A conservakin implied I’m not cosnervative because I said single-payer health care is not the worst thing in the world.
— double t (@tthrush14) August 11, 2015
So, I’m going to take a round about way to explain Canada and why single-payer is not good but not horrible, but why this might not necesasrily work for the US.
Contrary to what most believe English Canada is conservative, it always has been. The US has always been the liberal. When the US revolted against the British in order to install Puritan liberalism Canada was mostly French Catholic at the time and was wary of Puritan anti-Catholicism, so it refused to join the revolt and remained a British possession. The loyalists, Americans who opposed the revolution, moved to Canada because and formed the core of English Canada. At the very beginning, Canada was founded by conservatives who were opposed to the revoutionary liberalism of the Americans.
Almost a hundred years after the American Revolution, Canada became indpendent in 1867. The process was slow because of the inherent distrust fo the loyalists for republicanism and mob rule. Until 1931, the UK still had the power to legislate for Canada. It wasn’t until 1982 that Canada was allowed to modify its own constitution and introduced a Bill of Rights. The Queen is still the Head of State and technically legally owns Canada.
Until the late-70’s Canada was a liberal-conservative country, in the Burkean sense. It conserved its institutions, had a free-market, and reformed slowly. The Liberals were pro-free market, anti-government interventionism, and pro-responsible government. The Conservatives were aristocratic, in favour of noblesse oblige and organic community.
That changed in 60-70’s. During that time, Quebec had the quiet revolution, and its moved from traditional Catholic social doctrine to French socialism and an independence movement began. The Liberal Party under Pearson and Trudeau moved from classical liberalism to social liberalism and the New Democratic Party formed as a social-democratic party from an older farmer’s party. In the Progressive Conservative Party the Blue Tory (neo-liberal) faction began to arise in the traditionally Red Tory (aristocratic). The Blue Tories continued to grow stronger and eventaully eliminated the Red Tories in 2003 with the creation of the Conservative Party.
Around this time, English Canada, or at least the populous and powerful southern Ontario region, adopted US puritan liberalism and combined it with Quebec’s French socialism to outholy the American puritans.
Also up until this time, Canada was an imperial dependency of Great Britain. The Suez Crisis in 1956 and the development of NORAD in 1958 marked when Canada began to move from Britain’s Sphere to the US’ Sphere. This process was completed in 1982, when Canada officially became its own country and informally became an imperial dependency of the US.
Since WW2, Canada has joined pretty much every American war except for Vietnam and Iraq. In Afghanistan, Canadian troops were literally airlifted over by the US. Our military has been consistently and severly underfunded, as we rely on the US to protect us. NORAD made us an integral part of the US continental defence system, while the NATO partnership basically made Canada’s military a semi-independent arm of the US military. The Canadian and Americans markets are integrated through NAFTA and over two-thirds of out exports are to the US, much of which are just raw materials. OUr cultural products are almost entirely American in origin (despite fairly useless Canadian content regulations).
Despite the nationalist left’s posturing (and yes that exists, and essentially it is ‘we hate America and love socialist health care’), or any practical purposes, Canada is essentially a somewhat indpendent 51st of the US, and the left are the one’s forcing American liberal culture on the US.
Despite having adopted the American revolutionary puritan spirit and trying to outrun the US in the holiness competition, this is not natural to English Canadians. Canadians are pragmatic converts to the faith, not natural zealots, like our American breathern.
This manifests in different ways.
First, Trudeau is the only real radical who has ever led Canada. He combined adopted English puritanism and French socialism to enlarge the state. Under him came a huge bloat in government. But beyond that, all our leaders have generally been moderate, non-radical liberals or conservatives. Change, while always moving left, has generally been small, sane, incremental increases rather than radical, half-baked changes.
Example in point, health care. Canada has single-payer, public health insurance, which is technically more socialist that Obamacare’s mandatory private insurance. But even in it’s Trudeaupian radicalness, the Public Health Act is a short, sane 14-page document that basically says provinces need to offer universal comprehensive public health insurance to receive federal health funding. It mostly followed the lead of what provinces were already establishing on their own and the actual implementation was left up to the provinces. On the other hand, Obamacare is a 900-page monstrosity detailing every last specific of dozens upon dozens of provisions and forces them upon the states, willing or not, and has had to be rewritten by the Supreme Court twice, just to be feasible.
