How much is your life worth? Oh dear me no. I don't mean to you or your family. I mean to the Finance Ministry. You see, news out of Britain informs us that their government just isn't willing to spend that much to save lives. The National Institute for Health and Clinical Excellence (known scarily as NICE), which has already rejected various expensive drugs available in the U.S. and elsewhere in Europe, has now formally declared that "There is a powerful human impulse, known as the 'rule of rescue', to attempt to help an identifiable person whose life is in danger, no matter how much it costs. When there are limited resources for health care, applying the 'rule of rescue' may mean that other people will not be able to have the care or treatment they need. ... The Institute has not therefore adopted an additional 'rule of rescue'."

Of course government health providers should try to control costs, especially when medical care now consumes, not untypically, 46 per cent of the Ontario budget. And they have been trying in Canada, since at least the ill-fated 1992 decision to cut medical school enrolment by 10 per cent to reduce the number of doctors treating people and submitting bills. One is tempted to file it under "Be careful what you wish for." But the crucial point is that you didn't wish for it. They did.

Which takes me back to a century-old warning from Albert Venn Dicey about a then-novel wave of legislation intended to protect citizens from their own poor judgment or weak bargaining position, real or imagined. "The point is elementary," he wrote, "but it is worth insisting upon, since there is a constant tendency on the part both of theorists and of so-called practical men, to forget that protection invariably involves disability, i.e., limitations on the individual liberty of the protected person."

I remember when it was those on the "right" who had to insist that we think sensibly about tradeoffs in public policy. Thus Thomas Sowell once asked in exasperation: "Would anyone really spend half the Gross National Product to wipe out the last vestige of shop-lifting, or every minor skin rash?" But NICE is hardly conservative. And while Dicey's massive white beard and solemn praise for the Victorian constitution might tempt us to classify him as conservative, reactionary, even a fogey, as a Benthamite defender of political innovation in the name of laissez faire he doesn't quite fit today's pigeonholes, despite dating from an era when desks actually had such. So let's just read his words and see if they tell us anything.

They tell us that when the law prevents us from doing something that might be contrary to our interests, the tradeoff for the possible protection is the inevitable prevention. In this case, the prohibition on buying and selling medical care in the free market might protect you from being unable to afford it, buy more than you need, get worse care than the rich, etc. But in doing so it necessarily prevents you valuing your own life or health more than the government does. Which is every bit as bad as it sounds.

As things stand, you do not merely pay for health care what Dalton McGuinty says you should. You get the treatment he makes available to you, when and where he makes it available, of the sort and in the quantities he makes available, and nothing else. And if you don't like it, you cannot take your business elsewhere. It has, in every important sense, ceased to be your business.

If you were responsible for your own health care you would, of course, try to ensure cost control, as I presume you do in every aspect of your life with varying degrees of determination, skill and success. You'd want to look after yourself but you'd also want a car, a home, education for the kids, a retirement fund, a bit of bacon in your porridge and a decent chance of living long enough to enjoy all these good things. In short, you'd worry about getting the right mix of cost and service.

When you hand over health care to government, or your fellows do it for you, these still-necessarily value-for-money calculations are not merely done by someone else. They are also done very differently. They are generally not done well, for familiar reasons that need not be reviewed here. For now consider only that, even if the state did not have serious problems making rational tradeoffs, public servants and politicians would still make their calculations of efficiency based on different criteria.

Including, most importantly, that if you died they wouldn't miss you nearly as much as you would. But they'd sure miss the money needed to treat you. And you'd better think about that, because they are.

[First published in the Ottawa Citizen]

Put down the pill bottle and back away slowly. Aha! What’s this? Expired antibiotics? You’re in big trouble, buddy. Actually we all are. Antibiotic-resistant bacteria are everywhere, swarming over hospital towel-racks and bedsteads and heading right for our soft bits when we’re already feeling sick. Nature is, proverbially, short of mercy. But we’re making the problem way worse by misusing what were once “miracle drugs,” but have somehow become “whiny entitlement drugs.”

Look at this new study conducted for the Public Health Agency of Canada. According to Tuesday’s Citizen, the study “found almost one in three Canadians either wrongly believes antibiotics are effective against colds or doesn’t know if they are. Only 44 per cent know antibiotics kill bacteria, but not viruses. Close to half incorrectly think recent use of an antibiotic protects against reinfection or don’t know whether it does … one in 10 Canadians has used leftover antibiotics from old prescriptions belonging to them or someone else.”

Of course people wouldn’t be able to hoard expired antibiotics and take them for colds and other virus-based illnesses if doctors didn’t sometimes prescribe them just to get loud rude people out of their offices. In Britain, where the problem is so bad the government just issued strict new guidelines to doctors not to give antibiotics for coughs, colds and ear infections, the Daily Telegraph notes that family doctors “claim they often feel under pressure from patients who are angered if they are refused treatment.”

I can’t help thinking it’s a breach of medical ethics to give in to make these cretins go away. But I have a lot of sympathy for Canadian and British doctors, who are overworked, underpaid and treated like serfs by a public that seems to think their state-given rights include not only free access to whatever treatment does exist, but who also think that a treatment must exist for whatever is bothering them.

