Shawn Whatley, Author at shawn whatley md

Opening remarks Civitas Vancouver

Over the last year, I served as President of Civitas Canada. Civitas started in 1996 and revolves around an annual conference.

Conference magic cannot be planned. It comes as a surprise. Audience and speakers connect, questions delight, and responses enlighten. Each party comes away encouraged and grateful, not just informed.

The speakers, sponsors, audience, and organizers created something extraordinary at the Vancouver Civitas conference. Better than we could have imagined. I’m so grateful to everyone involved.

Here are my opening remarks (with a few edits). I review ground rules and then try to encourage conversation outside the ordinary.

If want to learn more about Civitas, feel free to write to see if it might be a fit for you.

Welcome to the 28th Annual Civitas Conference. My name is Shawn Whatley, and I’m your president this year.

It is really great to see you all. None of this would be possible without our sponsors. Please join me in a round of applause for our sponsors.

You know, I was very skeptical about a conference in Vancouver…

When I became president, as per tradition, I announced, at a board meeting, that the 2024 conference would be in Vancouver.

The board just stared in silence.

Finally, one person said, “That … is a REALLY bad idea. We will never fill a room … let alone pay for the conference.”

He made the whole planning committee panic.

Thankfully, panic sparked furious activity. And here we are at a SOLD OUT conference!

Thank you so much for coming and being part of this event.

Terms of Engagement

I need to say three things about Civitas — lay the ground rules, as it were.

Our purpose statement says that Civitas exists:

“to promote and deepen understanding through the exchange of a wide range of political, economic, social, religious, cultural, and philosophical ideas concerning the principles and traditions of a free and ordered society.”

Very briefly … let’s unpack three points.

ONE: We are here to learn.

Our purpose statement says, promote and deepen understanding. This means we need to be open, curious, and receptive.

TWO: We are here to be challenged through the exchange of a wide range of ideas.

The broader conservative movement includes a wide mix of ideas. You may be sitting between an anarcho-capitalist, on one side, and a monarchist on the other! This is a fantastic opportunity – don’t let it go to waste.

THREE: We follow the Chatham House Rule.

The identities of the participants are private and all discussions are not to be recorded, reported, attributed, or disseminated in any fashion.

All members and guests are asked to respect this rule.

Without this rule, we could only have conversations that were safe … and superficial. We want to go deep … so we need privacy.

Alright, that sets out our terms of engagement. What do we want to accomplish over the next 1 ½ days?

Goals

I’m hoping we can do two things [this weekend], and avoid one pitfall.

I am a physician and much of my time, over the last 25 years, has been spent in leadership and medical politics.

My work has focussed on improving service for patients, while improving the work experience for doctors and nurses.

Improvement means change. For example, you cannot improve wait times, without changing how people work.

But how can you change behaviour? Many of us can’t make our own children behave. How can we make 200 of our colleagues act differently?

Ideas and policy and strategy will not work to change behaviour.

They are not enough.

As Peter Drucker said,

“Culture eats strategy for breakfast.”

We need something more.

In my experience, we need to do two things.

First, we must find a wedge.

Consider emergency medicine. A robust clinical culture shapes care in the emergency department.

Culture is just a set of norms and behaviours. Culture rests on a conceptual apparatus – a whole clinical worldview.

We need to address that worldview and find cracks in it.

The best way to do that is by pointing out bits of reality that do not fit. Think Sesame Street: “One of these things is not like the others…”

For example, we would often say to the doctors and nurses in our emergency department, “Isn’t it interesting how we break all sorts of rules to get timely care for our friends and family? They never wait in the waiting room.”

Then let that comment float; let them ponder it. It takes many similar comments to crack the status quo.

Second, we need to tap people’s internal motivation.

Not just emotion. We need to connect with their internal drive.

For example, we would ask nurses about their experience at triage. They are the wardens of the waiting room. We would ask them to talk about their experience managing a packed waiting room.

It usually took several questions, but they would soon start to tell about people vomiting in buckets for hours or women miscarrying in the waiting room bathroom.

We would just listen.

Eventually, we would ask, “Is this why you went into nursing?”

They would say, “No!”

That is the moment everything changes. Now they want change and are willing to try something new – something better.

In all of this – identifying a wedge, tapping internal motivation – we are attempting to bridge the philosophical gap between theory and practice.

Ideas need to infect people. They need to come alive to shape how people think and see the world.

Our job this weekend is to reflect on each panel and ask: Where is the wedge? And, how can we inspire?

Can we crack open the conceptual apparatus that exists around each issue? What bit of reality does not fit? Think: Sesame Street or cognitive dissonance.

