As this is written, two days after the televised leaders’ debates in the 2004 federal election, the news is filled with stories about a Liberal collapse and a Tory minority or even majority ”” although in truth the polls still show a dead heat.
But it may be that even bigger news coming out of the leaders’ debate was that, at long last, we have begun a rational debate about health care. Late in the debate, Conservative leader Stephen Harper gingerly introduced a discussion of private provision of pub- licly-insured health care:
I know this is a dangerous sub- ject. My advisors say don’t talk about it, but the fact is some- times provinces have allowed in the past few years, they’ve brought in private services cov- ered by public health insurance. Ordinary people can get them. Why do I care and why do we care as a federal government how they’re managed? What we care about is whether people can access them.
That’s essentially what Health Minister Pierre Pettigrew said shortly before the election in a wholly sensible comment his leader made him recant publicly the very next day. The auguries for a reasonable discussion of Mr. Harper’s comments were similarly dismal. The day after they were made Prime Minister Paul Martin con- demned Harper for not caring. The election debate presumably will sink even lower before voting day.
And yet in the weeks and months that follow maybe it will be possible to steer the country’s official discussion toward calmer waters. At the end of the day it may not be necessary to have explicit agreement on what we are doing. Ambiguity and obfuscation have their purposes: In God’s Secretaries Adam Nicolson argues that the King James version of the Bible ”œincluded ambiguity and by doing so established peace” between the different Christian sects then in conflict. Perhaps ambigu- ity helps manage the struggle between our different social-policy sects.
But an academic is bound to think it should be possible to agree explic- itly on at least two principles to govern the debate. The first is that provision is not the same as production and that, as Mr. Harper suggested, we should prob- ably care less about public production than we do about public provision. The second is that how much we produce of a social service is a different question from how we produce it.
On provision vs. production, what we presumably want is provision. We want the ill to be cared for and cured. We want our kids and young adults to become educated. How exactly this is done, so long as there is reasonable access for all, shouldn’t really bother us. If private firms can do a specified job more efficiently than public agen- cies, if laundry, meals and lab tests can best be produced in the open market, there should be no objection to con- tracting jobs out.
It’s true that conservatives and social democrats each have strong views on who is likely to do a job bet- ter. Conservatives believe in the effi- ciency of competition. Social democrats think public servants will do a better job. In the very same leaders’ debate the NDP’s Jack Layton quoted a recent study purporting to prove pri- vate firms will always do a given job worse and more expensively than civil servants (they have to charge a profit, don’t you know?). But there is no earthly reason to decide this question a priori. It should be left to public pay- masters to draw up specifications, take bids and let contracts. If they never choose private suppliers, I will be sur- prised. But that’s a decision to be made on the ground.
The second general principle is closely related. How much of a social service we provide and how we decide to provide it are really two dif- ferent questions. I do suspect most people are one of two types. Either: We want more public services and we want them provided by unionized, regulated, tenured civil servants. Or: We want fewer public services and we want those we have to be provided in open competition by private actors.
Two of the cells in that implied 2 x 2 matrix (”œhow?” vs. ”œhow much?”) are effectively empty. They needn’t be. I doubt we’ll ever get those who want fewer public services to agree that such services as we have should be provided by union brothers and sisters””though you never know in politics. But it does seem possible that people who want more public services and people who favour their public services produced in a variety of ways by a variety of actors might well find a compromise.
For instance, although I would very much like to have my taxes cut at the moment I’m mainly concerned that the public schools in English Montreal are less than great. I’d be willing to back off a push for tax cuts in exchange for a system less dominat- ed by the teachers’ union and the provincial ministry of education.
Provision vs. production, ”œhow?” vs ”œhow much?” They’re two distinc- tions to keep in mind for quieter, post- election times.