Monday, July 25, 2005

Krugman on Canadian Health Care 

Out of respect for Tinfoil Hat Boy, who gently chided me for a "nyah, nyah" post about my life outside the cuckoo's nest, I will let Krugman's observations about Toyota's choice of Canada over Red State America for its new auto plant to pass without gloating.

Instead, I will note first that Krugman paints a too-rosy view of the state of universal health care up here. As a neighbor, who'd moved back to Canada from San Francisco in the 80s to get emergency medical care, put it wistfully the other day, "Of course, that was back when we had a world-class health-care system...." While from a business' point of view it's largely irrelevant what the quality of care is, as long as it does not have to bear the costs, the level of dissatisfaction in Canada is demonstrably up. The greatest sign of that discontent underlay a recent landmark ruling by the Supreme Court, that found that a Quebec law barring parallel private health insurance to be a violation of the Canadian Charter of Rights, insofar as it forced citizens to wait inordinate lengths of time for surgery. In the case at hand (or perhaps, hip), the plaintiff had been forced to wait over a year to get hip replacement surgery, during which time he had become addicted to painkillers.

No one would argue that being forced to wait a year for hip surgery is acceptable, and the usual claque of privatization enthusiasts promptly hailed the Court's decision as the beginning of the end for Canada's health care monopoly. But the way the decision was written makes that far from clear. For one thing, the decision appeared to be grounded, not on right of contract or free association, but the government's failure to fulfill its promises to the citizenry, a failure that the government seems to have acknowledged and promised to fix. For another, there is no discernible groundswell to move towards a mixed system (there is private health care available but from what I can tell, it's largely restricted to the peripery of available services).

In fact, the phrase "two-tiered health system" seems to have a lycanthropic effect on Canadian voters similar to what "tax increase" has on Americans. Here in our little Brigadoon-by-Lake-Kootenay, there have been serious cuts in health care services over the last few years at the hands of the Liberals and Premier Gordon Campbell. The response: in the May Provincial elections, the locals sacked the hapless Liberal MLA and replaced him, not with a privatization Conservative, but the NDP challenger. Informal polls I've seen show dogged commitment to maintaining the ideal of universal health care, even if it means raising premiums. (Yes, Virginia, Canadian health care is not "free", but the current maximum premium for a family is $C128/month. For the less well-off and for smaller families, the premium drops to around $20.) Still, it's something of a conundrum to me how the current health care system can be hurting when the government is running a budget surplus, the loonie is at a ten-year high, and GDP is growing at a healthy clip. (Royal Bank of Canada recently projected GDP growth to exceed that of the US in 2006.) Health care's heyday, by contrast, was an era of the 60 cent loonie and Bush-level fiscal deficits. Part of it is undoubtedly the same demographic shift that underlies our Social Security debate, but that can't be all of it. Despite being an American, I don't have a knee-jerk answer. I'm sure one of our savvy Canadian readers can educate us?

I was going to also expatiate a bit on Krugman's passing observation about the relative economic performance of Canada, but that's going to have to wait for another post.

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