> Marvin Gandall wrote:
>
>>No one in Canada is calling for an end to medicare, including the
>>capitalist
>>class.
>>
>>They are calling for the supplementary formation of private clinics,
>>mostly
>>for elective and diagnostic procedures, which higher-income Canadians can
>>afford through private insurance and would do so to avoid waiting in line.
>>At the same time, they want lower-income Canadians to assume more of the
>>cost of medicare through higher co-payments and deductibles and narrowing
>>the scope of available services.
>
> But isn't that a way of undermining the public system over the long term?
> Create more private services, which undermine public support and peel off
> the affluent, leaving the public system with the poorer (and probably
> sicker) people? Then, as the quality of the public system deteriorates,
> invidious comparisons are made, and public opinion shifts further in the
> direction of a private system? That's a lot better long-term strategy than
> a head-on assault, which would get nowhere at first.
>
> Doug
----------------------------------------------
Yoshie made the same point about the slippery slope, and I think it's better
to entertain that possibility and to raise the alarm about it than to become
complacent. But I also think it's misleading to assume the public system is
going to gradually wither away, or that this is even entertained as a
realistic possibility by those in power who are presumed to be resorting to
invidious salami tactics in pursuit of that objective. You're painfully
aware that it's only the US, of all the advanced capitalist countries, where
tens of millions of citizens can barely afford go to a doctor and stay in a
hospital. It's one thing to not have this access and to become accustomed to
making do within that framework by avoiding treatment or incurring enormous
personal debt or paying exorbitant private insurance premiums to obtain it.
It's another thing to already have experienced this level of free or nearly
free care for generations, and to passively accept having it taken away.
That idea is not even floated. No government could survive re-election if it
suggested it. Even modest increases in user fees generate vociferous and
widespread complaints and opposition.
I agree that if you could "create more private services" which "peel off the affluent" you could starve the public system to the point it resembled that in the US. But that's the problem facing those who would do so. The "affluent" themselves have a real stake in the basic services which are offered, and would resist their privatization. As I noted, their primary complaint is about wait times, so they generally support the expansion of private clinics which would give them faster access to diagnostic services and elective surgery. These are generally irregular medical needs which are reasonably affordable. Upper-income and even middle-income Canadians are willing to pay to go outside the public system in such cases, particularly if they're alarmed about cancer or some other serious illness which demands urgent attention. But there's simply no constituency anywhere, judging by the reaction of those of our friends and neighbours who are better-paid professionals, for an American-style system which would deprive them of their basic public health care services - the mostly free access to GP's and specialists and routine blood tests and emergency wards and hospital stays, which is the kind of care they typically require on a regular basis. They're appalled when they learn what private insurance in the States costs to cover these services, and they're not persuaded that the lighter personal tax burden in the US is compensation enough. Polls consistently confirm this.
Nor is there any discernable demand coming from Canadian employers to really gut the system. Most large corporations offer supplementary health insurance which provides coverage for drugs, private hospital rooms, and dental, chiropractic, counselling, and other services not included in the federally-subsidized provincial health plans. When public services are delisted, there is pressure on employers to make up the shortfall, and to incur higher premium costs for doing so. If they don't, they risk difficulties recruiting and retaining workers, especially at the higher-paid skilled levels, where supplementary health coverage is taken for granted. If they had to insure their workers for basic medical services, as in the US, they would face the same escalating cost pressures which are inviting American employers to dramatically limit and dump their plans, and there is no indication Canadian employers want to move in this direction even if they could. Of course, this isn't inconsistent with their continuing efforts to shift more of the burden of their more modest plans onto their employees through higher premiums, dedictibles, and co-pays.
I think the trend suggests the US will begin to incrementally catch up to the other capitalist states, even as their public health care systems are eroded at the margins, rather than the other way round. Well, let's hope.