Tomorrow's SC Decision...

on the constitutionality of banning private health care will be the most important thing to happen in politics this year. Not so much for what it says (can anyone really imagine this SC being the one that orders the health monopoly disassembled?), but for how it says it. I think there are a few broad possibilities:

1) Status quo is fine - any talk of basic standards must be a political decision.

2) The status quo violates security of person and rights to life - patients may not be forced to suffer "undue hardship" waiting in line for care.

3) The status quo violates basic freedoms - citizens may not be forced to wait in line if they want to and are able to seek other treatment.

I've already suggested that (3) is entirely unlikely. I think what we'll see is something that looks like (2) at the level of rhetoric, but is really (1) as far as substance is concerned. While perhaps not ideal, this is not necessarily disasterous. It will come down to whether the court suggests that the government has a responsibility to pay for quality care for everyone, or whether they have a responsibility to ensure everyone has access to quality care. The former is, of course, a prescription for continued socialist medecine, complete with everything that entails (queues to ration resources, lack of price signals, etc...). The latter, however, throws the door wide open to radical changes in the system's structure.

For a long time, I have argued for a system based on this latter principal. The system actually evolved from an argument in favour of the private school tax credit in Ontario.

Lets do the economics thing and imagine a one-good health care world, where "the procedure" is the only health care service available. Suppose in this world the government is the only party that ever pays the doctors, who provide the service. Lets say the government needs to pay the doctors $1000 to do the procedure. What if we let those who wanted pay $3000 to the government to have the procedure done in the queue-jumping hospital? The government has surplus revenue of $2000, which it can reinvest into the free system, increasing its capacity to offer the procedure. In this scenario, "the rich" (it would likely be the rich and a good part of the middle class) get care much faster than now, and indeed faster than everyone else, but everyone else also gets faster care than they do today.

This system does not cause all the resources to shift to the queue-jumping sector (there's no incentive to do so), nor does it require anyone to break the bank in order to improve on the quality of care they have today. The concept can be applied in conjunction with other reforms in both style of delivery and private sector involvement. To deny its value seems to be equal to asserting that it is better that everyone have an equally poor level of care, rather than a differentiated level of superior care. In other words, it is to deny the Rawlsian maxi-min principle with the argument that it is not socialist enough.

I'd be interested to here people's thoughts on this, or for reference to any discussion of similar ideas.