© 1995 Karen Selick
 Three Cheers for Two Tiers
An edited version of this article first appeared in the April, 1995 issue of Canadian Lawyer.  If you wish to reproduce this article, click here for copyright info.

 Three Cheers for Two Tiers

The new blasphemy in Canadian social policy is the possibility that some people might obtain more or better or quicker health care than others by--dare I even say it?--going out and purchasing it.  

Private medical clinics have sprung up in several provinces, causing fans of socialized medicine to rail against the development of a "two-tier" health care system.  Medicare--with its promise of equal treatment for rich and poor alike--has been pronounced a "sacred trust" not to be tampered with.  

Some provinces are reportedly preparing legislation that would ban private clinics outright or make it so difficult and unprofitable for them to operate that the effect would be tantamount to a ban.

What's really happening, of course, is that the traditional tools of socialism--taxation and income redistribution--have finally run up against a brick wall in Canada.  People are angry about high taxes and there's a whiff of rebellion in the air.

So the new ploy of the socialists is this:  we'll let you keep your money instead of making you give it to someone else, but we'll prevent you from spending it on anything that's important to you.  Thus having money will give you no advantage over not having money.  Voila--financial egalitarianism through the back door.   

This mindset has taken hold in other spheres as well.  When Ontario announced plans last year to reform the province's day-care system, one proponent said:  "You aren't supposed to get to the front of the line for heart surgery because you have a lot of money.  Well, right now in Ontario people with money are at the front of the line for day care.  That will change.  Now everyone will have the same access regardless of income."

There is something drastically wrong with the notion that having money shouldn't get you anything better than not having money.  For starters, it is as much a disincentive to productive work as heavy taxation.  Why bother working if you can't use your earnings to buy the things you really want?

It's also a disincentive to handling money responsibly.  Why put money aside for an emergency if you won't be allowed to spend it on one? 

Underlying this let's-make-money-useless philosophy is the erroneous belief that there is a fixed quantity of wealth, and that anyone who has more than his "fair share" must somehow have acquired it illegitimately--by theft, fraud, or the "exploitation" of somebody who has less.

An overview of human history shows that this idea is absurd.  Our ancient forebears didn't lope out of their caves to find houses, cars and computers waiting for them.  Nobody stole these things from anyone else.  People invented them, built them, and traded them.  And while it is certainly possible to point to exceptions, the general rule is that those who now have more of these things, or better things, than others have them precisely because they or their forefathers have contributed more to the welfare of humankind at large.  The marketplace, generally speaking, rewards people in proportion as they satisfy the needs and wishes of others.

Denying people the right to spend their own money on extra health care for themselves or their loved ones is tantamount to depriving the benefactors of humanity of the most precious form of reward for the benefits they have bestowed.  It is the grossest injustice imaginable.

The emotion that motivates this opposition to private health-care spending is not very pretty: it is sheer, naked envy.  The affluent are made to suffer for the sole purpose of making them equal.  No-one else will gain by it.  Making a rich man wait for heart surgery will not cure the diseased heart of a poor man, however much it might gladden the heart of a socialist.

In fact, quashing the development of private medical services will actually harm the poor, in two ways.  First, with current spending caps, it will force some poor people to wait even longer for "free" treatment than they otherwise would, because the rich will be in line too.

Second, it will delay the development of new facilities, techniques, and products that would eventually benefit both rich and poor.  All innovative new technologies start out as the speculative gambles of the few who have money to spare, but eventually become cheap enough for the masses.  It happened with cars, radios, and microwave ovens.  It could happen with medical products if markets were left free to function.

Supporters of socialized medicine like to boast that Canada spends less per capita on medical care than the U.S.  This is deceptive, because the U.S. has a higher proportion of elderly people and many more pregnant teenagers.  Both groups gobble up disproportionate amounts of treatment.  But even so, who's to say the amount we are spending is the best possible amount?  

If individuals, rather than politicians and bureaucrats, were making spending decisions for themselves, they might well decide that quicker treatment, shorter distances to travel for treatment, and less pain are worth the extra expense.

In my opinion, the development of a private medical system is the best thing that could happen to all Canadians.  If it means a period of two-tier medicine while the government tier continues to crumble into dust, let's get on with it.

     - END -


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June 13, 2000