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Saturday, 16 May 2015

The Conservative Standpoint Part 2: Conservative Perspectives on Healthcare

This is Part 2 of the Conservative Standpoint a serial post by Cole D.

Healthcare is a contentious issue for conservatives all over the world. The administration of healthcare in the OECD has become a point of confusion and frustration for many conservative administrations and policy commentators. Our confusion and frustration with healthcare stems from the fact that no single system seems to be addressing the needs of any society in an efficient manner either the quality of care is low or the costs are extreme; either one pays or the whole nation pays through some form of national insurance or provider: neither solution has proven effective.
Generally speaking, the conservative stands for the small government whenever it is feasible, and if not the small then the conservative stands for the local and this makes sense, but a massive undertaking such as healthcare requires massive resources. Some, especially among the American conservatives argue in favour of the multi-payer system, but this necessarily passes extreme costs onto the consumer and has its own limitations—as is evident in the calls for reform in the United States of America, where healthcare expenses have reached a tipping point. Even the republicans are arguing for a variety of reform proposals.
First among the considerations for any conservative examining the healthcare is issue is the moral obligations concurrent with healthcare: society is as Roger Scruton insists fundamentally understood in terms of obligation or allegiance, and indeed, we have a duty to care in some capacity for the least able among us. This was evident to the Canadian reformer Tommy Douglas: leader of the CCF (Co-operative Commonwealth Federation) a conservative social democratic party, rooted in both socialist and Baptist principles; Douglas would be voted the greatest Canadian in 2004, largely for his initiative to bring single payer healthcare to Canada. Douglas understood that medical needs were largely beyond choice and therefore, it was imperative to ensure service was accessible to all. He believed in the moral duty to offer care to those with little means because the health of society was embodied by the health of its people.
All of the prior points about Douglas and universal care may be true, but it must also be acknowledged that a universal healthcare system involved a massive expansion of the state in order to administer and resource such services as were previously provided by the private sector. Ronald Reagan would embody resistance to the expansion of the state into all parts of the individual's life with his production of ‘Ronald Reagan Speaks Out Against Socialized Medicine,’ (1961) where he recognized that he if healthcare became government business then so did all other spheres of private life which may impact the individual's health. All though the government, at least in Canada, has not infiltrated all other areas of life under the guise of ensuring individual health it has not stopped the bureaucracy from bloating to the point of comedic and desperate proportions driving the provinces of Canada as well as the British NHS into insolvency.
The conservative looks for opportunities for localization when possible, and though Reagan and in the modern day others, like Paul Ryan, have been at times the source of ridicule for their opposition to the implementation of single payer care they managed to strike at a deep conservative principle: that which states, that localization is always the best alternative to abstract authority. They insist that the individual can determine what is best for his and her family and this is indeed the truth, just as is the fact that the individual has very little control over whether or not he or she becomes ill. Although we may be able to take preventative measures keeping our weight low, exercising daily, limiting stress, and practicing good hygiene, we are still not entirely capable of preventing our own injury and illness. Trauma still happens; genetics predispose people to disease, unexplained phenomenon occur in the body and the individual pays for this doubly with both hardship and expenses—incurred either through tax or at the point of administration. The problem remains that with the expansion of the state we are increasingly disconnected from the daily health needs of our population compassion suffers; we fail to see that part of our duty in the social contract is to maintain the state of health for both our own family and in the abstract, the family of the nation.
In turn, the economic elements of healthcare merit some form of further examination. Firstly, we face the as a society, both individually as nations, and as the greater community of the western world the advancing age of the baby boomers. Baby boomers are estimated to make up 25% of some populations before the middle of the 21st century, and the majority of these people, unlike their forebears have had small families. This leaves the single payer system in increasingly dire straits as nations such as Canada face the need to cut budgets in order to accommodate a decreasing revenue stream just as burdens will grow to their most intense. In Ontario, it is forecasted by the C.D Howe institute that 2030 will be the year when healthcare reaches 80% of the budget in the most populous province in Canada.
