Mythbusting Canadian Health Care

February 13, 2008 11:11 AM

Mythbusting Canadian Health Care, Part I. Part II: Debunking the Free Marketeers. [Via Orcinus.]
posted by homunculus (227 comments total)

It's good. I emailed Part I to a "yeah but socialism" friend of mine yesterday.
posted by Kirth Gerson at 11:14 AM on February 13, 2008

MY MONEY and [apocryphal anecdote about Canadian healthcare] incoming.
posted by Pope Guilty at 11:14 AM on February 13, 2008

Lookin' forward to reading this.

One factoid that I find interesting is that Canada has the population of California essentially strung out along the border with the US. Hard to find efficiencies of scale with capital-intensive social services like health care with that thin distribution, but OTOH, speaking as a geolibertarian, having the entire natural wealth of half a continent with only 30M people seems quite, quite advantageous.
posted by panamax at 11:19 AM on February 13, 2008

AMEN
posted by fusinski at 11:20 AM on February 13, 2008

panamax, if the natural resources of every square mile of land were equally valuable, there wouldn't be any need to go to the Middle East to steal oil.
posted by Faint of Butt at 11:21 AM on February 13, 2008 [1 favorite]

It's not so much stealing as it is annexing.
posted by fusinski at 11:26 AM on February 13, 2008

It's not so much annexing as it is circumcising.
posted by Kirth Gerson at 11:30 AM on February 13, 2008

Those on the Right claim Socialized medicine. As this states, it is not. In fact, it is govt insurance. Don't like govt insurance? give up your govt insured bank account and social security and medicare.
posted by Postroad at 11:33 AM on February 13, 2008 [1 favorite]

It's good. I emailed Part I to a "yeah but socialism" friend of mine yesterday.

I just emailed both parts to a 'yeah but socialism' dad of mine.
posted by shakespeherian at 11:33 AM on February 13, 2008

Circumcision is what we did to Palestine in 1947 (and I suppose, a few decades prior).
posted by fusinski at 11:34 AM on February 13, 2008

But why should my tax money go to pay for other people's health care? Or to put out other people's fires? Or to educate their children? I'm an American and I don't want to pay taxes! Waaah! Nanny state! Waaah! It's socialism! Waaah!

Shit. I was crying so hard, I dropped my copy of Atlas Shrugged.
posted by Astro Zombie at 11:39 AM on February 13, 2008 [31 favorites]

I was just telling a pro-union, anti-single-payer-healthcare friend that universal coverage is the one thing that could save GM from death and dissolution. Well, that and manufacturing better cars. It's true, though; heavy industry is actually moving INTO Canada, in no small part because of the relatively cheap healthcare tab.
posted by Mister_A at 11:42 AM on February 13, 2008

I think I may pass this on to some liberal but waffling relatives of my girlfriend.
posted by klangklangston at 11:43 AM on February 13, 2008

Surprisingly fair and balanced. But somehow not like FOX news at all.
posted by GuyZero at 11:44 AM on February 13, 2008 [2 favorites]

I stopped listening when the writer used the phrase "more preposterious bogosity."
posted by spilon at 11:45 AM on February 13, 2008

IIRC, almost half of Canada's population is centered in six cities, so the experiences of a Vancouver professional are going to be better than those of a short order cook in Regina, so her anecdotal bits rankle me a bit, but on the whole, good article, nice post!
posted by Alvy Ampersand at 11:46 AM on February 13, 2008

postroad: Don't like govt insurance? give up your govt insured bank account and social security and medicare.

Hell yes! I'd love to stop paying a significant percentage of my income into programs that I'll never see a dime from.
posted by blenderfish at 11:49 AM on February 13, 2008

the experiences of a Vancouver professional are going to be better than those of a short order cook in Regina

The Canadian system aims for universality not perfection. A short-order cook in Moose Jaw has the same rights and access as anyone else. True, they may not get emergency cardiac surgery in Moose Jaw, but they'd get flown out for a hip replacement if necessary. Perfect is the enemy of good.
posted by GuyZero at 11:49 AM on February 13, 2008 [3 favorites]

A related editorial in the current NEJM.
posted by TedW at 11:51 AM on February 13, 2008 [1 favorite]

Hell yes! I'd love to stop paying a significant percentage of my income into programs that I'll never see a dime from.

The typical rejoinder for objectivists and liberterians in this case is to suggest you move to Rwanda where I am fairly certain you will not be taxed.
posted by GuyZero at 11:51 AM on February 13, 2008 [1 favorite]

Really well written, and as a Canadian Healthcare Employee (although not medical practitioner) entirely accurate in my experience.

The funny thing is, everyone here will still complain about healthcare. We would never give it up, but we like to bitch about it.
posted by WinnipegDragon at 11:52 AM on February 13, 2008 [3 favorites]

First: Canadians tend to think of tending to one's health as one of your duties as a citizen. You do what's right because you don't want to take up space in the system, or put that burden on your fellow taxpayers.

Did she confuse us with the Chinese?

The article as a whole generally hit the nail on the head, but this particular point does not resonate with any experience I've ever had.
posted by Adam_S at 11:54 AM on February 13, 2008

We would never give it up, but we like to bitch about it.

Cf. The Toronto Maple Leafs. Although I for one would give them up.
posted by GuyZero at 11:55 AM on February 13, 2008

It's not so much circumcision as it is fellatio.

Sorry.

I mostly agree with the articles, but they won't convince anybody. First of all, it's on a very liberal blog -- take a look at some of the headlines on the front page:
"Conservatives Can't Even Rig An Election Properly"
"Big Neocon"
"Rewarding (Conservative) Failure"

This would be like making a MeFi FPP of an article on, I dunno, international relations and economic theory that's hosted on Free Republic. It would be roundly dismissed and scoffed, out of hand, regardless of its merit, because... c'mon... Free Republic. Those of you forwarding these articles to your conservative friends can look forward to "Our Future??? Are you KIDDING ME???" types of replies... as they dig their heels in deeper...

Secondly, there are almost no citations. The skeptical reader is expected to take the author's opinions and assertions as facts. Just trust me. Honest. A simple statement of "America spends about 15% of its GDP on health care." should include a hyperlink to a good, impartial source of that data. If the data was researched, include a link to that research. It's not that hard; this is the internet. The skeptical reader already thinks you're a dirty, lying liberal; you gotta prove your case, practically rub his nose in the facts. Leave no room where he can dismiss your position with a simple "I don't believe you."

Good article. Poor execution. C+, and see me after class.
posted by LordSludge at 11:55 AM on February 13, 2008 [4 favorites]

I really hope I live long enough to see the U.S. join the civilized world.
posted by Kirth Gerson at 11:55 AM on February 13, 2008

I'd say we care about our health because we want to stay alive, is that so uniquely Canadian?
posted by mek at 11:58 AM on February 13, 2008

GuyZero The typical rejoinder for objectivists and liberterians in this case is to suggest you move to Rwanda where I am fairly certain you will not be taxed.

Huh. That doesn't make any sense at all.

"Waiter, there's a fly in my soup"
"Well, you could eat a shit sandwich; that probably wouldn't have a fly in it"
posted by blenderfish at 11:59 AM on February 13, 2008

Unless, I guess, you're somehow implying that the only reason Rwanda is a shithole is because they don't have Social Security and FDIC insurance. Which I don't think is the case.
posted by blenderfish at 12:02 PM on February 13, 2008

I'd love to stop paying a significant percentage of my income into programs that I'll never see a dime from

ah the sentiments of a free market fundie, God bless you.

I hit the FICA cap every year and would even gladly pay the unlimted 3% medicare on the surplus if the money in fact would go to people needing medical care -- health services that help them become and remain productive members of society -- that they can't afford.

We've got plenty of money and wealth in this country. We know this because the immensely wealthy -- the top 5% -- possess ~80%+ of it.

Plus there's the argument that it's more cost effective to do preventative care and early treatments than emergency room crisis care, but for some reason our system is structured around the latter for the default case.
posted by panamax at 12:02 PM on February 13, 2008 [2 favorites]

I agree with LordSludge. While I agree with the goal of universal health care, this article appears so conspicuously biased it can only preach to the choir-- there are no citations and the writer clearly frames things in the best possible way. All Canadian receptionists are cheerful? Really, there's data on that?
posted by justkevin at 12:06 PM on February 13, 2008

panamax writes: Plus there's the argument that it's more cost effective to do preventative care and early treatments than emergency room crisis care, but for some reason our system is structured around the latter for the default case.


Some reason: it pays much better.
posted by Foci for Analysis at 12:07 PM on February 13, 2008 [1 favorite]

"Well, you could eat a shit sandwich; that probably wouldn't have a fly in it"

Doesn't shit attract flies? I'd think a shit sandwich would actually be more likely to have a fly in it.

See, logical thought suffers when you've got an underfunded public school system. We need to privatize education now!

Have you guys read Atlas Shrugged? It's this awesome book I just found!
posted by hifiparasol at 12:09 PM on February 13, 2008 [1 favorite]

Nice Article.

One of the things I find striking about askmefi job questions from Americans is how inexorably health insurance is tied into your job. People seem to get locked into shitty positions by it.

Seems stifling.
posted by dr. moot at 12:10 PM on February 13, 2008 [2 favorites]

Huh. That doesn't make any sense at all.

It's subtler than that.

Saying that you don't want to pay for Medicare is essentially saying "fuck you" to poor people. My response, in return, is to offer you a shit sandwich. It's really not so much a counterargument as a counter-insult.

Besides, do you really not want Medicare or Social Security? Really? Have you even thought for a second what the US would look like without those programs? Because it would look like hell.
posted by GuyZero at 12:12 PM on February 13, 2008 [12 favorites]

...so the experiences of a Vancouver professional are going to be better than those of a short order cook in Regina...

To be fair, she admits, several times, that coverage isn't always as good in smaller communities than it is in the cities. I like the part about the government paying to fly people in the hinterlands to the city for treatment, though.

Excellent set of articles, homunculus!
posted by Thorzdad at 12:12 PM on February 13, 2008

Hell yes! I'd love to stop paying a significant percentage of my income into programs that I'll never see a dime from.

Wierd how those pamphlets never seem to come right out and say "Ignore network effects and you, too, can be a libertarian!"
posted by mhoye at 12:13 PM on February 13, 2008 [5 favorites]

heavy industry is actually moving INTO Canada

Is it? Even with the dollar the way it is?

The odd thing about Canadian politics is that a lot (far from "most," but a lot nonetheless) of the people who would self-identify as "libertarian" will vote NDP (Socialist) or Green. Up here, libertarian is a very rarely used term, but when it is used, it usually refers to personal freedoms, which are very different from corporate freedoms. The "free market," as a concept, doesn't pull much weight in Canada; other than the ludicrous cable bills, we generally don't miss it.

All that said, we still pretty much kinda sorta totally need private medical insurance on top of whatever "universal" care is provided for us.
posted by Sys Rq at 12:15 PM on February 13, 2008

I have a great PPO. 10% co-pay on just about everything after the deductible is satisfied, 10% co-pay on generics and 30% on the approved non-generic list, and my whole family is covered for what I pay for my five latte a week habit. Almost every doctor in the city takes it, and every hospital does too. And when you present your insurance card, they treat you like royalty.

And you know what? I HATE MY PLAN.

I hate it that it's so damn tough to fill out the forms. I hate it that they take FOREVER to pay the docs, and that sometimes they deny things for clueless reasons that take weeks of phone calls and sitting on them to undo. I hate it that when I bought glasses last time I had to fill out the forms and six WEEKS later I STILL don't have a check from them, even though my flexible spending account paid me off TWO BUSINESS DAYS after I faxed in their forms. And I HATE how their approved non-generic list works -- and the rigamarole it takes to get a non-approved med covered because the approved med made you nauseous.

So, why don't I switch? Well, it's a hell of a bargain considering what I'm getting, and I'm not locked in to some hospital 10 miles away when I get around to the family-required heart attack. And honestly, all the other plans suck by comparison.

I find it amazing that people on both sides can think that the American/Cuban/Canadian system has no problems. They all do. They're just different. And if we didn't have anything to bitch about, we'd still be bitching about it.
posted by dw at 12:16 PM on February 13, 2008

People seem to get locked into shitty positions by it.

Which is one of the reasons why it's so difficult to change the healthcare system here - employers don't want increased workforce mobility, so they lobby HARD to keep things the way they are.
posted by deadmessenger at 12:16 PM on February 13, 2008

ah the sentiments of a free market fundie, God bless you.
No, bless you for opening with a needlessly condescending ad hominem argument.

I hit the FICA cap every year and would even gladly pay the unlimted 3% medicare on the surplus if the money in fact would go to people needing medical care -- health services that help them become and remain productive members of society -- that they can't afford.
You are perfectly free to give your income that isn't taxed to people who need medical care, without the government's help. But that's not what you want; you want guys with guns to force me to pay, too.

We've got plenty of money and wealth in this country. We know this because the immensely wealthy -- the top 5% -- possess ~80%+ of it.

Yay standard socialist robin-hood argument. We should pull all of that money out of the stock market and give it to people who are either jobless, choose to work in non-profitable jobs, or don't have any education. Good plan.

Plus there's the argument that it's more cost effective to do preventative care and early treatments than emergency room crisis care, but for some reason our system is structured around the latter for the default case.

I agree. Prevention is tricky though; I don't think medical science is as much of a science as people would like to believe sometimes.
posted by blenderfish at 12:18 PM on February 13, 2008

It's subtler than that.

Saying that you don't want to pay for Medicare is essentially saying "fuck you" to poor people.

I'll do you one better. How about we let Rwandans collect Social Security and Medicare? Because, really, saying I don't want to pay for Medicare for Rwandans is essentially saying "fuck you" to poor Rwandans.


My response, in return, is to offer you a shit sandwich. It's really not so much a counterargument as a counter-insult.

o...kay.


Besides, do you really not want Medicare or Social Security? Really? Have you even thought for a second what the US would look like without those programs? Because it would look like hell.

No, I really don't not want Medicare or Social Security. But, bringing it back to the context of the original point, I don't think they're exactly success stories, and justifying something by saying 'it's no worse than Social Security' is pretty silly.
posted by blenderfish at 12:25 PM on February 13, 2008

You are perfectly free to give your income that isn't taxed to people who need medical care, without the government's help. But that's not what you want; you want guys with guns to force me to pay, too.

This is the things about the Canadian system - everyone pays and everyone uses it. So no one feels like they're getting the shaft.

Also, have you though about witholding your property tax? Because you probably don't benefit from the public school system either.
posted by GuyZero at 12:25 PM on February 13, 2008 [2 favorites]

Hell yes! I'd love to stop paying a significant percentage of my income into programs that I'll never see a dime from

Unless of course you find yourself in a situation where... you need it, then you just might reconsider. We are all just TABs anyways.
posted by edgeways at 12:26 PM on February 13, 2008

Yay standard socialist robin-hood argument. We should pull all of that money out of the stock market and give it to people who are either jobless, choose to work in non-profitable jobs, or don't have any education. Good plan.

That's your rejoinder, and you have the audacity to lecture someone for ad hominem?

