The Sound of Shifting Delusions

Frontier Centre, Healthcare, Uncategorized, Worth A Look

The other day, Jack Layton said an amazing thing: Even though the NDP opposes private health care, it wouldn’t ban private for-profit institutions such as MRI clinics from delivering medically necessary services. Canadians, he said, have a constitutional right to establish any business, and the NDP is not about to mess with that.

This is a major shift in NDP policy. It also shows how rapidly the health-care landscape is changing, even though no leaders will admit it. Obfuscation, after all, is an essential skill in politics. It is what allows you to declare that your principles and policies haven’t changed, even though they have.

Mr. Layton has read the writing on the wall. No doubt he’s also read the Supreme Court’s Chaoulli decision, which says timely access to health care is a fundamental right. Only yesterday, Paul Martin was warning that private clinics violate the Canada Health Act. Today, politicians are applauding an experiment in Alberta that has dramatically reduced wait times for hip and knee surgeries. Guess what? Much of the work has been farmed out to private clinics — the same ones Mr. Martin told us were a threat to medicare.

The dispute over the morality of who owns the MRI machines reminds me of the arguments medieval scholars had about angels on the heads of pins. The public has moved on. I was recently at a conference with a hundred professional women from Toronto (the kind who break out in hives at the sight of Stephen Harper). Someone asked if they thought some form of private-sector role in health care was inevitable. Almost all raised their hands. Then they were asked if they thought this was a good idea. Half the hands stayed up.

The polls say about the same. Many Canadians think that, as long as the government pays the bill, private delivery of public services is fine. Just two years ago, no politician dared whisper such a thing. Now the unsayable can at last be said — so long as everyone pretends that nothing’s changed.

All societies depend on a few necessary delusions — the beliefs everyone pays lip service to, at least in public. In Canada, one of those delusions was that there was no place for the private sector in public health care. Another is that the interests of Quebec and the rest of Canada are fundamentally compatible. If only reasonable people keep on talking, then reasonable compromises will be hammered out and Canada will remain the most splendidly bilingual, bicultural nation in the world.

Well, maybe. But maybe not.

Someone I know, a veteran of the constitutional wars and a lifelong fighter for national unity, told me recently: “Maybe Canada can’t accommodate the aspirations of Quebec after all. Maybe they’ll go their own way, and maybe we shouldn’t try to stop them.”

Among the political and thinking class of English Canada, this view is still taboo. But you can hear it expressed every day among ordinary people in Western Canada, far less politely. In the west, Paul Martin’s Captain Canada routine doesn’t play. People neither believe nor care he’s the guy who can keep the country together. As far as they’re concerned, Quebec has hijacked Confederation for long enough.

Here in the mushy middle, people are just tired. We can’t stand the thought of another round of constitutional wrangling. Been there, done that. Fighting for Quebec feels more like fighting to stay married to someone you’re pretty sure doesn’t love you. Eventually, you start to wonder why you bother.

The subterranean talk about Quebec reminds me of the talk about medicare that went on in private a few years ago. Educated people were very cautious about what they said, because they didn’t want to sound like yobs.

Today, no federal politician can talk openly about this view of Quebec, or even admit that it exists. Instead, they must position themselves as the ones most capable of managing an issue that, in the end, may not be capable of management. But you can be sure of one thing: Even as (or if) we drift toward soft separation, nobody will ever say so. As we evolve from 10 provinces into deux nations, they’ll just say Canada is more united than ever. That’s the Canadian way.

mwente@globeandmail.ca