And second, where is the ‘nursing’ question? [“Is this why you went into nursing?”] We must touch the fundamental aspects of human experience.

Example 1 — Finding the wedge

Here’s a quick example of finding a wedge. It’s meant to be fun. Don’t be stressed, if you don’t agree with it.

We opened the conference with applause for our sponsors.

What is applause?

Applause is a public endorsement.

Notice: applause is not transactional.

With applause, we declare that this [sponsorship] is good; not just that it makes us feel good.

It is agathos.

It is part of the True, the Good, and the Beautiful.

But hang on. How can we declare something to be intrinsically Good, in a secular, liberal democracy?

Philosophers across the political spectrum agree that modern liberalism avoids public endorsement of any preconceived Good.

In case you don’t believe me, consider three philosophers.

Starting on the radical left, Slovoj Žižek wrote that,

“[Liberalism] considers any attempt directly to impose a positive Good as the ultimate source of all evil.”

Irving Kristol, godfather of neoconservatism, wrote that

“a keystone of modern liberal secular society” is the impossibility of knowing “what constitutes happiness [the Good] for other people.”

Francis Fukuyama, great defender of liberalism, wrote that now,

“Personal autonomy [includes] the ability to choose the [moral] framework itself,” not just the particulars.

In other words, liberalism seems to say we must not declare anything Good – or at least we must not expect to be taken seriously, if we do.

And yet here we are applauding something we see to be Good.

Perhaps, we misunderstood the nature of applause?

Or we misunderstand the nature of modern liberalism?

Or maybe we misjudged modern society?

Or maybe, society isn’t so liberalised after-all?

Now, this is just an example – something fun. I’m sure you can come up with better ones.

Example 2 — Finding inspiration

Our second task this weekend is much harder. How can we inspire and tap into Canadians’ internal motivation?

Wordsworth tackled this with poetry, during the industrial revolution. He wrote,

“The world is too much with us; late and soon

Getting and spending, we lay waste our powers:

Little we see in Nature that is ours;

We have given our hearts away, a sordid boon!”

And later in the poem, he writes, “We are out of tune.”

Wordsworth is saying there is more to life than work and money and spending. We waste our talents and become out of touch – out of tune – with those around us: friends, colleagues, family, even with our own bodies.

We need to draw attention to fundamental aspects of the human experience, if we hope to inspire true change.

Aristotle did this by calling us to human excellence: wisdom, courage, self-control, justice. Christian thinkers added faith, hope, charity. We could add generosity, magnanimity, or the Roman liberalitas.

People hunger for these things. They need to hear it in our language.

One pitfall to avoid

Finally, we need to avoid a common pitfall for the right. Roger Scruton called it Hegel’s “labour of the negative”.

The labour of the negative refers to Hegel’s dialectical thought. It is the act of negation repeated relentlessly. Or as Karl Marx put it, “the ruthless critique of everything existing.”

Augusto del Noce, Italian philosopher and specialist on Marx, explains that Marx taught we cannot be free, if we accept anything created by anyone other than ourselves. If we accept anything as a given – even our own biology – we can never be truly free.

We on the right must be careful of adopting a ruthless critique of everything existing. When the left appears to be in control of everything – media, academia, culture – we risk becoming circumspect. As one speaker said at a conference in the US, “They are coming for everything.”

Now this may be true. In fact, it is what we might expect from the Hegelian left. And there is a time to diagnose and identify the negative. But then we need to turn our minds to treatment.

Scruton said it is hard to shift from a labour of the negative to positive, constructive work.

Conclusion

So in summary …

Our job is to find the cracks in the conceptual apparatus that sustains current opinion in each topic area …

… and find ways to inspire change by tapping into people’s internal motivation: “Is this why you went into nursing?”

We need to do these two things while avoiding Hegel’s labour of the negative.

Canada’s conservatives care about freedom—except in health care

Paramedics are seen at the Dartmouth General Hospital in Dartmouth, N.S. on July 4, 2013. Andrew Vaughan/The Canadian Press.

Canada needs conservatives to make space for clinicians and patients who are building their own solutions

Here’s a piece I wrote in response to an article in The Hub titled: We need neoliberalism now more than ever.

I pitched a piece arguing that Conservatives don’t actually believe in freedom, free enterprise, or limited government, when it comes to medicare. I was pleased that the editors tuned up the article and published it, March 20th (Here’s the piece on The Hub). Enjoy!

Canadian conservatives—particularly these days under Pierre Poilievre’s federal leadership—say they embrace freedom, free enterprise, and limited government. But too often conservatives at the federal and provincial levels have abandoned these intellectual commitments in office. Their past and ongoing support for central planning in health care is a good example.

