The long, slow death of public health care...

April 27, 2006 12:00 PM

Few things are more sacred to Canadians than the nation's medicare system. After years of health spending cutbacks by conservative politicians, debate rages over whether private providers should now be allowed to compete with the public system. In British Columbia, where the government is shovelling tax dollars into the 2010 Olympics, patients are being left to die in emergency rooms and long-term care facilities due to overcrowding and understaffing. Is it too late to save public health care? Should it be saved?
posted by 327.ca (89 comments total)

After years of health spending cutbacks by conservative politicians...

Traditional way to politically kill something - starve it of funding, then highlight the fallout from underfunding to demonstrate how it just didn't work.

It should indeed be saved, and to do so the system needs the funding originally promised.

The interesting part is that overcrowding and understaffing are a regular part of private hospitals in the U.S. One person dying in B.C.'s largest hospital made big news - here, it happens often enough to where we don't even put it on the front page, never mind launch an investigation. One person croaking in an emergency room due to neglect is just a footnote in a report. Try this report for an example.

Over half a thousand hospitals violated federal patient dumping regulations - and for-profit hospitals were 1.7 times more likely to dump patients than not-for-profit hospitals. People die as a result of such violations on a regular basis. Heck, our government often doesn't even bother to fine the hospital, never mind investigate why the hospital allowed a patient to die in the emergency room with no care.

The private sector isn't interested in taking care of you if you don't have the money to pay, period. Sure, public sector care can be substandard when you're underfunded, overcrowded, and understaffed - but at least they give a rat's rectum when someone dies. Here, it's cheaper to pay the fine, if one's even imposed, than to rack up the costs of having to provide health care for folks who can't pay.
posted by FormlessOne at 12:22 PM on April 27, 2006

For those of us south of Canada, privatized healthcare is breaking down badly, and the majority actually want a healthcare for all solution. Given that we USians are being priced out of our own health insurance policies, I'd say privatization is not the solution, certainly not with any long view of the situation.
posted by graymouser at 12:23 PM on April 27, 2006

As a whole, private insurance will always be more expensive than public because it has to be profitable. That said, public insurance comes with one major weakness; the "moral hazard."

Since everyone pays a fixed proportion of their money in the form of taxes, healthy people are heavily subsidizing people in poor health.

Whether poor health is caused by bad choices or bad luck though is the real question. Take for example that wealthier people are, on average, better informed about healthy choices, and buy better quality food. They pay a higher proportion the health care burden regardless.

On the other hand, lower income people who eat at McDonalds every day aren't internalizing the costs of their bad habits.
Maybe they should?

I'm not saying we should kill public health care, but the absence of a "insurer" model with lifestyle factored in has a detrimental effect on the quality of everyone's care. A hybrid model would work; where for example, a healthy-eating, gym-going person pays less than the person who can't be bothered to take care of themselves. It'd have to be done as rebates of course, because it would be a nightmare to implement otherwise.

(* Smokers pay more than they draw in cigarette taxes, but bad food is not taxed. )
posted by aubin at 12:28 PM on April 27, 2006

private health care here in the states is even worse, and it's certainly not going to get any better. hopefully your politicians will get their shit together up north and realize you had something that, at one point, worked.
posted by wakko at 12:38 PM on April 27, 2006

I can't believe this is even in question. Have the Canadians looked southward lately?
Save your health care system before you end up with an American-style system where the frequency and quality of your health care depends entirely on how much money you have.
Kind of like legal representation, taxation, and on and on...
posted by cows of industry at 12:39 PM on April 27, 2006

A hybrid model would work; where for example, a healthy-eating, gym-going person pays less than the person who can't be bothered to take care of themselves.

When new research comes out on the as-yet-poorly-understood science of nutrition, like the recent studies about how low-fat diets don't reduce the risk of various sicknesses and that certain fats may actually help, do we retroactively refund the surcharge for everyone who was eating lots of olive oil and avocados? Do we retroactively charge everyone who was eating fat-free cookies and trans-fat-laden margarine because they were told that it was better for them?
posted by transona5 at 12:42 PM on April 27, 2006

The typical argument in favor of private healthcare is that it is supposed to be entirely financed by sick people obtaining the service ; obviously a good private company needs to offer well above average service and to have a close-to-zero mortality rate to win customer satisfaction, so necessarily they will invest money into better drugs and better treatement and more trained doctors.

In theory it should work like that , but who is supposed to enforce that ? What if the private hospital management decides to behave exactly like a poorly maintaned, underequipped, understaffed hospital ? Who is going to go after them ?

Yet let's suppose that there are honest people out there, willing to work hard putting service to the customer IN FRONT of profit : yeah it's delusional daydreaming , but I am a dreamer.

Such an hospital , if well managed, would try to offer the services that are 1) the least expensive 2) the least risky 3) that pay the higher price 4) that involve as much people as possible. It's simple math, the more people require it, the better as it produces more revenue and more profit.

More risky and more complicated procedures would command an higher price, but they usually are rare procedures and not every person can afford the best, most expensive treatement, no matter how good their insurances are. One would think "lets the private do the risky procedure and put all the risk and cost on the State" which would make sense for the patient, but wouldn't be an incentive for private to do better..actually it would encourage sloppier performance at the expense of the patient, which is the weakest link in the chain.

So let's say the private hospital raises the price of all the less risky procedures and treatement and finance the riskier ones this way : most probable outcome is that the overall prices applied by hospital would raise, thus restricting access to less people or making average health insurace cost increase accordingly. That would aslo encourage insurance companies to develop any trick possible, including delaying payment in hope the insured person will die. That is excluding run-of-the mill mismanagement and corruption, that actually increases in private companies as their business is covered by secret, as opposed to public records that may give a fighting chance to concerned groups of citizens.

Consider also that some company suffer greatly from technological advancement, if their profit scheme can't be adapted to technology in a reasonable controllable way ; the developement of online music sale (other then ordinary shipment with online ordering means) has been slowed down by companies in a bid to obtain control over reproduction of music and , more importantly, to obtain more profit or the same profit per song sold.

What if a cure for many cancers or HIV virus is found ? That would probably destroy an extremely profiteable business, therefore many company have no interest in actually finding a permanet cure : treating is much more controllable and much more profiteable then offering a distributable solution. Similarly, if life threatening diseased are the reason that bring many people to hospital, they actually ARE the profitmakers of the company..why should one destroy such a powerful, profit bringing motivator ?
posted by elpapacito at 12:46 PM on April 27, 2006

I can't believe this is even in question.

Neither can many Canadians. Public health care is part of our national mythology.

Have the Canadians looked southward lately?

Every day. Our new federal government seems determined to follow the neocon agenda. (For example, the media is now barred from covering the return of coffins containing the bodies of Canadian soldiers killed in Afghanistan. Flags are not lowered to half-mast in their honour.)
posted by 327.ca at 12:46 PM on April 27, 2006

The United States doesn't have privatized healthcare. If it did, it would be much better. The only thing that keeps it from being excellent is the government involvement.

But right now, we have the worst of both worlds. It needs to go one way or the other.
posted by dios at 12:48 PM on April 27, 2006

Tags:
neocons

What the hell does this have to do with neocons?
posted by dios at 12:49 PM on April 27, 2006

What the hell does this have to do with neocons?

Feeling a bit twitchy today, dios? [Sorry, I just don't feel like playing your game any more.]
posted by 327.ca at 12:54 PM on April 27, 2006

How about just answering the question?
posted by dios at 12:56 PM on April 27, 2006

As a Canadian, I demand my gov't keep universal health care, improve service, AND keep the costs where they are.

