I've been traveling like a madblogger, so forgive me if I missed something, but I've looked around a little, and it looks like no one has commented on this astonishing quote from Paul Wells from a couple of weeks back:
I have long been a (fairly quiet) advocate of private, for-profit, two-tier, American-style, dance-on-Tommy-Douglas'-grave-style health care, on the simple principle that if something is important you should be allowed to buy it.If something is important, you should be allowed to buy it. Think about that. This means that if Wells had his way, the wealthiest among us would all be purchasing air, specific mountain ranges, human relationships, children, and success. Not to mention elections. Oh, wait a minute.
I adore Wells' writing, so it pains me to have to class him with Lyle Oberg, but come on, that one's right up there with "No one should have the ability to make anyone do anything against their will."
30 comments:
Good catch ! Even upon a second reading, I still can't tell if it's sarcastic, although the subsequent paragraph indicates a degree of sincerity.
You're back! Thank goodness, I was just about to beg.
canadian tar heel,
It sure doesn't read as sarcastic. I mean, we've all seen Wells' sarcasm, and it doesn't look like that.
deanna,
My head is still very much elsewhere, but I'm back in the country, at least. That's a start!
No one is stopping Paul Wells from buying his health care. He's free to travel to the US and purchase it anytime he wants.
I give up. What, on your list, can wealthy people not buy?
PW,
Well, are we talking figuratively or literally? Figuratively, the wealthy currently can't buy specific mountain ranges and air (except possibly small amounts of air, which...not the point), at the very least. Literally, it doesn't seem to be possible to buy any of them. I mean, yes, a wealthy westerner can go to a poor country and do things that could be cynically interpreted as buying a child, but if I wanted to buy my neighbour's child, I couldn't do that without legal repercussions. I could try to literally buy success, but I'd probably fail (which would be some delicious irony). &etc.
My question for you, though, is this: do you really think, literally, that "if something is important, you should be allowed to buy it"? I'm actually curious.
Me too. I have long been an "advocate of private, for-profit, two-tier", "dance-on-Tommy-Douglas'-grave-style health care" on the principle that with something as important as healthcare, you need a lot better reason than 'fairness' before you start telling people what they can and cannot have.
There is a huge ranch for sale in BC. I think it's North America's largest. It includes mountains, most of a river system, lots and lots of clean air, a staff of cowboys ... While a child may be hard to buy ( in the sense of owning one ) money can certainly be used to procure one, adopt one, gestate one or inseminate one.
Kevin,
All right, I'm not going to get into an argument with you about either of a) your opinions on health care or b) whether or not these things are currently possible to buy, because neither of those things are the point of this post. The point is the statement "If something is important, you should be allowed to buy it." Can you actually say you agree with that as worded?
My thought is that this is not the right question. The statement may be true for Mr. Wells and many others besides, but it stems from a belief of entitlement based solely on purchasing power. There's no question that this is a functional reality of commerce and modern social structures, so you really can't win an argument against it.
The better question is, I think, this one. If something is really important, should my right to it be at risk if I can not buy it? Mr. Wells will promptly respond that he's not looking to deny people access to basic health care.
If important things are available to people with money, will a smart, skilled doctor make his skills available for less providing basic health care? What if he has something important to buy?
Social institutions are not needed for all transactions, but why should a poor person be at a disadvantage in health care? What did they do to deserve it?
IP-
I think I agree with that statement. It's a short statement so it's not exactly clear what he means and doesn't mean but I think I agree with it. I'll expand on what I mean.
I approach it from a negative instead of a positive statement. I think that if something is as important as health care, then the state should not be able to limit your ability to spend your money on it. That's not exactly the same as saying you should be able to buy it but the difference probably isn't worth worrying about.