This is generally the case. Canada creates short, sensible, incremental laws that leave the details and implementation up to professional bureaucrats or the provinces, while the US creates insane, bloated, radical laws that address everything related or unrelated in detail.
The second is race. Canada is divided by region: southern Ontario thinks it rules the rest of Canada, if it even deigns to notice we exist, the West resents the East, and Quebec hates everybody. These regional divides define Canadian politics, but because they are regional they mostly don’t matter in everyday life. Our conflict is a distant thing with those folks over there. While we have some minor racial troubles, particularly concerning Aboriginals, race is not that big a deal in Canada.
In the US race is everything. All conflict is essentially racial conflict and evevrything must address race. There are two large minority groups each making up about 12% or so of the population. It’s white republicans vs everybody else. So, there’s constant pressure to keep pushing the racial divides and keep the holiness competition moving. In Canada, our largest racial minorities are well-behaved East Asians and South Asians (each at about 5%) and some struggling aboriginals (~4%), who live largely on reserves anyways. So, while there’s some racial nonsense in universities, in the real world Canada, race doesn’t really matter. A few neighbourhoods might be bad, but nothing compared to US ghettos.
The third is bureaucracy. Canada’s bureaucracy, while having all the problems a normal bureaucracy has, is a professional bureaucracy made up of competent people. Most civil servants have to undergo some form of testing when entering the civil service and it is seen as a public service to enter the bureaucracy. The politicians mostly leave the bureaucrats alone. This ensures that the Canadian bureaucracy is generally functional if inefficient.
On the other hand, the US bureaucracy operates on a spoils system and is essentially seen as an opportunity to plunder. The politicians appoint the bureaucrats for political reasons rather than professionalism and race issues eliminated testing for competency. So, the bureaucracy is dysfunctional looting rather than simple inefficiency.
Fourth immigration. Immigration in Canada is generally done on a merit basis. Other than a small number of refugees, the people allowed in are either competent job seekers or the families of said job seekers and immigration is generally spread out among varying countries. Illegal immigration is a relatively minor problem. In the US immigration is based on a lottery, Mexicans are the thoroughly dominant immigrants, and illegal immigration is a major problem. Canada does not share America’s fling the borders open attitude.
Finally, Canadian politicians rationally attempt to fix problems, even the liberals are sane in this regard. For example, in the 90’s Canada experienced a debt crisis. The ruling Liberal Party made large cuts to public and introduced some new taxes and eliminated the deficit and tamed the debt in a few years. Since then, the federal budgets have been more or less balanced and the debt growing but stabilized. Meanwhile, US politicians continue to ignore their debt and deficit and continue to ramp up spending without being able to pay for it.
So, while Canada has adopted socialism, it is not the wild-eyed fanatical puritanism of the US, but rather a pragmatic socialism. Even there though the US and Canada’s level of socialism is not that much different. While Canada’s tax levels are 10 percentage points higher, the US actually now has slightly higher government spending levels than Canada because the US funds its spending with debt rather than taxation.
So, now back to the original point. In Canada, single-payer health care is not the worst thing in the world. It’s probably less efficient than a fully free market one would be and tax levels are somewhat higher because of it, but in terms of health care, it not really that bad for most people. A few people have longer wait times for ‘elective’ surgeries, family doctors can be difficult to find in some place, and there’s the rare person who gets overlooked in the emergency room, but mostly it works fine. While the comparative effectiveness of the US and Canadian systems has been debated endlessly, essentially health outcomes are not really all that different once you account for race and obesity, and the Canadian system is cheaper overall.
The question is, though, if this could actually be applied to the US. The Canadian single-payer system more-or-less works because the government is basically functional. The US bureaucracy is basically dysfunctional. Look at Obamacare, regardless of the merits (or lack thereof) of a theoretical mandatory subsidized health insurance system, the actual applied system is one giant unworkable clusterfuck. I find it highly unlikely that the US would adopt a sane approach to a single-payer system.
Would the US federal government ever be able to create a simple 14-page law that says the states only get federal health funding if they provide comprehensive public insurance? Doubtful. Even if by some miracle they did, there is no way it would be competently and professionally run.