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A Chill Wind from the North

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Despite their love of liberalism and widespread opposition to the Iraq War, our friends to the north have been none too pleased with the Democrats and some of the ideas they've put forward in the primary campaign. The Great White North has turned into a source of constant bad news for both Clinton and Obama.

Canadian leaders have taken particular exception to promises from Clinton and Obama to repeal or renegotiate the NAFTA treaty. Canada is the single largest source of foreign oil for the United States; and they have threatened to strike back against any attempts to weaken NAFTA by cutting off the flow of Canadian petroleum, potentially raising the price of a gallon of gas in the United States into the double digits.

More bad news comes from an investigative article which made the front page of the Globe and Mail on Saturday. With both Obama and Clinton strongly advocating socialized medicine, the article provides a grim look at the failure of that approach to healthcare in Canada.

Apparently hundreds of Canadian patients every year are sent south to hospitals in the United States to receive critical care which local Canadian hospitals are unable to provide because of overcrowding, a shortage of skilled doctors and bureaucratic mismanagement.

In Ontario since 2003, 400 cardiac patients in the middle of heart attacks have been rushed across the border in ambulances to receive treatment from hospitals in Detroit. They arrive at the hospital, are given artery-clearing drugs, and if those don't work the only option is to rush them to the United States for an emergency angioplasty. It's a relatively commonplace operation available in virtually every US hospital, but in Ontario they have virtually no surgeons capable of performing one.

Similar problems exist throughout Canada. Ontario has also sent 188 neurosurgery patients, and at least 25 high risk pregnancies to hospitals in Michigan and New York. Hospitals in British Columbia are sending pregnant women and patients with spinal injuries to Washington State for treatment which they cannot handle. Just in the last year over 150 Canadians with life-threatening interior or exterior bleeding injuries  had to be rushed to the US for treatment.

This is not just a problem with one hospital. It appears to be system-wide. A previous article cites cases from a number of hospitals in different provinces; and earlier articles in the series explore the regular flow of patients from Canada to the United States for faster access to necessary treatments like chemotherapy and radiation therapy for cancer.

A 2005 case in Quebec points to one of the largest problems in the system: the long waits for any kind of treatment. The typical 8 hour wait for essential treatment in an emergency can be the difference between life and death, which is why so many emergencies are being sent to US hospitals when they are nearby. The problem is just as bad for less urgent treatment or to see a specialist where the wait may be months – in some cases long enough to turn a minor concern into a life-threatening illness. In the Quebec ruling, the court declared that long waits were a threat to the "liberty, safety and security" of citizens and commented that "delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care."

A series of studies from the Fraser Institute look at waiting times for treatment in Canada, and the picture isn't pretty. Waits are long and getting longer every year and have almost doubled in the last 15 years. In 2006 the average wait was 16 weeks just to see an orthopedic specialist and another 24 weeks to see a surgeon. Eight months is a long, long time when your knee or hip is in such bad shape that you can't walk. Even the simplest tests take too long. It can take 3 weeks to get an ultrasound when virtually every doctor in the US can do one in their office as needed.

It's not surprising that Canadians who are rich enough to afford it are seeking treatment outside of the country, going to the United States, Mexico, India, the Philippines and even Cuba. Conveniently located US hospitals like Henry Ford Hospital even advertise for patients in Canada, and specialized travel agencies in Canada offer medical tourism packages to popular destinations. All of this does little to help the average Canadian who can't afford to fly to California for their cancer treatment like wealthy Liberal MP Belinda Stronach.

Perhaps most telling of all is that while Canadians come to the US every day for the timely, quality care they cannot get at home, no one from the US is going north for treatment, though their heavily regulated pharmacies and low drug prices do seem to have an attraction.

So this shambling disaster is the model for what Barack Obama and Hillary Clinton want to bring to the United States – a system so inefficient and inadequate that many Canadians are working to convert to a two tiered public/private system. The healthcare system in the United States may indeed have many problems, but turning in fear to a solution which has been proven to be a disaster is not a rational response. Perhaps we should pay attention to what's going on in Canada and not let fearmongering and political opportunism stampede us into a cure which is worse than the disease.

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About Dave Nalle

Dave Nalle is Executive Director of the Texas Liberty Foundation, Chairman of the Center for Foreign and Defense Policy, South Central Regional Director for the Republican Liberty Caucus and an advisory board member at the Coalition to Reduce Spending. He was Texas State Director for the Gary Johnson Presidential campaign, an adviser to the Ted Cruz senatorial campaign, Communications Director for the Travis County Republican Party and National Chairman of the Republican Liberty Caucus. He has also consulted on many political campaigns, specializing in messaging. Before focusing on political activism, he owned or was a partner in several businesses in the publishing industry and taught college-level history for 20 years.
  • Nice strawman, Dave. Careful with those matches now.

    You paint a bleak picture of Canadian healthcare. However, I don’t see anything in either Clinton’s or Obama’s policy statements which suggests that they simply want to crib the Canadian system.

  • Exactly. Both have gone out of their way to make it clear that their proposals are not single-payer systems. They mandate individuals to buy coverage, mandate insurance companies to provide it, and offer government assistance to some in buying policies.

    Some of us think a single-payer system would be preferable. But the Schwarzenegger/Romney type of mandated universal care is the model for both Clinton and Obama. And Obama’s proposed mandate applies only to children, not to adults.

  • Perhaps we should also tell the full story as to what’s going on in Canada to avoid fear-mongering and partial information. Being Canadian, I’ll shed some light on my personal experiences and go from there.

    The problem with wait times comes as a result of a shortage of medical practitioners and of population overcrowding in areas of Canada that tend to be closer to the borders. The majority of the Canadian population lives towards the south of Canada and in the same metropolitan pockets, leading to overcrowding in medical facilities no matter how free or how costly the health care is. It isn’t a flaw of the system that there is overcrowding, as there had been no link to wait times and universal health care, but there HAS been a link to wait times and extreme population growth. The government has recently poured billions of dollars into the health care system to help reduce wait times.

    As per the wait times, non-emergency specialist surgeries tend to have long wait times because more people tend to get those surgeries than they would in the United States. When you’ve got the surgery essentially paid for, you do the surgery whether you need it or not. That’s part of the downside to the system, one could say, as many people are crowding hospitals having medical procedures done that aren’t necessary, leading to longer wait times for those that DO have emergencies. For the most part, however, in most major Canadian hospitals, the wait times are average with the rest of the world.

    Wait times in Canada, according to the Commonwealth Fund, stack up differently than those in the United States, of course. Studies by the Commonwealth Fund found that 24% of Canadians waited 4 hours or more in the emergency room, vs. 12% in the U.S. 57% waited 4 weeks or more to see a specialist vs. 23% in the U.S. The Kaiser Family Foundation found that 63% of Americans were worried about not being able to afford health-care services, whereas Canadians do not have that concern. Lower costs DO impact the performance of the system, there’s no question about that, and the key difference between the systems appears to be whether the “waits” for the surgery take place in a hospital with medical care or in one’s home or on the street. There are still “wait times” in American systems, but these go unreported as people wait to afford basic health care.

    Wait times are also impacted by the aging population, which is among the largest in centuries.

    As for your claim that nobody from the United States comes to Canada for health care, that is patently untrue. For starters, there is a HUGE market for prescription drugs up here and “medical tourism” is big business in Vancouver especially. According to CMAJ, Canada’s leading medical journal, the prescription drug business hauls in $1 billion a year simply from Americans.

    Many Americans also enter Canada for minor surgeries, plastic surgeries, and other non-essential surgeries, much in the same way that Canadians go to the United States for similar surgeries.

    Canadian health care is not socialized medicine. The government pays for about 70% of the health care costs here, which is slightly lower than the average of OECD countries. Publicly funded insurance plans pay for medically necessary care. Other services are distributed and decided on a provincial basis, with services like ambulances, dental care, home care, and other aspects of health care being decided on a more individual basis. Most services in Canada are delivered by private (both for-profit and not-for-profit) providers.

    The United States is the only industrialized country that lacks some form of universal health care. Over half of the bankruptcies in the United States, according to a study in Health Affairs, had something to do with medical bills. The irony here is that the United States government actually spends more per capita than Canadian government does. However, U.S. government spending covers less than half of all health care costs. Administrative costs in the United States are also significantly higher than those in Canada.

    So on and on we go and we can likely debate the merits of our systems all day long, but there are a number of misnomers when it comes to the health care discussion in the United States. Again, Canada does NOT have socialized medicine. Universal health care is NOT socialized medicine. In my experience, I’ve not had any problems with wait times or hospital issues. I have a chronic intestinal condition and have found the care in my local metropolitan (Vancouver-based) hospitals to be exemplary.

  • Also, the Fraser Institute is a conservative/libertarian think-tank with ties to many controversial issues. Their researching techniques have come under fire before for not being subjected to peer review or to standards of basic scholarship. The FI has also held to conferences denying the effects of tobacco, one such conference had the theme of “junk science” in reference to the risks of smoking. They are also skeptics of global warming and are heavily supportive of privatization of health care, security, and other government funded issues.

