The Single-Payer Myth

Like many nations, we Canadians have many favourite pastimes. Hockey, uninvited apologies, basking in the glow of foreign praise of our healthcare system…

It’s ingrained in us from a young age. Unlike those heartless, corporate Americans, we take care of everyone, rich or poor. After all, it’s the right thing to do. No argument there.

If only it were that simple.

Not long ago, none other than Bernie Sanders made the trip north of the 49th parallel on a ‘fact-finding’ mission whose reported premise was to take notes on what can be learned from the Canadian experience. At face value that seems like a perfectly logical endeavour; a politician doing their own research. How refreshing. The fact that tens of millions of Americans can’t afford basic medical care and in many cases are forced to choose between bankruptcy and staying alive is quite frankly pathetic, disgusting, horrifying, baffling, <insert adjective here>. Even among the most conservative Canadians, I’d wager that you’d struggle to find any serious number of people who resent the fact that a child born with a congenital heart defect isn’t going to die because his parents don’t have $100,000 for surgery (full disclosure, I was one of those children). Which brings us back to Bernie.

I like Bernie. I despise most of his supporters, but I like Bernie. He’s a pretty smart guy who knows how to tell people what they want to hear. Bernie, like most reasonable people, believes that access to healthcare ought to be a universal individual right. In the rest of the developed world it already effectively is. Ok Bernie, I’m with you so far.

Now, if you’ve heard him speak on the subject at any length, you know that Bernie is not just after universal health-care, but specifically a single-payer healthcare system. Like Canada. (Dammit Bernie, I’m feeling all warm and fuzzy). To help him accomplish this, he’s enlisted an entourage of Canadian physicians to help him push his proposed legislation through the court of public opinion as well as both houses on Capitol Hill. So what’s the big deal?

Well let’s start with the obvious. Canada’s healthcare infrastructure is crumbling. Years, maybe decades, of chronic under-funding have left major parts of the system basically broken, where seemingly routine procedures like a hip-replacement can have wait-lists lasting up to a year and beyond. Hospitals across the country suffer from shortages of everything from doctors to beds to test equipment. All the while, patients whose condition is deemed not to be life-threatening are faced with a choice between sucking it up or heading overseas. That’s not the hallmark of a system that ought to be emulated.

On the other hand, for the vast majority of patients, this broken system is still far superior to the one that would figuratively cost them an arm and a leg. And herein lies the problem. It’s easy to stop the comparison there and say “at least it’s better than financial ruin.” But that’s an incredibly lazy argument if I’ve ever heard one.

So then what’s the alternative? Two-tiers, obviously.

If you’ve heard this argument before and still don’t buy it, this is the part where you say that a two-tier system is unfair because it means that people who can afford it, get better quality care while the rest of us suckers still have to deal with the less-than-efficiently run public system.

Yes. That is the price of sustainability.

Let’s get something straight here. Universal healthcare as an individual right does not mean access to the exact same level of care, any more than the Liberal government’s recent declaration of access to housing as a universal right means that everyone gets to live in a mansion. The reality is this: the public system is overburdened. Allowing people with the means more freedom to choose how their care is delivered could go a long way to clearing some of the backlog in the public system. We know this because as much as the US is an anomaly among the first-world in terms of its healthcare system, so too is Canada in its staunchly and strictly centralized single-payer system. As much as Bernie and his Canadians-for-hire would like you to believe that many other wealthy countries also have single-payer systems which don’t suffer from the same chronic problems that Canada has, the truth is that that suggestion is incredibly misleading, if not an outright lie.

This past summer, The Commonwealth Fund published a study ranking 11 wealthy nations on the strength of their healthcare systems based on factors including access, administrative efficiency, equity and health care outcomes. Canada ranked 3rd last, ahead of only the US and France. So what’s so special about jurisdictions like the UK and Australia (ranked 1st and 2nd respectively)? Well for starters, both offer a far greater amount of freedom in terms of how healthcare is delivered. Yes both provide universal primary care funded through general taxation, but under the hood, a broader and cleverer use of private healthcare providers and insurance means that both of those systems are far more flexible than the centrally planned Canadian boondoggle.

