In medieval times, whipping boys were the young surrogates, often of noble birth, who were assigned to take the punishment meted out when princes misbehaved. And properly so, according to the divine right of kings, which held that only a king could whip a prince. With modest literary adaptation, the whipping boy now serves as an apt metaphor for Ontario’s lashing of doctors for offences they did not themselves commit.
Premier Dalton (“King Dalt”) McGuinty has decreed that Ontario’s best-paid and most skilled doctors – cardiologists, radiologists and ophthalmologists among them – must be punished for working harder, for treating more patients, for saving more lives. But the offender here is not our princeling doctors. It is the regent himself whose treasury, long depleted by royal profligacy, is now bare.
So 27 Ontario doctors earned more than $2-million last year – an increase of seven (yes, seven) from the previous year. So 400 Ontario doctors earned more than $1-million last year. So what? What specifically is the crime here? And who committed it, anyway?
Surely the crime is not the gross income of the doctors – which is determined strictly by the number of patients they have tended. Surely more healing justifies more pay, not less.
Surely the criminals are not the doctors themselves (who aren’t accused of cheating). Surely patients are more responsible for broken hearts than the cardiologists who fix them.
Surely the actual offence here is the province’s implicit decision to impose stricter rationing of health care in Ontario.
As a matter of fact, in ordering an arbitrary pay cut (which in some instances will lower doctors’ gross incomes by as much as 20 per cent), Mr. McGuinty has effectively decreed that the province’s most skilled doctors must personally finance the treatment of perhaps one-fifth of their patients. The province could achieve the same result more equitably by letting a lottery decide which Ontarians make it to an operating room.
Yet Mr. McGuinty prefers to blame rich and greedy doctors for the consequences of his own debt. It is always easy to blame the rich and the greedy. But the gross incomes of medical specialists are as phony as a false alarm. Sure, these doctors do well. Why shouldn’t they? But they pay half of their gross income in taxes – thus already paying a disproportionate part of their own salary. As everyone knows, they have offices to run, staff to pay, insurance to buy and pensions to fund. From this perspective, $2-million isn’t nearly as much as buck-passing politicians pretend.
It is so, of course, around the entire highly taxed world. Some European doctors, working in highly socialized economies, earn $2-million a year – as do some American doctors and, for what it’s worth, some Chinese doctors, too. The International Society of Aesthetic Plastic Surgery reports, for example, that 20 per cent of plastic surgeons in Western Europe earn more than $1-million a year – and that 10 per cent of plastic surgeons in China earn more than $2-million. If good plastic surgeons are worth $2-million in China, why aren’t good cardiologists worth $2-million in Canada?
Mr. McGuinty is wrong to single out doctors for whipping. So much for the rule of law. If governments want to cut people’s pay, let them cut everyone’s pay (progressively, of course). But don’t treat some of our most extraordinarily gifted citizens as intolerably greedy or improperly rich.
Mr. McGuinty has made a fundamental mistake. He has used his powers arbitrarily to determine incomes. Governments are never good at determining incomes – or prices. Governments can determine salaries and prices only at the risk of rebellion and rage – outcomes as predictable in the streets of Montreal as in the streets of Athens. (Quebec has priced education far too cheaply for far too long.)
We have an impartial, apolitical mechanism to determine incomes and prices. This mechanism is called capitalism. In the market, millions of people, through billions of transactions, determine incomes and prices in an orderly way. It is preposterous, of course, to suppose that the market can determine incomes in socialized, fixed-fee medicine. But there are only these two options. Either the market distributes incomes by consent – or kings do by decrees.