As I write this entry, I’m seeing the impact of Hurricane Katrina on CNN. It is difficult to fully comprehend the scope of the devastation which has occurred. It seems to me, though, that every part of the impact can be reduced to a person or family. It is ultimately thousands – millions I imagine – of individuals who have been impacted. An event like this is really about all of these individual stories.

One of those stories is a grandmother whose home was destroyed by the storm. Her granddaughter is with her (I think because her daughter, the girl’s mother, died some years ago). While they are alive and healthy (so far), everything they had is gone. In addition, she has no idea whether or not her two sons have survived, or what their condition is (and has no one to find out in the short run).

It is frightening to contemplate losing, literally, everything that makes one’s life what it is. A lot of people are facing exactly this.

There has been a great deal of talk lately about the increased use of private money in the Ontario health care system. On the face of it, some of the arguments for allowing limited private participation are compelling. However, I don’t think they stand up to much scrutiny. Let me take a shot at two of them.

First, if those who can afford to pay move their business to the private system, doesn’t that leave slack in the public system for the rest of us? I can think of at least 2 reasons why this isn’t true:

1. The supply of many medical practioners is fairly inelastic. In particular, specialists are in short supply. Moving practioners from the public system to a private one doesn’t actually increase the supply of health care. It just moves the supply around a bit, and it is less than certain the new arrangements would be more efficient.

2. If practioners in the private system are more generously compensated, there is the possibility that a gap in the quality of health care may follow. That is, better care for the wealthy.

Second, shouldn’t those who have the ability to buy medical care be allowed to do so? This is harder to refute – on the face of it, if someone can afford to pay for something, shouldn’t they be allowed to pay? However, things aren’t quite that simple.

First, again, the supply of medical professional in fairly inelastic, the creation of private clinics is likely to result in a drain on the public system. That is, the overall amount of health care available, per capita, to the less wealthy may actually go down. The idea that “if one can do something, one ought to be allowed to do so” is usually qualified by “as long as no one else is thereby made worse off”. The less wealthy will be worse off if private care is allowed

Second, since the 1960’s we have accepted that it is a matter of fundamental fairness that access to health care be universal. Permitting private participation destroys that principle. It does so directly by creating the conditions for the unequal provision of care; and indirectly by starting us down a slippery slope toward a full two tier system (once limited private clinics are allowed, the next step becomes all too easy).

I don’t deny the health care system is in trouble. But private clinics aren’t the answer.