We just need to give the federal bureaucracy a giant tube of Prep H. I would support cutting the federal civil service by 1/3 to support health care and other programs.

And I'm not talking about front-line workers or necessary clerical staff. It's all the fatcats who sit around dreaming about how to spend our tax dollars that kills me. And there are literally MANY THOUSANDS of those folks in scores of federal departments. Give the older ones buyouts, free tuition to the younger ones. In 10 years we'll have the best system in the world.
posted by crowman at 12:56 PM on April 27, 2006

No.
posted by 327.ca at 12:57 PM on April 27, 2006

That's "no" to dios. [Sorry for the interruption.]
posted by 327.ca at 12:58 PM on April 27, 2006

For future reference: "neoconservatives" are a defined thing. Neoconservative doesn't mean "evil conservatives", nor does it have a general application to all conservatives everywhere.

I highly doubt the Conservatives in Canada's parliament who passed policies were neoconservatives, so I don't think the bogeyman term applies.
posted by dios at 1:00 PM on April 27, 2006

I'm a social liberal, fiscal conservative who voted for the BC Liberal party and the federal Conservatives. Just so you know where I'm coming from.

The real problem in the Canadian health care is not politics or the money from the government. It's rampant mismanagement and egos within the system itself. Consider the uproar in having privatized, non-HEU and non-BCGEU, non-medical staff perform cleaning, gift shop, and other tasks in the hospital. Certainly some cleaning tasks require specialized knowledge and a little less adherence to the 'bottom line', but a lot of those positions did not in any way have anything to do with medicine. Yet the union fought like mad to protect the guy running the lottery booth in the lobby.

Having friends in the medical field I hear stories constantly of outright waste of resources, equipment and time. The unions would have a mental breakdown if someone went in to investigate these problems, so they remain and we all pay for it. At the same time, the unions point at the government and say it's all their fault.
posted by Kickstart70 at 1:01 PM on April 27, 2006

Privatization.
It's amazing to me how often this is presented as a fix-all for public problems.
I want doctors, not businesses, to make my health care decisions. Why would I cede control to an entity whose only motivation is the bottom line, not my well-being?
The only thing privatization cures is a cash-flow problem for the company awarded the contract. And we citizens pay more and more for less and less.
posted by cows of industry at 1:12 PM on April 27, 2006

It's amazing to me how often this is presented as a fix-all for public problems.
I want doctors, not businesses, to make my health care decisions. Why would I cede control to an entity whose only motivation is the bottom line, not my well-being?

Privatization has nothing to do with the decisions of physicians in the provision of healthcare. For instance, here in Texas, we have a statutory prohibition against the "corporate practice of medicine" which means that corporations cannot control the decision-making of doctors. Doctors are independent contractors.

Privatization has more to do with pricing and the costs of the provision of health care. And the fact we have a mixed system means that the pricing and costs aspect has the worst of both worlds.

And if you are really concerned about physicians being regulated, then you ought to oppose socialized medicine because it is more likely that that a physician will lose discretionary ability when the government has rigid controls on the provision as they do now. Go look at the Medicare restrictions. The Government regulates the hell out of medical decisions.
posted by dios at 1:17 PM on April 27, 2006

There are a number of things we can do to the current public system to make it more sustainable. The problem is that we have a private-system mindset ina publicly funded system.

There have been tonnes of recommendations made to do so, but private foreign businesspeople are so hell-bent on ripping it apart that governments are afraid.

The Romanow Report for example.

Here are some other recommendations:

- Doctors on salaries - not U.S. style fee-for-service
- Primary health care centres eg. More responsibility for nurse practitioners and pharmacists
- Electronic health records

Oh, and how about a simply focus on promoting better health for Canadian citizens - better eating and more physical activity

Some provinces are actually making efforts in these areas, but provinces are too little - it needs to be a nationally led operation. Problem is the turf war.
posted by SSinVan at 1:22 PM on April 27, 2006

Go look at the Medicare restrictions. The Government regulates the hell out of medical decisions.

Absolutely not true. In fact, Medicare is the closest thing we have to the Canadian system.

The "rigid controls" the Canadian government has over medical decisions are actually groups of physicians who study a particular issue and decide upon cost-effective treatments, rather than insurance companies that use unknown criteria to decide what benefits are covered.
posted by Slarty Bartfast at 1:26 PM on April 27, 2006

For future reference: "neoconservatives" are a defined thing. Neoconservative doesn't mean "evil conservatives", nor does it have a general application to all conservatives everywhere.

Really? So, dios, pray tell us what distinguished a neoconservative from a conservative, in the Canadian context. Also throw in the difference between the historical Progressive and Conservative parties and the relative influence of Reform on the current Conservative part of Canada.

What's that? You don't know anything about either Progressive or the Reform party? Perhaps you don't know what a Canadian neocon is either.
posted by GuyZero at 1:27 PM on April 27, 2006

What others have said. Why anyone would want to model a healthcare system on the US' is beyond me. It does some specific things very well, but can't seem to manage the simple stuff (anyone been to an American waiting room, even at a decent hospital, recently?)
posted by bardic at 1:28 PM on April 27, 2006

Privatization has nothing to do with the decisions of physicians in the provision of healthcare.

But when an HMO or insurance carrier refuses to pay the cost of a treatment, and the patient lacks the ability to pay, isn't that a de facto medical decision on the part of the business?

The Government regulates the hell out of medical decisions.

And I don't agree with that, either. But, instead of simply bitching about the government, we should be holding them accountable. Ostensibly, we have the power to effect change to our governement through our elected officials. So why don't we? Why would we rather give it away to private companies, and their decidedly un-democratic policies?
posted by cows of industry at 1:29 PM on April 27, 2006

Go look at the Medicare restrictions. The Government regulates the hell out of medical decisions

I'd wager this is the result of too few dollars in the public system in the first place.

In Canada we have enough money in the system and the only real common complaints are wait times for certain surgeries and in emergency wards. Okay, and too few family physicians for everyone. Hardly small complaints!

We simply need to do a better job of allocating funding. I suspect you'll counter that this is inevitable since it is the state doing the spending, but I don't think it's necessarily so. Few Canadians want to throw out the baby with the bath water. We just need to rationalize our system and ensure more money ends up spent on the front end.
posted by crowman at 1:31 PM on April 27, 2006

And what Slarty Bartfast said. Government involvement in the US medical system? There's not that much--it's the for-profit middlemen, i.e., HMO's and their lawyers. Deregulation =/ a whole new class on non-medical professionals who make a living deciding who gets what treatment (at least, in any sane and compassionate society, it shouldn't).

Another example--know anyone who's given birth recently? Ask how long they stayed in the hospital, even if they had some complications.

(And ignore the troll.)
posted by bardic at 1:31 PM on April 27, 2006

Absolutely not true. In fact, Medicare is the closest thing we have to the Canadian system.
posted by Slarty Bartfast at 3:26 PM CST on April 27

And as anyone familiar with Medicare regulates physicians decisions, which I was pointing out to the person who said they were concerned with that practice. As I was pointing out, there are far more restrictions in a government run system. There are limitations on what doctors treating Medicare and Medicaid patients can do. The user was concerned with such things, and it exists under government payor healthcare.
posted by dios at 1:33 PM on April 27, 2006

Why anyone would want to model a healthcare system on the US' is beyond me.

