Phony Health Care Debate Gets Phonier

When I blogged on the Supreme Court’s Chaoulli decision in June (see June 2005 Archive), I wrote:

As for the honest, realistic debate that many hope will be spurred by this ruling, I’m not holding my breath. The Supreme Court is unlikely to wipe away the health care delusions of Canadians, when a decade of declining services and increasing waiting lists have done nothing but reinforce those delusions.

As if on cue, here’s Jack Layton to inject a fresh shot of poison and distortion into the health care debate, by demanding – as the price of continuing to prop up the Martin government – that the federal government ban “double dipping” by doctors.

The term “double dipping” has until now generally been limited in its use to politicians who are drawing two government paycheques, such as a politician receiving an MPP pension plus an MP’s salary after having been elected to the federal Parliament. But The Toronto Star provided this definition in a November 3rd story, “Liberals draft health deal for Layton”:

Double dipping refers to a practice in which some doctors offer patients the same services in the insured public system or more quickly in private clinics for higher fees. Some medicare advocates have been urging Ottawa to guarantee that the public health system be kept completely separate from privately delivered services.

Although the practice of double dipping is not widespread, both Layton and Dosanjh have expressed concern about it and Layton, in his talks with the Liberals, has been demanding a ban on it in the Canada Health Act. Such a provision would head off any future attempts by the provinces to allow it.

Not widespread? I’ve never even heard of it until now. Frankly it sounds like another Lib-left bogeyman not unlike “extra-billing” in Ontario in the 1980s. Banning so-called extra-billing was one of the concessions Bob Rae extracted from David Peterson to catapult Peterson from opposition leader to the Premier’s Office in the minority Parliament that was the result of the 1985 election.

A doctors’ strike ensued, during which The Star ran a now-infamous editorial cartoon depicting doctors as pigs at the trough. The Peterson government eventually prevailed in banning extra-billing, however, and the province’s relations with doctors have been poisoned ever since.

The fact is, in many industrialized countries that have public health care, one of the things that makes it work is allowing doctors to work in both government facilities and private ones. But Layton will have none of this, nor will Sid Ryan, Tommy Douglas’ daughter, the health care unions, and the others who are too heavily invested in the Cuban model of health care to see reality.

One reality is that while the federal government can pass whatever laws it wants, it has little financial leverage over provincial governments to impose those laws. Since it gave up tax points to the provinces in the 1980s, all it can do is withhold cash transfers, which in many provinces account for less than 20% of their health budgets. Wealthy provinces can simply tell the feds to take a hike, as they could well afford whatever clawbacks the federal government imposes under the new law.