The Sixth Estate

As I have been predicting for some while now, pressure on the Canadian government — which is more prepared to embrace private healthcare now that is has been since the 1960s, in any event — continues to build, with the plagiarists at the Conference Board of Canada leading the charge. The National Post is the latest paper to endorse the Board’s vision for the future of healthcare, which can be summarized as “more private spending good, more public spending bad.” No evidence is introduced to support this claim, except for vague suggestions that it will improve competition and choice.

Oddly central to the Conference Board’s presentation on Health Spending is a chart that clearly reveals that the attack on public healthcare is a farce — but before I get to that, it’s worth pointing out that the Post’s editors are surprisingly ignorant about how Canadian healthcare works. For instance, they say that we have banned private insurance for private clinics here, which is clearly not the case. You can go to a private clinic all you like. And you can pay cash, too. When it comes to family doctors, Canada doesn’t have a monopoly on anything: we have a single payer insurance company (the government), which has persuaded — not required — the majority of doctors to work only with publicly insured patients. We also don’t have universal drug coverage. The only publicly paid, publicly provided healthcare happens in hospitals. So much for monopolies.

Now, back to the Conference Board. After all the complaints about how Canada spends too much on healthcare, that public healthcare is unsustainable, and that (as the Post insists) we are the only dinosaur clinging to an expensive old socialist healthcare system, you might be surprised to see that according to the Conference Board, we’re actually pretty much in line with everyone else when it comes to healthcare spending as a proportion of GDP. France and Switzerland spend a little more, while Sweden and Italy spend a little bit less. The only serious outlier is the only company which has enthusiastically pursued the efficiencies and improvements promised by private healthcare: the United States, which spends around twice as much as everyone else.

Where the difference does show up is in the balance of public and private spending. It turns out that Canada already spends more on private healthcare than most of the European models we’re being told are happily moving back to the markets, with the singular exception of Switzerland. In fact, private markets work so terribly that the patchwork of government insurance systems the Americans provide for soldiers, poor people, and the elderly gobble up almost as much of their GDP as we and other more progressive countries spend on their entire national healthcare systems.

I want to emphasize this point, because it’s not made nearly often enough. On a percent-of-GDP basis, the Canadian healthcare system is already more privatized than every major country except the United States, Switzerland. We spend around the same proportion of our GDP as most other advanced democracies, and we spend a little more in private funding than most do. And we have to compete with the U.S. for expensive medical professionals and other resources, something the Europeans don’t have to worry about. We already have a mixed public-private system. How’s it working out for you?

And speaking of costs growing out of control, this is another half-truth which is being faithfully peddled by idiotic reporters and biased editors. The United States spends around twice what we do already, and their costs are going up at around the same percentage rate that ours are. Assuming the rates remain similar, this means we will never catch up to what they spend. At what point does the “unsustainability” of the Canadian healthcare system lead to complete collapse? 12% of GDP? 14%? 16%? Not if the American system is any indication. Our society could grimace under the weight but could still afford to basically double healthcare spending. This would eliminate waitlists, pay for enough family doctors for the entire population, and probably convince provinces to fund new cancer drugs they’re presently refusing to fund.

If we’re going to have a universal healthcare system, and I continue to believe that we should, then we have to recognize that it is a public institution in need of constant public attention. For far too long now our governments have been permitted to sway people with ridiculous arguments that tax cuts will not require service cuts on the one hand, and that governments are faithfully committing more and more resources to healthcare to contain the growing costs on the other — for a little while, anyways. We do need to talk about reforms. But that returns us to a simple truth:

If you want healthcare, you have to pay for it. All this talk about moving to more private money implies that there is some magical pile of gold out there just waiting to save healthcare, if only we can break free of the restrictions of socialism. And that’s true for some people — people wealthy enough to get the full range of private care, most of which now costs more in Canada than it would in a free market. For the rest of us, though, public care costs decidedly less than private care. And at the end of the day, if you want healthcare, someone is going to have to pay for it. Either you’ll pay for it from your own pocket, or we will all pay for it collectively, with the wealthy paying a disproportionate share of the burden through progressive taxation because, at the end of the day, the wealthy receive disproportionate benefits from most of the other institutions in our society, like the courts and the police.