Everybody's a libertarian when they already have health insurance. But the moment they have to sell their house because of two heart attacks and excessive copays, that's the moment they become "International"-singing commies.
posted by Astro Zombie at 12:26 PM on February 13, 2008 [13 favorites]

The Canadian system doesn't pretend to be perfect. Only to the best possible system in existence on all of the known worlds. Excluding meepzorp of course.
posted by blue_beetle at 12:27 PM on February 13, 2008

I think the idea is that me paying into Social Security and Medicare and the school system does benefit me, and I do see returns from it, just not directly. Maybe the problem with libertarians is a lack of imagination.
posted by shakespeherian at 12:28 PM on February 13, 2008 [18 favorites]

But that's not what you want; you want guys with guns to force me to pay, too.

Yeah, because looking after other people is such a very bad thing to do.

Feh.
posted by dirtynumbangelboy at 12:28 PM on February 13, 2008

Plus there's the argument that it's more cost effective to do preventative care and early treatments than emergency room crisis care, but for some reason our system is structured around the latter for the default case.

I agree. Prevention is tricky though; I don't think medical science is as much of a science as people would like to believe sometimes.

Blenderfish, what the hell does this even mean?
posted by butterstick at 12:29 PM on February 13, 2008

I'll do you one better.

Well, my reductio ad absurdum is better than your reductio ad absurdum.

No, I really don't not want Medicare or Social Security.

So you want them but you don't want to pay for them. I think there may be a gap in your position.

justifying something by saying 'it's no worse than Social Security' is pretty silly.

OK. I'm not sure I saw anyone make that argument. I think the thesis of the posted articles is that the Canadian system works pretty well. Personally I think it's better than Social Security because (sorry to repeat) everyone pays, everyone uses it. Seems fair.
posted by GuyZero at 12:30 PM on February 13, 2008

...you want guys with guns to force me to pay, too.

I was wondering how long it'd take to get to the "guys with guns" canard.
posted by Floydd at 12:30 PM on February 13, 2008 [1 favorite]

blenderfish writes "You are perfectly free to give your income that isn't taxed to people who need medical care, without the government's help. But that's not what you want; you want guys with guns to force me to pay, too."

Can you show me an example where a pure free market system produced excellent medical care? The US doesn't count, because much of the medical research and schooling is government funded, along with Medicare and VA, and of course the insurance plan for government employees. Without government funding, we'd have a far worse system, and a lot more uninsured people, and that does cost you in many ways. You can pay for it up front, or you can pay later for the uninsured. Your choice, but you will pay; even if the government doesn't put a gun to your head, the insurance company will.
posted by krinklyfig at 12:31 PM on February 13, 2008 [3 favorites]

All that said, we still pretty much kinda sorta totally need private medical insurance on top of whatever "universal" care is provided for us.

We kinda sorta already have that. My coverage through my employer (with a private insurer) covers dental, vision, prescription drugs, various para-medical procedures (physio, chiropractic, etc), and a semi-private room for hospital stays.
posted by rocket88 at 12:32 PM on February 13, 2008

trying hard to be charitable here blenderfish, but your counterarguments are pretty weak, they really sound like something put forth by well-to-do, insulated, youth.
posted by edgeways at 12:33 PM on February 13, 2008

you want guys with guns to force me to pay

Well, this discussion certainly deteriorated quickly. We have moved right along to misdirection... when does the name-calling start?
posted by fusinski at 12:35 PM on February 13, 2008

You guys the market works. Never question the market! I learned that from the Spec Design thread.

For health care to be Utopian and align with the market we just need to die sooner. Hey! I think I just got another great business idea!

Prem-emptive Healthcare Fullfillment, Inc. The death squad with a heart of gold.
posted by tkchrist at 12:37 PM on February 13, 2008

I needed a big dose of counting my blessings today, so thank you for this.

I emigrated to Canada in '97 and recall my search for a "family doctor" (a GP) in Toronto. I was completely confused- there were no instructions with my OHIP card, and I had no idea where to start. Where was my list of approved providers? My last HMO (Health South, now Prime Health, Mobile, Alabama) made it easy by giving me a list of five. That's five total- I had to choose one, but the choice was pretty easy since I had no choice, basically...

So I turn to my partner- who was the whole reason I emigrated:

"How do I know which doctor to use?"

"You have to find one."

"Where do I find one? Which hospital?"

"Look them up in the phone book and ask if they're taking patients."

"Okay, stop fucking with me- who is my doctor?"

And so forth. I ended up with my partner's doctor, and when I called to see if he was taking patients, I was told yes, but the doc couldn't see me for a new patient getting-to-know-me until the next day. In Mobile it took- no exaggeration- two months to meet my doctor.

I've have my share of complaints about the system in Canada- my doc in Calgary moved into this group practice and for some reason it's getting harder to get hold of him- but there are some things that are just plain delightful about the system in Canada.
posted by ethnomethodologist at 12:38 PM on February 13, 2008 [3 favorites]

blenderfish writes "I'll do you one better. How about we let Rwandans collect Social Security and Medicare? Because, really, saying I don't want to pay for Medicare for Rwandans is essentially saying 'fuck you' to poor Rwandans."

No, it's giving you a choice. Most people in the US do not want to give up Medicare, and most want some sort of government-directed medical reform. Chances are, you aren't going to win this battle, so there are other places you can live the way you choose, without having to pay for anyone else in any way. In those societies, the police tend to be very corrupt and services non-existent, so you're on your own for more than just medical care. But it is, after all, your decision to make. Or you could stay here and complain, but it's not going to do much.
posted by krinklyfig at 12:39 PM on February 13, 2008 [3 favorites]

Prem-emptive Healthcare Fullfillment, Inc. The death squad with a heart of gold.

Sir, the Helms amendment and NSC order 725 both specifically prohibit the use of Omega Force against Caucasians.
posted by fusinski at 12:40 PM on February 13, 2008 [3 favorites]

I was wondering how long it'd take to get to the "guys with guns" canard.

Okay, needlessly emotional, I'll grant. But still true.


I agree. Prevention is tricky though; I don't think medical science is as much of a science as people would like to believe sometimes.

Blenderfish, what the hell does this even mean?

It means that if you have cancer and go to a doctor, whether he diagnoses that cancer in time to save you life depends on who he is, and luck. And doctors frequently operate on invalid or outdated research, or bad evidence (though, yes, they obviously try not to.)


Anyway, I've obviously become some kind of lightningrod Republican Libertarian Crazy Kook subject of pent-up rage because I don't like Socialized Medicine.
Yes, public education is good, yes a social safety net is good.

I'm out. I have work to do and lunch to eat. You may recommence the Great Canadian Healthcare Circle Jerk.
posted by blenderfish at 12:43 PM on February 13, 2008

Anyway, I've obviously become some kind of lightningrod Republican Libertarian Crazy Kook subject of pent-up rage because I don't like Socialized Medicine.

Actually, that's not why at all. I think coming in here, not reading the original links, and just spilling out a series of free market clichés is what did it.
posted by Astro Zombie at 12:45 PM on February 13, 2008 [10 favorites]

Sir, the Helms amendment and NSC order 725 both specifically prohibit the use of Omega Force against Caucasians.

Oh.That's right.

Well. PEHF will simply have to double our quota of non Caucasians, then. No. Wait. Triple. I think the boys can put in a few extra hours on weekends.
posted by tkchrist at 12:46 PM on February 13, 2008

We can always redefine people we don't like as not being Caucasian.
posted by Astro Zombie at 12:47 PM on February 13, 2008

It means that if you have cancer and go to a doctor, whether he diagnoses that cancer in time to save you life depends on who he is, and luck. And doctors frequently operate on invalid or outdated research, or bad evidence (though, yes, they obviously try not to.)


Ok, so some doctors are better than others, ergo preventative care is not as cost effective as emergency care. Gotcha.

Oh wait, no I don't. You still make no sense and your arguments read like a shotgun blast of talking points.
posted by butterstick at 12:49 PM on February 13, 2008

You know I really wish people who complain of ad hominem logical fallacies would actually take a look at some informal logic. It really pisses me off when they start using straw men and throwing out red herrings in the same breath.

yes blenderfish, this is you.
posted by dr. moot at 12:52 PM on February 13, 2008

Yet I routinely had to wait anywhere from six to twelve weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months.

Do people in California (or anywhere in the US) think this is typical? I've been lucky enough to have extremely limited need of specialists, but I don't remember ever having a wait of more than a few days, maybe a week.
posted by Crash at 12:53 PM on February 13, 2008

I dunno. Maybe he means Canadian doctors are worse than American doctors. Which is a moot point for me, as I have no health insurance, and so if I have cancer, it will probably go unchecked until it's lethal. I'd rather have a bad Canadian doctor than no American doctor at all.

But, you know, it's my own damn fault for making bad career choices, and has nothing to do with the fact that private insurance is prohibitively expensive, and the fact that businesses have discovered that, instead of hiring people full-time and having to cover their insurance, it's cheaper to hire them part time, or as freelancers, and let them fend for themselves. No, I'm to blame.
posted by Astro Zombie at 12:53 PM on February 13, 2008 [8 favorites]

Maybe it's because I grew up in the Canadian system, but I never understand why people can somehow justify for-profit healthcare.

I mean, I understand how they justify it to themselves, and it's normally something in the vein of "It's my money, you can't have it for people that refuse to work." What I mean is, can they really, honestly believe that? With co-pays, deductibles, rehabilitation, medication costs and long-term care even a 'fully covered' family is one stroke away from total financial ruin, and not just under-employed families. Even those nice middle-class, two-kid one SUV family with a reasonable mortgage likely can't absorb a sudden hit of tens of thousands of dollars along with a reduced ability to work.

The only people winning in this scenario are the insurance companies who will continue to post billion dollar record profits. Are their billions really worth more than the health and happiness of your neighbours? If that neighbour held a garage sale to try and save their house, would you sneer, turn your back, and tell them to work harder?

When did health and happiness cease to be a right, and become a product to be sold to those that can afford it?
posted by WinnipegDragon at 12:54 PM on February 13, 2008 [16 favorites]

Jesus Christ. Publicly funded healthcare != socialism. Whichever Karl Rove mothereffer that came up with the term "socialized medicine" needs to be given the asshat award for derogatory association. This is a human rights issue, nothing more.
posted by fusinski at 12:56 PM on February 13, 2008

When did health and happiness cease to be a right, and become a product to be sold to those that can afford it?

It's never been a right, therefore the American thing to do is to milk that fucker for every dollar possible. Not doing so would be missing a huge opportunity cost, wouldn't it?

I mean, how else could civilization progress without the profit motive?
posted by butterstick at 12:57 PM on February 13, 2008

Gov't funded ANYTHING is socialism. The american defense department is socialized warfare, I don't see the big deal. The VA is socialized healthcare. School lunches is socialized healthcare. Deal with it. Socialism != bad (when kept in check).
posted by blue_beetle at 12:58 PM on February 13, 2008 [2 favorites]

Floydd: "...you want guys with guns to force me to pay, too.

I was wondering how long it'd take to get to the "guys with guns" canard."

Well, we are discussing Canard-ian health care, aren't we?
posted by symbioid at 12:58 PM on February 13, 2008 [3 favorites]

The american defense department is socialized warfare

I fully agree that if you are going to call publicly-funded healthcare "socialized medicine," you have to go full boat and call national defense "socialized warfare." Republicans, however, conveniently ignore this type of reasoning in their fear campaigns against anything beneficial to the masses.
posted by fusinski at 1:01 PM on February 13, 2008 [2 favorites]

An armed monopoly funded through force and staffed by unionized civil servants MUST be more efficient, effective, and responsive to individual wants and needs than a collection of firms competing to offer a variety of choices at the best prices.

It's only logical.
posted by ZenMasterThis at 1:01 PM on February 13, 2008

What a strange thread.

It amazes me that people (okay, some Americans) are willing to fight on political/moral grounds against the idea of a decent working system that provides decent health care for everyone in the country. Of course it's not perfect. But it's cheaper than the American system, it's accessible, and hey, if I need a heart transplant? All I have to show them is my little plastic CareCard and I get one. For free. Subject to the availability of hearts, of course.

But no, you get frenzied statements about coercion, and guys with guns, and various utopic nonsense. I can't believe that some of you here would be willing to see your neighbour lose his house before you'd direct some of your tax dollars to universal health care (and trust me, our taxes aren't that much higher. And look at the value for money we get.)
posted by jokeefe at 1:02 PM on February 13, 2008 [2 favorites]

I've obviously become some kind of lightningrod Republican Libertarian Crazy Kook subject of pent-up rage because I don't like Socialized Medicine.

I think you're kind of a weenie for being a poor mixture of cheap and selfish. Please tell me why you don't like socialized medicine. Please use an argument other than that you don't like to pay for it. That's all I've heard from you so far.
posted by GuyZero at 1:02 PM on February 13, 2008 [1 favorite]

But that was in the second to last paragraph!
posted by Flashman at 1:03 PM on February 13, 2008

I don't think medical science is as much of a science as people would like to believe sometimes.

I don't think the words "medical" and "science" mean what you think they mean.
posted by Blazecock Pileon at 1:03 PM on February 13, 2008 [1 favorite]

Is there some bullet we can put in the myth that capitalism is a group of business fighting fiercely to make things as cheap as possible and as good as possible? Can anyone who has actually ever gone shopping believe this?
posted by Astro Zombie at 1:03 PM on February 13, 2008 [6 favorites]

Worst of all: 18,000 Americans die every year due to lack of access to healthcare. That's one every 30 minutes, around the clock, every day of the year -- the equivalent death toll of six 9/11s every single year that passes.

Yeah, but 40,000 die on our roads every year, and we're in no rush to change that either.
posted by Crash at 1:04 PM on February 13, 2008

An armed monopoly funded through force and staffed by unionized civil servants MUST be more efficient, effective, and responsive to individual wants and needs than a collection of firms competing to offer a variety of choices at the best prices.

It's only logical.

What the hell? "Armed monopoloy"? What on earth are you talking about?
posted by jokeefe at 1:04 PM on February 13, 2008 [1 favorite]

Everybody's a libertarian when they already have has health insurance.

Keep it simple. I have insurance but I'm not a libertarian.
posted by Kirth Gerson at 1:04 PM on February 13, 2008 [1 favorite]

An armed monopoly funded through force and staffed by unionized civil servants MUST be more efficient, effective, and responsive to individual wants and needs than a collection of firms competing to offer a variety of choices at the best prices

Apparently you missed last week's 'Cross-Country Checkup' where Canadian radio talk-show callers kept mentioning how they'd love to pay more tax as long as they get something for it. Note to Americans: not every country was founded on tax revolt.

A government monopoly has really good buying power. Think of the Canadian medical system as Wal-Mart for health care. Maybe that helps.
posted by GuyZero at 1:06 PM on February 13, 2008 [7 favorites]

Think of the Canadian medical system as Wal-Mart for health care.

Oh hell, does that make me a greeter?
posted by WinnipegDragon at 1:08 PM on February 13, 2008

I think by armed monopoly, he must have meant regulated monopoly. I don't think anyone could argue that professional football, for instance, would be better if there was more competition in the market. It amazes me how people can assume that everything is always true for all cases.
posted by fusinski at 1:09 PM on February 13, 2008 [1 favorite]

I agree with blenderfish that this is a circle jerk, but, blender, don't act like you're not a "Republican Libertarian Crazy Kook" if you use the "men with guns" line. That line applies to public education and all that other stuff too. It's not "this is good, that is bad" debate, it's crazy talk.
posted by Wood at 1:10 PM on February 13, 2008 [1 favorite]

Think of the Canadian medical system as Wal-Mart for health care. Maybe that helps.

