June 16, 2000
9:42 PM   Subscribe

Today I saw an ad on TV complaining that American health care is being “Canadianized.” All I can say is that I wish these Americans would stop lying about the Canadian health care system. While most Canadians seem to agree that our health system is a bit of a mess, we also seem to agree that we don’t want the American system, thank you very much.

The US market-driven medical system spends about 14% of its economy on health care, while Canada's cost is about 9% of GDP. Both countries' health care costs stood at about 7% in 1971, when the Canadian system converted to the public system and the US decided to stick with a market-driven private system. Yet the Canadian system covers everyone; the American system doesn’t. Private delivery of health care means money is lost to the profits investors demand (as much as 15%), higher executive salaries, higher marketing/advertising costs, and lost economies of scale.

Why attack the Canadian system? Part of the answer lies in the fact that to the American health care industry, Canada is just one huge, untapped market that they would love to have access to.
posted by tranquileye (24 comments total)
Well, that, and because you all are a horde of godless backbacon eating toke wearing hockey playing communists without guns or tobacco or any of the other values that made America great. :)

I know this because Jesse Helms tells me so.

(Please see the joke...please...I don't need a horde of computer-saavy Canadians screwing up my already tenuous life.)

Anyway, the US medical system and I parted ways along, long ago. I allowed them to treat my leukemia because I didn't want to die, and because I was willing to let the NIH test new stuff on me, I got free treatment. I don't recommend this to everyone. I'd be willing to give the Canadian system a shot. How hard is it to immigrate?
posted by Ezrael at 9:49 PM on June 16, 2000

It's interesting that you link to the pro-American-style site by describing it as a pack of lies, while you link to the pro-Canadian-style site as if the site is 100% impartial and automatically correct. The reality is that both sites belong to special-interest groups, with neither one having a monopoly on some "ultimate truth." But anyway...

>The US market-driven medical system spends about 14% of its economy on health care, while Canada's cost is about 9% of GDP.

Unless your only concern is the amount of money spent, these numbers are irrelevant, because the two healthcare systems have fundamental differences in their approaches to patient treatment. Trains and planes both get people to where they're going, but we don't get into political debates over which is the fairer, more efficient form of transportation (I could also say a Concorde costs more to run than a Boeing 737, heh heh).

>Yet the Canadian system covers everyone; the American system doesn’t.

1) No, it doesn't cover everyone.

2) Those it does cover, it covers by rationing services. Occasionally, this is done to the point where people die because they were made to "wait their turn" for things you can't safely wait for, like bypass surgery.

3) It relies on the US healthcare system to take up the slack, and to do all those messy, capitalistic things like invent lifesaving drugs in the first place.
posted by aaron at 11:30 PM on June 16, 2000

I can't comment on Canada/States arguments, but here in the UK we have a National Health System (which you could argue was the reward the "people" got for dying so selflessly in the second world war, but I digress).

It also has financial problems, but is something most people here care about immensely and would hate to lose.

The difference between the US and Canadian/UK/Cuban(!) systems seems to be the extent to which people are allowed to suffer at the expense of individual freedom. The US appears to be at the extreme "freedom" end of a wide range of trade-offs between the two. (In general people from the US seem to flinch from strong political views unless they advocate "freedom", in which case they are considered acceptable).

Whether extreme views are ever the "correct" ones I leave to others to decide, since I hold many views others would think extreme myself :-)


posted by andrew cooke at 12:58 AM on June 17, 2000

The big difference is one of attitude: US health care is based on the idea that you can see specialists without having to wait. (In reality, with HMOs, this isn't the case, but the principle is still there.) In Britain, we're prepared to go through our GPs, and wait for months, and put up with mis-managed hospitals and regional disparities in treatment, because we feel that it's worth it for those times when we need A&E treatment and don't have to proffer a chequebook or insurance card.

It's what you're used to. Personally, I'm minded to keep paying my NI contributions if I emigrate to the US, so that if the ague hits me, I can fly home and collapse into the nearest NHS bed.

