TRUTH VS PROPAGANDA

Health care: truth versus propaganda  
National Post  
Mon 20 Jun 2005  Page: A18  
Section: Issues & Ideas  
By Lorne Gunter

The June 9 Supreme Court decision permitting private health insurance in Quebec has left Canadians befuddled about the future of medicare.

Who can blame them? Health care in this country has been the subject of such outlandish demagoguing for the past quarter century, it's a wonder Canadians are capable of any critical thinking at all on the subject.

Yet, we are capable -- even if our faculties are overlaid by a mass of propagandized sediment, like a thin stratum of diamonds overburdened for millennia by a heavy layer of sandstone.

An Ipsos-Reid poll for CanWest papers and Global TV, published in Saturday's National Post, shows strong majorities of Canadians simultaneously hold mutually exclusive opinions.

Seventy percent of respondents said they should be permitted to buy private health services. Yet 57% say they want their provincial governments to use the Constitution's notwithstanding clause to maintain bans on private care.

Sixty percent believe the court decision will shorten waiting lists. Yet 57% are convinced there will be service shortages at public clinics and hospitals because doctors and nurses will now leave for the private system.

And 54% believe their families will see improvements in care -- even though 64% think the ruling will lead to two health systems in Canada, "one for the rich and one for the poor," and they don't define themselves as rich.

In all three cases, it's impossible to reconcile the results unless we conclude that a sizeable number of respondents are reporting contradictory opinions.

But there is good reason for such contradictions.

Most ordinary Canadians likely sense a parallel private system would improve the health care they receive. Even if it wouldn't, most instinctively know it is wrong in a free country to forbid law-abiding citizens from using their own money to purchase a legal service if they wish.

Yet advocates, "experts," politicians and analysts have drummed it into the public's heads over the past three decades that private care is to be feared, at least in the abstract. And so when it comes to such ideologically loaded questions as whether private medicine will lead to "two-tier care," they instinctively embrace the party line.

In other words, while substantial majorities look forward to being able to buy private insurance -- whether they actually will or not -- they have also internalized the conceit that Canada has the best care because we forbid private insurance, and that universal, government-monopoly care is integral to our nation's very identity.

Private care has come to be seen as a naughty pleasure -- something you'd like to try, but something the arbiters of official dogma tell you must remain forbidden. You have committed a sin against Canada if you even daydream about how your life might be improved by private health choices.

For me, the pair of statistics that puts the lie to our national health myth are these: Among the world's 28 industrialized and industrializing nations, Canada spends more per capita than all but two -- the United States and Switzerland. Yet by nearly all measures of quality care, we are no better than middle of the pack. In some cases, we are nearer the bottom.

For instance, on availability of high-tech diagnostic tests -- the key to precise, early treatment for a variety of deadly conditions -- we rank no higher than 17th. And in the number of physicians per capita, in the entire Organization for Economic Co-operation and Development, only Mexico, Turkey and South Korea have fewer.

Indeed, our doctor shortage (it will worsen in the coming decade as more doctors retire from practice than graduate from medical school) is a prime example of the perverse effects caused by our government-monopoly system.

Back in the 1990s, when federal and provincial governments first came to understand their budgets could not sustain universal care indefinitely, health ministers from both levels agreed to cap admissions to medical schools. Their real objective was the rationing of health services. But knowing that overt rationing spelled political death, they decided to perform this rationing indirectly. The theory was that fewer doctors would order fewer procedures and thus put less strain on the public health monopoly. The more than a million Canadians who are searching unsuccessfully for family doctors can trace their plight directly to this backdoor rationing scheme.

Similarly, while besieged governments have recently started buying a few more MRIs and PET scanners, their decisions over the last decade to limit the number of diagnostic technicians admitted to public colleges and universities means there aren't enough trained staff to run the new machines, so wait times have hardly shortened.

Canada has clung far too long to its socialist health care fantasies. Now patients are paying the price. Even with the aid of the Supreme Court, it will take many years for Canadians to overcome the blinkered policies imposed on them by governments more concerned with ideology than outcomes.