Socialized medicine’s failure

ONE PLACE IN CANADA WHERE WE’RE (TOLD NOT) TO COMPLAIN. — JOHN ROBSON

Can we talk frankly about health care? In Canada, the answer seems to be no. Which isn’t just frustrating. It’s sickening.

I’d like to discuss two stories out of Britain, whose troubles are instructive since its socialized health system is similar to our own. But normally the discussion goes: “Our health system isn’t working.” “Oh, I suppose you want American-style private care?” Then floggings continue until morale improves.

Which interestingly is the first story out of Britain, where politicians are characterizing doctors as overpaid, underworked freeloaders who will work until they drop, or else. “Or else what?” is unclear given chronic personnel shortages. Or possibly the chronic inefficiency that creates the effect of scarce resources, even in an incredibly wealthy country.

A recent story in the Telegraph started, “The average GP is now working a threeday week following a ‘significant’ drop in working hours, government research shows . ... There are particular tensions over access to face-to-face appointments, with Boris Johnson intervening last month to say every patient has the right to see a GP in person.” But what use is a “right” to a government service the government can’t deliver?

Also, what use is saying, “The new figures show that GPS carried out just 6.6 halfday sessions a week — the equivalent of just over three days — in 2019, the lowest on record,” when the same figures show doctors putting in on average 40 hours a week, which isn’t three days anywhere I ever worked?

Naturally, some activist was found to berate doctors, saying, “It’s hardly surprising that we are facing a national crisis in terms of faceto-face access to GPS when the average doctor is only working a three-day week. It worries me that when we spend all this money and time training doctors they are able to work part-time, and for many of them that means using that time to work in private practice or doing locum work.” Ungrateful wretches.

Speaking of ingratitude, on the patient side, patience is evidently wearing thin with marvellous free health care you can’t get at any price. The Guardian reported that “NHS staff across the U.K. are facing a ‘growing tide of abuse’ including assaults from patients, which they say is being caused by frustration at long waits for care.” Of course, “six key medical bodies and staff groups blame ... years of successive governments underinvesting in the NHS and not fixing severe workforce shortages.”

Which is easier said than done since, the Telegraph added, “Surveys of trainee GPS have found that just one in 20 ... intends to work full time.” Maybe all that chatter about work-life balance influenced people. Be careful what you wish for.

Including central planning, because maybe the system is really badly designed. Maybe it gets the incentives so wrong you wonder if anybody in charge ever read an economics text.

Further to being careful what you wish for, an epidemic of bad behaviour by patients, in Britain and elsewhere, is probably connected to the epidemic of bad behaviour from everyone everywhere, after half a century of relentlessly challenging social conventions that once protected others from the less attractive aspects of our imperial selves. But if it’s especially bad in health care, it’s probably because people with dubious self control are being provoked unreasonably.

I’m not blaming healthcare workers, who should never be cussed out, let alone punched or bitten, and especially shouldn’t be insulted when facing extraordinary strains. As the Telegraph quoted a spokesperson for doctors, “workload is escalating, yet GP numbers fell by 4.5 per cent between September 2015 and March 2021 ... GPS are burning out,” including because the system buries them in paperwork while making them scapegoats.

But in return, everyone should acknowledge that patients are frustrated and frightened with reason. Namely that the health system is obviously failing them, yet they’re ordered to be grateful.

Surely it’s revealing that there’s one place in Canada where we’re routinely told not to dare to complain if the service is awful: the public sector. From the post office to Revenue Canada to socialized medicine, prominent signs and terse phone messages warn that if you mouth off you’re out the door.

It partly reflects the natural arrogance providers develop when dealing with supplicants who lack alternatives. But also the soaring frustration such supplicants feel and, in a vicious circle, providers then feel from so often facing clients who fail to control their anger properly.

So can we finally question the design of our healthcare system? Can we admit the costs are unsustainable and the results intolerable because the system gets the incentives terribly wrong, for everyone from patients to providers to politicians? If so, join us for the virtual/actual Economic Education Association conference, titled Meeting the Healthcare Challenge, which I helped organize and will address, on Oct. 22-23, where nothing will be off the table except abuse.

If not, the results will continue to be sickening.

THEY’RE ORDERED TO BE GRATEFUL (FOR A FAILING SYSTEM).