Both the NHS and Aussie Medicare legislation have provisions allowing for private health insurance for primary care. Neither has a direct impact on the level of funding available to the public system. In Australia for example, all residents pay a 2% levy (income tax) that is directly earmarked to fund the public Medicare system. In addition, high-income earners are encouraged to buy private insurance via an additional 1-2% levy if they choose not to. In Canada, such a system is effectively illegal under the federal Canada Health Act. Canada is the only country of the 11 ranked by the Commonwealth Fund study where the provision of private health insurance for hospital and physician services is actually illegal.

Let’s be clear: the notion that allowing private healthcare will inevitably lead to the death of the public system is a myth. A simple look at Europe makes this readily apparent. Differences in architecture and bureaucratic hurdles aside, there is no logical argument to be made that Canada is a special case where only a government monopoly can work. Indeed, many ancillary services such as dental, physio, prescriptions, eye care, etc. are already almost exclusively the domain of private insurance and out-of-pocket expenses. Why are we allowed – sometimes even obliged – to buy private insurance for those services but not for surgery and doctors’ visits? Why can the UK and Australia cover many of those other services via their public system while still allowing their citizens to choose private care if they feel so inclined (after being taxed out the rear-end)? Somewhere along the way, the logic behind Canadian primary care has been lost.

Some nay-sayers will argue that private care doesn’t guarantee better care. Others will argue that the quality of public care will suffer as the profit-driven private industry will be able to attract all of the best doctors. Besides the fact that these two arguments are contradictory, they are both straw-men at best. Obviously when someone chooses to subject themselves to the rules of supply and demand, their level of choice (demand) will be limited by the availability of the service they wish to buy (supply). That is the trade-off that comes with the freedom to choose. But that freedom is the core issue. There is a very important ethical difference between imposing a minimum standard, and forcing the same minimum quality on the entire population. That’s not “fairness”. It is hostage-taking. As for all of those specialists that would supposedly flood out of the public system if given the option, tell that to the hundreds of medical students graduating from Canadian universities each year who are unable to find work in the country that subsidized their education. Besides, with a few notable exceptions (such as those at the Munk cardiac centre in Toronto), the vast majority of those distinguished specialists are already going south of the border.

You can argue the technical validity of rankings like those quoted here until the cows come home. For their part, the World Health Organization ranked France (which has a similar public/private hybrid model) tops the last time they published a similar study in 2000 (the UK was 18th, Canada 30th, Australia 32nd). Other studies in the intervening years each come up with slightly different results. But that’s not the point. Instead, the purpose of this self-criticism ought to be to bring Canadians to terms with the failings of our coveted “free” healthcare. “Better than the US” is not good enough.

I’m not going to pretend that a European-inspired hybrid model is a magic pill that will automatically cure long wait times and GP shortages, but it’s no coincidence that when we look at places with better healthcare outcomes than our own, they all have mixed public-private systems.

There is much that the US can learn about healthcare from Canada, but if you want to see what a truly functional patient-focused system looks like Bernie, you should head across the pond.

Jordan Peterson

…is not really the subject of this post, but I guess he is the reason for it (plus I’m guessing that title is more likely to get attention).

Some quick context for those who are unfamiliar: Jordan Peterson is a professor of psychology at the University of Toronto who made the news last year when he answered a question nobody asked about his personal stance on the use of gender-neutral pronouns by penning an open letter. In the letter, Peterson made it clear that he has no intention of ever using said pronouns, whether or not a student ever personally asks for such a courtesy. You can imagine how that went over. Ever since, he’s been making the rounds as a saviour of sorts to the virulently anti-PC crowd, giving talks about the perceived death of free-speech on campus and in broader society.

Enter Lindsay Shepherd. Lindsay is a Master’s student and TA at Wilfrid Laurier University. Since last week, she is also a poster-child for public censorship, workplace bullying, and anti-discrimination policies run amok. In a tutorial she was facilitating, Lindsay apparently had the audacity to play a video clip in front of the class of a year-old debate between Peterson and Nicholas Matte (also a professor at U of T). Soon after, she was told that a student or students had complained, and that she would be sanctioned for violating the university’s gender discrimination policy. Her crime? Presenting the clip from TVO (a public broadcaster) without sufficiently denouncing Peterson’s position. This, she was told, was tantamount to “neutrally presenting a speech by Hitler”. We know this because Lindsay had the foresight to record an actual conversation with 3 of her superiors where she was chastised for bringing gender based violence into the classroom.

