• In defense of Canada

    Paul Krugman has been on a tear the last few days with a number of posts defending Canada’s Medicare. This was all leading up to his latest column, where he questioned why Medicare should be unsustainable in this country, when it’s sustainable there.

    I’m sure we’re going to now face the usual howls of protest, comparing Canada’s health care system to a death sentence.  So let me summarize a few of my past posts to try and pre-empt some of the false rhetoric.

    1) Doctors in Canada are not flocking to the US to practice

    So when emigration “spiked,” 400-500 doctors were leaving Canada for the United States.  There are more than 800,000 physicians in the U.S. right now, so I’m skeptical that every doctor knows one of those emigres. But I’d especially like you to pay attention to the yellow line, which is the net loss of doctors to Canada.

    In 2003, net emigration became net immigration. Let me say that again. More doctors were moving into Canada than were moving out.

    2) Canadians are not flocking here to get care

    Look, I’m not denying that some people with means might come to the United States for care.  If I needed a heart/lung transplant, there’s no place I’d rather be.  But for the vast, vast majority of people, that’s not happening.  You shouldn’t use the anecdote to describe things at a population level.  This study showed you three different methodologies, all with solid rationales behind them, all showing that this meme is mostly apocryphal.

    3) Doctors are not less satisfied practicing in Canada than the US

    How satisfied are physicians with their practice?  It’s not a perfect measure, but it’s an important one:

    Given the rhetoric of how much physicians hate reform, you would think doctors were very happy before reform passed.  You’d be wrong.  With the exception of Austria and Germany, fewer doctors were satisfied with practicing medicine [in the US] than any other surveyed country.

    4) Claiming that hip replacements and cataract surgeries happen faster in the US does not prove that a single payer system doesn’t work

    When people want to demonize single payer systems, they always wind up going after rationing, and more often than you’d think with hip replacements…

    It’s not true.  They don’t deny hip replacements to the elderly.  But there’s more.

    Do you know who gets most of the hip replacements in the United States?  The elderly.

    Do you know who pays for care for the elderly in the United States?  Medicare.

    Do you know what Medicare is?  A single-payer system.

    5) Canada’s wait times aren’t due to its being a singe-payer system

    The wait times that Canada might experience are not caused by its being a single payer system.

    Do you know who pays for care for the elderly in the United States?  Medicare.

    Do you know what Medicare is?  A single-payer system.

    So our single-payer system manages not to have the wait times issue theirs does. There must be some other reason for the wait times. There is, of course. It’s this:

    Canada isn’t some dictatorship. They aren’t oppressed. In 1966, the democratically elected government enacted their single-payer health care system (also known as Medicare). Since then, as a country, they have made a conscious decision to hold down costs. One of the ways they do that is by limiting supply, mostly for elective things, which can create wait times. Their outcomes are otherwise comparable to ours.

    Please understand, the wait times could be overcome. They could spend more. They don’t want to. We can choose to dislike wait times in principle, but they are a byproduct of Canada’s choice to be fiscally conservative.  They chose this. In a rational world, those who are concerned about health care costs and what they mean to the economy might respect that course of action. But instead, we attack.

    6) Since Canada adopted their single payer system, infant mortality has dropped below that of the US

    Many people have told me that infant mortality used to be higher in Canada than in the US, but since the passage of (Canadian) Medicare, that hasn’t been the case.  The chart above, which I made from OECD data, would tend to agree.

    I know the usual knocks against infant mortality as a population metric of quality.  But I’d like to hear a good alternate explanation (if one exists) for the trend you see above.  Links to evidence or data supporting your theory will get you extra points.

    7) In Canada, they may “ration” by making some people wait for some things, but here in the US we also “ration” – by cost

    About one third of Americans report that they didn’t go to the doctor when sick, didn’t get recommended care when needed, did not fill a prescription, or skipped doses of medications in the last year because of cost.

    So feel free to have a discussion about the relative merits of the Canadian health care system compared to ours.  Just keep it to facts.

    Share
    Comments closed
     
    • I used to think that since they lived as long as we do despite consuming poutine, that there system must actually be better. However, now that we have deep fried butter on a stick, we have something to equal poutine.

      More seriously, it is all about the costs. Countries that have all of their people in a single system actually focus on costs. They make decisions that result in lower costs. Having everyone in the same system makes that more possible.

      Steve

    • Terrific post.

      As a Canadian living in the US for 10+ years, I’m still bewildered by the fact that so many Americans fear Canadian-style health care, instead of being angry that they’re not getting the same type of health care.

      In Canada, politicians use US health care as a way of scaring the electorate. There is absolutely no interest in US-style health care in Canada. I’m sure you can find someone in Canada who will speak out for US health care, in the same way that you could find Iraqis who loved George Bush. But be assured, they are a fringe.

      • “I’m sure you can find someone in Canada who will speak out for US health care, in the same way that you could find Iraqis who loved George Bush. But be assured, they are a fringe.”

      • “I’m sure you can find someone in Canada who will speak out for US health care, in the same way that you could find Iraqis who loved George Bush. But be assured, they are a fringe.”

        Head over to the Kurdish region….you just might find more than a handful there…one man’s occupier is another man’s liberator. However I do strongly support a single payer system….just a poor analogy

        • Probably not the best analogy, but not as bad as you might think; most Kurds probably don’t think of themselves as Iraqis (for better or worse) and want their own country, Kurdistan.

    • I am proud of Canadian system. There is nothing wrong with it other than lack of better management, operation control and more detailed review of MD practices. I find personally family physicians tend to over spend.

      • Ask some of the kids working who have been unable to get a physician in New Brunswick and elsewhere in Canada where there is a doctor shortage, and you might not see Canadian health care the way it’s promoted internationally as a model health care system. Israel’s health care system reportedly offers more health services to all its citizens than Canada does to its citizens at virtually no cost to Israelis.

        • You may not have noticed this but Israel is a tiny country. There’s no such thing as a local doctor shortage there because the entire country is local. You can drive across it in a few hours. You could put every single Israeli doctor in one town at the furthest extreme of the country, and while it would be very inconveninet the country STILL wouldn’t have a doctor shortage because everyone could just drive there.

          Canada is enormous. It can take two days to drive across the SAME PROVINCE. And I mean loong hours of driving. Plus outside 10 or 11 sizable cities, the remaining population is spread out INCREDIBLY sparsely. If you live out in the countryside in Canada the nearest doctor might be an enormous distances away. Israel does not have that problem. The US doesn’t even have it as bad, as they have 10 times the population living in a smaller country.

          Also, the Canadian population is strong along the US border… often times if you live in a low population density area, an American hospital is going to be the closest one just out of raw geometry, forget anything to do with different health care systems..

          • Ecks: I know Canadian geography. What I didn’t know was that your superb national health program fails to take geography into account so that you depend on my country, with its all its health care needs going unmet for Americans, to take up your unmet health needs. And have you noticed that Canada is not yet USA territory or part of our commonwealth territories like Puerto Rico, under our jurisdiction and sovereignty? But if we’re that vital to Canadian health care needs with all our deficiencies, it’s time Canada joins our union like Hawaii did, under the condition that we establish a single-payer health insurance program like Israel’s.

            • You are becoming increasingly incoherent. Planning a medical system is easier in Israel than in Canada because you don’t have to solve the problem of how to provide coverage in far flung communities. Israel has no equivalent of Dryden Ontario, that is hundreds of miles from even a small city, or Dauphin Manitoba that doesn’t even have a big highway going to it. Even a Saut St. Marie that is a 9 hour drive to a big city. Nowhere in Israel is even three hours from anywhere else in Israel. Providing rural doctors just is not the same problem.

              More importantly I freely admit that the Canadian health care system does indeed have a lot of the problems that you say it does. It’s certainly not perfect, and it’s quite possible that Israel does it better. But what I’m absolutely sure of is that all of the things that you say are problems with the Canadian system are BIGGER problems in America. Some people aren’t fully covered in Canada. In America there are MORE people that are MORE uncovered. In Canada drugs can be expensive. In the US they are MORE expensive (hence all these crackpot plans by American pols to “import cheap Canadian drugs”). I’ve lived in the US for about 7 years now, and I would take the Canadian system over the American one in a HEARTBEAT.

              And here you are saying Canada should join the US? WTF? First off, up yours for even suggesting it (if you’ve really lived in Canada then you should know that this is a rather national sore spot). Second, why would we take a flawed system and trade it in for perhaps the one system in the world that is categorically worse? Why pay almost twice as much for the exact same mortality and morbidity results, and in the process take a whole lot of people who should maybe have better care and throw them out of it entirely, or bankrupt them over it? I’m starting to think that you’ve been skipping your meds here, seriously.

            • Ecks: I”ll ignore your ad hominems and your claims, both general and absolute, for the superiority of the Canadian health insurance, despite your contradictory claim that it is probably inferior to Israel’s for geographical reasons. None of your arguments below refute my point:: Canadians are not citizens of the USA, don’t pay taxes here, and don’t have any right to benefit from our health systems for any reason, geographical or otherwise. It’s not the fault of the American taxpayer that Dryden Ontario, if what you claim is true about its lack of health care, is not served by your national health service because of its remoteness. As an American I resent the Canadian arrogance that motivates any Canadian to claim a right to our health care, which admittedly needs further reforms, and which you claim is inferior to yours, just because your superior system fails you for “geographical reasons.” We are making reforms in our system. We’ve just begun that effort, a process of trial and error, in a work–in-progress. But If you’re serious, based on your assumption that American taxpayers are responsible for the health of Canadians when they border our country, Canadians like you who resent strongly the suggestion that they join the USA, if we’re paying for their health care, then you ought to start taking care of your own. We have enough citizens on medicaid here that our national debt could do without. We don’t need to take on the additional burden of the health needs of Canadians as well whom the Canadian government fails to provide the services paid for by their taxes.

            • Ok, let’s get a bunch of things straight.

              1) The US taxpayer has zero responsibility to look after Canadian citizens. Zero. And nobody has suggested they do. American hospitals are quit willing to treat Canadians, but those Canadians and/or the Canadian government pay for the service. The same is true in reverse, Americans have been known (particularly when travelling) to use Canadian hospitals and are generally charged for it.

              2) Geography is not the sum total of the problems with the Canadian system – but it IS a big problem. If you have widely scattered communities with very small populations it is difficult to provide health care there, and sometimes to convince doctors that they want to live out in the middle of nowhere. There’s been some success in combating it, but it’s not always an easy one to solve. This is also a difficulty in some rural parts of the US (see, for instance, much of Wyoming), but Canada generally has it even worse, because the distances are often bigger, and the population often more sparse. Israel has none of this problem at all. This is nothing to do with the challengers of, say, teenagers in Ottawa, or other such things, but it is a difficult problem of itself

              3) Obama is making some efforts to improve the American system, and these are very good efforts. There are things he could have done that would have been even better, but the Republicans and Blue Dogs blocked it all in the senate. I’m really happy to see these reforms come through, because it will do a lot to start fixing a lot of the worst things with the American system. No need to go into the details here, I’m sure you agree with me that these changes are a great start, and will hopefully go much further once they start coming into practice (fingers crossed they can break through the strong opposition they will face from the scare mongering right wing).

              4) There is no question that from a purely technical point of view – health delivered in return for dollars spent, the US *currently* has the worst health care system in the Western world. The US spends something like 14% of its GDP on health, compared to 7, 8, 9% from other countries. The US government has to spend more per capita than the Canadian government on health. In return for all this extra money, Americans live no longer than anyone else, and their diseases aren’t cured any better (on average – there’s minor variance depending on exact conditions), and their medical quality of life (in the technical sense) isn’t any better. This is all controlling for diet, blah blah blah. Not worse, but not better, on average either. The proof is in the pudding – if you buy the same level of output for nearly twice the money you are doing a worse job.

              5) Add to that the the US currently has huge problems with access – lots of people are uninsured, lots of people with insurance lose it when their bills get too high, medical costs are the leading cause of personal bankruptcy in the US, etc. Obama’s reforms, if implemented will go a good way to fixing these problems, producing something much closer to universal coverage, and stopping insurance co’s from doing evil things like tossing people from coverage for pre-existing conditions and hitting coverage limits. This is a really really good things that we all need to support. His reforms won’t go so far, immediately, at least, on item #4 above, but hopefully over time (HOPEFULLY) the US can start catching up on these things.

              6) The Canadian system, to several of your points, surely could stand to improve quite a few things. I’m happy to talk about those. I’m not particularly attached to the Canadian vs. the Israeli vs. the French systems. The current US system, even, does have some things that it does better than Canada, although they’re often scattered and not systematic. I’d be delighted for Canada to pick up and implement some of those improvements, really I would. I’m not proclaiming it as any kind of gold standard for the world. Just that I would choose the current Canadian over the current US health system for myself, very very VERY strongly. Who knows, maybe in 15 years the US system will have solved its problems and be the better of the two. But it ain’t there yet.

            • Justvto let you know most Americans are not like this smart-mouth know-it-all.

          • On your post June 15th, you are wrong about the US picking up the tab for Canadians using our health care system. You must mean the Canadians who have an accident here, who have been sent here because they can’t get critical care in Canada, or who are part of some agreement between Canada and the US to reciprocate care. But there are large numbers of Canadians in my experience (personally witnessed, as a matter of fact, in one case) who could not find satisfactory treatment in Canada and when the health care system refused to pay for their US treatment they had to pay for it out-of-pocket. Our system, with all it’s problems, is overall more efficient in many areas over the Canadian health system. And that’s not just in free dental care. Poor people unable to pay for health insurance in Massachusetts and other states too numerous to name pay for the mandatory health insurance. In Massachusetts, it was Republican Presidential candidate and former state governor Mitt Romney who signed the mandate into law. Now everyone in Massachusetts has to have health care insurance, whether through an employer, Medicare, Medicaid, or through a state grant to the insurer in a special pool for anyone unable to pay for the insurance. In 2014, this is scheduled to become a federal mandate. On your other points, I only wish for Canadians that they are served as well for health care in Canada. But you now acknowledge that your system needs work. And I know it does: lots of work.

            • Heh? When did I EVER say that the USA has a responsibility to pay for the care of Canadians? Of course it doesn’t.

              There are a tiny number of very well off canadians who on occasion elect to pay for treatment in the US that they either would not have received in Canada, or who just want to receive it faster and/or in cushier surroundings, or because they live in a very far flung area to which the nearest hospital happened to be in America rather than Canada (this latter one is vanishingly rare). The rate at which all of these collectively happen is TINY (see the charts in the main posting up above). 99.99% of the medical care Canadians (living in Canada) receive is provided by the Canadian health care system. It simply is not the case the Canadians are flooding across the border in any significant numbers to get care that is not available at home.

