Socialized Medicine, Economic Catastrophe, and Morality

August 29, 2009 by  

2009-08-29.brain-cancerCapitalism Magazine yesterday ran a column by John Lewis, an historian and an Objectivist associated with the Ayn Rand Institute. Lewis reports on the economic predictions made by David Walker, who is the former Comptroller General of the United States, and former head of the U.S. Government Accountability Office. He explains that:

Medicare spending from now until 2032 will be 235% of economic growth. By 2040, Medicare will be spending about 10% of the nation’s Gross Domestic Product annually, and the annual deficits of the United States will total some 20% of the total Gross Domestic Product.

The bottom line is this: mandated fiscal entitlements, projected into the future, are over 52,000 billion dollars. That will equal 90% of all household wealth in the U.S., and will place a burden of over 450 thousand dollars on every household in the land. This is almost ten times the present median household income level.

Lewis quite rightly submits that:

A nation that violates the rights of its citizens cannot, in the long run, escape the consequences of its moral failure. When a nation with the unique strength of the United States does so systematically and over decades, the results must necessarily be catastrophic. The dire economic forecast of David Walker illustrates the connection between the moral and the practical. To regain our economic viability we must regain our moral viability.

However, many U.S. citizens might not be aware that, in Canada, we’ve seen the same kinds of predictions for years. Here, it has turned out that there is another variable that intervenes and prevents spending from reaching most or more-than-all of household income: rationing. Yes, taxes in Canada are crushing; and yes, the single largest expenditure is socialized health care; and yes, it is immoral. However, there is more to the horror than the fiscal catastrophe. There is also a health care catastrophe.

Under Canada’s constitution, only provincial legislatures (Canada’s analogue to state legislatures in the USA) have the authority to make laws concerning health care. Since the 1960s, each Canadian province has instituted tax funding for most health care services, and most have banned private health insurance and patient-pay arrangements.

In 2005, in the case of Chaoulli v. Quebec (Attorney General), [2005] 1 S.C.R. 791, 2005 SCC 35, the Supreme Court of Canada found that the rationing of health care in the Province of Quebec was resulting in extremely long waiting lists. Referring to various studies and to the evidence of physicians, two members of the majority of the court wrote:

Delays in the public system are widespread and have serious, sometimes grave, consequences. There was no dispute that there is a waiting list for cardiovascular surgery for life-threatening problems…a person with coronary disease is [translation] “sitting on a bomb” and can die at any moment…patients die while on waiting lists…Inevitably, where patients have life-threatening conditions, some will die because of undue delay in awaiting surgery.

The same applies to other health problems. In a study of 200 subjects aged 65 and older with hip fractures, the relationship between pre-operative delay and post-operative complications and risk of death was examined. While the study found no relationship between pre-operative delay and post-operative complications, it concluded that the risk of death within six months after surgery increased significantly, by 5 percent, with the length of pre-operative delay…
the one-year delay commonly incurred by patients requiring ligament reconstruction surgery increases the risk that their injuries will become irreparable…95 percent of patients in Canada wait well over a year, and many two years, for knee replacements…the harm suffered by patients awaiting replacement knees and hips is significant. Even though death may not be an issue for them, these patients “are in pain”, “would not go a day without discomfort” and are “limited in their ability to get around”, some being confined to wheelchairs or house bound…over one in five Canadians who needed health care for themselves or a family member in 2001 encountered some form of difficulty, from getting an appointment to experiencing lengthy waiting times…Thirty-seven percent of those patients reported pain…In addition to threatening the life and the physical security of the person, waiting for critical care may have significant adverse psychological effects…Studies confirm that patients with serious illnesses often experience significant anxiety and depression while on waiting lists. A 2001 study concluded that roughly 18 percent of the estimated five million people who visited specialists for a new illness or condition reported that waiting for care adversely affected their lives. The majority suffered worry, anxiety or stress as a result.

Apologizing, in effect, for the horrors of socialized medicine, two members of the minority of the court, who were opposed to striking down Quebec’s ban on private health insurance in order to preserve the tax-funded “system” (note: preserve not the patient, but the system), wrote:

Waiting times are not only found in public systems. They are found in all health care systems, be they single-tier private, single-tier public, or the various forms of two-tier public/private …Waiting times in Canada are not exceptional…The consequence of a quasi-unlimited demand for health care coupled with limited resources, be they public or private, is to ration services. As noted by the Arpin Report, Constats et recommandations sur les pistes à explorer: Synthèse, at p. 37:

[translation] In any health care system, be it public or private, there is an ongoing effort to strike the proper balance. . . . For a public system like our own, waiting lists, insofar as priority is given to urgent cases, do not in themselves represent a flaw in the system. They are the inevitable result of a public system that can consequently offer universal access to health services within the limits of sustainable public spending. Thus, to a certain extent, they play a necessary role.

The expert witnesses at trial agreed that waiting lists are inevitable…The only alternative is to have a substantially overbuilt health care system with idle capacity…This is not a financially feasible option, in the public or private sector.

Obviously, the underlying but unstated moral assumption made by the minority is that the same nature and degree of health care must be provided to every patient. But for that assumption, the falsity of their conclusion about financial feasibility would be more obvious.

Luckily for those who are or will be sick and dying in Quebec, a majority of the court concluded that because the government monopoly could not provide health care well enough, Quebec’s law banning private health insurance was unconstitutional.

In response to the decision, socialist governments in other provinces have taken steps to fast-track a short-list of common procedures (e.g., hip replacement) having waiting lists that have most attracted the attention of the media, and the outrage of the public. Their aim is to contrive data for future court challenges to their own government health care monopolies. Specifically, they aim to create evidence to make it look as though rationing leads to suffering and unnecessary death in Quebec, but rationing is a smashing success in their own provinces. They hope, in that way, to have the courts render different decisions with respect to their respective bans on private health insurance. But, all the while, people continue to suffer and die because health care in Canada is rationed. Faster access to hip replacement surgery necessarily comes at the cost of slower access to other procedures.

The lesson from Canada should be this. Do not be led to believe that the system will go bankrupt. Keep in mind that, to avoid bankruptcy, the socialists will simply let an increasing number of people suffer and die.

The guiding philosophical commitment of socialist governments with respect to socialized medicine is, in effect: So long as no person is permitted to use his own money to avoid the suffering and death to which less wealthy people are subjected, the system is just. As the minority of the Supreme Court of Canada put it under the ominously dictatorial subheading “Who Should Be Allowed to Jump the Queue?” (emphasis added):

In a public system founded on the values of equity, solidarity and collective responsibility, rationing occurs on the basis of clinical need rather than wealth and social status.


Quebec does not want people who are uninsurable to be left behind. To accomplish this objective endorsed by the Canada Health Act, Quebec seeks to discourage the growth of private-sector delivery of “insured” services based on wealth and insurability.

As Lewis rightly submits, economic catastrophe is evidence of the impracticality of altruism, collectivism, and socialist health care, but the essential problem is moral, not economic. The monstrous and unnecessary suffering and death imposed by socialized medicine in Canada provide additional evidence of the impracticality of the altruism that underlies socialized medicine. So long as citizens believe that it is immoral to put ones own happiness before the alleviation of other individuals’ needs, economic catastrophe will be just one of the many horrors resulting from socialized medicine in the USA.


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