Yes you read that right. A post-secondary classroom full of adults is apparently no place for controversial subjects, unless they are pre-emptively qualified or figuratively bubble-wrapped.

The recording is damning. If you’ve listened to it and aren’t at least a little disturbed, there is something horribly wrong with you. It will come as no surprise to anyone that Peterson’s supporters have seized on this as proof of everything they’ve been rambling about, and quite frankly you can’t really blame them. Here is a young student being accused by her superiors of violating the Canadian Human Rights Act, explicitly because she was “too neutral” when allowing a controversial and possibly offensive position to be aired.

Let that sink in.

Ignoring the irony of enforcing an anti-violence policy by ganging up on a subordinate, here’s what I find most disgusting: Every word of the recording suggests in no uncertain terms that these administrators feel it is their mission to teach students what to think instead of how to think. That is not education; it is quite literally the definition of indoctrination. Worse yet, it’s impossible to believe that this is the only university in Canada where this is happening. Usually, the line parroted by proponents of this pseudo-dystopian nonsense is that they are protecting the fragile mental health of some of their students. I find that insulting, because it effectively amounts to telling students: “You do not have the capacity to face people whose opinions you find repulsive, or the ability to handle positions that you vehemently disagree with. You are also incapable of discerning facts for yourself and might gravitate away from conventional wisdom… so we’re going to take it out of your hands and decide for you what you can hear and how you can hear it. It’s for your own good. Trust us.”

The truth is that as much as they may feel that they are ‘protecting’ their students from unnecessary distress, they are actually doing a terrible disservice by artificially shielding them from a wide array of dissenting opinions in a way that can never be matched after they graduate. When these graduates are eventually challenged (and they will be), they will only know to respond in 1 of 2 ways: either they turtle, or they become belligerent… in both cases unable to comprehend how someone can possibly disagree with them so fundamentally, much less be capable of dismantling the opposing argument.  But I guess it’s all in the name of social justice, so everything is fine and dandy… so long as they are unable to imagine a situation where the power structure is reversed. The shortsightedness is galling.

The fact that Peterson is basically an academic troll who appears to take a particular amount of glee from poking and provoking is completely and utterly irrelevant to the discussion. Post-secondary students pay thousands in tuition expecting to come out the other end with some tangible and marketable gain in knowledge and perspective, not just the ability to regurgitate their instructor’s opinions. At least that’s what I tell myself to sleep at night.

In the meantime, we can only hope that more students like Lindsay have the balls to speak out. But as long as administrators like the Laurier politburo are in positions of power, I won’t hold my breath.

 

Mike Pence walks out of a football game

< Originally written on Oct. 8 >

That sounds like the setup to a terrible joke, but I’d say it’s more of a punchline.

Yes it’s that time of the week again: Sunday Night Football. That means that we get to spend the next day, possibly two, talking about who did or didn’t do what during the playing of the national anthem. How this ever became such a huge deal is still somewhat beyond my comprehension, but then again I’m not American.

At this very moment, the top story (on the CBC mind you) is about Mike Pence walking out of the Colts-49ers game because he didn’t like how some players took a knee during the anthem. What I’d like to know is: what the fuck did he think was going to happen? Was that your strategy Mike? Show up to watch Peyton Manning get his jersey retired only to make a spectacle of leaving early? That ought’ta show ‘em!

Here’s my take on the whole ‘NFL players don’t stand during the anthem to protest racial inequity’ “issue”: Good for them.

Let’s take a step back here and put into context what we’re talking about. A bunch of millionaires doing the least they possibly can to express a popular opinion about a deeply rooted social issue. How outrageous. The reality is this America: you have a racism problem, whether you’d like to admit it or not. The problem was not “solved” with Martin Luther King Jr. and it was not “solved” with desegregation. There is no such thing as a perfect nation. For all the talk about “history” when statues are coming down, you seem to be real quick to “not focus on the past” when it comes to race relations.

