To kick off the silly season, which in Canadian politics now seems to run year-round, Pierre Poilievre wants to make it easier for doctors and nurses to get their training recognized across the country. Which is sensible. But also deeply foolish.
His proposal is sensible in taking square aim at two huge problems in our governance. The first is the ludicrous, enormous network of provincial “beggar thy neighbour” protectionist measures stretching from alcohol and coffee creamer to hairstylists, bus brakes, and, yes, medical credentials. And the second is that our vaunted health-care system delivers far too little at far too much cost. But it’s foolish in ignoring the causes of both, so it can’t work.
For 150 years they’ve been obstructing the free flow of goods, services, and people, and doing it on purpose. Now Poilievre’s “blue seal” testing standard would be open to any province that wanted to stop doing something they wouldn’t need his standard to stop doing if they wanted to. But they don’t. Since his proposal completely obscures the source of the problem, it can’t even improve the level of debate, let alone service.
The other problem is different yet similar. It’s that the provinces make it hard for doctors and nurses to get certified in the middle of a ghastly shortage on purpose, because they can’t even afford the ones they’ve got now. And not because they’re stingy, as some activists holler. Our socialized medicine is extremely expensive by comparison with other countries with universal public health care, taking at least 40 percent of program spending everywhere. It’s just extremely inefficient because it excludes market mechanisms as ruthlessly as it does intelligent discussion.
Like interprovincial trade barriers, the lack of doctors and nurses isn’t some random misfortune like finding black mould in your basement. It’s the result of deliberate choices going back 30 years to when everyone who was anyone in our chattering classes nodded sagely that much of Canada was “overserviced” by greedy doctors deliberately creating demand for unneeded procedures, so provinces slashed medical school enrolment.
Now you might think it’s one-tier foolishness, to be overcome simply by adopting some version of Brian, Bob, and my proposal to make provinces stop spuriously refusing to certify practitioners. But it’s not, because the provinces can’t afford the doctors and nurses they have now so how on earth would they afford more? As with interprovincial protection, they do it on purpose, in this case for cost control. And yes, waiting lists are deliberate rationing.
They are also stupid and mean, of course. It’s a heartbreaking betrayal that so many Canadians really believe our medical system is a shining example to the world until they encounter its grim reality when they’re too ill to push back within the system or in the public arena. But despite all the evidence from thousands of years of experiments, literally, the people who run that system, and those who defend it, are overwhelmingly convinced that free markets create exclusion and want, and socialism creates equity and plenty.
Because of this rather smug error, they can’t understand that allowing patient satisfaction to direct people and things to where they do the most good would provide far more care with the same resources even in the short run, and attract more resources over time. If Poilievre were willing to follow this insight even timidly, he could announce that he would not use the Canada Health Act to punish provinces that allow private insurance for publicly available services.
Instead, and here we run into the third big public policy problem, Poilievre is “thinking” based on what ideas polling tells him are currently acceptable. Which means wandering in circles in the desert going “water, water” instead of heading for a garden.
Nobody’s certified me as a psychiatrist. But I call that approach crazy.
