monk222 | Healthcare and Canadian Dreaming

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'Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of "socialized medicine." Two years ago the Conference Board of Canada - a who's who of the nation's corporate elite - issued a report urging fellow Canadians to bear in mind not just the "symbolic value" of universal health care, but its "economic contribution to the competitiveness of Canadian businesses."'

-- Paul Krugman for The NY Times

Thinking of our Canadian friends, one thought it might be nice to tag at least the latter portion of Mr. Krugman's discussion on healthcare policy. Krugman understands that our dominant ideology doesn't make the Canadian solution possible in any near term, going for the pragmatic solution of taking what steps we can in that direction - going for Kerry!

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...The fact is that the mainly private U.S. health care system spends far more than the mainly public health care systems of other advanced countries, but gets worse results. In 2001, we spent $4,887 on health care per capita, compared with $2,792 in Canada and $2,561 in France. Yet the U.S. does worse than either country by any measure of health care success you care to name - life expectancy, infant mortality, whatever. (At its best, U.S. health care is the best in the world. But the ranks of Americans who can't afford the best, and may have no insurance at all, are large and growing.)

And the U.S. system does have very high overhead: private insurers and H.M.O.'s spend much more on administrative expenses, as opposed to actual medical treatment, than public agencies at home or abroad.

Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of "socialized medicine." Two years ago the Conference Board of Canada - a who's who of the nation's corporate elite - issued a report urging fellow Canadians to bear in mind not just the "symbolic value" of universal health care, but its "economic contribution to the competitiveness of Canadian businesses."

My health-economist friends say that it's unrealistic to call for a single-payer system here: the interest groups are too powerful, and the antigovernment propaganda of the right has become too well established in public opinion. All that we can hope for right now is a modest step in the right direction, like the one Mr. Kerry is proposing. I bow to their political wisdom. But let's not ignore the growing evidence that our dysfunctional medical system is bad not just for our health, but for our economy.

-- Paul Krugman, "America's Failing Health"

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(September 12, 2004)

The following is a NY Times article on the shortcomings of Canada's healthcare system:

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...The publicly financed health insurance system remains a prideful jewel for most Canadians, who see it as an expression of communal caring for the less fortunate and a striking contrast to an American health care system that leaves 45 million people uninsured. But polls indicate that public confidence in the system is eroding, although politicians remain reticent to urge increasing privatization of services.

During the recent closely fought election campaign, Mr. Martin promised to fix Canada's health care system "for a generation," focusing on trimming waiting times for diagnostic tests, cancer treatment and elective surgery like hip replacements. He is eager to use this televised gathering, billed as a health care summit meeting, to reverse the current view among many Canadians that his government is vacillating and may well fall next year.

But medical professionals and local officials say a major reason it may not be easy to address the problem of slow access to treatment is because doctors who do preliminary diagnostic work, refer patients to specialists and monitor the care of chronically ill people are less and less available - especially in small towns and rural areas.

A 2002 report from the Canadian Senate said that the actual number of family doctors had decreased only slightly in recent years but that the demands of an aging population were growing. Meanwhile, several recent studies have shown that family doctors are working shorter hours.

Young doctors are more likely to seek the most lucrative work in cities or go to the United States rather than start more modest practices in small towns because of growing debts when they leave medical school. That has set off an increasing competition among small towns to attract doctors.

Ms. Pacione's predicament is surprisingly common even in this upper-middle-class community on the north shore of Lake Ontario that seems to have everything going for it: immaculate lawns, a yacht marina, a downtown graced by vintage Victorian architecture and quaint parks and fruit markets.

Despite all its attractions, Whitby has trouble attracting enough doctors to take care of its residents. The town has only 63 family doctors to care for its 110,000 people (medical officials and local officials say at least 16 more are needed), and many residents drive 45 minutes or more to Toronto for basic medical care. Whitby is one of 136 communities with a total of a million people in Ontario, Canada's most populous province, that are not adequately served by family doctors, according to the Ontario Medical Association. That is up from 100 communities in 2000.

Whitby officials estimate that 22,000 people here have no doctor at all, forcing them to go to emergency rooms at overcrowded local hospitals to wait in line for up to four hours simply to refill a prescription, get a doctor's note for an employer or care for their flu symptoms.

"It's like winning the lottery to get in and see the doctor," Mayor Marcel Brunelle said. "This is a very wealthy country. What happened to bring the situation to this point?"

The government statistical agency estimates that more than 3.6 million Canadians, representing nearly 15 percent of the population, do not have a family doctor. That remains better than in the United States, where an estimated 20 percent do not have a regular doctor.

