No one has yet suggested, in this country, trying to nationalize the food industry, and the results of attempting to do so in those unfortunate countries which have tried it surely constitute a complete refutation of any idea of doing so. Food is a lot more essential to life than medical services, but somehow the "front-line" nations of the world have managed to convince themselves that nationalization to some degree, at least, is the way to go in medicine, even though the tragic consequences of the same kind of program in the food business speak very loudly for themselves.
Well, I beg to differ with the virtually 100% of contemporary academics, politicians, and pundits who spend so much time trying to keep the current medical system from foundering (even more than it already has). The correct thing to do with the Canadian, or any other top-down medical "system" is to junk it.
People who oppose this have the idea that many people "can't afford" medical assistance, AND that this fact is a reason for resorting to government to provide. I deny both.
There are very, very few people who cannot afford medical service when needed. The GDP in Canada hovers around $30,000 per capita these days. A new house in my towns will cost you, says the morning paper, about $225,000, which means that that's what people are actually paying. A very tiny fraction of Canadians would not be able to afford medical expenditures on the order of $5,000-$10,000/year if necessary. We'd all like it to be unnecessary, of course, but that's hardly the point. What is the point is that it is prima facie absurd to think that we should let the Canadian and our Provincial governments tax us several thousand dollars per year per capita in order to enable us to "afford" medical care. If we didn't have the money, they couldn't tax it away, could they? But if we have the money, then taxing it away isn't going to improve our ability to pay - quite the reverse. Now suppose that some few Canadians would go without medical care if they had to pay for it themselves or out of self-purchased, genuine (as contrasted with government-imposed) medical insurance. Those few are then thrown, as they are now, on the beneficence of others. At present, actually, they are not thrown on the beneficence of others, strictly speaking. Instead, they are thrown onto the pseudo-beneficence of the voting booth, where we are able collectively to compel the rest of our fellow citizens to pay involuntarily for the provision in question. I don't think we should quite classify that as "beneficence", myself. But if there were no medical "system", then these individuals would indeed be at the mercy of their fellow men (including sympathetic medical service providers themselves). There are those who suppose that the set of beneficent people is too small to enable these few to get major medical service. I wonder why they suppose this? Americans currently give, in addition to their involuntarily extracted taxes, about $3,000 per family in charity per year. Canadians don't give at that rate, as yet - our taxes are too high. But they could, and if they did, giving at that rate would make a total almost equal to the current entire state expenditure for medicine in Ontario, say, or about 1/4 of Canada's expenditures as a whole. Would somebody please explain why this would not be "enough" to support the tiny percentage of those who can reasonably be claimed not to be able to afford it?
Of course, the pundits who say this are probably assuming that ordinary people are as skin-flinted and heartless as they themselves. But that's one of the many problems involved in taking up the political life: it insulates you from reality - especially any reality that is not conducive to enabling you to make it as a politician.
If medicine were at last returned, genuinely, to the free market, what would that mean? It would mean
- no government licensing of physicians. This would have to be done by organizations of physicians - which is, it might be said, what happens now. But the organizations of physicians in control of this now have the hefty assistance of the government in enabling them to keep the number of new physicians too low, or too high, as may be the case. Without government licensing, physicians will advertise their services, and prominent on their ads would be mentions of documents indicating a good record of service to date, training at the hands of recognized experts, and so on. Some physicians, also, would advertise that they don't accept various aspects of what the "established schools" provide in the way of training, and potential patrons of those physicians would know what they were getting into. (As now, of course, they would be able to sue for fraudulent advertising and malpractice.)
- all training of physicians would be at medical schools which would function as private universities, financially supported by tuition fees, which in turn would as usual be financed out of future MD income, plus contributions from the innumerable private parties who want to support or invest in medicine.
- Physicians would practice on their own, set fees on their own, set the terms on which they would treat people on their own - or else join organizations with standardized schedules of some or all of these. But those organizations would be strictly noncompulsory.