  • Clavos

    “They are also skeptics of global warming and are heavily supportive of privatization of health care, security, and other government funded issues.”

    My, my, my!

    How could they be so absolutely, totally wrong about everything???

    What a pack of dumbasses those conservative libertarians are.

    When will they ever toe the line, repent, and accept the god of nannyism in their hearts?

    Maybe we should round ’em up, put ’em in a camp and start re-educating them…

    Evil bastards.

  • Clavos, I could take one sentence out of a few and re-frame it in my own context, too, but I choose to be more respectful than that. The Fraser Institute is renowned around here for fudging their research. My point is that they have a vested interest in providing supportive information as per privatized health care. Now settle down.

  • Jordan, your use of the Kaiser foundation which is funded by an insurance company is far more questionable than my use of Fraser, which is at least not directly tied to the health insurance issue. Talk about having a vested interest.

    The ‘vested interest’ of a libertarian think tank is the freedom of the people. I find I can live with that sort of allegiance.

    he government pays for about 70% of the health care costs here, which is slightly lower than the average of OECD countries.

    So Canada has made the choice that everyone should be inadequately and partially provided with healthcare rather than going with the US model where most have good coverage and a small percentage – often by choice – go uncovered. The facts you provide basically confirm my concerns.

    Dave

  • Of course, you can always discount my opinion as biased ranting since I had a relative who died because the German healthcare system made her wait too long to have the battery on her pacemaker replaced.

    Dave

  • Clavos

    “My point is that they have a vested interest in providing supportive information as per privatized health care.”

    As does virtually everyone, pro or con. Theirs happens to be one you disagree with.

    “Now settle down.”

    Yes, Daddy. Sorry, Daddy; I’ll be a good little conservative and keep my mouth shut. Promise. Please don’t tell the nanny…

  • JustOneMan

    Dave…

    Isn’t overcrowding, unskilled doctors and bureaucratic mismanagement the three pillars of the Dumbocratic health care reform platform?

    JOM “Calling Dr. Moe, calling Dr. Larry, calling Dr. Curly”

  • “So Canada has made the choice that everyone should be inadequately and partially provided with healthcare rather than going with the US model where most have good coverage and a small percentage – often by choice – go uncovered. The facts you provide basically confirm my concerns.”

    MOST have good coverage? Most Americans are dreadfully under-insured or have their health insurance costs running them into bankruptcy or poor financial condition.

    A peer-reviewed comparison study of health care access in the two countries published in 2006 concluded that U.S. residents are one third less likely to have a regular medical doctor, one fourth more likely to have unmet health care needs, and are more than twice as likely to forgo needed medicines. This study is from the American Journal of Public Health and was done in 2006.

    And again, there’s issues of spending to consider. If the United States health care system is so great, why is it so costly and why are Americans considerably less healthy than the rest of the world and considerably more likely to die from major treatable diseases or afflictions? Is it genetic or could it possibly be related to health care issues?

    I do have to applaud the United States health care system for something, though, and that is their work with the elderly and the disabled. It’s comforting that my wife, who works in the health care industry in the United States (she’s an American citizen immigrating to Canada) is able to see the disabled and elderly receiving good quality care. The costs to this on the system are never called into question, despite the growing population of these individuals, and the growth of free clinics also shows that some things in the United States appear to be heading for a better ground.

    I’ve discussed the feeble connection between the wait times and “universal health care” at length in my post. I think this speaks to the inadequacy of the Canadian health care system and the mythology of socialized medicine.

    “The ‘vested interest’ of a libertarian think tank is the freedom of the people. I find I can live with that sort of allegiance.”

    Which is why they were so heavily couched with the tobacco companies and other corporate interests. Freedom for the people may be associated with libertarian ideals, but it isn’t associated with the Fraser Institute.

  • “As does virtually everyone, pro or con. Theirs happens to be one you disagree with.”

    Yep. It’s important to point out discrepancies, pro or con, too. This speaks to the broad variance of “facts” out there regarding Canadian health care. Mine are, as Dave pointed out, as subject to bias as well. I certainly take no issue with that being pointed out and welcome fact-checking of all kinds on my posts. I discuss things to learn and part of that learning is discovering where I’m wrong.

  • Re #8:

    That truly is a heartbreaking experience that I wouldn’t wish on anyone, but surely I could counter with stories of individuals being left for dead in alleys or on sidewalks because they couldn’t afford the healthcare they were supposed to receive. Human dignity is important in any health care system. The Canadian system is flawed, some say deeply flawed, and I agree that it needs an overhaul. But the majority of Canadians overwhelmingly agree with the rest of the world that the American system isn’t the answer.

    All health care systems have drawbacks and issues that need to be addressed as the population of our world gets older and people start requiring more care. It’s an important issue to look at and we have a lot to learn from each other in terms of developing good quality care that every human being can receive.

  • Jordan well said. I agree in some parts but overall I fear you are shortchanging the major problems we face. The Canadians system is socialized – in many ways it is almost communistic and Byzantine on many levels. The truth is that there are major problems. While I don’t think it’s as bad as painted the reality is that it is unacceptable especially considering how much we put into it. The Canadian health care system needs a major overhaul.

    As for the stats, the Fraser Inst. is not that far off from what we found. Just because they are cons/lib doesn’t mean they should be overlooked. I work in the field – http://www.findprivateclinics.ca – which is a directory we run and on our journey we discovered a lot about the Canadian health care system. In a nutshell, the theory of our system is noble, in practice it is proving to be a disaster.

    This not some ideological battle – well, it shouldn’t be. But the hard facts show that many Canadians are facing unacceptable conditions – again for what we pay into the system.

    My suspicion is that the Fraser probably employ a more intelligent premise to build their cases than all these “organizations” with their own little agendas. They are right to question much of what we are being fed. But I won’t get into this. There is indeed a lot of junk science out there that passes as science. Their findings fall closer in line with what we have observed with our company along with personal stories.

    I’m glad you have not had any problems but I personally have had problems (to go along with the the good) and I know many Canadians who have nightmare stories.

    One last thing: 5 million Canadians are without a family doctor or GP. In a system where the GP is the point guard so to speak to allowing you to see a specialist that’s a bit of major crisis.

  • “It’s a relatively commonplace operation available in virtually every US hospital, but in Ontario they have virtually no surgeons capable of performing one.”

    Uh, yeah. Sure Dave. Virtually no surgeons capable of preforming angioplasty in Ontario…right.

    So the 1,550 angioplasties performed in Ontario between September 2007 and November 2007 according to the Cardiac Care Network of Ontario were..imaginary? Performed by whom?

    Interestingly enough the median wait time recorded was 3 days…

  • Bennett

    “It’s a relatively commonplace operation available in virtually every US hospital, but in Ontario they have virtually no surgeons capable of performing one.”

    Not true.

    My brother in Toronto had his third mitral valve replacement last year and, based on the severity of his condition was admitted a day after seeing his specialist.

    The surgery took place 2 days later, performed by one of the most talented heart surgeons in the world Professor Tirone David, and was broadcast worldwide to other heart surgeons interested in seeing his techniques.

    It was touch and go (there was almost no valve left) but my little bro pulled through and is doing great these days.

    Much of what Jordan Richardson writes cannot be shrugged off as bias, and much of what Dave writes is, as always, fear mongering propaganda.

  • 1. I never said that the Fraser Institute should be overlooked, nor did I suggest that their findings should be tossed out of the discussion. I did say that their facts and figures, like many of the facts and figures in this often-convoluted discussion, are subject to manipulation due to vested interests. The same applies across the board and anything I cite is no exception.

    2. I agree with you about the major overhaul. I said as much in my other post. Large parts of how the system works is unacceptable, no question about it. There are things that must be changed and wait times is, I think, at the top of that list. I’m curious to see where Harper’s funding is going to get us on that, as I have very little trust for his government thus far.

    3. Canada is typically not thought of as having socialized medicine, but this all depends on how one defines the term. Finland, for example, has a much smaller private sector (between 3 and 4 percent) involved with health care and they are often referred to as having socialized health care. Do we draw the line at the percentage involved? With Canada having the private sector comprising about 30% of health care, are we still socialized medicine or do we offer universal care? Israel is said to have socialized medicine, too, through the National Health Insurance law.

    4. Part of the problem lies with what is actually covered. My GP is not covered by Canada’s basic health plan for individuals (universal health care) but it is offset by it somewhat. In the US, however, that same GP would be a pipe dream for me. While having a GP is a luxury for Canadians, the American system does not offer the same affordable access to GPs for most of its citizens, which is terrible considering the cost of that system. Our Canadian system is indeed costly, but it is nowhere near as costly as the alternative, both in lives lost and in dollars spent.

  • Deano, I think the latest is that we’re pulling in Tim Hortons employees to perform open-heart surgery.

  • Free timbits with every anglioplasty!

  • Bennett

    BTW Dave, You are a talented writer and I just don’t understand why you choose to spend your time writing such blatant distortions.

    Does someone pay you by the word to craft such irresponsible hit pieces?

    Or is there some thrill you get from making up this shit any trying to pass it off as fact?

