Leading up to the 2018 Ontario provincial election the Liberal Party hosted an online discussion forum to gather election ideas. I eagerly engaged in dozens of discussions. Here is an exerpt from one of the top rated ideas. On reading it I am struck by how persistently the idea creator avoids my main point - that central planning void the planning of millions of citizens and violates their rights, thus is both immoral and impractical. As I say near the end, people today cannot even conceive of what a free society would look like.
Idea creator:
Increased NURSE TO PATIENT RATIO FROM 5:1 to 3:1 while returning the 100 residency doctor spots cut this year. My Grandfather DR Alan Brown ran Sick Kids for 40 years cutting the infant mortality rate in half by insisting the Premier pasteurized milk BUT also insisted that patients received care SAFE ratios mean patients leave without complications, with minimal pain and alive His Doctors provided the procedures, however ever nurses sustained lives . NOW burn out, complications, pain and often times additional operations or staph infections occur due to impossible ratios hitting 7: 1 during evenings.
Me:
How can anyone tell what the "right" ratio is when the market signals for such a decision are almost erased by the creation of a monopoly? This idea would seem to indicate a massive increase in nurses and thus a massive increase in spending. Is this the best use of all this money? Would other spending have a better impact on patient outcomes and experiences? This type of problem is endemic when the valuable information gained from a price system is eliminated. I pity the hapless hospital administrators working under such conditions.
It's interesting to note that dentists seem to have no trouble identifying the best number of hygienists and administrators to hire and that in health care areas where there is no government monopoly that innovation is much faster, that prices move steadily lower per unit of value delivered and that there are no wait lists where patients suffer obediently waiting for attention.
Idea creator:
Ratios have always been an accurate measurement of need only limited by resources ( budget dollars) in exactly the same way that retail staffing is measured right down to the day/week/month/hr of year for maximum productivity sales per 4hr period to cash register transactions. Health care cutbacks to hospitals dictate budget and nursing doctor wage dollars available. The reduction of 100 resident doctors in 2016 increased wait times in both ER and on call resident doctor care.
Off-Site medical care such as your dentist or GP , OB GYN, Psychiatrist are still stand alone operation with appointments pre arranged and managed accordingly . This is completely different than a hospital's operation as you can not pre-arrange a car accident, heart attack, stroke , fall ( fracture/break), unknowns and the time required to deal with each.
Me:
I certainly appreciate that reducing doctors increases wait times and reduces quality of service. The problem I would identify here is a disconnection between supply and demand caused by a monopoly.
What I am saying is that the multitude of price signals that efficiently coordinate everything in a free market (such as retail staffing) are truncated or eliminated under a state-run monopoly, so mountains of valuable information are not allowed to work their way into the system to manage and prioritize everything. In a free market there is no such thing as budget cutbacks by bureaucrats since it is customers' decisions that decide where money is allocated, not bureaucrats. When competition is allowed it drives suppliers to leap into opportunities demanded by customers. When competition is outlawed the task falls to bureaucrats who are disconnected from the law of supply and demand and thus are challenged with making decisions with little or no information.
I appreciate the difference between a hospital and especially its emergency room and regular medical practices such as a dentist. Please understand that what I see as the most fundamental problem in Ontario health care is the fact that such an important and valuable service has been largely removed from the normal market signals, feedback mechanisms and motivations provided by a free market. It is now captured by a bureaucracy that can never have the right information to do the job as best possible and driven by political concerns that are far removed from the healthy win-win doctor-patient relationship that prevails when government gets out of the way. What do we think will happen when government controls the schools, the hospitals, the compensation arrangements, the services allowed, the procedures to be followed and even the gambling casinos used to raise funds to support such a broken system? If we didn't have such a crazy quilt of controls, who could imagine such a thing could ever be created - and why would anyone want it to be?
Idea creator:
National health care is a gift compared to the two tiered US system . Demographics dictates supply and demand . What constructive plan would you propose to 1) fund our health care system 2) provide the requires professionals to meet the needs not being met? I have provided a proposal to my MPP friend now tabled as a motion to spend 360 million to community services and our mental health care system to reduce the 12,000 children and youth on lengthy wait lists. ( as an example) this week.