Canada’s health-care system is marked by a government monopoly on certain types of insurance and similar top-down restrictions on the delivery of health care itself. Conservative governments across the provinces have been unwilling to liberate Canadians from this dirigiste model.

The paradoxical relationship between Canadian conservatives’ notional commitment to freedom and their practical affirmation of central planning in health care is best demonstrated by Ontario Premier Mike Harris’s health-care restructuring in the late 1990s.

Premier Mike Harris: the best central planner in Canadian history?

Will Falk, a former management consultant, recently wrote a detailed review, analysis, and scorecard of the Harris government’s health-care agenda in a new anthology about the premier’s record entitled, The Harris Legacy. Falk’s focus is the government’s Health Services Restructuring Commission (HSRC) and its effects on the province’s overall system and patient outcomes. He writes:

The Harris health program represents exceptionally well-done central planning. This is striking and ironic because a true ‘revolutionary’ of the ‘common sense’ school should not believe in central planning at all…Mike Harris ended up being among the best health care central planners in Canada’s history.

As Falk observes, though the Harris Conservatives were generally quite committed free marketeers (he notes for instance that many young staffers were acolytes of the Nobel Prize-winning and libertarian economist Friedrich Hayek), the government’s health-care policy preached freedom but actually practiced coercion. He explains:

As neoconservative revolutionaries, the CSR’ers ‘should’ have chosen an allocative method that would allow for freedom of choice…Instead, in 1995, the Harris government imposed a highly coercive, expert regime. The HRSC central planners closed over forty beloved institutions. More than 20,000 workers had their jobs disrupted.

Falk leaves no doubt in his conclusion: “It is ironic that Mike Harris is accused of being a free market advocate in health care while overseeing one of the best central planning processes in Canadian history.”

Two sides of Keynes

Reading Falk’s description of the Harris government’s health-care reforms got me thinking about the two forms of Keynesian thinking that came to influence post-World War II public policy and remain with us today.

The first form is John Maynard Keynes’ economic thinking which included the rather banal idea that governments can help to smooth the ups and downs of the business cycle in a market economy. One can argue for instance that the Harper government’s fiscal stimulus in response to the 2008 global financial crisis broadly followed Keynes’s counter-cyclical prescription.

The second is from Keynes, the philosopher, whose technocratic ideas became something of a “generalized theory”—particularly after his death. What sometimes describes as “bastardized Keynesianism” became a justification for all types of state intervention in the economy and society. His views about business cycles, which were contingent and narrow, were moulded and shaped into a scientific socialism that was subjected to virtually no constraints.

We came to abandon parts of economic Keynesianism in the post-stagflation era in the 1970s. But the “bastardized” parts remain prevalent in public policy thinking and practice, including in parts of Canadian health care.

Poilievre, freedom, and conservatives opting out

Free enterprise offers the best way out of a socialist slough. It worked well in the era of Reagan and Thatcher. It should work for Poilievre if he’s elected prime minister.

But will conservatives affirm freedom in health care and abandon the bastardized Keynesianism that still prevails today?

One possible answer can be found in a recent interview with Hub contributor Ginny Roth in which she said:

When Conservatives are losing, sometimes it’s tempting to opt out of the policy conversations that we think we are losing on. Provincially, this always happens: ‘Don’t talk about health care and education. Conservatives lose when we talk about health care and education.’

This instinct to “opt out” may be viewed by political strategists and the politicians they advise as good short-term politics. But the long-term result is to effectively abdicate public policy to their political opponents. What’s the point of winning if you’re simply going to implement the other side’s priorities?

If conservatives are genuinely committed to freedom and free enterprise, then they should propose legislative and policy changes to the health-care system that foster more freedom (including competition and choice) and reject the central-planning instinct inherent in Keynesianism.

Put differently: conservatives have only two realistic options. They can opt out of the health-care discussion and cede the terrain to progressives, or they can apply their principles to a much-needed reform agenda. They must, in the interests of Canadians and their well-being, choose the latter.

One key area for policy reform is to insist on greater provincial autonomy and in turn interprovincial competition and experimentation. This requires clarity on federal-provincial health-care mandates and a circumscribed federal spending power—including even something as bold as a possible constitutional amendment to limit it on a permanent basis.

Regardless of what approach they take, the federal Conservatives face a wide-open field in calling for market-friendly universal health care. No other party will steal their platform. They should resist therefore the temptation to match the Liberals on boutique health policies and instead fight for policy freedom in Canada’s most heavily regulated industry. At its core, this means granting clinicians and patients freedom to build their own solutions safe from regulators and planners.