I don't think anyone here is proposing to model our system on the US'. Those who want to abandon the current model seem to want some form of hybrid public/private system. The fear many Canadians have is that this will end up being "two tier" health care: wealthy patients would get the best treatment and the best doctors while the rest would get whatever's left over.
posted by 327.ca at 1:35 PM on April 27, 2006

Why anyone would want to model a healthcare system on the US' is beyond me.

The rhetoric is that if you can afford it, you can get better/faster treatment than people who can't afford it. Also, it's presumed that doctors who engage in private practice can make more money than under the current system.

Kickstart70 - yeah, there is a lot of waste and mismanagement... but, well some of the misappropriated funds and equipment are used to treat people who don't qualify for treatment (ie., immigration issues). These are actively ignored come review time.

Also, since the privatization of support staff services at Children's/Women's and the ancilliary buildings - custodial services haven't been as good and the cafeteria's quality has gone down, prices increased, and a there's a lot more disposable stuff generating a lot more garbage.
posted by PurplePorpoise at 1:37 PM on April 27, 2006

I want doctors, not businesses, to make my health care decisions. Why would I cede control to an entity whose only motivation is the bottom line, not my well-being?

How true, but.. Individual doctors in Ontario really are just small businesses, managing the number of patients they see and the way they treat problems to maximize their income from the provincial government. There have been numerous attempts to adjust how this is done, but the doctors associations have a great deal of political power to stop and/or neutralize reforms. All that is especially interesting considering kickstart70's complaint about unions..

At least it is 10,000 small businesses instead of ten large ones though.
posted by Chuckles at 1:38 PM on April 27, 2006

A hybrid model would work; where for example, a healthy-eating, gym-going person pays less than the person who can't be bothered to take care of themselves.

That's a recipe for disaster actually - because where do you draw the line?

Does someone who goes skiing regularly, thus greatly increasing their risk for broken bones or worse, pay more or less than someone who doesn't ski?

What about STD treatment? Does the person who has had 10 sexual partners pay more than the person who has had 5? Even if the person with 10 practiced safe sex nine times, where the person with 5 partners did not ever? And what about the spouse who was abstinent until marriage, and faithful within marriage, but gets an STD from his/her unfaithful partner. Who pays the higher premium in that case?

And as someone else pointed out already, medical advice changes almost daily. Right now, high fructose corn syrup is in just about everything. I bet withinn five years it will be the new horrible additive our mothers should have warned us about. Will some people have to pay higher premiums because we didn't watch for that in our diets?

No, universal means just that... universal.
posted by Zinger at 1:39 PM on April 27, 2006

Perhaps you don't know what a Canadian neocon is either.
posted by GuyZero at 3:27 PM CST on April 27

GuyZero, if it is the case that neoconservative in Canada means something different than the Irving Kristol fathered Neoconservative of the United States, then my apologies for being provincial. Here in the United States, the term has a definite meaning, and yet it is so often wrongly applied to conservatives in general. If Canada used the word differently, then I differ to you on that. Although I find that to a little odd unless it means the same thing as the Irving Kristol neoconservatism. It would be like applying the term Trotskyite to people who don't follow the typical Trotsky thoughts.
posted by dios at 1:43 PM on April 27, 2006

Few questions for the Canadians about their system:
What happens in Canada if there's a medical mistake? Can the patient sue the doctor & hospital for millions of dollars as they do down here?

Are Canadian hospitals/etc immune to the lawsuits?

How about illegal immigrants? (valid question, seeing as how Canada doesn't have the illegal immigrant issue that the US currently does, and we've all read the stories about how many hospitals along the southern border are having huge financial issues because they're treating people that will never pay the bills.)

Just curious as to how some of that stuff works up there.
posted by drstein at 1:43 PM on April 27, 2006

Why would I cede control to an entity whose only motivation is the bottom line, not my well-being?

What if your well-being is tied to the bottom line? I'd rather get health care from some greedy doctor businessman who wants to do a good job so he can make more moentym, than some do-gooder whose only motivation for caring for me is the sweetness of his nature.
posted by Faze at 1:44 PM on April 27, 2006

Hybrid models don't work. Healthy (read: wealthy) people use the private system because they don't get denied insurance, and the poor and ill use the public system, continuing to spiral the costs out of control.
posted by SSinVan at 1:46 PM on April 27, 2006

I don't have the heart to get into a debate on public medicine today, but I wanted to note that Dios's early comment was right, this issue isn't about neo-conservatives. It's about neo-liberals (and Paul Martin was a huge neo-liberal. Much as I hate him, you can't really lay all of this on Harper or his social conservatism).

As far as I know, neo-conservatism is something fairly specific to American politics. So, although it may be taking on a Canadian meaning as well in this Reform Alliance, post-PC era, you're bound to get confusion if you use it's Canadian meaning on an American forum. Regardless, this is a neo-liberal issue, not a neocon (in any sense) one. Pretty much anytime since the mid-80s that you have an economic policy with a privatizing agenda, you are talking neo-liberalism (as in, the reincarnation of Adam Smith's liberalism, in a post Keynes era), and neo-liberalism has been crossing party lines for years. Worth noting, I think, because if, as citizens, we are concerned about keeping public services then we have to be looking at policies across party lines.
posted by carmen at 1:49 PM on April 27, 2006

Can the patient sue the doctor & hospital for millions of dollars as they do down here?

I believe so. Every physician carries malpractice insurance, though I don't think we typically award settlements on the scale of such suits in the US.

How about illegal immigrants?

I'm not sure how much impact new arrivals have on the system. Philosophically, I think many Canadians see public health care as being as good for society as it is for individuals, though I'm speaking for myself when I say that. (Again, my opinion: people who contribute to the economy by working and spending deserve health care.)
posted by 327.ca at 1:50 PM on April 27, 2006

We never hear about doctors or hospitals getting sued up here. You hear about threats on occasion, but I don't think it happens that much - there is no financial incentive to do so, plus - we as the taxpayers pay the ultimate legal bill anyway.
posted by SSinVan at 1:53 PM on April 27, 2006

I'm a young'un, so I'm just learning how this whole crazy healthcare system works.
I personaly take welbutrinxl that costs $650 a month. Being a student, I'm on my dads union health care that absorbs $550 of the cost.
Whatever insurance I get out of college will not pay that much, and I will still need it.
I don't understand how people can afford basic health care without some type of assistance, so go government.
posted by ackeber at 1:59 PM on April 27, 2006

How about illegal immigrants?

I actually went and looked this up... many illegal immigrants are refugee claimants who stay when their refugee claim is denied (i.e. the people recently deported to Portugal). So if you're applying for refugee status, have a job and a record of landing, you can get a OHIP card. I assume the same is true for the other provinces.

Unlike the US, we have relatively few people who cross our southern border illegally to find agricultural work. Most of our illegal immigrants have already come through a Canada Customs check but stay past their allowed time.
posted by GuyZero at 2:03 PM on April 27, 2006

Oh, and where are all the people from the UK today to tell us about how much their two-tier system stinks? I'm sure that one has come up before.
posted by GuyZero at 2:06 PM on April 27, 2006

Oh, and where are all the people from the UK today to tell us about how much their two-tier system stinks? I'm sure that one has come up before.

Our neocon premier, Gordon Campbell, recently took a jaunt to Europe to (cough, cough) study their health care systems. It was a classic case of bad timing.
posted by 327.ca at 2:25 PM on April 27, 2006

I personaly take welbutrinxl that costs $650 a month

So, your profile doesn't say where you live, but the Canadian health care system doen't now and probably never will cover drug costs. That's always been the realm of private health insurance. Along with dental care. And non-doctor-based health care, like physiotherapy.