This dearth of service providers has led to another growing phenomenon in Canada and to a lesser extent the UK: a glut of doctors who are unable to find positions in which to practice, and a patient base, which experiences excruciating wait times that are occasionally debilitating if not lethal. This lack of an outlet for excess labour to meet the needs of demand has led to the flight of some of the best physicians to the United States where they are free to practice, with reduced regulation no less. This flight of the doctors is a triple blow to the single payer system, undercutting income taxes from doctors, increasing patient wait times, and further undermining confidence in the single payer system for those who actually practice the trade of medicine.
But what of the American system itself? The paradoxical goliath, which strips wealth from its citizens, has expanded the leviathan of state and yet to those who are able to pay provides outstanding health outcomes? Well, with the flight of the doctors to the United States it is no question that the suppliers of health services are doing well. It is a seller's market. The buyers, who cannot choose illness, find themselves left to foot whatever bill is pressed into their hands. Worse, if the individual lacks insurance this bill can lead to default and the destruction of entire family's meager wealth. This situation is instructive because it paints a picture of a demand curve that is highly inelastic. The demand for healthcare is not generally something that can be postponed, unless it happens to be an elective procedure, but when I address healthcare I do so in the most basic of terms. In essence healthcare consumers, as should be intuitively obvious, do not respond to changes in price this leaves those who are in charge of pricing such services free to determine the rate of exchange with little pressure to keep prices low. Certainly, those who insist the free market play a large role in healthcare believe that the competitive nature of business will ensure competitive costs, however anecdotally speaking this is not the case. This fixation on market solutions leaves us with further complications that leave a conservative uncertain of what constitutes the best solution to the emerging healthcare crisis in the western world.
A number of speculative health reforms have emerged in the western world. Some focus on expanding market based solutions, others with generating revenues, and some focus on limiting the size of the health care apparatus itself. Some of the solutions I will outline, and others are my own suggestions, but together the ideas proposed will outline a variety of conservative minded solutions to reforming healthcare in the western world.
First among the available solutions and most touted is the two-tier healthcare system advocated by some reforms in Canada and practiced in most countries in some form or another: the largest difference between nations is the robustness and availability of private services. For example, in Canada access to private insurance was limited under law until 2005 when it was found unconstitutional to deny private healthcare if waits in the public system were excessively long. Likewise, Canada’s medicare does not cover dental and prescription services in their entirety. A more traditional two-tier model exists in Singapore where services are delivered through both private and public hospitals with a minimum service being administered through public services.
Proponents of the two-tier health care system advocate for the fact that it expands the supplier network for healthcare services and relieves demand on the public system, especially for non-critical treatments and boutique services. The second tier of healthcare would in, proponents eyes, take up the excess personnel not currently employed in the public sector. Presumably, the two-tier healthcare system would alleviate some of the extremely heavy tax burden that currently exists in single payer only systems; a two-tier system would allow those who can afford to bypass the system to do so and at the same time generate income tax revenues from those employed in the service. In turn, those monies could theoretically be directed back toward financing the public system. Whether or not the system has worked in other locales is up for some debate.
Opponents of the two-tier health service, suggest primarily, that private health providers would act as a brain drain vacuuming up the best of professionals to the private system where they are able to demand their own salary and cater to clients of their choosing. This leads likewise to the assumption that a second healthcare tier is in some sense, immoral, though critics are at loath to call it that, because the private healthcare system would allow the provider to charge what they please for services and in turn generate an even greater income from the provision of healthcare. In many places throughout the world people consider the salary of a publicly employed health professional very high or excessive. To allow providers and staff to set even higher wages is often viewed as an act of injustice or exploitation by those who resist some form of privatized medicine.
So as one can see the two-tier system is leaves a number of concerns on the table and lacks a reliable consensus. What this means is that the conservative must look to other solutions to try and reconcile the civil good and health of society with personal liberty and accountability: it is these ad hoc and mixed solutions, which provide the best guide toward a more honest and efficient healthcare system. The wise conservative acknowledges that the sweeping reforms and engineering required for both sweeping privatization or centralization are not conducive to individual well being, leaving, again to draw on economic terms; a broad based system of incentives and disincentives for responsible and irresponsible use of healthcare respectively.
