September 02 2003 - Editor - National Post

RE: Health care's hidden costs [[RM archive copy]]

Editor,
I wonder if you might allow me just a few lines to reply to "Health care's hidden costs", by one Pierre Lemieux Financial Post Thursday, August 28, 2003.

I think your writer is making a rather one-sided and misleading case, when suggesting that "...the only efficient solution to the problems of the Canadian system would be to legalise private health insurance and let private institutions compete with the state system..." There are, indeed, other solutions to the problems the health care system currently faces (has this man not seen the Romanov Report? If so, how can he make this claim? And if not, how can he claim to know enough about the problem to comment on it???? - My my, another conundrum from the pages of the Post!!)

Right from the first, he seems intent on misleading, when he says that "...Socialist systems are especially efficient at hiding costs..." - he goes on to talk about how "socialist" systems encourage people to work hard for mere subsistence wages, and how people spend much time in queues, sacrificing valued leisure time or income... What is not clear is how (or why, for that matter) he relates this unreferenced or explained "observation" about "socialism" to the Canadian health care system - the last time I looked, Canada was a democracy, and a pretty capitalistic-oriented one at that - I rather doubt that any actual "socialist" would be running around the world bragging about the great "socialist" republic of Canada, although I could be wrong there, as I don't know many socialists. I do understand that the right-wingers of the National Post and their compatriots (sorry - is that a socialist word and thus an insult to a Post writer? - I don't mean to be unintentionally insulting here) refer to Canada as some kind of "socialist" haven, or backwater, compared to the great capitalist MIC utopia to the south of us, but I have always assumed that to be more or less rhetorical in nature, and not to be taken that seriously. Perhaps I was wrong - never, as they say, underestimate the shallowness and stupidity of greed and those who promote it as a "philosophy".

In any event, might we dare to point out a couple of things that would seem to contradict pretty much everything your Mr. Lemieux says - such as that, all comparisons to totalitarian Russia of the last century aside, Canadians by and large do not work for "subsistence" wages (although as a Labour Day report by the Fraser Institute indicates, that is something we should be working to overcome - the less wages paid to workers, obviously, the more profit for the investors - the people who really count), and whatever time they do spend in lineups waiting for health care, first, it is not the problem of sacrificing leisure time that most of them are concerned about, but about getting treated before they or the child they have brought to the emergency room dies; and secondly, those lengthy lineups are not an integral part of the system, as your writer implies, but are the result of over a decade of heavy cutbacks on healthcare spending at both the federal and provincial level - and the people of the country are somewhat unhappy about it, as the very positive response to the Romanov report last year indicated.

"Socialist systems are oblivious to anguish..." your writer carries on - well, I cannot say for sure one way or the other about 'socialist" systems, but I do know that nobody involved in the Canadian health care system shares this "oblivion to anguish", and it is, really, quite insulting to say so - pretty well everyone connected with the healthcare system that I (or any "normal" sort of person I have talked to) know is very, very concerned about providing good health care to their patients, and all are most unhappy at the funding cutbacks of the last few years that have contributed to the great stress on the system that causes some patients to receive delayed treatment (a small challenge, if I might, to your writer - go down to your nearest hospital, and make a joking comment to one of the Doctors or nurses in the ER about mistreating all the patients because they are "oblivious" to how they feel - no??? didn't think so). If you want to talk about anguish, however, it would be quite appropriate to examine the great 'free-market" healthcare "system' to the south of us - where they do indeed have excellent health care - for those who can afford it - BUT - why doesn't your writer examine the true (and systemic) anguish of some of the 40 million or so Americans who have no health insurance at all (because private premiums are astronomical in cost, FAR above the ability of minimum-wage workers to afford - and minimum-wage workers (and lately out-of-work ones) are what that country specialises in, and is trying to give to the rest of the world - as many of your writers well know and support) - what about the anguish of the poor parents who are forced to watch their children suffer or die from curable diseases or problems, but have no money for treatment? What about the hundreds of thousands of other Americans each year who are forced into bankruptcy and poverty because of unexpected health costs which their insurance did not cover, if they had any in the first place? Do you suppose there was any "anguish" on their part???? Really, even now in the degraded state to which it has come over the last ten years of cutbacks, at least all Canadians know they will at least get health care, and pretty good quality health care from caring professionals even if the system is stressed a bit, and even if they have to wait a bit for it - which is a great deal more than can be said for a whole lot of people in the "look-out-for-yourself" US "system".

Your writer tries to explain the added administrative costs in the US by saying that Americans are paying for good service - I wonder how it is he managed to forget that a great part of the added cost in the American system is that profits for the private health-care companies have to be accounted for - and, as we know in this era, modern "investors" are not content with any kind of modest profits as businessmen and investors used to be, but demand a minimum ROI in the 20% range these days - and the stories are legion, as your writer must well know, of doctors not being allowed to prescribe necessary treatments, of people being rejected for coverage, of inadequate treatment and so on, because the HMOs have dictated that doctors are not allowed to do anything more than the most basic treatments in many cases, to ensure the "investors" receive an 'adequate" ROI.

Well, your writer carries on with a number of other statements equally open to challenge as the ones above - but let us look quickly at just one more, which more or less encapsulates the never-never land of neocon capitalist theory completely divorced from the reality under which we all live, both here and to the south (and let us be reminded that most Americans, as poll after poll shows, want to move to a Canadian style healthcare system, but the politics of Big Business and profit has so far prevented it; and also that the US is the ONLY western "democracy" that does not yet have a public health care system covering all of its citizens - surely these people should be advocating that the US joins the civilised world in looking after all of its people, rather than advocating Canada regress to a less civil one!) - at the end, your writer avers "Even in the Brave New World of the public health advocates, Americans still get more (and better) health care after paying their administrative costs. The consumers get more of what they want, which is the ultimate criterion for any economic system..." - well, as pointed out before, although those Americans who are wealthy enough to afford it do indeed get good health care, not "all" Americans are getting what they want at all, and it is most dissembling (to be polite) of your writer to pretend this is somehow the case - at least 40 million of them have no health care insurance at all, and a great deal more (you can get different figures, from another 40 million and up) are substantially underinsured, to the point where any major health care crisis is going to cause them major financial hardship.

One might venture to say (many of us do, actually) that a system that provides good health care of ALL of its citizens, at a cost substantially below the privatised system in the US that leaves 20-40% of its citizens either with no healthcare coverage at all, or substantially underinsured, is very much better for ALL of the people, overall - and demonstrably so, to anyone who cares to examine ALL of the facts, not just a few selected statistics or opinions.