Don’t bullshit yourself with the idea that this is somehow about respecting the flag and military veterans, as if you’re standing and saluting in your living room every time instead of stuffing your face with nachos and beer. Your heroes didn’t give their lives thinking America was some infallible nation of peace, always beyond reproach. They did it to protect your relative freedom and prosperity, knowing that a constitutional democracy is worth fighting for. That same constitution guarantees these players’ right to express themselves as they please. If there is a more respectful way of saying “Guys it’s 2017, this is seriously fucked up”, then please, enlighten me.

Ultimately what this comes down to is that either you recognize the problem or you don’t. Personally, I love to tell people that I believe in equal opportunity, and NOT equality. But if you honestly believe that the kid born in the projects in Queens has an equal opportunity to the one born in the Hamptons, then you’re fucking delusional.

Although I may question the usefulness of these protests, I don’t for a second begrudge them for using their platform to make you uncomfortable. They’re not hurting you. They’re not inconveniencing you in any way. If anybody has been disrespecting military members and their families it’s the draft-dodger in the White House using them to score cheap political points. The same draft-dodger that spent a portion of his presidential campaign trading insults with a Gold Star family. But at the end of the day, none of this really matters, because if you’re so offended by a couple of football players quietly taking a knee during the anthem, then you need to grow some thicker skin snowflake.

Maybe find yourself a safe space.

The New Left

Ah centrism: Sweet intellectual refuge from the bigotry of the right, the self-righteousness of the left, and the logical fallacies and false dichotomies of modern political discourse.

Queue the accusations of false equivalence.

If you’ve turned on a TV lately, or scrolled through your Facebook or Twitter feed, you could be forgiven for getting the impression that our society is being faced with a stark choice between good and evil, and that nothing less than the survival of our species is at stake. Call it “polarization”. At least that’s the term that mass media seems to prefer. Personally, I’d call it “stupidity”, “irrationality”, “hysteria”, “ideological supremacy”, or some combination thereof. But what does it matter? As a self-professed centrist I’m just going to be dismissed as an elitist/globalist/neoliberal by the lot of them anyway. At least they have something in common.

You see, in today’s world, you’re either with us or against us. “Centrism” is just some meaningless, theoretical label that douche-bags use to make themselves feel smart and important; or so goes the narrative. We claim to be guided by logic and careful analysis, but really we’re just ideologues like the rest of them, right?

Well, no.

Centrism is NOT a complete rejection of all ideology. It is a rejection of totalitarianism and policy by emotional appeal.

Centrism is NOT compromise for the sake of compromise. It is a concern for consequences and implications.

Perhaps most importantly, centrism is NOT equivocation. It is criticism of lazy logic and a rejection of means to an end as a line of reasoning.

These concepts appear to be lost on a significant majority of the general population.

Not surprisingly, such insistence on logically sound reasoning, irrespective of moral considerations, tends to frustrate those who espouse a brand of populism based on little more than claims of moral high-ground and anger at an imperfect system that more often than not errs on the side of individualism. On one hand, we’ve grown accustomed to attacks and belligerence from nationalist, racist-types who see traitors everywhere… but those idiots are easy targets. Increasingly though, the very notion that moral superiority is not a be-all/end-all has found the fury of the self-styled progressive left.

Take for instance Mr. Owen Jones. Like many others around him, Mr. Jones has chosen to conflate criticism of brash generalizations and appeals to emotion, with passive tolerance of racism, xenophobia, and economic exploitation. The problem, in the view of Corbyn-ists and their Bernie-bro cousins, is that the post-Thatcher/Reagan era of political moderation has lulled us into a false sense of security, while the “elite” have endeavoured to rob us blind with the help of our own “centrist” complicity. Any and all inequality is seen as a direct failure of governments to adequately dictate a “fair” economic framework. Recent economic stagnation that has provided a pretext for the new-found confidence of the far-right is clearly the fault of “centrists” who failed to sufficiently regulate the financial sector, build enough social housing, and generally improve the lot of society’s most vulnerable.

Now let me explain to you why that’s fucking absurd.

