July & August, 2001.
The Medical System: Another Opening Crack.1
"These particular griefs and crimes are the foliage and fruit of such trees as we see growing. It is in vain to complain of the leaf or the berry: cut it off, it will bear another just as bad. You must begin your cure lower down."
The real and serious problems that exist in the Canadian medical system have existed for quite some time now, and, the seriousness of the situation is picking up momentum; further, newly to be observed, are the labour problems, unique to a single provider system run by the government such as exists here in Canada.
The idea of a national medical scheme, struck by the Canadian authorities some thirty years back, one which was to be run on the very same principles and system as then existed in Russia and the countries of eastern Europe, was, then and now, a bad idea. At the time we heard nothing from the medical workers, seemingly only too happy to be put on the government payroll. The consumers, voters, were happy to hear that they were going to get something for "nothing." And, the politicians -- well, they were elated to blow their newly found horns. The bad effects of a change from a free enterprise system to monopolistic system sanctioned and run by government were slow to be felt. Further, the euphoria of the perceived benefits that might be generated by such a system prompted the idealists to crow both at home and abroad. A generation has now passed away, and the fruits of the fallen tree have long since been eaten.3
I have already written on a number of the problems peculiar to the Canadain system: see "A Right To Medical Care," "Medical Services" and "The Reason for the Failure Of the Canadian Medical System." What I have yet to tie in, is the labour problems, which, as I have already stated, are unique to a single provider system.
I have already written a general piece on unions. For good historical reasons, at law, any agreement or association between two or more identities (trust, cartel, syndicate, or union) for the purposes of advancing the interests of the group, whether it be a union of business people (still illegal) or workers, had long been outside the common law. What unions of workers have been given is an exemption to anti-trust law which binds the rest of us. This was done by legislation (and, it therefore follows, it can be undone by legislation). The legislation (here in Nova Scotia, it's called the Trade Union Act) sets up strict procedures that must be followed before the destructive weapon of a strike can be brought to bear. In the first place the union and its leaders must be certified, respectively, as the bargaining unit and bargaining agent. By whom? By government. The relationship between the bargaining unit and the employer is regulated and overseen. By whom? By government. So, one might wonder about how such a legislative scheme should work when the government -- as is the case for the existing socialized medical system -- is cast both as an employer and the regulator.
As to what are its proper functions -- well, that is another subject, one on which I have written (The Theory of Government). Sufficient to say at this place, that the best of the political thinkers of all times (such as, Bentham and Mill) thought the role of government ought to be limited.4 Indeed, it was the advice requested by Diogenes of Alexander, "Stand out of my sunshine. We have no need of favour - we require only a secure and open path." So it is, that the role of government (if not the only one then the principal one) is to maintain an environment in which exchanges between people, within the law, voluntarily occur. It is there to punish the citizen who encroaches on the freedom of another, government's role is as a referee, it must stay clear of the play. Now, for sure, government needs to employ people in order to carry out its functions. And, to that extent, it has no choice but to act both in its functional role as regulator and as employer of government workers (civil service).
The problem that government has with its hospital workers, would, of course, be immediately resolved by it getting out of the business, on a monopoly basis, of supplying medical services. To solve the knotty labour problems is reason enough to get out, though secondary to the reason that it, as an impossibility, cannot deliver on the stated and admirable goal of a comprehensive and accessible medical care system. Only through the market will there be the greatest distribution of up-to-date medical care delivered on a timely basis. Only through competition can the optimum be achieved, where, without rancour, the proper amount of our limited resources will be expended so as to achieve the most favourable maintenance and growth in an area, the delivery of medical services, an area where (it becomes ever so clear) there exists a growing and an insatiable demand. In the free market process, those with the dollars have the vote (I hasten to add, getting dollars into the hands of all the people is a problem to be solved by economic policy struck by government, for example, specific monetary policies, the application of negative and positive taxation, charitable exemptions, and, alike).
When a monopolist (a government, at that, with all the political baggage) is at one end of the table and a self serving union at the other; it is the people not at the table, those who work in the system and those who consume the medical services, who get the raw end of the deal, every time. These parties never get it right. Normally, it is the market which sets prices, ultimately, for all things; it sets a value on our work, whether we immediately recognize the fact, or not. Never are the government and the union able to work out proper remuneration levels for the workers; never do these levels compare with the market (nationally and internationally). The deals struck end up by the government employer paying too little to the people who should get more; and, too much to those who should get less (as based on disinterested market principles). Nurses are one thing; hotel workers (cooks, cleaners, etc.) who are employed by hospitals are another. When the representatives of government sanctioned and government run industries get together with the representatives of large unions the results are never anything that can be either reconciled with the market or common sense (which to me are one and the same thing). The evidence of it can certainly be had by looking at the pay rates of those who work in the medical care system as it now exists here in Canada. One will see "the lunacy of paying hospital hotel workers"5 30% more than their counterparts in the hotel industry to which these workers have access. And, at the same time, we see nurses being underpaid with no other recourse then but to quit the profession. This is so, because -- on account of the socialized single provider system -- there is no local market to which the nurses might turn for better treatment.
To conclude, then: socialized medicine here in Canada is to be compared with the system that exists in the US. The socialists, those who subscribe to the notions of Plato, praise the Canadian system; why, it's "free" medical care; a system, the access to which cannot be determined by economics (nor, unfortunately, is the running of it). Notwithstanding their condemnation of the laws, the iron laws of economics, they all bow to these very laws when it comes to forcing the government, qua monopolist, to provide salaries as might be determined by the very economic market, which, on other occasions they condemn. The only real economic market in health services to which they point, when, as now, it serves their purposes, is that which exists in the US. In the US, nurses do not have to go on strike to get higher wages; they simply move on, or threaten to move on, to a hospital which will pay them more. In the US, the best compete with the best; and, the rich and politically powerful, world wide including those in Canada, flock in times of medical need, to the US clinics where they can put their money down and get immediate first class medical service with a smile. No such thing is available for Canadians in Canada.6
1 I am going to take the next two months off, at least in respect to the writing of Weekly Commentaries; so, treat this piece as my Summer Commentary.
2 Representative Men.
3 It was Montesquieu, that made the comparison of the savages who cut down the tree, in order to get at the fruit. For a time there is wealth, then there is poverty.
4 "The object of this essay is to assert one very simple principle, ... that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightly exercised over any member of a civilized community, against his or her will, is to prevent harm to others." (Mill, 'On Liberty," 1859.)
5 See Michael Walker's article, "Pay Canada's nurses what they are worth," editorial page of the National Post, June 28th, 2001.
6 I had in my office one day a young man who was in need of a new knee -- a sports accident, I think. He advised he was on a long waiting list and in the meantime could not play sports or do anything really but sit on his couch. I asked hypothetically that if he could get his knee done tomorrow for $5,000 would he go for it, or continue to wait for the "free" surgery. He replied he had no money (couldn't work with the bad knee, you see); but he would sell his pride and joy, his bright and shiny red sports car in a moment; -- only if, only if ...
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July, 2001 (2012)