  • Lumpy

    The only reason Clinton and Obama aren’t pushing for a true single payer system is that they know they could never get away with it. They are all about incrementalism as they inch us along to socialism.

  • Clavos

    “While having a GP is a luxury for Canadians, the American system does not offer the same affordable access to GPs for most of its citizens”

    If by GP you mean General Practitioner (or Primary Care Physician, as they’re called nowadays), then you couldn’t be more wrong.

    Virtually all HMOs and almost all PPOs require the patient to see a GP first. If the GP then determines the patient must see a specialist, he will refer the patient. If the patient sees a specialist without that GP’s referral, the insurance will not pay the specialists fees, except for emergencies.

  • Lumpy

    But isn’t one of the big inefficiencies of the US system that they use GPs as gatekeepers for access to care.

    As for Canada, what I gather from reading the links in the article is that the big problem there is that they can’t hold onto qualified doctors who can earn more in private practice usually outside the country.

  • Andy

    I am a Canadian, probably what you could call a healthcare “moderate”. I like having an universal system but I’m not against the idea of a private tier as well, assuming such a dual system is tenable. What the Canadian system really needs is more money. Most of the flaws people point out would be fixed by a short term cash infusion and minor bump in long term funding. Of course I say the same thing about our military, and both might be too expensive to do at the same time..

    For the US, I think expanding the government programs of Medicare and COBRA would be a good start. Working them into a basic guarantee of universal coverage might even make everyone happy. Doesn’t seem like such a big expense considering the money going into Iraq and Pakistan lately.

  • The only reason Clinton and Obama aren’t pushing for a true single payer system is that they know they could never get away with it. They are all about incrementalism as they inch us along to socialism.

    I’m not sure whether you [or Dave, or Clavos, who has had some favorable things to say about Obama] actually believe this hyperbolic horse hockey, or simply say it out of habit. I find it utterly ridiculous.

  • the US model where most have good coverage and a small percentage – often by choice – go uncovered.

    Dave’s economic and social philosophy in a nutshell: “People’s financial misfortune is their own damn fault, so to hell with them. The current system serves me just fine, so I think it’s great.” The self-serving nature of this is way beyond merely being an obnoxious, by-the-book libertarian.

    By the way, the [outrageously high] number of [not nearly all by choice] uninsured in this country make up just one part of the [extremely serious] problem.

    The other is that insurance companies think it is their business to deny care whenever possible, rather than to provide care whenever it is needed. If someone somewhere can come up with a way to turn this Wonderland logic on its head and provide incentives for care, rather than denial of care, they should be knighted or sainted or something.

  • Clavos

    “The other is that insurance companies think it is their business to deny care whenever possible

    You, know, I keep hearing this over and over.

    And yet, my wife is an especially high consumer of medical services (about $250K a year). She is hitting our private insurer for more than $50K a year (everything Medicare doesn’t cover, plus my bills, which are only about $3K, including meds), and we have never had anything denied, except in error, which is promptly paid when we point out the errors.

    We pay a premium of $10K a year, so the private insurer is losing $40-50K annually on us.

    Not a peep from them.

    I don’t what the basis is for all these comments about denial of care; one would think that people like my wife, who costs them so much, would be among the first to be denied.

    Has anyone on the thread actually been denied care, and what were the circumstances.

    Or is this purely anecdotal?

  • STM

    Nice to read Jordan’s explanation. Now it all makes sense, but if you just read Dave’s … well. Strawman is right.

    It’s not like most Canadians don’t like their system, either. They do.

    Here’s a classic example of something similar that happens in Australia.

    In New South Wales, if hospitals in Newcastle or the central coast are full, you’ll be re-routed to one of the hospitals in Sydney. In emergencies, once you’ve been stabilsed of course. That’s one State, perhaps three cities, all part of an urban strip – but in this case one country.

    It also happens all the time in the US in conurbations, which is really what’s going on here. The fact there’s a border running down the middle doesn’t mean that much.

    It’s more about urban overspill and utilising any available resources to save lives than it is about the failing of any one health system.

    And I bet the patients sent to the US in those situations and in those areas close to the US border have some private health insurance to top up their government-funded care, enabling them to be treated in the US.

    Which of course leaves enough beds and doctors in Canada for those who don’t.

    Just more of the libertarian every-man-for-himself flag-waving we’ve come to expect from Dave.

    You’d have hated to have been on the Titanic with someone like Dave.

    “Lifejacket? … did you pay for that?”

    Sure you never worked at Langley, Nalle???

  • Bennett

    “If someone somewhere can come up with a way to turn this Wonderland logic on its head and provide incentives for care, rather than denial of care, they should be knighted or sainted or something.”

    Quoted For Truth

  • Clavos, many people that my wife works with in the health field have been denied care. She works in Washington State with a community services facility, basically doing home care. She accompanies people on their visits to their doctors and to hospitals and has witnessed the refusal of basic care and most notably palliative care. Insurance companies tend to turn down most cases of palliative care. Lower income households, like those that make about 200% than the “middle class,” tend to actually receive basic care with greater ease than those in the middle class or upper lower class. That’s just from her experience, though, and she might be wrong. But the basis for the comments and for the “rhetoric” isn’t some mythological circumstance, Clavos. It’s the actual experience of individuals that have been denied care. There are always exceptions.

    “Virtually all HMOs and almost all PPOs require the patient to see a GP first. If the GP then determines the patient must see a specialist, he will refer the patient. If the patient sees a specialist without that GP’s referral, the insurance will not pay the specialists fees, except for emergencies.”

    I’m actually talking about a long-term GP, not a single-visit GP. I’ve had the same family doctor (here in Canada we call them family physicians, so I may not be using the right terminology for the American system) for 20 years. It costs very little to visit my family physician, if anything, and he does set up visits with specialists (of which I’ve personally needed many) and arranges for proper hospital care (which I’ve also needed from time to time). That family physician outlines a care plan with me on a regular basis, writes prescriptions, etc. I’m not sure if the GP an American visits before getting a specialist appointment is the same thing, but I do know that statistics from both sides of the aisle demonstrate that seeing a GP is not something that is affordable to ALL citizens.

    The reason there are so few family physicians in Canada now is because the wages stink, there are few people in medical school, and privitization forces doctors to where they could make more money. My family physician makes very little for the workload he has and that needs to change in the system. Like other Canadians have said in the comments thus far, the Canadian system needs an infusion of money more than anything else. We need a government that is committed to the plan that Tommy Douglas came up with in the first place and will pay doctors, nurses, and other health care professionals what they deserve. Making it more desirable to be in health care will help matters immensely.

    “I am a Canadian, probably what you could call a healthcare “moderate”. I like having an universal system but I’m not against the idea of a private tier as well, assuming such a dual system is tenable. What the Canadian system really needs is more money. Most of the flaws people point out would be fixed by a short term cash infusion and minor bump in long term funding. Of course I say the same thing about our military, and both might be too expensive to do at the same time..”

    Agree 100%. Some private care might take some of the pressure off of the system and those that could afford to seek out private care could do so while those that cannot could utilize universal health care. The best system really is a hybrid system of that sort, but more funding needs to be given to the universal system to ensure that all of the best doctors are not heading off to private waters because the pay is largely better. The private and universal systems would need to be competitive in the wages they offer their practitioners. The overcrowding issues, which affects the wait times more than anything else, can be solved by the construction of more hospital spaces and more facilities that allow for general care. Without these spaces, we have people waiting in crowded emergency rooms. The alternative, as in the US system, is that people can’t even do that.

    “For the US, I think expanding the government programs of Medicare and COBRA would be a good start. Working them into a basic guarantee of universal coverage might even make everyone happy. Doesn’t seem like such a big expense considering the money going into Iraq and Pakistan lately.”

    Obviously I agree with this, too.

    Part of the reason the United States health care system looks so crappy to the rest of the world is the idea that the United States government is STILL spending more than other industrialized countries on its health care per capita. Hell, it’s spending twice as much as Canada and millions are still going without basic care. I’m not talking specialty surgeries or other things, I’m talking about BASIC HUMAN CARE. With so much spending going on in terms of US health care, most of which goes to the administration traffic jam that is insurance companies and other nonsense, it becomes harder and harder for people to swallow the reality.

  • Clavos

    “I’m actually talking about a long-term GP, not a single-visit GP”

    So am I.

  • STM

    For a better idea of why much of Dave’s argument is bollocks, here’s a little breakdown on the Quebec-Windsor conurbation bordering the US.

    While the US border areas are not considered officially a part of this conurbation, they in fact ARE in everything but name since everything borders everything else and many facilities are shared.

    Noteworthy is that Detroit is often included in this conurbation. Getting the picture that Dave doesn’t give?

    What’s happening in this conurbation in terms of utilising health resources (and probably dozens of other shared resources too) happens in a thousand conurbations around the world every day.

    The fact there’s an international border running through the middle of it doesn’t stop it from being a conurbation.

    If you didn’t know this, however, you’d get the impression that Canadians were being ferried vast distances into the US for health care – which is patently not the case.

    My guess is that some Americans might also find themselves going in the opposite direction in cases of emergency where severe trauma is indicated.