For-profit health care in the US is, in general, managed by a group of heartless fucks who should be flayed and then thrown in salt water. My fiancée worked for Charter in Atlanta: they treated their patients like cash-cows, employees like McMentalHealthCarers, and are now bankrupt after "dubious" distribution of funds. They're not alone.
posted by holgate at 6:45 AM on June 17, 2000

...and the "freedom" above is "freedom to spend money as you want" rather than "freedom from poverty", "freedom from disease" etc etc.
posted by andrew cooke at 6:45 AM on June 17, 2000

I am terribly unprepared to enter this conversation proper, but I do recall hearing a report on NPR a few months back that touched on the subject. It seems most countries other than the US have laws passed with caps on drug prices, significantly lower than an even distribution of the research cost. Thusly Americans pay hugely inflated prescription prices to pick up the slack, and carry the rest of the world. Canada and the UK were mentioned in the report, Africa was covered in some detail because there was pressure to suppy drugs even though Africa has almost no money to pay for them.
posted by thirteen at 8:27 AM on June 17, 2000

All health care systems ration. In the US we ration by cost (if you can't afford it, you can't have it). In Canada, they ration by time (long waiting lines). In the UK, they ration by services offered (some treatments are not available, depending on age and condition).

As my medical economics professor used to say, "You can have it fast, you can have it cheap, or you can have it good. Or any two of the three. Never all three."
posted by alhawkins at 8:34 AM on June 17, 2000 [1 favorite]

>>Yet the Canadian system covers everyone...>No, it doesn't cover everyoneAh, that wacky conservative thinktank, The Frasier Institute, strikes again. What they neglected to mention is that residents of B.C. who prove that they can't afford to make any payments towards healthcare have their (small) premium costs paid for them. So those who don't have coverage either can pay and won't, or didn't bother to fill out the simple form.
posted by jess at 8:55 AM on June 17, 2000

Aww, crap. Rotten closing tags...
posted by jess at 8:56 AM on June 17, 2000

Andrew, I may be insane, but I've been to England, and it's rife with diseased poor people. They live on the streets, selling newspapers or just begging for money, much as they do in America. I haven't yet noticed a lack of poverty or disease in Britain. Hell, the other day I went to give blood, and I found out that because I lived in England for a year, I'm not eligible. Something about possible Cruetzfeld-Yakob contamination in my bloodstream. That freaked me out.
posted by Ezrael at 11:50 AM on June 17, 2000

Well, the blood transfusion service is talking bollocks, Ezrael. And did you notice that the diseased, poor and homeless were, um, still alive?
posted by holgate at 3:17 PM on June 17, 2000

Hasn't NAFTA already opened the Canadian Health care system to American companies? I remember some fair trade issue about forcing Canadian hospitals to accept bids from Americans. I assume HMO's and the like could set up business if they wanted, they just would not make any money there.
posted by thirteen at 4:39 PM on June 17, 2000

holgate: They're hardly zombies in this country either. I think if hordes of living dead homeless were wandering the American cities, we'd notice. We're hardly that thick. And as for the blood transfusion service...the International Red Cross is usually well respected. I think that's what the International is all about.
posted by Ezrael at 8:45 PM on June 17, 2000

You know what? Having just re-read that paragraph, I wish I didn't write it. Here's the thing: I'm very conscious of my country's flaws, and they anger me greatly. They are manifold and easily noticed. But it's similar to when you have an asshole uncle in your family...you can only take so much "God, what an asshole your uncle is!" before you want to turn and say "Fuck, you don't exactly have the best damn family either, pal!"

The American health care system is fucked up. I admit that. In a lot of ways, America is fucked up. I admit that, too. But God damn it, I am an American. It had made me what I am, for ill and for good. It is possible to get health care here and not go broke. There are good people in our hospitals and everywhere else. We do out best with traditions we aren't sure how to live up to, an infrastructure tasked to the breaking point in dozens of ways we never foresaw. When I had leukemia, as much shit as I gave the doctors and the nurses, they were never less than caring and professional.

I get very tired of seeing my country get dragged through the mud because of assholes like Jesse Helms. We tolerate his cracker antics, and people think that means we're all like him. Well, we aren't. Many of us are good, concerned, interested people who want to do the right thing and aren't entirely sure what it is. From health care to international relations, it's very easy for outsiders to come along and tell us all we're doing wrong. What, pray tell, should we do? Nationalize our health care and create a bureacratic snafu that would make the one we have now look tame? Guarantee health care when we can't even guarantee decent food and shelter to everyone?

There aren't easy answers to these questions. I, too, wish we would stop saying shit like 'If we Canadized our system it would be a nightmare' because that makes us look like idiots. We couldn't do that if we wanted to; there are more of us, the law is different here, the states have much more say than the Canadian provinces do...it wouldn't work. Most reasonable Americans realize that. We see the train coming, and we don't know what to do about it.

