In many ways being interested in politics is like having your own holiday season, only it’s called a writ period and it leads to an election. There is a lot of planning before the event, you don’t love all your relatives even though they all have to be there, and the moment it’s over you’re counting down the days until the next one arrives. The day the votes are counted and you win, is a moment when anything seems possible. When you lose, it’s a moment when you wonder what the future holds. Then it’s over, decorations are everywhere, and you’re waiting for what comes next. What do you do with the time?

There’s an easy answer for the political pundits: they turn to social media. They watch municipal races, follow every single vote in the House of Commons, and track the polls to see who will be the next prime minister of the Netherlands. If there is a general election called in Luxembourg, you can rest assured that at least two contributors to The Hub are having a viewing party. Don’t worry, it’s not until 2023. 

At least it is something to talk about. But what if someone has better things to do with their time than read about which staffer is moving into a new office? This insider political rhetoric can strike an outside observer as pointless. Aren’t there public policy discussions to be had? Granted, the vast majority of mainstream news articles don’t really discuss public policy at all. So, is there a way to be politically engaged beyond casting a ballot on election day, getting trapped in the Ottawa bubble, or arguing about inflation on Twitter? There has to be, but what is it? What should the informed and political, engaged citizen do when there is no one trying to win their vote?

Being like Ebenezer Scrooge is one answer. One of the most well-known images of Christmas, A Christmas Carol, tells the story of a selfish businessman who realizes the true spirit of the season and decides to give away money to those less fortunate. But readers and viewers are left to wonder, what is he going to do the rest of the year? This is the same question we confront ourselves, thinking about the day after election day. 

There is a hope that Scrooge’s realization lasts beyond Christmas day. That it is not simply a one-time show but a fundamental change of character. There’s also more to his transformation than money. He isn’t simply donating to charity, he is becoming a meaningful member of the community. He helps those in need not merely with a financial contribution but also a recognition of dignity. He takes the time to speak to those who work for him and shows respect to those people he had previously looked past on the street. 

Engaging with others is one of the most valuable ways we can contribute to political life. It means to take seriously living in a community with other people, and the impact that can have on people. There’s a tendency to want to remove politics from our daily lives. Either the very idea that charity or benevolence or kindness could be political makes it less meaningful, or those small and individual interactions are not important enough to be political issues. But policy is not the beginning and end of what we value in political discourse, and election issues do not define what is significant to us. The political, engaged citizen has to actually be a citizen, and that means taking seriously what one owes to the people we encounter as we go about our day.

This is not to encourage you to make a new year’s resolution to spend more time volunteering in the community that you will undoubtedly break three weeks from now. Just like I am not going to become a better person next year by drinking less coffee. Rather, it is to recognize that being politically engaged means so much more than simply reading about politics or casting a vote on election day. There is a reason why the cost of living is such an important issue at the moment—everyone knows people who are affected by it. Four years is a long time to just sit around and wait.

So, what can you do until the next election season? Start by spending less time thinking about politics.

Conservative leaders seem loath to mention health care in equal measure to journalists’ delight in raising it. John Ivison, a columnist at the National Post, took a stab at federal Conservative leader Pierre Poilievre last week: “You simply can’t aspire to be prime minister of Canada today and claim that health care has nothing to do with you.” 

Ivison has a point. Endless headlines about health care demand a political response: for example, overcrowding in children’s hospitals, federal-provincial funding battles, and emergency department closures, to name a few.

Some leaders love to dilate on health care. Last week, Jagmeet Singh, leader of the federal NDP, threatened to withdraw support for his confidence-and-supply agreement with the Liberals. Singh demanded that the (federal) Liberals detail solutions for (provincial) health-care problems.

Ivison’s demand for details and Singh’s confidence to deliver, “When I’m prime minister,” rest on a shared assumption, a shared vision of how government should address health care. They assume health care is a factory to fix, and Singh knows just how to fix it. 

Faulty logic

Their approach contains three problems. First, health care is not a factory. It is one of the most complex sectors of our economy. One tweak by government—for example, introducing national licensure for physicians—could have vast, unforeseen effects. 

Visions of economic dials, levers, pipes, and pulleys have delighted central planners for decades. They are deceitful dreams, a feverish mirage. As Robert Heilbroner, erstwhile defender of socialism, famously admitted: the centrally planned economy was “the tragic failure of the twentieth century.”

The first problem misunderstands the nature of what we hope to fix; the second problem assumes we are smart enough to fix it. But if Singh became prime minister, his unstoppable confidence would meet the immovable fact of Hayek’s Knowledge Problem. Friedrich Hayek, the Nobel-winning economist, argued that economies cannot be controlled because there is too much to know. Especially in a service industry such as health care, individual needs, wants, and preferences determine performance. These inputs are internal to the patients themselves and the clinicians trying to care for them.

The third problem is the least obvious but most lethal. It assumes a purchaser can fix the provision of a product or service. Government pays for health care, ergo, government can fix health care. 

What is obvious nonsense for every other product or service—from coffee to construction—somehow seems reasonable for health care. Purchasers cannot fix provision. True, a purchaser can influence providers to change behaviour by demanding different products and services. But purchasers have no idea how to reorganize, retool, or redesign to deliver change itself. 

A Christmas wish list

Just as Conservative leaders are loath to talk about health care, the rest of us should be loath to offer advice. Politicians know politics; outsiders do not. 

Furthermore, Conservatives represent a vast coalition of ideas, especially on health care. Red Tories support welfare in general and Medicare in particular. Prairie populists, classical liberals, libertarians, and a dozen other flavours of Conservative form a salad of mixed feelings. It requires fancy stickhandling to get through all the policy preferences, not just the ones at “centre ice“. 

So, take this wish list in the innocence and earnestness of a child at Christmas.

1. Show enthusiastic support for universal health insurance

Twenty-eight countries around the world have universal care. None of them have government monopolies like Canada. Universal just means everyone needs health insurance, in the same way that all cars on the road need to be insured.  

Medicare started as state-funded medical insurance but morphed into managed care. In fact, some argue we should stop thinking about “medical insurance” as insurance at all. Do not let that happen. As long as Canadians remain comfortable and familiar with medical insurance we have a tiny sliver of room for change. If insurance becomes verboten, change will be much more difficult.

2. Fix health-care governance 

As The Hub published in April, “Medicare cannot change because it is locked in an iron triangle consisting of government, the medical profession, and public-sector unions.” And in another Hub article, it makes no sense to talk about policy, until we have fixed governance.

3. Champion (local) innovation 

Like politics, all care is local. Care plans must be allowed to evolve based on the needs of particular patients in specific communities. Bold visions and national plans tend to deliver one-size-fits-all services, the antithesis of patient-centred care. Only government can create a regulatory environment that fosters growth, innovation, and expansion of care at the local level. 

The crucial element is to allow hypothesis testing to happen, not do it yourself. This means you need to find a way to let clinicians fail as they struggle to innovate towards better care. Easier said than (politically) done.

In summary, all I want for Christmas is for politicians to tell us what they believe about health care, tell us what they think is the biggest problem, and show us what only they can do. Again, this is a childlike Christmas wish. But given all the other advice out there this Christmas, perhaps this offers something new.

Merry Christmas!