Category: Canada Page 3 of 6

(PLEASE CHECK THE BYLINE ABOVE. YES, IT’S MANDOS AGAIN.)

Single-payer is proposed by many as the most ideal way to reform the payment/insurance process for health care in the US, for reasons with which I mostly agree, based on personal experience. The Canadian experience is drawn up, again mostly appropriately, as part of the evidence-base for this view. But if one is going to use Canada as an example, it is important to understand, in some detail, how single-payer was accomplished and what lessons this has for the US.

Canada has single-payer health care, but it did not come out of nowhere. It came from a left-wing government in the province of Saskatchewan, and it came after quite a dramatic fight, including a strike by medical doctors, who were its fiercest opponents.

The history of opposition to Saskatchewan was documented in a very detailed and high-quality MA thesis from 1963 by Ahmed Mohiddin Mohamed at the University of Saskatchewan, which, as far as I can tell, is the authoritative original history on opposition via media to the Saskatchewan single payer plan.  Mr. Mohamed (I am unable to locate his present-day particulars or even if he is still alive) managed to get his hands on a treasure-trove of documents from various “players” not that long after the original events.

That opposition involved a great deal of media and propaganda, including astroturf organizations called “Keep Our Doctors” (KOD) committees. It is important to note that even if a lobby group is “astroturf” in the sense of being supported by vested interests, it is not the case that the people who run it, work for it, support it, etc., don’t have genuine beliefs in line with activities of the group. The KOD committees actually and genuinely originated with mothers, particularly rural mothers, who had the vaunted “personal relationship” with their local doctors and the ideological belief that their doctors would be justified in leaving Saskatchewan and abandoning their patients if they were forced into a monopsony. The song should be familiar to Americans — professional liberty and all that. Their local doctors convinced them that the Saskatchewan government would be responsible for denying them access to health care.

Of course, not only were they egged on by their own doctors, eventually medical organizations and ideological businessmen got into the game via their wives and organized province-wide KOD committees, radio propaganda, etc. The public focus and concern of all the protest and propaganda were very simple, as above: Professionals should have the right to choose their working conditions, and the pricing power that single-payer insurance gave government effectively made the government the dictator of doctors’ working conditions, and the ordinary Saskatchewan patient would suffer from this in various ways.

There is one important feature, however, of the anti-single-payer campaign: All the Saskatchewan government’s antagonists went out of their way to agree that people who could not afford access to medical care themselves, should still receive it. Their counterproposal was instead that there be voluntary regulated insurance, and the government would instead use its funds to pay the premiums of those who could not afford it. Doctors would charge patients directly — remember, we’re talking about a health care system that involved direct cash payments — and patients would submit the bills to the insurance agency, if they didn’t just want to pay the cost themselves. The medical associations agreed then only to charge poor patients what the insurer would pay out, so that poor patients would not have to swallow the costs.

The problems with this are obvious, of course. The Tommy Douglas government didn’t buy it, and proceeded to institute single-payer and break that doctors’ strike. The rest is Canadian history. But what is remarkable, and what I would like to emphasize, is that at no time did anyone make the public argument that the indigent should simply go without care.

In point of fact, the Canadian health care system still has ideological opponents in Canada, both among doctors and rich patients who think their wealth should allow them to skip the queues that do indeed sometimes result from the monopsony more easily than they do now (by going to the US). The difference is that it is still not possible in Canada to admit in public that you don’t think that those who can’t afford it shouldn’t have access to quality care. Almost all domestic Canadian attacks on single payer acknowledge the need for universal coverage, even if their proposed solutions won’t work as well as single payer.

That is a deep and fundamental difference with the United States of America and its health care debate.  Admitting to a belief that someone should suffer medically for lack of funds does not put you beyond the pale of politics. I lived in the US during the Obamacare debate and had many acquaintances who expressed envy of the Canadian system under which I had lived my life previously; but I also had acquaintances who were willing to at least entertain the right-libertarian argument that property is an essential characteristic of being, and that to dilute my property for someone else‘s life — is a theft of my life. And they could make that argument in polite company and not be shunned.

To me, that is the most fundamental barrier preventing humane health insurance reform in the US. I find it difficult to believe that the US will achieve a single-payer health insurance system until nearly all opponents of single-payer, down to the college libertarian level, still feel obliged to make a halfway sincere-sounding argument that their preferred reform idea will pay for universal access to affordable care. From what I see in the health care debate in the US, that day is not here yet, although the discomfort that the Republicans have in trying to find a way to delete Obamacare suggests that some progess has been made; people are uncomfortable with taking away what has been given, and what has been given is at least some insurance for some of the uninsurable. But if arguing to leave some uninsured is socially acceptable, then that will usually be the path of least resistance.