The odd thing is our "armed monopolies" have less guns than an American Wal-Mart.
posted by Gary at 1:10 PM on February 13, 2008 [1 favorite]

Welcome to HealthMart fusinski. I just need to put a stupid little green tag on your IV bag there...
posted by WinnipegDragon at 1:11 PM on February 13, 2008

Welcome to COSTCO, I love you.
posted by fusinski at 1:11 PM on February 13, 2008 [5 favorites]

Do you need to see my receipt on the way out?
posted by WinnipegDragon at 1:13 PM on February 13, 2008

...a collection of firms competing to offer a variety of choices at the best prices.

hehehehehehahahaHAHAHAHAHAHAHAHAHAHAHAHAHAH!
posted by Kirth Gerson at 1:15 PM on February 13, 2008 [2 favorites]

don't act like you're not a "Republican Libertarian Crazy Kook" if you use the "men with guns" line

I guess we can cut him some slack. He could have said gays with guns and really melted down.
posted by fusinski at 1:16 PM on February 13, 2008

I'm actually in favor of a socialized health care system protected by homosexuals with weapons. That's the best plan I have heard yet.
posted by Astro Zombie at 1:17 PM on February 13, 2008 [4 favorites]

Yet I routinely had to wait anywhere from six to twelve weeks to get in to see a specialist. Non-emergency surgical waits could be anywhere from four weeks to four months.

Do people in California (or anywhere in the US) think this is typical?

For me it was close, though perhaps a little quicker to see a specialist. I had a pilonidal cyst (ouch!) removed in 2001. I was covered by PPO at the time (don't remember which). After my regular doctor couldn't figure out what was up, he referred me to a specialist, which was about a month later. The (non-emergency) surgery was scheduled about two months after that.

I have Kaiser HMO now (which I quite like, though HMO is apparently a profanity to most), and when I had another fucking cyst removed in 2005, it was a bit faster, especially for the specialist appointment (same week) mostly cuz the specialist/surgeon was under the same roof. The surgery was still 4 weeks later. (the second surgery was a local anesthetic - one of the most painful days of my life.)

I like the Kaiser model of assembling a cornucopia of services under one roof, but I think that government-backed health care is an inevitability for any developed nation.

I also think they should abandon the term "single payer" - it's confusing. Just call it what it is - government-insured health care, you know like Medicare (which is single-payer, of course). The second Wikipedia search result for "single player" is "socialized medicine."

Great find (as usual), homunculus.
posted by mrgrimm at 1:19 PM on February 13, 2008

I agree. Prevention is tricky though; I don't think medical science is as much of a science as people would like to believe sometimes.

I don't even know where to begin with this. Prevention isn't tricky if you have a fully-funded public health system, something libertarians don't think is all that important.

And the excuse that "doctors use outmoded information" is partially true, but most of the information on cancer, e.g. -- it's genetic and environmental, don't smoke, drink in moderation, eat your greens, get some exercise -- was true 25 years ago and it's still true today. A 60 year old doc is going to know this, as is a 30 year old doc. It's just that the 30 year old doc is more likely to know the new, super-cool, super-expensive treatments.

The problem with libertarians and health is that they have a hard time figuring out how to do preventative medicine without a government-funded public health and safety system. So, they just figure the market will sort it out. Problem is that the easiest way for the market to sort it out is through massive amounts of litigation. They think tort is bad now? Heh.
posted by dw at 1:19 PM on February 13, 2008

From what I've read about the healthcare provided by the US government to its staff, I'd love to have that.

Just let me pay into that, a not for profit, large customer advocacy group that's primary motivation is to cover it's operating expenses. Not to pay off shareholders. And let me not have to work a gov't job to get it.

That is really all I want. Oh, and a pony.
posted by mrzarquon at 1:21 PM on February 13, 2008

MrGrimm, I had a pilonidal cyst as well in 1996 or so, so it might be an interesting comparison.

To compare stories, I went to my doctor, was referred over to the local ER, and had it excised about two hours later. Homecare changed the dressing twice daily for a few weeks after that.

All free.
posted by WinnipegDragon at 1:23 PM on February 13, 2008 [1 favorite]

I'm actually in favor of a socialized health care system protected by homosexuals with weapons. That's the best plan I have heard yet.

Make those armed homosexuals fundamentalist Christians and you've got a political platform we can work with!
posted by shakespeherian at 1:24 PM on February 13, 2008 [1 favorite]

Yeah, but 40,000 die on our roads every year, and we're in no rush to change that either.
posted by Crash at 3:04 PM on February 13 [+] [!]


Whats that "ep...sterical" word?



I agree with blenderfish that this is a circle jerk,...
posted by Wood at 3:10 PM on February 13 [1 favorite +] [!]



because it just keeps popping up.
posted by edgeways at 1:25 PM on February 13, 2008 [1 favorite]

Plus there's the argument that it's more cost effective to do preventative care and early treatments than emergency room crisis care, but for some reason our system is structured around the latter for the default case.

Yes, that argument is often made, but unfortunately there isn't much research there to back it up. The research I'm aware of shows that other than a *very limited* number of procedures--much more limited than people think--preventative care is not cost-saving. I think it's just as possible that making preventative care cheap and accessible to all would pretty substantially raise costs. That's not to say it wouldn't be a good thing to do so, but the benefits certainly aren't from cost-savings.

I think people on both sides of the issue, both pro- and anti-single-payer systems, tend to have an overly simplistic view of how the health care market works. I'm really skeptical of arguments positing that because Canada or a European country has a single-payer system, we can transplant it straight to the US and have it work the same way. Even implementing an identical system across the entire U.S. is difficult, because of all the variation between states. Medicare, which is a single-payer system, pays out dramatically different average benefits to people living in different states, and many analyses have concluded that a major driving force behind that is variation in supply (like the number of per-capita hospital beds or number of specialists in an area). Provider groups have proved themselves exceptionally good at manipulating the system at both the state level (Medicaid) and federal level (Medicare) to create reimbursement systems that reward them for doing more rather than being effective. That is not going to magically change with a single-payer system--politicians have even less of an incentive to stand up to providers than insurance companies.

On the other side, anti-single-payer system people argue is that all we need to do is empower the consumer, who--through the magic of teh market!!--will contain costs and drive up quality by shopping smarter. Uh-huh. Shopping for health care is exactly like shopping for a cheaper deal on your cable, except the stakes are literally life-and-death, there's no such thing as a price list that hospitals or doctors regularly publish, and best of all, consumers are in the worst position of anybody involved to even know when they need to buy more health care. I mean, how many questions on the green involve someone saying, 'I stubbed my toe, should I ice it?' only to be met by thirty people exhorting them to head straight to the ER, lest they lose their foot? People go to doctors precisely because they need someone else with more training to tell them whether it's worth it to buy more health care. Not surprising that you end up in a weird situation where the regular laws of economics don't apply, and where supply drives demand rather than vice versa.

The linked articles had some good points in them, but overall that way of framing the pro-universal healthcare argument just leaves a really bad taste in my mouth. There's no easy and cheap solutions to be had this. Yes, it would be wonderful if there was some magic bullet that would insure everyone, raise the level of benefits, make everyone healthier, and be cheaper than the current system to boot. So would a pony. I wish the people pushing for universal care, and the people pushing against it, would stop pretending that anything worth having doesn't cost money.
posted by iminurmefi at 1:25 PM on February 13, 2008 [6 favorites]

I should add that it wasn't all perfect, the nurse packed the wrong gauze in the wound after the excision, so the first dressing change was *EXCRUCIATING* since the healing flesh had partially engulfed the dressing and it had to be, well, torn out.
posted by WinnipegDragon at 1:26 PM on February 13, 2008

An armed monopoly funded through force and staffed by unionized civil servants MUST be more efficient, effective, and responsive to individual wants and needs than a collection of firms competing to offer a variety of choices at the best prices.

I wouldn't say that it must be so, but all evidence shows that it is so.
posted by ten pounds of inedita at 1:27 PM on February 13, 2008 [3 favorites]

if canadians love their health care so much, why do we elect politicians who are openly hostile to it, and why is it that the head of the CMA also happens to have opened the first private, for-profit surgery in canada?

sometimes i think we as a people aren't equipped for the responsibility of democracy...
posted by klanawa at 1:27 PM on February 13, 2008

I don't think anyone could argue that professional football, for instance, would be better if there was more competition in the market.

Easy there buddy. The NFL FORCED the CFL out of American markets. The Baltimore Stallions would have done great if the NFL hadn't been predatory and sued then seven ways to Sunday. And it must be said: anyone can score in four downs. I must also admit to enjoying the WLAF during its time. The NFL is the only football league I don't like.
posted by GuyZero at 1:27 PM on February 13, 2008

Crash, I live in Maryland. When I had an ob-gyn emergency a few years ago and didn't have an ob-gyn, all the ones I called that were on my insurance had about a two or three month waiting list. I finally found one that could see me in two weeks. Turns out that was because he was on the verge of retirement and an absolutely awful ob-gyn. During my first visit when he found out I wasn't on birth control because I didn't date guys he proceeded to instigate a discussion about "why I hated men." Later during a minor surgery while I was under anesthesia he performed a few additional non-emergency procedures on me without my consent. It is a good thing I don't plan on having children, because I know now those procedures have jeopardized my fertility.

What a fucking nightmare. Now I wish I had never gone back after the first visit, but at the time I thought I needed the procedure as soon as possible and couldn't wait the three months it would take to get a second opinion.

It is not often I think that people end up with horrible doctors like that guy. But it is often to wait that long for a procedure if you are a new patient cold-calling doctors from your insurance list. Things are quicker if you have seen a specialist and they refer you to another specialist they know or who works in their practice or hospital.
posted by Anonymous at 1:28 PM on February 13, 2008

iminurmefi writes "I wish the people pushing for universal care, and the people pushing against it, would stop pretending that anything worth having doesn't cost money."

I have yet to hear either side make such an argument.
posted by krinklyfig at 1:28 PM on February 13, 2008 [1 favorite]

if canadians love their health care so much, why do we elect politicians who are openly hostile to it

Honestly, I think it's that people demand accountability, and someone more hostile to the system is more likely to demand it on their behalf.

Besides, the Conservatives weren't elected on a health reform platform, it was largely a reaction to AdScam.
posted by WinnipegDragon at 1:30 PM on February 13, 2008

I've tried to explain the benefits of universal health cover previously, but maybe the easiest way to say it is:
I've never met anybody who didn't receive the medical care they required.

I read in the paper and occasionally on TV news about waiting lists for elective surgery or medical screw-ups, but these things are newsworthy, not so common that they would go unremarked. I gather that in the US it is fairly common to see people who do not have care due to expense.
posted by bystander at 1:33 PM on February 13, 2008 [1 favorite]

if canadians love their health care so much, why do we elect politicians who are openly hostile to it, and why is it that the head of the CMA also happens to have opened the first private, for-profit surgery in canada?

Because the system precludes the possibility of profit higher than the provincially specified margins. The phrase "special interest groups" comes to mind.
posted by GuyZero at 1:35 PM on February 13, 2008

I'm curious as to why someone might think a federally-managed healthcare would be less of a corporate money grab than our federally-managed military industrial complex.

Is a Pfizer somehow more altruistic than a Raytheon?

Is their lobby less significant?

Is the FDA somehow less venal than other agencies? (Why can't you drugs from Canada, at Canadian prices?)

Will the government be a superior contractor for pills than it has been for steel, concrete, and guns?

An industry that's already writing our patent laws and import regulations has a significant hold on the state. This is something to bear in mind when conceiving or arguing for a nationalized drug coverage.
posted by kid ichorous at 1:36 PM on February 13, 2008 [2 favorites]

Why can't you [get] drugs from Canada, at Canadian prices?

The lead content isn't high enough.
posted by fusinski at 1:38 PM on February 13, 2008 [1 favorite]

kid ichorous writes "An industry that's already writing our patent laws and import regulations has a significant hold on the state. This is something to bear in mind when conceiving or arguing for a nationalized drug coverage."

Is that how SS works now? If not, why not?

The industry is also driving this debate and trying to put doubts in people's heads about it. So, it's in the medical industry's best interest (from the bottom line perspective) to make people think it can't work. If we design it with this in mind, we can prevent these issues.
posted by krinklyfig at 1:43 PM on February 13, 2008

Even implementing an identical system across the entire U.S. is difficult, because of all the variation between states. Medicare, which is a single-payer system, pays out dramatically different average benefits to people living in different states, and many analyses have concluded that a major driving force behind that is variation in supply (like the number of per-capita hospital beds or number of specialists in an area)

The Canadian healthcare system is administered on a province-by-province basis. There's lots of cross-province whinging, but it works well enough. For example, in Ontario I don't have to pay monthly premiums (as the article author talks about, in BC).
posted by anthill at 1:44 PM on February 13, 2008

I am amused that many, many nations already have a single-payer system that works splendidly, the US health care system is currently broken, and yet there are still people who say 'I think it won't work.'
posted by shakespeherian at 1:45 PM on February 13, 2008 [2 favorites]

Is the FDA somehow less venal than other agencies?

Well, until the FDA started being disempowered by the various libertarious administrations, it was considerably less venal than the health-insurance industry or Big Agro. Now it's an industry subsidiary.
posted by Kirth Gerson at 1:46 PM on February 13, 2008

I'm curious as to why someone might think a federally-managed healthcare would be less of a corporate money grab than our federally-managed military industrial complex.

An excellent question. I guess I would think it would provide less opportunity for these companies, and via regulation suppress their profitability. I mean that's kind of the whole point is to remove the profit motive from caring for people.

Do single payer systems have lists of restricted procedures/drugs that are deemed "non medically necessary"? i.e. do they cover Viagra?

I'm also in the school of "scaling Medicare", but I'm not sure how to determine if it is in fact scalable. The population numbers, density, and dispersion here isn't really comparable to Canada, and directly impacts if a single payer system would scale.
posted by butterstick at 1:48 PM on February 13, 2008

Do single payer systems have lists of restricted procedures/drugs that are deemed "non medically necessary"?

Sure. Many things are considered experimental or not yet proven and are not covered here in Canada. Drugs that have not been cleared by CSA are not covered, for instance.

Patients or companies can appeal to the various Provincial Ombudsmen for inclusion of a new treatment or drug though, and if they can show compelling clinical evidence that it offers benefits not offered by other existing treatments/drugs they will be added to the list of included options.
posted by WinnipegDragon at 1:52 PM on February 13, 2008

shorter kid ichorous:

"No We Can't!"

props to the O-man and word to your mother
posted by panamax at 1:53 PM on February 13, 2008

(Why can't you drugs from Canada, at Canadian prices?)

It's called re-importation, some states are for it, and have tried to do it, but invariably some jackass starts making "quality control" arguments and the big drug companies whine and the process gets dropped. The republican governor of MN promoted this for awhile.
posted by edgeways at 1:54 PM on February 13, 2008

Do single payer systems have lists of restricted procedures/drugs that are deemed "non medically necessary"? i.e. do they cover Viagra?

