About-face up north?

Posted: Jun 13, 2004 12:00 AM

While many Americans look to Canada for solutions to our health care mess, Canadians, in increasing numbers, look southward, to us.

Canada's National Post recently reported on a nationwide poll. "More than half of Canadians support a parallel private health care system that would let patients pay for speedier service," Tom Blackwell's June 1 article summarized. "The poll found 51 percent favour a two-tier system, with support highest in Quebec, at 68 percent, and Manitoba and Saskatchewan, the birthplace of medicare, at 57 percent."

Canada's political insiders hardly know how to react. No major party espouses private medicine, even in the watered-down form considered in the poll. How could so many Canadians want something very much like what America has? It's unpatriotic!

Patients Must Be Patient

America endures a mixed private-public system. Health care is still "privately provided," though our Medicare programs are nearly as large as our private insurance companies combined, and regulations on health care providers and insurance companies abound.

In Canada, on the other hand, it's pretty much government through and through. Though "free medicine" sounds great, its implementation has led to more than a few problems. For something "free," it comes with a high price tag: Canadians pay for the service in extremely high taxes. Worse yet, Canadian patients are often forced to be extraordinarily patient, even at the cost of their health.

If you need a test, getting it in Canada is not the speedy thing it is in America. There's usually a lag. This applies to treatments, too, especially the older you get.

In his book Code Blue, medical student David Gratzer reported that Canadians wait for radiation therapy three to four times longer than Americans do. The average wait for an MRI scan stretches almost to half a year, while Americans wait three days. Only a fifth of Canadians diagnosed with cancer can see a specialist within four weeks.

These problems aren't secret. Government commissions have listened to hours of horrifying testimony, and there have been numerous public studies. More strikingly, a current case before Canada's Supreme Court has made the problems front-page news. A Quebec doctor and his patient have sued the government for the right to contract privately for medical services. If the Court agrees, Canada's monolithic approach to medical care may be at an end, and with it Canadian waiting. (The court isn't expected to rule on the case until 2005, however, so they'll have to wait for an end to waiting. They're used to it.)

The Private Solution

Wealthier Canadians are lucky, though: they've had America to fall back upon. While Americans traveling to Canada for cheaper prescription drugs is a current news item, for years thousands of Canadians have traveled south of the border for testing, diagnosis, treatment ? and even drugs, some of which are just not available up north.

It's no wonder that some Canadians dream of adding another "tier." This would allow more Canadians to do what many do already. A number of polls before the recent one have demonstrated Canadian tolerance for this form of liberalization ? this smidgeon of freedom.

So why won't Canada's major parties talk about it?

Well, to jaded Americans, a taboo on talking about private solutions is no shock. Where powerful interests, fear, and fantasy combine ? that is, in politics ? rational discussion tends not to blossom.

But this sounds cynical, and Canadians try to be earnest. No wonder, then, that the National Post found a shill for the Canadian status quo, one who would tell pious whoppers without flinching.

The Post consulted James Smythe, a health economist at the University of Alberta. "[I]f it really was close to a 50-50 split on such a contentious change to health care, then you would think that that's where the Conservative party would be basing their platform," he told the paper. "I think they are smart enough that they would recognize it if it did exist."

From this I hazard that Smythe's work is narrowly directed to the field of medicine, not Public Choice. As an analyst of politics he seems a tad naive. But then, economics itself gives him trouble:

Prof. Smythe said there may be some argument to be made in favour of private medicine from a libertarian point of view, but he said there is no economic case to be made for it.
Two-tier health care does not create any efficiencies, he said.

Well then. If waiting for weeks and months for testing, diagnosis, and treatment is not an inefficiency, what is it?

The Dark Side of Socialized Medicine

Calling something "free" and paying for it with taxes doesn't take away the need to make hard choices. Demand for medical services is almost limitless, especially when you make the "demand" little more than a request. So some means of rationing has to be put in place. And in Canada, doctors and administrators naturally choose the easiest method: delay.

Like socialist systems elsewhere, Canada's health care system rations by procrastination.

Crude, yes, but it can be horrifyingly effective. If the system is lucky, enough people die while waiting ? or have their life spans reduced ? thereby diminishing resource drain. This is how socialist systems have generally distributed goods: by making the queue, the waiting line, integral.

Perhaps Prof. Smythe knows this. The historical record makes it quite clear that this is what happens when you establish a socialist system for a widely consumed good. The cognoscenti "figure in" the waiting as part of the equation, and call the resulting monstrosity "efficient." Or as they say in the computer biz, "that's not a bug, that's a feature!"

It's only the patients/citizens/rubes who are fooled. (They must not be reading my free Common Sense e-letter.)

Jump Ahead

But how can you fool so many people for so much of the time? In Canada, it's part national pride ("we're not Americans!") and part egalitarianism.

Funny thing is, just like in the late Soviet Union, Canada's system falls short of the egalitarian ideal. Even there, the richer you are, the better your recovery rate. And this is not simply because rich people treat themselves better than the poor can. It's also because queue-jumping ? "pushing ahead in line" ? is rampant. David Gratzer summarizes the importance of "celebrity and connections":

Last year, researchers from the Institute for Clinical Evaluative Sciences in Toronto surveyed cardiologists about preferential treatment. In a nutshell, the study's authors wanted to know whether the heart specialists were willing to help certain patients queue jump. Eighty per cent responded that they did. (On a whim, I brought this study up one afternoon with a group of medical students. The consensus was that 20 per cent of the cardiologists had blatantly lied.)

The rich and the famous just expect to go ahead. And do. "Bypass surgeries," Gratzer notes, "are performed 20 per cent more frequently in wealthier neighborhoods." Bypass indeed.

As Your Mother Put It . . .

"Would you jump off a cliff just because all your friends are doing it?"

For too many American policy wonks, the answer is Yes. Though jumping off a cliff can be hazardous to your health, many commentators on health care prescribe a similar leap into the abyss of socialized medicine. You know the litany: "Every major industrialized nation has national health care, except for America."

Americans should take caution. We certainly don't want to emulate a system whose patients now contemplate an about-face, emulating our system. Though our mixed public-private health care system is a notorious disaster, it's less of a disaster in some important ways than the costly, regimented government-run system that Canada established decades ago. As Canadians have discovered.

Mom was right: let's not jump.