But there are signs that the doctor shortage in Canada is worsening. The Canadian Medical Association estimates that the country requires 2,500 medical graduates annually but is producing only 2,200 a year.

Mayor Brunelle formed a task force in June to recruit young doctors by introducing them to real estate agents and giving them advice on how to start new practices, and the town government is considering building a municipal clinic. The town of Peterborough is offering large monetary incentives and a grab bag of perks, including memberships at the Y.M.C.A. and cable television. Other municipalities offer moving expenses and the inside track on real estate next to golf courses.

But experts say those efforts may not be enough. "If the current trends continue we can anticipate a crisis," warned Joseph D'Cruz, a University of Toronto business school professor who specializes in health care. "People will actually find it impossible to get general medical services in their towns."

The doctor shortage is hurting the economies of small towns seeking to attract businesses. But it is also taxing the energies of the doctors who do live in those towns, as well as the resources of local hospitals - and patients often complain that their treatment is rushed.

Administrators at the nearby Lakeridge Health Oshawa, an acute care hospital, estimated that more than 30 percent of the patients who went to the emergency ward would go to a family doctor instead if they could do so quickly. It is a burden on the hospital's staff, space and financial resources.

One patient who went to the emergency ward recently, Crystal Bentley, 22, complained of cysts behind her ears. She said she would prefer to see her family doctor but would have to wait in his office for hours. She said she went to the hospital because the emergency room was faster.

"Seeing a doctor and not having to pay is phenomenal," she said, "but here I am taking up emergency time from doctors. I really do wish I could see my family doctor instead of coming here and talking to a total stranger."

-- Clifford Krauss for The NY Times

Flat | Top-Level Comments Only

pinko

LOL So it was in my youth, and my heart still carries such dreams, though I think I now know better about our limitations. But when it comes to healthcare policy, this may be the better answer, as it might not be the best policy to treat healthcare more like other products of the market, such as cars or houses or furnishings or fancy dining. Healthcare is more of a necessity, and it may be better to find a rational solution to meet its costs, rather than purer market solutions.

Or maybe not...

pinko.

Surprising that I'm the one who's nice to wasps, ain't it? Professional courtesy, maybe.

One does get a sense of popularity for the anti-universal healthcare crowd, but polls are surprisingly in favor of universal healthcare in the US. I think it will just take time. Maybe not even in my lifetime.

But Germany had it in the middle of the 19th century. We're the last civilized nation to have the death penalty and the last to still not provide basic healthcare for all our citizens. It's a shame.

Ever since reading Paris to the Moon by Gopnik I've loved the fact that the French can walk into any doctor's office and be seen by a doctor by filling out absolutely no paperwork. Beautiful.

But yes, the conservatives you would think would be all over healthcare except that it "costs money"...like helping the poor rather than paying for prison time later, they don't realize that one way or another we all pay the medical bills. Business (to help the hardheaded capitalist types understand! LOL) suffers without universal healthcare. You would think that would be a motivator. If not that it is a basic human right to have the best medical care possible from one's government.

I imagine that the American elites, with the support of much of the middle classes, who work to prevent universal healthcare, are moved by their sense of American exceptionalism. Yes, America is last to give up on old notions like the death penalty and private healthcare, but, look, America is also the lone superpower in the world. So, rather than trying to emulate, say, a Canada, it would seem smarter for them to try to be more like the US. At least I'm tempted to think this might be part of the psychology involved.

Hmm, I think less "exceptionalism" and more just what is a part of who we are...naturally suspecting of government wasting our money and some Hollywood botox-er mooching it off of taxpayers. I can see a nasty fight already over what healthcare is covered and what isn't.

Though exceptionalism certainly does bite us in the ass often. Everybody wants the US to be "different" with our supposed "values" not realizing that we're shooting ourselves in the foot in doing so.

Practical concerns appear to be getting the best of the situation, however, as this Canadian Rx thing may be the straw breaking the camel's back. So many happy, healthy, low-cost-drug-taking Canadians will sooner or way give way to disgruntled Americans who are tired of it. LOL For America to really be a world leader, we can't have third rate healthcare and barbaric practices like the death penalty. Sooner or later we'll catch on. Being a somewhat stupid people it just takes awhile.

