Canadian medicare teeter-totters between two kinds of liberalism: classical and modern. We will never improve until we inject new ideas.
Inside the right-of-centre political parties, the classical liberals fight with the philosophical conservatives for supremacy. For the last two decades, the classical liberals have won.
If we want medicare to improve, we cannot keep using the same tired ideas. I suggest the right-of-centre political parties need to draw on classical liberalism plus conservatism.
This article published in The Hub explains what I mean and offers a concrete policy problem to start the discussion.
Enjoy!
Shawn Whatley: How to get Canada off the health-care teeter-totter
Liberalism works when you are healthy but fails when you fall ill.
Classical liberalism emphasizes autonomy, individual freedom, and free markets. These ideas have fuelled centuries of wealth and prosperity.
Modern liberalism, in contrast, pursues central decision-making and equality of outcome. Despite similar names and obvious differences, neither type of liberalism provides arguments for everything patients need.
When classical liberalism fails in patient care, it creates space for modern liberalism. Modern liberalism then applies central decision-making which creates inefficiency and bureaucracy. This in turn creates a call for efficiency, deregulation, and policy based on economic liberalism.
This seesaw creates a policy teeter-totter with each type of liberalism pumping furiously at either end.
The failure of liberalism cannot be solved by more liberalism. Only a coalition of classical liberalism plus conservatism will allow Canada off the health policy teeter-totter.
How Liberalism fails
Successful ideas explain reality and suggest solutions to life’s messiest problems. Political ideas fail when they do not reflect reality or cannot explain human experience.
Given liberalism’s dominance in Canadian politics, we should ask how it performs for patients. Does it make sense when patients need it most? Classical liberalism delivers advanced technology, therapeutics, and almost magical cures, but can it deliver care to patients?
Classical liberalism fails to fit patient care in two areas. First, it fails in trauma and acute care. Car crashes and strokes often create dependent, comatose patients. Free agents lose control, and agency passes to a third party.
An unconscious patient is not a rare or special case of information asymmetry, common in professional relationships. Unconsciousness is not a theoretical gap market thinking can overcome; it is an infinite and insuperable knowledge gap. And it occurs hundreds of times each day across Canada. …
Continue reading at The Hub.
I am a pragmatic idealist and not ideologically driven. I have always believed in a health care safety net within a classical liberal system, that is, capitalism with a heart. Once there is a consensus that allows for private money in Canadian healthcare we can then define the deductible for individual Canadians to pay out of their own pockets.
These are excellent ideas, Gerry. I think many (most?) agree that adding a little bit of liberty would help.
My issue is that market thinking is the only thing offered by those right-of-centre. It is all classical liberal ideas and nothing else. There are more ideas than liberalism.
Thanks for sharing a comment!
Cheers
My take away is a little different, Shawn. Those on the Far Left and the Far Right are making most of the noise and thus are defining the discussions/debate. Definitions of terms need to be redefined for current times: as our political landscape has gradually shifted leftward, the Centre is now in a different spot. Until we can push the extreme positions aside and let the vast majority of Canadians think and have reasoned discussions without being overwhelmed by loud talking points, we will lurch along or teeter totter until there is a catastrophic upheaval.
Well said, Gerry. Agree. Excellent comments!
Classical Liberalism, Mises/ Hayeck, advocates private property, an unhampered market economy subject to the laws of supply and demand , free trade, rule of law, constitutional guarantees regarding free speech, freedom of ( and from) religion.
Our health care system has become increasingly statist over the last 50 years , with government bureaucrats and our own representative bodies , dictating what we do and what we say, dictating what science is and what it’s not, what medications we may use, what medications we should not use and indeed should not be mentioned , verboten, and what our incomes should be .
The fate of our profession reflects the fate of that proverbial frog which was placed in a saucepan of cold water , the temperature of which was imperceptibly increased by the statists and so got boiled to death….there are only a few of us remaining that remember the clear cool water of the mountain streams.
In a free market , when there is a shortage, prices rise…statists such as Biden to our South cut and slash where energy production and pipelines are concerned and yet , express shock and puzzlement when energy prices rise….when there is a glut of something , prices drop.
In medicine the free market principles were cast aside.
There is now a government induced shortage of medical doctors and those not employed by government subsidized clinics, Fee for service doctors, find that their fees have gone down even as their office expenses and overheads have risen.
At the same time there is a glut of governmental health care bureaucrats and their wages and benefits are going up as the state picks up the cost of their overheads.
We are working in a statist system, our FFS colleagues , in particular, exposed to the downside of free markets and not receiving the benefits and security of being state employees.
Our “ representative” organizations don’t represent their grass roots functioning more like state commissars delivering instructions from above to the masses below.
The wokeness of their communication becoming ever more nauseating in their virtue signalling, regurgitating all the politically correct terminology with intersectionality, identity politics and PC pronoun usage at the fore.
One thing for certain, post COVID primary care will be changed for ever and older patients will have a warm memory of the “good old days” when the dictum of a good free market doctor were the 3 A’s…Ability, Amiability and Availability.
Fantastic (and provocative) comments as always, Andris. Thank you!
I, too, value market solutions and the freedom required to pursue them. However … (and this makes my libertarian friends howl) … markets need more than just freedom. We assume a boatload of norms, behaviours, and assumptions for a market to function. This is why capitalism fails in so many countries. A society needs trust, deference to logic and evidence, some level of civility, acknowledgement of the legitimacy of the current government … and a hundred other things. We never talk about these other things. Even something like the institution of medicine itself: it needs to be fostered and allowed to develop and maintain itself. Or the institution will whither.
Anyhow, too much to deal with properly in one reply. Thanks again! Great to hear from you.
Cheers
I love aphorisms that encapsulate wisdoms…Churchill had a few where capitalism is concerned.
“ Some see private enterprise as a predatory target to be shot, others as a cow to be milked, but few see it as a sturdy horse pulling the wagon”.
“ The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of its miseries”.
I see it as a sturdy horse, being abused as was Boxer in Orwell’s animal farm…many in medicine feel ,as did Boxer , when Napoleon sent him to the glue factory after he had worked to himself to exhaustion.
The era of the equal sharing of miseries is on us…but as we all know, some are more equal than others.
Boxer’s “I will just work harder” has been in my mind many times over my career and life in general. It is fascinating that the image of Boxer affected someone else just like it did me. Take care, Andris.
Fantastic quotes. I share your affection for Boxer, Gerry. It was the most moving for me also. Thanks to both of you!