              The number of states that currently offer anything close to universal health care is not “many”, it is one. MA is the only one. Mitt Romney implemented it, and he is now trying very hard to pretend that the cloned version Obama passed isn’t at all the same thing, and he’s claiming that it won’t work…

              If this law becomes implemented (and that is a big IF), then the US for the first time ever will start having something approaching the universal care coverage that was achieved by every other western country decades ago. All Americans will have access at what should be reasonable rates, there’ll be a mandate to buy insurance, and subsidies for those who can’t afford it. The Republicans are trying very hard to block this. They are putting in court challenges claiming that the mandate is unconstitutional (and so far republican-appointed judges have agreed that it is, while other judges say it is perfectly fine). That will hit the Supreme Court in a few months, and if they strike it down, that will cause enormous problems. State governors have to implement the exchanges themselves, and some, particularly republican ones are dragging their feet. The Feds may be able to force the issue, but it will take some hard work. Finally, if a Republican president and congress are elected in 2012 almost all the leading contenders are promising that they would abolish most of Obama’s health care laws.

              Until such time as these laws are fully implemented though, criticizing Canada’s health system from the US is like the pot complaining that the thimble holds too much water – the US is waaay worse. AFTER the laws are implemented the US system still will not be perfect, but it will at least start to be comparable to the Canadian system. At that point it will be the pot calling the kettle black… which is at least a more even exchange.

            • Further, in the rare cases when a Canadian does come to the US for an elective procedure it is not because the American system is “more efficient”, it is because the US system has slack unused capacity that the Canadians can buy. Part of the reason there are waiting times for some non-urgent procedures in Canada is BECAUSE the system is so efficient – all resources are used at all times, so there aren’t idle operating rooms waiting with open slots for whoever walks in the door this afternoon.

              But this is a side debate that isn’t wasting times on.

              Also you start off your post saying “On your post June 15th, you are wrong about the US picking up the tab for Canadians using our health care system.” My post on June 15th starts with the words: “The US taxpayer has zero responsibility to look after Canadian citizens. Zero. And nobody has suggested they do. ” Which part of that is wrong?

            • Ecks: I never claimed to represent your views on American responsibility for Canadian health treatment here. That’s my view. We’re not responsible for your lapses in health care because of geography. As for Canadians seeking treatment here, you have no figures on the number of Canadian health care workers here, which dwarf the numbers of American health care workers in Canada. Along the border states, the number of Canadians working in, say, Maine, amounts to anywhere from a quarter to a third of the visa workers in some state clinics and hospitals. And they may not be counted in your stats on Canadians seeking treatment in the USA, but they have it as an option which most of them exercise. As for the mandated states you may be confusing what that means. I refer you to http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2008.pdf
              for a discussion of the variation in state mandates, which as the study defines it as a “requirement” that an insurer cover, insurer in many cases being the state. Massachusetts has the most comprehensive mandates, but there are many other states with almost as many. I know that some Canadian chauvinists wish us unwell in our efforts at reform, just as some Canadians really wish us well, but not being a psychologist, I have only my intuitions as to which tone your posts reflect of the two. And I’ll leave it to my country’s foreign policy analysts of Canadian attitudes to decide which attitude you represent in the event they’re hopefully reviewing this web site (as I suspect they are). But I wish you well in any case. Again, you’re wrong in your previous post, in my experience. It’s not a non-urgent need that brings most of the Canadians I know here for treatment because your system, despite its dependence on us for treatment in areas of “geographical’ remoteness, is more efficient than ours. Most Canadians I know give the title of most efficient health care treatment to American doctors , hospitals (Mass General, Peter Bent Brigham, John Hopkins, etc.) and clinics (The Lahey, the Mayo clinics, etc.). I know that when a world leader wants first class medical treatment, with the exception of Israeli leaders, they usually come here for medical treatment, as did recently former Prime Minister Brian Mulroney, Jean Chretien, Newfoundland Premier Danny Williams (NFLD has the highest rate of heart attack deaths in Canada, some 18,000 in 2010 because of wait times for surgery), deputy NFLD premier Kathy Dunderdale, former Quebec Premier Robert Bourassa, and the list goes on. But most Canadians who have to wait for critical surgery or who do not have a physician and can get to the states, will use our facilities at some time. I don’t have the overall figures for foreign clients of our health care system. But more foreigners, including Canadians, use our system than we do any of theirs by a large margin. We don’t need Canada, you need us. And that is understandable. And I’ll let you have the last word on that. Go Bruins!

        • Well, you might want to look at a map there, Carl. Canada is VERY big, and VERY sparsely populated. It is a big challenge to provide adequate coverage to so many so far apart. Israel is VERY small and densely populated. Compare Israel to southern Ontario and it’s closer to an apples to apples comparison.

          • nolaboyd: Yeah, look at the map of Israel and Ottawa, the demographic map, that is, and you see that every Israeli is a member of the Israeli Defense Force, in other words, a military officer and a future veteran. Look at Ottawa all you want, and you see that not everyone is a member of the Canadian Armed Forces or a veteran. And you look at the demographic map of income and health care accessibility. Israel doesn’t have those problems when it comes to national health insurance. Israeli have better access to health care hands down over Canada. Canada’s health care system has serious problems. You don’t have to worry about us in the States. We can take care of ourselves. And we will. We also hope that Canada does too.

        • Of course look at the kids in Kenomore or Burlington ND. Same situation. In mainly rural communities throughout North America is difficult to see a doctor. However the parents of those kids in New Brunswick don’t have to worry about going bankrupt because Johnny fell down and broke a leg like in much of the US..

          • larry c. lyons: Most clinics and hospitals treat low-income teenagers with critical care needs without charge in Vermont and North Dakota. They don’t need a personal physician to be treated for a broken leg without cost. In Maine, the cost is covered by MaineCare and state Human Services.

        • Reputable studies show that Canada has a better supply of primary care doctors than the U.S., with short waiting times. They have a lower supply (per 1000) of specialists and thereby longer waiting times, but those are CHOICES that the Canadian system has made related to cost. It’s primary care doctors that most of us need.

          If you’re worried about access in rural areas of Canada, just come to south or southwest Virginia, anywhere else in the Appalachians, Indian reservations, inner cities. We have a terrible doctor undersupply here in the U.S., because every medical student wants to be a specialist and make the big bucks to provide of house and pool in the suburbs and a condo stocked with $200 bottles of wine in a downtown high-rise.

    • Well, I have been living for three years in Canada and still cant find a family doctor.
      I have to go to the walk-in clinics or emergency to see a doctor, and wait lines are on average 3 to 4 hours. When I needed a CT scan, I had to wait for 5 months and 3 weeks to get one.
      If you want to see a specialist you have to wait 4 to 6 months on average and it is really very frustrating.
      European countries have way better healthcare in my experience. Also drugs are really expensive in canada (at least compared to european countries with public healthcare that I had experience with)

      • We moved to Canada six years ago and found a family doctor immediately. I do understand that the situation varies by location, but it’s not a common problem.

      • I’ve been living in the US all my life and since I left home at seventeen I haven’t been able to afford a regular doctor ever — even when I had insurance provided by my job, I had to take a huge deductible because the premiums were so high, so when the kids needed check-ups I just took them and didn’t pay the bills. The offices actually would withhold their records as they could to extort me to pay up money I didn’t have.

        Now that I’m older I have high blood pressure and I only know that because I had a sports injury and had to go in for surgery — which I was nearly thrown out of for until I fought like a rabid dog for relief and then suddenly the hospital disclosed that they in fact had a program for poor people, if I could prove I was satisfactorily poor. I did, but couldn’t pay their co-pay, so even though I have the surgery, they suspended the “assistance pay” and have decided to slap me with the entire bill for the work, into the thousands.

        I’ve tried to get out of poverty after raising my three kids alone on low paying jobs after their father left the family, but I’ve never been able to get on my feet. I have horrible credit — guess what my major creditors are? I’ve never owned a house, bought a decent car and probably never will.

        I presently have no health insurance while I attempt to start my own business and have no dental insurance (my teeth are going to hell too).

        So, yeah whine on Jim. I’ll gladly take your place in line up there and you can have this greedy, corporate-care back – -every bit of it.

        • Try New Brunswick, Nova Scotia, Prince Edward Island, or New Foundland, if you can find a decent paying job. But you could also join a church that provides group dental coverage to its members or search for a pro bono dentist in your area. There are also teaching hospitals that treat the poor free of charge once they enroll in a research program. But under the Obama reformed health care system, you ought to have free health care under subsidized insurance programs. There’s not much benefit in going to Canada for specialized treatment.

          • PEI doesnt have great health care, and neither does Appalachia, West Kansas, or Northern Alaksa.

          • LOL! You Carl are the reason the United States has a bad reputation. Its a shame too, because 90% of the population isn’t like you.

            • Mark: if 90 percent of Americans don’t feel the way I do, how is it that my difference with them gives the country “a bad reputation”? I believe you might agree that Americans ought not to judge Canada’s health care system by the incompetence, say, of your recent pathology scandals of a career of incorrect lab reports by four provincial labs (http://www.canadianmedicinenews.com/2008/05/yet-another-canadian-pathology-disaster.html). Nor do we judge you because of criminals like Lord Conrad Black, even if many of us believe that had he been prosecuted in Canada, he’d have been acquitted, or conversely even when many of us believe here that if Brian Mulroney had been prosecuted in the states for bribery, he would have gone to jail.

      • I moved from Toronto to Vancouver two years ago and worried about getting a good doctor. I had to ask around, but found a great one. I moved downtown from the suburbs and found another great one. He retired at Christmas and after a month I found a third.

        I was unemployed last year and my income so slight that I didn’t even have to pay the provincial healthcare minimum. Then I had a cancer scare and they ran a slew of tests involving four different specialists, and discovered it was less severe than expected. The care was amazing.

        I now know that anyone who complains in Canada isn’t working hard to find the right doctors and doing their homework so as to work with them to make sure you get the care you need. Yes, you do have to adjust your schedule to get prompt appointments: which is not a lot to ask from an always over-burdened system.

        I lived in the U.S. for 15 years. I got the care I needed, but it cost me a fortune. Try getting specialists in the U.S. to look at you when you’re not covered by insurance. The U.S. system works very well for the wealthy and not at all for the poor.

        • “works great for the wealthy and not at all for the poor”. I’m afraid that won’t change, while the wealthy are more politically aware and active and can afford lobbyists.

      • It’s just like the post says (great post BTW) there are wait times because Canada spends less on Medicare than it could.

        Europeans have higher taxes and better services, I for one would be fine paying higher taxes for shorter wait times and better government services but you can’t have it both ways (low taxes and great government services).

      • This post is untrue, save and except emergency waits where patients are triaged. If you aren’t really sick, expect to wait several hours.

        • That hasn’t been my experience at all. In fact, I’ve never waited more than an hour at the longest, even at the walk-in clinic. When I lived in Washington, DC, my average wait was 2-3 hours.

        • If you aren’t really sick, why are you there in the first place? This is part of the problem. people want free and they also want instant, McDonald’s like service with no wait. Its a soup kitchen, get in line. If you want to avoid the soup kitchen call up, make an appt, tell them you are willing to pay your price.

    • Here in America, we prefer change through crisis (energy crisis, debt crisis, S&L crisis, Great Depression, Civil War, etc). For all of us who long for Medicare for all (instead of just old folks), the requisite crisis is on the way. With more aging, unhealthy and uninsured people every day, states cutting way back on Medicaid, and an activist Supreme Court likely to declare the individual mandate unconstitutional, our emergency care system is about to be buried by patients whose conditions are aggravated by a lack of preventive care. Cost shifting to insured patients and plans is reaching a breaking point and state and county health budgets that support hospitals are severely constrained, I support The Affordable Health Care Act but frankly, I’d prefer Medicare for all, with the government negotiating drug prices as in Canada and elsewhere.

    • Regarding point 5, do you have any data you could use to compare wait times using US Medicare and wait times using Canada’s single-payer system? I think that would sell your case well.

      • Regarding wait times, when calculating wait times in the US be sure to include those who never get on a wait list (since they couln’t afford the procedure anyway) and “wait” until they die.

    • You should mention the fact that Tommy Douglas, the founder of Canadian single-payer healthcare, was voted the “Greatest Canadian of All Time” by a poll involving 1.1 million Canadians.

      http://en.wikipedia.org/wiki/The_Greatest_Canadian#Top_10

    • I am a Yank living in Toronto. Used both systems cannot tell the difference. Don’t forget Canada’s heathcare system is provincially managed.

      • Proof Dan that having money is kind of like sleeping through a tornado in a sound-proof, storm-proof cellar.

        Just believe the rest of us that have to be out there in the storm; it sucks.

    • Canadian health care is not only good, it is AFFORDABLE & AVAILABLE TO ALL! there is no such thing as “ineligble due to pre-existing conditions.” Government aircraft ambulances are on standby in case you become ill or injured in a rural area where suitable care is not available.

      The average family pays just over a hundred a month. Most employers pay at least a part of that, often including additional benefits. Hospital care, including precription drugs, is free for residents of that province unless you request a private room -and that cost is modest.

      Drugs are not 100% covered -there is a sliding scale income test. I believe this threshold is too high -but the good news is that there is bargaining by the largest purchaser in the market place which keeps costs for everyone else much lower for the same products when sold in the US .

      In B.C., pharmacies can charge a market fee for dispensing the prescription, but the drug itself must be at cost. The result is competition for service and price -some choose the lower cost big stores like Costco or Walmart & others choose the smaller dispensaries with your “Neighbourhood pharmacist” -but the difference in cost is usually only a few dollars per prescription!

    • We lived in Ontario from 1984-1988 and had very good experiences with health care. No problem finding a personal physician, minimal wait time to see a cardiologist for a heart rhythm problem. We had friends who were both family practice physicians from England. They emigrated to Canada rather than the US because they felt that in spite of the differences in salary the overall quality of life was better in Canada than in the states. I would happily move back to Canada and strongly support Medicare for all.

    • Another meme worth mentioning is the idea of “choice.” Some American politicians like to suggest that the U.S.-style system offers choice, but the Canadian one doesn’t. Yet, as an end-user, the only time I experienced a lack of choice was when I lived in the U.S. It was strange to me, as a Canadian, to be told that I could only go to certain doctors, or even hospitals, because my insurance didn’t cover all of them.