My fear that single-payer won't happen in the US has more to do with how weird it is that it hasn't happened yet. At this point, I would worry that the lobby groups that represent those who profit so much off of the system have a stranglehold on both the discussion AND the process... and it is amazing to me that the people don't stand up and DEMAND more. I mean, Canada got it during a very difficult economic period in the Prairies, and it was a pretty major upheaval at the time... but I worry now that Americans are too complacent, too comfortable with corporate rule in matters of health to force their politicians to act.

Socialized health care
I lived in canada for 9 years. Without the health care system there, I might not have had a mother today

I think that we have more than our share of tragic stories for want of a better healthcare system.

I hope you all are fully insured here now!

oh yeah we are definitely
but at the time my parents were out of jobs(which is why we moved to the states) and my mom had a stroke
here if you dont have a job you don't have health care. basically.

and we are fully insured

life is good
<3
becky

My dad had a colleague in San Francisco who had decent health care coverage, but not the best. Well, his kid got leukemia, and life basically went straight to hell for the parents... mom had to get a second job, had to go into debt, re-mortgage the house, etc. etc. etc.

He had another colleague who was briefly without health care while he switched jobs. In the intervening period between jobs, he was diagnosed with a moderate heart condition... so of course was denied coverage because of a "pre-existing condition." It's like a death sentence.

And that's to say nothing of how massive your medication costs are. Did you hear about the Prescription Busses that have been driving seniors up to Canada? Drugs cost between 50% and 66% less here than there. That's weird to me.

It can seem tragically absurd. One can also see this sort of dysfunction in our public education system, with respect to the lower half, as you know. I suppose this is why rhetoric such as John Edwards' "two Americas" has especial resonance here - the perennial 'tale of two cities' argument. I mean, every country has its cultural divide between the rich and the poor, but it seems much deeper and broader here.

Lone superpower but among the worst of the developed nations when it comes to the basic standards of living - it's quite a story.

And I'm afraid that the emphasis on foreign policy and war only pushes such issues further off the table.

I'm not sure that the divide between rich and poor is worse in America than in, say, Saudi Arabia or even Russia, but I think it's the very fact that the US so singlemindedly sets itself above every other country on earth in that regard, when its own record increasingly speaks more to a rarified oligarchy of sorts. I don't see that there's any real reason that America can't maintain its superpower status while distributing wealth a little more equitably... beyond the fact that the people who keep the grip on power won't allow it to happen.

I recall once, a long time ago, one American family member said that ultimately, Canadians are just bitter because they want what America has. The older I get, the less I think that's true... I think we want the self-respect that America has, but I'm more and more convinced that we don't want the rest.

The irony is that in the face of all this, the news this week here in Ohio has been about how horrible our rankings have been economically with healthcare and standard of living suffering greatly.

We're worst in the nation for pollution, worst in job creation, huge growth in uninsured and those living below the poverty line.

Americans get very defensive whenever our ego is on the line...we're a chest-thumping lot. I think Canadians are a practical bunch...we seem to lack that sometimes. We very much envy that despite all our wonders, we still fall behind. It blows our little American minds. It's very psychological...accuse Canadians or French of something to avoid having to confront our own failings. Yeah, Canadians are bitter over their friendly reputation in the world, good healthcare, lack of crime. LOL

Well, it's not quite a "lack" of crime (and hey, I am living in the Murder Capital of Canada). But I take your meaning.

When we were at the hostel in Toronto, we met a slew of Brits and Aussies. At one point I was explaining to them that I always think that Canada has a bit of an inferiority complex because of having to live in such proximity to American nationalism. They just stared at us blankly, and basically said, "You guys have no reason to have a complex. Let us say, that having lived in Europe all of our lives, everybody loves you. Everybody thinks you're great. America is a different story."

What really came through on that trip was how severely Bush has affected the world opinion of America. Of course I always knew about it from reading about it: but to see it displayed was quite an eye-opener.

There's actually a lobby (and it's getting stronger) that wants to open the system to privatisation. Public opinion is strongly in support of what we have now, though.

I would imagine that they must be more like your fringe group. After all, I think a bonus in your system is just to be contrary to America, heh.

It's Harper and his ilk (though Harper's had to cut his rhetoric on that point since becoming Conservative leader). Overwhelming evidence shows that Canadians are extremely distrustful of the idea of privitization... in one poll, for instance, they asked Canadians if they would favour "alternative deliveries" (as Harper as re-termed the effort). Then they rephrased the question to ask if they favoured "two-tier" (a term for simultaneous privitization that is more familiar to Canadians).

I can't remember the exact percentages, but the first term saw many Canadians agreeing that they favoured it. The second term saw the overwhelming majority (into the 90% range) rejecting it.

