Response to a recent WSJ editorial
Source Dave Anderson
Date 99/05/01/21:56

/* Written 12:06 PM Jun 29, 1998 by in igc:labr.all */
/* ---------- "Response to a recent WSJ editorial" ---------- */
---------- Forwarded message ----------

Date: Sun, 28 Jun 1998 17:59:57 -0600 (MDT)

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"

.. 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

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

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

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).


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