The heated, sometimes lunatic debate over Barack Obama’s health care plan that has consumed Americans these past few weeks has already yielded one important benefit: it has provided the Canadian political class with yet another opportunity to instruct the public in the many and profound differences between our two countries.
For some, it is a chance to reflect upon the greater civility of Canadians. You know, we’re more polite, more deferential, yadda yadda please and thank you. It’s “a clear difference in the two countries’ political cultures,” writes Vancouver Sun columnist Barbara Yaffe.
For others, the unhinged quality of some of the opposition to Obamacare—possibly you have seen the Obama-as-Hitler allusions—is rooted in Americans’ historic mistrust of government, their instinctive hostility to the state. Whereas “the Canadian conception,” as Sister Nuala Kenny, professor of bioethics at Dalhousie University, explained to the Canadian Medical Association Journal, “is clearly different.” You know, medicare, common good, yadda yadda gun control.
Sigh. I suppose it’s a given that nobody in this country reads any history, but please, it was within living memory for most Canadians that we went through one of the most intemperate, rage-filled, all-out political tong wars this side of the Asian Triads: the free trade election of 1988. For those too young to remember, it was the explicit, often-stated position of the opposition parties in that campaign that the governing Conservatives were conspiring with foreign interests to sell out the country. Opponents claimed, inter alia, that free trade would mean the installation of nuclear-tipped ICBMs on Baffin Island, the dismantling of every social program, environmental regulation, or gun law that offended American tastes, and, in Sheila Copps’s imaginative tour de force, the imminent invasion of American lawyers in search of Canadian surrogate mothers—their services being cheaper, thanks to medicare. Compared to what sometimes goes on here, the Americans are conducting a graduate seminar.
In the same despairing vein, I suppose it is futile to point out that the allegedly innate Canadian preference for the state has no basis in historical fact; that every one of the institutions of the welfare state held up as totems of our unfathomable difference was tried out first in the United States before being imported here; that for most of our history we have had measurably smaller government, proportionately, than they. For pity’s sake, we stole the name medicare from them.
Watching the Americans working themselves into a froth at town hall meetings, I’m more struck by the similarities to our own debates than the differences. What could be more Canadian than mass hysteria over some largely invented threat to the health care system? To be sure, the American paranoiac typically focuses on the perils of the dreaded “public option,” whereas it’s the baleful “private option” that so distresses his Canadian counterpart. But what is common to both is their unstinting loyalty to the status quo. The newspapers may be filled with the failings of both countries’ systems, think tanks may reel off the latest depressing numbers on wait times or the uninsured, but the public in both countries continue to believe they live in the best of all possible worlds, health-wise, which any reform would probably make worse.
Actually, they’re not completely off base at that. Both countries’ systems are inarguably a mess—costly, haphazard, riddled with perverse incentives. In principle, both could be improved upon with the right reforms—in the U.S., by extending coverage to all; in Canada, by making greater use of market forces. But it’s also true that both could easily be made a lot worse in a hurry by reforms that are not thought through. No, there are no “death panels” in the Obama plan, but its critics are not wrong to worry that one consequence of greater government involvement might be rationing and longer waits for care—just as critics in this country are not entirely delusional to fear a parallel private insurance system might drain resources and doctors from the public system.
The question, in both countries, is not public or private, “American” or “Canadian,” much though partisans of the left and right would like you to believe it is. It’s to find the right mix of public and private, harnessing each to the purpose best suited to it. The American system’s well-known shortcomings are not owing to its “private” nature. In fact, the U.S. spends more on public health care than we do, not only per capita, but as a share of GDP. The problem, rather, lies in the American system’s heavy reliance on employer-sponsored plans as the delivery vehicle. One consequence of this is obvious: lose your job, and you lose your insurance. But it also contributes to the inefficiency of the system, since neither employers nor employees bear the full cost of the plans, owing to the tax deductibility of benefits.
Likewise, Canada’s problems have less to do with its “public” nature—30 per cent of health care spending in this country is private—than with the particular model of public insurance adopted at medicare’s inception, in which all spending decisions were centralized in political hands. Disperse these decisions, allow private providers to compete for public dollars, and it is quite possible to marry universal coverage with market efficiency.
But only if we do not fall prey to simplistic distinctions and exaggerated fears. After all, that’s exactly how Hitler started.