Montreal, September 14, 2002  /  No 109  
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Pierre Lemieux is an economist and an author.
by Pierre Lemieux
          There is no use to recriminating like children against Quebec's Bill 114, adopted in August, which forces some physicians into emergency room duties. Treating only the symptoms won't cure the disease.
State-managed medicine
          Suppose that instead of creating public health insurance three decades ago, the federal government (out of concern for the poor, of course) had created national public food insurance. Would anybody be surprised if, today, there were shortages of personnel in grocery stores and if it were difficult to find a convenience store open at night? When the state runs hospitals the way grocery stores were run in Eastern Europe, shortages and disruptions are not surprising. 
          The market is not perfect, true, but the state's political and bureaucratic processes are even less so. Quebec politicians and bureaucrats only woke up when somebody died because an emergency room was closed. Less visible and publicized deaths that were, over the years, indirectly caused by our state-managed medicine, went unnoticed. And what about the pain, discomfort and anguish that patients suffer daily in medical queues? Socialist production systems are notably incapable of efficiently taking into account subjective individual preferences. 
          Conscripting producers, as Bill 114 does, will not solve the basic problem of our socialized medical system. This law will divert coerced emergency staffers' time from other needed medical services, creating new problems elsewhere. Physicians will have new incentives to move out of the province or out of the country. When market prices are prevented from allocating resources (as an increase in emergency doctors' remuneration would have done on a free market), the state has to wave its visible fist. 
          The negative impact of controls on work incentives is not fresh news. In the early days of the nationalized health system, from 1972 to 1978, Quebec general practitioners reduced by 11 per cent the average time they spent with their patients.(1)  
     « For one, I do encourage and advise physicians to disobey this so-called law. Civil disobedience may be the only language that the state understands. »
          In fact, physicians have not really been conscripted by Bill 114: they already had been by 30 years of nationalized medicine. Besides normal fines, the new special law allows the state to punish any recalcitrant doctor by simply reducing what it pays him. Physicians may like to think that they are still independent professionals; in fact, they are minions of the state. 
          Socialized medicine also undermines the rule of law. General and impersonal laws cannot micromanage a complex industry like health: to do this, one needs minute regulations, special laws, and state diktats that violate classical liberal ideals. For example, look at how Bill 114 openly shifts the burden of the proof to doctors suspected of not obeying state whims. 
          Section 9 of Bill 114 provides another illustration of how our quiet tyranny works. It states that nobody may "encourage" or "advise" a physician or a medical association to break the law. For one, I do encourage and advise physicians to disobey this so-called law. Civil disobedience may be the only language that the state understands. 
          What is more worrisome is what will happen when part of Bill 114 expires at the end of the year. Will the state continue to strengthen its coercive stranglehold on consumers and producers in the health industry, thereby creating new problems that will call for more coercive, centralized solutions? Or will it allow real private medicine to develop, as the Quebec Chamber of Commerce recommended two decades ago? 
          In 1880, Herbert Spencer, a former British MP converted to libertarianism, wrote: "If government half a century ago had provided us with all our dinners and breakfasts, it would be the practice of our orators today to assume the impossibility of our providing for ourselves." We have become so addicted to the state that we simply assume that health services would not be produced if nice politicians and bureaucrats did not provide them for us – with our own money. We need to break the vicious circle of more state coercion to solve problems created by previous coercive measures. 
1. Gérard Bélanger, "Les dépenses de santé par rapport à l'économie du Québec," Le Médecin du Québec, December 1981.  >>
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