  • Lumpy

    I don’t see how the distance makes any difference. The point made in the article from the Canadian newspaper is that they are sending critical care patients home without treatment and then if that doesn’t work they trqnsport them to the US at an average of 8 hours delay whixh is almost triple the acceptable time for an emergency angioplasty massively increasing the risk of death.

    So on one side of that border the heart patient lives and on the other side he gets a nice ambulance ride andgets to die in a foreign country.

  • STM

    It makes all the difference Lumpy, especially when you read that one of the quoted patients from the Globe and Mail story lived in Windsor and was sent to Detroit.

    Eight-hour trip?

    Wrong … try eight MINUTES.

    Part of that story also quotes the desirability of “not having to send patients (from Windsor) to Detroit or London”.

    London just happens to be in Canada.

    Windsor isn’t the world’s biggest city, but it is part of a conurbation with Detroit, which just happens to be on the US side of the border.

    It’s no different than people in rural America being sent to bigger urban hospitals.

    This is where Dave’s story falls flat on its blurter.

    Try to see the wood for the trees Lumpy.

    Besides which, I’d think a couple of hundred patients a year wouldn’t be that many in the great scheme of things.

    Either way, the Canadian government pays for those trips into the US from smaller cities on the border areas, much the same as it pays the Canadian health system for surgery/treatment done in Canada.

    So the cost to the patient? Zilch.

  • #17 – thanks. For interesting reading on this (since I’m employing a business angle) look up Antonia Maioni. She’s a scholar at McGill for Health and Social Policy.

    #24 – don’t know if the answer is more money. We already spend a lot. I think it’s a question of shifting focus.

    Another problem with Canada is that there is no true “national” standard. Each province regulates itself. So what we have now is in the face of “privatization” (which has been around since the 1930s in whatever form) are provinces running are different speeds. By far, Quebec and B.C. are leading the pack here.

    Dave, the problem with Ontario is not lack of capable doctors (Canada has a great medical history) that doctors are not allowed to perform certain procedures on the private side. For example, a surgeon who goes private can only perform minor knee surgery as opposed to, say, ACL. That makes no sense.

    STM, about cross-border treatments. The truth is (and I’m in the business) is that there’s a growing business here whereby companies actually place Canadians in U.S. or international hospitals for a) quicker service or b) for major surgeries not performed here in Canada. According to our website stats the number of Canadians seeking health alternatives in the U.S. is growing everyday. They simply are fed up with waiting. You can’t twist this around and you can theorize all you like but this is what we are seeing. Now, in some cases the government will cover the expenses provided Canada doesn’t provide the service – which is often by the way.

    Interestingly and conversely, we’ve also seen a spike in Americans seeking services up here.

    Look, in the end, I would not look to Canada for on how to run a universal health care system. My job has taken me to many clinics both big and small and with conversations with several doctors ,politicians and patients. The bad outweigh the good at this point I’m afraid.

  • by the way, when I said twist around I didn’t mean you per se but in general.

  • Dave apparently considers 40 million uninsured people a small number. He claims that many choose not to carry insurance. He also claims that poor people are poor by choice. He has repeated these claims almost ad nauseam, not for their truth, but because they support his arguments.

    There is a reason why libertarians are so few in number, why they rarely carry more than a few percentage of votes in virtually every election at whatever level. The reason is that they are wrong about most everything, but, nevertheless, doggedly continue to believe that they speak the only truth for “true” Americans. They are nearly as self-righteous and sanctimonious as right wing fundamentalists.

    Forty million people in the U.S. have no health insurance. Only a small number of them have regular access to health care via free or subsidized clinics. And, I can tell you that in many such places the waits are often 3, 4, 5 hours or more.

    What those who oppose universal health care really fear is having to sit in the same waiting room with the “great unwashed.” It’s a class thing.

    I’m sure there are problems within every nation’s health care system. Perhaps the “Peter principle” comes into play most everywhere. But those who believe that the system in the U.S. is the best there is, that it shouldn’t be tampered with are NOT those who have little or no access to it.

    People ARE denied coverage on a regular basis. Clavos, I would bet that if you and your wife attempted to change providers, you would find that none of your pre-existing maladies would be covered. You would also find that if either of you have too many “red flag” ailments that they won’t provide any coverage, or if they will provide coverage, the premiums will be so high as to be beyond belief. I know this from experience.

    It is always those who are sailing along having no problems with whatever system who don’t want someone else rocking the boat. Of course, it’s usually the “rockers” who are getting the short end of the stick.

    B-tone

  • STM

    Alessandro: “Interestingly and conversely, we’ve also seen a spike in Americans seeking services up here.”

    Well, that’s a fairly important bit that Dave left out of his story.

    I maintain: in the case of the Globe and Mail story quoted by Dave in this article, it is about utilising the nearest available big-city resources in a conurbation – and Detroit just happens to be the closest to Windsor. In fact, if they weren’t separated by an international border, Windsor would just be a suburb of greater Detroit. Many people actually consider it so.

    You don’t even have to read between the lines to see that.

  • Clavos

    “And, I can tell you that in many such places the waits are often 3, 4, 5 hours or more.

    True. And my wife just spent 40 hours, not 3, 4, or 5 in an ER, awaiting a bed in the ICU after having had a seizure last week. During the 40 hour wait (which, to be fair, was in a cubicle, which I demanded, and a regular hospital bed instead of ER stretcher which I also demanded) she had another seizure.

    And we’re paying $10K a year in insurance premiums.

    “What those who oppose universal health care really fear is having to sit in the same waiting room with the “great unwashed.” It’s a class thing.”

    Maybe. You do see some really really creepy people in those ER waiting rooms, and I’m not talking just unwashed, either.

    But, as noted above, having expensive insurance doesn’t insulate you from them, either in the ER or up on the floors.

    I don’t oppose universal health insurance; I don’t even oppose Hillary’s mandate which will require everyone to purchase it.

    I DO oppose a universal insurance plan that will prohibit me from paying for private insurance in addition, so that I can pick and choose the doctors and hospitals I want to use.

    With my wife as sick as she is, this is of paramount importance to us, and we are willing to make whatever financial sacrifices are necessary to keep that private insurance.

    So far, I haven’t seen any proposals to prohibit having private insurance , but it worries us because there are countries where that is the case.

  • STM

    Alessandro: “The bad outweigh the good at this point I’m afraid.”

    There are millions of your countrymen who see free healthcare as a great thing, and don’t agree with your point of view.

    For all its failings, Canada’s system IMO is better than that of the US for one reason and one reason alone – it doesn’t discriminate against people who can’t afford insurance.

  • Clavos

    “I would bet that if you and your wife attempted to change providers, you would find that none of your pre-existing maladies would be covered.

    We change providers nearly every year. The law says that, as long as we go from group plan to group plan, with no break in coverage in between, we CANNOT be denied coverage for pre-existing conditions, and no carrier has ever even tried to deny us.

    You would also find that if either of you have too many “red flag” ailments that they won’t provide any coverage, or if they will provide coverage, the premiums will be so high as to be beyond belief.

    I don’t know what you classify as “beyond belief.” Our premium is $850 a month ($10K a year), but since we’re getting over $50K a year in expenses paid, we consider that a bargain.

    Still, with premiums counted, I’m able to take a deduction of between $15-20K a year in out-of-pocket medical expenses on our tax return. We spend about $600-700 a month in prescription copays alone.

  • STM

    And in my view, the country among the developed western nations that has the real healthcare crisis is the US.

    When a healthcare system is run PURELY (pedants: note the use of that word) as a business to make outrageous amounts of money that is not ploughed back into the system but into shareholders’ pockets, then it stops being a healthcare system.

    That is especially the case when many, many millions are denied even basic care because they can’t afford it.

    Medicine shouldn’t ONLY be about corporations and profits.

    It’s also about keeping people healthy and alive without regard to cost, something that’s been forgotten in the US.

    Read the hippocratic oath if in doubt. It still applies today, or at least it should.

    Doctors who don’t see it that way should have become lawyers instead.

  • Clavos

    Don’t just blame the doctors, Stan.

    Plenty of them (especially the primary care ones) make $150K or less a year. Plenty of ’em make a lot more than that, too.

    But the biggest money makers in the medical business are the hospital corporations, the private ambulance operators, the pharmas (that’s why I buy pharma stocks), and anybody who’s a supplier to Medicare, especially durable equipment suppliers. Medicare paid twice what I could have bought my wife’s wheelchair for (from the same Mfr.).

    Oh, and the lawyers.

    My wife’s brother, who’s never been sued, but is a gastroenterologist (high risk) pays more than $250K a year in malpractice premiums (he supports a single payer system).

    The tort system is responsible for much of the money spent on healthcare in the US. Every time my wife goes back into the hospital, they give her at least $20K worth of high tech tests, mostly to cover themselves in case of litigation, not because she really needs them.

  • STM

    Ok Clav, I was generalising a bit … I’ll change that to most people involved in the healthcare industry in the US, except for some doctors, some admin staff at hospitals and medical centres and GPs’ surgeries and mostly nurses, who are paid a pittance and do much of the good work that keeps people alive (I know, because my wife’s a RN in a heart-lung transplant unit).

