"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay.
What the did was both and still were stuck with a miserable system. Claude Castonguay, btw, chaired a 1960 Canadian government committee studying health reform. He recommended that his home province of Quebec adopt government-administered health care, covering all citizens through tax levies.
They did. The results have been pretty dismal. Castonguay now advocates "radical" reform.
"We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."
It is considered radical because the private sector has been shunned by Canadians and their government for decades.
Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.
As IBD points out:
In America, these ideas may not sound shocking. But in Canada, where the private sector has been shunned for decades, these are extraordinary views, especially coming from Castonguay. It's as if John Maynard Keynes, resting on his British death bed in 1946, had declared that his faith in government interventionism was misplaced.
Fear not, however - our intrepid politicians, particularly on the left, refuse to heed the hard learned lessons of those who've tried turning health care over to government. They apparently think the right people haven't attempted it yet and they are that chosen lot.
And if you think 9 trillion in debt and 54 trillion in unpaid future obligations (they've managed all that so well, haven't they?) is a load of dough - turn health care over to them.
Although I would agree that our (Canada’s) healthcare system is far from perfect, I don’t think it is quite correct to call our results dismal. By most International health indicators (average age, infant mortality etc), I think Canada measures up just "okay", but not dismal.
The ongoing debate in the US about universality is an interesting one. I think it may be helpful to point out a few things you might not normally hear:
- Make no mistake: A single payor, universal healthcare system will control costs by rationing care. In Canada, most kinds of emergency care can be accessed quickly (with notable exceptions), but if you want a new knee or fix the cataracts in your left eye, you will wait months on a waiting list because the needy go first...right? Except...
- Doctors and their families always find ways to get access to faster care than regular joe’s (eg "jumping the cue"). This is not allowed, but it happens all the time. (My own Mom for instance, for knee surgery because my sister is a nurse, who knew a guy...etc)
- Those on the Left in the US will insist there will be cost savings because marketing and profits will no longer form part of the cost structure under a single payor system. Well, that might be true, but guess what, there will be very little innovation precisely because there is no profit motive. (The Soviets were not known for their mastery of lowering costs, were they?)
- Don’t believe promises of lower costs due to "streamlining medical records" and such nonsense. There might be some initial efficiency, but in the long run with no profit motive, innovation will absolutely suffer.
- Once a government-run, single payor system is set up, unions will rent seek and drive up wages in nursing, support services, etc. For example, cafeteria staff make $25 bucks an hour to serve food. No contracting out allowed in Public hospitals, natch.
These are just a few passing thoughts...btw if I had my druthers, I would keep our public system, but allow a parallel private system to offer comprehensive healthcare services to Canadians. This way, we don’t feel guilty about reading stories about a family who lost their house because little Sally got sick. But for those of us who can afford it, we can get access to top notch healthcare when we want it. Yes, I know this is an ugly compromise for a small "l" libertarian like myself...
Finally take a look at our tax rates...we pay about 25% to 30% more in Federal and Provincial income tax than US citizens do (State and Federal)...now you know why.
Good points, JasperPants and points which have brought up in various posts on the subject in the past (well, except the one about doctors getting better treatment).
As writers on this blog have pointed out forever, you cannot satisfy unlimited demand with limited supply (only so many providers, only so many hours in a day) without rationing of some sort. And that relationship (unlimited demand/limited supply) is the very basis of the health care model. So rationing is an integral part as well.
Government, as Castonguay points out, really has only two choices - throw massive amounts of money at the system in an attempt to satisfy that unlimited demand, or ration care to hold down costs. The first is impossible since it would mean taxes most taxpayers would be unwilling to support and the second is just as bad because it ends up denying care to certain classifications of patients. And, of course, when you remove the profit motive from the mix, it stagnates and then worsens.
Like most proponents of government health care, they seem to hide from that reality and attempt (much like they’re doing now with the vaporware of alternative energy) to convince others of the savings to be had if they only did "x" or "y" and how that would set the whole system right.
JasperPants is pretty right, but that depends on one’s vision of what ’good’ health care would look like. For instance, Canada does a really good job of preventative health care in children and youth. Try transplanting that to the US where (idiot) parents refuse to vaccinate their children for all sorts of silly reasons and you’ll run into a lot of resistance and unhappiness. It also does a relatively good job of treating healthy adults for episodic situations. All well and good.
However, it does, indeed, do a dismal job if you consider saving resources by delaying treatment for chronic adult situations situations, or delaying or refusing altogether certain merely ameliorative procedures simply because it doesn’t show the proper benefit/cost relationship to be dismal.
It also does a pretty dismal job of treating ’end of life’ type situations, because the cost of adding an additional few days, months, or years in a serious situation can be very expensive, therefore not cost/benefit wise and thus typically not allowed.
He’s properly mentioned the cost in terms of reducing innovation, but he skips entirely the problem of ’Who Decides’ what the ’proper’ cost/benefit equations are and how they’re implemented. Let me run the data and make the resource allocation decisions and you’d get a vastly different result than if you let, say, Obama do it.
Finally, of course, the idea that somehow centralized decision making for complicated situation does anything other than petrify the system at some very sbu-optimal point is always studiously avoided by anyone advocating such systems. A quick perusal of the organization theory literature compared with actual history of organizations should rapidly disabuse one of the value of centralized, bureaucratic decision-making mechanisms in the face of evolving decision environments. (I.e., they’re always fighting the last war.)
I could certainly suggest some improvements to our current system, but single-payer and centralized rationing of resources would never, ever be among them. They are a recipe for dismal catastrophe for too many, even in they might work for an actual majority.
"By most International health indicators (average age, infant mortality etc), I think Canada measures up just "okay""
Since these indicators are largely affected by things such as safe drinking water, law and order, and basic health care and sanitiation practices, any country claiming to have an advanced health care system should have more than just ’okay’ scores in these indicators.