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From Friday's Globe and Mail

POSTED AT 10:13 AM EDT Friday, Aug 20, 2004

It has been a summer of dire warning about eroding health care, leading doomfully toward a health summit in September. This is not new. For a decade, virtually the entire political class and opinion elites have said our health care is not ''sustainable,'' as if it is a coastline faced by a weather system. The sole public voice (aside from the public) to reject this fatalism has been Roy Romanow. This week, he noted that tax cuts have cost $250-billion in revenue since 1996 while health costs have risen just $108-billion. In other words, the decline in health care is a result of free human choice.

The reason public opinion has resisted elite wisdom about our hopeless health care is not that people adore those "free" doctor visits, but that they have come to see it as a basic right. It may not have begun that way, but it soon took on that air. This sense of health care as a right makes it resistant to fiscal fear-mongering. What would you say if you were told we cannot afford free speech, or democracy, due to current economic conditions? Health care is different and similar. But rights can be lost, as well as gained. To shed light on how that happens, let me take another case: the right to be free of destitution, known disparagingly as welfare. (Welfare is not just about being poor but being destitute. Welfare incomes are often about 15 per cent of average income and miles below the poverty line.)

The sense of welfare as a human right emerged in the 1960s, like health care. It, too, occurred by stealth. Till then, welfare had been akin to charity, bestowed by their betters on the poor, who were seen as partially or wholly responsible for their plight. But during the Depression, the destitute started being seen as victims of market forces largely outside of their control. The token of this change was the 1966 Canada Assistance Plan (CAP), which offered federal funding for welfare as long as the provinces made it universally available, provided a decent living standard and removed distinctions between the worthy and unworthy poor. It was a kind of informal acceptance of the right not to be destitute.

The retraction of this right -- one of the "givebacks" of the 1990s -- was the work of then-finance minister Paul Martin. His 1995 budget abolished the CAP, replacing it with the Canada Health and Social Transfer, a pot of money the provinces were handed with far fewer conditions attached. Ontario and B.C. swiftly brought in the old divisions between the worthy and unworthy poor, plus programs such as workfare. The right of Canadians not to be destitute was effectively repealed. It's striking that this did not extend to the health component of federal funding. There, standards stayed in place and the right to health care stood. The ill as a class were now treated as more fully human, as mirrored by their rights, than the poor -- surely due to calculating the votes involved.

This was bad news for the poor. But I'd say it was also bad news for the rest of us. The loss of the right not to be destitute makes the poor less fully human. The non-poor, meanwhile, become more fully human, and they get to show it by lording it over the poor, deciding their fate by giving or withholding welfare. This kind of social breakup is the essence of charity, which was defined in 1825, for instance, as something that exists "to signify the promoting of the happiness of our inferiors." Welcome to the 19th century. Less human solidarity, more division and strife.

The accumulation of human rights is a social, historical process. It isn't handed down once and for all. It can move ahead and fall back. If you can find a reason to deny the rights of the destitute, you can do the same for those of the ill. Why not give health care only to those who deserve it, who exercise, don't smoke etc. It is not inherently illogical. The same for free speech. You can find reasons to withdraw it: terror, moral decay . . . The right to vote? At one time, it went only to those with property or other virtues.

When they came to take away the rights of the destitute, I was not destitute, so I did not speak out. Then they came to take the rights of the ill.