The annoying thing about fundamentalism is that it takes an idea and holds to it without interpretation, nuance or questioning. It dismisses contrary evidence and pays attention only to that which reinforces the belief first taken on faith. The most recent example is in the approach to health care by so-called defenders of the public variety. (Given what they defend, they should be called defenders-of-waiting-lists-that-kill.)
The willingness to examine assumptions is why Premier Gordon Campbell and Health Minister George Abbott are bang-on in their approach to ask more questions about Canada’s health-care system: Why are some citizens afraid of European-style approaches where private, non-profit and government sectors are involved in health-care delivery and insurance? Why is any health-care reform assumed to lead to an American-style system?
There’s another question that’s not on the list but should be: Why is talk of reform immediately taken over by the Shirley Douglas-Maude Barlow-Jack Layton axis of government health-care fundamentalists? Predictably, Layton is opposed to even chatting about change: “We have stated that we want to see the Canada Health Act enforced and it is distressing to hear this kind of initiative by the government of British Columbia.”
The federal NDP leader is distressed to even “hear” about an initiative? Now there’s evidence of a closed mind. Suppose all that comes of the B.C. initiative is more private delivery of government-insured services. So what? The Canada Health Act is about health insurance and payments; that’s it. The act prohibits some citizens from buying or insuring for health services already covered by the province. (Exceptions include injured Workers’ Compensation claimants, the army and selected others.) The delivery of insured services is an entirely different matter.
So is universality. One reason some people are afraid of change is because they equate the universal availability with government delivery and government insurance. But a country can mandate universal access to health care and allow for multiple ways to insure it and provide for it. As Winnipeg economist Dr. Philippe Cyrene pointed out in his recent book on health care in OECD countries, France, Germany and Belgium all have multiple insurers and vibrant private sectors for health-care provision. And they don’t have Canada’s waiting lists.
Then there’s the issue of user fees, which Opposition Leader Carole James tried to twist as equivalent to any and all ideas about health-care reform. James opposed a planned trip by the premier and health minister to Norway, Sweden, France and the United Kingdom on the grounds the fact-finding expedition was all about user fees. The James tack was another sign of a closed mind. It’s akin to not asking questions about sacred writ, which apparently the Canada Health Act has become to New Democrats.
User fees might be a good idea or a rotten one but they shouldn’t be off the table in any serious discussion on health-care reform. France, Sweden, Germany and Belgium all allow for co-payments (user fees) for basic services and hospital visits. Also, if the B.C. government needs help to open up the debate box, they can try Tommy Douglas, the patron saint of government health-care devotees. In a speech to the Saskatchewan legislature in 1961, here’s what Douglas had to say:
“I want to say that I think there is a value in having every family and every individual make some individual contribution. I think it has psychological value. I think it keeps the public aware of the cost and gives the people a sense of personal responsibility.
“I would say to the members of this house that even if we could finance the plan without a per capita tax, I personally would strongly advise against it. I would like to see the per capita tax so low that it is merely a nominal tax, but I think there is a psychological value in people paying something for their cards. It is something which they have bought; it entitles them to certain services. We should have the constant realization that if those services are abused and costs get out of hand, then of course the cost of the medical care is bound to go up.”
It’s one thing to take the 10 Commandments on faith. At least one can argue none of us were around several thousand years ago, so perhaps Moses really did receive two clay tablets from God. But it’s a bit much for the faithful to argue divine inspiration was involved in something as banal as 1984 legislation conceived and delivered in Ottawa.
New Democrats and their ideological allies should open up their minds as Douglas did and stop deifying the Canada Health Act.
Mark Milke is author of the forthcoming A Nation of Serfs? firstname.lastname@example.org