Last fall, Jim Carey, the well-known comedian, spoke on Real Time with Bill Maher about Canadian single payer medical care:
“I grew up in Canada, OK? We have socialized medicine.
I’m here to tell you this bulls**t line you get on all the political shows from people is that it’s a failure. ‘The system is a failure in Canada.’
It is not a failure in Canada.”
Carey used an old term for the mascot of Canadian exceptionalism. Twenty years ago, socialism was dead. People avoided calling anything socialized, especially Canada’s crown jewel of post-war welfarism.
Even today, people still prefer to talk about single-payer healthcare. It ranks between 5- and 25-times more common than socialized medicine on Google trends since 2004.
Celebrities love to defend socialized medicine. That should not surprise us. But their comfort with the term ‘socialized’ is worth noting. As the New Yorker published this spring, socialism is back.
A Glorious Beginning
Socialized medicine started in the late 1960s with a promise: care regardless of ability to pay. Doctors and nurses could keep doing what they had always done. And government would pay. Who could argue with that?
The glory days of socialized medicine ended soon.
By 1977, the federal government stopped giving the provinces blank cheques for 50% of whatever the provinces chose to spend on medical care.
That led to cuts and rationing, which led to hallway medicine and patients being admitted to closets and bathrooms.
Socialized medicine started as a wonderful dream. It has ended up a harsh reality for many.
Why Call It “Socialized”?
The ‘socialized’ half of socialized medicine goes back to Karl Marx. He and other socialists wanted to emphasize the role of society and downplay the role of the state.
Marx preferred ‘socialization’ to describe state control of an industry. He avoided using the term ‘nationalization.’ It sounded too much like state control.
The state, according to the famous sociologist and political philosopher, Max Weber, is a polity, or group, that possesses a monopoly on violence. If you break the law, the state can send people with guns to put you in jail. The state is a complex apparatus that includes government, regulators, the legal system, and more.
Marx did not like the state, but he needed it for his revolution. He and the early socialists believed that workers, who represented the bulk of society, would be free if they could escape the tyranny of business owners.
The socialists believed that the only way to free the working class was to use the state to “take ownership of the means of production.”
In other words, Marx wanted to take businesses away from business owners. But Marx also knew that the state could be just as tyrannical and oppressive towards workers. He needed the state to help free the working class in his revolutionary march towards freedom and equality, but he believed in a future where the state no longer needed to exist.
True freedom lay in the future with no private ownership of businesses — no private property at all, for that matter — and no state: a collectivized utopia where everyone shared everything, and we all helped each other.
Modern socialists realize that they do not need to actually own a business. They just need to control it. So, modern socialist governments take control of an industry, avoid the term ‘nationalization,’ and use ‘socialization’ instead. Thus, we end up with socialized industries, and in our case, socialized medicine.
So, What is Socialized Medicine?
Today, socialized medicine means state-run medicine.
It means centralized control and government rationing of care.
It means that patients do not decide when their pain needs treatment. Bureaucrats decide whether your symptoms merit treatment or not.
Socialized medicine has become a political football used to win votes and stay in power. In political hands, socialized medicine has little to do with patient care. Patient care, if it eventually comes up after budgets and benchmarks, falls to a footnote.
For policy makers, modern socialized medicine is about wealth redistribution. We take money from the wealthy and healthy and given to the poor and sick.
It is part of an overall plan to level economic inequality in a nation: one plank amongst many others that form the overall welfare state. Socialized medicine lines up alongside equalization payments, the Canada pension plan, unemployment insurance, and all the other handouts controlled by the state.
Canada Loves Insurance
Most Canadians still support a provincial insurance plan for medically necessary care. Canadians love insurance and medical insurance seems reasonable.
Except that Canadians do not have medical insurance, in the same way that we have other kinds of insurance. Waiting years to see a medical specialist does not seem like insurance.
Even if we insist on using the language of insurance, Canadians are woefully underinsured.
Canadians support medical insurance, but they have been given managed care.
Socialized medicine is not a single-payer state funded insurance plan. It looked like that at the start, in 1971. But the true nature of socialized medicine, and the original intent of its champions, showed up over time.
We should celebrate people using the term socialized medicine again. It lays bare the real nature of our approach to medically necessary care in Canada. An accurate diagnosis is the first step towards treatment.
Photo credit: Pixabay
I would recommend that every person who is interested in learning more about “managed care” read Managing Scarcity – Priority Setting And Rationing In The National Health Service by Rudolf Klein et al.
Thanks Perry! Hunting it down right now…
Democracy + private ownership= Capitalism.
Democracy + public ownership = Socialism.
Dictatorship + private ownership = Fascism and National Socialism.
Dictatorship + public ownership = Communism.
Vladimir Lenin pointed out that :” the goal of socialism is communism”.
Fascists and National Socialists discovered that leaving the means of production in private hands was far more useful than placing them in the hands of the state…state power could order the private sector what to do with their property, the private sector , having no control, had to follow the commands of the state whilst bearing the responsibility of any consequent shortcomings with the state taking credit for any successes.
Ownership without control is a contradiction….medical practitioners in Canada worked hard and went into debt to build / buy / lease/ rent their medical clinics/ buildings and built up their medical practices with all the responsibilities of running and staffing them— in the mean time dictatorial governments have increasingly imposed themselves onto the medical profession “ in the name of the people “, telling them what to do with their “ property”, how to manage their patients, piling increased responsibilities onto their shoulders even as they slash their fees and incomes.