What tends to happen is that certain politicians try and muck about with health care while Canadians aren't looking. But most of the country... even though it can be deeply frustrated with the system... out and out refuses to have the basic premise changed.

Ultimately, as long as the country keeps a watch out for that sort of thing, I don't think public health care in Canada is in immediate danger. We value it too much. *says a prayer for Tommy Douglas*

I agree with Krugman... a Canadian-styled system would not work in the US at this point. Perhaps sometime in the distant future. But there can be more equitable and socially beneficial solutions to the looming health care crisis in the States. Damned if I can pinpoint them exactly, but there definitely is potential.

To come back to an old topic, I thought you might be interested in this article on Canada's public healthcare system. (http://www.nytimes.com/2004/09/12/international/americas/12canada.html)

It would seem that there is some trouble providing incentives for doctors, lessening supply. Canada still sounds better, but it goes to show the real problems with the subject of providing healthcare for all. This article can even lead me to wonder if it is not inconceivable for some privatization, or that 'two-tier' idea you've mentioned endorsed by your conservatives. To quote one paragraph from the article:

"The publicly financed health insurance system remains a prideful jewel for most Canadians, who see it as an expression of communal caring for the less fortunate and a striking contrast to an American health care system that leaves 45 million people uninsured. But polls indicate that public confidence in the system is eroding, although politicians remain reticent to urge increasing privatization of services."

Oh, I agree there are problems. You wouldn't get a single Canadian to say that there AREN'T problems. But we believe that ultimately, the problems are outweighed by the benefits, and those can be PROVEN to be benefits in terms of measuring national health.

Because Canadians are all "in the same boat" when it comes to health care, it also follows that it is the single biggest concern for pretty much all Canadians. This means that we have the power of voting rather en bloc when it comes to health care: we don't need to fear politicians hacking away at it, because the instant someone messes with health care, they're out the door.

Since politicians can't polarize people on the subject of health care (well, some try, but they end up with 10% of people on their side and 90% against), it also gives Canadians a lot of leverage to demand better.

The health care system right now definitely needs a fix, but show me a government system that doesn't need improvement in either country (prison system, education system... though yours needs a fix more than ours, LOL) and I suspect that with this minority government, the Liberals will make that a major priority for them... the object of minority governing being to pass as much popular legislation as quickly as possible.

Since politicians can't polarize people on the subject of health care (well, some try, but they end up with 10% of people on their side and 90% against), it also gives Canadians a lot of leverage to demand better.

It just can look tempting for there to be this point when an effective consensus is derived that freezes out the botton fifth of the population in exchange for better service for the middle classes: 80% vs. 20%, favoring better personal healthcare over the idealism of knowing that all are covered. But maybe that's just the calculating American in me - and knowing what's it's like to be cut out!

No offense, but I don't really understand what was just said. I will, however, say this: I have never met a Canadian outside of Alberta who doesn't ultimately believe in universal health care. They want to improve the system naturally, and are willing to look at alternatives towards that (I've always thought the idea of tiny user fees... say, $1.00 or $2.00 per use was worth looking into).

And I grew up in the middle class. Middle class people don't want multipayer health either. Everyone wants to improve what we have now, and change it to be more responsive and more agile using creative solutions when necessary.

The essential format of universal coverage WILL remain. I do not fear its loss, because Canadians will not allow it.

God, Melissa, how you can just write and write and write!

The point I was trying to make is abstract, but it is central to my understanding, and so I'll take another stab at it, trying to break it down:

1) Canada has universal healthcare, whereby everybody has access.

2) Providing healthcare for Canadians costs a certain amount for the year - let's say one-trillion dollars.

3) Canadians know their healthcare system has problems, and they naturally would like better service.

4) Canada is a democracy, and majorities tend to rule in democracies.

5) In Canadian politicking, as leaders look for solutions to satisfy Canadian voters and keep or get power, there is a solution that (in my theoretical thinking) becomes irresistible.

Why not give, say, 75% (changing my numbers a little from my first comment) of Canadians more of that one-trillion dollars that we spend on healthcare!?

This should make that 75% happier because they'll be getting better healthcare services, and that lower 25% that will be effectively getting squeezed out will be politically ineffective in their unhappiness over getting even much less in healthcare services.

Hence, we see the new consensus - perhaps, the Harper Consensus - between the leaders and the middle & upper classes, with the people who lose being that bottom 25%.

The hard point being that that 75% may appreciate the better healthcare service more than they will feel bad about those who are in the bottom 25% who are getting the shaft.

