The Medicare Debate Isn’t Over

Worth A Look, Healthcare & Welfare, Frontier Centre

In the final days of China’s Sing dynasty, the British, French, Americans,
Germans, Russians, and Japanese all took large bites out of the empire.
Still, there were those at the imperial court who refused to believe there
were barbarians in the Middle Kingdom at all.

Invaders? What invaders?

This refusal even to acknowledge an unwelcome reality, much less accept it,
is shared by those who wish to preserve Canada’s government health care
monopoly. So fervently are they devoted to public health care that they
continue to delude themselves about the creeping decline of Canada
government-paid medical services and the desirability of private health

For instance, in September, an editorial in the Canadian Medical Association
Journal asserted “there is virtually no disagreement that private health
care is more expensive and less efficient than publicly funded care.”

“Virtually no disagreement” is not the same thing as concrete proof, though.
Lack of disagreement can arise from shared bias by all the so-called
experts, too.

To keep from entering into contentious debates — especially one they might
lose — far too many Canadian opinion leaders and lawmakers will assert that
this or that issue has been “settled,” that there is virtually no
disagreement about the facts or solutions, therefore no more discussion is

This has been done not only on health care, but also on global warming, gun
control, aboriginals, immigration, transfers and equalization, family
policy, moral issues, even human rights. Most often this consensus is
arrived at by a neat little trick: Those making the “no disagreement” claim
also decide who qualifies as an “expert.” Anyone with opposing views can’t
be worth heeding. If they were smart enough to listen to, they would agree
with the experts.

Thus it is that the Canadian Medical Association’s editors can ignore reams
of economic analysis that shows, at worst, neither for-profit nor
not-for-profit health care is clearly more efficient and economical than the

This has policy implications, of course. Private reforms need not be
considered when there is “virtually no disagreement” on the inferiority of
private care. Private reforms make no sense if one can establish that public
care is both better and cheaper as the starting point, even if that “given”
is based more on dogma and sentiment than objective analysis.

All of which is why we Canadians get to witness such mutations of reason as
a prime minister whose personal physician is the owner of the largest chain
of private clinics in the country claiming that he, Paul Martin, is not
treated as a private patient and why we have a supposedly free-market
Conservative party that is among Medicare’s most fervent defenders.

Enter the government of Quebec.

Last week, a provincial white paper on limited private reforms, which should
be released officially next month, was leaked.

It advocates giving doctors quotas or obligations in the public system,
perhaps a specified number of hours they must provide each year. After that
minimum level is met, doctors would be free to use any additional hours in
private clinics or surgeries.

Quebec’s Health Minister, Philippe Couillard promises there will be a public
consultations on the proposals next year, followed by a debate on new health
legislation in the National Assembly.

Montreal is already the private care capital of the country, and the
momentum is unstoppable. Vancouver is catching up and private clinics in
Calgary, although rare now, are unavoidable.

Now consider the reaction to Quebec’s plan from inside Ottawa’s imperial
court. Federal Health Minister Ujjal Dosanjh’s press aide, Ken Polk,
insisted, “the principles of the Canada Health Act are clear, and our position
is that those principles must be respected.”

The principles are “clear,” the debate is “settled,” there is “virtually no
disagreement.” See how Mr. Polk is trying to prevent a debate rather than
counter one.

The Canada Health Act does not forbid doctors from working in both private
and public hospitals at the same time, nor does it prohibit the private
delivery of publicly paid and administered care. But inside the health
policy establishment it is “clear” it does ban such practices.

So we will have virtually no debate on such reforms, thank you very much.

Thank God, that’s settled.