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In the article some such advocates were quoted as being outraged. But for the most part they’ve been carrying on, including in their thunderous warnings of potential ruin if we had such a system, as though it were not happening. How can this be?

One is entitled to different opinions on the fact that Canada has multiple health-care tiers. But not to different facts.

First, there’s the public system. Then there’s the ability of the rich, or desperate, to seek treatment abroad. Or to access private care in Canada (it’s not illegal to buy or sell it, just to sell insurance of publicly provided services or to work as a doctor in the public and private systems at the same time). Then there’s preferential access for the well-connected. How long do you think a provincial premier, or even an opposition backbencher, will spend on those waiting lists the Fraser Institute, among others, has been so diligent in exposing over many years? Or a professional athlete, elite businessperson or pundit? Or a doctor? Again, duh.

So how can people so ostensibly outraged at privilege and in favour of the common person be unaware that our system is so skewed? Or uninterested in it? And how can they denounce “two-tier” medicine, when we have at least four major tiers and lots of minor ones inside it, including famous politicians getting treatment at private for-profit clinics?

At this point there would be poetic justice in my resorting to the all-purpose peremptorily dismissive term “ideologue” to describe them. But it would be unconstructive. Indeed, it was hurled back and forth by supporters and opponents of the Romanow Report that, you may be excused for having forgotten, saved health care in Canada 14 years ago. And the hurling didn’t get us any further than the report.

So I will content myself with saying there’s nothing wrong with having an ideology, which is just a fancy or abusive term for thinking systematically. What’s bad is having the wrong one. Like thinking central planning can work in Canadian health care, which not only leads intelligent, compassionate people to insist that it is working when it clearly is not, but to react with abuse rather than analysis when challenged.

Multi-tier health care is all around us. The question is: what are we going to do about it?

National Post