Quotulatiousness

April 23, 2024

Justin Trudeau’s legacy may not be something he ever wanted (or imagined)

Filed under: Cancon, Government, Health, Media, Politics — Tags: , , , , , — Nicholas @ 03:00

Tristin Hopper outlines some of the attitudinal changes among Canadian voters during Trudeau’s term in office, with opinions shifting away from things we used to consider settled once and for all. Canada’s Overton Window is moving (relatively) quickly:

Front view of Toronto General Hospital in 2005. The new wing, as shown in the photograph, was completed in 2002.
Photo via Wikimedia Commons.

It’s been among the most volatile and untouchable third rails in Canadian politics: The adoption, at any level, of a private health-care system.

In the last federal election, a Conservative statement about “public-private synergies” was all it took for Deputy Prime Minister Chrystia Freeland to brand it as a right-wing assault on the “public, universal health-care system”.

But a new Ipsos report shows that “two tier health care” is not the threat it once was.

Among respondents, 52 per cent wanted “increased access to health care provided by independent health entrepreneurs”, against just 29 per cent who didn’t.

Perhaps most shocking of all, almost everyone agreed that private health care would be more efficient. Seven in 10 respondents agreed that “private entrepreneurs can deliver health care services faster than hospitals managed by the government” – against a mere 15 per cent who disagreed.

“People understand that the endless waiting lists that characterize our government-run health systems will not be solved by yet another bureaucratic reform”, was the conclusion of the Montreal Economic Institute, which commissioned the poll.

As Canada reels from simultaneous crises of crime, affordability, productivity, health-care access and others, it’s prompting a political realignment unlike anything seen in a generation. But it’s not just a trend that can be seen in the millions of disaffected voters stampeding to a new party. As Canadians shift rightwards, they are freely discarding sacred cows that have held for decades.

If Canadians are suddenly open to health-care reform, it helps that they’ve never been more dissatisfied with the status quo. The past calendar year even brought the once-unthinkable sight of the U.S. being officially called in to bail out failures in the Canadian system.

November 4, 2023

QotD: The munificent benefits of big government

Filed under: Economics, Education, Government, Health, Quotations — Tags: , , , — Nicholas @ 01:00

So, the things that capitalism produces have fallen in price over the past couple of decades. That’s the pure and unadorned free market capitalism that is. The things where we’ve a managed sorta capitalism have still fallen relative to wages. The things where the government is rather more responsible for production – education and healthcare – have risen in price with respect to wages.

This is the argument that government should run more of the economy of course.

No, don’t laugh, it is. Because these things are rising in price is exactly why, so the argument goes, government must regulate and control more, so as to lower the price.

Tim Worstall, “Ain’t Capitalism Great? Price Changes Over The Last 20 Years”, Continental Telegraph, 2019-07-13.

October 26, 2023

“… despite all the evidence, British people still believe the NHS is the single best thing about Britain”

Filed under: Britain, Bureaucracy, Health — Tags: , , — Nicholas @ 03:00

The picture Jess Gill paints of Britain’s National Health Service is equally true of Canada’s various provincially run socialized medical systems, and largely for the same reasons:

Not actually the official symbol of Britain’s National Health Services … probably.

It’s clear that Britain’s National Health Service is failing. 7.6 million people are on a waiting list, and 41% of them say their health has gotten worse while waiting for treatment. Compounding the problem, the UK has significantly fewer hospital beds, doctors, nurses, CT scanners, and MRI units than the OECD average. Furthemore, the UK has the second-highest rate of treatable deaths in Western Europe.

Yet despite all the evidence, British people still believe the NHS is the single best thing about Britain. From the country clapping outside their houses to “thank our NHS” during the Covid-19 pandemic, to the Prime Minister and the Leader of the Opposition attending a mass ceremony to celebrate the NHS’s 75th anniversary, praise for this institution is everywhere.

Even though it’s self-evident the emperor has no clothes, the NHS is treated like a sacred cow. This begs the question: why are people so loyal to a system that is clearly failing them?

