No Joy. Just (Temporary) Relief

The Liberals shouldn’t take too much joy from a recent Decima poll that puts them well ahead of the hapless Conservatives.

Nationally, the Liberals are said to have the support of 37% of the electorate, compared to the Conservatives 23% and the NDPs 21%.

The results are an indictment against the Conservatives’ obstructionist tactics in parliament and their lack of a positive campaign, but it’s worth pointing out that the Liberals are still less than a percentage point away from the vote totals they received during the 2004 election, which happened to be the lowest level of popular support received by the most popular party in an election, and the second lowest level of popular support received by the party that went on to form the government.

To put it another way: the Liberals aren’t winning this campaign. The Conservatives are simply losing it.

That could change at any time, either with Stephen Harper suddenly getting a clue, or with the NDP moving into the coveted second place position, making them a potential favourite for voters extremely dissatisfied with the Liberal government.

I also have to wonder at the level of undecided, and the number of people in the next election who just won’t vote.

Two Sides Talking Past Each Other

The recent Supreme Court decision declaring unconstitutional a Quebec prohibition on individuals seeking private health care has generated a lot of smoke both in the media and in the Canadian blogosphere. I think, frankly, that there has been much hysteria and very little rational thought. In reality, not much has changed. The debate between public and private health care in this country may have been given a boost, but it existed beforehand.

Though I am a firm believer in the merits of public health care, I am confident that the Supreme Court was just doing its job: holding our elected politicians accountable to the framework of this country as designed by the charter and the constitution. The decision they made comes down to this: it is unconstitutional to prevent someone seeking necessary medical care from finding it by any means necessary.

And they’re right. It’s a pretty serious breach of human rights as well.

But is this the nail in the coffin of public health care? No. The debate between public and private health care activists will continue because the two sides are talking past each other. This decision emboldens private care activists who will say that the Canadian health system is failing to provide adequate care to all of its recipients. And, you know what? They’re right. One look at the waiting lists for an MRI shows this.

But public advocates will argue that bringing in a parallel private health care system won’t solve the problem of long waiting lists and it won’t provide adequate care for all. And they’re also right.

I’ve said this before, but it is a fallacy to believe that the Canadian health care system is especially vulnerable to the perils brought about by our aging population. Yes, the fact that our baby boomers are getting older and are going to get sicker is going to hamper the system’s ability to provide adequate care. Yes, the demographic shift in this country will result in a significant increase in our taxes. But switching to an American model will not make the health care costs go away. Americans are also paying a high price for their medical system — through high health insurance premiums, through the tragedy of several million Americans going without health insurance, and through the thousands of American families bankrupted by medical emergencies.

The perils that Canada faces through its aging population are mirrored by America’s demographic shift as well. Insurance companies like Blue Cross Blue Shield don’t exist out of the goodness of their hearts; they exist to make money, and they make money by insuring Americans in the hopes that most Americans won’t use their policies. But as Americans age and get sicker, more will use their policies, and companies like Blue Cross Blue Shield will have no choice but to raise premiums to cover the costs. As premiums increase beyond the ability of Americans to pay, many will go off of medical insurance. Many will defer necessary treatment until emergencies strike, and these Americans will burden the emergency wards of hospitals across the country. Health professionals in the United States are already talking about “health care brownouts” by 2020, mirroring various doomsday scenarios mooted for the Canadian system.

The only thing that is going to prevent a medical crisis in both Canada and the United States is the throwing open of our doors to well-educated young immigrants, who will bolster our workforce and subsidize our aging boomers as they retire. Even if this happens, though, the debate between public and private health care will continue in this country, and it comes down to a fundamental question: should necessary health care be provided according to need, or should it be provided according to one’s ability to pay?

Privatization activists, though they may not know it, are twisting this fundamental approach of who gets health care. It may shorten waiting lists if people able to pay to jump the queue, but that’s only assuming the government doesn’t use this to let itself off the hook; that it maintains at least the level of service Canadians now expect; much less increase it to what it should be. It assumes that health care spending (and the taxes which support it) don’t decrease if a parallel private health care system is created, and that’s not what private health care advocates are advocating.

If people are waiting six months for medically necessary treatments, then the public health care system has failed, no doubt about that. But if a private system allows users, based on their ability to pay rather than their need, to step out of the public system and get treatment, it still hasn’t solved the central problem: that there are people in the system who need medical treatment, and who aren’t getting it.

The Canadian approach of providing health care services based on need rather than wallet size strikes me as the only humane approach. If we can be sure that a two-tier system didn’t limit access to adequate public healthcare, then I could support it, but while there may be benefit to those at the back of the line if those in the middle of the line are allowed to buy their way to an early MRI, it’s unfair to screw those at the front of the line who need that MRI now.

The fact that Canadian governments are too stingy to fund the health care system sufficiently so that waiting lists are eliminated outright is a separate problem to what was addressed in the Supreme Court decision, and one with a pretty obvious solution: if we want a health care system that provides adequate service to all, fund it. Don’t privatize it. As soon as you do that, you state that people who need medical attention are less important than those who can afford it. It prevents the poor from accessing medically necessary treatments that the rich enjoy.

And that’s as much of a violation of human rights as what the Supreme Court addressed yesterday in Quebec.

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