- Medical insurance would be unregulated, so that businesses getting involved in medical insurance could offer whatever kind of policies people would buy. For example, genuine insurance - as distinct from what we have now - could be advertised, with, say, $5,000 deductible per year plus 90% of the rest up to some high figure. Since the individual would pay the first considerable part of medical costs, he or she would have good reason to shop around and use due care in the selection of providers.
- charitable support for the indigent would, as usual, be by private donations from individuals or organizations interested in doing that sort of thing (churches, foundations, businesses with charitable interests, and so on.)
And the results? I expect that the net effect of these reforms would be as follows:
- The cost of medicine would decline markedly, given genuine competition and an enormous reduction in paperwork (typically, I should think, none)
- The availability of needed medical care would improve sharply, approximating current U.S. levels.
- Medical matters would rarely be found in headlines in newspapers any more.
It is this last that, I suppose, is by far the major contribution of socialized medicine to public life. It ensures that there will be great disparities between demand and supply in medicine, and the system of "public accountability" will see to it that politicians get their names in the paper for denouncing other politicians whom they can accuse of doing too little or the wrong sort of thing.
I am genuinely sorry about the latter, for as an occasional reader of newspapers I appreciate the value of a good scandal or other occasion for hand wringing and bitching.
However, I think we should care more about people and their health, and their budgets, than about the entertainment industry. Those who feel similarly should oppose authoritarian interference with this very important human service.
Prof. Jan Narveson - August 13, 2002
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Hi Jan;
I know you advertised it as "the World's Shortest Canadian Article on Health Care" but I would like to add a few suggestions regarding the results of junking the current system you might want to add.
People would not assume that they are automatically protected from unqualified doctors and would take extra effort to confirm qualifications. A recent article in the Toronto Star (August 13/02, Page A2) tells about a "doctor" who practiced in Hamilton for 15 years with a forged degree. (He billed OHIP $4.5 million through this fraud, and was given an 18-month conditional sentence.)
Insurance companies would need to assume responsibility for ensuring doctors are competent and stay competent. One of the things a consumer might want to know is what company is insuring the doctor. Insurance companies could confirm on the Internet that they cover a particular doctor for a particular practice.
Increased competition would rid medicine of those who are in it only for the money; doctors that see 10-12 patients/hour and are too quick to prescribe medication.
The waiting list for specialists would go down when they are allowed to set their own fees. Currently the waiting list for a good obstetrician is close to nine months! The government-set fee is not enough to compensate for the lousy hours and high liability insurance costs.
Voluntary, competitive medical associations would be motivated to maintain a good reputation and would do a better job of investigating patient complaints and weeding out bad doctors. The College of Physicians and Surgeons is motivated to dismiss complaints.
Private investors (instead of taxpayers) would buy expensive medical equipment, such as MRIs, and reduce the need for patients to travel to the US for tests or treatment. The availability of such equipment would benefit those who need it don't have the money to travel out of country.
Total medical expenditures would go down when the patient knows what is being charged. It is too easy in the current system for a doctor to charge for 40 minutes of consultation after seeing a patient for only 10 minutes. It might also discourage people from going to the doctor when they have nothing more than a cough or cold. And the doctor would need to justify any expensive lab tests to the paying patient instead of doing it just to be safe (and cover their ass, I mean liability).
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The fact that a small number of people might not be able to pay for required medical treatment is not justification for making it "free" for everyone. A better (but not a Libertarian) solution is for the provinces to pay for medical treatment only for those on welfare, or to operate clinics for the poor. This might be a politically acceptable approach to getting the government out of the medical business.
Or, to go back to your food analogy, charitable groups would organize free clinics, just like food banks. Prior to OHIP most hospitals were run by charitable organizations and would never turn anyone away because they couldn’t pay. Doctors at these hospitals were expected to provide their fair share of free services. I believe some hospitals in the US (likely teaching hospitals) operate free clinics. You might have to wait longer (like we do in Canada) but you will still get treated even if you have no insurance.
Regards; - Jim McIntosh - August 14, 2002