Basically, I'm just saying that it's a hard issue. What worked in Canada, or Europe, or Asia, won't necessarily work here. Instead of slinging attacks based on such canards, we should be trying to come up with an approach that will work here.
posted by Ezrael at 9:00 PM on June 17, 2000

>We see the train coming...

What train? There's no guaranteed singular destiny towards which the United States is headed.

posted by aaron at 10:47 PM on June 17, 2000

Guess what? I have plenty problems with the way things happen on my side of the pond, too. The shitty class divisions, the cultural hegemony of London, even the price of CDs. And I think that the US does lots of things right: such as produce my girlfriend, for instance.

But you have to be standing outside to appreciate just what an influence American culture has on the rest of the world. This isn't an informed exchange of shared values we see: it's a fucking tsunami. And that's nothing to do with J. Random American, I know, but it's everything to do with that implicit cultural jihad which is embodied in the US's story of nationhood.

See, in Britain, we have these red squirrels, and then the grey ones were imported from America in the 1950s, and because they were stronger and reproduced faster, they drove the native red ones into tiny corners. And that seems to me like a perfect parable.

So I can cope with McDonald's on my high street next to the Gap, and with Britney fucking Spears on the radio; with the abandonment of the benefits system, and with the grinning idiots of imported dot-com management suggesting that 80-hour weeks are the way forward, but allow be to be just a little bit defensive when I admit my fear that the next cultural imports will be the guns and the private health-care system, and you will only get the NHS by prising it from my cold, dead hands.

Because when it comes to cultural imposition, it's like this: we're like gnats biting the arse of the US; you can squash us just by sitting down.
posted by holgate at 5:36 AM on June 18, 2000

Hey, holgate, if I were you guys, I'd be nervous about that, too. Not because you are gnats; if you wanted to, you could stop it. Britain especially. Any nation that dominated the entire world from 1816 to 1914 and survived the Blitz can say no to the Gap. But when you stepped aside and let us step into your shoes in the Fifties (and they don't fit, and they never will) you seem to have abdicated that national will. I don't know why. I admire the hell out of England, always have, but I don't understand why you let us warp your language and customs so readily. I personally would love to see you burn the Taco Bells and the McDonalds' and so on. It's not like you can't do it. Again, I point out, you certainly told the Nazi's you didn't want any, you can tell us the same.

I've always seen America as a psychotic contradiction, but unlike Russia and India and Botswana, England has the least right to complain and the most responsibility to stand up and tell us to fuck off, you don't want any. It was the hundred years of English domination, of the spread of the English language and the Empire, that makes American Cultural Cancer possible. You're our Greece, and we're your Rome. You made us. We're your bastard child from your days of wild colonial oat-sewing, come round to screw up your golden retirement years and mess up the family dynamic, and we're not going to stop. (I just got done writing about how America is a spell cast by the School of Night, that whacked-out Renaissance group of magical punters started by Francis Bacon and Lord Fernando My Last Name Really Is Strange, Earl of Derby, and in a lot of ways it's true. The Elizabethans wanted Gloriana and they made it in Virginia, and that's why it took Virginians to write the documents that made the US a nation. Sure, it's crazy, but ideas have power.) But we can be stopped.

And aaron: I don't know. I think I meant in the sense of standing on the tracks and seeing it coming to crush us but I was feeling kinda fatalist.
posted by Ezrael at 7:23 AM on June 18, 2000

I think we're getting somewhere, Ezrael. In the Fifties, Britain was busily trying not to starve as a nation, given that we'd bankrupted ourselves during the war. Which is why the US was getting its consumer durables, and the social mechanisms to sustain that economy, while my parents were being raised in an era of ration books. (And why the US was lending us the money to save us from virtual famine.)

That's not a whinge: it's just a historical fact, and it's definitely what separates the two nations culturally. What's happening now, I think, is that for every Gap that opens on the high streets, a C&A or Marks & Spencer goes under, simply because it's not quick or smart enough to compete. But with the loss of every dowdy, dull brand -- every cloth cap maker or safety match factory -- there's a nail in the coffin for cultural heterogeneity. (Mister.) Reactionaries are always dull by definition.

But I like your Elizabethan bastard analogy a lot: I'm thinking of Edgar in King Lear, born under a bad sign and stronger for it, come to put out his father's eyes. You can run a long way with that comparison.