      • One can argue that you still have the choice too if you pick the right insurance or pay out of pocket. It is not the govt telling you that you cant go to a specific doctor but your insurance.

        • You don’t have much of a choice if your insurance is provided by your employer. You can either waste that (remember, your employer is paying for coverage on your behalf, which you’re not taxed for, whether you use that coverage or not) and pay for your own coverage through someone else at your own expense, or pay out of pocket.

        • Well sure. If you have enough money in the US you get a choice of pretty much anything. If you don’t, then your choice options start dropping off fast.

          Plus most non-retired Americans get their insurance through plans provided by their place of work, so they don’t really get a choice there either – unless they move jobs to find a new employer with a different plan, and that isn’t exactly like picking which pair of shoes to put on this morning. Especially with ~ 9% unemployment

          • Ecks: Obama’s reforms won’t make the USA health system a Switzerland’s or even in Israeli’s single-payer system, nor still more one anywhere close to a gold plated Kuwaiti, Abu Dhabi, Qatar, or Sultanate of Oman one. But it’s a step in the right direction. And I disagree with your assumption about doctors opposing any reduction in their fees, one of the real obstacles to true universal health insurance in both Canada and the USA. Medical doctors are divided over Obama’s reforms when it comes to reform in both countries, as Canadian doctors envious of the American system presently (or doctors of dentists there) will tell you. In the USA there may still be room for negotiations with doctors over waiving medical education tuition costs. The Times just ran an oped “Why Medical School Should be Free” by Peter S. Bach and Robert Kocher, May 28, 2011, linking service to waived tutition. And that debate among doctors is just beginning.

    • As a Canadian who has lived through this system all his adult life but one who respects the American’s strong sense of freedom of choice I must admit I have been torn by the debate.

      What I find objectionable about our system is that I can go spend my excess wealth on trips around the world but I am told I cannot improve my access to health unless I leave my own country. There is something very undemocratic about that.

      I think the perfect compromise is for me to pay my share for a universal system but have the right, as I understand exists in other jurisdictions that are much more socialistic than Canada, to pay additional funds for a higher level of medical care. This requires an investment in more doctors in Canada to accommodate such a system but that should not be a hurdle if brought in gradually (which really is happening at least in British Columbia).

      I have to admit the politicians in Canada are afraid to touch this idea of a two tier system with a 10 foot pole. In the same way that Americans are emotional about restrictiong their right to endless tests Canadians have this attachment to a single system that is also mindless.

      Norris

      • Why can’t you? What is stopping you? Even in Britain there are plenty of people willing to take your money for a bit of special treatment.

      • I agree with Bubba, what’s stopping you from jumping the border and coming over here, the Mayo Clinic and other places have premium beds and premium paid doctors, thirsting for your “wealth”.

        Last I knew, we allow Canadians to come to the US, in fact its regular legend among those who wish to say that Canadian doctors operate on their poor captive citizens with rusty knives in back woodsheds.

      • To say it’s mindless is a bit much. The principle of equality of access is what applies in maintaining the ‘single-tier’ system. And that principle is hardly ‘mindless’, rather it’s a reasoned principle. I’m not necessarily opposed to the idea that if one pays into the system then one should be able to seek alternative treatment at one’s expense, but Rawls’ principle must apply: Children, victims of genetics, casualties of accidents, any chronically ill person, are all individuals that YOU could have been as well. Therefore, if justice and honour are important, YOU will want whatever is best for the person that YOU could have been as well as whatever is best for YOU currently. There should be funds for any individual who is suffering, just as YOU might be. To magnify nature’s injustice for those lacking our luck is odious.

        I myself am waiting for a hip replacement in Canada, and I wish there were no delay but I can live with the wait and it reminds me that life is about compromises and sharing burdens and living with limits on resources not just immediate gratification. It will be a couple of months but it will cost me nothing, rather than $50,000. I have the money to go south for the operation but it’s not worth it to me in light of the bigger picture.

        My idea of life includes the obvious reality that we ALL die eventually in our own ways, and that we ALL suffer eventually in our unique ways, and that these things can’t be avoided. Thus they are opportunities as much as obstacles. This would seem the perennial wisdom. Is this not the spiritual truth of that ‘good book’ that is touted hypocritically by so many U.S. politicians, rather than the denial of death that one finds in the land of plastic surgery? I am an American, by the way, living in Canada, and much prefer the social fairness and more rational politics here to my birthplace.

        • I’d like to re-iterate a point from the article re: wait times for hip replacements.

          Most of the people in the US receiving hip replacements are on Medicare. If you’re on Medicare in the US, you’ll have ‘wait times’.

          One of the things not include in wait time calculations is ‘approval time’. Anecdotally speaking, it took my mother well over 9 months to get approval for TKR {total knee replacement} for one knee. It took another 6 weeks to schedule it. I’m not clear on exactly when she started agitating for a TKR with her doctor, but I know it was longer than 9 months from the start of asking. I know because I helped her with getting over the hurdles of obtaining the requisite approvals. This was time consuming and difficult to do. What I’m not clear on is how much longer than 9 months the actual process took. I started helping her after she initiated the process.

          We were finally only able to get approvals after the degeneration in her knee reached the point that she was falling every single day. With some of those falls, I’m surprised she didn’t seriously hurt herself like a broken hip or limb. I witnessed some of these falls and several of them were brutal and painful enough for her to go to her room and cry. And that doesn’t even address the constant pain from her bad knee.

          If you’re poor in the US, you either don’t get treated or you don’t get approvals without jumping over all sorts of hurdles. I’ve yet to see a single study which even looks at the approval process here {varies by state as well of course}. But I strongly believe such a study would change the ‘wait time’ metric substantially for the worse.

          Right now, I have no health care. Wow. What wonderful choice I have.

      • The problems with two tiered health care are that because private care is generally more lucrative to doctors (after all it’s not cost controlled), they tend to gravitate to it, thus depriving the “everyone else” system of needed medical resources. On top of that, the incentives for doctors are to provide worse care for the free system, which encourages more people to migrate to the more lucrative paid system. Further, one of the major quality controls in a single payer system is that rich and politically influential people are forced to use it, meaning that if the system performs badly, it’s not just poor voiceless people who get hurt, it’s also the Prime Minister’s golfing buddies.

        There’s nothing wrong IN THEORY with giving you the chance to opt to pay for more care, but in practice if you divide the Canadian health care system in this way you’re setting up financial competition for health resources that won’t just add them for the rich, but will also, to some extent, take them away from the poor. We’re better with the status quo where, as the other commenters point out, you can always go to the USA if you really want the pampered treatment.

    • A Canadian living in the US for many years and now on Meidcare I am now being “divorced” by several Dr.s that I have been using for years. They will no longer accept Medicare. Finding a primary care/family doctor has been very frustrating for us . No rationing in the US…. oh yeah sure..and the moon is made of blue cheese.

      • As an elder on Medicare, I have had the same problem. Had to leave my long time doctor, and then couldn’t find a doctor willing to accept me because I am on Medicare. When I offered to pay my own bills directly, I was told that would be a criminal act! I finally found a doctor at a hospital who has a lot of Medicare patients. I only go to him for bloodwork once a year. For the rest, I have found an alternative health care adviser and I use all alternatives that insurance would never ever cover. And I am pretty healthy as a result of not being prescribed a lot of meds.

        • I’m surprised the docs wouldn’t take your cash, every hospital or doctor I’ve ever dealt with always took my cash. In fact, it has always seemed that that was all they wanted. If I told them I had to sell my child into slavery to pay the med bills, I seriously doubt they’d flinch, accept maybe to tell me to make sure I have my payment ready at the first visit, or prove workman’s comp (which they hate but that’s another story) should he get injured.

          • If the doctor has no patients at all who use (not merely have, but use) Medicare to pay their bills at the Doctor’s office (put another way, if the doctor does not deal with Medicare whatsoever), then he/she can take payment directly from patients who happen to have Medicare.

            However, if the doctor has even a single patient who uses Medicare with that doctor, then that doctor cannot take any payment, in lieu of or in addition to what Medicare would pay, from a Medicare patient under penalty of law.

            This is an essential part of how Medicare controls costs. Because, otherwise, what doctors would do would be to charge Medicare patients whatever they wanted and demand that those patients make up the difference between the charge and what Medicare pays themselves. And thus most of Medicare’s ability to control medical costs as a setter of acceptable payment rates would be eliminated.

            In that world, if you had Medicare, you’d find it more easy to find a doctor who accepted Medicare, but you’d get a bill after every visit asking for a balance due–not just your deductive, but above and beyond it. For whatever the doctor wanted to charge.

        • I am disabled and on Medicare. Everyday I live in fear that I will lose my Medicare. I would not have this fear on Canadian style insurance.

    • I am a Canadian who is very happy with the Canadian system.

      Two points:

      I would like an additional graph or chart added: people who are bankrupt because of medical costs. It rarely happens in Canada.

      In regard to the US person above who had to wait for a CT scan they don’t say what for. I had one potentially serious issue and I had a CT scan the next day. I had a stress test with in afew days, and numerous other tests all around the same time. There was no waiting.

      I also had a knee problem (that didn’t impact my mobility) that was thought to be a torn meniscus. I had to wait 3 months for that one.

      If I ever considered moving to the US, the US health system would be a major negative for me.

      • “If I ever considered moving to the US, the US health system would be a major negative for me.”

        Exactly! While Republicans in the US are obsessed with keeping a “business-friendly” climate (mostly by keeping taxes low) they forget the other half of the equation: making the country a place where talented, globally mobile workers want to live.

    • Laugh thats stupid. ANY ECONOMIC EVENT is rationed by cost. Wait periods are when there is NOT ENOUGH SUPPLY TO MEET DEMAND, because Canada choose not to expend more money to increase supply. Also, in healthcare, by delaying care, there is a chance you simply decide not to get it, or die off – thus causing COST SAVINGS. That doesn’t make it the wonderful awesome system that you promote. Nor do you also include the FREEDOM aspect of US Healthcare – I am free to make my own choices (work harder in life so I have money to spend on healthcare, or take a risk and not make as much money), wherein the Canadian system, some government tells me what healthcare I get – period, end of story, too bad if you don’t like the rejection/wait period/alternate treatment. I guarantee I can REDUCE COSTS if you allow me to be a Dictator and sacrifice your freedom to me, but who wants to live like that?

      • @freedomlover:
        “I am free to make my own choices (work harder in life so I have money to spend on healthcare, or take a risk and not make as much money), wherein the Canadian system, some government tells me what healthcare I get – period, end of story, too bad if you don’t like the rejection/wait period/alternate treatment.”

        You seem not to be aware that medium-sized and large employers usually offer additional health coverage that considerably tops up the basic provincial program. I worked harder in life so I could get a good job that offers health benefits as part of my overall compensation package.

        You also seem to value the freedom of not having a government program provide a basic level of health care. You don’t mind having a for-profit company telling you what kind of health care you get? Deciding that you are too risky, or too expensive? That can’t happen in Canada, where, if coverage is available at all, it’s available for all.

        I’m a Canadian-American, with years and years of experience in both systems. The Canadian system is better, overall. Not light-years better; not night-and-day better; but definitely better. And less expensive to the country.

        • Thank you, Lars: I appreciate your concern. But having lived in Canada under one of its better employee medical insurance plans, I disagree that Canada’s national single-payer system is absolutely better than the one presently in the United States since the reforms of the Obama administration. Many supporters of the Canadian system, in my opinion, have little understanding of the loopholes in the system permitting health providers to charge fees for services and to deny treatment based on a patient’s ability to pay. There is no sense denying that there are such loopholes, which results in too many unhealthy Canadian poor people. The loopholes defeat the purpose, if not the motive and meaning, of any government national single-payer health insurance. Like our national single payer public school education system, class privileges for health care in Canada under its single payer system mean one service for one group of Canadians and another service or none at all for other Canadians.

          • Long post ahead – short story: It’s really given me back my dignity, and allowed me the freedom to live my life without worrying about where my health care was going to come from.

            As an American living in Ontario, I’ve found that while the canadian system isn’t perfection, it’s absolutely life-saving. Before I moved to Canada, I had been without health coverage for over a year. I was working full time hours, but as a contract employee (due to the economic “situation”) I had no employer-based healthcare. I had a pre-existing condition which prevented me from purchasing a private insurance plan at any cost. I was also working full-time, which kept me from being poor enough to qualify for medicaid. I received the medication I needed through a charity program offered by the drug company, but it needed to be administered in a hospital, which was paid for by my saintly middle-class parents.

            Since I’ve moved to Canada, my life has gotten that much easier. Just as in the US, there are many different care providers – the quality of care you receive is in large part a function of the place you go to for care. I found a teaching hospital for a specialist, and this amazing thing called a “family health team” (look it up – amazing) which includes specialists of nearly every kind working together with my family doctor for day-to-day care. As long as I am somewhat flexible in my schedule, I never wait longer than 4 weeks for anything non-urgent.

            When I first moved here, I didn’t have an employer-provided drug coverage plan, but I applied for and was approved for the provincial drug supplement plan, which pays for medications on a sliding scale, based on income. And now that I do have employer coverage, it is that much more comprehensive. Therapeutic massage, nearly 100% drug coverage, acupuncture, herbalists, and many other alternative/supplementary health treatments are covered.

            On top of all that, I see how it’s allowed others to be innovative. Many of my friends are full-time musicians, and have not had to worry about on-going health issues. People don’t have to stay at jobs they don’t like because they can’t afford to lose coverage (as was my case), and there is a lot less to worry about when starting a new business or creative venture.

      • @freedom lover:

        There is no freedom if there is no money.

        No money, no insurance

        No insurance, no medical care

        Everyone in america isn’t middle class with good benefits

        Many people work over 10 hours a day with no benefits

        I disagree with you – it’s not about freedom – it’s about access

        Everyone in Canada has access, everyone in america doesn’t

      • “I am free to make my own choices (work harder in life so I have money to spend on healthcare, or take a risk and not make as much money),”

        This person is either very young, extremely naieve, and totally lacking in empathy, or they are just unutterably stupid and (probably willfully) ignorant.

        CS – you.clearly do not understand the nature of illness. I pray that you never get seriously sick, because if you get in a car crash, or get severe cancer, or huntigtons, or scitzophrenia, or any of hundreds of medical conditions, the “freedom” to work harder you value so highly can dissapear. Your precious freedom to choose is lost forever. At that point in the USA you are free to lose your job when you can no longer work due to debilitating illness that you cant control, then you are free to lose your insurance when HIPAA runs out, then you are free to lose your house and bankrupt your family…. Or you could commit suicide – oh no wait that is one freedom you dont have… I guess in that case you are free to refuse treatment and die a long, painful (and probably still expensive) death.