So it is, in some ways, questionable to say whether Canada has a fully government-funded health care system.
posted by GuyZero at 2:36 PM on April 27, 2006

The "financial crisis" faced by the Canadian system makes much more dramatic headlines than the one we have here. The fact is that we pay much much more for much worse health care here in the U.S. I believe the reason why this isn't such a headline-grabber here is that the Canadian system all fits into one very large bottom line in the budget. Everyone knows what this number is and it is debated openly in newspapers and by politicians.

Here, the funding sources for the healthcare system is divided between federal government, state government, employers, and consumers. We can't even have a debate about how to fix the system because it's not easy to get reliable financial numbers and there are many more parties/interests that have to be satisfied to build consensus.

The fact that health care is a hot button issue in Canada right now in no way means that they have a bigger problem than here in the U.S. It means that they are actually dealing with it.
posted by Slarty Bartfast at 2:42 PM on April 27, 2006

The fact that health care is a hot button issue in Canada right now in no way means that they have a bigger problem than here in the U.S. It means that they are actually dealing with it.

Rather than actually dealing with it, I'd say we're waking from a long, long sleep. The reality hasn't quite sunk in yet, but it will.
posted by 327.ca at 2:48 PM on April 27, 2006

if you're applying for refugee status, have a job and a record of landing, you can get a OHIP card.

That's a nice scam.
posted by oaf at 2:56 PM on April 27, 2006

Are Canadian hospitals/etc immune to the lawsuits?

In practice or in principal ? :)
I don't think it is any different than in the US really. Doctors carry insurance against malpractice - you get to sue the insurance company - that is hard to do. Someone will surely have a more informed view than I about this though, so..

How about illegal immigrants? (valid question, seeing as how Canada doesn't have the illegal immigrant issue that the US currently does,

Well, we have a few paperless immigrants, no doubt it is far fewer than in the US though.. There are lots of migrant farm workers too - they are legal, but they are treated like dirt.. Apparently B.C. is currently refusing healthcare to those migrant workers, but other provinces do provide care. No doubt not full coverage though (I guess if the waiting list is long enough you have to go back home before your turn comes..)
posted by Chuckles at 3:02 PM on April 27, 2006

What if your well-being is tied to the bottom line?

How do you tie anyone's actual well-being to the bottom line?

How does making a person well, especially if that person can't pay for the services, generate actual revenue?
posted by treepour at 3:02 PM on April 27, 2006

Wake up Canada. Freedom is the ability to live your life as you want. I don't know how many times I've been told by Americans that the U.S. is the greatest country in the world with the most freedoms. However, I know several people who have to work part-time after they supposedly "retire" so they can get healthcare coverage. Pre-existing condition? - tough luck, you won't be covered.

Want to quit your job and start your own business? - sorry, you can't because you need the health care coverage of your old job to cover your family.

I've lived in the U.S. for 6 years. I was doing some calculations last night and realized that i've paid at least $3,000.00 a year, out of pocket for health care coverage. That's at least $18,000.00 I've paid out.

As well, most Americans do not realize that Canadian companies have excellent benefits because they do not have to pay for health care. For example, when I left Canada my yearly deductable was $15.00 for prescriptions. After I paid the first fifteen dollars out of pocket, all my prescriptions were covered.
posted by TorontoSandy at 3:02 PM on April 27, 2006

That's a nice scam.

*shrug* The refugee system is what it is. It's horribly abused, but if the false dichotomy is to not take any refugees, I say let the scam continue. The amount of resources consumed by refugee claimants is miniscule compared to the swelling ranks of retired middle-class Canadian citizens.

The other issue, speaking of retired middle-class Canadians, is basic demographics. 20 years ago the average amount spent on healthcare per person was a fraction of what it is today. I'm too lazy too look up statistics, but demographics combined with improved medical techniques (hip replacements, etc) is causing an explosion in health-care spending. Many people make it out to be a supply-side issue, but I don't think it is.
posted by GuyZero at 3:08 PM on April 27, 2006

The United States doesn't have privatized healthcare. If it did, it would be much better. The only thing that keeps it from being excellent is the government involvement.

So government involvment is the ONLY cause of all the problems of privatized healthcare ? I am sure communists between eating a frozen and a fried baby did manage to do something good, but not the government ?

we have a statutory prohibition against the "corporate practice of medicine" which means that corporations cannot control the decision-making of doctors. Doctors are independent contractors.

And that keeps them out of corporation control ? Doubtful at best, formality doesn't stop collusion from happening and the reason for the statutory prohibition to exist is , indeed, most probably to deter the phenomenon.
posted by elpapacito at 3:16 PM on April 27, 2006

Few things are more sacred to Canadians than the nation's medicare system.
Few things are more hated by Canadian editors than Americanisms like "medicare".
posted by Count Ziggurat at 3:17 PM on April 27, 2006

Well, CZ, you'll be horrified to know that the term "medicare" appears 16 times in the Wikipedia article on Canada's healthcare system. And that the plans in PEI and NB are actually called "Medicare." Heh...
posted by 327.ca at 3:27 PM on April 27, 2006

Canada's healthcare system was in damn fine shape until the assholes in our governments started cutting back their budgets in a deliberate attempt to make our healthcare look bad, so they could pitch privatization as a solution.

After watching the American system set about killing the most impoverished people in your country, I am astounded there are any Canadians at all who would wish to see us adopt a private care system: it is so obviously fucking evil that I'm always a little surprised to realize how very little you Americans talk up the idea of implementing universal healthcare. It's a no-brainer.

After watching the UK system fall into a dysfunctional mess, a veritable travesty of a healthcare system, I'm stupified as to why there are any Canadians who would wish to see us adopt a hybrid system. I mean, it's really combining the absolute worst of both, and I really can not see how to avoid that. It's inevitable; when has public+private commingling ever not resulted in theft and waste?

And, really, we already have a private care option: it's no more expensive to fly to Mexico or Europe for special-priority care than it is to pay the outrageously expensive fees you pay in the USA or UK.

Having had an upsetting amount of hospital experience by this point in my life, I think I can state fairly authoratatively that if there is waste and slack in the system, it is not at the front lines. My suspicion is that we have an overabundence of middle management that should be summarily fired without golden parachutes.

We Canadians need to pull our heads out of our asses and demand better accountability from our government representatives. We had it good, and there is no reason whatsoever that we can not have it good again.
posted by five fresh fish at 3:32 PM on April 27, 2006

I am horrified, 327. A lamentable development in the Canadian health care system.
posted by Count Ziggurat at 3:37 PM on April 27, 2006

years of health spending cutbacks by conservative politicians--

Spending on health care is actually going up.



Since then, the 2004 health accord has put another $41 billion into the system. I don't think medicare is going to expire from lack of funds, or lack of public support, any time soon.
posted by russilwvong at 3:42 PM on April 27, 2006

We had it good, and there is no reason whatsoever that we can not have it good again.

Some might argue that health care costs have simply outgrown the capacity of the public system. There are many more treatments available for common ailments now than, say, forty years ago. Life expectancy is longer. Baby boomers are huge consumers of healthcare. Things like drug-resistant bacterias, increased reliance on expensive, proprietary drug therapies, the ease and frequency of international travel, etc., increase the complexity of diagnosing and dealing with illness. Add to that the inconceivable burden a pandemic would place on our existing infrastructure and you've got enormous expense to deal with.

