Recently I've heard a lot of talk about the "two-tier" healthcare system, essentially on TV. Every politician was accusing every other politician of being in favor of such a thing, and every journalist or interviewer was trying to find out if the politicians attacked REALLY supported it. And then the "heroes" came in, claiming to be in favor of the total abolition of the private sector as far as healthcare is concerned, and that, in harmony with our Canadian ideal of equality(these days it's trendy for every Western country to have equality and diversity as their most "fundamental ideals"...), they would bring back and safeguard the monopoly of the public health-care system. Canadian Alliance leader Stockwell Day even brought to a debate a little piece of cardboard on which he wrote something to the effect of "NO TWO-TIER SYSTEM", so as to make sure that the mindless masses got the message that they definitely, oh no, do not condone the infamous system. But I think there's something I missed...

What is so horrible with the "two-tier" health system ? Would someone please explain this to me ?

For those who wouldn't know(hey, maybe the expression is limited to Canadian politics, or maybe this article will be read by some people who never opened their TV), the "two-tier" health system is a pejorative label for partial privatization of the healthcare system. In other words, in the "two-tiered" system those who can pay for health services can do so and get better(and especially faster) services, while those who can't will get the regular, public service -- which is obviously worst(since, after all, inefficiency, waste and incompetence are intrinsic to socialist policy !).

But, not only am I in favor of it(the "two-tier" system), but Rawlsian moral theory, upon which liberalism is (partially) built, should also support it... John Rawls writes that a society should allow inequalities only to the extent that they benefit the worst-off group in society. This seems to be the case with the "two-tier" health system. After all, the "poor"(referring here to anyone who can't pay for private health services) benefit from the "rich"(referring here to anyone who can pay for private health services) paying for their services. How ?

1) The "rich" who go to private "clinics"(or whatever) instead will leave room to the "poor", giving faster and more efficient public health services(since there are less people in the waiting lists) for those who really need it.(After all isn't the problem emergency-hallway traffic jams ?)

2) The "rich", by pouring money into the private sector, help invigorate the economy(and help produce more research and development -- another long-term investment), indirectly helping the public services(including, obviously, the public health-care system).

Both parties win. The poor are given better services, both in the short run(because the rich aren't in their way), and in the long run(by helping the economy, which feeds the public services). Thus, if a liberal wanted to be consistent(but since when are liberals consistent ?), he would have to support the two-tiered health system. But no, instead his ideas are based on totalitarian left-wing politics, absolute equality of result(but not of opportunity) for all. And the latter is not a good tactic, pragmatically speaking. It's simple games theory...

Let's say there's a pot of gold coins, containing two kinds of coins: 1000$ worth coins, and 2000$ worth coins. I have two offers. Either you:

1) Take a 1000$ coin and I take one too(i.e. 1000 for you, 1000 for me), or you;
2) Take a 2000$ coin and I take two 2000$(i.e. 2000 for you, 4000 for me) coins.

Which one will you choose ? Let's hope you'll go for the second option, even though it's "unjust". Otherwise, you're pretty stupid. With the first option, after three turns you'll only have 3000$, while with the second option you will have 6000$: obviously, the latter is more advantageous. Who cares how much money I make ? This isn't a "last man standing" or "kill 'em all" type of game. You don't go for the option that will put me down the most, but for the option that will give you the most.

Now, life is not a "last man standing" or "kill 'em all" type of game either... So, isn't it wiser for you(as a "poor" person) to choose the option that will give you a bit more, even though it gives a lot more to the "rich" ?

I know that to some, if not most(I hope), the question isn't really privatization itself but their fear that privatization would lead to less funding of the public services. First of all, I don't really see the link. It's entirely possible, desirable, and understandable that the government would want to allow the private sector to develop while keeping the funding constant(or even raising it). And, anyways, this is an entirely separate question(that I shall not address here). If that's what scares you, then why keep whining about privatization when the problem simply is "under-funding"(or fear of potential under-funding) of public services ? You're in fact attacking something good(as explained earlier), in order to prevent something not necessarily connected. You're attacking the wrong enemy.

Of course, whether or not the politicians really do want to use this as an excuse for giving less money to the public services is another question... but, in that case, the problem will be the politician(and the under-funding of the public service) not privatization ! There is, as far as I know, literally no direct causal link between privatization and diminished public funding.

What amazes me the most is that it's not solely the extremist left-wing nuts who hate the "two-tier" system so much, but so do the Canadian "Progressive-Conservative party" which, I may need to remind you, is supposed to be at least slightly right-wing and the "Canadian Alliance" party, which most other parties label a "far-right" party!?!?!?!

I mean, if the "Canadian Alliance" adopts such a left-wing position(I assume that a position that is more egalitarian than a liberal one can be considered left-wing), shouldn't the officially left-wing parties be off-scale or something ? But no, welcome to Canadian democracy, where there are five identical copies of one political party. And, you know what ? You get to vote for the name and the logo you like the most ! More than that, as a bonus, you get a semblance of freedom of expression ! Isn't it so much better than a totalitarian state ? Wow.

Simon Ouellette, 22/12/2000


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