      • “I am free to make my own choices (work harder in life so I have money to spend on healthcare, or take a risk and not make as much money), wherein the Canadian system, some government tells me what healthcare I get – period, end of story, too bad if you don’t like the rejection/wait period/alternate treatment. ”

        Wow, either you’ve lived a life of extreme privilege, have had someone else pay your way, you haven’t lived at all yet or you are just incurably dense.

        Either way, “freedom” means absolutely nothing when you have no money. In the American pro-corporate system, (no longer true democratic capitalism) everyone is a commodity, the value of which is only commensurate to the individual’s ability to pay their dowery at birth — to class or privilege.

        If you are so unfortunate as to be born middle class or lower, your freedom is on a very short tether and the lower you go economically, the shorter that tether becomes. Its called “agency” and agency is only commensurate to net worth in the US.

        Therefore, your argument means nothing on a real basis and morally and rationally it speaks volumes about you and other simpletons like you. We all pay dearly when people suffer from curable illnesses, when costs are driven up to cover those not covered, to keep the streets free of crippled children begging for a morsel of bread, diseased families spreading tuberculosis, diphtheria or many other commonly curable diseases throughout the country.

        Companies lose productivity as workers take long sick days or never return to work, or suffer disabling permanent injury due to uncured illness and disease or treatable injury.

        Then, ironically, even you, the privileged have no freedom either as you are now forced to pay for and deal with the burden of the ill and the diseased, the injured and untreated.

        Public healthcare is a no-brainer that the rest of the intelligent, educated world that isn’t dominated by corporate interests or a trenchant elite class, has figured out. When the people speak, they want quality of life and the FREEDOM to CHOOSE to get care or not get care.

        Presently, the US has no such thing and thus this “freedom” is just a shallow, meaningless chant among the rubes and the easily fooled.

      • @freedom-lover: Anyone who thinks “work harder in life so I have money” is living a fantasy. You can work three jobs in this wonderful country and make barely enough to keep your family housed and eating – if that. You can work not very hard and roll in dough. You can choose a job that pays well, that you hate (if you’re lucky enough to have that choice), or a job you love that pays less well(if you’re lucky enough to have that choice – and most people have neither choice). Thinking money is the be-all and end-all of life, even money for health care, is a sickness, promoted by American “conservative” extremists.

      • Freedom Lover,

        Do you know what “In-Network” and “Out-of-Network” coverage means? It means Insurance Companies dictate who you can and can’t see.

        That’s not government telling you who you can or can’t see. That’s a For-Profit insurance company restricting which doctors you can see.

        Get it?

        If you are in US, you are not free to choose your doctor. You are “free” to shop private insurance, and use one of their “In-Network” doctors.

      • In many ways, Canada’s health care system allows a GREAT DEAL MORE FREEDOM: no one has to refrain from taking the risk of starting a new business because health insurance costs are unaffordable for employees or the entrepreneur will lose his/her family’s own coverage; no one has to refrain from switching from one corporation to another because the second doesn’t have health coverage. There are many ways in which Canada’s system actually allows much more personal freedom….and a lot less worry.

    • My problem with Canada’s health care system relates to prescription drugs, eye and foot care, and dentistry. Canada is deficient compared to the USA in all 3 respects. But one never finds those areas debated in the defense or boasts of the “single payer” national insurance in Canada over the American health care delivery system. But Canadian dentists, for instance, get away with highway robbery of Canadians, and there is tremendous political resistance to bringing oral health treatment into Canada’s national health insurance system. But if you’re poor, unemployed and not a child under 18 of a family on social assistance, in most of the Canadian Provinces, you’re no better than an American without the means to afford both fee-for-service oral health. In fact, you’re worse off because at least in the States, many American dentists perform pro bono service for the poor, unlike in Canada, such as the Atlantic Provinces, where the idea of such a thing triggers lobbying against it.

      • I’m curious. What is your specific complaint about prescription drugs in Canada? I thought they were way cheaper up there than down here in the U.S.

        • Not for many drugs, under the Medicare system in the USA. A prescription for several blood pressure reducing drugs cost an American on Medicare nothing. I Canada, under an employer insurance coverage, the same prescription could cost the employee in your “single-payer” plan hundreds of dollars in copays until he reaches the maximum copay for the year (for some plans $400-$700), then he or she only has to pay $15.00 (CA) copay for each prescription drug. In the states, a low-income American employee under present health insurance, or an American on Medicare with a prescription for the same drugs pays nothing or at most $2.00 copay.

          • Wait, what low income jobs come with health insurance? And you are using Medicare for comparison as if everybody can get Medicare.

            I import my drugs from Canada because they are 1/3 the cost, and still cheaper than what I could get if I used my “insurance”.

            • No, everyone is not on American Medicare. But increasingly, a large number of Americans are on Medicare or Medicaid. And the Republican critics of Obama’s health insurance reforms are targeting Medicare and Medicaid, but the vocal criticism diverts media attention away from Ryan’s impolitic attacks on Medicare to demonize Medicaid, a program designed to help poor disabled. The problem with Canada’s prescription drugs is that they can be expensive for working poor. Stand in front of a Lawton’s, a Sobey’s, Atlantic Pharmacy or Jean Coutu, Shopper’s etc. and take a survey of how much out-of-pocket or percentage of income the pharmacy customer pays for prescription drugs. Or take a survey of kids working at department stores, electronic stores, or music shops; ask cab drivers and Kelly day workers as well—–and the answers will truly shock you about Canada’s health insurance: For most of the unemployed in Canada, health care takes a good chunk of their income. As a matter of fact, self-employed people end up falling back on the national health program for serious injuries and paying for prescription drugs out-of-pocket. In some case patients needing expensive new drugs have had to petition Member of Parliaments to force the province to pay for their prescription drugs. Or the patient must go to Mexico or the USA for emergency treatment and drugs forcing the province to pay for the foreign treatment.

      • Tell me where those “pro bono” services for dental care are, because I’ve lived all over the US and have never seen or heard of such. I know that in some states in the Midwest, dental schools will offer discounts, but pro bono? Not a chance, that’s a dream.

        Also, people on adults on Medicaid do not get dental care beyond extraction and that is only if the tooth is severely infected and if the person is lucky enough to find a dentist who will take Medicaid.

        Children can preventive cleanings and tooth decay care, which is better than nothing but again, finding a dentist who will take the program since it only pays a third of what private insurers will pay, is another hurdle. They do not cover orthodontic care.

        • My information on free dental care in the USA was deleted or does not appear. You’ll have to go to my blog for the information on the centers and dentists who provide free care.

    • Post script: And the other problem in Canada has been the shortage of general practitioners, a shortage which enables the option of doctors to close treatment availability to those who need a doctor, and the cattle car like treatment process in areas of doctor shortages where individual treatment may result in hasty diagnosis mistakes, repeat visits, and numerous referrals before the mistakes are corrected. Or the mistakes may eventually find the individual in a hospital emergency care unit, with all the expense of that visit added to the Canadian system. Individual annual fees in insurance premiums of Canadian employees through employers well exceed the expenses of many American workers for their health insurance, especially under the present Obama national insurance reforms. And I found that the costs of Canada’s “national single payer” insurance expresses itself in very high Canadian taxes on food, gasoline, prescriptions, clothing, and just about every retail good or service, including higher provincial taxes, compared to American tax rates. In Canada, for instance, there are real estate taxes, sales taxes, and “harmonized sales taxes” of the provinces. Neither the present American nor the Canadian national health insurance systems are perfect. But Canada’s system offers a lot of loopholes to specialists health providers, including funeral directors and addictive treatment counselors, and many of them, like Canadian dentists, have found a way to drive a mack truck through them to greatly enrich themselves, much to the envy of their American counterparts.

      • There is no tax on food in Canada

        You make some good points about dental care, but the rest of your posts are riven with inaccuracies regarding the situation in almost every Canadian jurisdiction.

        I suspect you are taking the worst case scenario in every Canadian province and building it into a whole.

        • To: Michael Cowtan on June 13th, 2011 at 09:03/”There is no tax on food in Canada.”

          You obviously do not buy the food snacks, prepared foods, frozen sandwiches, etc., cold drinks and other food products at local Canadian supermarkets or fast food restaurants, where there is a tax. In any case, much of your produce is often shipped from the states and there is duty on produce from the states at the border. New Brunswickers shopping across the border in Maine have to declare their food purchased in Maine when returning to Canada, and as many of them will tell you, it’s worth the trip even 2 hours to Bangor Mall to buy food in bulk taxable at the Canadian border versus purchasing at the higher cost the same groceries in Canada. For variety and low prices, Canadian grocers and fast food restaurants cannot compete with American sellers.

    • Perhaps this is just my perception, but it seems that people in northern US states — those most likely to encounter Canadians and/or observe Canadian health care — tend to be most receptive to a Canadian style health system.

      • I’m guessing, too, on your speculative comment, but I don’t think that is true for most Americans who have had direct experience for any length of time as beneficiaries of the Canadian system.

    • Postscript 2: In Canada, there are no tax reductions for individual preventative health practices in the national health insurance system. A daily swimmer, jogger or person using a daily treadmill pays the same taxes into the health care system as someone who sits in front of a TV, smokes, drinks a six-pack of beer, eats fast food daily and never exercises. What a healthy person with healthy life style habits saves in health treatments for prescriptions, and not paying for cigarettes and tobacco and alcohol consumption, the Canadian loses in having to subsidize the health care of those who have unhealthy lifestyles. This by no means defends the fee-for-service in the States, where only some insurers give credits for healthy life style choices as an incentive to reduce expenses overall. But my point is that Canada’s health care system has serious problems of fairness, delivery and quality. And as Americans, we ought to examine those problems carefully before deciding to emulate Canada’s single payer system, because in many respects Canada doesn’t really have a comprehensive single payer national health system. And calling Canada’s health care system a single payer system is quite a distortion of what it really is when we attempt to contrast it to the present American health care systems. Canada’s system isn’t really the equivalent of our Medicare, It’s far less than a Medicare insurance program for many Canadians who are taxed to the hilt to pay for it.

      • If you have an insurer who gives “lifestyle credits”, I’d like to know who and how I can get them! I’m at a normal, healthy weight. I don’t smoke. etc etc…

        I still pay almost as much as my monthly *California* rent in health insurance. (I’m self-employed.)

        • Most private insurance companies in my limited experience offering health and life insurance add a lifestyle point for not smoking tobacco. My last employer in Rhode Island offered a health insurance program that rewarded employees who exercised as part of a paid gym service on a regular basis.

      • CS you are full of BS.
        The ‘problems’ you highlight in the Canadian system are ones that the public appears to be happy to live with … otherwise it would change. You seem to ignore the greatest strength of the Canadian system – that is that it is directly funded by the people of Canada. The system is, generally speaking, the way it is because that is what the majority of people are comfortable with it.
        In the late 1980s and early 1990s in the Province of Ontario there were people who were waiting for heart surgery who were dying before they got their operations. Similarly, there were people waiting for cancer surgery who were dying. This news was carried in all the major newspapers at the time and the end result of a dramatic increase in the number of cardiac surgical centers and cancer speciality centers in the Province of Ontario and current wait-times for cancer and cardiac care is nonexistent. The reason that there was such a quick response was that the people who administer the health program answer to the politicians, who in turn answer to the electorate. There is a fairly direct connection between the people and the administrators of the health insurance program. If there is something which the population truly finds egregious then it will be changed.
        You can go on and on harping about dental care, foot care, prescription coverage, etc… but you are missing one key point. Generally, anyone who is employed has supplemental insurance which covers these expenses. In terms of the elderly (Medicare equivalent) population these services are provided by the provinces.

        • You have obviously drank the Kool-Aid of Canadian Propaganda. You ought to ask the kids working at Call Centers in the Atlantic Provinces what kind of single- payer health insurance they have, whether they can afford eye care, dental, pedi-care and how much their prescription drugs cost them out-of-pocket. Ask how many have primary care doctors they see regularly? I cannot speak for other provinces, but they would be better off at low-interest health clinics in the USA than in Canada under our present Health Care Reform Law than in New Brunswick under its so-called single-payer system.

    • I have a family member in the US who is very close to a premature death. She had medical insurance, but not a Cadillac plan. She happened to fall ill on a weekend, and waited until Monday to go in to get care. Had she gone in for care over the weekend, the insurance company would charged her $5,000. A Harvard study estimated that 45,000 people die from lack of insurance–this person was insured. I guess she would fit into another category of “had insurance that wasn’t good enough”. US health care is a mess.

      • “US health care is a mess,” for you, but not for Medicare recipients, members of the armed forces, welfare recipients of medicaid, the disabled, federal prisoners, US government officials, security workers in the government, etc. Canada’s health care is a mess, too, for anyone who has lived in Canada long enough to observe it. Both systems need further reform.They’re not better than one another in any objective evaluation of their loopholes. Address the loopholes in Canada’s National single-payer health insurance. How is your eyesight-oral health-feet —-budget for fee-for-service in Canada?
        Read former Saskatchewan Premier Roy J. Romanov, Queen’s Counsel (Q.C.), the author of the Canadian federal government’s November 2002 final report, “Building on Values: The Future of Health Care in Canada.” http://publications.gc.ca/site/eng/237274/publication.html

        • There is no “National single-payer health insurance”

          There is the Canada Health Act, which only with how the system is financed, but the rest of it is up to the Provinces, that is why you cannot make a comparison between New Brunswick, with a pop. of 750,000 and the major provinces.

          I see you live in Maine, Even it has a pop much larger than NB

          • Mike Cowtan: As you put it, “There is the Canada Health Act, which only with how the system is financed, but the rest of it is up to the Provinces, that is why you cannot make a comparison between New Brunswick, with a pop. of 750,000 and the major provinces.”

            Your so-called Canadian national single-payer system is really, as Dave above puts it, in effect a provincial payer system, the kind that 2012 American Presidential candidate Willard “Mitt” Romney claims he wants as a state single payer option, instead of Obama’s defacto national single payer system. That’s why Quebec has a different health plan for residents there than the Atlantic and other provinces, which all have different ones themselves for their residents.

    • $4,000 difference for $300M americans would be $1.2T annually. One thing that can’t be argued is that the US sytem is no better than the canadian system. Think about what could be done with $1.2T…

      Now, I’m not sure how many people would end up losing their jobs as a result of having a more efficient system and not needed thousands of billing specialists everywhere.

      Makes no sense…oh well it all comes down to politics.