  • Doug Hunter

    This, like most socialist policies, will be implemented in the coming decades here. It is not acceptable for a wealthy system to turn people down without driving the population crazy, it is more acceptable for a broke government to let you die on a waiting list because ‘they tried their best and the money just wasn’t there’ Same results, totally different perception.

    American stats on longevity, etc are more influenced by our fat asses and workaholic mentality than our healthcare system.

  • Doug Hunter

    As for the poster who pointed out the limited success of libertarian ideas in todays world, you’re absolutely right. Not because there’s anything ‘right’ or ‘wrong’ about the ideas it’s just most of the worlds population are sheep. They want and need someone to tell them how to live, where to eat, where to sleep, where to shit, and willingly they go to the slaughter. The wolves are at the top with the money and power on all sides. The only difference is in whether they walk in the open or wear sheep’s clothes. My advice Nalle, switch sides now and throw on some wool, the sheep have been startled and are on the move to ‘safer’ ground.

  • Clavos

    “American stats on longevity, etc are more influenced by our fat asses and workaholic mentality than our healthcare system.”

    Quoted for Truth.

  • Doug,

    Baa! It’s truly amazing that only the sagacious libertarians see the truth of things and are brave enough to face the world on its own terms asking no help from others. Man, they are a bunch of hard assed, steely eyed mother fuckers! The rest of us sheep can’t see the forest for the trees, and all that wool that keeps getting into our eyes.

    Clav – Premiums beyond belief: My wife was quoted a monthly premium from whatever Blue Cross/Blue Shield is now called about 5 years ago, of over $2000 per month, and it would NOT cover her for her diabetes, nor for any abdominal problems arising from her 2 surgeries caused by diverticulitis. More recently, she was quoted a premium figure of around $2300. that would cover her abdominal situation since nothing further has happened for more than 5 years. It would not, however, cover her for anything related to her diabetes.

    I have 2 self-employed brother in-laws who pay in excess of $2500 per month for their coverage. One is not married, so the premium is for him alone. The other’s premium would cover him and his wife. He has had a variety of health problems, although his wife has not. I’m not sure what, if anything, the policies will not cover as regards pre-existing conditions.

    Also, a key to your wife’s situation is the “no break in coverage.” If one is forced to give up medical coverage, it is VERY difficult to get another carrier, even in a group situation, to pick up the coverage with no restrictions. Attempting to get individual coverage is REALLY difficult.

    Oh, and one other thing – off topic.

    Congratulations to the Bush Administration in exceeding the five hundred billion dollar cost threshold for the Iraq war and occupation. We knew you could do it!

    Being of a positive bent, I’m betting that given inflation and the devalued dollar, especially if McCain takes the reins in the WH, that we can hit the one trillion dollar threshold in Iraq in far less time – say only 3 years, perhaps less. If we work hard enough in sending bucks to Baghdad, the Iraqis should be able pave the roads and paper all their walls in U.S. greenbacks, smiling and laughing, enjoying the irony while they go about planting roadside bombs (probably purchased with U.S. dollars) to kill more Americans.

    We seem to have plenty of money to finance killing and “nation building,” but can’t manage to find the bucks to insure that our own citizens have access to health care. It’s simple really. War = Profits. Government Health Care = Taxes. No brainer.

    Go team go!

    B-tone

  • Clavos

    “If one is forced to give up medical coverage, it is VERY difficult to get another carrier, even in a group situation, to pick up the coverage with no restrictions.”

    Absolutely true.

    That’s why I’m prepared to take out a second mortgage or sell my first born into slavery, rob a bank, or whatever it takes to make sure that break doesn’t happen.

    My wife and I have been VERY frugal throughout our lives; always living well below our means (small house, inexpensive cars, etc.). Our only extravagance has been the boats, and even there, we lived aboard for many years (until my wife got sick), renting out the house in order to save money.

    As a result, we saved a good portion of our earnings, which savings we still have, and which will be spent ONLY on necessities; NOT frivolities.

    Also, I long ago decided I like my work too much to retire, so I expect to have income until I finally keel over.

  • Ruvy in Jerusalem

    I have to agree with Stan that the American system is really sick. Canadians wouldn’t be running to the States for treatment if most Canadians didn’t live within two hours drive of some area of the States.

    The Canadian provincial governments use this proximity to the States as a crutch not to solve the problems of their own system. It’s a rule of human nature – give someone a crutch, and you can rely on him to use it.

    Similarly, as has already been pointed out upthread, Americans use their proximity to Canada as a crutch as well to solve their own health problems, usually problems of drastically overpriced (from their point of view) drugs.

    My suggestion:

    Look closely at the Australian or Israeli system of healthcare – both are far more successful than that of the United States. Adopt a continental system including all fifty states and the ten Canadian provinces and two territories, and as much as humanly possible, have the states and provinces administer the system. Base the system on the best elements of the Israeli or Australian system.

    The result is that
    1. You will have universal health care provided in an equitable manner.
    2. You have a system that is not dominated by a single bureaucracy in Washington or Ottawa.
    3. You have a system that will have large elements of private enterprise involved in it.

    IMHO, big part of whatever system is adopted would have to involve reforming the system of tort law so that someone does not have to shell out a quarter million dollars or more in insurance premiums to protect his ass against lawsuits. I don’t like saying that – suing a doctor is usually the only way to keep him honest – but providing universal health care will have to involve some sacrifices.

  • mostly nurses, who are paid a pittance and do much of the good work that keeps people alive

    Things must be very different Down Under then, Stan. My wife works closely with nurses and by her account, they’re vastly overpaid and do bugger all.

    To be fair, this might be just a special phenomenon of the area she works in, which is a rehab unit. Most of the practical patient care is done by therapists – the nurses seem to be mainly just glorified babysitters.

    That said, when my wife went to the ER last year after experiencing stroke-like symptoms (she’s fine – it turned out to be a complex migraine) she spent eight hours on a gurney without a nurse so much as looking at her in passing. The only people who paid any attention to her were the ER doc and the unit clerk. The nurses only seemed to be interested in paperwork and shutting patients up.

  • #35, alessandro:

    “don’t know if the answer is more money. We already spend a lot. I think it’s a question of shifting focus.”

    The United States spends 3 times as much as Canada per capita on health care. Canada spends very little in contrast with the rest of the countries that have universal health care, which is why we aren’t on the cusp when it comes to having more medical equipment, more hospital spaces, and more wages to pay doctors competitive rates so that we don’t lose them to private clinics. Of course, your website is designed to hook people up with private clinics, so it’s not necessarily surprising to see this point of view coming from you, nor is it surprising to see you walking hand-in-hand with the Fraser Institute. 😉

    “Another problem with Canada is that there is no true “national” standard. Each province regulates itself. So what we have now is in the face of “privatization” (which has been around since the 1930s in whatever form) are provinces running are different speeds. By far, Quebec and B.C. are leading the pack here.”

    The United States has different state-by-state regulations, too, with factors like level of income and other issues coming into play to determine how much coverage a Washington resident will get vs. a New York state resident. The different speeds you speak of are also related to how much funding each province can get. BC just had a big “conference on health” that cost millions of dollars which could have gone directly into the health care system. I’m not sure that the money IS being spent, as you claimed, and I’m not sure having various provincial regulations based around the various provincial issues is at the heart or even close to the heart of the issue.

    “According to our website stats the number of Canadians seeking health alternatives in the U.S. is growing everyday. They simply are fed up with waiting. You can’t twist this around and you can theorize all you like but this is what we are seeing. Now, in some cases the government will cover the expenses provided Canada doesn’t provide the service – which is often by the way.”

    Yes, and how many of these people are wealthy? This woman I saw on the news simply pulled together $50,000 because she couldn’t wait on a minor surgery. I’m not suggesting she should have waited, either, but I am suggesting that the situation you describe is relatively one-sided. The notion that a system modeled after the United States health care mandate would curb this issue is absolutely ridiculous. It would create MORE issues like this, except people would have NOWHERE to go seek alternative care. Private clinics would charge through the moon for simple procedures and people would have to choose between fixing a minor condition that could become major and paying the mortgage. Dave’s right about one thing, many Americans DO choose to do without health care. That’s because they choose to feed their families first!

    “The bad outweigh the good at this point I’m afraid.”

    According to who? Obviously it’s going to be painted that way when you advocate, through your job, the seeking out of private clinics. Yes, the situation involving private clinics is dire and yes, it paints your argument a certain shade. But what you’re missing is the idea that was already echoed here: MOST Canadians are still happy with their health care and wouldn’t trade it for the US system in a million years. It may not be a perfect system, it may even have some serious problems in SOME areas (not all), but it is far from being the last model one should look at and it is a significant step in the right direction from a system that puts profits before people and makes the poor choose between being healthy or eating.

    Tommy Douglas was voted the “greatest Canadian” for a reason.

  • Well Clav, I envy you your love of your work. I, too, will likely be working till I can’t walk any longer. The difference here is that I ain’t crazy about my job. I’ve been appraising houses for over 20 years, and if I didn’t have to look at another one, ever, I wouldn’t mind one bit.