In terms of healthcare ( which is the context of PW's statement ), that means I advocate a parallel private ( and yes, two tier ) health system. Everyone has access to an adequate ( as determined by how much taxation voters are willing to pay ) healthcare system and if you want to spend your own money on additional, or better, or faster care you should be allowed to do that. That's the way it works now it's just the practical income cut-off that's different. I ( hypotheticallly ) can fly to the US to buy whatever healthcare I think I want and virtually no one argues that I shouldn't be allowed to do that on the basis of fairness. However, a middle income earner who could afford to purchase the health care but can't afford the additional burden of flying and living in the US is precluded because it's not available here.
Back to your point. If it's really important, you should be able to buy it.
Let's take your example of children. Having children is very important to some people. I see no reason that the state should not allow couples or individuals ( assuming obvious things like being able to care for them ) to spend their own money trying to conceive. I see no valid reason for a state to draw an arbitrary line saying you are allowed to try this procedure but you are not allowed to try these others. As long as the agreement is consensual, I would see no problem with paying third parties to assist -- including surrogates.
In the example of personal relationships I think the same reasoning holds but I doubt that the money is effective in achieving the end. If you want to have lots of friends I don't see any reason why you should be precluded from spending your own money trying to acquire them. Whether I think spending money is going to be effective or not is irrelevant. You don't have to look too far to see examples of people doing this.
That money can be used to buy ( or attempt to buy ) success is, I think, a given.
Another way to look at it might be, why should we be allowed choice in things that are trivial but not allowed choice in things that are important to us? It wouldn't make any sense to say choice is more important for trivial things than important things. If anything, the importance of a thing should increase the importance of being allowed to buy it.
Since you've contrasted PW's statement with "no one should have the ability to make anyone do anything against their will," I'll assume you're thinking about competing principles. For example the state has an interest in a child's welfare and might reasonably consider whether prospective parents can care for a child before approving an adoption or perhaps even spending money on parents who are both infertile and unable to parent. Fair enough.
I agree with the PW's statement but, of course it's not the only principle that might apply in a given circumstance. Another example of competing principles might arise with exaggerated purchasing power or zero sum situations. You might not want, for example, to have three people purchase all the water in Saskatchewan and let the rest die of thirst. Fortunately, healthcare, like most every realistic scenario, isn't a zero sum game -- unless you make it one with a monopoly ;)
What about buying votes or buying elections? Obviously you shouldn't be allowed to buy an election with purchased votes ( beyond the usual practice of rich policy promises ). But a vote is not a commodity and I think it's fair to assume that PW was restricting the scope of his statement to commodities.
It seems to me that the only real argument against allowing people to buy what they value is the notion of fairness. Richer people will be able to buy better healthcare just like they can buy better houses, better cars and better education. Like Jopseph Heath, I think the notion of fairness is inadequate to justify telling people what they can and cannot have in terms of important things like healthcare.
Sorry for the extra long comment.
Fun things that are a hell of a lot more important than health care, ie immediately life-threatening in their absence, but that nobody advocates reserving for a state monopoly:
(a) food
(b) water.
People who think this for-profit, rich-people-queue-jumping setup is better than FoodWaterCan could ever be:
(a) me.
Presumed rebuttal from Anonymous:
"If Paul Wells wants his food before November he can just go to the United States and buy some."
Heh - I saw that comment and just figured it was Paul Wells expressing his disdain at the thought of having to get the same medical treatment as the rest of the proles.
The wackiest piece of what he wrote was 'American Style' (I notice Kevin cleverly left that bit out) - I mean, even Republicans don't support American style health-care, do they? The whole country is getting shorter! - this is not a system we want to adopt.
I'm not sure that importance really plays a big role one way or the other in whether or not society considers that things should be purchasable. I mean, typically we frown on people purchasing slaves, but that's because it is considered an ethical violation not because people are important (even though they are). Similarly, paying the ref on the side to help your child win their rec-league softball game would generally be considered unethical as well, and the fate of one rec-league softball game isn't all that important in the grand scheme of things.
Going on, you can't (or are not supposed to) buy endangered species, nuclear weaponry, stolen merchandise, (illegal) drugs, the great lakes, (body) organs, the Order of Canada and a whole pile of things, all for varying reasons, few having anything to do with importance. If there is any correlation I'd say that the more important something is, the less likely it is that you can purchase it - but it's probably a weak correlation.