There is a prevalent conspiracy theory that the NHS is being intentionally underfunded by the Conservative Government so that the resulting poor outcomes will provide justification for them to privatize it and transform it into the American model of healthcare. This theory is pushed by the establishment: from senior members of the British Medical Association, journalists, and Members of Parliament.

This theory achieves two things. One, it shifts blame for poor outcomes away from the NHS as a system itself and toward the politicians in power. Two, it frames the debate with the assumption that privatization is a bad thing, causing any meaningful reform to be met with fear mongering.

This narrative has caused a massive issue for opponents of the NHS as there are multiple levels of misleading rhetoric. The fact of the matter is that the Conservatives are not privatizing or underfunding the NHS. Furthermore, whether it be a fully privatized system or even the mixed system as seen in other European countries, free-market reform would significantly help patients and doctors.

February 8, 2023

“Smoking has been a net gain for the Treasury ever since King James I started taxing it heavily in the 1600s”

Filed under: Britain, Economics, Government, Health — Tags: , , , , , , , — Nicholas @ 05:00

Christopher Snowden asks whether we should believe the consistent claims of public health advocates on how much things they disapprove of (smoking, drinking, etc.) “cost” the taxpayer:

If smoking costs the taxpayers £173 billion, then how much does widespread forced feeding of office pastries cost?

If you say that a certain activity costs society £10 billion a year, most people would assume that if that activity disappears, society will save £10 billion a year.

They might have different ideas of what “society” means. Some will assume that the £10 billion is a cost to taxpayers while others will assume that some of the cost is borne by private individuals and businesses. But the majority will, quite reasonably, assume that the cost is to other people, i.e. those who do not participate in the activity.

And nearly everyone will assume that the £10 billion is money in the conventional sense of cash that can be exchanged for goods and services.

But when it comes to estimates from “public health” campaigners about the cost of drinking/smoking/obesity, all these assumptions would be wrong. Most of the “costs” are to the people engaged in the activity and they are not financial costs. Taxpayers would not pay less tax if they disappeared. In general, they would pay more.

Last month I mentioned an estimate of the “cost” of gambling in the UK and said:

    These studies have no merit as economic research. They are purely driven by advocacy. The hope is that the average person will wrongly assume that the costs are to taxpayers and agitate for change.

The main aim of these Big Numbers is to convince the public that heavily-taxed activities place a burden on society that exceeds the tax revenue, thereby justifying yet more taxes and prohibitions.

In the case of smoking, this has become more and more difficult. Smoking has been a net gain for the Treasury ever since King James I started taxing it heavily in the 1600s. Today, as the smoking rate dwindles and tobacco duty rises ever higher, anti-smoking campaigners have got their work cut out duping non-smokers into thinking otherwise.

Tobacco duty brings in about £12 billion a year. For years, groups like Action on Smoking and Health (ASH) used a figure of £13.74 billion as the “cost of smoking”. This came from a flimsy Policy Exchange report which included £5.4 billion as the cost of smoking breaks and £4.8 billion as the cost of lost productivity due to premature mortality. Neither of these are costs to the taxpayer. They are not even external costs, i.e. costs to non-smokers.

Last year, in a review commissioned by the Department of Health, Javed Khan came up with a figure of “around £17 billion” as the “societal cost” of smoking. This included “reduced employment levels” (£5.69 billion) and “reduced wages for smokers” (£6.04 billion). Again, these costs fall on smokers themselves and are not external costs. They are, in other words, none of the government’s business.

Last week, a report commissioned by Action on Smoking and Health (ASH) pulled out all the stops and announced that the cost of smoking to Britain was now — wait for it! — £173 billion. Go big or go home, eh?

February 3, 2023

A spectre is haunting Ontario politics: the spectre of [Shock! Horror!] American-style healthcare!

Filed under: Cancon, Government, Health, Media, Politics, USA — Tags: , , , — Nicholas @ 05:00

Everyone in Canada has heard alarming stories of people in the United States being presented with five- or six-figure bills for hospital care, and any hint that one of our provincial healthcare systems might move in that direction scares the pants off almost everyone. Politicians know this well, and salivate at the chance of deploying charges that their opponents favour “American-style” changes to our system because it’s a guaranteed vote-winner. None of it has to be true — very few Canadians know much about US systems aside from the horror stories — but it’s always effective.

