Some years ago, I did some work for a think tank called the “Atlantic Institute for Market Studies.” It was founded and run by a brilliant, somewhat mercurial economist named Brian Lee Crowley who has since moved onto other endeavours in Ottawa.
Health care reform was a policy focus at AIMS and I did a little work on this brief and was privileged to partake in a number of very enlightening dialogues with Dr. Crowley and others whose brows were more than a little furrowed by the formidable challenges faced by anyone or any group promoting change in our healthcare system. Dr Crowley’s frustrations had a great deal to do with the quality of the debate surrounding health care reform — the sound and fury that seemed to signify very little in the way of evidence-based assessment and the general tenor of which was often defensive, dominated by vested interests and frankly not very rational.
A particular sore point was the tendency of what we will call status quoers to accuse any and all reformists of representing a heinous plot to introduce American-style health care into our pristine, single payer world. It didn’t seem to matter to the SQ’s whether the suggestions for change came from best practices in France or Cuba , virtually any promotion of substantial change was tarred with that Yankee brush — as if Canadian health care was teetering on the edge of a volcano to such degree that merely whispering the word change would send it over the brink into the fire and ashes of HMO’s and uber-privatization.
If we could just jettison this U.S. is our only alternative fixation we could move on to the close study of best practices wherever in the world they may be found including, dare I say it, the United States. To do this, we must also jettison the remarkably silly notion that a way of providing health services is some sacred talisman deeply central to who we are in the True North Strong and Virtuous. Come on Canadians, get a grip! When I travel around the wide world, I do not feel the need to wear a tee-shirt that says, Hi, I am Canadian, we`re really compassionate and our health care system proves it.
A health care system is a purpose designed social construct, a mechanism for the provision of a valued human good. That this good is fervently desired is unarguable. In fact so desired is it, that the costs of its provision have come some distance towards pushing other human goods off the table so far as these goods can be provided by governments. As the OECD tells us, health care spending has outpaced GDP growth in most member countries for many years. This is a way of saying that a great deal is at stake here; and not just in the area of health outcomes. How we can best provide a service, a better mousetrap, which contributes to our capacity to live healthy lives into an ever riper old age should be a rather unemotional, evidence-based debate; but most of the time it is anything but. Smothering the debate in the Canadian flag is not very helpful.
The fist pumping for Dr. Martin was probably more to do with a Canadian standing up to a Senator in Congress than it was the health care issue in particular. The American right views their health care system as untouchable as the Canadian left does ours, and Canadians tend to see the flaw in that kind of thinking when it occurs south of the border more quickly than they see it here.
Understandably, but weirdly nonetheless and as you suggest, our identity is caught up in the healthcare debate. When two peoples are so similar small differences get seized upon much like identical twins pointing out how easy it is to tell them apart.
Finally, Canadians (and Americans) suffer from geography. All many Canadians know is how things are done in the States. For example, most of us gladly accept that we do not have a national pharmacare plan given that we have historically had much broader insurance coverage than they do in the USA. However, when you realize we are the only developed country with a public healthcare system without pharmacare coverage, it creates a different perspective. (As an aside, I don’t view this as an argument for expanding healthcare coverage, but I do believe we need better coverage of certain life-saving drugs even if that means dropping coverage of other more elective treatments. Our current system is not medically prioritized in some areas.)