive a publicly funded MRI within 48 hours, so long as their team pays $4,500 to cover their scan and two others.

The local health region defends the profit-making arrangement -- publicized this week -- as a way to fund more MRIs for the ordinary public, and insists the policy is well supported by the province's football-mad populace.

To borrow from Deng Xiaoping, it's socialized health care, with Saskatchewanian characteristics. These fudges of Medicare scripture, in its homeland no less, are rationalized as exceptions which reinforce the the system. Just as the battle for Medicare was inaugurated by a doctor's strike, so its demise may come from doctors frustrated with the system:

A letter from the Sentinelle Health Group arrived at MPs' offices this week, advising them that their Ottawa clinic "is now offering health services with all the advantages of a public clinic."

"We are not a walk-in clinic. The patient with an appointment can have his or her annual checkup and consultations just like in a public clinic. The only exception is that Sentinelle Health Group charges a membership fee to become a patient," reads the letter, signed by the company's CEO, Mylene Chaumont.

It's a nice touch. In effect taunting our political masters with they mess they've made, and which they continue to loyally defend. The above CEO insists that everything is perfectly legal. It may very well be. Contrary to what you were taught in school, and has been bellowed by American talk show hosts these last few months, Canada has a partially socialized health care system. An FAQ at Ontario's Ministry of Health and Long Term Care explains:

What services does my Ontario health coverage cover?

The ministry covers a wide range of health services; however, it does not pay for services that are not medically necessary, such as cosmetic surgery.


The ministry covers all insured medically necessary services provided by physicians. Physicians may bill you for uninsured services or if you miss an appointment or your health card is not valid. 

What is "medically necessary?" Whatever the Minister and the Ministry's bureaucrats decide. If a service is not covered by the Ministry, well then the doctor might bill to his heart's content, and the consent of his patients. Yes Virginia, there is private health care in Canada. About 70% of all health care spending in Canada is by the various levels of government (which is below the OECD average), the rest is from the evil and greedy private sector. Dental care is almost completely privately run and financed, yet there have been no nationally crippling outbreaks of gingivitis. Nor is there a dentist shortage in Canada. Coincidences, I'm sure. 

As the Brian alluded to his speech last week, the aging boomer cohort is threatening the financial viability of Medicare. To those less enamoured with the system, it is a possible moment of reckoning for this relic of Sixties socialism. Being a nation of compromisers, and our politicians a class of elected cowards, it's unlikely this reckoning will come in a big and dramatic way.

As budgets get tighter, more and more services will be quietly delisted - like eye examinations for adults in Ontario. Every fiscal crises will be met with another round of de-listings. The public only becoming fully aware when their doctors tell them that they must now, after decades of paying into the public system, pay again out of pocket for specialized treatments.

The alternative would be a massive inter-generational tax grab, targeting the most mobile generation in history. Whose gonna hang around to pay for gramma's new hip? Not her professionally educated grandson living in Qatar or Hong Kong. Who'll be left to shoulder the burden? The less skilled and mobile, i.e. the least capable of financing the system. The contradictions inherent in Medicare will lead to its own destruction. A cold comfort to those suffering on our waiting lists, or bankrupting themselves in trips to American clinics.

Posted by Richard Anderson on October 26, 2010 | Permalink


Liberal MP Keith Martin has also added his voice to the chorus calling for change, although thankfully he is far more blunt than Mulroney:


If only a Tory MP or two would now add something to this discussion, maybe we could move beyond debate and take action. Of course any Tory MP would be pilloried for daring to voice such sentiments, but this only serves to illustrate the pathetic double standards that operate in our collectivist media and political culture.

Posted by: Dennis | 2010-10-26 9:10:04 AM


Conservatives are not allowed to govern, but merely hold office and enact only from the centre-left. It will be a Liberal or NDP/lib/Green coalition that will eventually reform Medicare, but by then most (urban) Canadians will be forced to eat cat food. The politics of envy, resentment and hatred can only be reformed by its architects rather than its maintenance crew.

Posted by: John Chittick | 2010-10-26 9:38:35 AM

John, there are probably many benefits to eating cat food. But in the end they will screw that up too. There will be shartages. And then we will have eat the cats.

Posted by: TM | 2010-10-26 11:53:13 AM

Oops, meant shortages. Shartages kinda fits too though.

Posted by: TM | 2010-10-26 11:53:54 AM

If there was less government graft,special retirement parties, sole sourced contracts - there would be lots of Money to fund Medicare.

But for any politician with access to a taxpayer Till - the lure of getting re-elected is too much.

Posted by: The LS from SK | 2010-10-26 3:48:02 PM

The greatest failure of socialized medicine, apart from the poor to fatal treatments applied to its users, apart from the wild distortions it causes in the healthcare marketplace, is that it assures that individuals who pursue unhealthy habits will burden others with their various excesses. To end socialized medicine will assure that the stupid will die. Ending socialized medicine is looking better already.

Posted by: AB Patriot | 2010-10-26 7:09:09 PM

In your first code sample you use YFunc and Func. Is that a typo? If not, what is Func?

Posted by: coach outlet | 2010-10-26 9:50:48 PM

John Chittick: so when, exactly, can we hold the Tories responsible for how they govern the country?

Posted by: Bradley | 2010-10-26 10:28:08 PM


They are responsible now. They have chosen their actions based on their perceptions for success while holding on to their minority governing status. They have chosen to join the ruling class statists by their actions and justify their phony conservative credentials by pointing out how much more moderate they are compared to what the others would have done in their place. If they were more true to principle, they would be in opposition. What they aren't responsible for is the fact that Canada doesn't have the structural support that could give actual conservatives real power. Not saying it couldn't happen but it hasn't in living memory (Mulroney's fisrt term possibly close).

Posted by: John Chittick | 2010-10-26 11:41:19 PM

John Chittick redux: Cons never responsible; just victims of 'structural oppression' by Canada.

Posted by: Cytotoxic | 2010-10-27 6:06:28 PM

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