I'm not saying I disagree with you fff, but I don't think as a country we've yet come to grips with the true implications of preserving public heath care.
posted by 327.ca at 3:43 PM on April 27, 2006

327.ca: calling Campbell a neocon makes me completely disregard your posts. I'd like to listen, but it's really obvious that you don't have a handle on the definition of that term. Campbel is no Bush, definitely not a Rumsfeld, and absolutely not a Cheney or Rove.

Pull your head out of ideology and look at the reality of what his actions have been, and maybe you'll see that the term doesn't apply.
posted by Kickstart70 at 3:44 PM on April 27, 2006

I think the term "neocon" has a generally understood meaning. I'm also sure a political scientist would have a much more specific definition than I do. In this case, we're talking about a political leader whose time in office has been characterized by large-scale selling off of public assets, tax relief for the wealthiest, scorn for the poorer demographics, utter incompetence in the government's social portfolios, zero environmental credility, and a tendency to cast every provincial issue in economic terms.

But whether I think Campbell is a neocon is beside the point of this post. If it pisses you off, I'm sorry.
posted by 327.ca at 3:56 PM on April 27, 2006

if you're applying for refugee status, have a job and a record of landing, you can get a OHIP card. - GuyZero

That's a nice scam. - oaf

Well at that point they're taxpayers, so...
posted by raedyn at 4:01 PM on April 27, 2006

How about just answering the question?
posted by dios at 3:56 PM EST on April 27 [!]

How about reading through the comments? Your question is answered repeatedly well before you asked it.
posted by juiceCake at 4:08 PM on April 27, 2006

ackeber--Wellbutrin-XL is available as a generic (bupropion). It's much cheaper.
posted by luneray at 4:10 PM on April 27, 2006

Canada's health care system, at its worst, has the US system beat: it's cheaper, more effective and by and large gets the heck out of the way of the doctors and lets them do their work. In 25 years of using both systems while working in both countries, I can attest that the first question I was always asked in Canadian hospitals and clinics was "What are your symptoms?" and the first question I was asked in US hospitals and clinics was "How would you like to pay?". My treatment in the US was based on what I could afford, not on what I needed. Here, it was based on need.

Yes, there are waiting lists and shortages of all kinds: family doctors, specialists, the list goes on. But the idea that forcing us all to buy bad US HMO's would eliminate this problem is laughable. Right now I live in a small city that's got doctor shortages: the idea that this community would suddenly become a magnet for oncologists if they were allowed to charge whatever they wanted for services is laughable.
posted by jrochest at 4:14 PM on April 27, 2006

How about reading through the comments? Your question is answered repeatedly well before you asked it.
posted by juiceCake at 6:08 PM CST on April 27

Why don't you point to me where my question was answered? Because 8 minutes before your jackass comment directed towards me, 327.ca confirmed that my question was a good one and that 327.ca doesn't know what a neoconservative is and misused the term exactly as I alleged.

juiceCake, I have no idea what your obsession is with me that you feel it necessary to follow me all over this site to try to argue with me or insult me, but you clearly hear didn't bother to read the thread before going on the attack. I asked a question that wasn't answered and the subsequent comments confirmed what I alleged against the poster.

So next time, instead of tripping over yourself to snipe at me, try to think it through first.
posted by dios at 4:29 PM on April 27, 2006

In Canada, people dying in emergency rooms while they wait for treatment that would have saved them, or people waiting months for knee surgery: these are outliers. That isn't the way it normally works.

Four weeks ago, I broke my leg in three places. I waited under an hour before I got x-rayed. I was in a bed three hours after I came in. I got orthopedic surgery seven hours after hobbling into emergency. This is pretty typical healthcare service for anyone I have ever known. My condition was not life-threatening.

The idea that healthcare in Canada is broken frankly astonishes me. It appears to work fine to me. Our life expectancy is higher than that of the US (even within the same social and racial demographics) and our infant mortality rate is lower, and yet we pay about half as much per capita on health care as Americans do.

Not only does the system work, it works a helluva lot better than the system to our south.

I don't want to see private competition growing in this country. It is inevitable that such competition would suck away the best and brightest personnel from the system, leaving the dregs to the public system. The middle class would have their private care premiums paid for by their employers; just as the large majority of middle-class wage earners in Canada have extended group health benefits, you can bet your bippy that employers will have little choice but to include private insurance in benefit packages.

These employers will pass on these costs to consumers, and a disproportionate amount of these costs will be paid by the lower class. Thus, not only will the lower class get stuck with worse health care, but they will be subsidizing the private health care of the middle class through higher grocery and service costs.

Under the current system, the middle class subsidizes the health care costs of the underclass. A private-public system would be paid for the opposite way. And that's too fucked up to allow.
posted by solid-one-love at 4:32 PM on April 27, 2006

I think the term "neocon" has a generally understood meaning. I'm also sure a political scientist would have a much more specific definition than I do. In this case, we're talking about a political leader whose time in office has been characterized by large-scale selling off of public assets, tax relief for the wealthiest, scorn for the poorer demographics, utter incompetence in the government's social portfolios, zero environmental credility, and a tendency to cast every provincial issue in economic terms.

The correct term isn't neoconservative, it's neoliberal. Neoconservative is a very specific term for ex-Shachtmanites who went from the "State Department Socialism" ideology of the '60s to a radical pro-American and pro-capitalist ideology. Neoliberalism is the modern ultra-capitalist, globalist ideology that underpins the "free trade" and privatization agendas of the global right. There are people who are both, but your average "privatize everything, all power to the corporations" politician is neoliberal, while neoconservativism is a much smaller, specifically American, grouping.
posted by graymouser at 4:39 PM on April 27, 2006

s-o-l writes: Our life expectancy is higher than that of the US (even within the same social and racial demographics)

The proof in the pudding, so to speak. I love hearing my fellow Americans rail on about how bad healthcare is in Europe and Asia in countries where they outlive us. And again, anecdotes are powerful--in emergency rooms in even the best American hospitals, you will fill out paperwork before you will be treated, regardless of the severity of your injury. That's fucking insane by any reasonable standard.

(Hope you're feeling better, btw. Surgery is never fun.)
posted by bardic at 4:40 PM on April 27, 2006

The idea that healthcare in Canada is broken frankly astonishes me. It appears to work fine to me.

Me too. In fact, I've heard lots of stories like yours: someone needed help, got it, and was deeply grateful.

But then I read this. I listened to an interview with Dr. Glazer on the CBC yesterday. The guy was calm, reasonable, prepared with facts, and utterly devasting. Our Health Minister, George Abbott, responds with evasions ("we don't have data that suggests there is a link between emergency room staffing, and morbidity and mortality") that the very next day are shown to be untrue. There are seven nursing positions open at Royal Columbian's ER that are going unfilled because no one wants to work there. Etc., etc.
posted by 327.ca at 4:54 PM on April 27, 2006

And yet, politicians like GWB say things like "Americans have the best health care in the world" like it's self evident. Of course we do. How could argue with a statement like that.

