Health care would be better with choices

Public monopoly doesn’t serve us well, Dr. Brian Day writes.

The question of ranking those services that we all need and want is complex and very dependent on individual circumstances. It is unquestionably true that the denial of medical care to a sick person is a serious matter. Paradoxically, it is not a big deal if one is healthy. I went for the first 25 years of my life without medical care and didn’t suffer one bit. Contrast that with the outcome that would have occurred if I had gone without any education for my first 25 years. My friend’s father, Fidel Castro, told me that he believed education was by far the most important privilege that society can deliver to its citizens (health care being second). But there are other vital services such as housing, shelter, security, and public transportation. The latter is often underestimated, although its importance here in Metro Vancouver and its close relationship to affordable housing is gaining recognition.

As a 10-year old schoolboy in postwar Liverpool, England, my daily bus ride to school was a key to gaining my education. The buses were reliable, cheap, operated by a driver and conductor, and never completely full. Coincidentally, I sometimes shared those rides with other schoolmates, including future Beatles Paul McCartney and George Harrison.

So what has this to do with medical care? The fact is that health care alone, among the services mentioned, has been granted monopoly status by government when it comes to so-called necessary physician and hospital services. I challenge anyone to name a single monopoly that serves consumers well.

I would like to describe a theoretical scenario that uses the less emotional area of public transportation as an example. Perhaps the analogy might help explain why I believe Canada’s health system would benefit from shedding its monopolistic status. In using the example of people lining up for a bus, it is true that they will suffer from being frustrated, and possibly cold and wet, not to mention being late for school or

It is unquestionably true that the denial of medical care to a sick person is a serious matter. Paradoxically, it is not a big deal if one is healthy.

work. Let’s remember, to put health care in such a context, that the Supreme Court of Canada has previously ruled that Canadians are suffering and dying as they languish on waiting lists.

Imagine a government monopoly public transportation system that is funded through general tax revenue. There are no charges for tickets and the buses are always 100 per cent full. The buses run every two hours and lineups at bus stops exceed 100 people and extend for three blocks.

The government transport system is endorsed wholeheartedly by trade unions and their surrogates, who passionately promote “free” public transport, where everyone waits equally. Buses in the depot lie empty because there are limited funds to run them or to employ operators.

A private bus company decides to operate along the same routes, hiring from the large pool of unemployed bus drivers. The company buys its own buses, and funds all of its facilities and their employees; they give work to the drivers and other workers who were available but unable to get jobs in the public system. The company charges a fee for the ride, runs every 15 minutes, and the lineups disappear.

Has the private company undermined the public system by expanding capacity, offering unemployed drivers a job, eliminating queues, and making the previously frustrated passengers happy?

Imagine the story does not end there. The government bus company learns from efficiencies and methods that were perfected by the private company and applies them to their own operations. They become so efficient that passengers stop using the private system, since there is no longer any incentive to pay. The excellent and timely service that is now provided by government drives the private operators out of business, and the trade unions and their surrogates are happy again. Government has mixed feelings since the tax revenues from the private operators are now gone.

Could this happen with our state-run health system? Let’s find out.