Those doctors willing to pacify us with pills, as though we were children getting lollipops, are responding to what is plainly widespread and socially condoned behaviour. (In fact they’d probably get in a lot more trouble for giving candy to kids in an age that gobbles antibiotics, but shuns sugar.) And knowing the difference between a bacterium and a virus, even in the “information age,” isn’t snobby pedantry like knowing the Venetian from the Florentine school of Renaissance painters. We aren’t going to die if we mistake a Donatello for a Tortellini. Yet far more people know their star sign than their blood type even though the latter won’t even help you get a date any more. And people succumb to ridiculous scares about cell phones but don’t pay attention to bugs that can kill their kids.

Most people also have no idea what it was like to live in an era without antibiotics. “Hey, I scratched my finger.” “Oh. Goodbye.” Of course not every wound was fatal. But American president Calvin Coolidge had an all-too-typical experience of watching helplessly in 1924 as his 16-year-old son blistered a toe playing lawn tennis on the White House grounds, developed blood poisoning, and died. It would be silly to go back to those days because we can’t be bothered to read the label or just decide not to believe it.

On that last point, pollsters and analysts have recently hailed a “decline in deference” among Canadians, as though rudeness were a virtue. That deference is a bad thing is a common misconception among intellectuals, though it’s odd to hear it from the same people who praise Canada’s differences from the famously egalitarian United States. In any case, the American ideal required people, in place of deference to their superiors, to be self-reliant and community minded.

Abusing free drugs manifests neither quality. And insisting that the government look after our health care sounds deferential to me, even if we’re also whiny. But let’s make the best of it. The only proper way to get antibiotics, aside from a few ointments, is from a pharmacist on the advice of a doctor. And they both tell you exactly what to do. Take the pills as instructed, complete the treatment even if you feel better, don’t hoard old pills for some arbitrary use later on. Oh, and if you get the sniffles don’t go to the doctor. Just take some quack remedy you found online and the cold will be gone in seven days instead of lasting a whole week.

I don’t want to die of some wretched superbug because people were too lazy or insolent to follow simple directions on a bottle, or had a misplaced sense of entitlement that the universe owed them a cure for the common cold. So I say again, put down the bottle and back away. Doctor’s orders.

[First published in the Ottawa Citizen]

George Smitherman has again failed to produce his promised glorious 10-Year Plan for saving health care in Ontario. It's like sitting in a fancy restaurant with a mouth-watering menu and great prices but whatever you order you invariably get a long delay and a bunch of excuses -- and then they chuck deep-fried leftovers on your plate and charge you double. While you can change waiters and cooks once every four years, it seems you can never leave. In a speech to the Cato Institute this spring, P.J. O'Rourke explained that while he actually knows and likes many politicians, "The problem isn't the cook. The problem is the cookbook. The key ingredient of politics is the idea that all of society's ills can be cured politically. It's like a cookbook where the recipe for everything is to fry it. The fruit cocktail is fried. The soup is fried. The salad is fried. So is the ice cream and cake. And your pinot noir is rolled in breadcrumbs and dunked in the deep fat fryer."

Because government is force, it can do the things that need to be done through force, often very effectively: fight crime, beat Hitler, make people pay taxes -- just as a fast-food restaurant can often make a great burger and fries when that's what you want. Unfortunately at Chez Gouvernement, where they don't just insist on frying everything including the ice cream but they promise they can also bake, roast, sautée and serve raw, you don't simply get an unhealthy diet, you get deceived.

The latest sizzling empty plate was Stéphane Dion's carbon tax. I gave him some credit when he first suggested it because clearly it didn't come from focus groups. I would even say it came from conviction except, as so often, it didn't come at all.

It was proudly listed as delicious nutritious greens, price zero. Yes, zero, by shifting taxes from desirable activities to environmentally destructive ones. But when he put it on the menu he didn't have a recipe or ingredients, and he still doesn't.

Last week I asked Angel Gurria, secretary-general of the Organisation for Economic Cooperation and Development, which also favours a carbon tax, how such a tax would work in practice when carbon dioxide and methane both have one carbon atom but methane is said to be 23 or 30 times as bad for the environment. He replied, and I quote, "We believe the enemy is carbon and we believe carbon is the one that has to be priced and taxed."

This reply is unfit for human consumption. Diamonds are pure carbon, but if geologists announced that Greenland had unexpectedly turned out to be one giant diamond, no one would be concerned about the implications for global warming. If it then caught fire they would, because it would start releasing greenhouse gases.

As former Natural Resources Stewardship Project executive director Tom Harris recently observed, calling a tax on carbon dioxide a "carbon tax" is like calling your water bill a "hydrogen tax". To work, a carbon tax must fall on things that worry global warming alarmists, roughly in proportion to how much worry they cause. But Mr. Dion's "plan," larded with offsetting tax breaks, has as its sole nutrient a wholesale tax on fuels based on how much carbon dioxide they release, starting at $10 per tonne, rising to $40 in four years.