As for the other comments with your competing anecdotes, although I certainly credit your points, I am tempted to think there is some fire in all this smoke of discontent that is being reported.

I'm still inclined to think single-payer is better, and that America is really hard on its lower classes, as well as on those who are in the middle classes who just get caught in the interstices of the system (as with your stories above about some of your dad's colleagues in America). I'm only appreciating how difficult the problem may be to achieve universal healthcare on a truly satisfactory basis, wondering if it's even really possible.

Why not give, say, 75% (changing my numbers a little from my first comment) of Canadians more of that one-trillion dollars that we spend on healthcare!?

Because I can't imagine implementing that in a way that it would work? How in the world would you limit services to wealthier Canadians? Even middle-class Canadians would resist a system that required you to be of a certain income-level to obtain services.

It would be so sickeningly transparent that I think EVERYONE would rebel against it. Even Harper would call out such a proposal as being rascist and prejudiced (he likes doing stuff like that).

I'm not trying to be dense, but I really don't understand how you would redistribute spending so that it only targeted people of a specific income. I can't for the life of me imagine how that would work. It's either there, or it isn't. There's no way to qualify it.

Furthermore, even with the middle-class, there are both problems and successes. My dad considers the level of care he's received with his recent extended health problems to be a success, and he would be in the position to afford it down south. My friend Lea's experiences with her extensive lifetime of reconstructive plastic surgery has been a strange and frustrating journey, but I also consider it to be a success, and one that quite possibly she would not have been able to receive in America at all, as I would wonder if she would have been cleared for insurance at all if the companies were aware of the extensive and incredibly expensive surgery that she would require.

It's not like the middle class is languishing here. We're all getting taken care of. And when we don't... there are massive inquiries, another benefit of the public health system. When it fails, the whole system reacts to investigate the failure and address it.

As for the other comments with your competing anecdotes, although I certainly credit your points, I am tempted to think there is some fire in all this smoke of discontent that is being reported.

There's definitely fire in the need to fix current problems. I've never denied that, and I believe it's our biggest national priority right now. But I don't think they merit the disgust with the single-payer system that most Americans seem to have. And I believe that as a country, and as a country currently led by a minority government, we'll be able to address them.

In a way, I find it comforting that our biggest national priority is fixing health care. It's important to me that this is where we place our energy and our resources. Canada is in good economic shape right now (really good, actually) thanks to some excellent economic moves by the Liberals, and I think we have the resources available to really tackle it going into the next few years.

I'm only appreciating how difficult the problem may be to achieve universal healthcare on a truly satisfactory basis, wondering if it's even really possible.

Nothing is ever really ideal, is it? I've feared before that you've idealized universal health care in some of your previous writings. I think it's good that you recognize its drawbacks. But I also think that providing an equal level of care to all is the closest thing to a just and equitable system that we can achieve. Everything will fall short of the ideal. The important thing is that everyone has an equal ability to access modern medical care.

--

FIrst of all, I think it's a little unfair that they profiled Whitby, but I suppose it's representative of the little Kentucky Fried Cities that surround Toronto.

As for specific stories in that article:

Yeah, it can be a pain finding a family doctor (though Manitoba Health and I assume every other province too goes out of their way to maintain a database of doctors accepting new patients... there's also the route of just asking. My current doctor wasn't listed on the list but he ALWAYS takes new patients apparently, so I only waited a week between calling for an appointment and receiving one, and he is an INCREDIBLE doctor).

But it's irresponsible medicine to "not know her history" when every doctor in the country can easily get a patient's file from another doctor.

I also turned a walk-in clinic into my second primary doctor (the second I use for... "girl problems"), so now I actually have two. So I wonder why it is that the woman in question can't find a walk-in physician that she can return to.

"If you are not bleeding all over the place, you are put on the back burner," Ms. Pacione said, "unless of course you have money or know somebody."

Having spent a good deal of time in emergency care over the years, I don't buy this. Your wait may be long or short depending on your need, but I've gotten great care when I needed it WITHOUT being "bleeding all over the place."

My longest wait was about 2 hours (when I came in with a weird cold that after examination turned out to be a severe facial infection), my shortest was about 10 minutes when I was admitted with a lorazepam overdose and suicidal tendencies (they kept me overnight to wait for a psych consult). I think in the first case it's understandable why I had the wait I did, and I'd prefer the wait over having to pay gargantuan amounts of money that I can't afford to be covered.

The small town angle I suppose IS something that needs more work, but I wonder if that would be true in any American city? The problem being that when Canada is rural, it's... REALLY rural. More rural than America ever gets.