Viagara is not covered, same as boob jobs.

There are sometimes grey issues where not everyone can get promising but experimental drugs that have not been approved for general use yet. A woman in my neighbourhood was raising money for bowel cancer treatments because there was some drug that was supposed to be great but had not yet been approved. It's not like she wasn't being treated, but obviously she wanted to do everything possible. The Bureaucracy was somewhat less motivated.
posted by GuyZero at 1:54 PM on February 13, 2008

krinklyfig, the linked articles seem to be making the case that the Canadian system is superior to the U.S. system because it's less wasteful, and that it wouldn't significantly raise costs to implement a single-payer system here because we'd just get rid of all the waste that currently goes to insurance company profits. For example, she says that

Shareholder profit, inflated CEO salaries, and top-heavy administration -- all of which serve to work against the delivery of care, not facilitate it -- are anti-efficiencies that siphon off 20-25% of America's total health care spending. These are huge sums; yet it's mostly money down a gold-plated rathole.

I think that's either the argument of someone who has never actually gotten their hands dirty looking at the data of what drives health care spending in this country (seriously--25%? I'd love to see a cite on that), or it's an bad-faith argument made by someone who is convinced that Americans would never vote for universal health care if it ended up costing more than the current system. I think an honest argument for universal health care should acknowledge that it's pretty likely that covering millions more people will, ya know, cost more than not covering them, but that it's worth it (because it's a human rights issue, or a fundamental issue of fairness, or just because dammit, they'd rather live in a society where they don't worry about dying of cancer if they lose their job).

You say that if we design a universal health care system with potential problems in mind, then we'll be able to prevent those issues. I emphatically agree with that. The problem is, it seems like the people in favor of universal health care are afraid of talking about what real problems might arise because they are afraid it'll be used as ammunition against the idea of universal health care itself. That's no way to design a system, refusing to acknowledge potential problems just because they're politically inconvenient.
posted by iminurmefi at 1:57 PM on February 13, 2008

America, since Reagan, has been this bizarro world where you can no longer say anything that is, on its face, factually and pragmatically true, without worrying about whether it's going to be attacked by the right wing thought police.

"Government, as the agent of the people, has a role in sorting out the health care mess."
"What are some kind of fucking commie?"

"We cannot simultaneously wage war in Iraq and give tax cuts to the wealthiest Americans."
"You sound like you want the terrorists to win, Osama."

I am really hoping against hope things change after the next election so we can get back to having an actual debate of ideas without worrying about how Karl Rove et. al. will use our words to bully us about.

I will say this. With the possible exception of the abolition of slavery, Medicare and Social Security are two of the *most* resoundingly successful government programs in the history of the United States. Ending World War II? Nope. Putting a man on the moon. Not even close. Medicare and Social Security may not be perfect, but *millions* of American lives have been saved by this little socialistic experiment of ours. I couldn't not say it.

WTF blenderfish?
posted by Slarty Bartfast at 1:57 PM on February 13, 2008 [6 favorites]

MUST be more efficient, effective, and responsive to individual wants and needs than a collection of firms competing to offer a variety of choices at the best prices

The free market is splendid at providing for our wants. Needs, on the other hand, not so much, for obvious reasons that anybody with sufficient brainpower to fall into the rugged individualism BS should be able to figure out on their own, eventually.
posted by panamax at 2:02 PM on February 13, 2008 [1 favorite]

I'm glad that at least a few here have moved away from the stupid "which is better" to the "health care should be a right" position, which I think will be in future viewed as the most natural and compelling reason for government funding of healthcare.

To me the argument goes like this: around the time of the American Revolution, the concepts of "all men are created equal" and "... life, liberty and the purfuit of happineff" were not a universal world opinion at the time (and it still took a while for these rights to trickle down to women, children and slaves) but nowadays it's a given. These individual rights and liberties have a cost (electoral system, judicial system, defense, etc), but we mostly accept this cost, right?

So, in the same vein, I think that is IS time to agree that health and medical treatment should have proper status as a personal right. When we enact laws regarding where one can smoke, food and product safety regulations, etc, we are already affirming the position that the health and safety of citizens is of common concern. It's just another half-step to providing single-payer health care.
posted by Artful Codger at 2:03 PM on February 13, 2008 [1 favorite]

Ugh, don't get me started about BC's MSP premiums. It's basically a convenient way for conservative politicians to make the tax structure more regressive. For example, Gordon Campbell (our current Premier) promised to cut taxes if elected (what else?). So what does he do? He cuts from the progressive provincial income tax, and raises MSP premiums, effectively cutting taxes on the rich, and balancing it out by increasing the effective marginal tax rate of the working poor (the poorest people are eligible for premium assistance).

Most provinces have figured out that funding heath care from general revenue makes sense. Not BC and Alberta, no, we need a separate body collecting funds just for this. It's fair you see. A family making $30,000 pays the same dollar amount as a family making $30,000,000. Fair, you see.
posted by [expletive deleted] at 2:04 PM on February 13, 2008 [2 favorites]

Lest I be accused of being unconstructively critical: If these articles were properly cited and printed in a mainstream, reasonably unbiased publication, such as Time or Newsweek, they would fucking rock -- and probably sway a lot of moderately anti-healthcare folks.

It's just so important to realize that the skeptic is reading every line, saying to himself "bullshit, bullshit, bullshit..." to every point. These are the people that need convincing -- not us pro- universal healthcare folks!
posted by LordSludge at 2:07 PM on February 13, 2008

krinklyfig No, it's giving you a choice. Most people in the US do not want to give up Medicare, and most want some sort of government-directed medical reform.

First of all, thank you, and others, for your thoughtful replies (and your earlier one, which I really don't have time to get into,) as opposed to Astro Zombie's "He's a libertarian stereotype LOLZ amirite?" radio talk show host antics. I think most of this article is pretty fucking cliched, too, Astro Zombie.

My problem with socialized medicine and these sorts of programs is that, with health insurance (at least until Hillary has her way,) if I don't want insurance, I can choose not to have it, or change providers. I mean, insurance in general is a form of socialism-- but it is a voluntary and competitive one. I don't have that same choice with Medicare or Social Security, or Socialized Medicine. I understand that numerous people (anecdotally) are pleased as punch with the Canadian system, but I still can't shake the feeling (yeah, yeah, I'm a wacky walking Libertarian stereotype) that the government is going to do a worse job than industry.

Also, I think its pretty unfair to talk about how 'inefficient' the US is at medicine when so much of the world's medicine was and is developed here.

Finally, and this is it, I promise, I reject the notion that healthcare is a 'right'. "Rights" protect you, not obligate others to do things for you. I have the 'right' to free speech, or not be imprisoned without a trial. I don't have the 'right' for you to have to make me a sandwich or bandage my leg.

Anyway, I'm done. I'll leave my pamphlet at the door on the way out.
posted by blenderfish at 2:11 PM on February 13, 2008

I love how you pop in, demonstrate, once again, that you haven't read the original links (cliched? In what way?), and then declare you're leaving. It's just ... too ... marvelous for words. But that's the talk show host in me. We like that sort of conversation.
posted by Astro Zombie at 2:14 PM on February 13, 2008 [2 favorites]

Finally, and this is it, I promise, I reject the notion that healthcare is a 'right'. "Rights" protect you, not obligate others to do things for you. I have the 'right' to free speech, or not be imprisoned without a trial. I don't have the 'right' for you to have to make me a sandwich or bandage my leg.


What a sad little world you live in.
posted by WinnipegDragon at 2:17 PM on February 13, 2008 [2 favorites]

I mean, insurance in general is a form of socialism-- but it is a voluntary and competitive one.

Huh?
posted by shakespeherian at 2:19 PM on February 13, 2008

I understand that numerous people (anecdotally) are pleased as punch with the Canadian system, but I still can't shake the feeling (yeah, yeah, I'm a wacky walking Libertarian stereotype) that the government is going to do a worse job than industry.

Sadly, too much of the debate from one side of the aisle goes on "feelings" rather than citations.

I'm not going to say which side of the aisle it is, but tell me... which side do you feel like I'm talking about?

Weird:
Fox News article Funny, what i felt Fox News was going to say didn't turn out to be true.

Hrm...
posted by Bathtub Bobsled at 2:21 PM on February 13, 2008

It's just so strange to hear people attempt to articulate selfishness into a political philosophy, and one that seems almost exclusively rooted, if I have to pay taxes for it, I'm agin it. When did this become a nation of adults who honestly believe that taxation is immoral, and that the only social contract we have as a society is to be left alone.
posted by Astro Zombie at 2:22 PM on February 13, 2008 [6 favorites]

"Also, I think its pretty unfair to talk about how 'inefficient' the US is at medicine when so much of the world's medicine was and is developed here."

Also, I think it's amazingly stupid to not be able to differentiate between health insurance, which is what this discussion is about, and medical treatments, which were not the subject of the articles and further undermine your point by being, in the US, heavily subsidized—almost all of the medical innovations in America come with heavy public funding.
posted by klangklangston at 2:24 PM on February 13, 2008 [2 favorites]

Well taxes are tough on people who are already giving 10% of their income to this guy.
posted by Bathtub Bobsled at 2:24 PM on February 13, 2008

I still can't shake the feeling (yeah, yeah, I'm a wacky walking Libertarian stereotype) that the government is going to do a worse job than industry.

I am a doctor. I look at questions like this the same way I look at clinical problems with my patients. What makes sense "in my gut" doesn't carry nearly as much weight as "what do I have evidence for?" The amount of evidence that government does a better job than industry in funding the health care of a population has moved beyond anecdotal. If you can please show me several examples of countries that allow the market to fund health care and do this both more cheaply and more effectively than Canada, Britain, France, Spain, Denmark, The Netherlands, Italy, and Australia then I will have to call my hypothesis into question enough to go look more examples beyond those I can list off the top of my head.

But, by all means, let that feeling in your gut continue to prevent us from actually helping people in this country.
posted by Slarty Bartfast at 2:26 PM on February 13, 2008 [26 favorites]

if I don't want insurance, I can choose not to have it, or change providers

For you as an individual that may seem to work better.

For the country as a whole it's beneficial to lower premiums as much as possible by making coverage mandatory and universal. Plus you end up having fewer critical problems because you treated them early on, at least in theory.

If you make every decision based on what's best for you but is worse overall (not that every decision has this dichotomy) then you end up locally optimizing your life while turning your country into an uncompetitive also-ran. Which, in the long run, will make things worse for you. But I suppose you can always leave and go somewhere better - if they're willing to take you.

And again, not every country was founded on the belief that the government is inherently bad like the US was. America's 'Life, Liberty and the pursuit of Happiness' is 'Peace, Order and Good Government' up here. The CIA and I both agree that there is such a thing as too much liberty.
posted by GuyZero at 2:30 PM on February 13, 2008 [2 favorites]

When did this become a nation of adults who honestly believe that taxation is immoral...

December 16, 1773. Or am I mis-reading American history here?
posted by GuyZero at 2:32 PM on February 13, 2008

I love how you pop in, demonstrate, once again, that you haven't read the original links (cliched? In what way?), and then declare you're leaving. It's just ... too ... marvelous for words. But that's the talk show host in me. We like that sort of conversation.

I really don't have the resources to hang out all day and take on all comers. I'm 'what's wrong with America' to too many people in this room. Sorry to drop so many canards and cliches and talking points or whatever. I disagreed with Postroads first post, and things pretty much mushroomed from there.

I will discuss my problems with article with you line by line over metamail after I'm off work if you want.
posted by blenderfish at 2:35 PM on February 13, 2008

Though on re-reading it maybe I'm confusing the Tea Party with the introduction of the Stamp Act. I never got taught no American history.
posted by GuyZero at 2:36 PM on February 13, 2008

Finally, and this is it, I promise, I reject the notion that healthcare is a 'right'. "Rights" protect you, not obligate others to do things for you. I have the 'right' to free speech, or not be imprisoned without a trial. I don't have the 'right' for you to have to make me a sandwich or bandage my leg.

Oh boy. You have the 'right' to free speech because the police and judicial system are there to stop anyone from taking away that right. That isn't for free.

The right being suggested is the right to receive reasonable health care and necessary medical treatments, not something to force other people to treat you. And your argument about choice is completely wrong. If every supplier is paid by the "single payer" then you have the right to choose ANY supplier.

And it's pointless to talk about choosing NOT to have health care. If you're healthy right now, it's not because you and John Galt work out together, it's due in part to the economic conditions created and nourished in your country, and in part by the fact that your government has taken steps to make sure you have safe food and water, and that your environment (public places, roads, cars and other transportation, etc) have some modicum of safety. And when you DO get sick or old (and you will) you aren't going to look in the bank account then put your requirements out for tender. You will want the best care and you will want it NOW, regardless of whether you've made your first million or not.

A single payer system is the only way to ensure that all citizens have that opportunity.
posted by Artful Codger at 2:42 PM on February 13, 2008 [10 favorites]

with health insurance (at least until Hillary has her way,) if I don't want insurance, I can choose not to have it, or change providers.

You can change providers? You must be young and in very good health.

When you're older and inevitably have pre-existing health conditions, the only reason that you'll ever be able to change providers is that under some circumstances HIIPA, a socialist regulatory law, requires insurance companies to accept you and your pre-existing condition.
posted by ROU_Xenophobe at 2:54 PM on February 13, 2008 [1 favorite]

Though on re-reading it maybe I'm confusing the Tea Party with the introduction of the Stamp Act. I never got taught no American history.

No, you're confusing "taxation without representation" with "any taxation at all, for any reason, under any circumstance."
posted by dirigibleman at 2:55 PM on February 13, 2008

I think it's a lot of people that are confusing the two.
posted by GuyZero at 3:07 PM on February 13, 2008

Welcome to COSTCO, I love you.

Get your hands off my junk!
posted by Blazecock Pileon at 3:29 PM on February 13, 2008

panamax writes "The free market is splendid at providing for our wants. Needs, on the other hand, not so much, for obvious reasons that anybody with sufficient brainpower to fall into the rugged individualism BS should be able to figure out on their own, eventually."

ten pounds of inedita writes "An armed monopoly funded through force and staffed by unionized civil servants MUST be more efficient, effective, and responsive to individual wants and needs than a collection of firms competing to offer a variety of choices at the best prices"

Ok let' set some things straight.

1. Go read Wikipedia Entry on Free Market . No matter how bad it can be , it's way better than the simplistic generalization and gross errors that I have heard over and over again all over the damn internet

Free market is any market operating under a set of very strict, quite simplifying hypothesis, somehow described in the link above. It is quite often confused with the perfect competition model, whose hypothesis are even more unlikely.

What is usually argued is that both "models" are just fruit of imagination, not scientific in the sense that they are not based on observation and collection of empirical and measurable evidence by means of a scientific method. Additionally, as the study of economies belongs to social sciences, it is often considered as "not really a science", as opposed to natural science studying natural phenomena.

Not surprisingly, all this contempt is possibily motivated by
1. abuse of the abovesaid models
2. widespread deficiency in education on maths, logic, modelization processes
3. a distorted concept of privatization

Primarily, the free market and perfect competitions weren't marketed as models, but as panaceas, which are drugs that can cure any illness. Of course, panaceas don't really exist, but damn we so much want some no matter what. Also, much of the attention was focused on the DEREGULATION of markets, so that private companies could operate outside of control or under very limited control of LAW , not necessarily by state. In my opinion, the position of rentiers living inside the State apparatus was just shifted to rentiers outside the apparatus, who decided that it was much better to exploit a more efficient market than an heavily regulated one.