      • Think again! Think about what we could do for health care by ending the Bush tax cuts for the wealthy! Think about what we could do for health care by taxing the individuals and the corporations with employee unhealthy life styles in diet, lack of exercise, and the neglect of regular medical evaluations!

    • Despite a negative general perception of Canadian pharmacies in the US, I order my cholesterol meds by mail from a pharmacy in Vancouver for less than the co-payment of my otherwise good US drug coverage in retirement. And for anyone who thinks they
      are “counterfeit,” my cholesterol is lower since I’ve been taking it (generic Crestor). Good stuff.

    • I have no expereince with the american healthcare, but having lived in uk, belgium and france for many years , and experienced the canadian system as well, I can say that the canadian healthcare is vastly inferior to those systems. It costs about 50 euros to do a filling in Belgium and about 70 euros to have a root canal. Then you get reimbursed about 80% of those expenses by the healthcare system.
      In canada the cost is about 800 cad for the filling and 1200 cad for the root canal. No refund at all.
      If I need to see a specialist for my kids, I first need to go through a walk in clinic , get a refferal and wait for months. So if your kid has fever, the best option is to call 911 or drive to the emergency room and wait for hours. Maybe the canadian system is good for the canadians who havent seen better, but I personally gladly will pay more to get a more efficient system.

      • Eye & dental, last time I checked, are not covered under Canada’s healthcare system, but they can be covered by an employer. Whenever I saw a dentist as a kid, I was covered by my dad’s employment coverage, and had to take an insurance form with me. After he died, I was no longer covered, and had to pay for everything myself. I also stopped going for regular checkups.

        Since I moved to the US, I found an excellent dentist, and have used a couple different insurance providers (depending on where I worked), as well as paying costs myself. I’ve yet to get a physician though.

    • I’m a Canadian who thanks God every day that I do not live in U.S.

      I pay nothing for hospital stay, nothing for doctor visit (once a month), nothing for lab tests

      I do have extra insurance through work, so nothing for dental, nothing for prescriptions, nothing for foot care, eye care, spectacles, nothing for naturopath, nothing for chiropractor, nothing for registered massage therapist,

      Those are just things that pop to mind, undoubtedly there is more.

      • and I do realize that European systems are probably better yet, but I am thinking in comparison with (shudder) U.S. system.

      • If you lived in the USA you could find a dentist offering pro bono service.

        • Ah – charity fulfilling known need. So USian these days. So utterly demonstrative of the politics of the matter – any benefit is automatically regarded as undeserved and thus not to be provided. Charity is always to be substituted.

        • Would the charity dentist do root canals.

          Why would I go to a charity dentist if I don’t need to.

          • What’s charity got to do with it? Doesn’t Canada have charities? See Iriving Foundations! See McCain Foundations! Oh, and something else about Canada’s health care system that few people like Paul Krugman of the Times seems to understand. Canada cherry picks its immigrants. And that means no sign on a statue stating “Give me your tired, your huddled masses yearning to be free….” Au Contraire: Canada’s welcome mat seems aimed at professionals or business immigrants, bilingual people, the educated. Canada does not welcome blue collar workers as immigrants. And all immigrants go through rigorous health checks, unlike the USA’s more lenient immigration requirements for health. So the single-payer system in Canada, to the extent it can described as single-payer, has a much healthier and less expensive population immigrating to the country.

      • If you are not paying for these things, someone else is.

        The biggest problem with socialized medical care is that people become accustomed to justifying the use of majority rule to achieve an end–ignoring the fact that their “solution” abandons persuasion and voluntary interaction as the moral standard for social interaction, and replace it with the initiation of the force against peaceful individuals.

        If it is wrong for your neighbor to come to your house and demand you pay for his health care, why is it ok if the whole neighborhood gets together and makes the same demand?

        The problem of access and cost are significant—but the solutions should not include violating an individual’s right to their own life, liberty and property—and only to their own.

        • We mandate automobile insurance if one is going to own a car. So we do mandate, but you could just not own a car if you want to split hairs. The thing is, when someone gets hurt or sick it is often not their choice to do so, and perhaps not our choice to support our hospitals who are very reluctant to turn injured and sick away. Or at least many of them are. So if someone needs health care and chose not to or couldn’t buy health insurance, we all end up paying for them anyway. Let’s get practical here. You are what some may call “dead right”. Probably right in theory, but not in practice. In practice, we do indeed all pay one way or another, to treat sick and injured. After an auto accident, are you going to turn the mangled away if they don’t have insurance? What would you really do if you were at the scene?We may as well spread that cost by mandating insurance purchase.
          The other thing I forgot to mention is that in the provinces, if a treatment is covered, it is not capped. You don’t run out of insurance in the middle of your cancer treatments. However, not all treatments are covered based on best practice studies and that can lead to a lot of howling and sometimes a need to reexamine the policy. But it is an example of how they keep the costs down. The crucial part to any system is not so much the rationing, but the cost control factors. Who do you want to decide that, the for profit insurance companies or some other entity? It is happening now.
          Here is our reality. As a community we pay for things not directly related to us – roads, bridges, police, firemen, whose services or acess we may never use. We do that with mandated taxes. It is not a choice. We’d like to think health care is not one of those items but it ends up indeed, costing us when someone uninsured uses health care. And shame on us if we turn them away. So there has to be some way to spread the costs. We figured that about car insurance already.
          I don’t wear rose colored glasses – any system has injustices and policies in need of change. At this point, ours does too.

          • Joy-I have to reply to your last comment here b/c there wasn’t a ‘reply” under your last one.
            Thanks for engaging. I am truly interested in understanding how and why other people come to different conclusions than I do. It’s important that you know that I care very deeply about community, and creating a society which engenders peace, good will and the best possible chance of a good life for all. And, I believe that the only way to do that is to respect equally the right of each individual to his own life, liberty and property–but only to his own. I believe that the route to peace, good will and prosperity is to never sanction the initiation of force–not ever, not for any reason. If I can not obtain someone’s voluntary participation through persuasion –I have to leave that person alone, no matter how important something is to me. To do otherwise is to turn another into the means to my ends–which means to violate their right to their life for its own sake. That is my understanding of the right to life,.

            So what I do not understand is what is the basis others are using to justify coercing people to contribute to the community when they can not be convinced to to so voluntarily?

            In regards to health care, what is the justification for a “right” to health care? If it is a the right to life– why is the right to life of the person forced to contribute not as sacrosanct as the one who benefits from the forced contribution? It seems to me that either there is a right to life, or there isn’t. It makes no sense to claim it in one instance and deny it in another.

            If you do justify the use force, how do you know where to draw the line? If universal access to health care could be achieved by reinstating chattel slavery, would you do it? Why not? What principle differentiates between the community getting to decide how a person employs his property and how a person employs his labor? His life?

            Does that mean we should find other ways to create and sustain “public goods” like roads, and the fire department? I think yes–and that if we put our thinking caps on, we will come up with ways to achieve those goals without force. Is that a realistic goal for anytime soon? Hell no. But it is a conversation I think we need to all have.

            Thanks again for this civil exchange.

            • Beth, isn’t it delightful to have a real exchange of ideas without attacking and labeling?
              I think there is a continuum in terms of what has to be demanded by society for society’s well being. For example, there is the Food and Drug Administration, to protect us from bad medicine etc. The individual in one way or another is “forced” to support such an entity, and an individual is not able to opt out of those sorts of support structures. We have so many things in our society which we all pay for for the good of the group.
              The Canadians voted Tommy Douglas who started provincial health care in Saskatchewan in the 60′s, as the most influential and admired Canadian ever. They simply have decided that access to health care creates a good society, just as we think we should have access to education etc.
              We actually pay for many things as a group. We subsidize education, health insurance for older (do you plan on taking Mdicare?) It is a continuum, and a society which values human life should value the quality of human life, too.

        • Oh come on, we do this all the time. If I don’t drive on public streets then why is income still forced out of my hands to pay for paving them? If I don’t care about national defense, why is money forced out of my hand to pay for it?

          The thing that medical care has in common with streets and national defence but that none of them have in common with plasma TV’s is that pretty much everybody needs them. I can happily live without a flat screen TV, but I can’t live without health care. If I break a leg or get cancer or pick up SARS, fixing it is not a consumer lifestyle choice, like hardwood floors are. This is why the same market forces that are very good at efficiently distributing flooring materials and TV’s are TERRIBLE at distributing health care. In economic terms, when people get sick they are extremely price insensitive, giving doctors enormous leverage to negotiate prices, and there are enormous barriers to entry for setting yourself up as a health care provider (I can’t just buy a stethoscope for $30 bucks and start charging my neighbors for checkups), giving health care providers even more leverage. Insurance partly solves this problem, by pooling customers together into units with bargaining power, but the problem is that insurance is a model that only works well to cover things that are unpredictable – house fires, or burglaries, etc. But ill health is often too predictable (if you’re 80 or have cancer you WILL incur a lot of expenses), and so unregulated insurance co’s will start customizing individual prices to cover individual estimates of expenses – and that means that 80 year olds and cancer sufferers are going to be required to pay more than they can possibly afford. One way or another you have to regulate it.

          OTOH, if you’re saying that money should NEVER be forced out of your hand, then you have a problem with taxes in general, and you should go take it up with the dudes who wrote your constitution (I’m assuming you’re American here).THEY sure seemed to think that it was important when they wrote the thing, or they wouldn’t have said it was something the federal government should do..

          • Joy and Ecks–
            You did not answer my question. I am not asking what we do, I am asking what we should do. This is where I get stuck:

            “If it is wrong for your neighbor to come to your house and demand you pay for his health care, why is it ok if the whole neighborhood gets together and makes the same demand?”

            • Right on Beth. This is not Ezra Klein’s narrow website journolist, or about simply economics, or the fallacious delusion that one can divorce politics from economic decisions that affect personal financial ones. At every stage of the debate on health care, ideology informs the empirical selection of information (e.g., how to define compensation in a market, whether and to what extent the market is regulated, who is to be, as Geo. W. Bush, Jr.. once infamously would say, “the decider,” etc.) . Ideology and Canadian nationalism inform also the basis of arguments here and elsewhere. But Canadians and supporters of the single-payer national health insurance there ignore the political bias in their assumptions. They do not really comprehend the meaning of our American emphasis on individual responsibility, political intent and the need for social agreement on how our government operates. We’re have a bottoms-up political process that is fundamental to our identity as Americans. Canadians diverge from us in their emphasis on top-down dispensation, order and freedom within that pecking order. American politics tack differently from the Canadian politics in our fundamental values, since we’re start out with the principles of individual liberty, equality and justice. Our principles may be different from Canada,’s but the poor there under their single-payer system do not have equal health care with the wealthy any more than they do in the States. In fact, on the frontiers next to the American border, some Canadians like Ecks believe that Canadians without government health services have a right to American tax supported health care services . My question is: even if Canada pays us for treating Canadians on their frontiers, why should we? Who asked us to do so? And couldn’t we better serve Americans by dedicating our services to only Americans? In America there is such a thing as a Constitutional right of choice about every decision affecting us. We the people are the sovereigns of our government. We have the power to change our laws and our government. But in Canada, there is no such right to change their Constitution. You see, they have to ask the British Monarch their sovereign through her representative the Governor-General of Canada to change the Canadian Constitution. And that explains how the ideologues defending Canada here start their defense, as subjects to the British monarch. Thank the Lord for the American Revolution that we never have to think of her when we decide how to organize our society for our benefit as free citizens not subject to any foreign monarch.

            • Beth, is it wrong for the whole neighborhood to insist you help pay for the fire department and bridges? There are just some things that are best for the whole group even if the individual takes no part in it. For example, SARS. If your uninsured neighbor gets it, you sure as heck want him hospitalized and not spreading it. To you.
              What should be done? Understand that indeed the individual has to do things for the well being of the whole group. And paying for health care is one of those things, or it comes back to bite you. So here’s what we should do. Look at all the systems in other countries, Stop labeling them socialist, and see what works moderately well. I’d like to see each state work out their own, like the provinces do. But everyone needs to be covered. I don’t like the idea of complex competing insurance companies. Waste, duplication, complexity. Frankly, a single payer system for each state. Not for profit entities. The goal – not profit, but keeping costs down and preventative health measures up.

            • 1) Canada is every bit as free as the USA. The Queen has a role in Canadian politics, yes, but it is a purely symbolic one. The last time she (or her representatives) took any political action here that wasn’t first given to her by Canadian political powers was in 1926, and that was considered a scandal even back then (Google the “King-Byng affair” if you want to know). Canada is currently a vibrant democracy, with fully autonomous decision makers elected by the Canadian people. Canada has a “charter of rights and freedoms” that guarantees the freedoms of free speech, assembly, etc, etc. There are some legal differences between the USA and Canada, yes, but they’re generally small fry stuff. If you find yourself saying things like “Americans are free and Canadians aren’t” you need a serious reality adjustment.

              2) Carl says: “Canadians like Ecks believe that Canadians without government health services have a right to American tax supported health care services”. I don’t know what to say. We’ve been through this multiple times already. I have repeatedly told you POINT BLANK that I do not believe this. Repeatedly Carl. Yet you keep insisting I believe this. Why? How am I supposed to have any kind of a conversation with you if you either cannot understand plain English, or are willfully lying about what I say? Or are you just not reading what I write, and are having a conversation with someone in your imagination?

              Seriously, it’s not like I kind of implied something about this once in passing, I repeatedly stated it in absolutely plain language. Here are three different quotes by me, from three different messages, right here in this very thread:

              1) “The US taxpayer has zero responsibility to look after Canadian citizens. Zero. And nobody has suggested they do.”

              2) “When did I EVER say that the USA has a responsibility to pay for the care of Canadians? Of course it doesn’t.”

              3) “Also you [Carl] start off your post saying “On your post June 15th, you are wrong about the US picking up the tab for Canadians using our health care system.” My post on June 15th starts with the words: “The US taxpayer has zero responsibility to look after Canadian citizens. Zero. And nobody has suggested they do. ” Which part of that is wrong?”

              So Carl, if I see you say this about me again, I’m going to have to jump past any thought that this is maybe careless reading on your part, and will be left only with the attributions of malice and stupidity. And I don’t waste my time talking to people who are that stupid or that dishonest. Do we understand each other?