In The Line, Harrison Ruess makes the sensible point that there are more healthcare systems in the western world than those of Canadian provinces and our closest neighbour:

Toronto General Hospital in 2005.
Photo via Wikimedia Commons.

First, to be emphatic on this point, we need to be realistic about where our system ranks globally.

It is truly bewildering to me the lengths that otherwise smart and empathetic Canadians will go to to defend the status-quo approach to health care in Canada. The results we get, versus the money we spend, is simply not brag-worthy. The argument that our system works great, if only we threw more money at it, doesn’t stand up to scrutiny.

Is our health care okay? Sure. Decent? Probably. Is it great? Hardly. Could we do better? Yes, much. Do we need to spend more? Maybe a tad, but not likely much, if any. To wit:

    According to OECD data, on life expectancy Canada ranks 16th. On mortality rates from avoidable causes, we’re 23rd. On cancer survival rates we range from 13th down to 18th, depending on the cancer type. On the number of one-year-olds vaccinated for diphtheria, tetanus and pertussis, we rank an abysmal 37th (even the U.S. is higher here at 27th. Gulp.). One area where we do rank closer to the top is spending as a proportion of GDP, where we sit seventh.

World Health Organization (WHO) data wasn’t any more flattering, where Canada’s health care ranked 30th in overall performance despite being 10th in spending. The Commonwealth Fund ranks Canada 10th out of 11 in performance and 6th out of 11 in spending. In report after report Canadians aren’t getting the outcomes we need or want based on the money we’re spending on our current system.

Besides for reasons of nostalgia, why would anyone spend their energy defending these sorts of results? “We’re 16th! We’re 16th!” is hardly a chant you’d hear at a rally. It’s time to do better. And I get the feeling most people recognize this – certainly when you get onto Main Street.

Ipsos polling from December 2021 reported that 55 per cent of Canadians are “somewhat satisfied” with their health care, alongside 22 per cent that are “somewhat dissatisfied.” I.e. three quarters of Canadians find themselves in the middle of the road on the quality of our health care. This seems about right — mediocre support for mediocre health care. (The strongly satisfied and strongly dissatisfied were about even, at 12 per cent and 10 per cent respectively.)

But today Canadians are also, rightly, very worried. Leger polling in January 2023 showed that 86 per cent of Canadians are worried about the state of our health care.

December 18, 2022

Euthanasia, Canadian-style

Filed under: Cancon, Health, Law — Tags: , , , — Nicholas @ 05:00

In the free-to-cheapskates portion of his Weekly Dish, Andrew Sullivan considers the alarming growth of euthanasia in Canada:

Front view of Toronto General Hospital in 2005.
Photo via Wikimedia Commons.

I mention all this as critical background for debating policies around euthanasia or “assisted dying” (a phrase that feels morbidly destined to become “death-care”.) Oregon pioneered the practice in the US with the Death with Dignity Act in 1997. At the heart of its requirements is a diagnosis of six months to live. Following Oregon’s framework, nine other states and DC now have laws for assisted suicide. Public support for euthanasia has remained strong — 72 percent in the latest Gallup.

But this balance could easily get destabilized in the demographic traffic-jam to come. In 2016, euthanasia came to Canada — but it’s gone much, much further than the US. The Medical Assistance in Dying (or MAID) program is now booming and raising all kinds of red flags: there were “10,000 deaths by euthanasia last year, an increase of about a third from the previous year”. (That’s five times the rate of Oregon, which actually saw a drop in deaths last year.) To help bump yourself off in Canada, under the initial guidelines, there had to be “unbearable physical or mental suffering that cannot be relieved under conditions that patients consider acceptable”, and death had to be “reasonably foreseeable” — not a strict timeline as in Oregon. The law was later amended to allow for assisted suicide even if you are not terminally ill.

