HEALTH CARE

When governments decree all will have free medical care, the laws of nature seem to have been abolished. There is at last something for nothing for everyone.

Time passes. Needs keep growing by leaps and bounds. They become difficult to satisfy. Meanwhile, the taxpayers reach their limit of tolerance for demands to hand over ever more of their money to satisfy the wishes of others. No more can be extracted from them. The easy times are over.

There are now many problems with government health care in Ontario. Notwithstanding high taxes and enormous expenditures, there are shortages of medical staff and facilities, poor allocation and distribution of resources, and inadequate patient care. Treatments are often available only after long waits if at all. These are the consequences of unrestrained demand for “free” services coupled with central bureaucratic planning and government mandated supply restrictions.

In spite of all the problems, 35 years of government health care makes it difficult for many to envision that this important service can be provided without any government involvement whatsoever. Nonetheless, getting government entirely out of health care is the only way to provide the greatest access for the most people to the best available treatment at the lowest possible cost. That is the policy of the Ontario Libertarian Party.

The old-line political parties proclaim themselves able to preserve Medicare in its current form. No matter what they say, you can expect further deterioration to occur while they continue to spend more money attempting to address the scandalous issues which happen to receive media attention. Furthermore, health care will become increasingly privatized in the near future. There is no other way to provide the services. Even now, many who can afford it are forgoing the lower quality service in Canada and are choosing to receive medical treatment in the U.S. To relieve pressure on local facilities, the Ontario government is already sending patients there for treatment.

A mix of private and government medicine will approximate what now exists south of the border. U.S. medical care is probably the best in the world. However, it is very expensive and often unaffordable for people who are ineligible for government assistance and do not have health insurance. Contrary to commonly held belief, high cost and inaccessibility results primarily because American health care is not even close to being free market medical care, with governments in the U.S. being very much involved in controlling and paying for it.

Ontario will begin to have competitively priced, widely accessible, high quality health care the day there is no Minister of Health. A number of outcomes are predictable. Firstly, all the taxes needed to support government health care will be entirely eliminated. Ontario residents will have more money in their pockets. They will then be able to afford to pay for their own medical care and will cease being supplicants begging government to give back some of their own money for this purpose. Another predictable outcome is that variously structured private health insurance plans will spring up to provide protection against disastrous major illnesses. Unlike the U.S. system, the cost of insurance will not be boosted by government laws forcing extended coverage upon insurance companies for political reasons. Those who wish to obtain insurance for more than major medical catastrophes will be able to do so at additional expense.

Once government is out of the picture, there will be less frivolous use of medical services. When the benefit of a service is received and the cost paid by one and the same person, it is less likely there will be abuse. If privately owned insurance companies are paying, they will protect themselves from having their money spent without good reason. At the same time, competition and the need to preserve and improve their businesses will result in a reasonable balance being struck between heavy-handed coverage restriction and too easy payment of benefits. For similar reasons, there will be less health care fraud. Governments simply do not have the same interest in protecting money under their control that you and private insurers have.

A Libertarian government will eliminate any requirement for government licensing of physicians, medical treatment facilities, or other medical care providers. The existing government licensing monopoly reduces competition in medicine by erecting needless barriers preventing or impeding entry into the medical services field. Getting rid of these will lead to increased supply of medical personnel, less costly health care services, and more innovation. Private certification will let us know whether someone is qualified to provide medical treatment.

Dismantling government health cannot be done overnight. A transition period will be necessary. This could take the form of government continuing to pay for medical services for the elderly while requiring co-payment on an increas­ing scale as age decreases. Another possibility is to have the government continue to pay for more serious illnesses with the level of payments decreasing over time. Eventually everyone will be respon­sible for the full cost of their own health care.

What about the poor or the unlucky? This question is often asked. An important Libertarian objective is freeing people to create abundance. Abundance cannot be achieved in the absence of free markets. Where there is abundance people will be more benevolent to those who need help. Where there is scarcity benevolence is less likely and there will be many more poor people needing charitable assistance. Government meddling in health care has led to scarcity. A truly free market in medical services will lead to greater abundance which will benefit everybody including those unable to provide for themselves.

References

The following articles illustrate the failings of a government operated monopoly in Health Care and offer some solutions.

The Price of Public Health Care Insurance: 2012 Edition - Canadians often misunderstand the true cost of our public health care system. This occurs partly because Canadians do not incur direct expenses for their use of health care, and partly because Canadians cannot readily determine the value of their contribution to public health care insurance. In 2012, the estimated average payment for public health care insurance ranges from $3,418 to $11,401 for six common Canadian family types, depending on the type of family. For the average Canadian family, between 2002 and 2012, the cost of public health care insurance increased more than twice as fast as the cost of shelter, roughly four times as fast as food, more than five times as fast as clothing, and 1.6 times faster than average income. The 10 percent of Canadian families with the lowest incomes will pay an average of about $487 for public health care insurance in 2012. The 10 percent of Canadian families who earn an average income of $55,271 will pay an average of $5,285 for public health care insurance, and the families among the top 10 percent of income earners in Canada will pay $32,628.