I mean, if you have a population centre of a thousand or so in Northern Ontario that's only reachable by land for six months out of the year and even then it's a ten hour drive from any other population centre, certain hurdles come with it. it's hard to get qualified physicians to go out to those kinds of places (though the benefits of going to work up North are pretty huge for a doctor, nobody wants to take it, and I don't blame them).

I'm not sure that America ever has to worry about rural locating on that scale, since the country in general is both so much more a) habitable, b) crowded and c) accessible.

As far as I'm aware, a lot of people in towns around Winnipeg just come right into Winnipeg for their doctor, which really isn't so bad.

Whitby officials estimate that 22,000 people here have no doctor at all, forcing them to go to emergency rooms at overcrowded local hospitals to wait in line for up to four hours simply to refill a prescription, get a doctor's note for an employer or care for their flu symptoms.

I did that by choice for years (I didn't get my doctor/s until last year), and never thought anything of it. But what Manitoba did to alleviate this was to transform one of the city's Emergency-capable hospitals (the Misericordia) into an Urgent Care facility. What this means is that emergency patients are directed by ambulance to the nearby Health Sciences Centre, while the Mis retains its services primarily for "walking wounded..." cuts, sickness, broken bones... and things like mentioned above. It's definitely helped to deflect the strain off of the emergency hospitals.

That is something for PROVINCIAL governments to deal with, BTW, not the federal one.

It's really the provincial governments that deal with the execution and administration of the public health system. So it's up to them to address the challenges, while it's Ottawa's job to look at improving and restructuring funding.

Blaming all the problems on Ottawa isn't fair... the provincial governments have to step up to the plate to work on them. The NDP in Manitoba won over the old Tories back in 96 or whatever primarily because the Tories had let health care slip SO badly in our province. So the NDP have been having a good deal of positive effect in changing it... they've almost eliminated so-called "hallway medicine," for instance, which had grown to massive proportions under the Tories.

The Canadian Medical Association estimates that the country requires 2,500 medical graduates annually but is producing only 2,200 a year

True, but we're also successfully starting to lure American doctors back here, which this article doesn't explore. But I do personally know of several who've come back to Canada in the last few years.

She said she would prefer to see her family doctor but would have to wait in his office for hours

What the hell? Has she not heard of making an appointment?

Also, anent the growing disparity between medical school graduates and needed doctors... the provincial governments have been very pro-active about getting doctors in from overseas. There are a lot of immigrant doctors in Canada (my girl-doctor is I believe originally from India), and without them we'd be sunk... but that's not so different than anything else in Canada. In all things, we depend on immigration to move forward.

In 2001, we spent $4,887 on health care per capita, compared with $2,792 in Canada and $2,561 in France.

Strange that my parents paid practically nothing for mine. Most health comes through your employer, it's free. I wonder where this guy got his figures anyway.

Yet the U.S. does worse than either country by any measure of health care success you care to name - life expectancy, infant mortality, whatever.

And yet, none of these are accurate measures of the quality of a health care system. There's lies, damn lies and then there's statistics. This is one of those situations where people try to use simple statistics to try to describe something that is much more complex involving other factors. Life expectancy is easily explainable, Americans are fatter and have unhealthy eating habits. That's not something that the health care system can solve, doctors aren't going to watch you make sure you eat healthy. Without seeing the reasons for infant mortality it's naive to assume what the reasons are for it.

(At its best, U.S. health care is the best in the world. But the ranks of Americans who can't afford the best, and may have no insurance at all, are large and growing.)

So clearly the solution is socialized health care! Let's not increase medicare/medicaid spending so that they can get the same exact "best in the world" health care available to the more fortunate. If you switch to socialized health care you're going to see that quality depreciate as it requires the government to put spending and salary caps on hospitals and doctors. All those specialists are just going to move to another country where they won't have those limitations, just like they do now when moving to the U.S. My surgeon, who is arguable the best in the world at what he does, was born and raised in Canada, but came to the U.S. to practice, I wonder why...

And the U.S. system does have very high overhead: private insurers and H.M.O.'s spend much more on administrative expenses, as opposed to actual medical treatment, than public agencies at home or abroad.

I'd like to see this guys source on this. Administrative costs are very high, but it's doubtful they are higher than medical costs. In any case there is legislation being considered now to reduce administrative costs. Anyway, this is something that can be fixed through other means, it's not a reason to jump to a socialized health care system.

"economic contribution to the competitiveness of Canadian businesses."

