If people in influential positions say stupid things, I used to chuckle, shake my head, and make a mental note not to take them seriously in the future. Bit by bit, however, I’m chuckling less and feeling alarmed more. It used to be that when politicians intoned “no two-tier health care” I would assume that they were simply saying what they think people expected them to say, and that they actually knew, deep down, that mandating the same level of care for everybody flies in the face of human nature. Now I wonder—don’t these people get it?
People are different—trite, but true. There are people who are endlessly patient—my mother was, for one—and who will wait unquestioningly for their turn, regardless of need. There are also people who cannot wait under any circumstances. In between are the great majority, people who can wait for a certain period of time but who, with increasing wait time or worsening symptoms, will feel that they cannot wait indefinitely. In theory, the entire Canadian population can wait for all kinds of treatment—but, human nature being what it is, a fair segment of the population will find waiting for treatment intolerable. This section of the population will use whatever means available to expedite treatment, including leaving the country if alternatives are unavailable here. As Alan Nixon wrote here a few years ago, we have always had multiple tiers of care in Canada; they depend on who you are and who you know.
Political niceties aside, there is a theoretically harmful aspect of the one-size-fits-all recipe for medical care. The primate research group in North Carolina has for many years examined the effects of hormones, diet, and stress on the progression of atherosclerosis in the macaque model. In a series of studies, they examined the consequences of forced social restructuring on the coronary arteries, by interfering with the behavior of social groups of monkeys to lower the status of dominant members and elevate that of submissive members. This social restructuring caused acceleration of coronary atherosclerosis in all, but especially so in the previously dominant monkeys who were made submissive. The studies showed the cardiovascular effects in primates of taking away the power of self-determination. I know monkeys aren’t human, but it’s food for thought. Take away self-determination, and there’s a real likelihood that you do more harm than you think. Take away my ability to provide care for myself or my family, and you demonstrably affect my cardiac health.
But underlying all this is the cynical understanding that even the fiercest protagonist of single-option care would not be prepared to sit idly by if it was his or her own health, or the health of a loved one, that was subject to rationed care of any kind. Show me tangible evidence that the people who so strenuously oppose private options for care would never use these options themselves, and I’ll accept their opposition as sincere. Until then, I’ll assume they don’t get it, because—human nature being what it is—we’re all looking out for number one.