To the extent that importance is an issue, Anon at 8:23 hit the nail on the head. Things which are really important are those that everyone in the country should have reasonable access to, even if they can't buy them.
In that vein, I always understood the Canadian ban on private health insurance as being driven primarily by pragmatic concerns - that is, if (enough) rich people have no stake in the system, they will use their political clout to squeeze funding for it, not particularly concerned for the poor people who end up suffering and/or dying as a result.
This doesn't (hasn't) happen(ed yet) in Europe, but I think there is a stronger sense of a social compact there in that people have greater faith in the willingness of the elite to support the lower/middle class and/or the elite have more fear of uprising/retribution from the lower/middle classes.
If you don't think this could/would happen in Canada, I recommend taking a ride on the TTC and/or reading it's budget and wondering if things might be different (i.e. better) if rich people had to ride the rocket as well. Again, a comparison with Europe (well funded public transportation used by all classes of society) and the U.S. (rich neighbourhoods that fight transit because it will lower their property values) is instructive.
On a final note, the comparison with the markets for food and water is pretty silly, you could apply the same 'logic' to argue that there is no reason for people to need health insurance at all - after all, they don't need food or water insurance, do they?
It seems pretty plausible to me that if water consumption followed the same pattern as health care consumption - unpredictable, potentially very large expenditures, most likely to occur at a point when your income is low, with a strong information asymmetry favouring those likely to need the water (i.e. you know a lot more about your risk of needing water than your insurance company does) - then people would also purchase water insurance and a universal public water insurance market would be far more efficient than a private water insurance market.
Kevin,
Thoughtful response, as per usual. It will come as no surprise to you that I can't agree about health care, of course, but I appreciate the effort you put into explaining where your views come from. (Your point about competing principles makes a lot of sense, too.)
Back to the topic at hand, though--I have to say that some of the things you describe aren't really the same thing as If something is important, you should be allowed to buy it. Having procedures done that will help people have children, or paying someone to gestate your child, isn't the same thing as buying children--that's buying a service that might help you achieve your goal of having a child. And spending money in the hopes of making people like you isn't the same as purchasing a friend or a partner. That's hedging quite a bit from Wells' blanket statement of philosophy, and it was that blanket statement that I was calling him on. And if Wells really meant to limit his statement to commodities (i.e., "something that can be relatively easily traded, be physically delivered and be stored for a reasonable period of time"), that counts out health care as well.
PW,
I'll ask again, do you really believe that you should be allowed to buy anything that is important?
Declan,
I actually took "American-style" and "dance-on-Tommy-Douglas' grave" to have invisible scare quotes around them (suggesting that the people who characterize what he wants that way are being silly), but who knows with someone who believes that anything "important" should be able to be purchased.
As for the Canadian ban on private health insurance as being driven primarily by pragmatic concerns, yes, that's the idea. On the other hand, this is a peculiarly Canadian answer to a peculiarly Canadian problem, and it wouldn't be necessary if we actually funded our system adequately. Look at France, for example--a country which does allow people to purchase medical procedures, but because all necessary and most merely desirable procedures are funded by the public system, this doesn't deny anyone anything. If two-tiered medicine in Canada meant adopting the French system whole-cloth, I'd find it a heck of a lot less objectionable.
"...it wouldn't be necessary if we actually funded our system adequately.''
So because our system is underfunded, it must remain a state monopoly? We mustn't give anyone an alternative in Canada because they would... you know... need to take it?
PW,
If you wouldn't mind, I'd appreciate it if you responded to my on-topic question before asking me to respond to your tangential one.
Hmm. Touchy.
All right, then. I'm quite sure it is possible to conceive of important things that cannot or should not be bought. Clearly you're just the person for that task. But as a rule of thumb? An imperfect guide to a funny old world? Yeah. Sure. You bet. I actually believe markets are more efficient allocators of scarce resources than governments; that to be on the safe side it's handy to have both markets and governments playing on the important files; and I note that most sane countries in the world act accordingly.