More safeguards are now being stripped away:

    Gone is the “reasonably foreseeable” death requirement, thus clearing the path of eligibility for disabled individuals who otherwise might have a lifetime to live. Gone, too, is the ten-day waiting requirement and the obligation to provide information on palliative-care options to all applicants. … [O]nly one [independent witness] is necessary now. Unlike in other countries where euthanasia is lawful, Canada does not even require an independent review of the applicant’s request for death to make sure coercion was not involved.

This is less a slippery slope than a full-on, well-polished ice-rink. Several disturbing cases have cropped up — of muddled individuals signing papers they really shouldn’t have with no close relatives consulted; others who simply could not afford the costs of survival with a challenging disease, or housing, and so chose death; people with severe illness being subtly encouraged to die in order to save money:

    In one recording obtained by the AP, the hospital’s director of ethics told [patient Roger Foley] that for him to remain in the hospital, it would cost “north of $1,500 a day”. Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care. “Roger, this is not my show”, the ethicist responded. “My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”

It’s hard to imagine a greater power-dynamic than that of a hospital doctor and a patient with a degenerative brain disorder. For any doctor to initiate a discussion of costs and euthanasia in this context should, in my view, be a firing offense.

Then this: in March, a Canadian will be able to request assistance in dying solely for mental health reasons. And the law will also be available to minors under the age of 18. Where to begin? How do we know that the request for suicide isn’t a function of the mental illness? And when the number of assisted suicides jumps by a third in one year, as it just did in Canada, it’s obviously not a hypothetical matter.

October 16, 2022

QotD: State monopolies

Filed under: Bureaucracy, Economics, Government, Quotations — Tags: , , — Nicholas @ 01:00

Competition leaves people with choices. But under the New Socialism, people will really discover what it means to be unfree when they only have this choice: work for the state and spend your falling wages on government-supplied goods — or starve. And to whom does the unhappy citizen turn when there is only one healthcare provider, one landlord, and one education system? The state monopolies under socialism offer a kind of subjugation and submission far greater than that in competitive markets. The faceless corporate decision makers that trouble professor Robin are far less sinister than government bureaucrats who can block all exit options. Imagine how poorly the Post Office would function without competition from Federal Express and UPS.

Richard Epstein, “The Intellectual Poverty of the New Socialists” [PDF], 2018.

July 23, 2022

Still living, still breathing, still walking around … but “legally dead”

Filed under: Bureaucracy, France, Government — Tags: , , , — Nicholas @ 05:00

I missed this from Alistair Dabbs last weekend, but it’s still just as concerning as it was then:

Zombies walk among us – until they need a nice sit-down, of course. It can be tiring to be undead. No wonder they drag their feet around and do all that moaning.

One such moaner is 58-year-old Michel from Montpellier. He has never stopped complaining since the postman delivered a letter one morning in June to offer him condolences on his recent death.

It was, as you might imagine, an administrative error: someone had probably clicked in the wrong checkbox or filed a request in the wrong folder. It was unlikely to be the result of a concerted Kafka-esque conspiracy to erase Michel from existence. Uncheck that box, drag the file out of the folder. It should be easy enough.

Evidently not. Once you’ve been declared dead, it sets in motion a sequence of automated digital-only procedures that sprint towards completion with alarming rapidity. You may have heard of France’s notoriety for officious paperwork and the snail-pace of its bureaucracy when you are living and breathing. But once you’re a stiff, it’s the fast lane electrons all the way.

Michel discovered that his bank accounts had already been frozen. His social security file had been closed immediately. His national health ID card was no longer valid and his top-up health insurance was cancelled.

He nipped over to his local social security office to see if they could put the brakes on the process but apparently it was too late: everything had already been done to kill him off, bar physically shoving him in a box and inviting friends and relatives around for beer and sandwiches.

Surely there’s a rollback option?

Ah now, it’s not that simple. The system architect that designed the automated process did not think of making [Alive] and [Dead] a pair of either-or radio buttons. They did not envisage a situation in which death, our ultimate existential destination, could be reversed by choosing Edit > Undo. There are no second- or third-life Power-Ups IRL. Instead, the system architect not unreasonably assumed that dying would be a one-way trip from which nobody is expected to return.

