The Unsolved Riddle of Affordable Health Care and the Medicare Mystique

Imagine that you are suffering from chronic pain due to a condition that can be alleviated by fairly simple surgery. You schedule the surgery but are told that it has recently been re-classified as elective or cosmetic surgery and so is no longer covered by your health insurance. If you want the surgery you must now fork over thousands of dollars.

Or imagine that you live in a rural community that is only a half hour drive away from the second largest city in your province. You have a condition that is fairly common but the city close to you does not have any of the specialists who treat that condition, despite having a decent sized general hospital and several smaller clinics, and so twice a year you must travel half way across the province to see a specialist in the capital city.

How about this scenario? Your spouse has an irreversible, progressively worsening, mentally debilitating condition that requires round-the-clock supervision and extremely expensive medication. As your savings disappear paying for the expensive and ineffective medication you find that you are now figuratively chained to your spouse because the health care system seems unable or unwilling to provide you with relief from the duty of watching over your spouse 24/7.

Suppose you are a young, expectant, mother on the verge of giving birth. You are staying with your family in a rural community that has its own, modest, health centre. When your water breaks you contact the local health centre and are told to go to the hospital in the nearest city which is approximately an hour’s drive away. So you hop in your pickup truck, the father of your child takes the wheel, and off you go but you do not have time to make it and give birth along the road.

Let’s say that an elderly loved one was discharged from the hospital in a particularly harsh winter, taken home by taxi, and later found dead on his porch. What would you think if the provincial health minister were to try and pin the blame for this entirely on the cab driver?

All of these scenarios are real. Two of them are taken from stories that made the news here in Manitoba during the last six months. One describes a situation within my own family. One describes something that friends of mine from church have had to deal with. One is a story that was relayed to me by these same friends.

What all of these scenarios have in common is that they point to the fact that our publically funded health care system is overburdened and unable to meet the demands upon it or the medical needs of Canadians.

That the publically funded health care system is overburdened is not exactly news. For years now Canadians have had to put up with waits to see their family doctor, followed by longer waits either to see a specialist, to have lab work done or both, followed by yet another wait until they actually receive treatment. These waits can be months or even years long, even if the condition is serious enough to require urgent treatment. It is openly acknowledged that there is a problem here and there is also a pre-packed, knee-jerk, pat answer to the question of what the solution is. That answer is to say that the government needs to devote more resources to health care, to put more money into it.

That is the wrong answer but to point that out in Canada is to be like the boy in Hans Christian Anderson’s story who observes that His Imperial Majesty is strutting around naked as a jaybird. This is because it is the only answer that is consistent with the prevalent Medicare mystique.

By Medicare mystique I refer to the ridiculous but popular idea that our single-payer health care system is not only superior to all other systems but a glorious national institution, Canada’s pride, joy, and crown jewel, and that its monopoly on the provision of health care services must be protected against competition at all costs, lest we become like the Americans. I have often heard this mystique put in these words “our health care system is what makes us different from the Americans”.

I wonder if those who put it this way realize how utterly stupid it makes them sound? On the national level, universal, single-payer, health care dates back to the Medical Care Act passed by Parliament in 1966. Not that the Pearson Liberals invented it from scratch. It developed over the course of a couple of decades as the provinces, starting with Saskatchewan under the socialist government of Tommy Douglas, developed provincial public health insurance programs, and the federal government, under both the Liberal and Conservative parties in the ‘50’s and ‘60’s, began to provide funding. Something that is less than fifty years old in its present form cannot be what defines us as a nation and makes us distinct and different from our nearest neighbour. Canada is a parliamentary monarchy and a federation of English and French provinces, formed out of colonies that had remained loyal to Britain when the Americans rebelled and by Loyalists that had fled persecution in the new republic, which developed as a country within the British family of nations rather than through revolt and rebellion. This, and not Medicare, is what distinguishes us from the Americans. I will not dwell on this point further, however, because I am writing about what is wrong with our health care system not what is wrong with our educational system.