          • In 1982, Canadian Prime Minister Pierre Eliot Trudeau made the most recent big step forward with the Canadian constitution. He put an end to this business of Canada going to the United Kingdom to have it make amendments to the constitution. He arranged for the Canada Act (U.K., 1982) to be passed in the United Kingdom, and the Constitution Act (Can., 1982) to the passed in Canada. Carl, Canada no longer goes to the UK for permission to amend its constitution. But I sure have noticed the emphasis on individual rights vs collective rights. There is a wonderful zest here in the US, leading to all sorts of entreprenerial things – in part because the individual is so empowered. The only area where this emphasis doesn’t work is with the less fortunate. Our charitable giving is huge and helps with disasters of magnitude. But health care may have to be looked at like building and maintaining bridges, snow plowing etc. Not for the individual, but for all. Having individuals be responsible for their own health care costs by choice, costs you and me too much. Too many for profit insurance companies, too much money for heath care built into the cost of manufacturing, Too complex, too many gotchas! and even depressing hiring. Who wants to hire rather than paying overtime if it means more people on a comany’s health care bill? We don’t have the will to let people suffer unduly because they made the choice not to, or couldn’t afford health care. We let them into our hospitals and hold bake sales. We shouldn’t have bake sale health care.

            • Joy: As a Canadian living in the States, you no doubt have noticed that we do not have the face of the British Monarch on our currency. And you no doubt have noticed that the basis for our laws, our Constitution, is in the United States, not in Westminister, UK. Yes, your Prime Minister passed laws with the approval of his appointed Senate to control your constitutional laws. But when I was in Canada in just before the millennium and a few years later your parliament was still considering the request of Canadian Republicans that you sever your status as subjects of the symbolic head of your government, Queen Elizabeth, who, in the office of Canada’s Governor General, reigns as the head of your Canadian Armed Forces. Yes, you are an independent country but the United States is also an independent country. But that being so, we can’t both be independent if one is still under the authority, be it ever so slight, of a foreign power, in Canada’s case, its former colonial master the UK. I congratulate on gaming our Medicare system in both countries. Many Canadians would envy you to have both American single payer health care as well as Canada’s. Many Americans, too. But one of the complaints of Americans is that we are paying for too many foreigners like you, whether from Mexico, Canada or Kenya (Pres. Obama’s Kenyan immigrant aunt in Boston, recently granted asylum in the USA). And there is pending legislation in the next 4 years to stop that diversion of our taxes to non-citizens. We hope by 2014 to have universal health care insurance as a federal mandate for all of our people. We hope that Canadians see the light and give all their citizens the same health care insurance that your government officials in the provincial assemblies and national parliament receive. Until then, your system is as broken as the American one for poor people without private insurance as a backup for specialized care.

            • Exactly so.

              Beth I appreciate your constructive engagement, and I think that yes, these philosophical debates are important to have. For instance, I don’t put the right to property on quite the same level as the right to life. I do not think that taking a stick of gum from you is equivalent to killing you They’re both bad, but one is much worse, and should be treated as such. That’s not to say that a right to property is unimportant – it obviously is – but living in a complicated society inevitably involves certain complicated trade-offs. There are obviously points at which my life could be not just saved, but further improved by impinging yet further on everyone else’s property rights, and there has to be a line somewhere that accommodates a meaningful right to the accumulation and possession of property.

              But important as that stuff is to consider, at the end of the day to my mind the practical questions are usually more important. It would be philosophically nicer if we could get rid of jails and just put polite notices up in the middle of every town saying “please don’t kill or rob anyone”, but in practice that doesn’t work once your town gets bigger than a few dozen people. Similarly it would be nice if we never had to coerce anyone to contribute to any public good – fire services, health care, feeding the starving, etc. And at times societies have tried doing exactly this (see the industrial revolution). The problem is that in practice it doesn’t work. There would be fires that would spread to burn down whole cities (see fire of London, etc), and there was never enough aid to sufficiently look after all of the poor and sick. It would have been nicer if there were, but there never was. My parents have memories of growing up in England years back, of some of their classmates literally wearing their parents dentures because they couldn’t afford any new ones of their own. That’s just gross and verging on inhumane. I’d rather a small portion of my income be taken and used such that I don’t have to have my own neighbors living through that. And that’s just a small example.

              None of us think we have a responsibility to give our neighbors everything they might want (big TV’s, hardwood floors, art, whatever). But there are certain minimal standards below which there is genuine suffering, and we’re often not as comfortable with letting our neighbors slip below those. I’m talking the basic necessities of life – enough food to eat, at least some kind of shelter over their head, and someone who will fix their broken limbs, and cure their diseases (both for the sake of the patient him or herself, and for everyone else, as Joy says, before it spreads). For these things nobody has ever found a workable alternative that relies purely on the free will of neighbors. If you can point me at one example that has ever worked anywhere in any reasonably sized society, I’ll change my tune, but I’ve certainly never seen one.

              Carl’s odd beliefs about me to the contrary, I’m not actually at all dogmatic about HOW basic healthcare has to be provided, so long as it is delivered in a practical manner to everyone who needs it. Canada does it with a single-payer system (like Medicare in the US), in the UK the hospitals are directly run by the government (like the Veterans Administration in the US), and in Germany, I believe, the system is largely entirely private, but heavily regulated by the government to remove a lot of the problems with non-universal access and spiraling costs. At the end of the day I don’t really mind WHAT the system is, so long as it works. You can talk philosophy to me all day, but if you have innocent people dying and suffering horribly because your system neglects to provide them with care, then I don’t like your system. The US currently has bad problems with this, while most of the rest of the Western world does not (again, Carl’s odd assertions to the contrary – I’m really not sure where he’s getting his “facts” from).

            • It looks like the format of the comments only allows for so many back-and-forths.
              Thank you Joy for the civil discourse. I am still curious as to what principle you rely upon to justify the community employing the force of government to override an individual’s right to their own life, liberty and property.(see my previous questions.)
              My guess is that we will end up disagreeing on this very fundamental issue. I value community very much, but a community that abandons the principle of voluntary association is not one which holds much value for me. for me, Any potential positive gains are destroyed by the means being used in attempt to achieve the stated goals, e.g. education, health care, roads, fire protection etc.
              But what also probably plays a major part is that I believe we can achieve these things through voluntary means, ie through the exchange of value for value in the free market in combination with charity. I realize that many who advocate for government force to achieve their goals think this is unrealistic.
              However, I believe the moral is the practical. Refraining from the initiation of force is (in my thinking) the prime principle of moral human relations–and any solution to be truly practical must be consistent with this standard. Use of government force for the majority to impose its will on a peaceful minority just isn’t in my moral toolbox.

            • This format is not set up for extended discussions–and I do not know how much longer I will have the time to continue this enjoyable discourse.
              Let me just say thank you to Ecks and refer you to my last response to Joy which addresses much of what you bring up.
              In regards to voluntary systems which address the needs of the disadvantaged—before government stepped in, there was a much greater voluntary effort going on. If you are interested in researching it, you should not have trouble finding good sources. Government programs do crowd out private charity just as government education crowds out private education.
              Also–I would recommend being careful about conflating a lack of generosity with a lack of prosperity.
              Thanks again.
              Beth

            • Ecks, I’ll skip your sophistry (is it Ezra Klein or his clone? BTW?). I interpreted your response about the consequences for us of Canadians receiving American health care as de minimis; but as with Joy, you miss the moral point I was making. What right do Canadians have to jump in line here for American tax supported medical care when, as you and Joy argue, your system offers better and more accessible care to Canadians than our American system? My assumption, as I interpret your scanting that fact, is that you do not object to Canadians receiving American health care. And when Canadians need us, I do not object either to our treating them whether they pay for it or not. But let’s be fair and honest. In that case our health care delivery is more accessible and better than yours at least for those Canadians who use it rather than Canada’s: It’s a point you refuse to concede.
              As for Canada being just as free as the USA, you need to consult your laws, esp. our first 10 Amendment Rights to your Charter. We have freedom of speech, freedom of religion, the right to bear arms, and many other freedoms qualified and restricted in your Charter. Not only that, but we can prosecute government officials a lot easier than Canadians, we have an ELECTED SENATE, not one appointed as you do by your PM, and we have lower taxes, much lower than Canada’s. We are a freer society than Canada in all those respects. But Americans can also recall elected officials who abuse their office, unlike the residents of Canadian municipalities who must suffer the abuses, broken campaign promises, and bad faith of city from their elected officials. I pity some Canadian residents in many of your cities where elected office is foremost a career job to boost one’s lifestyle and pension. PUHLEASE spare me and the readers here your preposterous arguments that Canada is as free as the USA. Argue all you want about the advantages of your health care system. But my experience in Canada belies your assertions. And the 3 million Canadians, illegally and legally living here, seem to agree with me.

            • @Beth, I admire your idealism, and I think you are right that we will disagree about what our ideals should be, but at the end of the day- you NEED to have something that works or you just have a miserable mess on your hands. Yes, government spending can crowd out some private charity, but my argument was never that private charity didn’t exist before, or that charity wasn’t a good thing. All I argue is that the sum total of the private charity was never enough to cover the need. In practice you had SOME poor people get SOME free care, and some food, and some housing… but you still had lots of people clinically malnourished, living in deeply unsanitary conditions, and not receiving basic standard medical care. I am willing to make some moderate concessions towards practicality if that is what it takes to eliminate these things.

              My personal take on it is this: I see libertarians who say “wouldn’t it be nice if we all left each other alone and everything worked out great”, and I see communists who say “wouldn’t it be nice if everyone shared everything, and it all worked out great”, and while their proposed solutions are exactly the opposite of each others (indeed they tend to hate each other passionately), they are both much longer on idealistic fervor than on building countries and communities that really work. If I have to live along side 300 million other people (and I do), then beautiful ideals are a great start but I’m also faced with crime, pollution, sick and starving neighbors, fraudulent and deceptive commercial practices, cruelty, generosity, indifference and empathy, intelligence and stupidity, and everything in between… and then I find myself asking not just “what should we do” (as you do), but also “what will work?”, and then negotiating a space between the two. It’s not easy, but it’s the human condition, and for better or worse it’s what we’re stuck with.

    • In Canada, i don’t pay those prices for Gold crowns, or root canals let alone fillings!!

      Are we talking about real people working hard to afford health care?? Families with children don’t have enough time to save for illness.

      True story -family I know-14 month old child of two modest income hard working semi professional parents , hasn’t been feeling well, crying, upset. Goes to doctor for tests, called back next day at 4 Pm. Father calls mom to leave work -helicopter has been ordered to fly child from small island community to major urban Children’s hospital. 6PM Child is receiving chemotherapy for leukemia -no discussion about who pays, no consultation about coverage.

      Parents must leave work to spend 24 hours a day with child for 6 months. They live in a Ronald Mc Donald house, with other parents with similar challenges.. Chemotherapy os misery for their beautiful child.. Friends & co-workers raise money to help with their personal expenses but all medical treatments & hospital stay are covered -there was only a40% chance of recovery!!

      But today, 18 months later, they have a beautiful healthy child, and no significant debts. Poor healthis bad enough -but families should not have to deal with bankruptcy at the same time.

      • Again, I refer you to Atlantic Canada and the terms of service for the working poor, who work without employee health insurance, and who cannot access those services without an ability to pay for them. You cannot describe a health insurance program as a national single-payer one that excludes large segments of the population because of their inability to pay for many critical health services. And that my Canadian friend is a fact. The truth is that Canada has large under-served populations with health needs, and your politicians, your unelected representatives in your appointed Senate included, and your provincial Assemblies are largely responsible. And they’re also responsible for the active role of Canadian propagandists in the American media touting the Canadian system against the evidence of experience from Americans with direct experience of the system—-such as me!

    • Another comment -you can tell I am passionate!! Referrals to Canadian specialists are required -it IS a form of rationing!! Generally, it is your family doctor who refers you -and I have seen specialists within a few days when it was warranted -or within a few months when it was purely optional . My husband has seen them within minutes on arrival in emergency on two occasions when warranted-and in one case, long before any evidence of insurance coverage was provided! Any insurance program needs to have checks & balances against abuse -intentional or through people who believe they know better than a G.P. & should be able to decide when they need a specialist.

    • I note that Aus most likely refers to Australia not Austria (Au). See http://www.commonwealthfund.org/Maps-and-Data/ChartCart/View-All.aspx?charttopic=Access+++Equity

    • I’ll read Dr. K’s items after commenting here.
      1. Each province and territory is responsible for its own health care system, so it isn’t a truly “national” medicare system like many European countries. Also, the level of medical services in rural areas is not the same as in major cities and Canada has 1/10th the population and a lot more rural areas!
      2. Medical rationing is subject to political pressure (unlike abusive insurance company practices). The provinces routinely make additional resources available in response to political pressure, e.g. hip and knee and cataract surgeries.
      3. The province, as single payer, knows what it spends money on and this data is public. Here’s a link to the top 50 for B.C. Y/E 3/31/10.
      http://www.health.gov.bc.ca/msp/paystats/pdf/ffs_top50.pdf
      4. I would fret about Canadians traveling to the U.S. for medical services if the U.S. critics would make it illegal to go out of state for any medical services! The top U.S. medical clinics have an international reputation for a reason.
      5. The Canadian system can be improved (health care for First Nations people is sub-standard and the PBS program which compared countries criticized the lack of control on “frequent flyers” ). Unlike the U.S., the various stakeholders like the system and want to make it sustainable.
      6. The excessive taxation in Canada is comparing apples and oranges: while Bush was running up massive deficits, Canada was running surpluses for something like 12 years in a row, ending with the current recession. As I understand it, U.S. taxes would have to double to eliminate the deficit!
      7. Lastly, one anecdote for the “I’m OK, Jack” crowd: a Seattle colleague essentially begged me to hire him so his family of 6 could get access to Canadian health care; one of his kids had been diagnosed with a chronic medical condition. In our mid-20s, could any of us have guessed the illnesses and accidents that we and our families would encounter over the next 40 years?

      • Carl, I live in the U.S. and I benefit from Cadillac health care, wonderful care. But my friends don’t. When I lived in Canada all of us had health care, and if it was urgent, we got it immediately. Otherwise we insisted it was an emergency and grumbled, but lived, and got what we needed. Canadians still grumble about how their provinces allocate health resources, but none of them would switch places with us in the US where “them that’s got, gets.”

        Don’t split hairs. Don’t argue philosophy. If your family had a health emergency and you hadn’t coverage, you wouldn’t split hairs over philosophy. We in the U.S. MUST find a way to get the profit out of basic insurance and just do it. Supplimental insurance, like in Canada, can thrive and make profits, but basic, you can sleep at night, insurance – we MUST. And I ask again – are all those arguing against some kind of system which covers everyone, going to take Medicare? Of course you are, Carl, even you will.

