I cannot emphasize enough how good this piece is, and what a necessary antidote it is to — you guessed it — Gwyn Morgan:

The anti-medicare approach goes like this: Given the impact of aging, we cannot continue to spend billions of taxpayer dollars on health care. It is time to be grown-up about this, and to make Canadians assume greater individual responsibility for health care by delisting services and imposing user fees and co-payments. This way, we can release the pressure on public budgets by funding more health care privately. Moreover, since health care is a provincial responsibility, the federal government should reduce, or eliminate, federal transfers to the provinces, and allow them to experiment with private funding — even if this means getting rid of the Canada Health Act. In effect, this approach to health-care reform assumes that the problem is on the funding side, and thus advocates replacing a tax-based pooling with private financing as the fix. Far from being a visionary, future-oriented approach, this is in fact a trip back to the past, to the era before the existence of universal medicare.

… the sounder choice for reform is to provide more innovative, responsive and integrated care, but to do so in ways that preserve the advantages of universal access under medicare. There are many ways to encourage this innovation, and none are really impeded by tax-based funding.

Single-payer administration of hospital and physician services has been “our ace in the hole” in terms of keeping administrative costs down. Private insurance is far more costly and administratively burdensome for both patients and providers. The two most costly health systems in the world — in the United States and Switzerland — have been built on private health insurance.

Expanding on the arguments about funding: fundamentally, the question is not, “how much can governments afford to pay for healthcare?” It’s “how do we as a society afford to pay for the healthcare we want?”

If anything, single-payer administration and restrictions on payment mean that both demand for and the price of healthcare services are being artificially reduced. Moving to a private-payment system would imply allowing greater demand. It would also imply higher prices, both because of the increased demand and because it would be less efficient at keeping prices down.

Copayments might reduce demand somewhat further, but they would probably do so by encouraging people without money to avoid necessary, preventive care, while wealthier people would continue to consume the same services. Furthermore, the vast proportion of healthcare spending is on things that you can’t exactly just skip: hospital costs near the end of life, emergency surgeries, etc. The studies on this are very, very clear.

You can make an honest argument for allowing private payment by saying that it would encourage greater innovation, which might in turn reduce costs. But that’s not exactly working out in the US. In fact, the argument there is that they need to spend so much more than we do on healthcare because those excess profits pay for innovation! (I’d also argue that Canada’s public healthcare system produces plenty of innovation — our academic hospitals, for example, are truly world-class.)

It’s true that rising healthcare spending is a strain on government budgets. But that doesn’t necessarily reflect an impending crisis or that anything is going particularly wrong. It arguably just shows that rising healthcare spending is something we want and appreciate: we spend less and less of our incomes on food and shelter and household goods, and more of it on innovations that let us lead longer, healthier lives.

Any argument about healthcare financing needs to acknowledge that the costs of the healthcare services we enjoy can’t just be wished away, and nor would we want them to be: somebody is going to end up paying. If you don’t acknowledge that, then you’re probably more interested in who’s paying for whom.