Which is also why I made the "jihad" analogy: there's a virility about modern Islam which rivals that of the US, as to who'll be the world's biggest political stud.
posted by holgate at 9:28 AM on June 18, 2000

Well, modern Islam has only modern Islam to prevent it from spreading like wildfire. But really, the idea that these cookie-cutter America companies are of neccessity a threat is only true if you patronize them. I personally never shop in a Gap, and I know a lot of other people who feel the same way.

America in the Fifties had a whole different series of problems to face, really; while England was starving, we were becoming a fascism of the mind, seeing enemies under every bed and needing to see them. America's always been a bit crazy, but we've always done best under threat. It makes us focus. America has never been bombed from the air the way England was, and it certainly has never been invaded by the German army the way many other nations were, or occupied by conquering armies the way Germany was (unless you count the one that killed the native tribes and pacified the West.) and so we have little knowledge of that kind of suffering. Hunger exists in the US, but it's a hunger we could alleviate (there is more food here than there needs to be...I remember reading somewhere that three tons of edible food is scavenged from Washington DC's dumpsters every day, and that number might be a lowball figure) so we don't have the knowledge of that kind of hardship. America is 10th Century Denmark with 18th Century Enlightement ideals and the economic might of a world empire. One of the big reasons we don't especially like the UN is because we don't get it. Why bother with proxies when you can just tell people what to do? Sure, that irritates the foreigners, but fuck them, right?

Also, at least as long as I've been alive, America sings the lip service hymns to the Melting Pot, which if you think about it is the exact opposite of Cultural Heterogeny. America, to put it bluntly, is the Borg. You will adapt to service us. And you do. Canada has done so (you may hate me for saying so, but you signed NAFTA and buy and sell with us like a symbiote...I honestly can't imagine a North America without strong Canadian-US economic ties, but if it happened, it wouldn't be us who suffered), Britain has done so, Singapore has done so, Russia has done so to such a degree that it's actually become a mafia-run nation which handles all the money laundering for America's illicit economy (nearly as boisterous and powerful as our legal one), and England...well, the fact that I could find a Taco Bell in Earl's Court, down the street from the Wendys and not especially far from the Pizza Hut made me want to vomit. A friend of mine actually ate at a McDonalds in Calcutta. I have a hat bought in the Ginza from a mini K-Mart.

It's so frightening to me that the American cancer has sunk its roots into the world, because unless people start to turn away and not pump funds into these megalithic corporations, they'll sink roots so deep they'll never get dragged out. I don't think the world is ready to be rendered like fat in the Melting Pot. When you want to make a beautiful statue out of gold and silver inlay on Bronze, you don't melt down all of the metal in one crucible. That just makes a mostly brassy alloy of no real intrinsic worth or beauty. You use the gold and silver as accents, to highlight and enhance the beauty of the art.

This sounds like I'm down on America, and I'm not. I'm sometimes in awe of my homeland. Like I said, we're Rome to England's Greece. But I am afraid we're heading into that nasty Caligula-Nero patch, and I would rather see the world resist such influences.
posted by Ezrael at 1:23 PM on June 18, 2000

Ezrael, I think it is safe to say that America’s “Caligula-Nero patch,” as you call it, began for most of the world a long time ago. America has a flavour of democracy at home. But overseas the United States is an empire that engages in economic, cultural and military realpolitik. The theory and rhetoric of freedom are all well and good, but the sun must never set on the American empire, so we have Vietnam in the 1960s, Latin America forever, Pepsi plants in Burma, the United Fruit Company, the current Saudi regime, Cuba under Batista, Chile under Pinochet… a very long list of trouble.

It isn’t all bad, of course, but it is always difficult. Much of the discomfort with American hegemony comes from the realization of one’s own weakness, both as an individual and as a nation. We want to say no, but those clothes are so cheap and pretty. We want to say no, but then someone else will move in and make the money. We want to say no, but we’re too scared.

posted by tranquileye at 7:46 PM on June 18, 2000

Y'see, compared to say, King Leopold of Belgium or the French African Colonies, America is a positively gentle tyranny. European Colonization was much more in your face brutal...American Cultural Contamination is a Faustian Bargain, easier to swallow up front.

Basically, in my mind at least, if people really want to stop America from spreading, then they need to stand up and say no. It's that damn simple. We could sit here all night and trade how the world sees America versus how America sees the world and itself and while I'd actually be interested in doing that, I don't know who else would be. I'm already feeling massively self-conscious about how I've pulled an America on this thread. The EC, for example, is at least on paper an enormously powerful economic engine. Use that power. Same goes for Japan, for the Arab Nations, for Latin America. If you don't want the US to be an omnipresent force in your lives, stop inviting it in.

