Health Care | More Liberty - Less Government

Long waits for procedures are common in Canada; Montana offers same day service.

Medicare For All – Lessons From Canada

By: George Noga – December 8, 2019

Regular readers know we spend our summers in Whitefish, Montana – 50 miles from Canada and only four hours from Calgary and its 1.3 million souls; altogether two million Canadians live within an easy drive. Neighboring Albertans, flush with petrodollars, descend on us every summer. They come for the world-class attractions of Whitefish and Glacier National Park. They come for cheap prices vis-a-vis Canada. They come for weddings, which cost 50% less due to Canada’s sky-high alcohol taxes. They also come for medical care to escape rationing and long wait lists at home.

I have made it a point for 15 summers to ask our northern visitors how satisfied they are with the Canada Health Act (“CHA”), the name of Canada’s national health care. Out of scores I have queried, only two said they were satisfied. The first liked the care in Canada but comes to Montana when the wait lists are too long. The second defended CHA by asserting it was good at triage, i.e. if you were mired on a long wait list and your condition deteriorated, they would move you up on the list.

There are long waits for procedures in Canada, while Montana offers same day service. Some Canadian medical refugees are so desperate they pay out-of-pocket at great sacrifice. I have heard many heart-wrenching stories about CHA and most of my Canadian interlocutors passionately forewarn me against the USA adopting Canada’s style of socialized medicine. The data should scare the bejesus out of Americans.

The median wait time between referral and treatment in Canada is over 21 weeks, 42 weeks in some provinces and a staggering 4 years in extreme cases. The wait for a CAT scan is 11 weeks and increasing; there are no waits whatsoever in Montana. An average US city has more MRI machines than all of Canada. At any given time, over 1 million Canadians (3% of the population) are in line. The long waits are not just inconvenient; they often transform potentially reversible conditions into chronic or permanent disabilities. “Free” medical care is not much good if you can’t get it.

The free medical care is anything but free. Canada’s confiscatory taxation results in high living costs; that’s why Canadians flock to Montana to load up their SUVs. The federal income tax is 29%; provincial income taxes are 15% to 20%; health care is 6% and a 13% VAT is embedded in all purchases. The grand total is 64% to 68%. Canada also is a nanny state that doesn’t want its children, err citizens, drinking and imposes alcohol taxes that make cocktails 600% more expensive than in Montana.

Americans can learn much from the disaster that is Canada’s national health care. Whenever anything is in great demand, it must be rationed via either time or cost. Since healthcare is free, it can’t be rationed via cost; that leaves time. BINGO!

How comforting it must be for Canadians to know if their medical condition goes to hell in a handbasket, they could be moved ahead of some of the other one million desperate souls waiting in line for treatment – that is instantly available in Montana.

On December 15th, we reprise the greatest Christmas story in American history.

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More Liberty Less Government – mllg@mllg.us – www.mllg.us

The story of four Christmas presents is an economics primer. It also applies to government health care and indeed to government spending in general.

The Four Presents of Christmas

By: George Noga – December 3, 2017

The process of shopping for Christmas presents contains valuable lessons about economics and government. The four presents fall into three economic categories.

Present #1 The most felicitous gift is the one you buy for yourself with your own money. Clearly, you know better than anyone precisely what you want as well as how much you will spend. Your priorities are both price and quality; you want the highest possible quality for the lowest possible price. There are numerous trade offs between product features, quality and cost and many places to shop. You are uniquely qualified to evaluate all the permutations and to make the correct choice. Gifts like this are never returned. This is a first party purchase; the person paying is the person using.

Present #2 Your Great Uncle Warbucks sends you a generous check with the proviso you buy a gift for yourself. Although you remain the best judge about what to buy for yourself, you now are tempted to purchase something you would not have bought with your own money. You still want high quality because you are consuming the product, but now you are not quite as concerned about the price. When someone is buying your dinner, you order the lobster rather than the brisket. When using OPM (other people’s money) the temptation is great to splurge. This is a one example of a second party purchase; the person using is not the person paying.

Present #3 This is the arch-typical Christmas present – you buy a gift for someone else with your own money. However, you often are reduced to guesses about the needs and wants of others – even those close to you. Because you are spending your own money, you care about cost but are less concerned with quality as you are not using the product. You are not very interested in investing much time comparison shopping. Frequently, you buy something that the recipient would not have bought for him/her self and your gift is very likely to be returned. This is a slightly different example of a second party purchase; the person paying is not the person using.

Present #4 Now we have the situation where you buy a present for someone else with money supplied by a third party. Say your boss asks you to buy a present for a customer. You buy the present with money that is not your own; therefore, you do not care about the cost. You are not going to consume the present; therefore, you don’t care about the quality – or even the appropriateness of the gift. In any event, you have absolutely no idea about what the person may want or like. Therefore, you don’t waste any time shopping and promptly buy a ten-foot rubber elephant at the store next door. This is by far the worst of all scenarios; it is called a third party purchase.

* * * * * * * * * * * * * * * * * * * * * * * * * *

All government spending consists of third party purchases. The government takes money from you and distributes it to others based on what government considers best. They are not concerned with either cost or quality. It is even worse; they have priorities of their own that often are directly opposed to the needs or wants of the recipients. Government employees respond to their own personal incentives and disincentives.

The lessons of the four gifts of Christmas apply with a vengeance to health care. The cost of government funded health care continues to skyrocket while at the same time, the service and quality deteriorate. Compare this to private health care as is the norm in dentistry, ophthalmology and cosmetic surgery. The inflation adjusted cost of all of these is either stable or decreasing while quality and service are good. The difference is easy to explain. Government health care consists entirely of third party transactions while dentistry, plastic surgery and eye surgery are first party transactions.

Our next post previews MLLG’s plans for 2018