    • I am a healthy 29 yr old Americn male (no diseases, prescriptions or illnesses) and have had employee “provided” healthcare offered by the same job since 2004.

      Here’s what it is like for a healthy young American paying for HealthCare Insurance:

      In 2004, my employer provided healthcare premium was $57.62/month. That included dental, medical, prescription and vision coverage.

      By 2009, it had gradually increased to $116.58/month. That is a 102.32% increase in 5 yrs.

      In 2010, we were offered our renewal package . It jumped to $255 a
      month. An increase of 118% in one year.

      Not only have the monthly premiums skyrocketed but the coverage has been watered down. My “insurance” no longer includes Dental or Vision coverage. My Co-Pays have doubled. There’s a $300 deductible that you have to pay before the insurance company even kicks in their first dime towards a bill. And even once I meet paying the deductible, I STILL have to pay 20% of every bill.

      Since 2004 my monthly premiums have skyrocketed 342.55%

      2004 – $57.62/month
      2010 – $255/month

      That’s US HealthCare for you. No thanks. Give me single payer.

      • Many Canadians are still waiting for a government single-payer national health insurance that covers prescription drugs. What the Canadian government and many Canadians call a single-payer system is anything but, and there are many Canadians who would echo your complaints and in some cases describe a system that doesn’t work for them at all. Don’t take my word for it. Please take a trip across the border. Visit the Call Centers, the McDonald’s and other fast food restaurants. Visit local Canadian retail stores like Future Shop. Ask the employees there what kind of health insurance they have, if any? Then visit an urban regional hospital a few times and ask the folks there what kind of health insurance they have, or whether they have primary care physician (silly question, of course, because if they’re not there on an emergency, they’re there because they don’t have a physician).Ask whether any of the patients are there in the emergency ward for a tooth extraction? And ask them how much they expect to pay for it! $75 or $150?

      • p.s. Oh, yes, almost forgot. Ask the cabdrivers at the airport and in town and other self-employed what kind of health care insurance covers them, including dental and eye care?

        • Carl, you obviously whiffed on the point of my post. You try to create misdirections and point to canadian cabdrivers and ask if they have dental or vision coverage.

          My point is in 2004, I paid $57/month for medical, dental and vision.

          I now pay $255 a month and have no dental or vision. That’s a 355% Increase from 2004 and I lost dental and vision!

          Now Find me a canadian, or Frenchman, or German, or Sweede…anyone who paid 355% more and received less coverage.

          • Sorry Drew, I was trying to respond generally to a point I was making about the Canadian system that I know personally. It’s not all that it’s made out to be for many Canadians, and in some respects inferior to some of their needs compared to what’s available in the USA. No question but that the American system needs more substantial reform in the direction of a national health insurance program. H.M.O.’s in the states have followed the lead of fee-for-service providers, medical specialists, dentists and others to charge whatever the traffic will bear for the working segment of our population, the ones not on government payrolls and government programs for health insurance. President Obama now has set out on a path of reform to lift that burden from people like yourself. If you’re an American you ought to support his efforts.

            • Obama’s bill (assuming the Republicans let it be implemented – which they’re fighting hard against) is an excellent step forward for the States, but it isn’t a magic bullet. It will allow people with pre-existing conditions to get coverage (which is VERY important), and it will start putting a bunch of experimental programs in place to reduce the overall cost of care. But it doesn’t immediately slash the rate of payments to hospitals and doctors – if it did that the doctors would have taken to the airwaves saying “I’m a doctor, and this bill will hurt your health” and people would have gotten scared and it would never have passed. So while it will start to bend the cost curve downwards over time, the immediate state of affairs (which has the identical procedure costing twice as much in the US as in any other western country) isn’t going anywhere any time soon.

              Plus also it sounds to me like your main problems with the Canadian system is that it’s not comprehensive and single-payer ENOUGH, rather than objecting to single payer as a system in general.

    • Three years ago I reported to the Kentville Nova Scotia ER complaining of a suspected anxiety attack that had left be depleted for about two weeks. Within minutes I was told that I was in AFIB, had experienced a mini-stroke (TIA) and might have a small bleed on my brain. Soon after clots went to a kidney and spleen.
      The care I received was immediate and first rate. Combined hospital stays of 30 days, a pace maker/defibrilator inplant, regular device check-ups, and a bedside monitor connected to Minneapolis and Halifax cost me (retired military pensioner) ZILCH.
      God bless Canadian Medicare!!!

    • Had the same job, same employer, same salary, when a project brought me from Toronto to Virginia. Taxes were a little lower in Virginia, but adding in hundreds of dollars for health insurance took a lot more out of my paycheck. With co-pays at every turn, one time I happened to be short on cash, and postponed a trip to the doctor. Instead of being able to take a regular prescription to the pharmacy, I had to send documentation to a website (a sufficiently onerous task that my doctor’s office couldn’t take the time to get involved); this occasionally meant delays in getting prescriptions, not to mention extra time in doing paperwork for the health-care system that I could have spent doing something else.

      On a macroeconomic level, the productivity generated by allowing people with pre-existing conditions to be treated and come back to the labor force generates more than enough income and revenue to cover the cost of health care for those people. It is unfortunate that the United States imposes this economic burden on itself. Not to mention the 45,000 people who die each year because they don’t have adequate health care (or putting that figure a different way, over 1% of the population over a lifetime).

      • I understand that CS is a die-hard fan of the US system. After reading almost all the above posts, it seems clear to me that Canadians in general are satisfied with their single-payer system. The loopholes and lack of coverage in some aspects are true, but in general the system is preferred by many people. Yet, the current US system seems to be shaky, and does not provide coverage to a large segment of her population. Moreover, the medical costs are skyrocketing – thanks to the litigation system and the accomodating insurance companies.

        • Derek: My response did not get through the filters, same as my information on free dental service providers (so I had to refer to my website). But I am a proud American. I hope to see further health care reforms under our first African American President that will surpass the benefits for Americans of Canada’s so-called single-payer system with all of its loopholes for greedy providers and class bias against the poor. I once lived in Canada, very recently. I know what I am describing there. Wake up Canadians. Your health insurance system needs lots of work if it is to serve all the health needs of your people, not just the working middle class and healthiest segment of your population.

        • Carl, to say that Canadians are “satisfied” with our health care system i inaccurate. Canadians in general, at levels of 90%+ approval, are ecstatic with our health care system. It is the single political achievement of Canadians that we are proudest of, along with our Charter of Rights and Freedoms.

          Canada’s health care system, for all of the mild dissatisfaction with its *cost*, is enormously popular.

    • One of the ways in which your previous post (busting the myth that Canadian doctors are flocking to the US) was misinterpreted, or rather, one of the ways in which commenters attempted to knock the data, was by claiming that the stats you cited for the net gain in doctor immigration Canada has seen the past couple of years can be attributed to non-US doctors from places other than the US (“South Africans, Indians, and Pakistanis” is I believe how they put it). While I have no doubt that significant numbers of physicians born and trained in those countries have emigrated to Canada (and the US as well), the stats you cite, showing a net influx of doctors, are based on the numbers of physicians previously trained or licensed in Canada who have moved away, and are now returning. Thus, the data suggest an even stronger argument against the “Canadian doctors flee” meme.

    • “I know the usual knocks against infant mortality as a population metric of quality. But I’d like to hear a good alternate explanation (if one exists) for the trend you see above. Links to evidence or data supporting your theory will get you extra points.”

      Per haps you ought to look up the definition of infant mortality in Canada versus the definition in the USA. As a lawyer who has worked in and with the medical sectors of both countries, I can assure you they are not the same.

      What does this mean? Well, for starters,you are comparing apples and oranges…

    • I am in Montreal often and one day, I was having a conversation about the differences in the US system vs. Canadian. A US educated female physician was at the table next to me. She chimed into the conversation and said she would NEVER practice medicine in the US because she could not in good conscience deny proper care to people who did not have adequate insurance. Her former US colleagues are always astonished that she prefers to work for the ‘low’ Canadian wages rather than the extravagant pay a specialist would get in the US.

    • On a macroeconomic level, the productivity generated by allowing people with pre-existing conditions to be treated and come back to the labor force generates more than enough income and revenue to cover the cost of health care for those people. It is unfortunate that the United States imposes this economic burden on itself. Not to mention the 45,000 people who die each year because they don’t have adequate health care
      http://health-med-news.com

      • Yes but pressing against that are the political and productivity gains for capital when labour is forced to accept any job at all with health insurance, without regard to wages or conditions. The benefits to capital of the US health care system are extremely powerful, which is a principal reason why the Canadian system (like that in most countries with universal health care) is under very powerful attack.

    • I am a Canadian primary care physician located in central Canada

      Physician immigration to the USA has reversed itself; at least for primary care physicians, for at least three reasons:

      1) The collapse of the US dollar

      2) Marked increases in Canadian physician income in the last decade. Negotiation with provincial and territorial governments were spurred on by a physician shortage of graduating physicians (a policy recommendation of Dr Bob Evans of UBC made in the 80s) and immigration to the USA in the 90s. My own medical school dropped medical school admissions from 100 to 75 as the provincial population increased from 1 million to 1.3 million. Dr Evans calculated a cost saving to the tax payer of $250,000 per doctor removed from the system

      3) The introduction of professional corporations, reducing physician tax rates to 12 – 16 %

      I make considerably more than my colleagues in North Dakota and have a larger disposable income.

      Wait times fluctuate wildly, in terms of months, are are difficult to pin down on any give day, but always tend to be longer than desired. Summer time is a dead zone for most elective procedures and specialist visits, and one must wait to the fall for these.

      I have had many patients waiting, usually 6 – 18 months, for hip/knee surgery. I control their pain with opiods during the wait. Despite my suggestion, they would rather wait for surgery in Canada than receive surgery immediately in the USA, citing prohibitive costs.
      Wealthy patients prefer cancer care and difficult elective operations in the USA. Vancouver seems to prefer Cedars-Sinai, Winnipeg the Mayo Clinic, Toronto the Massachusetts General Hospital, and Montrealers most hospitals in New York City or Johns Hopkins.

      Uneven pharmacare coverage in Canada can be an administrative and clinical headache for the physician. Patients not quite poor enough to meet the means test for pharmacare coverage very often will not purchase medications. I have often scrounged around for medication samples to give something to that indigent class of patients.

      Finding family doctor is often cited as a problem by patients who come to me.

      The lack of co-payment in Canada leads to a high volume of trivial complaints that are presented to walk-in clinics, house call services and emergency rooms. First Nations (AKA “Indians”) persons seem to have been indoctrinated to see a doctor if they have a common cold. Unemployed persons with time on their hands will use the time to get free medical attention and free medications. These all tax the time and financial resources of the Canadian health care system.

      The assertion by a member of Congress that Canada has a “two-tiered” system (an unfortunate pejorative confected by the defenders of Canada’s so-call “single payer” system) and that the USA is the second tier gives his country way too much credit. As I mentioned above, wealthy Canadians will seek care in world-class USA institutions (just like Arabs go to London) and Canadian tourists will seek attention in the USA for an acute illness, but that is about it. The preference for elective cosmetic procedures is with in Canada or affordable medical tourism (Cuba, Thailand).

      I am not a dentist, but I refer my indigent patients to the government-operated clinic behind me for “free” dental care. There is a long waiting list, in y view, as I have to maintain these patients with opioids and antibiotics until they get definitive dental care.

      A recent report by several Canadian economic experts (David Dodge, form Governor of the Bank of Canada, et al) has stated the current funding arrangement and system structure is “unsustainable in the long-term”.

      It is illegal in Canada for a healthcare provider to charge a patient anything for an “insured” service. Each physician receives a thick binder listing these insured services, and how to bill the various government agencies for them. Cosmetic services are uninsured and are a popular business in Canada as they attract a well-to-do sophisticated patient-clients.

      “Single-payer” in Canada could be defined as only _pubilc_ monies may legally pay for insured services.

    • RE: Free dental… I’ve had dental and vision covered under employer coverage in the US…. 2 cleanings a year, x-rys,then co-pys and a limit that made anything for someone with bad teeth extremely expensive. The vision was decent, but was through a rider that cost more per year than me going to Sears vision center and paying out of pocket. WITH dental, I spent close o $900 the last time I had all my teeth fixed up andpretty. Dentures.orthodontics, and caps were not covered. I hve access to a sliding scale dental clinic around here, if I can afford the gas and time to rive 50 miles each way. I don’t think they do dentures either, and I am now missing 6teeth and would be best served by simply removing them all. Free and sliding scale clinics are great fr folks with transpotation and aflexibleschedule,but out of reach for many working poor, simply due to time. Saying that the lack of dental and vision in Canada’s plan automatically makes it worse than the US because we have free clinics is absurd. When I was working my las job, a clinic visit would have cost me a day’s pay as well as several gallons of gas. Now my only constraint will be gas, but with the price of gas, I’m putting it off.

      Several commentators are talking abut what our US system is under the ACA as if the provisions were all in place. I’m praying that by 2014 the republicans haven’t de-funded it and I can actually afford a policy again. My present employer does not presently offer insurance, but will pay 50% of your premiums if you get a plan. No system is going to be perfect, but by every measure, the US system does not measure up to places with pubic supported care, be it single payer or a public/private partnership. I also see my personal physician at a clinic with multiple doctors where volume is everything. It wasn’t like that 21 years ago when I started with him, and he was independent. There are very few one man offices anymore, mainly due to the huge burden of administrative costs stemming from having to deal with .multiple insurance companies and their quirks. Single payer would in many ways give doctors more freedom t practice medicine, rather thn fight with paperwork..

      Every horror story I’ve heard n-line abut Canadian medicine has an equal horror story I’ve heard or experienced here in the US. Every Canadian I have know as an on-line friend has liked their system, and the couple ex-pts I know their also like it better than whaat was in the US. I’ve had 3 hour waits at m doctor’s after hours clinic for urgent care. I’d happily have that the norm if I also did not have to figure out how I’m affording the co-pay 2 days before payday.

    • One of the reasons for some Canadians using US health care services is that Canadian Medicare outsources some work to the US.

      On the sparely populated Prairies and in the Far North a US hospital is often the closest — so in many of these cases Medicare will pay for the care in the US.

      Health care required by Canadians travelling abroad is often reimbursable by Medicare, though only to the Canadian rates, which are often lower than those charged by the care-for-money free enterprise US.

      And of course many Canadians are older snow-birds, wintering in Florida or elsewhere in the US. For them there are those good ARPA insurance programs to supplement the partial help the get from outsourced Medicare.

