No health care system is ever un-repealable. Not even in Canada.
President Obama’s health care bill has only been law for little over a week, but that hasn’t stopped the pundits of both sides from offering all sorts of grand prognoses on how the thing has already irreversibly altered the indefinite future of American politics. And to the extent the left and the right have reached consensus in their analysis, their conclusions can be summed up in one word: permanence.
So on the one hand you have liberal pundits, and indeed most of the Democratic Party, chuckling scornfully at the GOP’s newly-minted “repeal and replace” 2010 campaign slogan. Don’t they get it, they say, it’s a done deal. No right-thinking voter, especially one from the lower classes, is going to eagerly line up behind a politician who pledges to scale back their access to affordable health care, no matter how imperfect that access may be. And on the other hand you have an increasingly depressed conservative punditocracy, Mark Steyn among their most articulate, who are saying… pretty much the same thing. The final line in the sand has been crossed. We’re over the waterfall. The genie is out of the bottle. America has taken a fundamental step to the left that cannot be reversed, because no entitlement program can ever be reversed, or even substantially revised, once implemented. Oh sure, the Republicans may be hooting about it now, but soon they’ll go the wishy way of the British and Canadian Conservative parties, and turn into passionate, defensive protectors of the new socialized medicine status quo. After all, wasn’t the GOP in favor of repealing Medicare at one time, too?
While there may be some broad validity to the general theme of these optimistic/dire predictions, and while the history of Medicare’s evolution from right-wing pariah to sacred cow may indeed be prophetic, the international precedents are hardly as solid as the pundits imply. I can only speak from the Canadian experience, of course, but it should be known that socialized medicine is, in fact, enormously controversial in modern-day Canada. It always has been, and 40 years later, it still is. The fact that the ruling Canadian Conservative Party is not actively seeking to repeal our existing single-payer system does not in itself prove that the system is so beloved as to be politically untouchable, as many American pundits assume. It may imply some things about the priorities of our political leaders, or the ability of our political system to respond quickly and intelligently to pressing dilemmas, but it doesn’t imply much about the overall ideological climate of Canada regarding health care.
You can pick up a newspaper anywhere in Canada, on any given day, and find an editorial bemoaning the state of the Canadian health care system. Though there will always be some far-left demagogues who argue the single-payer system does not go far enough, the vast majority of critical columns usually contain phrases like “presently unsustainable,” “must adapt,” “restrain spending,” “increase choice,” and so on. And it’s not radical right-wing libertarian types who are churning out this kind of stuff, either. It’s in fact the height of respectable Canadian moderation to admit that there are profound problems with the Canadian health care status quo, and to state that market-based solutions may provide some of the most-needed relief.
During my time in university, for example, the student union created a health insurance plan to provide extended coverage to students through a private insurance corporation. This was necessary because the universal health coverage provided by the provincial government is increasingly covering less and less, for cost-cutting reasons. For a college campus as famously liberal as mine, the proposal was hugely uncontroversial. Despite the fact that the student union is always clamoring about rising tuition fees and other leftist causes, the notion that students should pay into a private insurer to increase their health care coverage seemed to offend the sensibilities of precisely no one. Health care costs already consume nearly 50% of the provincial budget, after all, and regardless of whether you’re on the right or left it’s hard to look at that number and believe that the state is going to be paying for more of your procedures in the coming decades.
I live in British Columbia, which is under the rule of a moderate Liberal government. But the story of provincial cuts to health care coverage coupled with an expanding role for private insurers (and, increasingly, though supposedly forbidden by federal law, private clinics, doctors, and surgeons, too) is true in virtually every other province in the country, regardless of what party is in power.
This is the genie that is out of the bottle in modern Canada.
The fundamental understanding, shared by virtually all members of the Canadian politico-academic-media-bureaucratic class, is that our nation’s present health care system, which combines a network of government-run hospitals and insurers with strong limits on alternate, for-profit programs, will have to be significantly retooled, in the direction of less overt government control, in the near future. There can be no doubt whatsoever that this is what Prime Minister Harper and Liberal leader Michael Ignatieff believe, and the subject featured prominently in the Liberal Party’s high profile “thinkers conference” held last week.
The question is mostly, when, not if. And where, in the sense of whether it will come from a legitimately pursued political initiative (“Is there room for courage in politics?” quipped Premier McKenna at the Liberal conference), or through some dramatic crisis, or the courts.
Indeed, for all the wistful hope among conservative Republicans that the US Supreme Court overturn Obamacare, it’s worth noting that the Supreme Court of Canada already has declared, in a mild, though symbolic and constantly-cited 2005 ruling, that excessive government interference in health care, when it amounts to the restriction of an individual’s ability to freely peruse his desired form of coverage, does violate fundamental civil rights. A more dramatic ruling somewhere down the line would hardly be unanticipated.
Canada is a weird and complicated country, and our ability to have a truly frank dialogue about health care reform is hampered by various patriotic fables that have arisen around the system, many of which, I would argue, are more tied to issues of pride and anti-American competitiveness than either genuine ideological commitment to what a single-payer system represents, or a deep-seeded satisfaction with the coverage provided by the status quo.
Americans should be wary from reading too much into the Canadian health care experiment for the simple reason that Canadians themselves rarely provide accurate information about it. Both the right and the left endlessly misportray the realities of the system for their own reasons. The nationalistic left denies the system’s inefficiencies and increasing unpopularity as a way to protect their side’s reputation as the competent and enviable architects of Canada’s supposedly world-class welfare state, while right-wingers similarly pretend the system is more entrenched, socialistic, and unquestioned than it really is, in order to re-enforce a pity-party narrative of the tragically beleaguered Canadian conservative.
The real lesson for Americans to draw from the Canadian experience is that government intervention in health care management creates a prolonged national psychosis that exacerbates the tensions between (and, significantly, within) the right and left, rather than mollify them through some new-found mutual support of big government. The phenom may take a while to fully manifest (during the 70s and 80s the Canadian right was fairly silent on health care, for example, distracted with other things), but it’s a fight that is inescapable. The economics, logistics, and ideologies surrounding a government program as enormous and ambitious as universal health coverage are simply too intense and too pressing to ever fully fade away from the public discourse.
The American experience is likely to be even more volatile for the simple fact that the Obamacare reforms are so new, and had the misfortune to be birthed into an era I’ve previously described as the first truly ideological age of post-war politics. It’s a grossly imperfect analogy to write, as many do, that since Canadian health care was controversial in the 60s, but not in the 70s, American health care is destined to be controversial in 2010 but not 2020. A more accurate reading of history would suggest that the America’s government-managed health care system will become widely contested and unpopular at exactly the same time that Canada’s is.
Which, oh by the way, is right now.