That's hardly surprising, as heavy regulation can be detrimental to any activity, if the regulation is poorly developed and conceived primarily to strangle initiative, form factual monopolies and basically insure a rent to the regulators. Regulation in itself isn't necessarily bad, even if a proliferation of regulation may be in itself just the expression of the incapacity of effectively dictate some behavior ; as students of law know or should know, the best law is the one that most people agree with and that is automatically respected, almost to the point that codification becomes a mere exercise in memorization. Yet, the fact that most people agree with a law doesn't make the law good for its supporters , it just makes it popular.

So if privatization is popular , that doesn't imply it works well, it only implies that legislation favoring privatization will be more supported, exactly by people who aren't suppsoed to understand why, but just to think it's ok. But when government oversight is gone and law has no way of effectively stopping an abuse, the opportunity for profit may raise exponentially ; indeed it becomes possible to obtain control over a market, or a significant part of it, and decide exactly what to do with it .

If , by chance, the recipient of this market is a wide population that is mostly unable to understand the risks or implications of accepting some deal and if there are limited consequences for violation of rules, it only follows that somebody will soon start to abuse the market if that's profiteable. Clearly, such a behavior is likely to alter the market in the long term, but if the goal is short term profit maximization, anything will do.

The abuse itself doesn't need to be illegal to become an economic problem ; indeed, while some form of pollution and some quantity is deeemed to be legal, the combined effect may be detrimental in ways that are not often immediately evident to the masses.

With respect to healthcare, I believe that substance should prevail over form ; I find the notion that 250 millions americans are insured and so have access to private healthcare to be almost meaningless, because it doesn't tell me anything about the quality, efficacy and efficiency of this healthcare and what it does effecively cover.
It is perhaps more significant to learn that the number of americans that can rely on state medical services are counted in millions, if we were to consider this as necessarily worse then being covered by a private insurer. To me, it seems evident that the biggest and most direct beneficiaries aren't necessarily the insurance recipients, but the companies who offer these insurances, that can count of amounts of money that boggle my mind and with contractual powers and market influences I can't being to imagine.
posted by elpapacito at 3:38 PM on February 13, 2008 [3 favorites]

I'll reluctantly pick up the libertarian flag long enough to make a couple of points. I'm not a classic libertarian, but I do value the idea of letting the market solve the problems that markets solve effectively (which often requires regulation, at least to control fraud and mitigate tragedy of the commons scenarios).

The current widespread coupling of employment and health care in the US which in my opinion is partially responsible for the complexity and inefficiency of the system can be traced back to WWII wage and price controls. I doubt many free market libertarians supported that.

Libertarians should like the effectiveness of the Canadian system of health care, because it delivers similar outcomes to the US system even though per-capita government spending is similar in Canada and the US. That means that despite our much higher per-capita public and private spending, we aren't getting much bang for our buck. One of the weird argument that libertarians make is that the inefficiencies in our system are increased by the amount of government spending.

However, If we were to theorize how to create a private market for health care that gives us more value for our health dollar, I'd think decoupling employer insurance would be an essential first step. The next would be to create a market where the insurance companies are not in a completely adversarial relationship with the customers. This could be done be encouraging the tie in of disability, life and medical insurance into the same policy. At that point killing patients before they rack up medical expenses would be less useful for insurers, as they'd be forced to make life insurance payouts. Market efficiencies would hopefully kick in, and create incentives for insurers to mandate preventive care. Similarly, the huge beauracracy of claim denial would not be fueled by the profit incentives that fuel it today.
posted by BrotherCaine at 3:55 PM on February 13, 2008 [1 favorite]

*Bureaucracy*, I like to undermine my own points by mispelling things.
posted by BrotherCaine at 3:58 PM on February 13, 2008

I seem to post this in a lot of these discussions, but since it always seems to come down to "I don't want to pay for it" I'll throw it in here too: Americans spend exactly the same amount per person, through their taxes, on health care as countries with universal health care. About $4000 per annum. That is, $4000 of your tax dollars go to paying for programs like Medicare and Medicaid each year. The only difference is that in other countries that $4000 covers everyone, whereas you then need to spend, on average, another $3000 each year to actually cover yourself. And yet the single-payer system is supposed to be inefficient?
posted by markr at 4:33 PM on February 13, 2008 [3 favorites]

I can't resist pointing out that Blenderfish's "men with guns" are paid with the same tax money that other "men with guns" take from him.

Of course other "men with guns" hired "men with sliderules" to design the essential devices that made Blenderfish's job and all other computer related jobs possible.

"Men Without Hats" live in Canada so they already have healthcare.
posted by Megafly at 4:36 PM on February 13, 2008

Also, I am generally pro-market, I really am. But the market, as it stands, does not work for healthcare. Once I have a pre-existing condition I can no longer shop around for health insurance. If there is a life saving drug I need that is currently patented I can not buy it from a cheaper supplier, or, more importantly, choose to just not buy that drug, like I can with a TV or other consumer item.
posted by markr at 4:36 PM on February 13, 2008 [1 favorite]

It's not going to happen any time in the USA for the simple reason that they'd have to change their ideals about so many other things as well, such as the tendency to sue the living hell out of everything and the never ending opportunistic habits. I'm not saying we don't have the same in Canada, but we seem to do a better job at keeping them in check, and our society having the right attitude for this plays an important part in this. I wish the Americans luck, and hope that individual states will take the lead, that's how it started up here.

Also, I think using only Canada as an example is one of the biggest straw men of them all.... wtf about Europe?
posted by furtive at 4:40 PM on February 13, 2008

Ugh, don't get me started about BC's MSP premiums. It's basically a convenient way for conservative politicians to make the tax structure more regressive. For example, Gordon Campbell (our current Premier) promised to cut taxes if elected (what else?). So what does he do? He cuts from the progressive provincial income tax, and raises MSP premiums, effectively cutting taxes on the rich, and balancing it out by increasing the effective marginal tax rate of the working poor (the poorest people are eligible for premium assistance).

A number of years ago I was standing in line at the 5th Avenue movie theatre when I realized that Gordon Campbell and his wife were standing in line behind us. I was kind of tickled by this demonstration of democracy in action-- he was Premier at the time-- so we shot the breeze with him and his wife (they were going to see some thriller).

Knowing what was in store, I should have started kicking him in the shins. Oh well.
posted by jokeefe at 4:43 PM on February 13, 2008

iminurmefi writes "You say that if we design a universal health care system with potential problems in mind, then we'll be able to prevent those issues. I emphatically agree with that. The problem is, it seems like the people in favor of universal health care are afraid of talking about what real problems might arise because they are afraid it'll be used as ammunition against the idea of universal health care itself. That's no way to design a system, refusing to acknowledge potential problems just because they're politically inconvenient."

I am not generally favorable to tempering meaningful solutions with less debate out of fear of the political climate. I'm very much in favor of practical solutions and understanding the whole issue, including the problems that new systems introduce. But enough about me ...

Yeah, in short, I agree with you, but I don't agree that, "the people pushing for universal care, and the people pushing against it, [claim] that anything worth having doesn't cost money." Although you probably were just exaggerating for effect, which is fine. I do think our medical care costs too much, and it's clear beyond a doubt we could save money and enjoy better care with single-payer (or, heck, even something along the lines of Obama's plan) and eliminate some of our own serious problems; but single-payer (or other major reform) is not free, and it does introduce its own set of problems, and, yes, those should be considered before we do anything.
posted by krinklyfig at 4:45 PM on February 13, 2008

I have a number of close friends who trained in Canada and have practiced medicine on both sides of the border. Their observations, synthesized and arranged four part harmony are thus:

The amount of time, money and staff devoted to dealing with insurance companies is extraordinarily greater in the U.S. than the time dealing with the comparable paperwork in Canada. Typically relatively less freedom choosing a course of treatment in the U.S. Certain diagnostic tests get done faster in the U.S.

This last point I think is really interesting, because more tests sounds good but does not necessarily mean better outcomes. More tests = more positive results = more medical intervention. Human nature and medical science being what they are, it's difficult to ignore conditions that carry risk, even if statistically you'd be better off ignoring them. On top of that, you have the profit motive and legal jeopardy that perhaps are an incentive for too much intervention. On the other hand, with a single payer system you perhaps have an incentive to ration care. However, in the latter case the motive of the doctor is lined up with the interests of the patient (against rationing*), while in the former case the profit motive isn't really lined up with the patient's interests.

(*Hmm... This is too much, I guess. Certainly doctors in Canada who are responsible for allocating resources such as hospital beds can be on the other side of the rationing problem.)

Lord, I hate how smugly patriotic the above reads looking back at it. Oh well. I s'pose I'll add this last anecdotal, unsourced, unproven and agrammatical anecdote: Canadian medical students I have known have, to a one, done better on their American licensing tests than their Canadian licensing tests, in terms of percentile. I admit fully that this observation is meaningless with selection biases and structural differences and what-not, but still insufferably smugly and patriotically choose to present it.
posted by ~ at 4:51 PM on February 13, 2008 [2 favorites]

I can't resist pointing out that Blenderfish's "men with guns" are paid with the same tax money that other "men with guns" take from him.

Yep. It's quite a racket.

Of course other "men with guns" hired "men with sliderules" to design the essential devices that made Blenderfish's job and all other computer related jobs possible.

Yes, some of the earliest computer tech was developed through (or, really, accellerated by) governments for WWII. I'm not sure World War is an ideal or sustainable means of technological development, however. I prefer the peacetime private industry model which has been pretty successful in the intervening 60 or so years, even if it's a bit slower.
posted by blenderfish at 4:58 PM on February 13, 2008

Having experienced a decade of Canadian health care, dealing with my parents dying in Canada of fairly long-drawn out diseases, and 25 years of the US heath care system with top-of-the-line insurance, I'd go Canadian in an instant.

The big difference is fear. Many Americans simply avoid getting checkups for fear that they will find something and then they'll lose everything they had. They'd rather simply get sick and die.

Many Americans won't leave their job for the fear that they'll end up losing health coverage and then (see previous sentence).

If you're seriously ill, you don't want the first though through your mind to be, "How am I going to pay for this?"
posted by lupus_yonderboy at 5:14 PM on February 13, 2008 [9 favorites]

Hate to break it to some of you, but the largest employer in the US is already providing socialized medicine and we, the taxpayers, are footing the bill for it. Do you see any congresscritters that dislike socialized medicine arguing that members of congress should have to pay for their own insurance out of pocket? Or argue that no Federal employees should have health insurance provided by the government (Socialism! Commies! Men with guns!)?

As a taxpayer, why should my taxes pay for "socialized medicine" for 2 million people and not cover me? If socialized medicine is good enough for Minority Leader Boehner (R - OH), it's good enough for all of us.
posted by ryoshu at 5:35 PM on February 13, 2008 [1 favorite]

Speaking from my gut now, at the end of a day, with a stack of charts on my desk at a typical American medical office...

I would *happily* take 1/2 my pay if someone could make the insurance bureaucracy go away. I would sing songs all day, my heart would be so full of joy I could heal people with the simple glow of my presence. I could practice medicine. I could read journals and be a better doctor. I could see my family at the end of the day.

I wouldn't have to negotiate with my patients who are self pay the tests they really should cough up $300 for versus the ones that are "probably" going to be normal so yeah, I guess, you could save your money by not getting those done. I wouldn't have to deal with patients asking me to lie on their medical chart about their new diabetes diagnosis which will forever exclude them from buying new insurance. I wouldn't have to deal with rich patients who are getting far too much health care for their own good while I watch poor patients die from entirely preventable illnesses. It's not a theoretical bogeyman, all these things are happening in my practice, *right now* every day.

I like to deal with evidence and hard numbers when it comes to health care systems. Because the evidence makes it such a no-brainer that it almost even defies discussion anymore. I mean, there is literally no reasonable argument to be made against a single payer system.

But maybe the emotional arguments are more compelling. Maybe we should pit a libertarian's gut reaction to paying for government funded health care against my gut reaction to the horror of the current system. Because my gut really does make me sick every day at 530pm when I send my last patient out the door, confident that we've done another piss poor job of managing peoples' health. I don't see any realistic chance of change, but I don't know how much longer we can ignore this. Like they say, If other countries can do it, why can't we? And if we can't, what does that say about us as a nation?

Ok, I'm done bemoaning my career, back to my charts...
posted by Slarty Bartfast at 5:44 PM on February 13, 2008 [23 favorites]

tilde: I appreciate the recoil from smugness. But Astro Zombie postulated that a previous commenter may have thought "Canadian doctors are worse than American doctors." Anyone in medicine knows that this is, of course, not true. But I'll bet American doctors are worse, in many cases, than Canadian doctors because they are forced to operate in a system that diverts their energy from dealing with patients to dealing with insurance companies. My familiarity with Canadian medicine consists of medical school and internship in the eighties, and being a patient since then. But, as inevitably happens, many of my friends are physicians in the Canadian system. They are worked off their asses (but note that none of them is hurting for money. At all.) But to have the extra burden of having to wrangle with private insurance company, vs. submitting a bill to the provincial insurance system? I don't know how you can do it.

Now here's my outsider's view of the what seems to be middle class America's fear of a Canadian-style single payer system. It's not "socialism," although that's probably part of it. More to the point, though, if you could get to the heart of what's going on in the brain of someone who resists for no good reason, it's that they are going to be lined up behind the (insert racial group here) when they try to seek medical care. Bad enough that they have no security now, but at least they're not forced to line up behind the Hispanics and the Blacks to get to a GP.

Now this is just a speculation. And I'm not American, so I don't really know anything. But I'm interested to learn.
posted by Turtles all the way down at 5:44 PM on February 13, 2008

I reject the notion that healthcare is a 'right'. "Rights" protect you, not obligate others to do things for you. I have the 'right' to free speech, or not be imprisoned without a trial. I don't have the 'right' for you to have to make me a sandwich or bandage my leg.
posted by blenderfish at 5:11 PM on February 13

You think the right to a trial does not obligate anybody to do anything for you? The police are not obligated to Mirandize you? If you can't afford a lawyer, the court is not obligated to appoint one for you? A judge isn't obligated to ... oh hell, you get my drift.

I'm a Canadian living in the US, and this is the best analogy I can come up with to explain how I feel about the health insurance system down here. Imagine you moved to a country where police protection was privatized, and access to police protection depended on your job and/or income. If you were really poor, the government would provide some police protection for you at taxpayer expense, but if you weren't poor enough, you wouldn't qualify, and if you didn't have police protection and were the victim of a crime, you had to decide whether or not it was worth the expense of reporting the crime, and if you decided it was, some of the time the police would refuse to do anything until you demonstrated you could pay them for their time. Imagine people made decisions about what jobs to get based largely on whether or not that job came with good policing benefits or not. Imagine talk show hosts in your new country take stories about criminals getting away because the police in the US didn't get to the scene fast enough, and use it as evidence that obviously socialized policing doesn't work.