Or not. In his press conference yesterday, Mr. Dion talked about "carbon dioxide," as did the press release, but the bit on pricing in the "Handbook" (see thegreenshift.ca) only says "carbon emissions" and "greenhouse gas emissions." The handbook doesn't mention methane and neither did Mr. Dion, like chefs who don't know butter from margarine. But both stress that gasoline gets a free pass because there's already an excise tax on it that exceeds the proposed final $40-per-tonne-of-CO2 price.

The whole plan is absurd if the point is to change behaviour significantly by changing incentives dramatically. But the plan is logical if you suddenly realize all you can do is fry up a politically attractive mess of empty calories. I don't know if this meal will really be free, but it sure won't be nourishing.

Nor does it help to change waiters. No one has a more substantive carbon plan than Mr. Dion.

And while Ontario Tory health critic Elizabeth Witmer berated Mr. Smitherman over his missing 10-year plan, in her press release she quoted herself that "Ontario requires a long term vision .... How much longer must we wait for this government to take action and develop a long overdue plan?" As if she had one either. Like Mr. Smitherman, she's happy to list it on the menu but let her take your order and it's, um, uh -- oh, look here's some batter, fry some excuses for me quiiiick I've got hungry rowdies at table 42.

I hate this restaurant. Is there no way we could eat somewhere else?

[First published in the Ottawa Citizen]

Do you know what I think every time I get into my car? "Hands up everyone who's on tranquilizers." I'm not saying people need drugs to drive badly. But it must help. Especially since literally millions of people are taking these things. Monday's Citizen said 30.2 million prescriptions for antidepressants were filled at retail drugstores in the 12 months ending last Nov. 30, and 8.5 million for antipsychotics. I realize there are people with severe problems for whom these drugs are a Godsend, and I know the typical prescription runs for considerably less than a year, so 38.7 million of them doesn't mean everyone's got one. Still, when there are more prescriptions for happy pills than there are people in a country I say something is very wrong.

Especially as some researchers say that most of these drugs do nothing for most of the people taking them except make them fat. Like Dr. David Lau of the University of Calgary, president of Obesity Canada, who calls psychiatric-drug-related weight gain "a huge problem," although he says scientists aren't quite sure how it happens.

My first thought was that while other factors contribute, from rising incomes to TV and video games, surely pills that take the edge off our worry contribute to obesity by making us less concerned that we are fat and out of shape. If not, aren't we being ripped off given that the point of these pills is to relieve anxiety?

Apparently so, since recent research suggests that, except for those with really serious problems, these pills do no more good than a placebo. In which case they must be inducing obesity through some indirect route and with no compensating benefits. At least alcohol, which science now suggests can be medically beneficial in moderate doses, really does induce the mental effects for which it has long been famous. Maybe it's time to empty the medicine cabinet into the trash and have a beer. After working out, I mean. And driving home sober to eat dinner with the kids.

I know such blunt talk is considered antisocial in some circles. But euphemisms don't solve problems and in this column, the court of common sense is in session. And it asks: If modern society with its loose morals and lavish state subsidies is the last word in human fulfilment, how is it possible that so many people cannot, or think they cannot, get through their day without a little yellow pill? Especially as it's not as though other more traditional intoxicants have disappeared. If literally millions of people need anti-depressants every year maybe there's something wrong with our society.

Theodore Dalrymple, a British commentator and psychiatrist, wrote in August 2003, "I very rarely see a patient who is in a dreadful personal situation, in which it is inconceivable that he or she should be happy, who has not been prescribed these drugs ... If I had $100 for every female patient of mine who had been prescribed these drugs who was embroiled with an abusive, violent, jealous, possessive, drunken or drug-taking man, I should be able to retire tomorrow." He even suggested that "By actively discouraging other, more constructive approaches to life's problems, without producing any benefit other than the avoidance of painful choices, it is very possible that (popular antidepressants) actually add to, rather than reduce, the sum of human misery."

It's a pretty obvious conclusion if you believe people are moral actors. If, on the other hand, you think they are just animate bags of chemicals it makes sense to redefine happiness as "suitably medicated" and call it a day. As Dr. Dalrymple also wrote, nowadays "we have a right not to the pursuit of happiness, but to the thing itself: and if our way of life leads us to misery, then a pill will, indeed ought and must, put everything right." But of course it can't, and doesn't. These things are a long way from the "soma" in Aldous Huxley's Brave New World and that novel was, you'll recall, a warning not an advertisement.

Speaking of which, is it not also curious that we do not permit the marketing of alcoholic beverages on the premise that they will make you happy or, failing that, induce a mental state where you care a lot less that you're miserable? Yet they are far more likely to keep such a promise than the mother's little helpers millions of people out there are taking.

I don't even understand why, when we rightly devote so much attention to drunk driving, and wish we had tests for driving under the influence of marijuana, no one wonders whether all these antidepressants aren't rendering people dangerously mellow behind the wheel.

So I ask again: Who's driving on drugs? Maybe you shouldn't be.

[First published in the Ottawa Citizen]

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]