In the Canadian province of Quebec, it is technically illegal for patients to purchase private health insurance or pay for private medical procedures. Quebecans pay into the public health system and take the treatment the system hands out, whenever it can manage to hand it out. This latter variable—the variable of time—is the subject of a new legislative proposal released by Premier Jean Charest and Health Minister Philippe Couillard.

The issue is that of waiting in lines. In Canada, the demand for medical services far outstrips the abilities of its doctors to supply those services. It has to. With comprehensive care literally guaranteed by the government, demand is, in effect, infinite¹. But while such grandiose promises can always be offered on the demand side, the solution of supply cannot be faked. Supply entails real equipment, real facilities, real medications, and real doctors. When demand exceeds supply and prices are not allowed to rise, the result is a shortage. And a shortage means waiting, and waiting, and waiting.

(In a study quoted in the Wall Street Journal, The Fraser Institute, a Vancouver think tank, calculated that in 2003 the average waiting time from referral by a general practitioner to actual treatment was more than four months. Other waiting times from the same study: two months for post-surgery radiation therapy; three months for an MRI; a year for neurosurgery. Across all cases, the average waiting time from referral by a general practitioner to actual treatment is more than four months.)

Charest and Couillard's proposal guarantees that, for certain procedures such as knee and hip replacements and cataract operations, Quebecers will no longer have to wait more than six months. If a patient does have to wait for more than six months, then the province will pay for the procedure to be done by a private doctor. And if the patient has to wait for more than nine months, then the province will pay for the procedure to be done outside of the province or even outside of the country. They say their proposal will mark the beginning of "a new era for health care in Quebec."

I hope the people of Quebec are prepared for a budget crisis.

Previously, keeping people waiting in lines was the one way in which the government could achieve the effect of cost control. It could offer "unlimited" care because it could fulfill this promise at whatever pace it chose (i.e. a very slow one). It limited the demand it met by limiting the supply of doctors, nurses, operating rooms, and MRI machines. Want to reduce outpatient expenditures by 29 percent? Easy: just shut down medical centers for the weekend (thereby eliminating two-sevenths, or 29 percent, of the work week).

Allowing patients to send the bill to the government for receiving medical services in other countries will decrease some waiting times, but it will do so at tremendous expense. The government could control its costs (dishonestly) by limiting the supply of services in Canada. They cannot, however, be controlled on the much larger world market, where Canada's freebie-fueled demand actually can be met by existing capacity. When people get to see how expensive free and unlimited healthcare really is, will they still think their system works?

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¹ This irrational creation of infinite demand is not to be confused with the rational sense in which man has a limitless need for wealth. The difference is that in the latter case, man seeks goods to the extent he is able and prepared to pay for them, i.e. to the extent that he has produced things with sufficient trade-value to be able to exchange for the goods and services he desires.

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