councilor.org
| Source | Dave Anderson |
| Date | 99/05/01/21:56 |
| /* Written 12:06 PM Jun 29, 1998 by jshell@netcom.com in igc:labr.all */ /* ---------- "Response to a recent WSJ editorial" ---------- */ ---------- Forwarded message ---------- Date: Sun, 28 Jun 1998 17:59:57 -0600 (MDT) From: ANDERSON DAVID This posting is a defense of the Canadian single payer public health insurance system (called Medicare) from a Canadian responding to a Wall Street Journalarticle. Subject: Fwd: response to WSJ from Canadian perspective This response is from Bill Blanchard, Friends of Medicare, Edmonton, Alberta, Canada. Thank you to our Canadian colleagues! Friends of Medicare is a "coalition of individuals and organizations committed to the principles of Medicare....We seek to raise public awareness and educate Albertans and Canadians about the benefits of our Canadian Health Care System." -- Ida Hellander From: "William A. Blanchard" To: pnhp@aol.com .. Response to the Wall Street Journal Article (Bill Blanchard) There is so much error in fact and reasoning in this article it is difficult to know where to begin. But perhaps we should begin with the one small bit of truth in it. It is true that our Doctors are extremely dissatisfied with the current state of our Medicare System, but so also are the majority of Canadians. But from there on, the article goes down hill. First, the bald statement shouted out in the headline that our doctors are on strike is a misrepresentation. Doctors in several of the Provinces have engaged in various forms of "job action" which are intended to express their dissatisfaction but designed in such a way as to protect patient safety. Second, the consistent inference that our doctors do not support our system is simply untrue. The great majority of our doctors are fully in support of the five principles of our Canada Health Act: Universality (everybody is covered) Comprehensive (covers all medically necessary treatments - for everybody) Publicly Administered (contrary to the implication of the article we do not have socialized medicine in Canada. Doctors are independent practitioners, not employees of the state. They are reimbursed by the state for their services, but are free to opt out of the system for private practice if they wish). Accessible (Is reasonably available both in time and geographically--to everybody) Portable (It goes with you even if you change jobs or province) It is true that when Medicare was first introduced many doctors objected. But now, after thirty years of success the great majority of our doctors strongly favor our system because it frees them to concentrate fully on the medical problems of their patients without keeping one part of their attention focused on whether or not the patient can pay the bill. (I have been in doctors offices in the U.S. where at least one persons full time role is to keep track of the paper work generated by health insurance companies). What both the the general public and the medical practitioners in Canada object to is the extremely reduced level of financial support that our Medicare has received since the early 90's. Like governments all over the world, including yours, both our provincial and federal governments have been intent on reducing deficits and paying down debt. Unfortunately, and unnecessarily, they have done this by draconian cuts to Canadian social programs, in which Canadians take great pride, including Medicare. For example, our Alberta Provincial Government has reduced the per capita amount spent on health care from over $2000 in 1992 to $1600 today. It is obvious to anyone who wants to deal with our realities, rather than their own mythical conception of them, that a system cannot take a reduction of nearly one fourth of its budget and function adequately. It is a mistake to think of, or to portray, our doctors as only asking for more money for themselves. They are also demanding adequate funding for the system as a whole. These seemingly deliberate misrepresentations are all too prevalent. But coming from a presumably prestigious publication like the Wall Street Journal they are simply unacceptable. But what is even worse is the errors made in economic thinking underlying many of the articles propositions. One gets the feeling that the writer got his basic economics from the Primer of Libertarianism (see Boas, Libertarianism: a primer, 1997) and has never opened a cover of a book on the economics of health care. All such books that I have read make it abundantly clear that the health care market is different from the market for lipstick and hair dyes that are made just for men. The theory of supply and demand do not directly apply to health care. First, standard theory assumes that the consumer is fully knowledgeable about matters of health. This is patently not true, nor could it ever be reasonably expected. Even doctors have to consult specialists. Second, health care consumables are not things that most people hanker to have more of simply because they are there (this is the myth of the "welfare Burden"). We don't opt to have as many operations as possible just because they are "free". And if our family doctor [and we still have them in Canada, and we are free to choose any one we wish] tells us we need an appendectomy we don't let our fingers do the walking through the yellow pages to shop for the cheapest cutter in town. But perhaps the most objectionable is the implicit ethical position which underlies much in this article: The article states that we cannot afford Medicare. This is a statement commonly made without qualification as though there were some law of nature that prohibited us from spending more. This is simply not true! In one of the richest nations on earth ( and we are a rich nation, contrary to some perceptions of us as the poor northern cousins) there is plenty of wealth to support a more than adequate Public Health System. It comes down to a matter of the choices that we must make. And whenever we make choices we are always drawing on our values (which do we value more, this or that). And in the case of medical care we are dealing with matters that are central to the quality of life, and even to life itself. So the values that we draw on here are ethical or moral values. What do we want? More million dollar sports heroes or adequate prenatal care for our young women? The question we should always ask when politicians (or others) say we can't afford good medical care for our people is ..."On what other good things are we going to spend the money that we save?" The article denigrates our system of rationing health care. All societies must ration almost every good there is, including health care. You simply do not give a precious heart for a transplant in a man who is 102 years old. The question is how you ration. We agree with the article to the extent that Canadians don't like our present governments' approach to rationing, which can only be characterized as "slash and crash". But then to suggest, as the article unashamedly does, that the "market" will simply and painlessly solve the rationing problem is either naive at best, or deliberately deceptive. Sure the "market" will efficiently ration health care. The rich, or those covered by adequate insurance, will get the best, and all the rest can beg. (I saw a discussion on U.S. TV several years ago which brought together experts from both countries, yours and ours. The one statement that has stuck with me over the years was made by a Canadian Nurse. She simply asked, "Don't you Americans care for one another?"). The elites in both the U.S. and Canada seem to have been caught up in the now popular "Libertarian" philosophy of distributive Justice (See Boas).The essence of this philosophy idolizes the individual and ignores mankind's historic and continuing need for community. The fundamental right in Libertarianism is the right to liberty. And it follows from this that whatever goods a person has rightfully gained for herself cannot be taken without her consent. "Market forces" are the best protection that this right to liberty can have. Governments, by their very natures, limit freedom, so the only function of government is to protect that freedom (police, defense and contract law are the only legitimate functions of government should have). Under Libertarianism we are free to give voluntarily to charity, including charities for health care, but our money cannot be "arbitrarily" be taken away from us (Taxes are theft). Most of us would reject this philosophy, and adhere to a more communitarian creed. Not that we would denigrate liberty, which is important, nor the importance of the enterprising individual. But we would recognize that mankind has survived and prospered over the millennia not only because of the energetic, inventive and industrious individuals but also because of the community which succored and supported these individuals. We need both. And it is our belief that democratic government is the most effective tool (with all its warts) for taking the collective actions that support community values (like caring for one another). ****************** |
Copyright (c) 1998, Joongpil Cho