Will there be an election in 2008? Gosh, it’s so exciting. We journalists hope not because if one is called we’ll have to stop writing about whether it might be, which is more fun than dull stuff like health care policy. Mind you, we can cover an election like a horse race, then start speculating about the next one, so we’re probably OK. Unlike you. For speaking of health care, here’s a boring story to make your hair stand on end, turn grey in that position and then fall out. In Britain, the National Health Service is planning to make people do their own health care to save money.

OK, not appendectomies. But, the Daily Telegraph reported Wednesday: “Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a government plan to save billions of pounds from the NHS budget …”

The report says patients will find themselves: “Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home; reporting medical information to doctors remotely by telephone or computer; administering their own drugs and other treatment to ‘manage pain’ and assessing the significance of changes in their condition; using relaxation techniques to relieve stress and avoid ‘panic’ visits to emergency wards.”

New prime minister Gordon Brown naturally spun it as giving “all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition.” But a document obtained by the Daily Telegraph indicates that while the public rhetoric is about empowerment, the private incentive is to save money.

It would be. It’s curious that people attack private markets because providers think about money, but never admit that it’s bad when governments don’t and often worse when they do. A company that cuts costs so much it can’t provide decent service goes out of business. Governments face no such incentives, and it matters.

Indeed, just one day earlier the Telegraph noted that “patients could be required to stop smoking, take exercise or lose weight before they can be treated on the National Health Service, Gordon Brown has suggested.” Offering a startling new definition of universal, he told NHS staff the government would “examine how all these changes can be enshrined in a new constitution of the NHS, setting out for the first time the rights and responsibilities associated with an entitlement to NHS care.”

Bored yet? Britain may seem like just this place where Lord Durham might have been from if he’d had the gall to exist. But actually it has one of those Parliament thingies and is the big powerful country whose cultural influence we used to resent bitterly before moving on to hating the United States. It even pioneered many policy initiatives we later invented, most notably socialized medicine. It is thus highly instructive that their health system, unlike ours, includes dentists and, unlike ours, has a shortage of dentists. Almost as if … nah, can’t be.

My point is, back of the corridor, you boozy, disgusting tobacco-stained fatties. Our governments must reduce medical costs too, whether you like it or not. Mark Steyn boasts of being a demography bore. Amateur! I’m a health provider demography bore. So here I quote Nadeem Esmail in the latest Fraser Forum. “In 2006, 19.2 per cent of Canada’s physicians were 60 or older, and 47.3 per cent were 50 or older.” And older physicians work less, then retire or die.

Just hire more, you say? From where, and with what money? Another Fraser Institute study just warned: “Six of Canada’s 10 provinces will be spending 50 per cent of all revenues on health care by 2035 if current spending trends continue …” You’ll be 28 years older then, and a distinct drag on the system. And how about the C.D. Howe Institute study (by my brother) last month saying “Canadian governments are unprepared for the fiscal impact of demographic change as baby-boomers move closer to retirement, and face a net liability of $1.4 trillion to pay for the current package of public programs …,” of which a provincial liability on health of $1.9 trillion dwarfs expected federal surpluses.

The actual C.D. Howe never did say “what’s a million?” and I hope no one out there now wants to say “what’s a trillion?” But just in case, it’s one of these: 1,000,000,000,000. What a big dull number.

Saaaaaay. Think there’ll be an election?

[First published in the Ottawa Citizen]

Wait a minute. What’s this? While everyone’s been standing on guard against two-tier health care it turns out we’ve got two-tier education. I want an expensive, restrictive, dysfunctional federal law and I want it now. Now now now.

We cannot delay, for we face a crisis. The Canadian Council on Learning’s 2007 Survey of Canadian Attitudes Toward Learning reports that almost one in three Canadian parents has hired a tutor for their children. And it’s not a matter of helping kids overcome disadvantages. The study says “Families with annual household incomes greater than $100,000 are almost three times more likely (2.9 times more likely) to hire tutors than families making less than $40,000.” Even worse, if anything could be worse than the rich having money, “most parents who hire tutors (73 per cent) estimate that their children’s overall academic performance is in the A or B range.”

How does that cheery Leonard Cohen song go again? “The poor stay poor, the rich get rich/ That’s how it goes/ Everybody knows.” But this is Canada. Here we have universal health care and nobody gets better treatment than anyone else unless they live in a big city, know somebody, are a politician or journalist, can afford to go to the U.S. or buy private catastrophic illness insurance, get to jump the queue thanks to a workers’ compensation board or some such irritating detail. Everybody else gets to wait in the same dingy corridors for the same exhausted ER nurses and doctors, wondering if there’s much C. difficile in this place and when that floor was last mopped.

That’s how it goes. Everybody knows. But what’s the deal with education? I ask, indignantly, because apparently everybody also knows, at least everybody who’s anybody, that we need Early Childhood Development because socioeconomic status is a far stronger predictor of lifetime health than medical care, and success in life depends on the state getting between you and your parents early on. (See for instance the chapter by Robert Evans, Clyde Hertzman and Steve Morgan in the IRPP book A Canadian Priorities Agenda that I wrote about two weeks ago.)

