December 10, 2009 -- As the U.S. Senate argues about how best to take over the American health care industry, it is worth taking a look at how government health insurance works here in Canada, where I live. Judging from popular opinion, one would think Canadian health care was great. My fellow Canadians by and large love their single-payer, universal coverage, according to a recent Nanos Research poll
. Fully 80 percent of the 1,005 Canadians interviewed support universal health care, with another ten percent supporting it somewhat. A mere five percent were opposed or somewhat opposed, with the remaining five percent unsure.
Yet these poll results are frankly surprising, because universal coverage in Canada comes at a high cost: long waiting lists. The free-market Fraser Institute’s latest annual report on waiting lists
was released on October 29, 2009. The study found that “waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed” was about 16 weeks this past year. While improved slightly from around 17 weeks the year before, this is still an awfully long time to wait, whether for cancer treatment (5 weeks), “elective” heart surgery (8 weeks), or brain surgery (33 weeks!). Patients also waited over 4 weeks for a CT scan and almost 9 weeks for an MRI.
To be fair, roughly one third of respondents in the Nanos poll mentioned above identified “waiting times for treatment / lack of accessibility” as our system’s key weakness. Another 14 percent thought the fact that there are “not enough doctors, nurses and/or personnel” was its number one failing. Still, in spite of these defects, most Canadians support our system. Why aren’t more Canadians more upset about having to wait for health care?
The Doctor Won’t See You Shortly!
There are surely many reasons Canadians support our flawed system, warts and all. One of the foremost is that we really do want everyone to have access to health care. We have big hearts, and we can’t stand the idea of someone going without just because he can’t afford to pay. This is all well and good, even if we are a little misguided about how to reach this goal, as I will discuss below. But on the flip side—and far less flattering to our national self-image—many Canadians also can’t stand the idea of someone jumping to the head of the queue just because he can afford to pay. Everyone must be equal, even if it means being equally miserable. Of course in reality, some people (i.e., those with pull) are much more equal than others. And notice how the existence of a queue is not even called into question by this line of thinking.
A truly voluntary society would allow individuals to make their own decisions about health care.
Some people, though, are probably unaware of just how long waiting times are. They may not know anyone who has been seriously ill of late, or they may know someone who got lucky and waited “only” four weeks for heart surgery instead of an average eight (or an above-average twelve).
Conversely, many of those who do
realize how flawed our system is nonetheless believe that the alternative of free market care would be worse. They look south of the border, to the United States, and see a system that, while not as damaged as some maintain, has some very real problems. But strangely, they attribute these problems to the market. They ignore the fact that health care is one of the most regulated industries in the United States. Large parts of the system are already controlled by the government, providing coverage to the poor and elderly. More importantly, it is the American government itself that has caused the price of health insurance to skyrocket, although admittedly in somewhat convoluted ways. (See an earlier installment of this column
for more details.) Personally, I blame our schools, which do a terrible job of educating students about how market competition efficiently lowers costs while raising quality and promoting innovation.
Toward a Voluntary Society
In addition to these economic misunderstandings, though, many Canadians have been seduced—with language about society and solidarity—into glossing over the moral issue of force. Taxation is force. Government-funded health care is health care at the point of a gun. It is more flattering to one’s ego, however, to focus on one’s generosity than to focus on how one is willing to force others to be generous, too. Some are willing to bite this bullet, saying that everyone has an obligation to help others. But by what right does one person impose unchosen obligations on another? I have never gotten a satisfactory answer to this question. Most people would rather just talk about something else.
Health insurance to cover unpredictable and expensive illnesses or injuries is generally a good thing to have. The important point here is that not all good things should be provided by government. In fact, when governments decide what is good for us, they prevent individuals from making their own individual decisions
—for instance, decisions about how much and what specific kinds of insurance they want. More essentially, if every individual human being owns himself, then the initiation of force must be disallowed. Governments need to focus on their proper role, which is keeping the peace by defending the rights of individuals to live their lives as they see fit. Governments need to keep their hands off of everything else, lest they become guilty of the very harm they are entrusted to prevent: the initiation of force.
A truly voluntary society would not mandate what kinds of treatments must be covered by insurers, nor dictate that employers provide health coverage, nor subsidize employer-provided health care as against individual insurance, nor prevent interstate commerce—all measures that drive up the price of health insurance in the United States. A truly voluntary society would allow individuals to make their own decisions about health care, and about charitable giving. And a truly voluntary society would allow market actors to provide health care and health insurance. In so doing, that society would enjoy a system that was more flexible, more responsive, more affordable, more timely, and more innovative than any that currently exists anywhere on the planet. It would be both more just and more efficient, because unlike what we have been taught for millennia by just about every ethical system under the sun, the moral and the practical are actually one and the same.