A better health system for a more confident Canada
by Conrad Black https://www.conradmblack.com/876/a-better-health-system-for-a-more-confident-canada
I was recently accused by a rather bumptious woman from Newfoundland, apparently a radio-television personality, on the television program where I am a co-host ("Zoomer"), of having once said that Canada was a "lousy country." I never thought or said Canada was "lousy." But I did say it was morbidly self-conscious and should stop appeasing the Quebec nationalists and cease always reflexively to govern to the left of the United States. The advocacy of these views was one of the reasons I helped found this newspaper, and all of these objectives have been achieved. One of the elements of this outdated, self-conscious Canadian self-image was the idea that our health care system is a raison-d'être of Canada remaining as a country separate from the United States. But this view is an artifact of the 1990s, when Quebec was loudly threatening to secede; our dollar was worth around 70 cents U.S., and Canadian national self-confidence was thrust back onto rather flimsy foundations. Canadians engorged themselves on fictitious notions of Americans having to produce a credit card for an ambulance to pick them up, even in emergency cases. (This was nonsense, of course.) Because Canada's health care system was based on egalitarian universality, we proclaimed our health care system to be the best in the world, and a good reason to soldier on as an independent country and not fold into the rich and omnipotent American colossus. The Canadian health care system is indeed better for the bottom 30% of people on the income scale than that of the United States. But it is inferior for the more prosperous 70%. It is far from the best in the world, and we have much better reasons to maintain our nationality. Putting health care to one side, Canada has been one of the best-governed countries in the world for nearly 30 years; Quebec separation is a noisily dying pigeon screeching its last; and American post-Cold War fallibility has largely vaporized Canada's ancient self-consciousness. Given all this, Canadians need no longer cling to nationalist conceits about their health system as a badge of national distinction. Tommy Douglas kicked the ball off in Saskatchewan in 1960 with the country's first universal medical care plan. He proclaimed a floor but not a ceiling to provide coverage for all, and had a user fee for all those who could afford it. But under the whip of the Trudeau government and its Health minister, Monique Bégin, Canada froze into a multi-partisan fixation on universality, absolute equality of care regardless of means, and a holy martyr's resistance to the satanic heresy of private medicine. The federal government, going back to the Pearson era, had paid 50% of health care costs, and was reasonably tolerant of provincial health-care diversity. But Trudeau and his successors reduced the federal financial participation to 25%, while putting the provinces in an egalitarian straight-jacket. For a decade, after banning extra billing in 1980, Canada lost half as many doctors to emigration to the United States as it graduated each year, compounding the problems of cost and access. Because of the rigidities of the system imposed by Trudeau and Bégin, in willful and jubilant disregard of the strongly expressed wishes of the provinces and the medical profession, there are long waiting lists for sophisticated facilities such as scanners, which sit idle 16 hours per day, and many treatments are rationed by confinement to only a couple of sessions. As Canadians learn that their national destiny reaches higher than just tugging at the trouser leg of the United States (and, before that, Great Britain), they should have the earned self-confidence to reform their health care system and not recoil from reform, as from disrespectful contact with a sacred cow.
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