There. Now it's your turn. What the hell were you trying to say? Because it came out kind of ridiculous.
PW,
Thanks for answering my question.
As for yours, I was disagreeing with Declan that a two-tiered system would necessarily result in the poor getting lousy care (since it doesn't necessarily mean that in other jurisdictions), while agreeing with him that it would mean that if we simply added a second tier to the current system rather than radically revamping it.
I've waited several days to see how PW would continue this discussion and now I have to agree with what I read on a blog a few days ago. I used to think the pundits in the media were talking at a level of abstraction above what I'm normally used to and were setting up new constellations of meaning that would never have occurred to me myself. Now, I'm convinced they're really not particularly bright, nor informed, nor humble, judging by how haughty and churlish PW has come across here (I don't know, maybe he thinks it's 'wit').
...oh, well.
anon at 9:40,
I'm not going to ask you not to express negative opinions about other commenters, nor will I ask you to provide your real name. But if you could at least provide a pseudonym when you post so that Wells can address you directly if he chooses, that'd be great. Thanks.
So because our system is underfunded, it must remain a state monopoly? We mustn't give anyone an alternative in Canada because they would... you know... need to take it?
Well, Paul Wells, I should point out that health care in Canada is not a state monopoly at all. Not only is some 30% of all health care expenditures paid privately, but there is not a single province in the country that prohibits physicians from opting-out of the public system and charging patients directly. Please read this article and commit to memory.
Not only that, but private insurance for publicly insured services is not prohibited in Saskatchewan (yes!), New Brunswick, or Nova Scotia. Yet, we don't see much of any "parallel private system" because it is simply unprofitable for all but simple, elective procedures - which is exactly the experience in Europe and Britain in particular.
I suppose it's too much to ask that our "expert" pundits be well informed about the issues beyond flippant arguments.
IP-
In common usage, I think there is an intersection of commodity and service.
Declan-
"if (enough) rich people have no stake in the system, they will use their political clout to squeeze funding for it, not particularly concerned for the poor people who end up suffering and/or dying as a result."
The reason you cannot pay for a private room for your mother's hip operation or pay more and have it done sooner is because you are a bad person. If you were allowed to do so you would certainly stop paying your taxes. While this may not be the case in most of the rest of the developed world, this is certainly the way it is here -- well, except for education but better safe than sorry. Besides, we suspect that you are more selfish than most of the rest of the developed world. [ ;) ]
I know, the point was, should you be able to buy it if it's important. Still, I couldn't resist.
Kevin,
Since when can you not pay for a private room?
"if (enough) rich people have no stake in the system, they will use their political clout to squeeze funding for it, not particularly concerned for the poor people who end up suffering and/or dying as a result."
The US - which seems to be the "worst" example people are fond of highlighting - must have very few wealthy people, or perhaps they have no political clout, because they sure haven't made much of a dent in the growth of Medicare or Medicaid spending. Nice chimaera.
Regarding the question "I'll ask again, do you really believe that you should be allowed to buy anything that is important?", we must first assume there exists a seller with the legitimate authority to sell it. Health care is certainly well within the authority of its creators and providers to sell - unlike, say, Lake Superior (barring the most egregious dictatorship or statist plurality).
lrC
Paul, if you are still reading this. Have you read Joseph Heath's "The Efficient Society"? If you have, I wonder what you think about his take on health care and market failure?
I for one wouldn't mind the French health care system, but that's not what we would get. The French system developed over the better part of the last century, is very complex, and is unlikely to be copied here. I suspect, given the ideological bent of those advocating private health care in this country, that we will emulate the system closest to our leader's hearts. And that ain't France's.
"The US - which seems to be the "worst" example people are fond of highlighting - must have very few wealthy people, or perhaps they have no political clout, because they sure haven't made much of a dent in the growth of Medicare or Medicaid spending. Nice chimaera."