Happily, Ontario’s new old government campaigned on making ours the first province with full-day kindergarten for everyone. And having gotten re-elected, Dalton McGuinty has now even appointed a professor to spend a year trying to figure out how on earth you do that. The premier pontificated to the press that “I’m of the view this is no longer a luxury in a society that lays claim to being progressive and availing itself of all the best pedagogical advice that we can get our hands on.”

I’m personally of the view that it is no longer a luxury to figure out how to do things before promising you’ll do them and winding up scrambling desperately for usable advice. Especially after a newspaper told me the learned professor admits “designing a full-day kindergarten system will require consultations with a ‘huge number of doers and thinkers,’ but declined to discuss many details” except he doubts the half a billion bucks put aside thus far would be enough. On which point Mr. McGuinty confessed fatuously that he “would be surprised” if it were.

In short the premium, I mean the premier, made yet another promise he has no idea how to keep. At least this time he knows it will cost more than he said, which actually is an improvement on his habit of making promises he has no idea how to keep and doesn’t realize are hugely expensive. I guess watching himself in action he detected a pattern. He’s no fool, unlike those who re-elected him. But I digress.

The point is, it may well be that the government can no more give us all good education from cradle to grave than it can give us all good health care over the same period. But if not, it can at least give us all the same bad education and call it happiness. And isn’t that the Canadian way?

Sure, taxing people so heavily that most can’t afford private school, while stifling choice within the public system, is a good start. But it’s not enough. A veritable crisis of private tutoring is upon us. The dream of equality recedes. I demand a federal Canada Education Act that imposes the same rigid, wretched requirements on teachers and schools as the Canada Health Act does on doctors and hospitals.

Oh, and did you know wealthy people are flagrantly buying their kids nicer food, too, and taking them to fancy restaurants? Food matters more even than education, let alone medicine. It’s no longer a luxury in a society that lays claim to being progressive that everyone should eat in a state cafeteria where George Smitherman dumps slop on our trays.

[First published in the Ottawa Citizen]

It is a melancholy reflection that we had to wait for the Ontario provincial election to lurch to a dismal end before we could turn to urgent questions of policy. Melancholy turns to depression at the urgency of health care reform. And tears begin to flow at the thought that the major parties’ positions on that topic contrived to be at once irrelevant and profoundly inimical to any sensible solution.

The diagnosis here is grim. On Saturday the Globe and Mail’s Jeffrey Simpson wrote, “The Liberals boast they have jacked up health-care spending by 29 per cent over four years, to $37-billion, a staggering eight per cent a year.” Strange for a government to boast of its profligacy. Especially as, Mr. Simpson went on to note, the Liberals also promised to reduce the rate of spending increases to five per cent a year, which suggests there was something wrong with their previous behaviour. The Conservatives said they’d do the same, which suggests there was nothing wrong with the Liberals’ new promise. Uh, unless you count Mr. Simpson’s pointed observation that, “No Ontario government has been able to keep annual increases to five per cent.”

Thus we may swiftly conclude that neither party had a plan for doing what they promised, and move on to the next problem. Namely, that if the party leaders did somehow keep their word it is not obvious what advantages would accrue. For one thing, increasing spending faster than revenue generally causes trouble, especially on an item that already devours nearly half of program spending. For another, laying aside the calculator for a stethoscope, how will a health care system that couldn’t cope with existing demand while gobbling down eight per cent annual increases deal with the growing needs of aging boomers on just five per cent? Sadly we were not favoured with a discussion of such alarming matters.

Alarming is not too strong a word. Mainstream politicians generally dismiss as “ideological” those of us who saw trouble coming and urged preventive action years ago. But Mr. Simpson is hardly the excitable sort of columnist prone to the print equivalent of leaping about hollering, so you might think his observations would worry the people who run the system. Apparently they don’t worry easy.

Most politicians didn’t break a sweat when Health Canada warned that Canada will be short 5,800 doctors by 2010. Nor at last week’s Citizen report of one Ottawa doctor who predicts that with middle-aged doctors working so hard they’re burning themselves out and younger doctors working less in pursuit of a more rational work-life balance, the real shortage might be as large as 10,400. Politicians also shrugged off the Canadian Nurses’ Association warning that nationally we’ll be short 78,000 nurses by 2011 and 113,000 by 2016 and this week’s Citizen story saying we’re even short of nursing school faculty to train replacements. People with weaker nerves would be especially bothered by the demographics that make these problems so hard to fix. Not only are the patients aging, so are doctors, nurses and even the remaining nursing school faculty; the Canadian Nurses’ Association says more than half of the latter were over age 50 in 2005.