    I don’t hate doing it. There are bazillions of much worse jobs out there. But, like many jobs, even very good ones, it is repetetive in some aspects of it, and I deal with a lot of petty bullshit.

    Back in the 90s and now again with the sub-prime mess, appraisers were then and are now often pointed to as the scapegoat. Certainly, some appraisers have been culpable, part of the problem, but by and large, the greed and corruption has come from the heart of the lending industry. Oh, well, that’s another soap box to mount.

    B-tone

  • Eight-hour trip?

    Wrong … try eight MINUTES.

    Stan, I see what you’re saying about conurbation, but you’re missing key elements here.

    It’s not just the drive. You’re leaving out the fact stated in the article that doctors in Windsor attempt to treat patients with clot clearing drugs first, wait to see if that works and THEN make the decision to send the patient to Detroit. That sometimes involves sending them home because of the shortage of beds in Windsor hospitals. The ones they send home essentially get to have a SECOND heart attack before the hospital acknowledges drugs aren’t working.

    Then add in the average 3 hour wait time in Windsor emergency rooms and wait time at the US hospital, and you’d be lucky to wait only 8 hours from heart attack to angioplasty.

    Dave

  • #15 and #16. I should have said either Windsor or Southern Ontario rather than Ontario in general. Toronto is a different deal. Their problem appears to be a shortage on neurosurgeons, not a shortage of heart surgeons.

    If you read the articles I linked to you’ll see that the main hospital in Windsor has only one cardiothoracic surgeon and is looking forward to getting their second. That’s not good.

  • The Obnoxious American

    Dave,

    Excellent article and well said. There are quite a few things universal healthcare proponents don’t tell people when they talk about government run healthcare.

    1) There is no evidence to suggest that it will be better healthcare

    2) There is no way to estimate what it will cost, but you can be sure it will cost more than rolling back the bush tax cuts

    3) The government is actually less able to negotiate lower prices for drugs and care, because unlike independent insurers, their customers can vote government reps out of power

    4) The WHO ratings that rank US 39th in the world in terms of healthcare don’t consider things like the fact that we are also so rich that we are obese and diabetic, which contributes to a shorter lifespan. Yet the WHO does consider lifespan.

    We hated the handling of the Iraq war, we felt the handling of Katrina was severely lacking. Why would we be in such a hurry to hand our private health care industry, one that has created countless medical advances, and has extended average lifespans, to the government?

    And once we do that, do Obama supporters really believe that they can keep their employer subsidized healthcare? Let me ask these people, would your corporation really keep paying for a private health care plan for employees when government offers one? You know the answer.

    There are ways to fix the many issues with the U.S. medical industries without a marxist style government expansion.

  • 4) The WHO ratings that rank US 39th in the world in terms of healthcare don’t consider things like the fact that we are also so rich that we are obese and diabetic, which contributes to a shorter lifespan. Yet the WHO does consider lifespan.

    Obnox, I’m sitting here scratching my head over this point and I can’t for the life of me see how it strengthens your argument.

  • The Obnoxious American

    Doc,

    Here is an excerpt from my article, The Obnoxious American Loves Hillary that talks about this very point:

    Liberal pundits are quick to point out that the WHO ranks the US health care system at #37, adding that the average lifespan in the US is not the highest in the world. Mark Twain once said something about statistics, and it’s just as true now as it’s ever been. The WHO rankings are based on access, per capita costs, and overall health of the citizenry among other things. These metrics make sense in poorer nations, where access or per capita costs might literally be a prohibitive factor in obtaining any care at all, and where average life spans more directly correlate to the quality of care. But it doesn’t translate so well when dealing with a prosperous and free nation such as the United States.

    It’s worth pointing out that the US per capita costs of everything from blue jeans to milk is higher than in most nations in the WHO list. As far as health of the citizenry, let’s not forget that US lifestyles are not always so healthy. Our rich nation also leads in terms of diabetes and obesity – diseases brought on by our excessive lifestyles, not by a lacking health care system. Certainly our average lifespan would be longer if we had healthier diets or spent less on vices such as alcohol and tobacco. And the impact of a healthier lifestyle would be lower per capita costs of health care. But healthy lifestyles aren’t fun – Americans choose an unhealthy way of life by eating too much or smoking and drinking because we can, and we pay for it. And while the quality of our healthcare system has nothing to do with these factors, the WHO ranks the US healthcare system lower as a result.

  • The Obnoxious American

    So, frequently, one of the arguments in favor of Government healthcare is that our WHO rankings are lower than say Saudi Arabia and Columbia as well as a few other countries. But it’s always a matter of the details behind the comparison isn’t it?

  • Two things, Obnox:

    1. Legions of obese people keeling over from diabetes and/or heart disease hardly lets America off the hook here.
    2. It’s not those who are enjoying the wealth who are obese.

  • The Obnoxious American

    1) You’re scaring me a bit doc, are you suggesting that we start mandating behaviors such as how much to eat and drink?

    My point is that, even if our health care system was 10x better, it wouldn’t change our habits of excess, and thus our WHO rankings would remain unchanged because peoples habits still would result in a shorter lifespan.

    2) Well, I think Obesity in America does not discriminate by paycheck. But regardless, the causes of Obesity are not medical. Whether you are rich or poor, have access to healthcare at Podunk Medical or NYC’s Mount Sianai, more often than not it’s the way a person takes care of themselves that determines how long they will live.

    Here are the CDC’s leading causes of death:

    Number of deaths for leading causes of death

    Heart disease: 652,486

    Cancer: 553,888

    Stroke (cerebrovascular diseases): 150,074

    Chronic lower respiratory diseases: 121,987

    Accidents (unintentional injuries): 112,012

    Diabetes: 73,138

    Alzheimer’s disease: 65,965

    Influenza/Pneumonia: 59,664

    Nephritis, nephrotic syndrome, and nephrosis: 42,480

    Septicemia: 33,373

    The three biggest, heart disease, cancer and stroke. How much smaller would just those three numbers be if people didn’t eat to the point of puking, drink to the point of alcoholism, or smoke 2 packs a day? More importantly, how would government healthcare change this? It wouldn’t. And I wouldn’t suggest mandating behaviors either (not saying you would).

    The real answer is to fix the problems we have, and there are ways to do that without throwing out the entire system.

  • Kolobos

    The problem with using WHO figures to rank who has the best healthcare is that those figures are predicated on the assumption that a country has socialized medicine and on ranking certain types of care way out of proportion to their logical necessity.

  • Jordan, check out cimca.

    I’m jumping off this boat.

    Don’t get me going on the Tommy Douglas thing. I’ve always found that to be an odd choice. Do it in ten years and he won’t win. ;<)

  • Doug Hunter

    “The problem with using WHO figures to rank who has the best healthcare is that those figures are predicated on the assumption that a country has socialized medicine”

    Someone has done there homework. Excellent.

  • I’m not saying we should mandate any behaviors, just that healthcare doesn’t (or shouldn’t) begin and end at the hospital door.

  • Doug Hunter

    “Baa! It’s truly amazing that only the sagacious libertarians see the truth of things and are brave enough to face the world on its own terms asking no help from others.”

    At least we can read. Rip that strawman to shreds.

  • Well then let’s look at something not “skewed” by ideology – femail infant mortality rates in 2006, generally considered a reasonable gauge of most countries overall health care, although it can be skewed dependent culturally on how societies treat female babies:

    Deaths / ‘000 live births:
    1 Angola 172.54
    2 Afghanistan 155.45
    84 China 25.94
    131 Russia 12.70
    176 Korea, South 5.75
    177 United States 5.74
    179 Cuba 5.41
    185 New Zealand 4.89
    191 European Union 4.50
    193 United Kingdom 4.47
    193 Denmark 4.47
    195 Netherlands 4.38
    196 Australia 4.22
    196 Canada 4.22
    199 Belgium 4.01
    200 Spain 3.95
    201 Switzerland 3.81
    203 France 3.69
    205 Germany 3.66
    206 Czech Republic 3.52
    207 Austria 3.50
    209 Norway 3.29
    210 Finland 3.22
    211 Iceland 3.14
    212 Liechtenstein 3.04
    213 Japan 2.97
    214 Hong Kong 2.75
    215 Sweden 2.59
    216 Singapore 2.07

    Strangely enough the US ranks 39th from the bottom…

  • The Obnoxious American

    Deano,

    Again, this isnt a question of healthcare in the US, it’s a question of behaviors. It may be indicative of healthcare in a developing nation, but here it’s more often a reflection of drug use or other unhealthy behaviors by the mother, or a lack of care shortly after the baby is born.

    Look at this page from the CDC, which talks a bit about the topic. Notice they are not recommending government run healthcare to resolve this, not by any stretch.

  • STM

    There are also issues Deano in some western societies where there are indigenous populations. Ie, infant mortality rates among aboriginal families in Australia are still way too high.

    There are a number of issues, and poverty is one of them. Another is that many aborigines choose to live more traditional lives in the outback, where they might be hundreds of kms from the nearest hospital or health clinic.