The way the system works, each province operates its own public health insurance plan with a large part of the funding coming from the federal government. The province issues a card with a health number on it to each of its residents which they show to the hospital, clinic or doctor’s office. The provincial health plan is then billed for the services.

Public health insurance systems like Canada’s were created in response to the rapid and exponential rise in the cost of health care over the last century brought upon by such factors as the explosion in the development of new health technology. The rise in the cost of health care put it beyond the reach of many people and so public health insurance was developed with the goal of making sure that everybody who needed medical care had access to it and that families did not have to clean out their savings, take out a loan, or go into bankruptcy to pay for life-saving surgery.

This was and is a laudable goal but the problem with public health insurance is that it is an answer to the question how can we make somebody else pay for our health care rather than to the question how can we make health care more affordable overall. Indeed, if we think of the expense of health care as being the problem, public insurance adds to the problem rather than decreases it. Health care that is paid for by public insurance is not free because we pay for it with our taxes, but by separating the payment from the use, it creates the popular illusion that it is free. This in turn leads people to use the system more often than they would if they had to pay per use. When you increase the demand for any commodity you drive up its price and so public health insurance increases the total cost of health care even though you don’t pay for it at the moment of use.

If this sounds like an argument for private health insurance of the sort that we ordinarily associate with the United States, think again. Private health insurance also increases the overall cost of health care, albeit for different reasons. Look at how much the Americans spend on health care every year if you want evidence of this.

If both public and private health insurance drive up the cost of health care then it seems like we are trapped between a rock and a hard place. Paradoxically, however, countries that have both seem to have better overall health care than countries that have only one or the other.

Several decades ago, in an interview that was published in the Paris Review, British novelist Anthony Burgess remarked that despite his loathing of the State he conceded “that socialized medicine is a priority in any civilized country today”. To this, he added that “there’s no reason why a private practice shouldn’t coexist with a national health one”. This, he noted, was how it was set up in England, and then remarked on how the difference in treatment is indistinguishable, except that “the State materials (tooth fillings, spectacles, and so on) are inferior to what you buy as a private patient.”

What Burgess was describing is what exists not only in the United Kingdom but in every other first world country other than Canada and the United States. Canada and the United States do have a mix of public and private in the sense that the United States has had public health insurance for the elderly and low-income families since the 1960s and Canada allows private coverage for procedures not covered under the public plan. In the UK, Europe and Australia, however, a universal public health system exists alongside competing private systems and the health care is generally superior, both in quality and affordability, to that of the North American countries that have taken the more extreme routes of either relying mostly upon private companies for health coverage (the United States) or giving the universal public plan a monopoly (Canada).

Technically it is the provinces that give their public health plans a monopoly, although the Canada Health Act of 1984, one of the last bills passed by the Trudeau Liberals, provides strong incentive for them to do so. While this monopoly was successfully challenged before the Supreme Court in Chaoulli v. Quebec (2005) it has not yet been broken. The refusal to allow private insurance to compete with public insurance is downright stupid and is the single biggest reason why the public system is failing. It is also the sort of thing that outside Canada only exists in Communist dictatorships. Unsurprisingly, it is also the aspect of our health care system that is most protected by the Medicare mystique. You may recall that in the 2000 general election the other parties ganged up against Stockwell Day of the Canadian Alliance and accused him of wanting to Americanize the country by introducing “two-tier health care”. Day’s response was to hold up a sign in the leader’s debate that said “No 2-Tier Health Care”. There is irony in the fact that two-tier health care would have given us the British/European/Australian model and not the American model but this irony is lost on the type of people who, with the twisted reasoning of egalitarianism which in a wiser age was known as Envy, one of the Seven Deadly Sins, would rather have all Canadians waiting in long lines to receive more expensive, poorer quality, health care, than to allow Canadians who can afford it to opt out of the public system and pay for private care, thus relieving the burden on the public system and allowing it to operate better.

As long as this mystique prevails, the burden on our health care system, especially in provinces like Manitoba where the socialist NDP government is determined to cling to the public monopoly even as it finds itself closing rural emergency rooms and obstetric wards across the province, will continue to grow, and the riddle of affordable, quality health care, will go unsolved.