The one thing I’ve noticed recently that might make politicians panic is the increasing tendency, noted in Wednesday’s National Post, for doctors to bill for various services not covered by socialized medicine, from telephone advice to faxing prescriptions, that most provided free before provincial governments got so tight-fisted with their fee schedules. Apparently, the harder the government throttles the goose that lays the golden eggs, the harder the wretched bird fights for air. But our statesmen’s fingers are as strong as their minds are weak.

I do not exaggerate either the seriousness of the crisis or the feebleness of their understanding. From time to time I may inflict upon readers obscure quotations or arcane research. But you’ll notice that all the examples in this column are from very recent newspaper stories. You don’t have to be smart to uncover this stuff. But you have to be singularly dim to ignore it. And politicians are.

Faced with such atrocious mismanagement of such a key policy issue, I occasionally fantasize about entrusting affairs of state to persons selected by citizens in a competitive process designed to oblige candidates for public office to offer detailed, practical, intelligent solutions on matters of particular import.

Wait a minute. We just did that. * Sob * Could someone please pass me a large, absorbent handkerchief?

[First published in the Ottawa Citizen]

In a shocking breach of etiquette the Canadian Medical Association just proposed loosening the governmental stranglehold on health care before the patient, having turned blue, becomes completely unresponsive. Much virtuous swooning ensued.

As it spiralled toward the drawing-room floor, the Globe and Mail led off a Tuesday news story, under the headline “MDs launch fresh bid for two-tier care,” by gasping that “Canada’s doctors want to be able to work simultaneously in both the public and private systems, a flexibility that critics say could lead to queue-jumping and further depletion of public health care.”

When “critics say” appears in the first sentence of a story, we old-timers diagnose opinion disguised as news. And before bothering us with trivia like what the CMA actually suggested, the piece continued, “It’s also a proposal that puts the medical community on a collision course with Prime Minister Stephen Harper, who argues that physicians would have an incentive to stream patients into the private portions of their practice.” So there. Even hard-right neo-cons think this is right-wing lunacy. We’re just saying.

On Wednesday, the paper still had the vapours, editorializing (at least it was in an editorial this time) that: “Perhaps the key reason that the Canadian health system costs less than the U.S. system is that governments pay the tab for hospitals and physicians. That monopoly power as a single purchaser has enabled governments to restrain those costs while the bills for privately funded medical products such as prescription drugs have gone through the ceiling.”

Forsooth, my equilibrium is returning. Wave away those rubes who think governments have restrained costs by restricting services through such short-sighted measures as reducing medical school enrolment and underpaying doctors who then leave (one in nine Canadian-trained doctors is practising in the U.S.) or retire. Four million Canadians don’t even have a general practitioner? Mention it not; such vulgar persons are hardly the sort with whom prestigious editorial writers associate.

Instead on Wednesday the Toronto Star chimed in editorially that: “Once again the Canadian Medical Association, the national lobby group for Canada’s doctors, has started beating the drums for two-tier health care.” With the sang-froid of Marie Antoinette, the Star scorned the proposal: “It rests on two flawed assumptions: First, that medicare is broken, and second, that it is too expensive for governments to fix.”

Dismiss the rustic jibe that if medicare looks like this when it isn’t broken, I shudder to think how it will look when it is, and for once I shouldn’t have to wait long to find out, with one in three Canadian doctors already over 55 and one in nine over 65. Instead, Wednesday’s Globe ran a gravely sublime academic opinion that: “The CMA says the public would benefit from shorter waiting lists. But long wait times and suboptimal care are, in large part, a function of doctor and nursing shortages. For-profit clinics would not lead to the training of a single additional doctor or nurse. Indeed, such clinics would suck desperately needed personnel from not-for-profit hospitals and clinics. Physicians practising in public and private settings have a vested interest in keeping waiting lists long in publicly funded facilities.”

‘Twere ill-mannered to quote Henry Hazlitt, 60 years ago, that: “Today is already the tomorrow which the bad economist yesterday urged us to ignore.” Or that “governmental policy almost everywhere today tends to assume that production will go on automatically, no matter what is done to discourage it.” The state may have caused the shortage of doctors but, gad Sir, everybody knows continuing to bleed the patient is the way to restore strength. And who among us, righteously collecting our own salaries, does not resent doctors who dissipate their youth in hard study, disport themselves all day preserving life and health then presume to request a decent reward? Dedicated professionals in despair over their inability to provide proper care within our Soviet-style system? Pshaw. They’re just sinister, self-interested miscreants.

Should vertigo return, focus on the soothing reflection that it must be doctors in private practice who create waiting lists due to their own deplorable self-interest. Resolutely deny admission to any thought that, in mere shabby reality, the state did it and, by happy coincidence, thereby saved itself a big stack of cash on treatments it didn’t provide.

Should some yokel blurt that only public systems have waiting lists, pass, prithee, the smelling salts. They mask not just the displeasing odour of heresy but the far worse stench of ill breeding.

[First published in the Ottawa Citizen]