This review of the book Miracle Cure, appearing in Commentary, reminded me of something I’ve long thought: that the Canadian health care system isn’t all it’s cracked up to be. I used to be active on a forum that dealt with health issues, and over and over again I heard the same complaint from Canadians—unconscionably long waits for testing and treatment, and often-inadequate treatment even when it finally arrived. This was especially true of chronic pain patients, who usually waited through months or even years of intense suffering for a precious MRI, diagnosis, and treatment. When I would hear Americans touting the wonderful Canadian health care system, I would wonder where they were getting their information.

But, as the Commentary article states, I think it’s a classic case of “the grass is always greener on the other side of the border.” It’s nice to think that top-level health care could be had by all. But it just doesn’t appear to be realistic. It’s easy to see the flaws of one’s own system, and to ignore the flaws of the system across the border, especially when one doesn’t have personal and bitter experience of those flaws.

Socializing anything, including health care, tends to lead inexorably to wider availability of a more mediocre service. I am reminded of the drab high-rises of eastern Europe under the Soviets, the norm of tiny apartments shared by multiple families, the hackneyed art, the lack of variety in the stores, the dullness of reduced expectations for everyone. Everyone, that is, except the elites.

For, as even a casual observer of human nature is forced to admit, ye shall always have the elites with you. The Soviet elites got whatever they wanted, Communism or no Communism–spacious apartments, fancy clothes, plentiful food, dachas on the Don (or wherever dachas are). In the US, the rich certainly get better health care, which is one of the many reasons people want to get rich—to have access to better food, clothing, shelter, vacations, and health care. And in Canada, the rich also get better health care—the only difference is that they have to travel to do it, mostly to the US. And travel they do. As Miracle Cure points out, the Canadian health care system might not be able to function even at its current level if not for the safety valve afforded by the exodus of the rich to the US for their health care.

In the US, we don’t lack for proposals to solve our health care system’s problems, but my guess is that all of them are flawed because they all involve difficult choices about allocating resources. I think most people would agree (although not the most extreme Social Darwinists) that we need to have some sort of bottom line health care for everyone, although we don’t agree on how to provide it, how much is enough, or at what point it would kick in (at death’s door, or preventatively, or somewhere in between?). The answers to these questions depend on the answers to the larger questions: how far are we willing to go towards health care equality, and how low will our standards of general health care have to dive in order to attain it (and isn’t it the case that the rich will always find a way to get better care under any such system–and, might that not even be a good thing in some ways, since it provides motivation and energy for work and achievement )?