Now imagine a citizen of your new country telling you that they don't think police protection is a right, because rights don't obligate anybody to do anything for you. Wouldn't you just boggle at them in disbelief?
posted by joannemerriam at 5:56 PM on February 13, 2008 [7 favorites]

That's pretty inflammatory, but you might be on to something, Turtles. Americans, one and all, think they are special snowflakes. More than half of us think we make more than the average income. We're not just racist, we're afraid of any challenge to our security. We don't want to share. It could be just that juvenile. Maybe that's what Michael Moore meant when he asked "What does this say about us as a nation?" We're a bunch of stupid, self centered children.
posted by Slarty Bartfast at 5:57 PM on February 13, 2008 [1 favorite]

I'm not sure World War is an ideal or sustainable means of technological development, however. I prefer the peacetime private industry model which has been pretty successful in the intervening 60 or so years, even if it's a bit slower.

The private industry model that includes a public education system, NASA, the National Science Foundation and very expensive government-funded research done by private schools (MIT, for instance)? I'm all for private industry and agree they've made huge contributions. But please don't pretend they've been doing it on their own all these years.
posted by Gary at 6:06 PM on February 13, 2008

so her anecdotal bits rankle me a bit

Even though she's edited her original article she still gets under my skin on a number of points.
posted by squeak at 6:08 PM on February 13, 2008

BrotherCaine...Although I agree with you that decoupling healthcare coverage from the employer could, possibly, simplify things, I can't agree with your conclusion that it will do anything positive about the cost to the consumer. If anything, just the opposite could prove true.

Individual private health plans (as opposed to employer-provided group plans) are where the big profits are for insurers today. They are much less regulated than the old group plans and, as an added bonus, unencumbered by many HIPAA mandates, like pre-exisiting conditions. Insurers have realized that, individually, consumers are marginalized, having absolutely no real barganing power and, thus, pretty much have to take what they are handed, as far as costs and coverage goes. It's a system practically custom-made for unlimited profit with absolutely no incentive to offer a product of any real value. It's a captive market. Consumers have to have insurance, and will have to take what's thrown their way, no matter how expensive.
posted by Thorzdad at 6:09 PM on February 13, 2008

Slarty: I don't at all mean to be inflammatory. I meant it as an unedited expression of what I am guessing is at the heart of the resistance, by many intelligent, educated Americans, to what is viewed in other countries as a system that, despite its flaws, works best for the population.

Let me approach my thesis from another direction. I'm a highly educated individual. When I find myself in a bar here in Vancouver, or elsewhere in my travels in Canada, I can pretty easily strike up a conversation with most, let's say 90%, of people I meet. I'd go further and say that 80% of those I'd feel comfortable putting up in my place if they needed a place to stay for the night. That is less a statement about me than about the homogeneity of Canadians in the essential aspects of their character. While we have criminals and sociopaths, the remainder tend to have a fairly common set of values.

When I lived in America (San Diego) I was struck by the diversity of "types of people." There were obviously rich people who clearly wouldn't give me the time of day. There were the grizzled guys with no shirts on the freeway driving beat up old wrecks that struck me as 'serial killer.' And there is a distinct black and latino culture, which seems to persist across generations, unlike our corresponding immigrant populations in Canada who tend to assimilate once the first or second Canadian born generation is reached to become just 'regular Canadians,' other than superficial racial characteristics and cultural heritage.

So, I'm not surprised that, in my view, Americans fear sudden assimilation into the melting pot vis a vis health care. The (health care) club they belong to may be very flawed, and they might be kicked out at any time, but it's their club and they know it and feel safe, for the time being.
posted by Turtles all the way down at 6:14 PM on February 13, 2008 [1 favorite]

I think your analysis is right on, you are being more charitable to Americans than I would be.

That's *so* Canadian of you : )
posted by Slarty Bartfast at 6:30 PM on February 13, 2008

The racism angle is bogus.

The conservative argument is, off the top of my head:
- I have good health care in America. I don't want crappy socialized health care. Heck, people come here from Canada for our great health care. Why would I want theirs?? (crappy = waiting lists, poor quality care, etc.)
- A free system would be abused. Because it costs nothing, people would be running to the ER when they stubbed their toes. That would be a huge waste of taxpayer money
- Why should I pay for other people's health care?
- Free health care is already available at public health clinics. You may not be getting fillet mignon, but you're at least getting a burger.
- Government is incompetant. You really want it running our health care system??
...And maybe I've forgotten a few.

Now, in my opinion, all of these arguments are easily rebutted. So rebutt them already. The article gets 'em all, I think, but not in a way that's convincing to a skeptical reader.

As for the racism stuff... just stop.
posted by LordSludge at 7:17 PM on February 13, 2008

LordSludge: Why are you saying I'm racist, or, God forbid, accusing Americans of racism? Please read my comments again and try to understand that I'm talking more about "the other" than the other race.

And no, I won't "just stop."
posted by Turtles all the way down at 7:28 PM on February 13, 2008

Just to set my own tone, FWIW, I'm not all offended or anything, but unless I'm really stoned and don't know it, you're pretty clearly accusing Americans of racism here:

More to the point, though, if you could get to the heart of what's going on in the brain of someone who resists for no good reason, it's that they are going to be lined up behind the (insert racial group here) when they try to seek medical care. Bad enough that they have no security now, but at least they're not forced to line up behind the Hispanics and the Blacks to get to a GP.

Now I think there's merit to the idea that Americans fear and resist change (to the health care system) in and of itself, and there is merit to the idea that rich conservatives prefer their more expensive care to that of Joe Everyman (and they believe universal health care will erode that perk of being rich), but I think the idea that they refuse to share health care with different races is absurd in all but edge cases.

Again, I'm not trying to go all OMGRACECARDBBQ on you -- I just think this idea is taking the debate in an unproductive direction and I wish we could focus on the actual conservative objections rather than go down some weird tangent. Just my opinion.
posted by LordSludge at 8:01 PM on February 13, 2008

Are there any first-world/G8 nations that do not have "socialized" medicine?

I suspect that, as with the death penalty and metric system, the USA is hanging out with the worst regimes on the planet.
posted by five fresh fish at 8:20 PM on February 13, 2008

Canada is only half-assed on the metric system (temps in Celsius, speed and distance in km, but height and weight in pounds and ounces), fish, but otherwise you're about right.

I don't know what it's going to take for you guys: maybe you'll need to do it state-by-state? We started with one province.
posted by jrochest at 9:04 PM on February 13, 2008

>...so the experiences of a Vancouver professional are going to be better than those of a short order cook in Regina...

>>To be fair, she admits, several times, that coverage isn't always as good in smaller communities than it is in the cities. I like the part about the government paying to fly people in the hinterlands to the city for treatment, though.

Anecdotal evidence ahoy, and I've mentioned this before in a similar context, but both of my parents, in their early-mid 60's, who live in a tiny community more than 1000km north of Vancouver (that is, in the real honest-to-god boonies) would have been dead in the past three years due to sudden catastrophic health issues (one cardiac, one an on-the-job accident). Access to medical care included helicopters, private jets and all manner of emergency stuff, for which effectively none, thanks to Canadian healthcare, they had to pay out of pocket. In fact, around that very time, they were just emerging from some financial difficulties that would have made them unable to do so, which would have meant that they'd either have died, or that I would have gone broke trying to pay for their medical bills as well.

The system may not be the best possible, and I have had my share of less-than-optimal experiences with Canadian doctors in decades past, but I'm damn proud of it and it's hard to express how happy I am that it exists, even if I haven't actually lived in Canada for any length of time for a couple of decades.
posted by stavrosthewonderchicken at 9:50 PM on February 13, 2008

My part of Canada isn't half-assed about weight, afaik. At the two big grocery stores all meat is priced in grams or kilograms. I don't recall if our bridges have imperial measures on them. Our weather reports the snow line as meters, not feet.

My wife was run over in a bad accident a few years ago. The emergency and follow-up care has been superlative every step of the way, and what would have easily been a complete bankruptcy in the USA has cost us bugger-all: the only expense I can think of off the top of my head was the initial ambulance ride, and that was all of a hundred bucks.

The money we put into our healthcare system through taxation has paid off several orders of magnitude for us. There is no doubt we'd have been completed fucked in the USA, unless we were so fortunate as to have a comprehensive healthcare plan through an employer... and then only if the health insurance company actually paid out. (Speaking of health insurance, did I read that one of the HMOs is being prosecuted under the RICO law?)

Quite frankly, anyone who argues against universal health care is as ignorant and hopeless as a creationist, jihadist, or flat-earther. I find it simply absurd that there's even a discussion to be had about it: in my opinion you simply can not consider yourself a civilized, modern nation if your government does not provide universal basic healthcare and education. It's simply daft to think otherwise.
posted by five fresh fish at 10:07 PM on February 13, 2008

Who is a metre tall? Who is two metres tall? Metric sucks for height IMO.
posted by stinkycheese at 10:11 PM on February 13, 2008

I'm 185cm, and it feels far more natural to say that than it does to say '6 feetish' to me. Then again, I've been living for a long time in a country where expressing height in feet and inches would draw blank stares, so that's probably part of it.
posted by stavrosthewonderchicken at 10:25 PM on February 13, 2008

Consumers have to have insurance

No, they don't. And when they do, they don't have to have a low deductible high premium health plan. The classic rule of insurance is that you only insure yourself for what you can't afford to pay out of pocket. Part of the problem with health insurance is the combination of high premiums and frequent claims. Excepting a heavily regulated single payer system, every insurance claim is an adversarial fight, with all of the inefficiencies that entails. As a type I diabetic who has lived with individual insurance, no insurance, and insurance through work, I can tell you that the work insurance is often just as expensive. What you don't always see as an employee is that the 'employer covered' portion of the premiums is money that would probably have been your salary if it weren't spent on health.

Although the coupling of employment and insurance guarantees some collective bargaining, in some ways it reduces the leverage of the individual. There are other collective bargaining arrangements possible (such as the National Association of the Self Employed), and if we could choose them we'd be able to have some say over the structure of our insurance plans and what is in the formulary. How much input does the average American worker have in their employers selection of health plans? Sure you can vote with your feet, but that doesn't give you a very fine level of control over the process.
posted by BrotherCaine at 11:00 PM on February 13, 2008

The Canadian system aims for universality not perfection. A short-order cook in Moose Jaw has the same rights and access as anyone else. True, they may not get emergency cardiac surgery in Moose Jaw, but they'd get flown out for a hip replacement if necessary. Perfect is the enemy of good.

I'm probably overreacting here due to tiredness and paranoia of being lumped in with the 'OMG Commies with guns!1!' crowd, but where did I say that it wasn't? In my experiences and those of my family members, there have been numerous issues with wait times, accessibility, and transport which could mainly be chalked up to the limitations of service in rural areas. That doesn't mean I think the system is shit and should be scrapped, it's one of the few things I genuinely like about this country. I'm just offering a counterpoint to her own urban-centric anecdotes.
posted by Alvy Ampersand at 11:02 PM on February 13, 2008

if your government does not provide universal basic healthcare and education. It's simply daft to think otherwise.

To be fair, this is the Democratic Congress we've got to rely on to implement this here in the states.

As a renter, I'm finding their repeated chicken-with-head-cut-off proposals WRT housing bailouts, debt "Jubilees" and what have you to be entirely disgusting.

I think there are valid Commerce Clause reasons to get the Congress involved (instead of 50 separate state-level systems), but the sticking point is that we're stuck with the present Congress, the number of members I respect as lawmakers I can count on one hand.
posted by panamax at 11:43 PM on February 13, 2008

but I think the idea that they refuse to share health care with different races is absurd in all but edge cases.

Again, I'm not trying to go all OMGRACECARDBBQ on you -- I just think this idea is taking the debate in an unproductive direction and I wish we could focus on the actual conservative objections rather than go down some weird tangent. Just my opinion.

Not races per se, but classes. My mom [on Medi-Medi] is very open minded about race but detests being thrown into the very low-class Medi-Medi care system. Any established doctor (as a rule) trims his clientele of these people as quickly as a he can.
posted by panamax at 11:47 PM on February 13, 2008

Now imagine a citizen of your new country telling you that they don't think police protection is a right, because rights don't obligate anybody to do anything for you. Wouldn't you just boggle at them in disbelief?

My favorite anti-Libertarian reposte that I've seen online is:

"Libertarianism: all the rights/liberty/freedom you can afford, and not one drop more."
posted by panamax at 11:53 PM on February 13, 2008 [1 favorite]

Like shakespherian, I am amazed that there is still a debate about this. The experiment has been running for fifty years. It's clear that in terms of bang-for-your-buck, the US PHI model is far behind the universal healthcare model.

BrotherCaine points out that the health outcomes are roughly similar for a range of diseases. Even if this is the case, the per capita expenditure in the US model is much higher.

I would also question the conclusion of 'similar outcomes' as these analyses rely on diagnosis of disease. Do these studies control for the uninsured who are not diagnosed? When you look at wider metrics like life expectancy and infant mortality, which clearly include the uninsured, US outcomes are much worse than other industrialised countries, especially considering GDP.

Will it be difficult to remodel the US system? Of course. You don't think all of those PHI companies are just going to walk away from all of that filthy lucre without a fight, do you? However, you have to look at how much extra that the US is laying out on healthcare every year. Paying to change that system and reduce the annual cost is an investment that makes sense on an economic basis. On a social equity basis, there isn't even an argument.

I just can't see the rationale or morality of opposing something that is cheaper, more equitable, more compassionate and demonstrably no worse/perhaps even better.
posted by Jakey at 3:54 AM on February 14, 2008 [1 favorite]

I just can't see the rationale or morality of opposing something that is cheaper, more equitable, more compassionate and demonstrably no worse/perhaps even better.

You left out "less profitable". And that's what matters most in the US system.
posted by Thorzdad at 4:21 AM on February 14, 2008

The big difference is fear. Many Americans simply avoid getting checkups for fear that they will find something and then they'll lose everything they had. They'd rather simply get sick and die.

That's right! I had a healthcare scare a few weeks ago (don't worry, it all turned out fine) and the first things I thought were:

1. They're going to figure out some way to throw me off the health insurance if this is bad because I'm a domestic partner and not a spouse, and

2. Maybe I should take out a big life insurance policy just in case all hell breaks loose, because if it's bad, I certainly won't be able to get one then.

How sad is it that in the middle of my "well, my grandmother died of that cancer type when she was 47, and suddenly the doctor is worried about mine" freakout that all I could think about was whether or not I'd become a burden to my boyfriend and family?

How sad is it that my mother, in the middle of my one crying jag, said "we'll figure something out" (if it came to the worst)? My parents don't have any more money than I do. Had it been cancer, they'd have probably lost their house trying to save me. And the fucking GUILT of that would've been more than I could take. I probably would've done the exact same thing my grandmother did in 1982: have one month of massively expensive treatment above the insurance cap, say fuck this and go home to die. This, in the wealthiest (but arguably stupidest) country in the world.

I'm tearing up even thinking about it. I don't particularly want to die, but had I ended up with a lovely Stage 4-outta-nowhere cancer, I don't think I'd have had much choice. And that, my friends, is what the "choice" in American healthcare really is.
posted by bitter-girl.com at 7:05 AM on February 14, 2008 [2 favorites]

I understand that numerous people (anecdotally) are pleased as punch with the Canadian system, but I still can't shake the feeling (yeah, yeah, I'm a wacky walking Libertarian stereotype) that the government is going to do a worse job than industry.


as has been said above.. it's already been proven, in many countries worldwide, that actually, yeah, the government does do a better job at providing healthcare.
posted by dirtynumbangelboy at 7:12 AM on February 14, 2008

They are exactly the same drugs, made by the same pharmaceutical companies, often in the same factories.

