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Daniel Dufort: La maladie canadienne de la santé

Commentary

The following is the second in a series of French-language articles presented in collaboration with the Montreal Economic Institute. The English translation is included below.

Une expression populaire veut que la folie puisse se résumer à la propension qu’aura un individu à poser les mêmes gestes tout en espérant obtenir des résultats différents d’une fois à l’autre. Si tel est bel et bien le cas, on devra conclure que les gouvernements canadiens successifs qui se sont penchés sur les failles de notre système de santé sont en proie à la détresse psychologique. 

En effet, l’approche du « tout-à-l’État », où un monopole gouvernemental tente sans succès d’optimiser le déploiement de nos trop maigres ressources en matière de santé, ne cesse de produire des résultats insatisfaisants. Un récent sondage commandé par l’IEDM, Second Street et la Canadian Constitution Foundation, révélait que près des deux tiers des Canadiens et Canadiennes sont d’avis que nos systèmes de santé nécessitent des réformes majeures. Pis encore, 67 pour cent des Canadiens et Canadiennes ont la conviction que les générations futures hériteront d’un système encore plus mal en point. 

Cependant, une étrange symétrie est en cours. Témoins de tous ces va-et-vient qui caractérisent l’activité gouvernementale en santé, le gouvernement albertain tâche de se défaire d’une agence centrale en matière de santé, l’Alberta Health Services, alors que le Québec fait des pieds et des mains afin d’en créer une, Santé Québec. De façon moins charitable, on pourra conclure qu’il s’agit d’un diagnostic probant de la maladie qui nous afflige en matière de santé. 

Soyons clairs : la décentralisation a toutes les chances de mener à des résultats plus favorables. C’est là un apprentissage phare de l’école autrichienne d’économie en ce qui a trait à l’information qui est de nature diffuse. Un administrateur, quelles que soient ses qualifications, ne sera jamais en mesure de réagir rapidement à un flux d’informations aussi soutenu et diversifié. Cela peut sembler évident, mais nous peinons manifestement à le mettre en application.

Comme Québécois ou Québécoise, on peut parfois avoir l’impression d’observer certains aspects de la scène politique fédérale canadienne comme simple spectateur. Le débat en matière de soins de santé en est un exemple probant. En effet, il semble parfois que l’objectif du modèle « tout-à-l’État » en santé n’est pas tant de soigner le plus grand nombre, mais plutôt de se convaincre que nous avons un trait distinctif par rapport à notre voisin du Sud. 

Je comprends tout à fait l’importance des symboles. La vie n’est après tout pas qu’une question arithmétique et elle ne se résume pas en un ensemble d’absolus tels des zéros ou des uns. Mais en l’occurrence, nous payons un prix beaucoup trop important pour simplement maintenir les apparences. On peut facilement affirmer qu’une mort sur les listes d’attente en est une de trop. Que nous reste-t-il à dire lorsque ces décès se comptent par milliers en une année

À force de transformer une simple question pratique—comment fournir rapidement des soins de santé au plus grand nombre—en une question philosophique—qui sommes-nous—la classe politique et le gratin médiatique canadien ont complètement perdu le nord. 

Or, pour trouver des systèmes de santé dont nous pourrions nous inspirer, il n’est nullement nécessaire de regarder vers le sud ou encore d’imaginer un quelconque eldorado. De nombreux pays ayant une vaste gamme de politiques publiques autrement liberticides et anti-croissance économique sont l’exemple parfait d’une horloge brisée qui a raison deux fois par jour. Effectivement, des pays européens tels que la France, la Suède ou l’Allemagne—qui n’ont rien à voir avec une dystopie libertarienne telle qu’imaginée par des gauchistes peinant à maintenir un lien avec le réel—sont la preuve que le secteur privé peut facilement contribuer à fournir une couverture de soins de santé universelle et performante. 

À l’instar de l’horloge brisée, Gilles Duceppe déclarait naguère que la politique du pire est la pire des politiques. De ce fait, on devrait se garder d’espérer que nos systèmes de santé n’éclatent pas de toutes pièces afin d’ouvrir la voie à des systèmes qui s’inspirent du modèle en place outre-Atlantique. Nous devons en quelque sorte garder la foi et continuer de faire valoir la possibilité bien réelle de réformer notre système de fond en comble. 

