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
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
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.