Like I said, you Canadians are light years ahead of us, just by virtue of the fact that you're even discussing the problem.
posted by Slarty Bartfast at 4:57 PM on April 27, 2006

Wow. That was like 60 posts down before someone blamed Bush for anything!
posted by Slarty Bartfast at 5:02 PM on April 27, 2006

One of the biggest problems with American health care (as it seems to be with Canadian health care) is the ever-spiraling costs, and the perpetual debate about how to pay for it.
The reasons cited by 327.ca for this further up the page are all valid and, I believe, accurate.
But, I think another big reason is the lack of actual preventative care. Insurance companies, HMOs and doctors all say preventative medicine is more beneficial to patient health, and dramatically cheaper in the long run. If a person waits until a condition becomes chronic, then reports to ER, they are consuming a much larger share of health care resources than someone who has regular checkups. This, I think, is clear to all of us.
So what is very interesting to me is that my current dental plan, while spending lots of cash on brochures that talk up prevention and regular checkups, steadfastly refuses to pay for the very basic preventative dental procedure of an x-ray, among other things. Only the cheapest procedures are covered under the prevention umbrella, and all is else is reclassified as "elective" and not covered.
I have received varying explanations for this from my insurance carrier, none of which jibe with the marketing materials.
So now I must ask this question: If my insurance company is a business first, what do they lose by denying me coverage for basic preventative care? If I am proactive enough (I am), then I will have the procedure, and absorb the cost myself.
If I am not proactive, and ignore the prevention until something major has developed, then I will consume greater resources to fix me at a much higher cost, and my carrier will still refuse to cover the majority of it because it was a "pre-existing condition.” In either case, the majority of actual expenditures by my carrier are paid by me. And they still collect their monthly premium.
Now, I am not a great one for conspiracy theories, but if I were to follow this all to a potentially repellent conclusion, I could conclude that, from a purely business standpoint, it makes more sense (and money) to ensure that most Americans are either underinsured or uninsured altogether. Because as the costs of health care rise, so do the profits.
With the insurance lobby (among others) holding so much influence over Congress these days, it is hard to imagine that the current health care crisis in the U.S. is a very, very good situation for those in the health care business.
posted by cows of industry at 6:06 PM on April 27, 2006

if you're applying for refugee status, have a job and a record of landing, you can get a OHIP card.

That's a nice scam.

I'm not sure how I see that as a scam or as abuse of the system.

If you've put in your claim for refugee status, have all your paperwork in order and have a job (ie., are being a productive taxpaying member of society), what's the problem?

We do the same thing for immigrants - you don't have to wait until you're a full citizen (a three year wait, minimum), you can get your health card and SIN card when you're a permanent resident.

Given how long the refugee/immigration process can take in some cases, I think Canadians would be more upset if we didn't offer health coverage for the duration. It'd be a heck of a thing if some poor bugger died because he got into a car accident and was refused health care because he wasn't a full citizen yet.
posted by Zinger at 7:02 PM on April 27, 2006

My mother was diagnosed with breast cancer about 7 years ago.

- She had two surgeries within two months.
- Then she had a nurse practitioner come to her home over to change her bandages daily at first, then weekly until she was mostly healed.
- Then she started her radiation and physiotherapy.
- She then took the drug Tamoxifen for 5 years.

How much did she pay for all of this wonderful health care?

Other than her regular taxes - ZERO. NADA. NUTTIN'.

My mother was working part-time at a jewellry store at the time, and because of our employment laws (and culture) in Canada, her employer allowed her all the time off necessary, and then scheduled her for a gradual return to work when she was ready.
posted by SSinVan at 8:22 PM on April 27, 2006

Those individuals that suggest that the Canadian healthcare system is "falling apart" are generally those with an interest in privatization. The reason this topic likes to float to the front page every now and then is because there's money to be made. Shocker.

As others have pointed out, it is absolutely NOT the case that there have been "years of health spending cutbacks by conservative politicians." The Liberals funded healthcare very well and the Conservatives know that cuts will absolutely not be tolerated by the electorate. IMO the majority of the healthcare system's issues are management-related and not financial.

On the subject of two-tier, I do believe that some private clinics should be allowed to operate independently as it would relieve waitlists for government-run facilities, and it's already the case that we DO have a two-tier healthcare system; it's just that at the moment, you have to leave the country to get the fancy-shmancy medicine.
posted by mek at 8:44 PM on April 27, 2006

SSinVan: that's communism. We can't have that. Your mother didn't earn that health care, there's no reason hardworking taxpayers should have to subsidize it.

Not only that, it wrecks natural selection. If we keep saving people who are prone to breast cancer, we're never going to breed into people who can resist it.
posted by namespan at 8:52 PM on April 27, 2006

Healthcare in BC sure as heck is being cut back. We've had closures, privatization of support services, and lines a mile friggin' deep in the hospital here. Asshole Campbell should be terminated, along with MLA George "Lying MoFo" Abbott. Grrr.
posted by five fresh fish at 10:04 PM on April 27, 2006

"I think the term 'neocon' has a generally understood meaning. I'm also sure a political scientist would have a much more specific definition than I do. In this case, we're talking about a political leader whose time in office has been characterized by large-scale selling off of public assets, tax relief for the wealthiest, scorn for the poorer demographics, utter incompetence in the government's social portfolios, zero environmental credibility, and a tendency to cast every provincial issue in economic terms."

No. That's not a "neocon". If you know people that use the word that way, they're misusing the word. At some point the misuse will swamp the correct use and the whole matter will become moot.

But as far as I'm concerned, that time hasn't yet come and I appreciate the misuse of the word neocon because it reveals ignorance and the opportunity to correct it.

This has nothing to do with dios, nothing to do with anyone's supposed conservatism, and nothing to do paranoid fantasies of thread-persecution. You're misusing the term neocon, you've mis-tagged your thread with neocon, and you defend your misuse. If I, a progressive, had stumbled upon this thread and seen your misuse of neocon, I would have objected.

I know you probably won't listen to me, being on the defensive; but there are probably those reading who'd like to have a better grasp of this. Here comes a lesson.

A neocon is a species of American political wonkery that is foreign-policy oriented, is moralistic with regard to American foreign policy, specifically in favoring unilateral military intervention to promote the supposed American values of Democracy and Capitalism, is thus related to Reaganism's "Great America" view (but otherwise distinct), and which derides multilateralism as ineffectual, is at this time chiefly associated with the cadre of Bush advisors that are/were concentrated in the Pentagon's civilian leadership, and a movement whose flagship magazine is Weekly Standard and Bill Kristol, and of greatest interest these are the designers of the Iraq invasion and which envisioned a reverse-domino effect in the Middle-East of peeling away radical Islamicism and replacing it with western values by virtue of a supreme American effort which would have included a commitment to nation-building in post-occupation Iraq—a commitment Rumsfeld and Cheney notably opposed. Bush nor Cheney nor Rumsfeld are neocons, though Rumsfeld and Cheney have toyed with them and used them for their own purposes.

How do I know that Cheney and Rumsfeld are not neocons? Let's actually think about that word: neocons. Does supposed definition above encompass it? Well, it describes perfectly both Thatcherism and Reaganism, and no one was calling them "neoconservatives". If they were in any sense "new", then it would be Goldwater who was among the first "new conservatives". But no one called him a neocon.

Everything in that definition concerns domestic politics and everything in it describes the state of anglophone conservatism for three decades. It is not "new".

However, in the domain of foreign policy, neo-conservatism is quite distinct from modern American conservative foreign policy. It is distinct from Thatcherism foreign policy. What one person most exemplifies American conservative foreign policy during the second half of the 20th century? Kissinger. And what characteristic is Kissinger most associated with? Realism. Well, actually, the answer would probably be a lack or morality, but that's just another word for his brand of political realism. Yet another word is realpolitik.

