John Rawls, in Justice as Fairness says that the fair way to choose the societal structures that will serve you is to do so behind a Veil of Ignorance. Effectively, you make your choices about the society you will live in, its laws, its rules, its social safety net, without knowing who you will be in that society. You don’t know if you are male or female, if you are able bodied, or a paraplegic, smart or not, the poorest immigrant, or the most powerful person in the world. You chose on what you would want, based on knowing nothing about your life, knowing that you could need every ounce of that social safety net, or that you could spend your life paying for it, and never need it at all. This is the way, Rawls says, that we get justice as fairness.
And it seems in our world, that we should get fairness this way. Its smart to assume that you could get the worst of the cosmic dice toss, and you could be poor, disabled, not smart, not wealthy. For every opportunity to be healthy, wealthy and wise, there is an equal opportunity that you won’t be. That would be the safe assumption. Not everyone in Rawls’ society is going to be healthy, wealthy and wise. It’s the law of averages. You may all have unlimited opportunity, or at least believe you do, and that’s fine, but you won’t all succeed.
Can I just say as nicely as possible, that Americans don’t always seem to make the safe assumption? It seems like many Americans, rather than assuming they will be the poor sap, assume they will be rich and powerful. I have to confess, I’ve never met so many people who believe in the awesome power of a boot strap. Especially when all the evidence of the world seems to indicate about 10% of your population succeed by bootstraps, and the other 90% of the population languish in whatever socio-economic strata they were born into.
This is the only way I can understand the American health care system – other than to consign most of your country as selfish, thoughtless hypocrites who have no thought for their fellow man(1). I can only think that you all believe you will fall into the healthy, wealthy and wise category. I think your faith in yourselves is commendable, but perhaps not that sensible. Some of you will be poor, sick and weak, with no health care.
So, to Canadian health care. I won’t lie. We don’t have the Rolls Royce, the Porsche, the Aston Martin of health care. We have a nice, reliable Toyota. It looks ok, it gets you where you want to go, but it’s not fast, and as you drive by, no one looks at it and says “Wow!”.
When I got sick with Gabe, I had world class care, as quickly as I needed it. Care that literally saved my life. No complaints. I want to see an RE to try and get pregnant? It’s going to take 11 months to get in, and if I need an IUI, that’s $1500, including the drugs. An IVF is $9K, including drugs. Our system is not perfect. Not at all.
The reality is this: If you have gold plated health coverage, that can’t be cancelled, in the US; you don’t want a Canadian system. You get faster treatment, at nicer facilities, with more renowned specialists, than you would in the Canadian system. I get why you might be opposed to change. I really do. But, as near as I can figure, from pretty extensive reading, that’s not most of you. That’s not even a third of your population. Maybe a quarter.
What about the rest of you?
Could you please explain to me why you are not rioting in the streets about the state of your health care system?
If you have coverage with an insurer and it’s costing you $500 a month for your family? I bet your take home wage is the same as mine, with the higher taxes I pay. If your coverage can be cancelled when you lose your job, or can’t afford to pay your bills, if you aren’t covered for pre-existing conditions, well, your system is screwing you. If you’ve ever had a HMO tell you that they won’t cover you for that doctor, because they are out of network, well, the Canadian system has 1 network, Canada. If you’ve ever driven past a hospital that was closer to your house, to go to the one in your network, if you’ve ever had a doctor file an appeal to an insurance company to get the treatment they say you or your family need, would you please explain how your system is better?
Maybe it’s just me, why hold out hope for an Aston Martin system that you don’t have access to? Why not insist on the Toyota? Maybe it’s a Canadian thing, but I’d rather know that I don’t get to see an RE at the snap of my fingers, but my neighbour next door, the single mum whose barely making ends meet, gets health care coverage. And in a catastrophe? We both get treatment.
Learn something from us, would you? A reliable Toyota in your driveway is still better than an Aston Martin in some one else’s.
(1) Except not my readers. You are all nice.