The system is not a complete disaster, though. The woman at the desk of the social security office was able to use it to find that a French national with exactly the same name and birthdate as Michel had died – albeit 4,500km (c 2,800 miles) away in Israel – and the two strangers’ records had probably been mixed up by a poorly trained official. So the error has been located. Good. Can it be corrected, please?

Yes, she said, before booking him in for a meeting to discuss it in two weeks’ time. No doubt he was also asked to bring documents that explicitly state when he didn’t die.

May 7, 2022

Death MAID easy, Canadian style

Filed under: Cancon, Health — Tags: , , — Nicholas @ 05:00

It’s quite surprising how quickly Canada moved from societal rejection of the idea of euthanasia to today’s situation where people are requesting euthanasia to escape dismal economic circumstances:

Front view of Toronto General Hospital in 2005. The new wing, as shown in the photograph, was completed in 2002.
Photo via Wikimedia Commons.

Canada refers to “euthanasia” and “assisted suicide” by the friendlier-sounding term of “medical assistance in dying” (MAID). The MAID programme was first introduced to end the suffering of terminally ill people, but its mission creep is now undeniable.

Denise (not her real name), a 31-year-old Toronto woman who uses a wheelchair, is nearing final approval for a medically assisted death. She only applied after her many attempts to move from her apartment, which she says worsens her severe sensitivities to household chemicals, all failed. She told Canada’s CTV News earlier this week that she was “relieved and elated” by the likelihood of the approval. “I was scared that they weren’t going to say yes.”

To get approval for her assisted death, Denise has consulted with a psychiatrist, who deemed her competent to make the decision, and a doctor who reviewed her medical history. Another doctor asked her to finalise her documents, including a power of attorney and a do-not-resuscitate order, and to make funeral arrangements. Denise has also asked doctors to waive the usual 90-day waiting period for those who are on “Track 2” of the assisted-dying programme – meaning that they are not imminently dying. She is likely to get her wish.

Hers is far from an isolated case. Sophia (also not her real name), a 51-year-old Ontario woman, who suffered from the same severe sensitivities to chemicals as Denise, was euthanised back in February, after she could not find affordable housing free of cigarette smoke and chemical cleaners. Four doctors wrote to federal government officials on her behalf, urging them to offer alternative accommodation. “The government sees me as expendable trash, a complainer, useless and a pain in the ass”, Sophia said in a video filmed eight days before her death.

In British Columbia, police are investigating the case of 61-year-old Donna Duncan, who was euthanised despite her daughters’ objections that she lacked the mental capacity to make such a decision. This was following months of physical and mental decline that began with a concussion caused by a car crash. Her family says her condition was made worse because she was unable to access proper treatment, due to months-long waiting lists. “It’s unacceptable – it took a year to get treatment but it could only take four days to die”, her daughter said.

Shockingly, many Canadians are now requesting a medically assisted death for economic rather than medical reasons. As one woman put it: “An increase [in income support] is the only thing that could save my life. I have no other reason to want to apply for assisted suicide, other than I simply cannot afford to keep on living.”

March 21, 2022

QotD: “Protect the NHS”

Filed under: Britain, Bureaucracy, Government, Health, Quotations — Tags: , , , — Nicholas @ 01:00

The relations between the population and the state in Britain are those of duty and obligation: the duty and obligation of the population toward the state, not the other way round. During the first Covid lockdown — one is beginning to forget how many there have been — the population was enjoined to stay at home in order to “protect the NHS”, the behemoth centralized health-care system that has served it so ill for more than seventy years. In essence, the population was asked to modify its behavior for the convenience of a state bureaucracy. The government might as well have said, “Protect the Inland Revenue: Pay Your Taxes”.

