The case for sensible universal acess to health care
Politics is often so shrill and mindless, that I've often felt that many policy questions are a matter of just sitting down dispassionately with evidence, rather than the self-righteous fits that people are often so given to.
Single-payer health insurance as a route to a commitment to universal access to health care is one such issue, I believe.
It is encouraging that the architect of the Quebec single-payer system has arrived at the same conclusion.
Canadian Health Care We So Envy Lies in Ruins, It's Architect Admits
"Back in the 1960s, Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.
The government followed his advice, leading to his modern-day moniker: 'the father of Quebec medicare.' Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.
Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in 'crisis.'
'We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it,' says Castonguay. But now he prescribes a radical overhaul: 'We are proposing to give a greater role to the private sector so that people can exercise freedom of choice.'
Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.
In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It's as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.
What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.
Years ago, Canadians touted their health care system as the best in the world; today, Canadian health care stands in ruinous shape.
Sick with ovarian cancer, Sylvia de Vires, an Ontario woman afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care in Canada. She crossed the American border to Pontiac, Mich., where a surgeon removed the tumor, estimating she could not have lived longer than a few weeks more.
The Canadian government pays for U.S. medical care in some circumstances, but it declined to do so in de Vires' case for a bureaucratically perfect, but inhumane, reason: She hadn't properly filled out a form. At death's door, de Vires should have done her paperwork better.
De Vires is far from unusual in seeking medical treatment in the U.S. Even Canadian government officials send patients across the border, increasingly looking to American medicine to deal with their overload of patients and chronic shortage of care.
Since the spring of 2006, Ontario's government has sent at least 164 patients to New York and Michigan for neurosurgery emergencies — defined by the Globe and Mail newspaper as 'broken necks, burst aneurysms and other types of bleeding in or around the brain.' Other provinces have followed Ontario's example.
Canada isn't the only country facing a government health care crisis. Britain's system, once the postwar inspiration for many Western countries, is similarly plagued. Both countries trail the U.S. in five-year cancer survival rates, transplantation outcomes and other measures.
The problem is that government bureaucrats simply can't centrally plan their way to better health care.
A typical example: The Ministry of Health declared that British patients should get ER care within four hours. The result? At some hospitals, seriously ill patients are kept in ambulances for hours so as not to run afoul of the regulation; at other hospitals, patients are admitted to inappropriate wards.
Declarations can't solve staffing shortages and the other rationing of care that occurs in government-run systems.
Polls show Americans are desperately unhappy with their system and a government solution grows in popularity. Neither Sen. Obama nor Sen. McCain is explicitly pushing for single-payer health care, as the Canadian system is known in America...
However the candidates choose to proceed, Americans should know that one of the founding fathers of Canada's government-run health care system has turned against his own creation. If Claude Castonguay is abandoning ship, why should Americans bother climbing on board?"
I favor a commitment to universal access to health care, actually. I just think a single-payer system or any system driven by government is far from ideal and trades off with the advantages of a private market unnecessarily.
A voluntary, decentralized for-profit and non-profit commitment to universal access to health care is a better model. It offers more diversity, more choice, better care and better opportunities for care for everyone, it threatens the advantages of our private health care market not one iota (in fact, it very much supports those advantages since it alleviates pressure to curb the all-too-taken-for-granted advantages of our health care market, with all of its research and development, specialties, technology, pharmaceuticals and drug research, and all of the plethora of advantages of a robust health care market), it offers patients the ability to more readily navigate a robust and forever imperfect marketplace of ideas, relationships, options, etc., in a way that a socialist system could never match, and it could, as Castonguay suggests, be easily transitioned to from single-payer systems, by simply decentralizing control of existing hospitals, doctors' offices, drug manufacturers, and the like from the top-down model currently in place in Canada and giving them autonomy and responsibility for patient issues and results.
Public education, the field I work in currently, is the last bastion of socialism in the United States, and it should be plenty evidence of the failure of that route to anyone not dead-set on defending its every failure. Like health care, the freedom of choice and the freedom to develop institutions that care for peoples' most basic needs is critical to strong institutions and strong services.
What maintains socialists commitments is not their success. What maintains them is persistent defense of the part of their apologists, the fear that abandoning socialist projects equates with abandoning people and serious needs, much agnosticism and ambivalence on the part of a lot of citizens, and the lack of adequately argued and understood alternatives.
Decentralized for-profit and non-profit markets, the kinds that are advocated by school choice advocates in the United States, is the strongest general idea to address institutions where citizens have commitments to universal access to fundamental needs in modern societies, like education and health care.
Properly conceived, it is the only reasonable way to offer the highest quality care and services to the most number of people possible. And it is the only way to most adequately and constructively address inequities in those services, with a given understanding that such inequities will never fully be addressed, no matter what system is now or ever adopted. We can reduce the inequities, we cannot eliminate them, ever. And decentralized for-profit and non-profit markets offer us the best opportunity to do that in a way that single-payer and socialized care and services could never, in their wildest dreams, accomplish.
Here's to one more important voice to contribute to that chorus.
