Wednesday, December 15, 2004

Look for the fruit on the tree

Babble on.

I don't go to a plumber for legal advice. I don't go to a poor man for investment advice. And I don't go to Hog on Ice for relationship advice (hat tip to Jaeger). If you're not in a successful relationship, I don't care what you have to say on the matter.

I do go to a doctor for medical advice. And I definitely go to Dr. Monger for advice on the Canadian medical system.

Perhaps most Canadians don't feel there is a problem. After all, most Canadians are not sick. But those who get sick will soon discover that I and other Cassandras of the Best Health Care System are right. The personal goals of individual patients are only met when they coincide exactly with the Collective Goals our political masters agree on.

He's right, of course. Not a month ago, Canadians voted Tommy Douglas, the creator of the Borg Best Health Care System Greatest Canadian. I wonder how many sick Canadians gave Douglas their vote?

Babble off.


At 1:05 p.m., Blogger Greg said...

I have been "talking" at Jerry Aldini's place about this. I can appreciate Monger's frustration. However, I am still not sure how he would finance his alternative system. He makes it almost sound like if only the government was out of the way, things would be fine. People would not have to wait for operations and everyone would win. I disagree. Mainly because I know myself I could not afford to pay for cancer treatment out of my own pocket. So, I would have to go through an insurance company to pay for it. Once I do that, it is their priorities that will prevail and those may not be exactly the same as mine. Am I missing something?

At 10:09 p.m., Blogger The Monger said...

Hi Greg,

I would make one little tiny change. I would make it legal in Canada to pay for one's medical care by private means. I don't care if the government owns the hospital (although as a matter of interest the government can usually be counted upon to spend roughly 30% more than a private corporation to achieve the same goals...). All I want is for private health care to be legal.

Therefore, health care would be funded by taxes, on the one hand, and private insurance companies and/or out-of-pocket payments on the other hand.

In this kind of system, if you could not afford to pay for your care--or even if you could--you would be able to continue to have Medicare wrap you in its cozy loving arms. Sorry. I don't mean to be facetious. As Saturday Night Live said a while ago, it's not sarcasm--it's a speech impediment!

Look, I understand that there's no way in a million years that Canadians would be willing to evict government from their health care system. Fair enough. All I want is the freedom to have something better than the second rate system which some Canadians are so smugly proud of.

At 10:45 p.m., Blogger The Monger said...

UPDATE to my ealier comment:

I re-read Greg's entry, and I realized I failed to answer his question.

Broadly speaking, he is correct that if you go through an insurance company, you would be limited by their "priorities" in a fashion similar to the limitation we face from the government. But the point is that allowing private care injects a great deal more resources in the system, outside the control of government.

Free markets allocate resources far more efficiently and productively than closed statist economies. This is true in medical care just like it is true in ball bearing production. There is a reason the American economy was more productive in practically every sector than that of the former USSR: it's not that Americans are smarter, or worked harder, or were more blessed by a merciful Christ. It's that the Americans had a free market, whose invisible hand guided the economy consistently onto the most advantageous track.

Incorporating a free market aspect to the Canadian health care system would not only add more resources (because most of us would be willing to pay some extra bucks to get better care, in a way we would not be willing to pay extra taxes), but would focus them in such a way as to benefit the whole (medical) economy.

Do you wonder why the Americans have more MRIs in Seattle than we do in the whole country? It's not because they're smarter than us or richer than us (although on average, they are wealthier). It's because they have a more free medical marketplace.

Personally I think it would work here too.

Philosophically, from my point of view, this is a very very easy question indeed. If the free market works better than socialist planning in every other sector in which it has been tried, why wouldn't it work in health care?

Just so you know where we stand internationally, there are only three countries in the world where a free market in health care is forbidden by law. The other two are North Korea and Cuba. I don't know about you--to paraphrase Groucho Marx, I wouldn't want to belong to a club that would have them as members.

At 2:24 a.m., Blogger Matt said...

This is an excellent topic, with three excellent comments. I am working on a response, but need to sleep. Let me start with these two notes to the Monger:

* Your first comment killed - I actually don't think the second advances your argument (or at least, among the people who need to be persuaded). My overall contention is: your second comment brings up ideological differences of opinion which are still being debated (I just report!), whereas your first does no such thing, and can only be protested out of bald self-interest.

* It was Dave Foley on Kids in the Hall, and not SNL, who can boast of the character with the sarcasm "speech impediment" (oh, nooo, don't stop talking, this is really IN-teresting).


At 8:40 a.m., Blogger Greg said...

Hi Monger,
I don't think you can escape the central problem of your position. Really the only people who are free to choose are those with the means to do so. Once you are dependent on a third party to pay, you give that power to them. Anyone who has dealt with insurance companies in other areas (autos for example) know that they do not always act in a way that agrees with what we perceive as our interest. I am not sure that tossing ourselves from government control to insurance company control is much of an improvement.

As for having a mixed system, that is more interesting. My only problem is this. What is to stop the people who opt out of government medicare (who incidentally would tend to be our nation's wealthier individuals) from turning around and demanding more tax cuts? They would have no investment in the government system and so would not feel like they should have to pay for it. It would be the old double taxation argument. If you can solve this problem, I would be willing to look at a proposal for a mixed system.

I am not however willing to make a leap of faith. Humans are humans and if they think they are getting taxed with no benefit, they will organize to change that situation. If they succeed, the funding for medicare will get more and more scarce, leading to a further deterioration and the flight of the middle class to the private system. Once that happens, medicare will become the preserve of the poorest who have no other choice. I have heard it said (and I believe it is true), that services aimed just at the poor, lead to poor services. I am not sure we can avoid that if we go down the road to private health care. If we are all in the same boat, at least we have a stake in keeping that boat afloat.

At 9:33 a.m., Blogger Babbling Brooks said...

I'll let more thoughtful types like Greg, Matt, and The Good Doctor carry this debate. As I've said before, I'm essentially lazy. The one comment I will add is that voluntary withdrawl of participants from a public system doesn't lead automatically to forced withdrawl of funds. In high-school I fooled a private school into thinking I was worth a scholarship. My parents continued to pay taxes into the public school system. That was twenty years ago, and the situation hasn't changed dramatically since.

At 10:24 p.m., Blogger Mike H said...

I agree with "the Monger," and not just because of his cool blog identity.

A major contributing factor to our health care crisis is the fact that we're using more of it. Medical advances are saving and enhancing lives, and our current single payor system can't feed enough cash in to provide everyone with these advances in anything resembling a timely fashion. In theory of course, the socialist health care delivery model eventually gets to everyone who hasn't died while waiting in line.

Greg, our universal medicare system was just dandy in the 1960's, when we had a much younger population, and we couldn't do half the things we can today for people.

I'm all for letting people choose to pay their own way if it moves everyone up in the queue, and I don't see any way this wouldn't occur if we allow private purchasing of health care. As Damian and the Monger have pointed out, a two tiered system means more money for the system,, purchasing more health care services.

And in the end, nothing should be more free of political ideology than health care, yet our current system is driven by a leftist determination to maintain the illusion that we have a government monopoly, single payor system. That isn't reality any longer. Private purchasing of health care has insinuated itself into our current system in a big way. Might as well take the full plunge. I've no doubt it's coming, and the sooner the better.


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