Common Law or Sharia?

Countries within the British family of nations, such as Australia and my own country of Canada, have reason to be thankful for the many priceless civil and social institutions that we have inherited from Great Britain. Through these institutions, we benefit from over a thousand years of civil, social, and political evolution prior to the establishment of our own countries and do not have to attempt to remake the wheel. The parliamentary monarchy form of government is one such priceless institution. The common law is another, one from which even the family prodigal, Uncle Sam, continues to benefit.

The common law is the legal and judicial system that evolved in England in the Middle Ages. Its principles are basically these: there is one law of the land that is embodied in the customs and traditions of the people who live in it, that the Sovereign’s main duty is to uphold and defend this law, that the unity of the law means that the law must be applied in the same way in cases with similar circumstances and so the courts must rule in accordance with past precedents, and that the role of Parliament in the passing of statutory laws is primarily one of tweaking the system when needed. It is a legal system that has served the English-speaking world well and which harmonizes well with our parliamentary system of government. Attempts by politicians to monkey with it have been generally quite ill-conceived and usually ended up working out for the worse.

Late last month, John Bingham, Religious Affairs editor of the Telegraph reported that the Law Society of England and Wales, the professional association of English solicitors, has been instructing its members on how to draw up wills that comply with sharia, i.e., Islamic law. A day later he reported that this had prompted members of Parliament to demand an inquiry as to the extent to which sharia law has been integrated into the British legal system.

It should be pointed out that this is not the first time Britain has accommodated sharia law. Several years ago it was reported that sharia courts had been established in the United Kingdom for the arbitration of certain kinds of disputes among Britain’s Muslim community. This was made possible by a bill passed by the British Parliament almost twenty years ago that allows for disputes to be mediated by an arbitrator agreed upon by both parties rather than going through litigation before a court of law. Muslims here in Canada attempted to get similar legislation passed in Ontario about a decade ago but then-Ontario premier Dalton McGuinty opted to get rid of all religious based arbitration tribunals rather than to allow sharia tribunals to be established. There is an important difference, however, about this more recent development. While the Arbitration Act brought about the establishment of sharia courts, it did so by basically allowing for any third party, that both sides in a dispute agree upon, to act as an arbitrator under certain general guidelines. The Law Society’s guidelines, however, are for the drawing up of legal documents to be recognized in Her Majesty’s courts.

Perhaps you are asking yourself what the big deal is. Surely Britain’s solicitors will only be drawing up sharia wills for Muslim clients who request them. If a Briton has the right to draw up a will disposing of his possession as he pleases then does it not follow that if he wishes to follow the dictates of sharia in doing so that is up to him?

It is important that we be clear what the cause for concern here actually is. Several voices have been raised in opposition to the introduction of sharia wills that ground their objections on the “sexism” of sharia, its barbarism, or its incompatibility with the objector’s abstract understanding of human rights. Whatever validity these complaints may or may not have, the most important issue here is that if the British courts are to follow the common law tradition most of the time but to follow sharia law when dealing with Muslims then the whole point of having a common law, a law of the land that is the same for everybody, is pretty much defeated. If the common law ceases to be this, then one of the greatest of British institutions will have fallen. A country is an entity composed of a land, its people, and their traditional political, social, cultural and legal institutions. Forty six years ago, the great Tory statesman Enoch Powell warned that through a combination of large-scale immigration and legislation that aggressively favoured new immigrants over native Britons, Great Britain had become a nation “busily engaged in heaping up its own funeral pyre.” When sharia law begins to replace common law in Her Majesty’s courts that indicates that the nation has gone beyond piling up logs and is now holding a match to the kindling.

In economics, Gresham’s Law states that bad money drives out good. In this situation, a similar remark could be made about bad law. Introduced into Britain as an alternative to the courts in arbitrating disputes among Muslims, sharia has now entered the British courts as an alternative standard for the drawing up of certain legal documents. It would be naïve in the extreme to think that this is as far as it will go. What will happen when a dispute arises between a Muslim and a non-Muslim and the former wishes it to be settled in accordance with sharia and the latter in accordance with common law?