A friend of mine compared the international geopolitical situation to a barroom brawl the other day, a peculiarly American take on the situation. Basically, he said, it's like this. If we don't do anything when a fracas breaks out, everyone wonders why we didn't, what with us being the biggest guy there and all. If we do get involved, we are always accussed of throwing our weight around in order to preserve the admittedly American-biased status quo. It's a no-win situation for us. At least when Germany was gobbling up Pacific islands in the 1880's, or Japan kicking Russia's ass in 1904, no one decried their actions as bullying. It was a series of naked power grabs, and that was accepted at that time as par for the course in geopolitics.

Ironically, the legacy of WWII is that America became the lead geopolitical cop. Well, nobody likes a cop. They make people nervous, even when you know you need them. American military bases stick out like tumors all over the world, American missles whisper songs of atomic death that people aren't interested in hearing anymore...America has mortgaged itself to provide a stability many nations find paternalistic and stifling, and in the process we've used our staggering wealth and media savvy to create poison sugar cubes for the rest of the world to consume.

Come get high on the American Way of Life. Look at our large-breasted women! See our flashy cars! Marvel at our sybaritic luxury! We generate a cloud of fantasy, like a GHB cocktail, and we slip it to the world...and nowadays, even though everyone knows what's in the drink, they swallow it anyway. When I was in Scotland, I was staying in a youth hostel, and they were showing the movie Pulp Fiction. When the movie was over and I began talking about it with one of the girls I was traveling with, a scottish man walked up to me.

Slowly it dawned on me, as he and I began talking, that he thought the movie was cinema verite. And he wasn't the only one, either. And America keeps cranking out the movies, doesn't it?

Basically, my message is this. Stop buying the clothes. Stop listening to the music. Stop reading the books. Stop going to the movies. Don't drink Coke. If you want to be free of us, reject America in all its forms. If you think that price too high...well, I can't help you there.

Now, if you'll excuse me, I gotta go drink my coke, listen to my CD player, and think about going to see Gladiator again. But that's all right...I'm an American. I got used to hypocrisy a long time ago. It's the grease that moves the gears of the great engine, isn't it?
posted by Ezrael at 8:15 PM on June 18, 2000

Just poking my nose in and just saying that I think this is one of the best discussions I've seen on Metafilter.

And I'd add something, but considering my foreign experience consists of two days in Vancouver in 1995, I'm woefully underqualified.
posted by solistrato at 6:47 AM on June 19, 2000

In many cases, the United States can afford to be a gentle tyrant. But it will also resort to the short, sharp shock when needed. I find it amusing that you talk about America being the policeman of the world, when in more than a few cases, America is clearly the bully.

Ezrael, it is not as simple as just saying "no" to American products. We are dealing with a tyranny of the mind, a notion that there is one best way to do things, one best way to think about things, and that that best way is the American Way. And when I says "American," I don't mean the diverse bunch of individuals who make up the place, but rather the globalizing empire that wags the dog of American democracy. As awful as state Communism was, at least it provided a rhetoric of economic equality which has since been driven from the scene.

There are people in Canada, mostly a power elite of business people and others, who have great admiration for the American Way and think Canada should become even more like the United States. The most grating example of this right now is our country's largest newspaper chain, which is being run with a specific political agenda in mind. The Canadian right used to harp about deficits and the national debt, claiming that ruination was just around the corner if we didn't get our fiscal ducks in a row. Now that the federal debt has been eliminated, mostly by offloading social service funding onto the provinces, the right complains about taxes being too high and leading to a mythical "brain drain" of talented workers to the United States. I doubt they will ever be happy until we are, in fact, part of the United States in everything but name.

posted by tranquileye at 12:40 PM on June 19, 2000

I have no interest in how your country is run Tranquileye, especially since so many of the Canadian people I know LOVE the way your government works, but damn your taxes are high. Compared to mine anyway, and I think mine are high. Whenever I come back from Canada, I usually have $150 American kicked back to me at the border, GST (GSM?) tax refund. Your government kindly does not tax visitors for your social services, but I have no doubt you pay dearly for the services your government provides. If the people who believe as you do are in the majority I am sure your system will not change. If you are not in the majority, then your system is unfair. Am I wrong?
posted by thirteen at 1:26 PM on June 19, 2000

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