    Similar situation applies in Canada, and I believe also the US in relation to native Americans. So when you factor those in, it’s probably not too bad a figure, especially the US.

    Probably the respective governments should be looking at those indigenous issues, however.

    America’s health care problems seem to start a bit down the track for most people, if you believe the WHO criteria, and it actually looks reasonable to me.

  • #40 – STM, I’m glad you like it. Next time I go wait for nine hours in the emergency while staring at people suffer and rot in the hallways like I’m in some sap country I’ll give you a call. ;<) Punch in the 'Chaouilli ruling ' in google and work backwards from there. Jordan, wish I could go into what we are finding. Let's just say we're making some noise and our traffic is growing every month - which says a lot about the situation.

  • I don’t doubt there are social and economic disparities but you need to measure somewhere…infant mortality and life expectancy offer at least a good starting point.

    I don’t think you can claim that the statistical measurements are all that far off. Most developed nations suffer from decidely similar issues – food and diet, smoking, alcohol, drug use, endemic poverty. The developed nations of the west all have highly similar demographic profiles indeed, the US and Canada have very similar diets, cultures and socio-economic circumstances yet the Canadian infant mortality rate is still markedly lower. The US also lags in life expectancy, despite the similarities.

    So I don’t think you can point to the health care system in Canada and scream “utter failure because of socialized medicine” and still have that level of statistical disparity. The numbers don’t back up the claim.

    The Canadian health care system has many faults, issues and problems, but I’ll note what previous commenters have already noted – relatively few Canadians would ever vote to discard the system although a fair number would probably support the development of a second tier of support to plug the gaps.

  • Clavos

    “Most developed nations suffer from decidely similar issues – food and diet, smoking, alcohol, drug use, endemic poverty.”

    Don’t forget the murder rate. In the period 1998-2000, the US ranked 6th in the world for total murders with 12,658 – more than 4,000 per year, according to the Seventh United Nations Survey of Crime Trends and Operations of Criminal Justice Systems.

    Interestingly, on a per capita basis, the same survey ranks the US 24th in the world; a MUCH lower ranking than many of those in favor of gun control would have us believe.

  • Punch in the ‘Chaouilli ruling ‘ in google and work backwards from there.

    So who is Chaouilli?

    Is his first name Hugh?

    😀

  • STM

    Alessandro” “STM, I’m glad you like it … ”

    I didn’t say I liked it. I’m happy with Australia’s healthcare system.

    I said many millions of your countrymen think it’s good.

    If you had to go to a system like that of the US where it’s two-tier quality and user-pays, you’d really have something to whinge about if you ever got really sick.

    Maybe you should be glad for small mercies and keep hoping in the meantime that you get the option of some kind of private hospital insurance with a tax break that allows a two-payer system with no out of pocket medical expenses while still offering the top-quality care to those who can’t afford insurance and continue to use the government-as-payer system.

    At least your government is good enough to take care of you one way or the other if you get sick, even if that means being shuttled across the border, which the US government isn’t.

    You might note too that Canada scores much higher on the WHO rating than does the US, and considering the wholly reasonable criteria I reckon that’s telling.

    Some of Dave’s points might be relevant, but he’s forgotten to tell any of the horror stories we hear time and time again around the world in relation to America’s ailing and failing health system.

  • “Jordan, wish I could go into what we are finding. Let’s just say we’re making some noise and our traffic is growing every month – which says a lot about the situation.”

    That’s not really significant in any respect. All sorts of anomalies and claims receive traffic growth online. It is the true nature of the beast that people come to watch it suffer.

    By the way, I can’t seem to find any of your research on the FindPrivateClinics website. I can find several private clinics, though. Can you provide me (and any other interested individual) with a link to some of your research?

  • Ruvy in Jerusalem

    I’ve lived under the American health care system, and now live under the Israeli health are system, which is universal health care.

    Frankly, I much prefer the Israeli system. It’s much cheaper, even as a proportion of monthly income; there is much less bullshit in it, even though the Israeli culture tends to produce a great deal of bullshit.

    It works – quite unlike most other societal systems here.

    But as with Stan in Australia, nobody wants to know. They prefer insanity; continuing to act and think only in patterns that have produced failure and continuing to expect success.

  • Clavos

    I don’t think that’s fair.

    Stan’s not like that at all…

    :>)

  • I don’t think that’s what Ruvy meant, Clav – I think he just phrased it badly.

    Stan keeps telling everybody that they should take a leaf out of Australia’s book, but his words just wash over a lot of people around here…

  • Clavos

    Doc, Doc, Doc;

    Please say it ain’t so…anybody but you!

    Did you not see my little smiley face?

  • STM

    That’s because there’s a view that if it ain’t invented in America, it’s automatically no good.

    Sad but true. Ruvy’s right: the definition of insanity is doing the same thing over and over again and expecting a different result despite evidence to the contrary.

    Clav, you guys have to do something about that mindset. It’s going to bring you down one day.

    There are postive lessons to be learned from others, as well as negative ones.

    Our health system is far from perfect (like most health systmes), but it’s really popular and that’s always telling. Ruvy hits the nail on the head too … what’s happened here has taken a lot of the bullsh.t out of it, whilst still giving you a choice.

  • I did, but I wanted things to be ABSOLUTELY CLEAR for the benefit of the ‘washovers’…

  • Ruvy in Jerusalem

    You’re right, DD – but the insane asylum known as the United States and her inmates don’t want to know. They prefer the insanity of their useless arguments and the insanity of their useless “candidates” for president.

    Ein milim – there are just no words to describe it or excuse it. Perhaps G-d’s description of Ninveh to Jonah is most apt: “people who neither know their left from their right and many cattle….

  • Clavos

    G’night guys.

    You’re much too serious for this hour, not to mention waaay too apocalyptic…

    :>)

    ^NOTE SMILEY FACE (=joke!)

  • Believe me, there’s no love for the way healthcare is here. Everyone hates it. They just don’t know any different.

    The voices of people like me, thee, and Mr Upside Down 😉 , who do know different, get drowned out in the tumult.

  • ^NOTE SMILEY FACE (=joke!)

    Note getting crick in neck from tilting head sideways in order to see smiley face = NO joke!

    :-p

  • STM

    You blokes should learn to do a proper smiley face …. very simple 🙂

  • If I didn’t have a nose there wouldn’t be much to smile about!

    😀

  • {:^p~~~~~~~~~~~~~~~~~~

  • bliffle

    “#20 — March 5, 2008 @ 15:14PM — Bennett

    BTW Dave, You are a talented writer and I just don’t understand why you choose to spend your time writing such blatant distortions.

    Does someone pay you by the word to craft such irresponsible hit pieces?

    Or is there some thrill you get from making up this shit any trying to pass it off as fact? ”

    Bennett, are you suggesting that Dave is insincere? Do you accuse him of having ulterior motives? That perhaps he’s preparing himself for a post-apocalyptic career as a rightwing gadfly columnist pestering the coming Democratic-left triumvirate? That he’s just honing his perceptions to always find the sinister left in any policy failure and the virtuous right in any success?

    You should be ashamed of yourself, “Bennett” (if, indeed, Bennett is your name, which I sincerely doubt given your apparent bent for hyperbole).

    Surely our beloved and respected Dave is incapable of such deceitfulness. He wouldn’t cynically use the BC platform to practice partisan skills and build up an extensive CV of political articles to impress a future employer such as National Review, would he?

    Only a cynic like you, “Bennett”, would accuse a fine man like Dave Nalle of writing provocative articles to accumulate irate responses as ammo for demanding Big Pay from rightwing publications by showing how expert he is at hitting leftwing sensitivities on the money.

    Go wash your mouth out.

  • #73 – Jacques. Hugh is a jerk. ;<) But for those of you interested in what is going on here that's a good case to read about. I know many of you are pretty literate and educated to take a look. He basically took on the government and expressed the frustration many Quebecers and Canadians feel. #74 - STM, I never said I wasn't glad nor do I suggest it should be picked apart. I agree with you and Ruvy and Jordan in parts. I'm well aware of the horror stories ON BOTH sides. I do have friends and family in the States but they don't seem frightened by it either. And yes, that is more or less what we are waiting for. However, some public egalitarian zealots want to prevent this - which is not right. And boy do I have personal horror stories by the way for you all. I'm just advocating change. Large parts of the system need to change. That's all. #71 - Is on the right track. NO ONE advocates the dismantling of the health care system. What they want are options - people like Andy. Absolutely nothing wrong with this. Look, doctors are leading the way on Canada's medical private revolution. That says a lot. My buddy is a pediatrician and we've certainly had some wonderful discussions with his nutcase doctor friends. To the man, they are perfectly fine with what is transpiring. It's long over due. A few of us have been through both the public and private system so what's the difference between the two? Well, we often joke it's the classical music, quality doctors, coffee and danishes, timely service, no stress, calm and polite staff and free magazines.

  • I’m still curious as to if I can get a link to your research, alessandro.

  • Bennett

    ah bliffle,

    I would never think that.

    Wait a minute, now I do think that!

    And it beats the hell out of MY theory that Dave, while in Washington working as a “staffer”, was suborned to the dark side of the force.