There are many who would look upon this development and see it as a step towards the transformation of Britain into an Islamic society in which Christians and Jews will face the experience of dhimmitude. Others would condemn such fears as Islamophobia, a term of recent coinage that would seem to denote an irrational fear of Islam. I confess to being among those who consider the former point of view to be by far the more sensible of the two. Words like Islamophobia are a dime a dozen, being coined on what sometimes seems like a daily basis to demonize those who object to rapid, massive, and irrevocable changes being made to the people, culture, institutions and traditions of Western countries. Ironically, those who shout the loudest about the evils of Islamophobia are also those who have the most to lose from Islam gaining strength and power in the Western world. The growth of Islam in the West is incompatible with virtually every other pet project of the progressive left which almost tempts me to cheer it on. Instead, I would remind those who see the crumbling of a thousand years’ worth of barriers between Christendom and the Islamic world as an unmixed positive development of G. K. Chesterton’s principle that would-be reformers who do not know or understand why a fence was erected in the first place, should never be allowed to tear it down. Go out and learn a proper appreciation for what the Frankish armies of Charles Martel accomplished at Tours in 732 A.D. and what the Holy League led by King Jan III Sobieski of Poland achieved at the Gates of Vienna in 1683 A.D. and then maybe you will be in a position to explain, if you still think so, why those who would rather live in a nominally Christian country than an officially Islamic country are displaying an ignorant and irrational form of bigotry.

Do not misunderstand me. We are required to behave justly to the stranger in our midst and indeed to behave justly to all men everywhere. Justice does not require, however, that countries in the British family of nations suspend the common law in favour of sharia when dealing with Muslims. Indeed, I would suggest that it would be far more in accordance with justice that we insist that Muslims in our countries answer to the common law just like everybody else.

It would be both an injustice and a terrible shame if the common law tradition were to be broken in the country that bequeathed it to the rest of us.

The Younger Brother

The Rage Against God: How Atheism Led Me To Faith by Peter Hitchens, Grand Rapids, Zondervan, 224 pages, US$22.99.

In writing The Rage Against God, British journalist Peter Hitchens undertook a much more humble project than writing a comprehensive rebuttal of the atheistic arguments his brother Christopher compiled in his god is not great. Some of the younger Hitchens’ readers will probably be disappointed in this at first. Upon further reflection, however, I hope they will see that humility is this book’s greatest strength. It is a refreshing contrast to the arrogance of the new atheists.

The first and largest section of The Rage Against God is autobiographical. It is also, from this reader’s perspective, the most interesting part of book. The author has given it the title “A Personal Journey Through Atheism” and while it is that, to be sure, it is also much more. In telling his own story Hitchens also tells the story of his country’s journey away from Christianity towards secularism. The two stories are intricately intertwined and World War II plays a key role in both.

The War marked the end of Britain’s being a Christian nation in anything other than name. It also marked the end of the British Empire with the United Kingdom being eclipsed as the world power by its wartime allies, the United States and the Soviet Union. What this meant for the Hitchens family was that their father, a career officer in the Royal Navy, would have to search for alternate employment when the Navy, once so vital to maintaining the Empire, was downsized.

Peter Hitchens describes the Britain of his youth as a country that was using the memory of World War II to shield itself from realities of political and economic decline. As events like the humiliation of Britain by the Yanks during the Suez Crisis and the Profumo scandal caused the British youth of Hitchens’ generation to lose faith in their country and its leadership, the country itself clung to the cult of Winston Churchill, and the idea “we won the War”.