Nous ne pouvons pas nous permettre d’attendre le Grand Soir, où le désespoir qui nous paralyse en pensant à nos systèmes de santé serait balayé par un vent de renouveau. Soyons lucides, cela n’arrivera pas. Certainement pas tant que des ministres de gouvernement prétendument conservateurs exhorteront le gouvernement fédéral à limiter encore davantage l’accès aux soins de santé

Il faut plutôt miser sur des gouvernements provinciaux qui en ont assez de se cacher sous les jupons du gouvernement fédéral. Des provinces comme le Québec et l’Alberta pourraient, au fil du temps, commencer à amener des solutions viables à ces enjeux. Mais ils auront besoin d’une bonne dose de courage. Heureusement, l’opinion publique est en train de s’améliorer. Espérons que cela ne tombe pas dans l’oreille d’un sourd.


Dr. Paul Belletrutti, right, and nurse Leslie Peoples demonstrate a new surgical approach to stomach cancers at a hospital in Calgary, Alta., Tuesday, March 3, 2020. Jeff McIntosh/The Canadian Press.

Canada’s health care sickness

According to a popular saying, insanity can be summed up as the tendency to keep doing the same thing over and over again while expecting different results. If this is accurate then we have to conclude that successive Canadian governments which have tried to address the failings of our health-care systems are suffering from psychological distress.

Indeed, the all-encompassing governmental monopoly model, which has tried unsuccessfully to optimize the deployment of our too-meagre healthcare resources, has repeatedly yielded unsatisfactory results. A recent poll commissioned by the MEI, Second Street, and the Canadian Constitution Foundation showed that nearly two-thirds of Canadians believe our health-care systems are in need of major reforms. Moreover, 67 percent of Canadians are convinced that future generations will inherit a system that’s in even worse shape.

As a testament to all of this back-and-forth that characterizes governmental activity in health care, there’s a strange symmetry at the moment as the Alberta government is trying to get rid of a centralized health agency, Alberta Health Services, while Quebec is going out of its way to create one, Santé Québec. Less charitably, this amounts to a compelling diagnosis of the disease that’s afflicting us when it comes to health care.

To be clear, decentralization has every chance of leading to better results. This is a key lesson of the Austrian school of economics regarding information, which is naturally diffuse. Administrators, no matter their qualifications, will never be able to react quickly to such a sustained and diverse flow of information. That may seem obvious, but we clearly have a hard time applying it.

As Quebecers, it can sometimes feel like we’re observing certain aspects of the Canadian federal political scene as mere spectators. The health-care debate is a good example. Indeed, it sometimes seems that the goal of the government monopoly model in health care is not so much to treat the most patients, but rather to convince ourselves that we’re distinct from our southern neighbours.

I understand the importance of symbols. Life, after all, is not just a matter of arithmetic, and can’t be summed up as a series of ones and zeroes. But in this case, we’re paying far too high a price just to keep up appearances. It’s easy to state that a single death on our waiting lists is one too many. What can we say when there are thousands in a single year?

By transforming a simple practical matter (how to provide health-care services to the greatest number in a timely manner) into a philosophical question (who we are), the Canadian political class and media elite have completely lost their way.

To find health-care systems from which we can take some inspiration, there’s no need to look to the south or to imagine some kind of El Dorado. Many countries otherwise equipped with a vast array of restrictive, anti-growth public policies are the perfect example of stopped clocks being right twice a day. European countries like France, Sweden, and Germany—which are very far removed indeed from the libertarian dystopias imagined by leftists struggling to remain tethered to reality—are proof that the private sector can easily help provide universal and efficient healthcare coverage.

Like a stopped clock, Gilles Duceppe declared not too long ago that the policy of making things worse is the worst policy. As such, we should refrain from hoping that our health-care systems fall to pieces in order to pave the way for systems inspired by the model in place across the Atlantic. We need to have faith and continue to push for the very real possibility of profoundly reforming our system.

We can’t wait for night to fall, when the despair that paralyzes us when we think of our health-care systems will be swept away by the winds of change. Let’s be realistic: it’s not going to happen. Especially not when supposedly conservative ministers exhort the federal government to further limit access to health care!

Instead, we need to count on provincial governments that have had enough of hiding behind the federal government’s skirts. Provinces like Quebec and Alberta could, in time, start to implement viable solutions to these challenges. But they’ll need a good dose of courage. Thankfully, public opinion is starting to change for the better. Let’s hope it doesn’t fall on deaf ears.

Abdi Aidid and Benjamin Alarie: AI is about to fundamentally transform our legal system—for the better

Commentary

As part of a paid partnership, this month The Hub will feature excerpts from this year’s five shortlisted books for the Donner Prize, awarded to the best public policy book in Canada. Our podcast Hub Dialogues will also feature interviews with the authors. The winning title will be awarded $60,000 by The Donner Canadian Foundation on May 8th.

