Tuesday, December 11, 2007

Canadian health-care: vouchers, rhetoric, and revolution

Peter Shawn Taylor wrote in “Vouchers look pretty in pink”, (National Post, Dec.10, 2007):

“You may have missed the release of the federal Liberal's Pink Book II last week. Certainly the Liberal Women's Caucus new women's platform was overshadowed by other female issues, such as the bizarre allegation that Tory MP James Moore was ogling lingerie models in the House of Commons or, more seriously, Liberal MP Belinda Stronach's recent mastectomy.

But if you did miss it, you probably don't realize that the Liberals have suddenly decided to endorse vouchers in lieu of direct government involvement in social programs. The reason? The Liberals claim government delivery of social services can be inefficient, poorly targeted, supply-constrained and limiting of choices for recipients. Better to leave it to the private sector.
This surprising new position represents a massive change in perspective for a party that has traditionally supported heavy centralization and government control over social programs at the expense of personal choice and the market. Medicare is a perfect case in point. So the voucher issue clearly deserves greater daylight. Unfortunately, further investigation suggests it is just a brief break in the clouds for the Liberals, and not a sign of any broader dawning of enlightenment or economic practicality. But at least it's a start.

Pink Book II's chapter on poverty notes that the traditional approach towards affordable housing has been direct government investment in subsidized apartments. It hasn't worked. "Not only is the creation of new subsidized housing costly, but subsidized housing benefits only a small number of households who are in need," the report states. The report notes that reliance on government-supplied housing creates supply constraints which in turn cause "lengthy wait lists and other restrictions."

Instead of this top-down approach, Pink Book II argues in favour of a "portable shelter subsidy." A simpler name would be a housing voucher. This could be a monthly cash benefit or a tax credit delivered to low income Canadians deemed in need of housing support. While housing is largely a provincial matter, and affordable housing itself can be a rather vague concept, vouchers are worth exploring in their own right.

With vouchers, recipients are freed to make their own choices. With respect to housing, they can choose where and how to live instead of being constrained by government building decisions. Such a system is more convenient and discreet for recipients, better targeted to those truly in need and far less expensive to run from a taxpayer's point of view. Quebec, B.C. and Manitoba already have similar programs, as does New Zealand and Germany. The Federation of Rental-Housing Providers of Ontario has long advocated vouchers for that province. (Although the report's claim that former Liberal housing minister Joe Fontana was an early advocate of vouchers is blatant revisionist history.)

To summarize, a new federal Liberal report eschews rent controls, publicly funded construction and all the other failed but doctrinaire government approaches to housing for the poor in favour of vouchers, choice and the free market. It is an acceptance of the practical over the ideological.”


I wonder if our local provincial Liberal, MPP Jim Bradley, will heed the Grit feds call for the end of rent controls in Ontario?! After all, rent control is a provincial law here. And we all should remember the subsidized housing fiasco which David Peterson's Liberals, including Jim Bradley, were embroiled in in the 80s. But now, the Liberal family is decrying rent controls!? And now recognizing that creating and perpetuating government housing kingdoms is inefficient?! Oh, my! So, why should healthcare still be a monopoly?

Speaking of health care, will Jim Bradley stand up in the House and call for the Liberal Commitment to the Future of Medicare act's abolishment, as well as call for health vouchers to be established in Ontario? This would bring more market, rather than government, control into the health system.

Michael Coren wrote in "Two-tier trauma", (Toronto Sun, Dec.8, 2007):

"Canada's locked-in thinking on medical care needs hospitalization

Last week it was revealed that the president of the Canadian Medical Association, Dr. Brian Day, jumped the queue to obtain speedy treatment for his five-year-old daughter who had a tumour in her leg. There was a chance that the little girl might have had cancer and the public system required her to wait six days for a verdict. Dr. Day used connections to have the results back within a day.

Thus the debate begins. Is the man a hypocrite, should he be punished? Of course not. He did what any parent would do in a similar situation. To have done otherwise would have made the man a monster. But in discussing Dr. Day's personal actions we have missed the point entirely. The good doctor would not have been forced into such a position if we had a less authoritarian medical system.

Along with Cuba and North Korea, we make criminals of doctors who dare to set up clinics where people can spend their own money on the health care of their own choice. It's hardly an extreme proposition. Just as we are able to buy the cars, food and clothes we want, we should be able to buy the health care we want.

We have, for example, a public education system but only a lunatic would argue that Canadians should not be allowed to buy private education for their children. The public system still works. And as some of the leading leftists in the country have sent their children to private schools, we can only conclude that this system must work too.

Those who resist two-tier medicine argue that public medicine would suffer because the best doctors and nurses would leave for the private system, where there would be better money. This assumes that the private system would pay more than the public system (in fact the public system currently pays doctors extremely generous salaries). It also assumes that medical professionals are only interested in profit, which is damning of doctors and largely untrue.
The argument continues that the poor would receive no treatment or shoddy treatment. But this is not the case in Europe, where most countries have some form of two-tier medicine and where everybody is covered. In countries such as France and Germany the least able to pay invariably receive swifter treatment than most Canadians.

Then there is the point that Canadian-trained doctors should have to pay back some of the cost of their subsidized education if they work in private medicine. It's strange that we don't apply this standard to other graduates who work in the private sector or even leave the country. The problem, however, is easily remedied. All doctors should be obliged to devote a portion of their time and a proportion of their career to the public system.


Nobody wants the American medical regime -- not even the Americans. Not that it is the fantasy given us by trendy filmmakers who, ironically, usually enjoy the best medical care money can buy. There are numerous other models throughout the world that could be adapted to Canada, from countries that have far more in common with us than does the United States.

Yet when we even discuss this issue we are marginalized as sinister, un-Canadian and elitist. Not so. We're just brave enough to admit that a failing system has to be repaired by revolution rather than rhetoric."


Coren nails all his points well. There's another counter to the leftist argument that medical workers would leave the public system for the private system. (By the way, the same argument was tried and dismissed by the Quebec court in Chaoulli, so why would the same argument somehow be more valid in Ontario?)

Firstly, this transition to a market health-economy, were it to occur, should be phased in, not just 'happen'. We are so embedded in our current medicare myth, that we need to be weaned off our dependence on it. However, a charter challenge, like Ontario's McCreith/Holmes case, might quickly alter the landscape (which is what the government just might be hoping for, so they won't actually have to make the decision themselves: 'the courts made us do it'! It is best to end the rhetoric and prepare and implement market-reforms now, regardless of the challenge's outcome.

Secondly, the same unions that fear-monger about all the defections that would supposedly occur, should have no problem with this: during the phase-in period (say, five years), simply ban any present public-system union health care worker from leaving to a parallel system. Easy.

Unions are all about banning, preventing, barring, limiting, exempting. They use these tactics to their own advantage. So, they can inform their membership that they will forced to remain employed in the public-system, which for so many years we have been forced into, and which for so many years has had the privilege to force competition away from its cozy monopoly.

Let their membership stew about that. Let the union bosses see what their membership says about that. Meanwhile, during the transition, the private parallel system(s) would be free to take the entreprenuerial risk to source, train, administer, finance, and employ another cadre of med staff, and facilities, at what ever cost and timeline that may take. And this would have nothing whatsoever to do with those strident lefties who for years opposed even small health care reforms, to the current system's eventual detriment; they would remain to carry on in their own (publicly-paid) feifdom.

Why, it's only fair. Let the patient decide.

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