Wednesday, February 20, 2008

Claude Castonguay can fuck right off.

See here if you're not yet informed.

(1) The guy works for insurers. Does he maybe, possibly, kinda, sorta have a conflict of interest thingy going on here? No, of course not... insurance company execs are entirely dispassionate and not in the least bit interested in expanding their profits. Like every other executive in every other field ever.

“People can choose what car they want to buy, what suit they want to wear, what house they want to live-in, but when it comes to their health, they don't have a choice. That's what I'm against,” Mr. Castonguay said in an interview Tuesday. “We are proposing to give a greater role to the private sector so that people can exercise a freedom of choice.”
Fuck off. Seriously. This is such a stupid argument it's almost hard to know where to start in critiquing it.

First, you do have a choice when it comes to healthcare. You can choose your doctor, which hospital you want to go to, which specialist you want to see (or, at least, which you don't), and so on. These are all choices, for fuck's sake.

Second, you don't have unlimited choice when it comes to cars, suits, and houses. You choose the ones you can afford. So, if you can't afford a new car, you buy used. If you can't afford a recent used car, you buy an older one. If you can't afford a car that runs efficiently, you buy one that doesn't. And so on. Your purchase power limits the quality of the goods you can purchase. If we extend the model to healthcare, then, the lower classes will end up with shit healthcare, the middle classes will end up with healthcare that's kinda maybe good enough, and the upper classes will get gold-plated healthcare to go with their luxury cars, thousand-dollar suits, and sprawling estates. In other words, extending private interests into public healthcare will reduce our ability to choose. Obvious to the sane amongst us, I know, but apparently this has escaped M. Castonguay.

Third, so fucking what? Framing this in terms of "choice" is absurd. It's not about choice. It's about a scarce resource (healthcare) that we all need and how to distribute it in a just fashion. Framing the issue as a matter of "choice" concedes the significant political point to the libertarian fringe: it accepts their understanding of justice and tries to foist it off on the rest of us. Which is pure bullshit. Libertarians -- honest ones -- defend the claim that a just distribution turns on individual choices (rather than, say, distribution according to need, or according to outcome, or according to one of the many egalitarian measures). Dishonest libertarians -- like M. Castonguay -- just assume it and hope the reporters are too stupid to notice.

So, fuck you, Claude Castonguay. And fuck you Rhéal Seguin, for falling for his bullshit.


Catelli said...

He also leaves a big glaring hole about the lack of medical staff.

All his incentives revolve around encouraging current doctors to do more work.

Not enough money in the world to encourage doctors to work 120 hours a week for the rest of their lives.

ADHR said...

Most seem to give it up by the time they have their first kid. I worked for a family physician in Vancouver who put in long hours -- 9 till 7 weekdays and every Saturday -- until he had a daughter. He had to shut down the clinic for other reasons, but his new practice was very reduced. Sooner or later, it happens to everyone, 'cause physicians are people, too. They have goals beyond being doctors.

We need to train more staff, put more of the burden on non-physicians (insofar as they can handle it; e.g., nurse practitioners), and recruit more foreign-trained staff. And also encourage staff to practice in underserved areas. Without those kinds of incentives and changes, the system will continue to stagger.

Of course, we could also discourage people from going to the ER for the sniffles, but (a) that's only part of the solution, and (b) it's partly due to not having enough non-emergency staff for people to see when they're sick!

Anonymous said...

So he is acting in his own self-interest? Was he acting in his own self-interest when he established the socialized health insurance system? Was he putting forth a "stupid argument" when he advocated socialized medicine? He has gone from angel to devil, and from smart to stupid, even as he grew older. Most people learn as they grow...

ADHR said... Speaking of stupid arguments....

(1) I strongly suspect he is trying to build up a little nest egg, yes.

(2) I love how "socialized" is supposed to be a knockdown argument, all in one word. I have no idea why he helped to build up Canadian medicare. Enlighten me as to his selfless motives.

(3) Are you seriously suggesting that because his argument for position A is stupid, his argument for position not-A must have been equally stupid? Ye gods. I also like the hand-waving dismissal of the actual reasons I gave as to why the argument was a stupid one.

(4) I'm not persuaded most people learn as they grow. I think it depends on the person. Some become set in very stupid ways, some retreat from bold positions out of an ill-considered caution, &c.

Marty Lee said...


Claude Castonguay's views received a moments attention today in the House HELP Subcmte. USA which held a hearing examining the merits of a single-payer. Click on the little red camera to watch.

The man speaking about Mr. Castonguay's supposed repentance is Dr. David Gratzer.

I believe that in order to make his point, Dr. Gratzer may have over-stated or misstated Mr. Castonguay's position when he says that Mr. Castonguay wished to "stoke the fires of entrepreneurship," within the Canadian health care system.

Is Mr. Castonguay currently working for or representing the interests of a private health insurance company? If so, could you name that company?

I live just south of Vancouver B.C. in Washington State. Our Health care financing system is bankrupting the country (and killing people) as the high costs of medical care represent obscene profits for the private insurers.

ADHR said...

Wow... this is an old post to generate attention. To answer your question, I don't know if he's working for any insurer in particular, but that doesn't necessarily mean anything. He can still be connected to them even if he's not an on-the-books employee. In order to find out, you'd probably need to have some connection to the private health insurance industry, and I just don't (auto insurance, I have some contacts, but nothing in health).

Marty Lee said...