Political economists have concerned themselves with this and similar questions, (such as the need for public transportation, who should operate utilities - water, electricity, gas, ...) all the way back to Adam Smith., the question being from a political economist's point of view: “Can and should markets be allowed to govern themselves in these areas or is some government intervention / control needed?” The answer is, of course, that some government intervention is called for and needed in all of these and other areas.

Government intervention can be limited, (eg. power generation in the US ), or quite extensive (eg. public transportation in most countries), or ever present (witness controls over food, drugs, labeling, labour etc.). Government in this context refers to all levels - national, regional and municipal.

The question is not whether governments should exercise some form of control (in fact that is the very purpose of government) but rather how much control is right. Or, turning the problem around: “At what point does government control become too much and stifle economic growth rather than facilitate it”. Clearly, excessive control, as was the case for the better part of the twentieth century in the USSR, does not always produce the desired results.

This brings us back to medicare. If an underlying premise of medicare is to ensure that Canadians are taken care of “in sickness and in health” regardless of their financial situation, how much government intervention is needed, or appropriate, to ensure that this goal is achieved with the utmost efficacy?”.

To answer this question we need to take a closer look at the the circumstances which call for government intervention. For example, if all Canadians had the financial wherewithal to pay for healthcare services out-of-pocket, then the need for government intervention would, all of a sudden, be substantially reduced, or disappear. But such is not the case and therefore government intervention is needed in this area. Also, it is worth noting, that while even a few decades ago Canadians who were financially well off could pay for healthcare out-of-pocket, the rising costs of healthcare, (fueled largely by the cost of pharmaceuticals and technology), is such that even well to do Canadians may no longer be able to pay for the more expensive services they require.

Yes, there is healthcare insurance, but the interest of the insurer and insured diverge dramatically. The interest of the insurer is to insure, to the extent possible, those people who will require minimum care now and in years to come and conversely reject those people who are or are likely to become sick, who are precisely the ones who need insurance the most. The notion that private health insurance (or insurance of any other sort other than government run insurance plans funded by taxpayers) can effectively provide sick people with the coverage they need in the event of serious illness is, more or less, oxymoron-ic.

Coming back to the question... “If only some Canadians need financial assistance to pay for healthcare (this number could be very substantial witness the number of Americans without the means to pay for needed services combined with the rising costs of services)... should all Canadians have to be forced to participate in this government-run health insurance program?”.

There is, unfortunately, no easy answer to this question. However, most people will agree, for example, that healthcare costs are rising so rapidly in many areas so that even the wealthy may find it difficult to shoulder that burden. And so, in this regard, a government run program ensures that everyone will be taken care of (more so than private health insurance plans)! But to say that government run health insurance programs will ensure that everyone is taken care of is simply not the case. For starters, governments like insurance companies, are subject to the rigours of balancing income and expenditures (and making a profit on the way through), which is to say that governments like insurers have little choice but to spread the money around as best they can to get the “biggest bang for their buck”. On the other hand, we can and do exercise pressure on governments (through the electoral process) more so than we can on insurance companies and therefore effect, to some degree, how and where funds are allocated.

For the government to take care of the health of its citizens, especially those who are financially strapped, is without question the right thing to do especially from a moral and ethical perspective. The world needs good Samaritans. The church and its nuns used to fill this role. Now it's up to the government to ensure that sick people are taken care of. This is also the right thing to do from an economic perspective. Healthy people are better able to contribute to a country's production than are sick people. If a country's citizens are so sick as to not be able go to work, or worse still become a “care” burden on those who are healthy, everyone looses in the end.

But having said all this, and being not much closer to a satisfactory answer, even though some form of government intervention seems appropriate, the question remains whether the government is spending the money where it is most needed or whether the allocation of funds needs to be scrutinized. True, it would appear that essential i.e. life threatening, procedures are generally covered by the governments' insurance programs but, on the other hand, any number of other services, which could easily be seen as essential, are not. Dental care for example is not covered and yet are healthy teeth not important to our well being. Neither are visits to the optician, the podiatrist (being able to see, or stand and walk pain free are also important to our well being). Expensive drugs and other treatments for people with rare conditions and diseases are generally not available (these represent too much of a strain on an already well picked wallet).

It's true that in the process of electing those who govern us we entrust them with our money and the power to decide over our lives in countless ways. This however does not mean, as many seem to believe, that it is the sole responsibility of our elected officials, and only theirs and not ours, to ensure daily that the problems which plague our healthcare system are identified precisely and correctly and workable solutions are developed and implemented at every level from every man, woman and child all the way up to Parliament Hill.

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