Promoting democracy, human rights, western values, was a concern of Jimmy Carter's, not the typical conservative. Conservatives are generally isolationist and will be moved to interventionism only when they believe their direct interests are threatened. (Thus, the power of 9/11-soaked tales of Iraq to move conservative voters to support war.) Reagan talked ideals, but he acted realistically. (A combination comfortable to conservatives.) He could joke about dropping bombs on the "evil empire" but he was perfectly happy to support Gorbachev and glasnost, just as Nixon was willing to dine with the Chinese, and so, too, G W Bush. Nixon and his advisors and successors supported tyrants that were US-friendly, like the Shah of Iran, Marcos in the Philippines, Pinochet in Chile, the Salvadoran military in El Salvador, the Saudis in Saudi Arabia, Duvalier in Haiti, and many, many more authoritarians who were no friends to Democracy. But they were friends to the realist interests in America, most of whom were Republican. Most of these tyrants were, and are, fighting democratic forces side-by-side with American consultants and with American funding. This included training and support for Hussein as he and his military opposed the vehemently anti-American, religious fundamentalist, revolutionary government of Iran. This included training and support for Al Qaeda who opposed the Soviet Union in Afghanistan.

The GOP was proud of its realist foreign policy and expertise. In fact, it had some right to be proud of it because, in realist terms, it was largely successful (if often repugnant) in contrast to the Democratic Party's facility with foreign policy—an expertise and credibility which were left in tatters and disarray from Kennedy's and LBJ's Vietnam War.

This is why Kristol and Perle and Wolfowitz are called neocons, not conservatives. They are idealists, they are not nationalists, they are Western Culture warriors (more's the pity).

And they are unimportant. They are unimportant because history will remember them as fools, as astonishingly foolish, simpleminded in their idealism, mistaking wishes for acts; they were the stalking horse of the true powers in this administration, Cheney at the center. They've already been cast aside. They were most essentially cast aside when Rumsfeld took their plans and substituted his own in their name.

On the stage in my narrative we have whatever were and are the American liberalism's former and current foreign policy, the foreign policy of the conservative realpolitik, and the foreign policy of these hapless neocons. Which is the true foreign policy of the power behind the American thrown? Is Kissinger, or his ilk, pulling the strings back there in the dark somewhere?

Were that this was the case. The realists may have been reprehensible, but they were competent. The Republicans in power today are not competent. Nixon stands above these folks in competency. Terrifyingly, Nixon stands above these folks in morality.

No, to find a historic example we need to look at a different breed of Republican: we look to Spiro Agnew or Warren Harding. We look to the robber-barons, the amoral plutocrats of the GOP. But they're not alone. Alongside them in an uneasy alliance are the theocrats of the extreme American religious right. In terms of foreign policy, on their best days the radical religious right will make just cause with those who wish to intervene in Darfur. On their worst days, they see Fortress America supporting Israel against the heathens and an imminent apocalypse. Their long-term interests are not those of the plutocrats, but right now fighting the so-called "Islamo-fascists" suits them fine.

So call Bush and his cadre robber-barons, plutocrats, thieves, liars, radical religionists, theocrats. But don't call them neoconservatives because in doing so you are supporting their grand joke, their lie which they (had) hoped would leave the hapless, sputtering neocons holding the ball while they held the cash...all the way to the bank.
posted by Ethereal Bligh at 1:11 AM on April 28, 2006

As a whole, private insurance will always be more expensive than public because it has to be profitable.

So competition between private entities doesn't drive costs down?

So inherently non-competitive government programs never suffer from expensive bureaucratic bloat?
posted by ZenMasterThis at 3:05 AM on April 28, 2006

Flagged EB's long neocon comment as fantastic. I think I finally have a grasp on the subject. Thanks.

(As for dios, he's not "crapping," he's presenting a different viewpoint in a deliberately in-your-face way. If you don't like it, argue with it or ignore it; those of you who are responding with insults are the ones doing the crapping.)
posted by languagehat at 5:53 AM on April 28, 2006

note: Help maintain a healthy, respectful discussion by focusing comments on the issues, topics, and facts at hand -- not at other members of the site.
posted by ZenMasterThis at 6:39 AM on April 28, 2006

As most know, Canada pays a lot less for their health care per person than the U.S. does, despite thefact that Canada is a lot more spread out. If Canada spent as much as the U.S. did per patient, there would be no comparison.

The U.S. system is an incredible mess. Doctors, especially primary care doctors, are totally overwhelmed by administrative work. They have to deal with a zillion differrent insurance companies, Medicare, Medicaid, various other state programs, etc. - each with its own different requirements, acceptable drugs, referral systems, cost structures, forms, etc. People have employer insurance, individual insurance,, federal government insurance, state government insurance, or several of those mixed together. It's a complete nightmare.

Insurance companies often are divided into their own little fiefdoms that don't work with each other. The drug divisions try to limit spending on drugs. But in many cases, limiting spending on drugs raises other medical costs. Trying to make patients pay a larger share of their drug costs is a good way of making sure people stop taking medication they need to take. Trying to limit trips to the doctor means more patients won't take care of their health problems until they absolutely have to, and at that point it's an emergency and hugely costly. Capitalism just doesn't work very well in certain parts of the health care system.

Meanwhile, few people do medical research unless that research has the potential to make a drug company make a lot of money (or it's a big name disease). The result is that new remedies are often not tested against old remedies, and we don't know whether the old, cheaper remedies will work better than the new expensive remedies. The drug companies just want to test their new expensive drugs aagainst other companies' new expensive drugs.

Now, I fully understand that the drug companies have to make money. If they don't, people won't invest in them, and the pipeline of improved medications will greatly slow. This is not something we can get away from. But drug companies shouldn't be making their money with new products that aren't better than old products.

I know before the year starts that my health insurance will cost less than my health costs. I'm lucky to live in New York State, where I can get a policy; I'd have a hard time getting insurance anywhere else. But I recognize that calling what I have "insurance" is ludicrous.

And perhaps the biggest problem, in all our health systems, is that we as a society refuse to make judgements about what treatments are worthwhile. By refusing to do that, we make those judgments anyway, but we do it indirectly. This society already rations health care; it just doesn't want to admit that it does, or do it directly, and because of that we do it very badly.

There are lots of other things wrong with the medical establishment. Medicine is often not treated as scientifically as it should be. Doctors are forced to have other priorities than treating their patients. The malpractice system is a mess, especially in obstetrics, where desperate parents who need money to care for their disabled child try and get it the only way they can, and juries want to help them and find someone to blame even when no one did wrong. I don't believe in capping lawsuits, because I want doctors and others who really do wrong to pay severely, and doctors often do not a good job of policing their own.. But science and rationality has to play more of a role in the courts, and we have to find another way of helping people who are hit with medical disasters deal with them financially without lawsuits.
posted by spira at 8:47 AM on April 28, 2006

I'm a Canadian living in the UK. The two-tier system stinks. Recently, a local dentistry clinic said they wouldn't take me under NHS, but would happily take me if I would pay private. So instead I have to go farther to another clinic willing to take me.

That said, there are aspects of NHS that are better than OHIP (the Canadian system I know). Dentistry is covered for one thing -- as it should be. Mouth health is just as much about health as the rest of your body - it's not like an impacted wisdom tooth hurts less because it's in the part of your body looked after by a specialist. Though they are having problems with shortages of dentists willing to take people under NHS.

Family planning is more accessible and more covered as well here, and prescriptions all have one low flat fee (about £6, or 12 CND).