Poilievre has offered three cheers for freedom. He doesn’t sound like a Keynesian planner. Let’s hope he expresses the same enthusiasm for freedom in health policy.

Health minister’s berating of suffering patients was downright cruel

Federal Health Minister Mark Holland, seen at a Feb. 28 press conference on Parliament Hill, last week told patients who have been waiting months for surgeries and to see specialists that they should “be patient.” PHOTO BY ADRIAN WYLD / THE CANADIAN PRESS

Desperate Canadians criticized for considering health care outside Canada

Here’s my piece about the hypocrisy of politicians berating patients, who consider care out of country when they cannot access care in Canada. Published in National Post Mar 13, 2024. Enjoy!

An Ipsos poll for Global News revealed last week that 42 per cent of Canadians would personally pay to travel to the United States for health care, if necessary. This is a 10 percentage point increase from 2023.

Federal Health Minister Mark Holland promptly scolded the 42 per cent.

“Going and paying your way out of your circumstances creates a terrible malady for our system. Because what it means is that private carriers will take the cases that are the most profitable ones, leaving the public system eviscerated,” Holland said at a media conference. “And that is a circumstance we cannot allow.”

Holland asked Canadians “to be patient.” He said we will “get through these health workforce issues.” It is not clear how “workforce issues” explain why 6.5 million Canadians cannot find a family physician.

Leaving aside Holland’s woolly thinking, his comments just seem heartless and cruel. Canadians do not seek care outside Canada on a lark. They’re desperate.

Canadians are underinsured. Canadian governments nationalized medical insurance companies between 1968-1972. With nowhere else to go, patients must moulder in queues with a median wait of 27.7 weeks to see a specialist.

Having nationalized private medical insurance companies and then put people into waiting lines, politicians berate the desperate few who step out of line and flee south for care.

Minister Holland echoes what elites have been saying for decades. In the 1990s, the associate deputy minister of health in B.C. was asked how she felt about patients on waiting lists looking for care in the U.S. She said, “If we could stop them at the border, we would.”

The hypocrisy becomes especially rank when we consider how many of our elected elites have been escaping Canada for care themselves for decades.

Robert Bourassa, then premier of Quebec, had melanoma surgery in Bethesda, Md., in 1993. Danny Williams, then premier of Newfoundland and Labrador, had heart surgery in Miami, Fla., in 2010. Former Liberal member of Parliament, Belinda Stronach, had breast cancer surgery in California. The late Sen. Ed Lawson, former Canadian trade unionist, also had surgery in the U.S. Former prime minister Jean Chrétien used government aircraft to fly to the Mayo clinic.

The list of elite medical refugees who flee Canada is long and include many of the same people who refuse to change the medicare status quo.

Speaking on 900 CHML, Sean Simpson of Ipsos suggested Canadian interest in cross-border care simply reflected a “post-pandemic world” in which we began to see that medicare was “threadbare.”

But Canadians were fleeing Canada to find care long before the pandemic. In 2019, the Second Street think-tank used Statistics Canada data to determine that more than 217,500 Canadians had left the country for care in 2017. Hospitals in the U.S. advertise to Canadians, eager to meet growing Canadian demand. Patients can buy books to guide them on their quest for surgery abroad, for example: Medical Tourism – Surgery for Sale! How to Have Surgery Abroad Without It Costing Your Life.

But so what? Tasteless comments and elite hypocrisy make us angry, but if wait times are unavoidable, all we can do is stick together and weather the storm, right?

Wait times are not like natural disasters. They are not random. Wait times are created by professional managers.

Dr. Charles Wright, former vice-president at Vancouver General Hospital and wait-list consultant to the BC Ministry of health, said, “Administrators maintain waiting lists the way airlines overbook. As for urgent patients in pain, the public system will decide when their pain requires care. These are societal decisions. The individual is not able to decide rationally.”

Or as a former deputy minister of health of Ontario puts it, “We have waiting lists for some procedures as a means of better organizing our system.”

In other words, patients would not need to wait at all, if elites chose otherwise.

Minister Holland’s comments of last week betray a deep distrust of patients and their ability to make decisions for themselves. Patients should be patient. They should stand in line; wait for care. But as Canada’s foremost health economist, Bob Evans, has explained, the “rational consumer” is a “highly dubious assumption.”

Canada is changing. Last week’s Ipsos poll also found 63 per cent support for private health-care options. Most Canadians do not mind the Toronto-area Highway 407 toll road if it frees up space on the (public) Highway 401 without making it any worse.

Medicare must reform; the status quo is crumbling. While we wait for reform, let’s stop berating desperate patients, who consider leaving Canada for care when wait times grow too long.