Tuesday, August 23, 2011

What ails Canadian health care

The other day an acquaintance related how he had needed to find a new family doctor when his previous doctor retired.  The old doctor, he said, had always had a very personable approach, taking his time to know patients and understand their concerns.  The new doctor processes patients fast and hardly looks at the patient, much less takes the time to know the patient personally.  I realized this story was symbolic of the changes well underway across Canada and understood why it is taking place. 

Government intervention in the science and practice of medicine is wrecking health care.  Already a huge proportion of Ontario's budget is dedicated to health care and the amount is growing rapidly as the average age of the population rises and government forces costs up.  Before government seized control of large portions of medicine, health care was a product traded freely like food, housing, transportation or any other important product.  Almost all Canadians could afford basic health care, insurance was available to cover large risks and the few who could not afford it were served by a large number of charities.  If this had continued, health care productivity would have risen steadily, variety of services would have increased and costs would have come down as technology advanced.  There would have been no such thing as waiting lists or bursting provincial budgets.

When people came to think of health care as an entitlement and used the coercive force of government to create a monopoly, they tried to impose their own health care expenses on their neighbors.  Since such a monopoly can only create less health care than before, everyone attempts to feed off his neighbor's budget while facing little individual accountability for health and related expenses.  When expenses are shifted away from the person actually incurring them and onto a faceless mass, the demand for services explodes until government must respond with rationing and triage.  When government first took over, there was a vast increase in spending that at first seemed to increase services, but soon this became too expensive and turned patients into an expense instead of a customer.  As the intervention grew and distorted the health care market, protesters demanded even more intervention to "fix" the problems.  In Canada we patiently wait like sheep for appointments, testing, diagnosis and treatment.  In the US, intervention has driven the cost of being a doctor through the roof, and Obama is proposing to make it worse, not better.

To solve the problems of health care what is needed is not an increase in government coercion, regulations or funding.  The solution is to return the business of health care to the citizens and let them make their own individual choices, decide their own priorities in life and be accountable for their own health and related care.  The resulting market signals to doctors, hospitals, drug companies, nurses and all other aspects of health care would shape the system according to the desires of the population.  As in all products not rationed by government, lineups would vanish, technology would flourish, costs would decrease and shortages would end. 
You do not have the right to make a doctor to treat you or make other people pay for your expenses.  The real fix in health care requires a change in morality - a rejection of the philosophy of sacrifice to provide for the many.  All such efforts are doomed to fail since they can only destroy rights, not create them.
To be a doctor traditionally meant not only years of study, but long hours seeing patients, being on call, accepting some work without pay, continuing education, little family life, tremendous reasoning skills, an entrepreneurial spirit, a willingness to innovate and a desire to improve.  Doctors were skilled businessmen whose value was constantly assessed by their patients and their successes and failures.
My friend's new doctor is a government product - good at filling out forms, dealing with bureaucracies and regulators, skilled at processing visitors to his office and working regular hours.  His income has little or nothing to do with medical success and mostly to do with his ability to comply with regulations.  He has little accountability to patients.  He does not seek to innovate in medicine, but in processing speed.  He is the future of government-run health care and you are his unfortunate patient.  Few doctors remain from the pre-monopoly years and what type of student would want to go into the profession today, knowing what it is really like?  The compliant bureaucrat.

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