Opportunity for health reform: Lessons from Switzerland - This article from the July/August 2012 issue of Fraser Forum describes how Switzerland provides universal health care without having to rely on a government-run health insurance monopoly. Importantly, Switzerland spends less of its GDP on health care than Canada (when adjusting for the age of the population), and yet appears to have superior access to, and availability of important medical services and resources. Swiss residents have greater control over their health insurance. A system that allows the Swiss to shop around for an insurance scheme that best suits their individual or their family’s medical needs and financial means also promotes choice and greater responsibility. Individuals and families who cannot afford to purchase private insurance receive government subsidies to finance their basic health insurance premiums. 

PRICELESS: Curing the Healthcare Crisis By John C. Goodman. This groundbreaking book reveals how healthcare is a “complex system” that cannot be managed from the top down. True reform requires liberating doctors and patients by allowing them to interact in innovative ways to help meet unique individual medical needs.

Canada’s health care system needs to be ‘blown up’, says Wayne Taylor, a speaker, educator and consultant in health policy and the founding director of the MBA program in health services management at the DeGroote School of Business at McMaster University. He was the guest speaker Wednesday evening (June 13, 2012) at the Waterloo-Wellington Community Care Access Centre annual general meeting and he talked about “blowing up” the publically funded health care system Canadians know for a system funded with public and private money.  he pointed out that Austria gets much better health care for the same level of expenditure.  Doctors, nurses and administrators are overpaid in Canada because there is no free market to keep wages low, he said. The cost of labour makes up 75 per cent of health care spending.

The private sector within a public health care system: the German example: Economic Note on the benefits of for-profit private hospitals in Germany; - The evidence from Germany suggests that hospital systems with more competitive elements and where private ownership is allowed provide higher quality care, investment levels and technological standards compared to an exclusively public health care system.

Longer Than Ever, the Fraser Institute’s 21st annual waiting list survey, finds that the total waiting time between referral from a general practitioner and delivery of medically necessary elective treatment by a specialist has risen from 18.2 weeks in 2010 to 19.0 weeks in 2011. At 104 percent longer than it was in 1993 (9.3 weeks), this is the longest total wait time recorded since the Fraser Institute began measuring wait times in Canada.
Studies have shown that operating rooms are systematically underused, hospital beds are inappropriately occupied by Alternative-levels-of-care patients, and the supply of physicians is insufficient to meet demand under the country’s current system - all of which may be contributing to the long wait Canadian patients endure.

National Post editorial board: Canada must abandon its health-care monopoly "The non-partisan Conference Board of Canada has released a new study enumerating the weaknesses in Canada’s public health-care system. In short, the report says that while Canada spends a lot on public health care, our health outcomes are middling compared to other developed nations. Many countries — such as Australia and Sweden — spend less but with better results."  Lots of details are avialable at the Fraser Institute below.

A snapshot from my Ontario healthcare family album describes Allen Small's personal encounter with Ontario's medical system.  The Terence Corcoran article he links to is especially good at describing the fundamental problem. 

The Right Way to "Run" a Medical System by Professor Jan Narveson.

Health Care: A Future Free-Market Alternative provides a vision of how health care might work in a libertarian society.

"Time as a Price" This article by Predrag Rajsic, a PhD candidate in Economics at the University of Guelph, argues that Healthcare in Canada is not free for the patient. Constantly full waiting rooms and long waits for procedures are not an unavoidable fact of life but a product of a “priceless” supply system, where waiting for service acts as a rationing substitute for the market price.

The Fraser Institute has a wide variety if articles on Health care in Canada.  Canada is at the top of the list of OECD countries in per capita spending on health care, but close to the bottom when it comes to measuring what we get for all this money.  What can we learn from these other countries?  Is our health care system economically sustainable?

Give Patients Info on QualityHealth systems in other countries empower consumers with much higher levels of transparency on safety and effectiveness.
Excerpt:  “In most parts of Europe and in the U.S., market pressures apply to hospitals as to any other institution. If one centre has a poor safety record, or refuses to publish information about outcomes, patients can go elsewhere. In Canada, no matter how bad the local provider is, choice is limited if it exists at all. Only those who can afford to travel to another country for treatment can exercise real choice.”  More . . .

Market Medicine As the borders tumble in Europe, a budding consumer bonanza in healthcare is quickly developing.
Excerpt: 
“A legally regulated internal market will help patients by helping them to cross borders to access better or more timely care than at home, and by encouraging new providers to enter their national market. To entrepreneurs ready to export their services, an integrated market will be of significance.”  More . . .

Nobody Should Profit from Health Care?  Get Real! This article by Karen Selick (a founding member of the Party) points out that, "Like it or not, every single person who attends to the sick in our current system of government-monopoly medicine is there for his or her own profit." She argues that allowing the private sector to participate in delivery of health care would result in lower costs and improved safety, as has happened with laser eye surgery. 

Canadian Health Care: A Monopoly on Lives - This YouTube video was produced by two students from Queen Elizabeth High School.  It presents a damning indictment against government-run health care.