This loss of faith, among Hitchens’ generation, in Britain and its institutions went hand in glove with that generation’s rejection of the faith of their fathers. Like his brother, Hitchens became a revolutionary socialist in ideology in his youth. He writes:

I had replaced Christianity and the Churchill cult, with an elaborate socialist worldview—because I had decided that I did not wish to believe in God or in patriotism. (p. 100)

The words “I did not wish to” are the operative words in that sentence. They form one of the author’s major insights, spelled out in various places throughout the book. A significant element in faith is choice and this is as true of the atheist as it is of the Christian believer. Atheists, like Hitchens’ brother, charge Christians with believing in God because we want God to be real. While that is hardly the entire truth, it is a partial truth, and Hitchens willingly concedes it. However, he adds, it is also true of atheists. They do not believe because they do not want God to be real. This they generally are unwilling to concede, although Professor Thomas Nagel, who Hitchens quotes from in chapter 10, appears to be an exception.

Exposure to the realities of socialism caused Hitchens to lose faith in that secular alternative to Christianity which paved the way for his return to the Christian faith. His account of his return to the faith is not the typical conversion testimony North American evangelicals have come to expect but that does not diminish the book. He describes how his love for architecture led him to the churches and cathedrals of England and the realization that the men and women who built these buildings could hardly have been the ignorant bumpkins the atheists believed them to be. He describes a visit to the Hotel-Dieu in Beaune, France where in Rogier van der Weyden’s The Last Judgment he was confronted with the fear of divine retribution. In L. M. Montgomery’s The Chronicles of Avonlea there is a short story entitled “Each In His Own Tongue” in which a fallen women, in fear of damnation at the end of a wicked life, is brought to an understanding of God’s forgiveness and mercy, through the playing of a violin. Although the details are world’s apart, the common theme of God speaking through art, brought this story to my mind as I read Hitchens’ moving description of his own gradual return from unbelief to faith.

While this book is not, as has been said, a rebuttal of his brother’s book, in the second section of the book Hitchens does answer three arguments of atheism. First, he points out that religion itself appears not to be the root cause of many conflicts that are fought in the name of religion or depicted as religious conflicts.

Then he tackles the matter of God and morality. Atheists such as Greg Epstein insist that man can be “good without God”. Hitchens shows that apart from an external source of justice morality among humans ultimately breaks down into “might makes right”.

The third atheist argument Hitchens answers, and the most important, is the argument that atheist states are not really atheist. Hitchens’ answer to this question spills over into the third and final section of the book where he takes a good look at the atheist regime that existed in the former Soviet Union.

The reason this argument is so important for the atheists is because the truth is so damning to their position. Atheists continually try to downplay the countless ways Western civilization has benefited from Christianity and to condense Church history into the Crusades, Inquisition, and priestly child abuse. As Hitchens points out however, violence and persecution that has been conducted in the name of faith is “not because they are religious, but because Man is not great.”

The same cannot be said for the atheist regimes. Hitchens puts it this way:

Atheists, in return, ought equally to concede that Godless regimes and movements have given birth to terrible persecutions and massacres. They do not do so, in my view, because in these cases the slaughter is not the result of a misunderstanding or excessive zeal. Utopia can only ever be approached across a sea of blood. This is a far greater problem for the atheist than it is for the Christian, because the atheist uses this argument to try to demonstrate that religion specifically makes things worse than they otherwise would be. On the contrary, it demonstrates that our ability to be savage to our own kind cannot be wholly prevented by religion. More important still, Atheist states have a consistent tendency to commit mass murders in the name of the greater good. (pp. 153-154)

The only way atheists can get around this is by claiming that governments like the Bolshevik regime, the Maoist regime, the Castro regime, and the Pol Pot regime, were not, despite their proclaimed ideology, atheistic.

Hitchens blasts these claims to smithereens, showing repeatedly how these regimes relentlessly strove to drive God out of their countries, how they sought to keep parents and churches from passing on their faith to their children, and how their worst atrocities were directly connected to their atheistic ideology.

In focusing on the deleterious effects of atheism upon civilization in countries like the former Soviet Union, Hitchens is not just answering his brother’s arguments. He is also indicating where Britain and North America might be headed. The militant new breed of atheists seem rather open about their wish to use the power of the law to prevent parents from bringing up their children in the faith.

Let us hope and pray that as Peter Hitchens returned to the faith of his fathers, so our countries will as well.