The Evolution of Health Care Control

Paul Murdock
Campaign For Liberty
Friday, January 29th, 2010

The Evolution of Health Care Control: America to Forgo Liberty by Following the Pattern of Canada

In Canada, one of Alberta’s most prominent ex-Premiers boldly called for a two tier health care system. Here in American, politicians are secretly finding ways to force it upon us. Typically, we only hear about how universal and efficient public health systems are. However, if we examine the evolution of the Canadian Health Care system, we can see why we should be scared here in America.

First, it is important to note that provinces and territories are generally responsible for administering their own public health care plans. The federal government acts as a partial financial partner and enforcer of basic uniform, national standards. Sound familiar already? Progressively minded individuals wanted to provide care to the “poor” and the federal government naturally assumed there was a constitutional right to become involved. In Canada, the federal government has questionable constitutional authority over health care, except over specific populations including First Nations, Inuit, and military personnel. Yet, a clause providing authority in times of crisis allowed the government to justify itself. Anyone hear of a health care crisis lately?

The power of the citizen’s vote was quickly diminished by the intruding federal government. Our ability to quickly remove politicians by popular vote and thereby influence events is key to our liberty. This is why the sovereignty of the state is essential. Our vote counts most at the local level such as municipalities, counties, and states. Thus, if you are liberty minded, it is important to keep laws and regulations as close to your vote as possible. Canadians lost this power as they ceded power to the federal government. The result was not pretty.

Prior to the 1940s, health care services were predominantly provided by private or charity hospitals and clinics. Canadians, generally, paid for their health care services out of pocket, through charity, or private health insurance. Doctors were in a similar position that we find here today, either in private practice or associated with a particular hospital or clinic.

In 1966, the federal government of Canada introduced the Medicare Act. Under this legislation, it committed to sharing costs with the provinces for all physician services, regardless of whether they were provided in a hospital. Moreover, the Act stipulated certain criteria which a province would have to meet in order to gain this federal funding. This was no accident, and the government was aware that no province could afford not to comply. The introduction of the national Medicare Act firmly established the federal government in the center of health care policy. Moreover, health care policy, like Medicare in America, quickly became the center of political power.

This is similar to what would occur in the United States. Obama promised that you can keep your current insurance and health care providers. Similarly, the federal government in Canada can also claim that it does not choose your health care services or the care you receive from your health care providers. However, the government’s ability to indirectly influence policy through the conditions it attached to Federal funding insures compliance to federal mandates. Like in Canada, the power lies in money, which is controlled by federal law and regulation. Whom do you think will control this in the United States? Not you!

Naturally, the power of the federal government was quickly revealed. As a result, tensions grew between provinces and the federal government. Shockingly enough, this occurred after the Federal government informed the states that it COULD NOT AFFORD to live up to its end of the bargain. Provinces were left to foot the bill. Provinces were also furious about the health plan criteria the federal government now required.

In an attempt to make a reasonable living, physicians began charging fees and extra-billing to supplement the low reimbursement fees paid by the government. The federal response was to change the criterion in which funding was provided to provinces. In 1984 the government introduced the Canada Health Act. The legislation re-established conditions that the provinces would have to follow in order to receive federal health care funds. Central to the Act was the prohibition of user fees and extra-billing, and the establishment of other criteria deemed essential for the operation of provincial health care services.

Here is an obvious lesson in point. Once you give federal government the power, they are free to change the rules. Moreover, all socialist systems of health care including Canada and Europe have struggled to pay the increasing costs. This is no different than America. Yet, why increase government involvement to pay for health care, when every country who has tried, struggles?

In 2002, a federal commission on health care proposed even greater expansion of official power. The commission sought a relationship where each level of government was an equal partner in the public health care policy. Here we see the federal government seeking direct power from the Provinces. Additionally, the Commission recommended enacting a Health Covenant which would have set out a national vision and framework for public health care, and be binding on all governments. It also recommended that a Health Council of Canada be created, with the goal of fostering collaboration between levels of government. The end result is that the federal government now controls health care and the provinces are left with no sovereignty.

The laughable commission finally recommended the federal government increase its share of federal funding for health care to a minimum of 25 percent of provincial/territorial costs. Of note, this is half of the original proposal, made to entice the public, by the federal government decades earlier. Like the proposal in Canada, we have a government promising to fund health care by the billions. In the end the fate will be the same; too costly. The end result the same; less quality, restricted access, longer waits, and no way out. As we all know, federal projections fall significantly short, and the true cost will be in the trillions. The government will not be able to pay, the states will have to comply with federal rules, and your taxes will be increased. The true fate lies in the loss of your medical freedom and the erosion between state and federal powers.

The problems mentioned above are not restricted to Canada. Hundreds of thousands in Britain must wait for some type of medical care, with thousands waiting six months or more. France is in a similar situation. In Ontario, Canada, 1.5 million Ontarians (or 12 percent of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment.

As a result, the goals in Europe and Canada are the opposite of the United States: Increase privatization and access to care. The Provincial Court of Quebec ruled that Canada’s restriction on private care violated an individual’s right to care. Consequently, doctors are leading a bold charge against Federal regulations. In addition to businesses arranging care for Canadians in the United States, Dr. Jacques Chaoulli organized a private Quebec practice. This is rare, but many believe it will become the trend.

Sir William Wells, a senior British health official, recently said: “The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture.” In 2007, the private sector provided about 5 percent of Britain’s nonemergency procedures; Labour aimed to triple that percentage by 2008. The Labour government also works to provide vouchers for certain surgeries, offering patients the choice of a private provider. And in a recent move, the government will contract out some primary care services, perhaps to American firms such as UnitedHealth Group and Kaiser Permanente.

Sweden’s government, after the completion of the latest round of privatizations, will be contracting out some 80 percent of Stockholm’s primary care and 40 percent of its total health services, including one of the city’s largest hospitals. And modest market reforms have begun in Germany; increasing co-pays, enhancing insurance competition, and turning state enterprises over to the private sector (within a decade, only a minority of German hospitals will remain under state control).

Although American media outlets continue to praise health care in other countries, they neglect the important facts about American hospitals. In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country. Other statistics also support American superiority. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England.

If we use the Canadian health care system as an example we can see progressive losses of freedom as health care has expanded. Not only do they lose personal freedoms, but they have become deluded about their own system. In a recent survey found on the Canadian governments own website, more than 80% of all Canadians approve. As an expatriate Canadian, I do not, neither should Americans.


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