It was, I think, Hugh Trevor-Roper who first described Nazi Germany, far from the monolith imagined, as rather a ''jungle of satrapies'' consumed by the inner convulsions of a thousand tiny power struggles. Or to generalize: the defining attribute of a totalitarian system is not absolute authority, but absolute anarchy - the supplanting of the rule of law altogether by the rule of men.

Health care in Canada is not yet organized on totalitarian lines, but the principle is as true in degree as in the absolute, and applies in economic as much as political spheres. The suppression of the price system - the rule of law - plunges the allocation of scarce resources into the ''jungle of satrapies'' of interest-group politics.

The absence of price as a means of rationing demand does not mean that demand goes unrationed. It is simply effected by more brutish means. It may be random chance, in the case of those patients circling Toronto in the back of an ambulance searching for emergency care beds. It may be ''who you know'' or ''the squeaky wheel'' for the thousands on months-long waiting lists for surgery. It may be geography, for those rural areas without doctors.

Or, at the policy level, it may ultimately amount to deliberate discrimination: Britain's National Health Service has for years refused kidney dialysis to elderly patients. Such arbitrary limits mock any claim to guarantee universal access merely by virtue of free delivery at point of care.

ABSURD CONCLUSIONS

One of the results of living within such a system, however, is one becomes ensnared in its assumptions. Public support for any such public service tends to be the square of its decrepitude, for monopoly not only breeds inefficiency, but ignorance of alternatives. But even proposals for ''reform'' typically start from existing premises, and so inevitably reach absurd conclusions.

If one accepts the present method of allocating health care resources, then the response to a shortage is quite naturally to cut off services to the elderly, as some ''ethicists'' advise, or to place controls on doctors' numbers, or movements, or incomes, as various provincial governments have done. But these are no less quackish then the more popular home remedies making the rounds: more spending, to increase supply, and user fees, to restrict demand.

Doctors are especially keen on the first. As they do every year, they have been busily filling the newspapers with letters and stories of the many lives that will be lost because of ''government spending cuts'' and ''underfunding.'' There has, in fact, been nothing like a cut in health spending in 25 years: spending nationwide has increased 12.4% per annum, easily outstripping growth in the economy. Ontario now spends a third of its budget, or $12.7 billion, on health, twice the share it claimed in 1970, when shortages were unknown.

But beyond that, it is simply not meaningful to talk of ''underfunding,'' as if there were some set standard we are falling behind. How much of our national wealth to devote to health care is a political decision; how to spend that efficiently is an economic one. Until we have some assurance that efficient use is being made of existing funds, then we cannot judge whether we should prefer to devote a greater or lesser share. In the absence of competition and market prices, indeed of the most elementary opportunity cost analysis at any point in the health care system, not a penny more.

Likewise, disappointing as it may be to its conservative advocates, there is simply no evidence to suggest that consumers are in any meaningful way ''overburdening'' the system for lack of user fees. That is, the demand for health care is relatively inelastic with respect to price. A user fee would have little effect on demand, but for the lower income levels, where it would deter not only ''frivolous'' use but more essential services as well - adding to costs in the end.

The mistake of these false friends of markets is to think the general necessity of pricing scarce resources requires that patients must pay directly. But since most of the decisions on treatment are made not by patients, but by their doctors, this misplaces the source of the trouble.

The problem, rather, lies in the role assigned to doctors as gatekeepers of a system in which no one, not doctors, not health administrators, has a direct incentive to monitor costs and husband health care resources wisely. Why this is so, and how the system might be redesigned, I shall treat of next week.