Private healthcare for Canadians? Bring it on.
Although it was particularly concerning for us in Quebec and urgent to do away with, our now slightly relaxed post-secondary tuition freeze has not been the sole taboo resulting in good part from the defensive collectivism that is so prevalent in this country, on both sides of the language divide by the way. And we are only starting to understand the dire consequences of this on our economic as well as social and cultural development, more so in this province actually than in a large part of a Canada still obsessed with a need to feel fundamentally different from its southern neighbour. Another such taboo from coast to coast this time, which will probably be put to the test here quicker just because its consequences hurt us more, is the surreal and persistent defense of wall-to-wall state-funded medicare, a taboo which is just one more knee-jerk rejection of modern economic liberalism, against all logic since it is the only way our complex societies are at all sustainable. Now, it is not my intention here to discuss recent controversies about the viability of the present system, which is not really my current concern. I also fully recognize that the monopsonic character of a one-payer system as well as the administrative cost-saving and returns to scale that it affords are major advantages of public medicine over any private or even mixed alternative, as far as providing efficiently a given set of healthcare goods and services is concerned.
The real problem however is exactly there: providing a given set of goods and services one way or another is not a particularly meaningful health policy goal per se. What is tremendously more important is to provide access to better health for each dollar that society invests in it. And equity just as well must certainly mean a concern with providing people with more equal access to health rather than to healthcare. Once the question is put in proper context, answers just can’t be as simple as advocates of the status quo suggest. Let me consider three key elements which still lack proper emphasis in the current debate: (1) without a responsive private healthcare sector, the political pressures for more curative as opposed to preventive interventions will likely further crowd out crucial public health dollars, with heavier consequences on the less fortunate among us, who need enough life expectancy before they can benefit at all from multiple bypasses; (2) technological change and spreading innovation are more rapid and extensive in a system of private gain, and the public sector generally benefits from positive spillover effects - I know of nobody refusing modern treatments because of their having been developed and tested originally in for-profit environments; and (3) better standards of living are also powerful determinants of health, yet there exists a major difference between a healthcare dollar forced out of a taxpayer’s pocket and one freely expended with similar intent: all else being equal, the former is a disincentive for the very economic activities needed to have such better standards, while the latter simply has the opposite effect. And there is no more or less “ideology” here than in the very foundation of economic science: resources are just too scarce to have all human desires satisfied at once.
Obviously, none of these arguments can nudge at perfectly valid justifications for global public control and universal basic coverage. If our southern neighbours’ system does need substantial reform, it is clearly because the lack of such coverage makes public programs suffer from the worst inefficiencies of a private sector which is the rule rather than the exception. Completely different points must be made however, if one wants to argue seriously against a complementary private sector and duplicative private insurance. For sure, there is a need for mitigating a number of potentially perverse effects and a thoughtful transition process will have to minimize predictible shortages. We must also expect significant resistance in powerful federal quarters with all the usual slippery slope rhetorics, but all this is still insufficient to remain in a state of denial. The current situation is not unsustainable because it can’t last, far from it actually, but because making it last amounts in fact to little more than a form of collective masochism. Or maybe it is just one more example of our fear to confront a world that changes too fast for our tastes. Come on. We’re stronger than that, aren’t we?
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