Let’s start with the obvious. Basically, the argument is that all of the bad things that have happened in the world in the past 30 years are either the result of, or were enabled by, uninspired leadership (to put it euphemistically). Wars, recessions, terrorism, social unrest… all made possible by such grave sins as attempting to balance public welfare spending with the interests of the private capital that ultimately bankrolls it. Nevermind that crime rates, on average, have been consistently declining during these same decades, or that public health and life expectancy have seen major gains (both facts that these same critics will gleefully point out when responding to anti-immigrant fear mongering). And nevermind that the problems that we’ve faced are neither new nor are they confined to countries that have followed a capitalist model; there’s a short-term correlation and cheap political points to score! “If only those in power had been more caring or empathetic to the plight of the nation’s Joe Plumbers, they would have never been swayed by someone like Donald Trump!” How cute. By making this argument, proponents of a more ideologically socialist model must be insinuating that all of these problems could have been avoided if only the private sector had been more heavily regulated; otherwise they’d be hypocrites. It’s not like self-professed leftist governments have ever been responsible for economic disasters, or had authoritarian or nationalist tendencies… That’s sarcasm if you can’t tell.

If Mr. Jones and his ilk are to be taken at face-value, the solution to the current sorry state of affairs is simple: the state must impose “fairness” by force (arbitrary definitions of “fairness” aside). Increase taxes on corporations and the proverbially “elite”. Eliminate post-secondary tuition and anything else that might look like a user fee. Force companies to hire and “train” unqualified graduates with irrelevant degrees. Hire more doctors (but don’t pay them so much, and make sure to demonize them if they dare complain). Open the borders to economic migrants. Close the borders to foreign investment. Outlaw speech that offends our sensibilities. You get the drift.

The problem with this logic is that it is always incredibly short-sighted and ultimately never has any basis in rationality. These leftist point-men love to cry foul any time their affinity for peddling easy answers is compared to the xenophobic right, yet all you need to do is poke a few holes in their bold proposals and watch with amusement as these self-styled progressives become progressively more authoritarian in their stance. Yes you read that right. Their broad pronouncements are not “poorly thought ought”; they’re bold (God I hate semantics). Suggest that businesses and high-earners will simply relocate if faced with substantially higher costs, and they will fire back with suggestions of arbitrary financial penalties or retroactive taxation… I can only presume that exit visas are not too far down the list. If their hell-bent attacks on private sector profits dis-incentivize long-term investments and R&D spending, they’ll just nationalize (read annex/occupy/seize) entire industries, and as a corollary, outlaw competition. Point out that tax increases have historically never generated the promised level of revenue, and they’ll begin to rant about loopholes and imprisoning bankers and CEOs. And so on and so forth.

Here’s the best part, and the crux of Mr. Jones’ article and others like it. Because I don’t share their social-spending-at-all-costs philosophy, I am the extremist; A petty, simple turn-about. Effectively “No YOU’RE stupid!”, transliterated into roughly 1,000 words. Because I demand a practical examination of the costs of their proposals, I am out-of-touch. Deflecting criticism to a monolith of successive governments of a not-sufficiently-progressive persuasion is pathetically facetious, and ironically a prime example of the false equivalence we in the centre are accused of on a daily basis. But then, these are the people who will openly suggest that assault, arson, and vandalism are nothing more than “passionate repudiation” of racism and fascism (when directed conveniently at groups of their choosing). Who could possibly argue with that?

Don’t let our derision fool you. We are fully aware of the political abyss being faced by “centrist” governments worldwide. It turns out that a majority of the general public likes easy answers. What a surprise. But to those people I would say: don’t let these snake-oil salesmen fool you. Occam’s razor does not apply to running an economy (nor is it really a logical basis for anything, but that’s beside the point).

I recently saw a pro-Trump bumper sticker that read “don’t underestimate the power of stupid people in large groups”. Go figure.

Welcome!

Welcome to The Radical Centrist.

No longer is the angry rant the exclusive domain of the ideologically pure or the conspiracy-prone. Here we strive to rain on every parade and shit on everyone’s feelings. It’s time to fight fire with fire. Join me or go fuck yourself.

…On a more serious note, if you’re still wondering what to expect from this site, don’t hold your breath. I’m kind of feeling it out as I go (still playing with the layout). Podium for satirical indignation? Community forum? Meme-filled shitposting? Serious political discussion? You tell me… or don’t. I probably won’t listen.

Enjoy!

-Sven