But they have different names. Sinutab? Gravol? What?

I'm amused that she uses the SARS outbreak in Toronto as proof that the Canadian system works well, considering it was actually caused by medical staff not following the rules. (I'm not saying that the Canadian system doesn't work—my girlfriend and her mom were seen by their doctor, without an appointment, in the time it took me to navigate Richmond Hill traffic to go to the bank and the gas station.)
posted by oaf at 7:39 AM on February 14, 2008

One of the other things my "yeah, but socialism" friend said was that Canada and other single-payer systems are burdened more by acute-care expenses, while the U.S. is burdened more by chronic-care expenses (because of all the bad lifestyle choices, of course, and why should he have to pay for that?) While it sounded like statistical hooey, does anyone have a counter showing why it's hooey?

I think what we need is a campaign similar to the anti-tobacco one, showing how the current system destroys lives. The health-insurance industry is not so very different from the tobacco one, except for more blatantly claiming to promote health.
posted by Kirth Gerson at 7:40 AM on February 14, 2008 [1 favorite]

I don't like Socialized Medicine.

That's nice, but we're talking about the Canadian healthcare system, not socialized medicine.

I don't have the 'right' for you to have to make me a sandwich

sudo make me a sandwich.

My part of Canada isn't half-assed about weight

How much you weigh, not how much your meat weighs.
posted by oaf at 8:10 AM on February 14, 2008

jokeefe: It amazes me that people (okay, some Americans) are willing to fight on political/moral grounds against the idea of a decent working system that provides decent health care for everyone in the country.

Blenderfish: I reject the notion that healthcare is a 'right'. "Rights" protect you, not obligate others to do things for you. I have the 'right' to free speech, or not be imprisoned without a trial. I don't have the 'right' for you to have to make me a sandwich or bandage my leg.

The issue is about what rights are and whether rights are positive rights and negative rights. That is, are other people entitled to have you give them something? Are you obliged to provide things that others need because they need them and you can provide? As long as you can argue that we should all support a system that gives everyone healthcare on the grounds that it is a necessity, we ought to also be arguing for a whole slew of things people need: food, water, clothing, shelter, education. Some people don't have any problem with extending this indefinitely. Libertarians say no to subsidized/socialized/single-payer healthcare because they reject positive rights.

Much of this thread (at least the parts about efficiency and rationing) does not really gibe with what I have heard from my Canadian relatives in the past six months. A brother living in Toronto says that getting a primary care doctor is a limiting factor in moving to the city. It's that hard. My mother moved to small-town Ontario (Cobourg) and contacted all of the doctors in town. No dice. My brother in Victoria had a really hard time getting an ob/gyn for his fiancee. Doctors aren't taking a lot of new patients, and my relatives say that's because doctors' pay is essentially capped. These comments are laymen's hearsay so you can take that for what it's worth.

One last personal note: my uncle has a business targeted at provincial governments that performs simulations of economic (costs) and patient outcomes (wait times, mortality) based on how the governments adjust the availability of doctors, nurses, hospitals, money, etc. One of the parameters is to direct overflow to the US, avoiding developing and supporting infrastructure and jobs in Canada. I'd think this would give someone on the other side of the argument pause; it's pretty clear to me that there is rationing at work.
posted by A-Train at 8:45 AM on February 14, 2008

For your Canadian libertarian living in the US commentary, try Mark Steyn's Is Canada’s Economy a Model for America?:

Canadian dependence on the United States is particularly true in health care, the most eminent Canadian idea looming in the American context. That is, public health care in Canada depends on private health care in the U.S. A small news story from last month illustrates this:

A Canadian woman has given birth to extremely rare identical quadruplets. The four girls were born at a U.S. hospital because there was no space available at Canadian neonatal intensive care units. Autumn, Brook, Calissa, and Dahlia are in good condition at Benefice Hospital in Great Falls, Montana. Health officials said they checked every other neonatal intensive care unit in Canada, but none had space. The Jepps, a nurse and a respiratory technician were flown 500 kilometers to the Montana hospital, the closest in the U.S., where the quadruplets were born on Sunday.

There you have Canadian health care in a nutshell. After all, you can’t expect a G-7 economy of only 30 million people to be able to offer the same level of neonatal intensive care coverage as a town of 50,000 in remote, rural Montana. And let’s face it, there’s nothing an expectant mom likes more on the day of delivery than 300 miles in a bumpy twin prop over the Rockies. Everyone knows that socialized health care means you wait and wait and wait—six months for an MRI, a year for a hip replacement, and so on. But here is the absolute logical reductio of a government monopoly in health care: the ten month waiting list for the maternity ward.

posted by A-Train at 8:49 AM on February 14, 2008

My understanding is that a lot of our doctor and nurse shortage is directly attributable to the USA. Because the USA has for-profit healthcare, doctors and nurses can make a shit-ton more money there. And since they're only human, of course they want to make more money.
posted by dirtynumbangelboy at 9:00 AM on February 14, 2008

dirtynumbangelboy: My understanding is that a lot of our doctor and nurse shortage is directly attributable to the USA.

Yeah, that's obviously the case, but according to my relatives, it's also that if your income is capped, you're not going to be interested in allowing your office hours to be open-ended, so you limit the number of new patients you take on. I'm talking here only of the primary care doctors and specialists, not, say, a shortage of ER doctors.
posted by A-Train at 9:09 AM on February 14, 2008

A-Train, here's the funny part about that.

The Canadian system doesn't care where care is available, they only care about paying for it. Those people had to tgo to the US? Fine, send the Canadian Gov't the bill.

And having worked in several hospitals, let's just say that this was a rare case. I doubt Kaiser Permanente would have send them to a competing hospital and picked up the tab if they were out of NICU beds.
posted by WinnipegDragon at 9:15 AM on February 14, 2008

if your income is capped, you're not going to be interested in allowing your office hours to be open-ended

Doctors down here have open-ended office hours? No.
posted by oaf at 9:29 AM on February 14, 2008

Doctors down here have open-ended office hours? No.

No, but they have control over how many hours they work and how many of those hours they get paid for. By my hearsay reports, not so in Canada.

Maybe, to be clearer, I should have said extended rather than open-ended.

Okay, since I've cited anecdotes a few times, what is the case on Canadian doctor salary caps? I'll look into this and get some current numbers.
posted by A-Train at 9:49 AM on February 14, 2008

I doubt Kaiser Permanente would have send them to a competing hospital and picked up the tab if they were out of NICU beds.

Nope, they'd have said "you're shit out of luck, lady."

Then again, given the considerably larger number of midwives in Canada vs. the U.S. (I know some in Ontario), you don't necessarily NEED a maternity ward unless you're high-risk patients like the identical quadruplets + mom. Pregnancy and childbirth are not diseases and don't need to be treated as such. Hell, in my family, I think my dad was the first one to be born in a hospital at all. Ditto my boyfriend. (Which is why, if we do have children, he's slightly more amenable to the thought of home birth -- it's not an alien concept to him like it is to most Americans).

Born-in-the-States friends of mine who've married Canadians will no longer travel to the U.S. without major-league travel insurance, in case they end up in an emergency room somewhere.
posted by bitter-girl.com at 9:51 AM on February 14, 2008

Okay, since I've cited anecdotes a few times, what is the case on Canadian doctor salary caps? I'll look into this and get some current numbers.

Well, I know one Vascular surgeon, an assistant department head and university professor whose total income is over $700,000 a year. If there is a cap, he is unaware of it.
posted by WinnipegDragon at 10:43 AM on February 14, 2008

Nope, they'd have said "you're shit out of luck, lady."

Didn't the articles cover this?

Canada rations care on a first-come, first-served basis, with some exceptions for severe cases.

The US rations care on the basis of who can pay for it.

At some point, every medical system runs out of resources. The question is how the systems deal with that situation.

For your Canadian libertarian living in the US commentary, try Mark Steyn's Is Canada’s Economy a Model for America?

But most people don't wait and it's a false dichotomy: many people in the US don't get seen, ever. Sure Canada's wait times look bad - if you throw out the US's wait times that equal infinity.
posted by GuyZero at 11:17 AM on February 14, 2008 [2 favorites]

I always wonder how the USA raises so many extreme sports champions. I mean - one snap, and your parents are going to pay $100,000 + to fit you a new spine.
posted by anthill at 11:33 AM on February 14, 2008

The four girls were born at a U.S. hospital because there was no space available at Canadian neonatal intensive care units. Autumn, Brook, Calissa, and Dahlia are in good condition at Benefice Hospital in Great Falls, Montana.

The strange part about this is that Autumn, Brook, Calissa, and Dahlia, by virtue of having been born on this side of the line, are US citizens and will be able to come here and pay out the ass for their own healthcare any old time they want now.
posted by deadmessenger at 11:40 AM on February 14, 2008

My understanding is that a lot of our doctor and nurse shortage is directly attributable to the USA. Because the USA has for-profit healthcare, doctors and nurses can make a shit-ton more money there. And since they're only human, of course they want to make more money.

There is also a shortage in the US; I know people in nursing school who've received offers far in advance of graduation.
posted by Pope Guilty at 11:48 AM on February 14, 2008

Well, I know one Vascular surgeon, an assistant department head and university professor whose total income is over $700,000 a year. If there is a cap, he is unaware of it.

Yes, but to be fair, part of his salary would come from surgery (which I would guess is what's capped), some would come from the admin budget of his hospital(s) for being the ass't dept head, and part would come from the university.

Canada rations care on a first-come, first-served basis, with some exceptions for severe cases.

The US rations care on the basis of who can pay for it.

Ding ding ding ding.
posted by dirtynumbangelboy at 12:03 PM on February 14, 2008

Canada rations care on a first-come, first-served basis, with some exceptions for severe cases.

The US rations care on the basis of who can pay for it.

I don't understand why people say this. It's true that you don't get healthcare in the US if you don't pay, but you also don't get food, clothing, housing, education, consumer goods, capital goods, anything, if you don't pay for them. So something that is rationed is synonymous with something that is sold. By this reasoning, if there is not a supply that matches or exceeds demand, then the item is rationed.

And the Canadian approach is rationing. I don't know why there is this attempt to make an equivalence between two totally different concepts.
posted by A-Train at 12:08 PM on February 14, 2008

I can sum up this entire argument in one sentence.

The only people who oppose single-payer, Canadian-style healthcare are those who have never been without insurance, never been seriously ill, or never worked in the healthcare industry.

In other words, the people least qualified to judge whether or not the US system is "effective".
posted by scrump at 12:35 PM on February 14, 2008

Many people - specifically many people outside the USA - do not equate health care with a sandwich.

Slavery is illegal not because it's not possible to buy and sell people - it still happens today - but because it's immoral.

Health care is not about doctors and bandages, it's about pain and suffering. If I have the right to be free - which is not without a cost - then should I not have the right to be free of pain or disease to contribute society?

To equate health care to "food, clothing, housing, education, consumer goods, capital goods, anything" is akin to saying the suffering of others is unimportant to you.
posted by GuyZero at 12:39 PM on February 14, 2008

A-Train, give it up. Your talking points are showing.
posted by dirtynumbangelboy at 12:58 PM on February 14, 2008

“An armed monopoly funded through force and staffed by unionized civil servants MUST be more efficient, effective, and responsive to individual wants and needs than a collection of firms competing to offer a variety of choices at the best prices.”

You would think the opposite, yes. But the firms don’t really compete. There is a sort of backdoor socialism in place now through lobbyists and the way the laws are written to benefit larger firms providing smaller services.

The argument appears to be, free market solutions, given that they are in fact free market based, may be more efficient and responsive to individual needs.

In the case of health care however, the potential for abuse and gaming of the market through influencing lawmakers once a firm has enough wealth to build that kind of connection pool is unacceptable.
This in contrast to places where that kind of cut throat activity is more tolerable, the car industry perhaps, or the food/agrabusiness. The case against Archer Daniels Midland for their violations was airtight, but they are still in business.

While people can bear some dealings of this type when it affect only their wallets and breakfast cereal, many people would rather have tighter controls on an industry, health care, that directly impacts their lives and health.

In short, businesses have greater latitude to seek profit when they are not government controlled which is an ideal situation for them.
Greater control over the end product is afforded by consumers however when their government is more directly responsible for it.

People make this kind of decision all the time. Some people choose to have less liquid assets available in favor of mitigating catastrophic risk, they might have a large life insurance policy for example.
Others choose to have more ready cash.
In this case the argument is that your freedom to compete is not as great as my right to life and health.
In some states auto insurance is mandatory. So, blenderfish, you cannot choose not to have it. But don’t mistake the coercive element as arbitrary government mandate. It’s meant to be, and ultimately is, something you cannot realistically do without.

Health care is a similar sort of contractual relationship to auto insurance in that, while it does limit variety and choice, it provides greater mutual assurance of control when something catastrophic occurs.
You cannot choose not to buy auto insurance when there’s a chance you might crash into me.
Similarly, as said above, when you have multiple heart attacks, your choices become severely curtailed and that becomes clear to you very quickly and if your firm cannot pay you still become a burden on the state only in another form. “No free lunch” I believe is the term.

When choices become limited for a consumer, an institution that has profit as its primary goal is not the most efficient source for purchasing.
In such a case it has nothing to do with the market or the firms, but the limitations of the consumer. Therefore the focus is accuracy in meeting the need such that less money overall need be thrown at the problem, however individual cases vary.
In such a case control is more important than variety.

It may seem less money is thrown around in the competative model of health care, that it is more efficient, but that is because any money spilled falls into pockets. Spilled money can be more easily seen when there is mismanagement by the government.

But perhaps not the firms themselves are capricious, their suppliers may be.
Consider the price gouging that occurred before and after Katrina in gasoline, parts, supplies, even basics such as plywood.

So while it’s correct to observe that Home Depot does a much better job providing plywood and supplies to consumers on a more regular basis than the government might, in an emergency where a consumer has no other option this may be not so.

And it may be the case that it is not Home Depot’s fault, the plywood suppliers might note the need. Or the transporters. Or the logging firms. And so forth, and take advantage.

Corruption abounds in any system. But with government provisions and constraints there is some more protection and insulation from this, or at the very least someone reachable and replaceable to hold at fault should something go awry on a large scale.

The only real argument against health care in the U.S. is that citizens seem to refuse to hold politicians accountable for anything as alluded to in the “federally funded military industrial complex” comment.
But again, that is a matter of contractual enforcement, not the substance of a social contract or the form it may take.

The effectiveness of that, certainly, is debatable. But if something is in short supply I’d rather wait based on availablity than have to bid on it.
posted by HVAC Guerilla at 1:29 PM on February 14, 2008 [2 favorites]

If I have the right to be free... -- a negative right

then should I not have the right to be free of pain or disease...? -- a positive right

I still say it comes down to whether you think that rights are positive or negative or even whether you are willing to mix them freely.

Slavery is illegal not because it's not possible to buy and sell people - it still happens today - but because it's immoral.