-----

As for the charging poor people for not eating well, well that's just about the stupidest policy I've ever heard. Have you even been shopping on a budget recently? Heathy=more expensive. I'm a student, and I try to eat well, but in my local store frozen french fries are half the price of frozen vegetables, let alone fresh. A recent British study went around comparing the fat and sugar levels of different brands, and the cheaper the brand, the worse it was for you. They even found that the poorer the neighbourhood, the more expensive the same set of healthy options became.

So any suggestion that poor people should be penalised for not eating well is just ass-backwards. And don't give me any of that "they eat McDonald's" crap - I've lived on welfare, you can't afford McDonalds if you are poor. Wendy's value maybe, the baked potato or the chilli. Now working class people might go for fast food, because they can't afford to go to your lovely organic raw food bistro, but making them pay more money for health care isn't going to make healthy food any more affordable.

If you really care about health, how about we start making the manufacturers stop pumping in extra fats and sugars (mmm high fructose corn syrup!) to improve the taste of their products and actually try to use decent ingredients that taste good without the crap.

Or at least just LABEL the damn stuff honestly - I have to search the labels of everything in the tiny print just to find out if there is added sugar or aspartane (I hate the British love for aspartane). Put the calorie levels front and centre, and none of this deceptive "per [tiny unrealistic] serving" nonsense.

Oh, wait, that would lower their profits slightly, we can't do that, that would be putting the well being of society before the creation of greater wealth.
posted by jb at 10:27 AM on April 28, 2006

Oh, to add:

In Canada, neocon is synonymous with neoliberal. We are a different country, we have a different political language.

It refers to "new conservatives" who believe in laissez faire capitalist economics as opposed to "old conservatives" who believe in social heirarchy and old fashioned ways. (Britain has a similar division.)

As for American-style neocons, most move south and write speeches for George Bush (ala David Frum). There's just not much as much work in Canada for politico types whose main platform is based on the use of American military force to intervene in the affairs of other states.

So the use of "neocons", in a Canadian context, was absolutely correct.
posted by jb at 6:43 AM on April 29, 2006

No, that's not correct. Sorry. Radical (by UK standards) laissez faire capitalist economics is 25 years old and has a better and oft-used name: Thatcherism. No one was calling Reagan/Mulroney/Thatcher "neocons" 20 years ago and they match your definition quite well. In contrast, the term "neoconservatives" was used in the UK in the early 70s as a subcultural, not popular, term meaning former socialists who became quite (relatively) conservative but still supported the welfare state (which in no way describes the 25 year old wave of anglophone conservatism you have in mind).

Your use and your claim about its use are incorrect. The term has a very specific, American-centric meaning that has everything to do with foreign policy, and is (relatively) recent, as I said. Because the overwhelming number of people who have enough interest to be opposed to BushCo discovered the term as it was used correctly by the minority who knew what they were talking about, the term leaked into widespread public use meaning "those dominant conservatives these days" and, as we can see from these comments, has even spread into the wider Commonwealth sphere as some sort of term for "those conservatives".

The nomenclature for what both you and 327 are describing is quite correctly "Thatcherism" and it applies to Canada as well as the UK. It's the rise of an anglophone conservativism that is primarily oriented to a radical privatization project and not primarily interested in cultural conservativism. That breed has existed in the US for a very long time; but Thatcher was truly revolutionary in the UK in the way that Reagan really wasn't in the US. "Thatcherism" is the correct term and it's quite precise. "Neoconservative", even if it were in some sense accurate, would be nowhere near as precisely descriptive.

Please, go and sin no more.
posted by Ethereal Bligh at 10:00 AM on April 29, 2006

Again, Canada is a different country. It is not Britain, it is not the US. It's nice that you have your American words and culture, but we have our own, and in Canada we do use neocon as a synonym for neoliberal. They may not use the word that way in Britain - I wasn't saying that they they did, just that they have a similar divide between old and new Conservatism.

The Canadian usuage of "neocon" in this way may be recent, though I seem to remember Mulroney being called a neocon, but I was young then. But it in no way changes the fact that it is used this way currently. In Ontario, we certainly were calling Mike Harris, who would love to have been Thatcher but just didn't have enough hair or brains or integrity, a neocon.

Please, go and impose American culture on Canada no more.
posted by jb at 4:38 PM on April 29, 2006

A bit of research reveals that I'm mostly wrong and you're mostly right. I apologize. But I'm not unfamiliar with Canadian politics, having been married to a Canadian, and both my memory and my quick web research indicates that Mulroney was probably not referred to as a neoconservative but, instead, the Canadian use of this term arose in the late 80s from the influence of the Reform Party and all that followed. (Which I do remember quite well, particularly the sinister Preston Manning.) And I'm quite sure that in the 80s the Progressive Conservatives in Canada and Mulroney were seen as of a piece of the Thatcherist transformation throughout the Commonwealth. I'd wager a few dollars—Canadian dollars, even—that "neoconservative" was at most a sparsely used term in that context at that time. And at all times and in all its guises has neconservative been shortened to the slang "neocon"? I'm inclined to suspect that the rise of "necon", in Canada and elsewhere, parallels its use to refer to this modern US political subculture I previously discussed.

Also, according to wikipedia, so-called Canadian "neoconservatives" don't self-identify as such; and while in Canadian historical relative terms western "neoliberlism" (which is a relatively universal term) and so-called Canadian neoconservatism are more alike than different, they're not the same thing.

At any rate, as I said, I'm pretty much wrong and you're pretty much right. Your correction is to my benefit and I thank you for it. But don't you think that because of the US usage, and that neconservatives in Canada don't self-identify that way that perhaps the use of the term is ambiguous and confusing? And certainly it's my claim that in the US this is the case and this misuse no matter how prevalent if becomes is far less useful than the correct usage. If "neocon" means nothing more than "that group of conservatives crooks running Washington" then it's not very helpful.
posted by Ethereal Bligh at 6:26 PM on April 29, 2006

Ethereal Bligh writes "But don't you think that because of the US usage, and that neconservatives in Canada don't self-identify that way that perhaps the use of the term is ambiguous and confusing?"

Only from the point of view of Americans.
posted by dirtynumbangelboy at 8:10 AM on April 30, 2006

I'm pretty sure Mulroney was called "that fucking asshole" a whole lot more than "neocon."

As a Canuck, I try to avoid using the word neocon when describing our politicians. It only muddies the waters: our right-wing/sociall-conservative party is mostly left of the US Democrats. Calling them "neo-cons" encourages the Canadian political scale to shift further to the right, which is the last bloody thing we need.

We in Canada are so close to striking the best balance between citizen best-interests and corporate best-interests. I hope we can collectively pull our heads out of our asses before we let things slip too far to the right.
posted by five fresh fish at 9:25 AM on April 30, 2006

the sinister Preston Manning

Heh. Funny. The guy has all the gravitas of Orville Redenbacher. A brilliant populist political thinker, to be sure, but about as menacing as an extra on "Green Acres".

As for this surprisingly long-running debate on the relavance of "neocon" in the Canadian political context, I would have to sort of excuse EB in that it really isn't used in any significant way in mainstream Canadian discourse. While I am no polisci major, we seem to identify policies with the leaders who brought them forward - thus we have Paul Martin budgets, Mike Harris "common sense", Harper converatism, Manning's Reform platform, Rae's Ontario NDP paltform (which may keep him out of the liberalleadership in the end), etc, etc. There are too many shades of gray to start giving them all labels and even leaders from a single political party can have significantly different positions (think of Trudeau vs Chretien vs Martin... were those three guys really from the same party?)
posted by GuyZero at 5:55 AM on May 1, 2006