Me:
I certainly made no mention of the US system, almost half of which is fully government controlled and the rest of which suffers under massive government intrusion and distortions.
I propose a system where the market is allowed to operate in a normal, healthy, moral and efficient way; where doctors and patients make agreements without coercion; where market demand and the price system drive professionals into the specific fields, specialties and locations in demand by consumers; where innovation, experimentation, competition and imagination are left free to flourishing and create value; where no one is allowed to enslave others to their whims and wishes; where insurance is offered in all the diversity and creativity possible to free thinking people, where coercion is forbidden and consent is required. I propose a system proper for homo sapiens, man, the rational being.
Idea creator:
In other words. No you have no plan.
Me:
That is not at all true. Saying I have no plan for nursing care in Ontario is like saying I have no plan for my supercomputer mobile phone, my car that my parents would have never imagined fifty years ago or my groceries that are available in wonderful abundance from all over the world at very affordable prices - I can buy fresh strawberries in December for goodness sake!. In a free market all the items I trade for are available in abundance at a relatively cheap price and their diversity and quality steadily improves per dollar spent while the portion of my income needed to pay for them steadily declines. Only under a system such as socialism is there a central plan for any economic exchange of values.
For example, in the USSR they produced shoes through central planning but had no idea how many to produce, how much to sell them for, what sizes and what types were preferred by consumers, so the shoes were of poor and stagnant quality because there was no multitude of price signals to coordinate the production of shoes with all the inputs required and with all other goods produced, workers had no incentive to innovate or create because their pay bore no relationship to value created and there was universal dissatisfaction with all aspects of production and consumption. The black market flourished to meet the actual wishes of consumers, but it was illegal and suppressed by the state. In Ontario, while we retain a large portion of the free market so many parts of our health care can be integrated properly into the economy, major portions are disconnected and prevent people from thinking rationally about how to optimize their role in the economy, thus we are partly similar to Soviet production and coordination problems.
In Ontario major portions of health care are essentially illegal if performed outside government controls and the rest of health care is heavily regulated by government and thus stunted. Do you remember when a business tried to bring private MRI machines into Ontario to solve the shortage created by government central planning, and the government said they would stop the machines from coming in using guards and guns at the border, that they would never allow privately run MRIs? Is that a moral position? Is it practical? In Ottawa I am about to pay for my daughter to drive five kilometers into Gatineau to get a cervical MRI to rule out factors in chronic pain, where it can be booked in just a few days, is cheap considering the value provided, and she will walk out with a CD of the scan. No months-long waiting list, no hassles. This is how the entire health care system should be run.
To say Ontario has a plan for health care can only mean that we have a central plan and that the ideas, imaginations and reasoning of millions of us are being prevented from operating properly. No, I do not have a plan for health care in Ontario because I am not a central planner with the power of omniscience to replace the thinking of millions of my fellow citizens. Rather, I advocate for a system that sets them free to think, plan, decide and act freely so they can create the best system possible with the knowledge of humanity at any given time and constantly adapt. The fact that Ontario has a plan and that you think you or I can ever have a plan is the root problem with health care in Ontario.
Idea creator:
So OHIP ( plan) as I mentioned needs funding change and /or additional funding to provide the correct nursing ratios. i don't have time to read your replies.
Me:
I am trying to point out that putting used band-aids on a compound fracture is not a path to good health for the patient. Something radically different is needed: a return to the principles on which the Liberal party and Canada was founded, the principles of individual rights and freedoms and a government to protect them, not damage them. I believe we have moved so far from these principles most of us cannot even conceive of what a free country even looks like and have been trained to recoil in horror when actual freedom is proposed. Scary, isn't it.
Idea creator:
1)"Something radically different" is not a plan 2) It was the NDP to first start Provincial health care in canada History of Canada's Public Health Care. The Saskatchewan Government, led by leader Tommy Douglas, introduces the first provincial hospital insurance program In Canada. 3) Canada is the freest country in the world and most diverse and inclusive. 4) Not scary in the least.
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