The government was able to get away with so ludicrous a slogan because of one of the most successful propaganda campaigns of the second half of the 20th century, namely that the institution of the National Health Service was a great social advance. It was nothing of the kind: Before it was founded, the country had one of the best health systems in the developed world and soon found itself with among the worst. The intention of the new service was egalitarian — treatment free at point of care and paid for from general taxation — and no one really bothered to check whether its effect was egalitarian. And since it has very unpleasant aspects for practically everyone, rich or poor, the British people still believe that it is egalitarian in its effect, when it is nothing of the kind. Such benefits as it confers are conferred in the rich, educated, and articulate, for the general principle of British public administration is for something to be done only if not doing it is likely to cause the relevant bureaucrats more trouble in the end. The rich, educated, and articulate can make trouble; the poor, uneducated, and inarticulate can only shout or throw bricks at the window (usually bulletproof and often soundproof, too).

The British population, believing that equality is a good in itself irrespective of whatever is equalized thereby, has come to regard the sheer unpleasantness of the NHS — to obtain treatment from which is an obstacle race in shabby buildings operated by exhausted and disgruntled staff — as evidence of its essential moral virtue, for it is unpleasant for all. Everyone is a pauper at the NHS’ gates, and where everyone is a pauper, no one is.

In addition to being treated better, the rich, educated, and articulate have escape routes, albeit expensive ones. Private medicine is still permitted in Britain, but in conditions of scarcity prices rise and so it is vastly, indeed fantastically, more expensive than it need be, or is elsewhere in Europe. The rich can also go abroad for treatment, and do.

Theodore Dalrymple, “Beneath the Surface”, Taki’s Magazine, 2021-12-09.

January 13, 2022

Canadians believe we have the world’s best healthcare system … we’re sadly deluded about that, as the pandemic has demonstrated

Filed under: Cancon, Government, Health — Tags: , , , — Nicholas @ 03:00

In The Line, Harrison Ruess points out how far down the international “league table” Canadian healthcare ranks, despite our fervent beliefs that it’s our healthcare system that somehow “defines” what it is to be Canadian (I’ve honestly never understood that particular belief):

Toronto General Hospital in 2005.
Photo via Wikimedia Commons.

Millions of Canadians are extremely proud of our health-care system. They defend it and are utterly convinced of its greatness. They react with hostility to any hint of change.

But on what basis could Canada make a claim to health-care greatness?

According to OECD data, on life expectancy Canada ranks 16th. On morality rates from avoidable causes, we’re 23rd. On cancer survival rates we range from 13th down to 18th, depending on the cancer type. On the number of one-year-olds vaccinated for diphtheria, tetanus and pertussis, we rank an abysmal 37th (even the U.S. is higher here at 27th. Gulp.). One area where we do rank closer to the top is spending as a proportion of GDP, where we sit at seventh.

In modern parlance of TL;DR, what the OECD data says is that Canada spends a disproportionately large amount of money to get strongly mediocre health outcomes.

For an overall picture we can look at the World Health Organization’s ranking system, which measures, “responsiveness (both level and distribution), fair financing, and health inequality, in addition to the more traditional goal of population health.” Here, Canada ranks 30th overall.

“But …” I’m sure you’re about to say … “Canada has universal health care!”

Yes. And that’s good. But the shortfall of that argument is that dozens of other countries have universal health care and many also have far better overall outcomes. In short, universal health care access is not a unique feature in Canada. For instance, a few notable countries from the WHO’s top 10 include France, Italy, Singapore, Spain, Austria, and Japan. These are hardly countries that let citizens go bankrupt or die in the streets when they need health care.

So why are we so darned committed to defending the Canadian status quo?

I genuinely can’t make sense of it. Canadians are smart, sensible people. We want the best for ourselves and our children. But at the same time, we have a very long history of refusing to change and improve our health care despite every piece of evidence that says we desperately must do better. The COVID pandemic has made this especially clear over the last couple years, but none of this is new.

As Robyn Urback recently asked in the Globe & Mail, “When do we admit Canada’s health-care system just isn’t working?” and as Matt Gurney pondered on TVO, “When can we start trying to make it [better]?”