So I think the argument on the table is, "It's as immoral to deny people medical care as it is to enslave them." I'm saying there are lots of things that people need to live (food, water, clothing, housing, medical care, and education for a start), so as far as that goes, I think that we should be hearing a case for why providing for everyone's living needs is similarly moral.

For my part, I don't agree that we are our brother's keeper and I don't agree that it is our duty to provide those things for others.

To equate health care to "food, clothing, housing, education, consumer goods, capital goods, anything" is akin to saying the suffering of others is unimportant to you.

What? You don't care if people run around naked and hungry, with no roof over their heads? So you care about medical suffering but not all the other varieties?

Make no mistake: these are all goods and services, produced by someone and having a cost. If you give these things away, then someone still has to pay. There should be a better argument for why robbing Peter to pay Paul is justified.
posted by A-Train at 2:08 PM on February 14, 2008

I can sum up this entire argument in one sentence.

The only people who oppose single-payer, Canadian-style healthcare are those who have never been without insurance, never been seriously ill, or never worked in the healthcare industry.

I've never been a big fan of this line of argument, but some people find it valid and compelling: you could substitute food, water, housing, education, and clothing for healthcare and have an argument of much the same validity. People suffer and die as surely from the need of these five things as they do from need of healthcare. What makes it special in your eyes?

But what's more, someone else's need is not an obligation on me or anyone else.
posted by A-Train at 2:18 PM on February 14, 2008

Canada rations care on a first-come, first-served basis, with some exceptions for severe cases.

Well. Let's say Canada manages demand by applying a wait-time tax on the provision of health-care that is decreasing in need.
posted by ~ at 2:36 PM on February 14, 2008

Incidentally, if you want to see how easy/hard it is to get a family doctor in Ontario, check out the Family Doctor Search provided by the College of Physicians and Surgeons. You will see that finding a doctor in a large city is very very very easy, and in small towns not as easy.
posted by y10k at 3:45 PM on February 14, 2008

Make no mistake: these are all goods and services, produced by someone and having a cost. If you give these things away, then someone still has to pay. There should be a better argument for why robbing Peter to pay Paul is justified.

Both Peter and Paul pay and are paid. So that's a false analogy. And by your argument there should be no welfare, social security, municipal water system or educational system (I too can play reductio ad absurdum). But all those things do, in fact, benefit me.

(As an aside, why do people against this system constantly use the language of theft? Is your current HMO stealing from you? Is the local school stealing from you? It's not like you're not getting something here)

If I am the only educated person then I get ahead but the economy in general suffers. A rising tide floats all boats as they say. So it goes with health care - it's no good for the rich to enjoy their health if workers cannot afford to keep themselves healthy. (not that I want to cast this in terms of class, but everyone benefits economically from having a healthy population)

I will conced that you are correct in your assessment of positive vs negative rights. They are not the same. I would argue, however, that you already explicity or implicitly support some sort of collectivist system that you both support and benefit from. You participate on Metafilter because you are literate and you were probably forced into literacy against your will. Just as society is collectively richer when everyone is literate, it is collectively richer when everyone is healthy. And empirically, the cheapest way for society to keep everyone healthy is to create a state-sanctioned monopoly on health care that seeks to minimize costs while maintaining mandated standards.
posted by GuyZero at 3:45 PM on February 14, 2008 [1 favorite]

you could substitute food, water, housing, education, and clothing for healthcare and have an argument of much the same validity.

And there already is a collective state-sanctioned and state-funded monopoly in both Canada and the US for education and water. I suppose they're not monopolies, but they're pretty close. There's no law against selling water or setting up a private school. Just as there's no law in Canada against setting up a private medical practice. Do you really advocate removing the water supply from state control? (Two words: Walkerton. Look it up)

Look, I (personally) am not calling for a full-on nanny state that suckles me from cradle to grave. People should reap benefits proportional to the economic activity they generate (sorry for sounding so stiff when I write, blargh). But a rich country should make sure that no one is left in inhumane conditions. We give people welfare. Not everyone, but some people. I (and I would assert that most people agree) don't see it as a black and white issue. Some people need help. Not everyone. A line is drawn. Near the line things get confusing. But it keeps people at a certain minimum standard.

The absolute minimum in the US health care system is very close to nothing. The absolute minimum in the Canadian system is pretty good. Overall, it costs us less per capita. My poorly formed arguments about morality aside, the single-payer system seems pragmatic. The only people who "lose" are 21-year old males in perfect health who don't understand what the externalities are.
posted by GuyZero at 3:55 PM on February 14, 2008

But if something is in short supply I’d rather wait based on availablity than have to bid on it.

Imagine the housing bubble except in medical care. Nice.
posted by GuyZero at 3:57 PM on February 14, 2008

Y10K -- hey, thanks! I'd forward that to my Mom but according to the link, not one of the 43 doctors in Cobourg, Ontario, is accepting new patients.

Quite amazingly sad, really:

Peterborough 1 in 80 000
Ajax 3 in 90 000
Kingston 5 in 117 000
Mississauga 107 in 668 000
Ottawa 19 in 812 000
Toronto 343 in 2 500 000

First number is doctors accepting new patients, second is population of town/city.

If you assume, for the sake of argument, that Ontario has the population/#GP that Alabama has (about 2000 people per doctor), then Ontario has 2.5% to 8.5% of GPs accepting patients for all cities except Mississauga and Toronto which have 32% and 27%, respectively. All the numbers go below 11% if you assume that Ontario has the service that New York has (656 people per doctor).
posted by A-Train at 4:54 PM on February 14, 2008

GuyZero: The only people who "lose" are 21-year old males in perfect health who don't understand what the externalities are.

Yes, those people get poor value for their money, but, at least anecdotally, it is easier for them to get a doctor. Again, as I understand it, doctors express a preference for taking on young patients:

• My 30-ish brother in Victoria has found a GP who is happy to take on his healthy 30-something friends. He speculates that doctors are compensated by patients-seen, so having brief visits with healthy people pays better.
• Compare with this story from 2006.
  "Doctors are cherry-picking patients, rejected applicants charge"

posted by A-Train at 5:07 PM on February 14, 2008

Keep in mind that "accepting new patients" ≠ lack of healthcare. There are walk-in clinics all over the place.

But what's more, someone else's need is not an obligation on me or anyone else.

[Haley Joel Osment voice: "I see assholes"]
posted by five fresh fish at 5:27 PM on February 14, 2008

A-Train, your numbers don't make for any kind of interesting comparison with the U.S. The number of primary care doctors accepting new patients in the U.S. doesn't matter when there isn't universal coverage. There's a well described primary care physician shortage in the U.S. that has gotten worse in the last 10 years, but we have more doctors accepting new patients because people aren't able to access their doctor. For all you know, the U.S. "needs" more doctors than Canada. We import them from all over the world. My practice has been full from three years after hanging out my shingle. And I am a terrible doctor!

I am dismayed to pop back into this thread and discover that it's been all about "my brother heard this" or my one experience is such and such. There really is evidence that Canada does a better job, looking at medical outcomes, financials, and customer satisfaction. Unfortunately, I really am much too busy today to send links but I would strongly encourage people who are on the fence about all of this to ignore anecdotes and look at the many good, quality studies that have been done because it really is a no-brainer.
posted by Slarty Bartfast at 5:33 PM on February 14, 2008

Oh what the hell, here's a seminal article. Most of the references are also good, I have read many of them. Now please, will you let me get back to work, Metafilter?
posted by Slarty Bartfast at 5:37 PM on February 14, 2008

Eh, thanks for the link SB. Regarding outcomes, here. (Not NEJM, but I think the journal is somehow associated with CMAJ. The metastudy got a little play in the news here.)
posted by ~ at 6:44 PM on February 14, 2008 [1 favorite]

Now that's the kind of thing that contributes meaningfully to the discussion, ~. That Himmelstein guy is the shit, let's hope he's on Obama's short list for Secretary of Health and Human Services. I really am not necessarily a zealot for re-engineering health care into a single payer system, it's just that when you try to look at it dispassionately, one answer keeps rising to the surface.
posted by Slarty Bartfast at 8:27 PM on February 14, 2008

OpenMedicines history and relationship to CMAJ.
posted by BrotherCaine at 8:56 PM on February 14, 2008

The CMAJ sent 13 women to buy the emergency contraceptive levonorgestrel (Plan B) over-the-counter in pharmacies across Canada, and report their experiences. The pharmacists asked them for personal data, including the woman's name, address, date of last menstrual period, when she had unprotected sex, customary method of birth control, and reason for dispensing the medication. This was at the recommendation of the Canadian Pharmacists Association, which also advised members to store the information permanently in their computers.

WTFWTF? I am literally and wholly shocked.

I want to know more about the CPA and where they get off on making that sort of inquiry. I want heads to roll. If anyone knows more, I would very much like to see an exposé front page post. This is absolutely wrong.
posted by five fresh fish at 9:00 PM on February 14, 2008

See, this is why you guys in the US don't have universal care. We were debating the merits of a universal healthcare system and now for the last 20% of the thread we've been talking about Free-dumb(TM).

The cost effectiveness of a universal system is not in serious dispute, so the tactics of the nay-sayers have switched to scaremongering and diversion, branding such a system socialist and tyrannous.

Oh, and A-train, I don't care if you are young, fit and not in need of healthcare. A rational agent cannot expect to always be so, and the most cost effective means of providing yourself helathcare when you need it is to be in a universal system all along. Given the penalties for not being part of such a system (eg 50% of the bankruptcies per annum), it doesn't make sense to do anything else. (Unless you are in the super-elite, of course).

You want to be free not to participate? What about schooling? Police? Well, you know, there's freedom to be free and there's freedom to be just plain dumb. And objecting to this doesn't make any sense on cost terms over your lifetime. You're not paying for anyone else, you're paying for you, and just being deliberately obtuse and/or contrarian about recognising it.
posted by Jakey at 5:59 AM on February 15, 2008

The pharmacists asked them for personal data, including the woman's name, address, date of last menstrual period, when she had unprotected sex, customary method of birth control, and reason for dispensing the medication. This was at the recommendation of the Canadian Pharmacists Association, which also advised members to store the information permanently in their computers.

WTFWTF? I am literally and wholly shocked.

That looks like responsible dispensing to me. Pharmacists need to be able to track drug interactions and ensure that the correct medication is being dispensed. These are all questions a doctor would ask. Pharmacists are doctors.

As long as the information is kept very strictly confidential, of course.
posted by dirtynumbangelboy at 7:14 AM on February 15, 2008

The only people who oppose single-payer, Canadian-style healthcare are those who have never been without insurance, never been seriously ill, or never worked in the healthcare industry.

Not true, on that last part. My sister is a doctor at a public health clinic, where they see the poorest of the poor, and she's one of the biggest opponents of universal health care I know. Or, more accurately, she insists that we ALREADY have universal health care. Anybody can get free health care at public clinics, anybody can go to the emergency room, regardless of means, and they BY LAW cannot be turned away.

Unfortunately, I simply don't know enough about the law with regards to this to mount a credible argument, but it certainly smells like bullshit to me. What happens if/when you're presented with a $300k bill for cancer treatment and you can't pay? Can the hospital put a lien on your mortgage, garnish your wages, or otherwise seize your assets? Is declaring personal bankruptcy the only option? (I suspect that all of this is true, otherwise hospital bills are basically optional.)

I need more details on this: What exactly are your health care options in the US if you have no way to pay for health care?
posted by LordSludge at 7:33 AM on February 15, 2008

Lordsludge: Well, even if you do get in, you might get dumped...
posted by anthill at 10:13 AM on February 15, 2008

Lordsludge: The free clinic will see you, but I don't think they can perform any major services, they're basically just a general physician visit. Correct me if I'm wrong, but the big ticket items (MIR, hip replacements, etc...) will never come from a free clinic, only a referral will. And you're correct about the emergency rooms, they have to take you, but they will bill you and they will turn it over to a collection agency if you don't pay. I'm not sure what happens if you refuse to identify yourself, but that's not exactly universal care.
posted by Crash at 12:03 PM on February 15, 2008

“Imagine the housing bubble except in medical care. Nice.”
posted by GuyZero

I don’t see how your statement addresses my argument. Explain.


“But what's more, someone else's need is not an obligation on me or anyone else.”
posted by A-Train

This is certainly untrue when it comes to health care. It is intrinsically unhealthy for the population at large to have people dying in the streets. It is unhealthy for you to have disease running untreated in others. What they can afford, or any other ideological position has no bearing on the biological facts of the matter.

Let us address the other possible substitute matters: “food, water, housing, education, and clothing”

Food is in vast abundance in the United States. Most of the deaths from hunger in the world are a result of market food prices determined by what wealthier countries are willing to pay.

People in the U.S. over eat and over pay for food and marketed food varieties, this pattern of consumption diverts food from meeting the needs of, in many cases, the people who have grown it.
This is not a natural free market result, this is an artificial shortage caused either by high price or low quality to maximize profit.

Water is a similar situation. Private corporations have used force to deprive local residents of their own natural water resource. Meanwhile bottled water is sold at extremely inflated prices.

It is a similar state of affairs in the housing market with loans on real estate being commodified and overvalued. But again, an artificial situation caused by the type of systemic control that is in place.

Clothing is vastly overpriced to such a degree that it is nearly emblematic of such a pattern of consumption and oppression. The Indian resistance under Ghandi is a classic example.

Many Indian workers were unemployed and yet they continued to buy clothing from British industrial interests. So they began to make their own clothes. It is without question that the situation wherein a cotton shirt that has a certain name emblazoned upon it is a thousandfold more valuable than an equal shirt without such a name, is an artificial situation.

Such controls are ubiquitous in the garment industry. In the U.S. the point is, again, nearly moot given the degree of abundance. But anyone can clothe themselves given the tools to do so are not taken away.

The pattern of Education on the other hand certainly can be substituted for health care. It is, I believe, universal in the U.S. There are even provisions for children of homeless residents of an area to attend school.
Higher learning is based more on wealth, but for the most part a good education can be made available to all.

Of course, there is resistance and opposition to this. And obviously the design is to destroy the universality of education whether it is by knowing intent, ideology or unthinking ignorance.

I would not assert anyone here opposing universal health care intends the same thing. But the pattern of argument in opposition is the same.

I have no duty to save your life if you are dying in the street. But neither do I have the right to deprive others of the resources to do so because I believe those resources are best utilized to maximize my profit.
And it is still your business when the state serves someone else’s need in an improper or inefficient manner.

Which they do under the current system. An impoverished man having a heart attack will receive emergency medical treatment at a government funded hospital.

That a private firm won’t treat him because he has no money means that he won’t get the preventative care he needs. Which means it will cost tax payers, you, ultimately more money.

If he receives preventative care from a government run system, then that could, and statistically does, ameliorate the situation, not only his health and his continued productivity and payment of taxes, but reduces the ultimate amount you pay in property tax to fund government care now.

Private health care only seems efficient by comparison because of the selective nature of it. Similarly, private schools can drop poor performing students while public schools have to take everyone. This most certainly affects the bottom line on test scores.

Using the private school model nationwide is obviously impractical as there are children who would go uneducated. The long term detriment to society is obvious there.
The equivalencies to a similarly patterned health care system are obvious.
posted by HVAC Guerilla at 3:45 PM on February 15, 2008