A number of possible solutions immediately come to mind, and they are piecemeal and non-comprehensive: I mean that I may not have only touched the surface of possible healthcare incentives and solutions. But first, if we are likely to contain healthcare spending and improve individual accountability we must give a nod to personal changes we can all make along the way to living healthier lives and taking responsibility for our families, and communities. We have seen tax credits go underutilized in Canada alongside programs like participaction, children, despite our best efforts gain weight, but we have succeeded in reducing alcohol and tobacco consumption through a number of punitive taxes. Therefore, I believe it is a reasonable solution to institute relatively high sales taxes and tariffs on sugar products, MSG, tobacco in some countries, and high fructose corn syrup. Some may argue that the state has no place in making the health decisions of the individual or that government will bloat as it absorbs more revenue. These individuals would be wise to think it Scrutonian terms, and know that the state and society are one and that our bonds of communal well being necessitate some form of action if we are to preserve our well being.  This negative incentive would be couples with a renewed program of intensive physical education in the school alongside a health program and home economics program that emphasizes nutrition and healthy living beyond what is currently provided.  In North America robust physical education, which does not accommodate slackers, the overweight, or parents' sensitivities and instead only concerned itself with wellness and excellence has fallen by the wayside, and funding cuts for many schools have only enhanced this effect. We owe it to our children and their children to provide them with long and healthy lives, society can afford such an investment: redundancies abound in other places.
To further the exercise in healthcare reform we must reduce national dependence on government provisions whenever possible. What do I mean by this? I suggest that we reconsider accessibility, among the nations with universal care, of services, which are not essential to life and limb. We need to cut off government funding to all services non-essential to the immediate physical well being of the nation. An emphasis on acute care only and the abandonment of elective procedures by our insurance umbrella would go a considerable distance in preventing needless expenditure and dependency. I see no reason why most cosmetic surgeries, and non-acute injuries need to be addressed in hospital or by our doctors if a person is triaged and deemed non-essential they should be free only to pay for treatment not receive it.
Coupled to this solution we could add an invoice of services registered by the medical establishment for all visitations: this is especially necessary in nations where universal care is the norm; people rarely consider the opportunity cost and resource burden of their visit. Although it is not a perfect solution, it is a means to make the individual consider the reasons for their visit and the drain on society's precious resources. Will most find this useful, no, but it gives patients a chance to understand the service and critics of healthcare to make sense of costs and ensure that expenditures remain transparent. Likewise, all healthcare expenses by the government would benefit from published online for download and scrutiny by any concerned citizen.
Finally, the demographic trap needs to be investigated because it is the most salient issue in healthcare in almost every nation of the western world, where birth rates are minimal and the cost of importing immigrants by the hundreds of thousands just to stabilize population is high. First, most countries provide a subsidy to stay home parents and a childcare benefit, this subsidy must be expanded drastically. Once we can convince women, it is more profitable and stable to stay at home and raise the next generation the quicker we can stabilize demographics in the western world and end our dependence on the importation of dissimilar foreigners who weigh heavily on society’s capacity to assimilate.  To supplement a growing population and to make all people more self-reliant in terms of funds we could implement a healthcare savings account model. Fraser Institute's Mark Milke advocated such savings accounts for Canada based on the Singapore model and they are critical if we wish to preserve a universal medical infrastructure. Such a program could even work in the United States where individuals would become less dependent on insurance providers by contributing a portion of their salary into a designated savings account only to be withdrawn for either long-term care requirements or medical purposes depending on the model. A mandatory medical savings account infrastructure similar to the nationwide CPP is one of the only ways to make the individual self-sustaining in old age while preserving society's ability to care for both the ill and those suffering acute medical distress. It is by far the most synergistic and conceivable of reforms addressed in this article.
Edmund Burke said that the social contract was, ‘a compact between the dead, the living, and the unborn,’ and healthcare above all other institutions embodies this social reality. The costs both physical and monetary are passed from generation to generation both in terms of debt and in terms of predisposition to ailments. Yet, we do a disservice to our elderly by failing to provide them with a means to live out their last days in affordable dignity. I have done my best to highlight a number of solutions and reforms that are suitable to the conservative temperament. I know that they are not ideal, but nothing is, and I know that Republicans will find them distressing, but coming from statist Canada disposition borders on Red Tory. Therefore, I only wish to emphasize that above all a conservative does not rely on universal solutions, but instead does their best to adapt to time, tradition, and circumstance.

If you disagree let me know in the comments!