The following is an excerpt from The Legal Singularity: How Artificial Intelligence Can Make Law Radically Better, by Abdi Aidid and Benjamin Alarie (University of Toronto Press, 2023).

We are on the path to the legal singularity. Advances in technology, especially the improvement and widespread proliferation of artificial intelligence (AI), are driving us relentlessly down this path. By legal singularity, we mean a stable and complete legal order, capable of addressing and resolving practically all types of legal uncertainty in real time and on demand. Over the coming decades, the emergence of this legal singularity will fundamentally transform our existing legal systems and, with them, our societies.

The stakes are high. Navigating the path to the legal singularity safely is necessary for humanity to flourish during the rest of the twenty-first century and beyond. For society to evolve and leverage these new technologies effectively, we will need to develop an ever deeper and more responsive legal infrastructure.

The good news is that the very technologies that are upending our existing practices will also enable us to construct the deeper and more responsive legal infrastructure that is sorely needed. The stability and resilience of the legal singularity will require more adaptability in our legal systems than they exhibit today. Fortunately, if we can get things right, the technology for a profoundly beneficial legal singularity will be in place just as we need it most.

This book is the first step towards articulating a vision of a legal singularity and motivating a discussion about its pathways and consequences. The legal singularity is the idea that law will reach functional completeness, in the sense that practically any legal question will have an instantaneous and just resolution. In the legal singularity, the law will be knowable with a high degree of certainty—perhaps not perfect certainty, but practical certainty—for much of human activity.

The legal singularity will evolve and be able to absorb and accommodate changes to our social, economic, and technological contexts. If it is successful, it will not be dogmatic. Indeed, the nature of the legal singularity will be to provide quiet confidence that justice will prevail. Disputes will be resolved justly and in the best interests of society. Powerful actors will be held accountable to a greater extent than they are even in today’s most advanced legal systems. Weaker parties will have their positions bolstered.

The legal singularity will require deliberation, experimentation, wisdom, knowledge, and the cumulative efforts of governments, academia, and industry over the coming years. There will be problems. There will be dead ends. There will be experimentation, failures, and more experimentation. Ultimately, there will be significant progress. The good news is that many efforts are being undertaken even as we write. With this book, we aspire to echo and amplify those who seek to leverage technology as a means of improving law. To this, we add our own vision of how technology, ambitious problem-solving, and responsible stewardship will guide law towards the legal singularity.

Our goals with this book are threefold. The first is to firmly root the legal singularity in the popular imagination as an idea that we collectively must address to ensure that the world’s legal systems undergo changes that are in alignment with humanity’s interests as artificial intelligence and machine learning continue to improve. If managed deftly, these technological developments in artificial intelligence and machine learning can and will lead to astounding improvements in social justice and distributive justice, and will contribute to widespread human flourishing. This is, of course, an optimistic and ambitious vision. Others have pointed out less rosy possible scenarios; our view is that those scenarios are avoidable if efforts are undertaken now to help to navigate towards positive outcomes.

Our second aim is to press the point that technology-based changes to our legal systems are not simply a possibility to be discussed on a theoretical level by the intellectually curious. It is tempting for many in the legal profession to want to assume that we could simply press “pause” on technological progress and the concomitant evolution of our legal systems until a sufficiently widespread level of practical confidence and psychological comfort is reached. Many would prefer to defer serious consideration of the uncomfortable topics that are explored in this book until they are first convinced that (1) the status quo is unsustainable; (2) the kinds of changes that are being driven by technological advances have been thoroughly tested and designed with normative and conceptual coherence; and (3) an implementation plan has been devised to accommodate these changes in a manner that will be minimally disruptive to the existing legal order. These instincts are understandable. Unfortunately, the context in which law functions and operates is changing too quickly. 

Our third and final aim with this book is to join the emerging international movement in academia, government, the judiciary, and civil society, and among actors in the legal system more generally, to secure the safest, wisest, and most effective path to the legal singularity. The forces driving us towards legal singularity are persistent and powerful: there is no “off” switch to the internet; computing power looks to continue its exponential growth. 

The shape of an eventual legal singularity can undoubtedly be influenced for the better by careful monitoring, concerted action, and thoughtfulness (or, for the worse, by the abuse of technology to oppress or suppress populations). It is in our collective interest to work to forge and secure the best-possible path to legal singularity.