December 10, 2021

How WW2 Created a Welfare State – WW2 – On the Homefront 013

Filed under: Britain, Economics, Government, History, WW2 — Tags: , , , — Nicholas @ 04:00

World War Two
Published 9 Dec 2021

In predicament due to the extreme situation of war, people are in dire need for a working system of social security. Therefore, Beveridge is instructed by the British government to draw up a report on the state of the country´s insurance schemes. But in his opinion, a war is no time for patching up a collapsing system – and he is ready to make some waves.
(more…)

October 11, 2020

QotD: Britain’s National Health Service cult

Filed under: Britain, Bureaucracy, Government, Health, Quotations — Tags: , , , , , — Nicholas @ 01:00

The NHS has not served the nation well, if international comparison is the criterion by which it should be judged. For example, when the NHS was founded (when British healthcare was among the best rather than the worst in Europe) the population of France had a life expectancy six years lower than that of Britain; it is now two years higher. The health of the population in Spain improved more under Franco than that of the British under the NHS in the same years. Of course, there are determinants of life expectancy other than healthcare systems, but at the very least the comparisons do not suggest any particular virtue to the NHS.

Survival from many serious illnesses such as cancer, heart attacks and strokes is lower in Britain than in most European countries. Publicity is sometimes given to these statistics but they are not immediately apparent to patients or their relatives, and in any case the NHS is immune to criticism because its deficiencies are assumed to be departures from its essential goodness or the result of inadequate funding.

No number of scandals, such as that of Mid Staffs in which hundreds of patients were neglected to a degree that often defied belief, all in plain sight of a large bureaucracy supposedly devoted to ensuring the quality of patient care, can dent faith in the NHS. Staff committed, and management connived at, acts of cruelty that would have made Mrs Gamp blush. Mr Cameron’s government, anxious not to seem an enemy of the NHS, which would have been politically damaging, swept the scandal under the carpet.

A system whose justification for its nationalisation of healthcare was egalitarianism has failed even in the matter of equality. If anything, the difference between the health of the richest and poorest sections of the population has increased rather than decreased under the NHS.

The gap between the life expectancy of unskilled workers and that of the upper echelons, which had been stable for decades before the foundation of the NHS, began to widen afterwards and is now far wider than it ever was. Again, there are reasons for inequality in health other than the deficiencies of healthcare, the prevalence of smoking and obesity, for example; but if systems are to be judged by their effects, the NHS has failed in its initial goal.

Theodore Dalrymple, “Empire of conformists”, The Critic, 2020-04-29.

September 30, 2020

The feds go trampling all over provincial responsibilities again

Filed under: Cancon, Government, Health, Law — Tags: , , , — Nicholas @ 03:00

Ted Campbell suggests that even a cursory reading of the constitution does not give the federal government the power to trespass (again) in what is clearly, legally, a provincial government area of responsibility:

“The Fathers of Confederation”
The original painting by Robert Harris (1884) was destroyed in the 1916 Parliament Building fire, and this image for the “Gallery of Canadian History” series of lithographs by Confederation Life Insurance Company is based on a photograph by James Ashfield (1885).
Libraries and Archives Canada item ID number 3013194. http://central.bac-lac.gc.ca/.redirect?app=fonandcol&id=3013194&lang=eng

[T]he Parliament of Canada should look to §91. Here is what the Constitution says are the areas of national government’s concern: The Public Debt and Property; The Regulation of Trade and Commerce; Unemployment insurance; The raising of Money by any Mode or System of Taxation; The borrowing of Money on the Public Credit; Postal Service; The Census and Statistics; Militia, Military and Naval Service, and Defence; The fixing of and providing for the Salaries and Allowances of Civil and other Officers of the Government of Canada; Beacons, Buoys, Lighthouses, and Sable Island; Navigation and Shipping; Quarantine and the Establishment and Maintenance of Marine Hospitals; Sea Coast and Inland Fisheries; Ferries between a Province and any British or Foreign Country or between Two Provinces; Currency and Coinage; Banking, Incorporation of Banks, and the Issue of Paper Money; Savings Banks; Weights and Measures; Bills of Exchange and Promissory Notes; Interest; Legal Tender; Bankruptcy and Insolvency; Patents of Invention and Discovery; Copyrights; Indians, and Lands reserved for the Indians; Naturalization and Aliens; Marriage and Divorce; The Criminal Law, except the Constitution of Courts of Criminal Jurisdiction, but including the Procedure in Criminal Matters; The Establishment, Maintenance, and Management of Penitentiaries; and Such Classes of Subjects as are expressly excepted in the Enumeration of the Classes of Subjects by this Act assigned exclusively to the Legislatures of the Provinces.

