Sunday, June 12, 2005

The Dike is Leaking

Lots of folks have had plenty to say about the recent Canadian Supreme Court ruling which struck down a law banning private health care insurance --- see DB, Dr. Andy, and Kevin, M.D. for thoughts and comments. Perhaps the reasoning behind the decision can be summed up by this quote from the ruling itself (emphasis mine):

"The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care," the Supreme Court ruled. "In sum, the prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services."
I won't belabor the many ills of the Canadian system --- most physicians in the US have a ready source for that kind of information in the form of colleagues who are Canadian expatriates. And, I won't belabor the purported benefit of the system -- universal coverage -- in comparison to the US. What I think can be said, however, is that the cracks in the Canadian system would have shown up much sooner, and be much deeper, if many Canadians had not had ready access to care in the US (at their own expense).

While this decision may be a way for the Canadians to start moving away from total government control of their health care, I am afraid that we in the US are firmly headed in that direction. What would our system look like if all were covered by Medicare and Medicaid? Would we end up with lines, waiting lists, and worse care? I believe so, but in the current climate of "sound bite" politics, it is easier to propose "universal coverage" than it is to design a system that works.

UPDATE: Monday June 13th -- The Wall Street Journal has a good editorial on this today. As usual, their ability to write far outstrips my meager efforts. To me, the pithy part of the editorial states:
The larger lesson here is that health care isn't immune from the laws of economics. Politicians can't wave a wand and provide equal coverage for all merely by declaring medical care to be a "right," in the word that is currently popular on the American left.

There are only two ways to allocate any good or service: through prices, as is done in a market economy, or lines dictated by government, as in Canada's system. The socialist claim is that a single-payer system is more equal than one based on prices, but last week's court decision reveals that as an illusion. Or, to put it another way, Canadian health care is equal only in its shared scarcity.
It's worth taking the time to read. I suspect you already know that I would not recommend reading Paul Krugman's take on things (I wouldn't even spend the time to link to it.)