“If you think healthcare is expensive now, wait until you see what it costs when it's free.”
These are sage words of PJ O'Rourke, a humourist, author of books, and writer for the National Lampoon and the Rolling Stone magazines.
Following early steps by Saskatchewan Premier Tommy Douglas, over decades, government healthcare eventually advanced into the Canada Health Act, established in 1984. The sanctimonious Members of Parliament, congratulating each other, voted unanimously to take over the role of provider, funder, and legal authority of healthcare.
These pages have previously written that the government's inability to deliver healthcare in Canada was inevitable. The timing was predictable, as demographics are set decades in advance. Without the benefit of market signals or the inherent incentives and discipline of bottom lines, the cost of Canada's healthcare system, currently averaging more than 50% of provincial budgets, increases annually.
This betrayal of all Canadians is especially difficult for senior citizens who, after paying taxes for decades to fund healthcare, are too often denied timely access when most needed.
After 1984 until recently, Canadians insisted that our healthcare was the best in the world. But more importantly, it demonstrated supposed superiority as a country versus our southern neighbours who have the temerity to ask citizens to fund their own healthcare. This is no longer Canada’s identity.
Americans receive healthcare through mostly market-driven approaches, hardly perfect, but vastly superior to Canada, where individual choices are limited, and private care is mostly illegal. Many aspects of healthcare are complex, and there are exceptions to the theme.
The Canadian system covers roughly 70% of healthcare costs, delivered by the provinces. Ottawa originally funded 50% of costs; now only 22% — another betrayal. Not covered include prescription drugs, dental care, vision care, physiotherapy, massage, psychology, medical appliances and equipment, travel insurance, administrative fees, lifestyle cases such as cosmetic surgery, and much more.
The 30% delivered privately creates a national health crisis, right? No, in fact, the market-driven delivery component is functioning better than the government-run bureaucracy and the inevitable wait times. Ever wonder why there is minimal waiting for your dentist, physio, and prescription providers? Maybe the market works!
In every system — Canada, the US, or elsewhere — there are those in our society who need financial support from governments. This is not limited to healthcare and includes housing, education, and other necessities of life. But should the needs of some determine the compulsory structure for everyone?
The establishment of a socialist system is much more significant than just the important outcomes and access for patients. In Canada, healthcare is a COST to be managed with inevitable political intrusions reducing efficiency. In the United States, often criticized for much higher per capita healthcare spending, it is a large and important INDUSTRY in part governed by the discipline of markets.
In Canada, there is a notion that healthcare is too important to be left to the market. I would argue the exact opposite — because of its importance and complexity, the discipline of market forces, efficient allocation of capital, incentives of the profit motive, and other benefits of free choices provide innovation versus the ossification of the public system.
We need to remind ourselves of the brilliant Scottish professor, Adam Smith, who, in the mid-1700s, explained the pathway to economic prosperity — if consenting parties transact whereby the self-interest of both is satisfied, the prosperity of everyone is enhanced.
While this seems counterintuitive, Adam Smith's “unseen hand,” freedom of choice (competition), and the coincident burgeoning of democracy in England have provided unimaginable prosperity for the citizens of those countries which feature an open market system.
Another benefit of the US industry is that people from all over the world, and especially frustrated Canadians, travel to the US to benefit from the access and high standards that are the result of its mostly market healthcare system, costs notwithstanding. Do patients care about the motives of the players, be it doctors, nurses, janitors, and the many others who satisfy their self-interest while serving them? Doubtful.
Sadly, Canada is an ever more socialist country, well beyond our failing healthcare system, augmented by the shiny new command-and-control Prime Minister. It now appears that critical infrastructure for our most important industry, oil and gas, is now mostly determined by Mark Carney and Danielle Smith, with a cameo appearance by Doug Ford. Already violating market principles with what appears to be another government pipeline, are we headed to a repeat of the Trans Mountain cost and delay debacle?
The important side issue driving this top-down process is that both Carney and Smith want to demonstrate that Canada works — or will be the opposite?
This is the important topic of the sequel.