    He then discovered that writing articles like this one was “much more fun” than doing anything that would serve his own country’s interests.

    Either way…

    Bennett

    aka Bennett z”l hy”d

    or just z”l hy”d to my friends

  • Some of Dave’s points might be relevant, but he’s forgotten to tell any of the horror stories we hear time and time again around the world in relation to America’s ailing and failing health system.

    Well, that’s not the subject of this article. I agree that those problems need to be addressed, but what I wanted to point out here, without going to the lengths necessary to address the entirety of healthcare reform, is that a single-payer single-tiered system like they have in Canada is not necessarily the wonderful cureall which so many on the left seem to assume it would be.

    I’m writing up my alternative proposal to deal with the problem and will post it at some point.

    Dave

  • Bliffle/Bennett, two peas in a pod that you are, if you have actually read anything I’ve written, you’d realize that my views are absolutely incompatible with writing for National Review, American Spectator or most of the other right-wing rags. I might be able to write for Reason, but I’m probably not enough of an ideologue.

    Believe it or not as you choose, but I just see problems and do my best to address them. Plus I have a bit of Mencken’s desire to ‘comfort the afflcted and afflict the comfortable’.

    Dave

  • troll

    (Dave – what happened to the radio work – ? I thought you guys were doing a good job)

  • STM

    DD: “and Mr Upside Down ;-)”

    Lol.

    But how many times have I got to tell you guys?

    It’s you who are upside down.

    North and south are artificial constructs (from the northern hemisphere, of course) and no one really knows what’s up or down. Maps from this heathen region of the world also tend to show Europe and the US as much bigger than they actually are.

    My Correctional Map of the World has Australia and NZ at the top, and to me that seems more logical when you consider they are highly-evolved and advanced societies when compared to anywhere else and both countries have a Union Jack in the corner of their flags which just about seals it for me.

  • Arch Conservative

    There are two things that for the most part never get mentioned by anyone on any side of the issue when it comes to discussing the American healthcare system.

    The first is how our individual choices affect our individual health. there are of course certain afflictions and conditions which so many suffer from through no fault of their own. This is truly unfortunate and I think all reasonable compassionate people have some degree of sympathy and desire to help those in situations like this.

    There are also those who make the most unhealthy choices possible for themselves on a daily basis and then experience poorer health which in turn results in greated healthcare costs. The American obesity epidemic isn’t a genetic epidemic. It’s a lifestyle epidemic that costs our healthcare system billions of dollars that could be saved every year if more Americans would just make the personal committment to eat healthier and exercise more regularly. We’re not talking rocket science and contrary to a lot of the propaganda that get’s thrown around you don’t have to be financially well off to educate yourself on and adopt healthy eating and exercise habits.

    The second thing that almost never gets discussed is the billions of dollars a year that illegals cost the system. Some might say why blame the poor poor when we can just villify those evil insurance and pharmaceuticals companies for everything. The problem is that if a citizen were to go to the ER they would get stuck with a huge bill for services rendered. If an illegal goes to the er, the hospital must provide treatment and after services are rendered there is absolutely no way to hold the illegal who received them financially accountable so the cost of those services gets past on to legal citizens when they receive care. What’s even worse is when illegal women have anchor babies in American hospitals and the babies are eligible for welfare. It’s gotten so bad in border states like Arizona and California that hospitals have had to shut shut down.

    By raising these two points I am not suggesting that thereis no need to exmaine our insurance companies, billing practices, drug costs, red tape beuracracy etc etc….. Far from it. I just believe that if we are going to have a serious discussion about our healthcare system we must be prepared to discuss everything that affects our health and the costys and delivery of our healathcare and the two issues I brought up are definitely major aspects.

  • #91 – Hunt me down. Ask one of the editors to act as a middleman and we’ll exchange emails.

    Ok, now I jump off this sucker for real.

  • Ruvy in Jerusalem

    Bennett

    aka Bennett z”l hy”d

    or just z”l hy”d to my friends

    Bennett,

    Have you been killed recently? Do you seek for G-d to redeem your blood for you murder? Are you a mere memory (blessed or otherwise) to your loved ones?

    That is what your comments indicate.

    If you want to make fun of someone else’s religious customs, fine. But be careful not to make yourself into an idiot in the process…..

  • Arch, not that you don’t have good points here, but The Obnoxious American did bring up the question of lifestyle choice in comment #56, with subsequent responses by myself and others.

    Where he and I differ is whether the WHO stats are skewed because of America’s relative prosperity. It’s the poor who tend to get sickest. Any good doctor will tell you that a large part of healthcare is prevention, and under the present system those in lower income brackets are the least able to afford insurance and/or regular doctor visits.

    It’s also an unfortunate economic reality that the cheapest foods are generally the ones most full of crap. I used to live paycheck to paycheck myself (actually it was more like ‘paycheck to another three weeks before next paycheck’!) and I can tell you from personal experience that to stretch your money you have to either bulk-buy cheap, nutritionally poor foods or grow your own (not easy if you live in a tenement block or an apartment complex).

    That said…

    I just believe that if we are going to have a serious discussion about our healthcare system we must be prepared to discuss everything that affects our health and the costs and delivery of our healathcare and the two issues I brought up are definitely major aspects.

    Quoted for truth.

  • Bennett

    Heh, Ruvy chill out. I thought those character strings were what “The artist formerly known as prince” used to spell his name.

    But seriously, no insult intended.

    Since you never explained what or why you were using them, I figured that they were foreign character sets not showing up on my ‘puter.

  • Ruvy in Jerusalem

    Well,Bennett, let’s make those character strings thoroughly clear for you. The italicized term is Hebrew.

    zikhronó l’brakhá – may his memory be for a blessing, abbreviated z”l, said of a dead person.

    hashém y’nakém damó – may G-d avenge his blood, abbreviated hy”d, said of someone who was murdered.

  • Arch Conservative

    Dreadful I think that if you factor in the fact that most Americans are gluttons who don’t understand what portions they should actually be eating it doesn’t cost all that much more to eat healthy with proper planning and portion sizes.

    Then there’s the whole exercise component and the last time I checked, walking, practically the greatest exercise there is, is still free.

    Another lifestyle choice that represents a major drain on our health and healthcare system is the fact that far far too many americans are either sleep deprived and/or have very poor sleeping habits. This keads to many accidnets which in turn leads to the need for healthcare.

    Did you not feel liek commenting on what I said about illegals affecting the system dreadful?

  • Ruvy, what characters would I use for ‘may his terroristic ass rot in hell’?

    Dave

  • AC. Sleep deprivation can also lead to weight gain, etc.

    Dave

  • Did you not feel liek commenting on what I said about illegals affecting the system dreadful?

    Sure, I’ll comment. I was having problems with my wireless connection earlier so I figured I’d better post my comment as it stood before I lost it completely.

    As you know, you and I don’t see eye to eye on this issue (or most others!). But as I said, you raised some good points so they’re worth looking at.

    It would be foolish to suggest that immigration doesn’t have any effect on healthcare services. That said, I can’t find much substantiation for your claim that hospitals are closing in some border states because of the burden of providing care for illegal immigrants who can’t/won’t pay for it. I did come across this report which looks at closures in California between 1995 and 2000. But unless I missed something, there isn’t a single mention of illegal immigrants as a factor.

    You yourself say that any reasonable and compassionate person would have the desire to help those in need. I’m very uncomfortable with the idea that hospitals should turn away any patients in need of care – the Hippocratic Oath being a prime ethical reason why they shouldn’t.

  • Ruvy in Jerusalem

    Dave,

    I thought atheists didn’t believe in hell….

    Nevertheless, the closest that we come to that idea in Hebrew is y’mákh shmo, meaning “may his name be erased”, and used with such wonderful folks as Hitler, Stalin and Arafat. It sounds kinda limp – until you actually hear it in the Hebrew, with the full contempt of the speaker larded into the phrase.

    I’m not aware of any characters that abbreviate this, but if he sees this comment, MAOZ, who comments occasionally, is liable to know….

  • I’m willing to accept the theory that there is hell or there are a variety of hells for those who believe in them and earn their way into them. It just seems poetically just.

    Dave

  • MAOZ

    Re #108, you mean like Arafat y”sh, or Hitler y”sh, or Alaa Abu Dhein [or however the heck you transliterate his name] y”sh?

    Just as a point of further information, the convention is that when abbreviating a single word, one “apostrophe” is used, at the end of the abbreviation. E.g., Rav [Rabbi] Kahane = R’ Kahane; or ReHov Yafo [Jaffa Street] = ReH’ Yafo. When an expression consisting of more than one word is being abbreviated, 2 “apostrophes” are used, before the last letter of the abbreviation. E.g., Artzot HaBrit [The United States] = Arha”b; or Tzava Hahagana LeIsrael [Israel Defense Force] = Tzaha”l.

  • MAOZ

    [Dang! Meant re #107! (*#@&^^#@!$”@!)

  • Ruvy in Jerusalem

    Dave, I hope you enjoyed your Hebrew lesson.

    MAOZ, how much were you planning to charge these guys?

  • It was all greek to me, Ruvy.

    Dave