Merciless Wells

Never one to miss a chance to stick a shiv in the Martinites, Paul Wells shows no pity on the Pettigrew pirouette, and rightly so. It's not really a pirouette, of course: there is no practical distinction between saying you wouldn't prevent private provision of health care (Tuesday) and saying you wouldn't encourage it (Wednesday). But it's one of those non-distinction distinctions that the media seems to find endlessly confusing. The whole Romanow report was based on this: every report had him saying the government should ban private care, but in fact it said nothing of the kind, as the great man was finally forced to admit. It just said that his personal preference was for public care. But as there is no law against private providers -- the Canada Health Act does not prohibit it, contrary to another popular impression -- you'd have to amend the Act to prohibit them. That, and nationalize all the doctors, private for-profit providers every one of them, which not even the NDP is contemplating (I think). But if disliking private providers is not the same as banning them, allowing them is not the same as preferring them, always and everywhere. This is the distinction that eludes those countless experts who pop up at times like these to announced that "studies prove" that private care is more costly, kills people, etc. "Studies prove" nothing of the kind, of course, but in any case that would only be relevant if we were deciding whether to shift the whole system over to private providers, en masse. But we're not: the only issue is whether to allow the privates to compete with existing providers. If they can't offer better service at lower cost, they won't get the contract. That in most cases they can, even allowing for the necessity of earning a profit margin, shows what you can do with those studies. So why was Pettigrew so anxious to correct the "impression" he had left the previous day? Because the media had misunderstood his position in precisely the way the Liberals had hoped they would misunderstand the Conservative position: namely, that because the Conservatives would allow the provinces to experiment with private care -- as the Canada Health Act does in law, as the Liberals do in practice, and as Pettigrew had just declared was the Liberal position in principle -- this somehow made them a threat to public health care; indeed, that this was somehow a change in policy. It's not: it's simply an acknowledgment of what the policy has always been. Why is this charge -- "you're in favour of private care (because you would not prevent it)" -- so potent? Why were the Liberals so anxious to use it against the Conservatives, and why was Pettigrew so deathly pale at having thrown it away? Because of yet another distinction that no one seems to be able to keep straight in their head: between private provision and private finance. The public-sector health care unions and their proxies on the left have thrived on the false suggestion that private care equals user fees equals "two-tier" care. For that matter, too many people on the right have been all too willing to fall into that trap, thinking that the only way to reform the system is to charge consumers directly. But there's no necessary connection between the two, and certainly there is no logical equivalence between them: you can have private providers operating within a wholly publicly-financed system. As in fact we do. As in fact we have always done. And this is where Wells is so devastating. Pettigrew is the Health minister. He is a senior minister in a government preparing to run on a pledge to "fix" health care as its main, if not only platform plank. He has had weeks to prepare for this moment, culminating in a speech, a press conference, and an appearance before a Commons committee. And he -- they -- still can't get it right, or deliver a consistent message from one day to the next. Gosh, do you think this means they won't be able to demagogue this issue, after all? What a shame.