Did I mention the whole country is getting shorter? Or that one of the primary reasons for personal bankruptcy in the U.S. is health care costs? Is your counter-argument really that the U.S. system is just fine and does a good job taking care of poor (and middle class) people?
Kevin - basically, yes. Although a) normally you can pay for a private room, at least in my experience, and b) obviously people wouldn't stop paying taxes, they would just vote for Mike Harris types that cut them - not worrying too much if stagnant or dropping health care spending was what paid for the tax cut. Hardly an inconceivable scenario, is it? Wouldn't take everyone behaving that way, just a few percent, most likely.
And your comparisons to 'most of the developed world' fail to mention the big exception next door, or that England, another close political relative of ours, has one of the most underfunded public health care systems in the developed world. In my opinion, we have lots of reasons to believe that a deteriorating public system is more likely in Canada that it is in most of the (non-English speaking) developed world, if we decided to pursue a full scale two-tier system. Whether this is because we are 'bad' and 'selfish' in your words or just because he have a more 'right-wing' political culture is another discussion.
IP - Sure, there are lots of good health care models out there and France is one of them but, as Greg says, the question is whether one of the good systems is what we would end up with if went to two-tier or whether it would be something like the American system.
May I take it the red herrings you are now tossing out mean you concede that your imagined spectre of defunding is just a straw man? Moving on...
>Did I mention the whole country is getting shorter?
That's a plea for what, exactly? Enforced nutrition? Genealogy-based immigration restraints? Monitoring mothers-to-be to prevent ingestion of anything which might shorten the otherwise natural height of a child?
>Or that one of the primary reasons for personal bankruptcy in the U.S. is health care costs?
Why stop at health care costs? What about the other primary reasons? Very well, though; let's put public personal bankruptcy insurance on the table for discussion. Regardless, public insurance doesn't require the absence of private insurance or absence of a free market on the delivery side.
>Is your counter-argument really that the U.S. system is just fine and does a good job taking care of poor (and middle class) people?
My counter-argument is that your imagined falling sky doesn't exist. However, I observe that the US system does in fact do a "good job", since you're asking for a subjective judgement. If you desire something which more closely approaches your criteria for perfection (taller people?), you've the right to pursue it within your means but no right at all to conscript others or restrain them from pursuing their own paths.
lrC
And here is an article which illuminates findings which question the fraction of personal bankruptcies resulting from health care costs in the US:
http://www.washingtontimes.com/article/20070726/COMMENTARY/107260002/1012
lrC
"If something is important, you should be allowed to buy it." Can you actually say you agree with that as worded?
Yes my wife has cancer and they have put off removing the tumour for 6 months SO FAR. I should be able to buy treatment for her without going to the USA.
The government is useless at running anything. They sit with their thumbs up their butts while cancer spreads.
Imagine the health care system trying to run McDonalds. First thing to go would be the smiles.
You want a big mac come back in 3 months....
No nurse in Canada ever lost their job for being crabby all the time. But their are many who should be in jail, cos they are so mean to patients.
"If Paul Wells wants his food before November he can just go to the United States and buy some."
:) indeed lets channel all those billions out of the country the Yanks need help so lets give them dollars that should be spent here. Lets pulverize our economy,...
In north Dakota there are doctors from Manitoba.
All that money on training lost.
PS you can buy a child next door it's called a private adoption.
I bet Bill Gates could buy a mountain range.
If faced with a potentially life threatening illness that required immediate diagnosis, would you wait three months for a CT scan or drive away to the US, plunk down a thousand bucks and have it done? I fully (almost)believe in our public health care system but think there might be some improvements? I'm going to Buffalo...ciao
Hey,
Long time reader and fan…
Have you seen this video yet? It’s so bizarre and I’m not sure if it’s legit. I know this is up your alley….
http://www.youtube.com/watch?v=Xtc1MG9bDrg
The website seems just as bizarre.
-Will
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