In that looooong list I can find more than adequate justifications for ministers and government departments that are responsible for: finance and revenue; industry, trade, and commerce; defence; foreign affairs; transport; fisheries and oceans; citizenship and immigration; health; and for independent agencies like the Bank of Canada, Canada Post and Statistics Canada. I cannot find anything that says we need a Minister for Women and Gender Equality, nor one for Diversity, Inclusion and Youth nor, especially, Ministers for Canadian Heritage and Middle Class Prosperity.

A lot of things have changed since 1867; the telegraph was still fairly new and innovative, a practical telephone wouldn’t be invented until ten years after confederation and the first useful long-haul radio transmission and reception, from Britain to Signal Hill in St John’s didn’t come until the dawn of the 20th century, thus ideas like the CBC, the Internet, Netflix, air traffic control and the North Warning System were far beyond the imagination of the men ~ they were pretty much all men, working in government, back in the 1860s, weren’t they? ~ who drafted the Canadian Constitution.

What was clear to them, based on the United States experiences, was that §90 to §95 which spell out “who does what to whom” were important to the functioning of a federal state, especially to one in which traditional provincial rights and diverse cultures were well established. Now, it is important to remember that in Canada’s long and rich history there were instances, especially during great wars, when the provinces agreed to federal intrusions into their areas of responsibility; this is not one long story of federal bullying. But what seems perfectly clear to me ~ and I suspect to e.g. John Horgan, Jason Kenney, Doug Ford, François Legault and the other premiers is that last week’s Throne Speech marks another major and quite unjustified federal assault on their jurisdictions. What’s happened, according to Manitoba Premier Brian Pallister, is that the provinces have all the health care delivery problems but, thanks, in some part, to tax decisions made in 1942, the feds have all the money. The solution is blindingly obvious: transfer tax “points” as some experts call them, to the provinces so that they, not Justin Trudeau, who have the problems of too few physicians, too few nurses and too few hospital beds also have the money to solve them.

September 1, 2020

QotD: The “envy of the world”, Britain’s NHS

Filed under: Books, Britain, Bureaucracy, Government, Health, Quotations — Tags: , , , , — Nicholas @ 01:00

No good crisis, including the present COVID-19 epidemic, should go to waste. In this respect, the high priests of Britain’s secular religion, its highly centralised National Health Service, have certainly not been sitting on their hands. There has been so much propaganda in favour of the Service during the epidemic that one might have believed that it was under central direction.

One morning, for example, I received an e-mail advertisement from a chain of bookstores (a near-monopoly in the British bookstore trade) of which I am an occasional customer, for an anthology of stories specially written in praise of the NHS titled Dear NHS: 100 Stories to Say Thank You. An anthology of poetry, These Are the Hands: Poems from the Heart of the NHS has also just been published. I will pass over in silence the emotional kitschiness of all this.

These books, of course, deliberately confound the NHS itself with the devotion and skill of the people working within it. They are not the same thing — very far from it — and it might well be that good results are often achieved despite the system rather than because of it.

The propaganda in favour of the NHS has been more or less continuous since its foundation in 1948, though it has become ever shriller, as propaganda tends to do, as it departs further and further from reality. Indeed, one might surmise that the purpose of propaganda in general is to forestall any proper examination of reality in favour of simplistic slogans convenient to political power.

I grew up, for example, in the inculcated belief that the National Health Service was, according to the slogan of the time, “the envy of the world.” Millions of people believed this, and indeed it was an assertion heard for many years whenever the subject of health care came up. The slogan was last wheeled out in any force in 2008 for the 60th anniversary of its founding.

Theodore Dalrymple, “Worshipping the NHS”, Law & Liberty, 2020-05-04.

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