How are they substantiating this?

Strange that my parents paid practically nothing for mine. Most health comes through your employer, it's free.

Going by your argument, I would think you among the first to appreciate that nothing is free. I think the employer contribution is included in that $4,887 per capita figure.

We appreciate the power of the free market, I think. The question is whether healthcare should follow that same model, whether it might be better to lessen the power of competition for universality. But this is all hypothetical anyway. Even Clinton's historic effort wasn't anything like the single-payer solution, and we aren't going to be experimenting along those lines for some time, especially if Bush secures his re-election, which it looks like he well may do.

Revisiting this argument, I thought you also might be interested in today's NY Times article on the problems with the Canadian healthcare system. (http://www.nytimes.com/2004/09/12/international/americas/12canada.html)

Just as one cannot legislate morality, so some say, it would seem that we also cannot truly legislate universal healthcare. But I suppose we can try...

We can try, but I don't see the need for socialized health care. It's a radical change from the current system, for a system which does provide good health care for those who can afford it. Instead of completely changing the system, why not try to increase medicare/medicaid spending? This way you get the same exact quality of health care, but people who can't afford it get financial help. I'm sure there are plenty of impractical programs that can be cut to do this. For example, the current space program is spending billions to send rovers to mars, which isn't exactly something with much practical value. Don't get me wrong, I love space exploration and the progesesion of technolgy, but other issues have higher priority.

Oh and because doctors and hospitals don't have fixed spending caps with medicare/medicaid, they simply add more doctors and resources to fit the demand rather than having those long wait lines mentioned in the article. Without the hospitals essentially being businesses like that it's not realistic.

The catch, I suppose, is that we really are spending a lot on healthcare as it is, that is, we have a quasi-socialized system with medicare, medicaid and other gap fillers. Everybody getting good quality care would probably take more than can be got from such things as space programs.

That's the catch on healthcare. We like to think that all should get good healthcare, but the real problem is that this isn't a realistic expectation. Our struggle is with trying to realize that expectation.

Just to add a quick aside, the reason you're spending so much with a "quasi-socialized" system is because the private system is so huge and so unwieldly, resulting in massive costs. Eliminate that, and there is more to go around.

My surgeon, who is arguable the best in the world at what he does, was born and raised in Canada, but came to the U.S. to practice, I wonder why...

And the head of neurological surgery at the Health Sciences Centre, who is also the father of a friend of mine, came back to Canada after ten years in a multi-million dollar position in Westlake (a wealthy suburb of Cleveland). to take a job here heading up a new neurosurgery initiative. There's a trade on both ends, though Canada tends to lose professionals to the states anyway, in MANY areas... the "brain drain" was the worst in the mid-90's. That's one of the reasons that we depend so much on immigration (that, and the fact that Canadians don't actually breed enough to replace themselves).

We need to look increasingly towards that option, and we need to pressure our provincial and federal governments to be more pro-active in recruiting more specialists. I suspect we'll see great change on this end with there being a minority government in power now. Too many years of cocky Liberal majority resulted in a lack of initiative, I suspect. It's a problem we have to address, but I'm confident that it's one we definitely CAN address. Then again, I'm also confident in my system in general.

I don't really want to open up the debate again except in a friendly-like way, but all I can say is that I've been treated in America and I've been treated in Canada, and I'm staying where I am. I take that inspiration from my parents and siblings, who are American citizens, and speak every day about how grateful they are for the current system (and my father is in the top 10% of wage-earners).

Ultimately it's not that we're like "OMG SOCIALIZED MEDICINE!!" (and it's socialized insurance, not socialized medicine, but whatever). And I don't think Canada's system would work in America given its overall cultural climate, its population, and other considerations.

Basically it just breaks my heart to hear of so many Americans lacking the basic security of knowing that health care is available to them whenever they want it. I've benefitted so much from our system here. It scares me to wonder what would have happened to me under an American-style system.

I don't really want to open up the debate again except in a friendly-like way, but all I can say is that I've been treated in America and I've been treated in Canada, and I'm staying where I am. I take that inspiration from my parents and siblings, who are American citizens, and speak every day about how grateful they are for the current system (and my father is in the top 10% of wage-earners).

Why would your father prefer Canadian health care if he can afford the best care in the US? There are many more specialists here in case something bad happens.

Ultimately it's not that we're like "OMG SOCIALIZED MEDICINE!!" (and it's socialized insurance, not socialized medicine, but whatever). And I don't think Canada's system would work in America given its overall cultural climate, its population, and other considerations.