Provincial governments do not bear the responsibility of running medical practices even as they reap the advantages and benefits…medical practitioners, in contrast, bear the responsibility and increasing costs of running their practices whilst being increasingly denied the advantages and benefits of ownership.
It is a collectivist / statist principle to negate individual rights and to subordinate the individual to the collective…since it has been declared that health care is “ a right” , Canadian medical practitioners will have to be enslaved, be deprived of their individual rights, to provide that “right” to the collective.
The US “ fathers” spoke of the right to life , liberty and ( wisely) the pursuit of happiness…they did not say that there was a “right to happiness”, in which case others would have had to be enslaved to provide it… I would say that , in a similar fashion, Canadians should have every right to pursue their own health and well-being and that the medical profession should not be enslaved to provide it…unfortunately the dictatorial statists in Canada have the upper hand and the wind in their sails.
Well said, Andris
The state is whittling away the benefits of private ownership but leaving the responsibility.
Mises said that there is no such thing as partial state ownership, or a mixed socialism. Socialism in part is socialism in full.
Thanks again for providing such a thoughtful comment!
In the recent federal election, those from the NDP, Green and Liberal parties argued that Canada was one of the few countries without a pharmacare program. However, they failed to mention that we are also one of the few without modest user fees, co-payments, etc.
If you watch CNN and other American channels, this is the time of year when patients select their supplemental insurance plans. The commercial states that medicare covers only a portion of total costs and “The rest is up to you.”
That statement seems alien to many Canadians, who increasingly expect the government to pay 100% of health expenses, costs of university, etc., etc.
Charles. S. Shaver
Ottawa
If the Canadian health care system is so wonderful, why is it not copied, adopted and implemented by more/other countries (especially those that have comparable demographics and other variables)?
Excellent point, Robert.
Canada is exceptional in its exceptionalism around medicare. No one does like us. Not even North Korea outlaws private provision for medically necessary care (I’ve been told).
Although our irrational rationed system screams out nonsense, silliness works to bring change all on its own. The more that government double down and insists that the Emperor’s new clothes are thus and such, the more obvious it becomes to the rest of us that he is naked and embarrassing.
I suspect that we will always need some form of public system. Like the post office, government care will always exist. And the socialists will always push for government control/ownership of medical business. But reason lies in a more balanced approach.
The current socialist position is the extreme, even if people try to convince us that saying so is the radical opinion to hold. We need to keep saying, calmly and with thoughtful insight, that Canada has the most extreme form of socialized medicine in the world today. That is a fact. And patients would do better with some change.
Thanks again for posting!
Great point, Charlie.
And as George Will, columnist and political philosopher, is fond of noting that state decisions shape citizens’ character. If anything is ‘up to you’, then each of us, as individuals, had better pay close attention to it. That requires development of certain kinds of behaviours, patterns of decision making. Of course, a small portion of society will never be able to manage decisions on their own for anything. For those few, we will always have to provide 100% care. But that is not most of us.
Thanks so much for taking time to read and post your thoughts!
Cheers
We shouldn’t forget that when Jim Carrey is speaking about socialized medicine, it’s to an American audience. America has a polarized political discourse distinct from Canada’s, and a word like socialism carries different baggage south of the border than north. The Carreys and Mahers of the world have to engage the “meta-debate” of how politics is discussed before they can successfully discuss a policy on its substance.
There are concerted efforts to bring a more polarized discourse into Canada, but it hasn’t happened. As no less than Preston Manning would say, our political divisions run along jurisdictional rather than ideological lines. It’s why the three major parties offered nothing in major differences in their campaign platforms except vis-a-vis the oil sands, though that too is ultimately a federal-provincial rather than a left-right squabble.
We’d all be better off taking a practical view of what ails our health care rather than debating in terms that don’t matter to the public. The Canada Health Act should be repealed or revitalized based on its impacts – wait times, out-of-pocket costs, physician access – rather than the thoughts of very dead men. There are aspects of the system that would benefit from more central planning (or at minimum a firmer commitment around central funding), and places where the reins badly need to be let out. But there’s no progress in a battle of “ism”s, just frustration and shoulder shrugging among ordinary Canadians.
As for fear of the spectre of Marxism coming back in vogue, I discovered that my son’s latest high-school book assignment is A Day in the Life of Ivan Denisovich. I’ve never been happier with his state run education than I was last night.
Wise words, Frank. Thanks so much for taking time to write.
I agree with your thoughts that most Canadians do not engage in a debate about ‘-isms’. And those who do often do not know what the ‘ism’ means for which they argue (including me sometimes, as I find out painfully later). Labels are shorthand for complex ideas. They only work well if each of us agrees on a shared understanding of the complexity in question. So your very gentle rebuke is noted and appreciated.
If we do not use label or -isms, then we have to use first principles. That is a good thing in general. But it creates a tonne of work. Furthermore, debating first principles for a system of thought that has a long record of human suffering behind it seems to verge on dishonesty. Then again, if people truly do not know history and only shrug when they hear political terms, then we have no choice; we have to argue it all over again from the start.
Finally, I really like your call to practical solutions. We need real solutions for real patients.
Thanks again.
PS VERY cool that your son is learning about Solzhenitsyn’s work! Wow. I did not expect that. My son is learning about benign dictatorships 🙁