It's socialized medicine, the hospitals are government controlled and the doctors are paid by the government. Socialized insurance is something like medicare/medicaid.

It scares me to wonder what would have happened to me under an American-style system.

It seems that you're pretty well off, so you'd actually do very well. I'm middle-class and I got insurance to pay for procedures that costs hundreds of thousands which weren't, strictly speaking, medically necessary (they were a quality of life issue). I may have said this already, but even if it were available in Canada I doubt they would pay for it. It all depends on who you're insured through and your plan...

Why would your father prefer Canadian health care if he can afford the best care in the US?

Because he prefers to live in a system where he can both access the best care for himself (which, unfortunately, he has had to do quite a bit in the last two years), and also know that he doesn't have to fear loss of coverage for his friends and loved ones. He prefers it here where his options aren't limited by HMOs and where he doesn't have to run the maze of corporate insurance. He prefers it where he never has to dread some kind of medical crisis that his insurance would cap and even he could not pay for, as he has seen happen to his American colleagues. He's lucky in that he doesn't have to fear for the loss of his job (tenure is a beautiful thing), but it's important to him to know that he doesn't have to worry about his friends or family losing their coverage or seeing a decrease in it if they lose their jobs.

It's socialized medicine, the hospitals are government controlled and the doctors are paid by the government. Socialized insurance is something like medicare/medicaid.

http://en.wikipedia.org/wiki/Medicare_%28Canada%29

"Health institutions are either private and not-for-profit (such as university hospitals) or state-run (such as Quebec's CLSC system), and doctors in private practice are entrepreneurs who bill the medicare system for their fees."

The phrase as it is continually taught here is "socialized insurance," not "socialized medicine." I think this is just a matter of terminology, but it is the one that we are taught and the one that I choose to use, as I still feel it is a) more accurate and b) I dislike the negative connotations of "socialized medicine." Some of the hospitals are overseen by the provincial governments, others are not... there is a mixture here in my city. But applying the term "socialized medicine" implies a universal standard that does not exist, particularly insofar as differences in provincial delivery are concerned.

It seems that you're pretty well off, so you'd actually do very well.

I would not, because I am self-employed, and I myself do not have a very impressive income. There is no way in HELL I could afford any of it, and I would not be covered by my career. And I've had to rely on the health care system quite a bit in my life. I feel grateful to have that chance.

I may have said this already, but even if it were available in Canada I doubt they would pay for it.

That certainly depends on the specifics, but in most cases where there can be shown to be a need, it will be paid for. I've had several small plastic surgeries over the years that were not medically necessary. The first, when I was a child... I was born without a tendon connecting one of my fingers to my hand. As a result, that finger was immobile. I had plastic surgery to correct it. When I was in my teens, I had some minor work done on my face through a private surgeon. All of it was covered.

I've also benefitted from an awful lot of psychological and mental-health treatment, but we won't go into that here. Suffice to say I've had to avail myself of "quality of life" treatment and been thankful for it.

Similarly, my friend Lea was born with a rare genetic disorder that caused the bones in her face to grow, erm, incorrectly. It was not life threatening, but she has had twelve major surgeries in her life to correct it (it will finally finish this year when she's flown to Toronto to complete her transformation). None of that was life-threatening in the slightest, but it was important to improve her quality of life. What she has had done is extraordinary work (my brother is a maxillo-facial plastic reconstructive surgeon, and he's taught me a bit about his field) and, like I was saying to Monk, I wonder if she would have been able to receive it to the level that she has in the States.

Furthermore, for services which the various provincial governments choose not to cover (all provinces must cover a certain range, and have the option to cover more if they choose, but not less), many employers still offer extended benefits. So if you are employed, I would think that you would be able to access that kind of care anyway.

Actually, to paraphrase my dad anent why he prefers it here... when he moved to Canada he had three children. He had three more since living here (which is why half of us can vote in your election and the other half can't, LOL), and as he always says it, "The more I got used to it, the more it felt like a weight off my shoulders. I didn't have to worry about my children's health being provided for anymore, or my grandchildren's, for the rest of their lives. I had never even noticed the weight until it wasn't there anymore."

I suppose growing up with that kind of talk was very influential on my viewpoint. I have never met someone so grateful to be a Canadian as my dad, even if he's only half-Canuck (dual citizen). All my life I knew that my dad considered himself the luckiest man on earth to have been able to come up here, and I suspect my ideas have grown up accordingly. At the very least, he's taught me not to take anything that this country gives me for granted, and to fight for it always.

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