    • MB MD: Canada is the only place where a the health system permits dentists to charge as a top-off 10 times over service fees paid by private dental insurance; and when you observe dentists refusing patient care of one family member because another family member could not pay the top-off, you have to wonder what kind of two-tiered system operates in other areas besides so-called cosmetic medical services. In Canada, you find many young people in their 20s and 30s walking around either with no teeth or with most of their front teeth missing because they cannot afford to pay a “denturist” (that is, someone licensed to manufacture and install dentures to patients, someone not a dentist) the up-front cost of the dentures, so the patient (yes, the patient, not the denturist or the dentist) can get partial reimbursement from his or her dental insurance, if the person has insurance. Why are replacement teeth considered “cosmetic” when teeth are necessary for oral health, a defense against mouth medical conditions? Canada still has the problem (same as USA) of how to wean doctors and dentists off the idea that their degree is a license to print money, and that there is no difference between wanting to practice medicine and dentistry as a career and practice one and the other as a public service. Somehow helping people often gets lost in the desire to help yourself. Thank goodness that in the USA there is a movement to provide free dental and medical service that is growing here. But in Canada, I found that the idea of giving a pro bono medical service as part of one’s private practice for doctors and dentists is anathema among a group of practitioners dominated by careerists.

    • I have experienced it all in Canada. I was down to 99 pounds two years ago (I am 5′ 6″) and desperately seeking a referral to a gastroenterologist from my G.P. Although he is an excellent G.P. in many ways, I guess he found it hard to get me into a specialist. Now I have gained 30 lbs. but am still subject to recurrent periods when I cannot eat much. I have been helped however, with an anti-nausea chemotherapy drug prescribed by my G.P. Quite simply, when I take it (usually 2 at a time at a cost of $12 a pill) it changes the situation for me. Otherwise, I would not be able to eat anything due to nausea and fullness, despite having ingested nothing. How do I pay for this? I get extended health benefits from my employer, which cover 80%, until I have paid $1000., Then they pay 100%. Unfortunately, you have to pay upfront at the pharmacy, and they reimburse you later, once you have completed and sent in your paperwork and bills.
      Many Seniors have a different program. They are directly reimbursed when they pay for the drugs.
      My experience with endometrial cancer has also been interesting. I first went to my doctor with symptoms in the fall of 2009. He ordered an ultrasound, which I did not receive until March 2010. We had both assumed that my symptoms were due to perimenopause, and the presence of an extremely large fibroid. After consultation with a ob/gyn in my hometown, who wanted simply to remove my uterus abdominally, I switched, on the recommendation of a friend, to a ob/gyn in a nearby city. This lady was extremely thorough, and in July, through the samples she took during a minor surgical procedure, determined that I had cancer. I was scheduled for a full abdominal hysterectomy in late August (almost half a year from when my symptoms had first appeared. The surgical procedure went quite well. There were no lymph nodes involved, although there were some “atypical cells” found in the peritoneal fluid. Although my cancer was stage 2 (spread to the cervix) It was, fortunately, grade I (a slower growing cancer. in fact, my ob/gyn said I had probably had this cancer for years.) I had the option, after the surgery site had healed, of proceeding with bracytherapy, a more localized and supposedly positive alternative to full-beam radiation. I was treated with thoroughness, consideration, and care during these procedures, with minimal side effects. I have check ups with my regional cancer centre every 4 months. If I choose, I can get free rides for these visits through the Canadian Cancer Society volunteer drivers, who have been amazing. Ultimately, what is my point?
      I paid zero for all of this. No co-pay, no deductible no nothing!
      Even for a lovely semi-private room in the hospital after my surgery, my bill was zero. I simply walked out of the hospital with some friends to help, and went home, with no bills to pay, even for post-surgery painkillers (which I used minimally, and which were reimbursed later.)
      Why on earth would I want to submit to a U.S.-style system where I could conceivably go into bankruptcy and potentially lose my home, while simultaneously dealing with a potentially life-threatening illness.
      The thing that galls me the most, is that many of the people in the U.S. who support the current system, are Christians. What happened? Did they not read the bible properly? Did they skim the parts about Him washing the feet of the poor, and caring for the lepers?
      It seems to me sometimes that American conservative doctrine has nothing to do with religion. It simply stands for lower taxes (allowing you to keep more money for yourself, and not help others) more guns, and simple abandonment of those who cannot afford preventative care, eg: mammograms, pap smears etc., and essential medications, forcing them to use emergency rooms when their disease is sometimes in advanced stages, costing not only more in emergency room and hospital care, but taking a terrible toll on family members who fully realize, that if the system were different, their relative could have been saved. Many of these family members must also curtail their jobs while caring for kin.
      The Canadian system is not perfect. We need to pump more money into it, which is unlikely under our current government. But still, how ever attractive a job might be, nothing would induce me to reside in the U.S. and deal with their policies for pre-existing conditions, denial of claims, and never-ending, and sometimes ruinous, deductibles and co-payments. I am proud to be Canadian!!!

    • Elaine: Insurance companies in the USA can no longer deny you health insurance based on a pre-existing condition under Pres. Obama’s health reform laws. Slowly, like other great reforms, America is changing for the better on health insurance. Like other great reforms that began here, such as social security, public education, the land grant colleges, the GI bill, and Civil Rights for minorities, Federal Drug Agency, Medicaid, health care reform here has some issues here that Canada ought to consider as well. One is how we provide health care. The role of nurse and the role of physician need to be reformed and fundamentally changed from careerists to care-takers as public servants. American is a feer country than Canada, and our freedom scares many Canadians except when they want a nice vacation below the border in the winter, a stock broker, or medical specialist in 24 hours. Few Americans want to retire in Canada, but the number of Canadians who want to have a second home for retirement in the USA have created a real estate specialty market here.

      • “Few Americans want to retire in Canada, but the number of Canadians who want to have a second home for retirement in the USA have created a real estate specialty market here.”

        Funnily enough, Sweden is full of people who retire to Spain, but Spain has very few people who retire to Sweden. I guess Spain must be much freer than Sweden. Either that or people like to retire to warm climates. Nah, I’m just kidding, if that were true, then the Canadians would all be retiring to Florida instead of flocking to North Dakota like they currently do.

        :facepalm:

        • yeah, best to quit there, or I would suggest that Canada become part of an American Union, like the European Union, but that would mean giving up your sovereign, the Queen of England, and becoming part of our Democratic Republic. I suspect the Loyalists still there would have a fit. Oh, well. not everyone wants to be under British rule either.

      • Carla,
        I was under the opinion that it is only children, at the current time, who cannot be denied coverage due to pre-existing conditions. I am sure that a plan exists to extend this to adults, but when will it be implemented? And will the House or congressional support be available to do this when the time comes? So many politicians benefit from the financial support of for-profit insurance companies that I really fear for your country, and for what its politicians will can dare to do!

      • Carla, as for freedom for Canadians, go ahead and conduct a poll. How many Canadians would be willing to exchange their system for yours?
        Personally, however attractive a job offer in the U.S. might be, I would feel compelled to reject it. Why would I want to submit to co-payments, deductibles, and maybe denial of care? (and at this point, for adults, possible rejection, due to pre-existing conditions)
        I got two new cats this year when they were kittens, just so I would not have to deal with the requirements for prior conditions, and higher premiums, due to the date at which they were enrolled. The for-profit pet insurance industry in this country more closely mirrors your circumstances.
        Why would I want to risk possible bankruptcy, or the risk of losing my home because of the medical bills that accumulate even if you have, what is considered in the American system, to be “good insurance”
        Why would I want your drug costs?
        As I have said before, I believe for-profit medical care should be banned!!!

      • You wrote that insurance companies cannot refuse us, but what about the doctors. I am on Medicare, have good secondary insurance, but when I tried to find a new doctor, every office I called asked me what my primary insurance was or my age, and as soon as they realized it would be a medicare patient, they told me in no uncertain terms that they do not take medicare patients. When I offered to pay on one call, I was told that is illegal and that I would be breaking the law.

        This is why I am ever so grateful for alternative practitioners and natural care. I hope I never need to real doctor because the one I have is not of any help. And I know that I cannot find a new one.

        My advice, be sure you have a good doctor before you retire and before you are ready for medicare.

    • There’s one problem with your analysis. The diversion in 1966 was NOT the diversion of Canada from the US in spending. It was the diversion of the US from everyone. From the late 60′s on, the US has outstripped every country in healthcare spending. Is it a coincidence that this was when Medicare — an open-ended un-cost-controlled single payer system that shifts some costs to the private sector was introduced?

      • Medicaid’s cost isn’t controlled? Here’s the problem with YOUR analysis. Medicare rates of payment are growing, yes, at 400% the normal rate of inflation… but the rest of non-medicare spending has been growing at 700% the rate of inflation. Medicare clearly does a BETTER job of controlling costs than the American private sector, it’s just not doing as well as the rest of the Western world… but then it doesn’t have as much power as other centralized systems (Obama’s bill does some things to help fix this – SOME things).

    • The doctor shortage in Canada reflects the administrative malfunctioning of the medical school educations in Canada. Too many Canadian doctors are overworked so that they repeat their diagnoses rather than individually tailor the diagnosis to the distinctive pattern of the condition of the patient. Too many medical diagnosis seem to be based on rote memory of the doctor rather than observation. Med School officers have the same problem. The Dean of Alberta School Dr Philip Baker NPR reportedly gave a speech at a banquet for medical school graduates that he plagiarized from a speech given by Dr. Atul Gawande at Stanford University’s medical school in 2010.
      http://www.npr.org/blogs/health/2011/06/13/137152590/canadian-med-school-dean-irks-students-with-copycat-speech?ft=1&f=1001&sc=tw&utm_source=twitterfeed&utm_medium=twitter

    • In case anyone is curious the province of Ontario maintains a wait times statistics web site: http://www.health.gov.on.ca/en/public/programs/waittimes/

    • I truly appreciate this post. I’ve been looking all over for this! Thank God I found it on Bing. You have made my day! Thanks again…

    • I’m Canadian, happily living in the US, and have dealt with the Canadian (actually, provincial) health care system for my parents who died at 90 and 93. Unfortunately most of their health concerns were emergencies. Mother had her new hip the next day, replacing a broken one, and Dad’s shattered shoulder was operated on the nexr day. My sister waited for her hernia appointment, as it was not going to kill her.
      There is such peace of mind, and Christianity, that all, no matter their economic station, get treated. Grumble, but get treated.
      Those who can afford to, buy supplimental insurance for medication, dental, vision and other things. The provincial systems are bare bones but suffice – really – . Canadians grumble until you ask them if they’d like the American system of insurances.
      I feel guilty that my husband and I have excellent insurances here in the US, but we’re not retiring until we can get on Medicare.
      The people against a single payer system all can’t wait to get on Medicare, which is a single payer system. Ooops!
      I like the provincial, rather than a national system. Saskatchewan has a higher incidence of M.S. so they are trying some alternative procedures to see if these procedures fall into best practice studies. The provinces must do these studies to try to keep costs logical. It is rationing, but so do our insurance companies in the States, with a for-profit motive.If a province finds a procedure works or doesn’t work, the other provinces would likely follow. Innovation would happen if each state did its own.
      Americans are much much more religious than Canadians, yet they fool themselves that the poor get treated but some charitable entities all over the place. The poor struggle and the middle class sometimes bankrupt themselves over medical treatment. Greed for Cadillac insurance programs, for low taxes, and a disregard for the true suffering does not really line up with Christian values- where are all the churches and “values” people on the issue of care for our poor and middle class? The less religious Canuks are caring more and sharing more. We musn’t turn a blind eye to our own people. Our system is not working for 43 million, and they are struggling and indeed suffering.

    • There is a question not addressed here: how does the legal system in Canada handle medical malpractice? In the US, the cost of med mal insurance is enormous. My sister and her husband, both doctors whose practice was almost all medicare patient, spent far more on insurance than their combined salaries – and neither of them has ever been sued.

      • Dear Unsure, I am unsure. I don’t remember hearing horrible malpractice suit stories, but I was only in Canada once a month for 10 years, helping with my parents’ care. I do read their newspapers daily(Toronto Star and other Ontario papers) and don’t read about suits. I suspect as a people they are less litigious, but someone out there will know the answer to your question.

        A doctor can take OHIP (Ontario Hospitilization Insurance) or be paid privately, but cannot do both in the same year. So one private payment means no insurance payments from any patient. It is not two-tiered.

      • Canada is generally a lot less litigious than the US, so people don’t tend to sue doctors quite as readily, and I don’t think awards tend to be as big.

        That said, I believe the studies on malpractice reform in the States tend to show that it really wouldn’t save much money at all in the big scheme of things. Expensive as legal insurance is for American doctors, it’s peanuts compared to the overall amount of billing and over-billing, and failure to control overall costs. It’s not that it couldn’t save any money, it’s more that it’s the proverbial bandaid over a chopped-off leg.

    • Hey everyone,

      We’re getting a huge amount of traffic today on this post, coming from Ezra Klein’s blog. Anyone want to tell me how they got here (what sent you to Ezra’s post)?

      Thanks!

      AC

      LATER — We have our answer. Thanks all!

    • I got here thru Washington Post

    • Came to Ezra Klein’s website via washingtonpost.com

    • I grew up in the Wash DC area and read the WaPost online regularly.

    • I arrived at your website from Ezra Klein’s post, which I saw on the Washington Post website.

    • Today’s front page of the WaPost: Ezra Klein’s link to this page, under the headling “Busting Myths about the Canadian Health Care System.”

      Great post, by the way.

    • Came though Ezra’s link. Interested in all things related to health care costs and single payer system.

    • Ezra Klein’s post is linked to the front page of the online Washington Post today. Glad I saw it, as it answers a number of questions I have had about the Canadian system. My son is at Mount Allison, and I have talked to Canadians who say their system is fine, sometimes they have to wait a little, but that’s not a big problem–which is confirmed by your statistics.

    • Linked to it from Washington Post

    • I live in the us, and have had insurance from my employer throughout. As an earlier poster reported, premiums have risen, and coverage has fallen every year. Dental and vision care vanished years ago, the premium is now some hundreds of USD per month, and the deductible $5000 with coinsurance beyond that. (These are the in-network figures). Choice of insurance company vanished about 10 years ago.

      My wife needed a surgical procedure. Her doctors proposed it, she met the insurance company criteria, but approval by the insurance company took more than a year. This, of course, meant that many of the tests that the insurance company insisted upon to check for ‘need’ were spread over two years worth of deductibles.

      Finally we had to advance more than $20000 so that the surgery could be scheduled. Once that happened the insurance company finally OK’d it (the papers reached us after the surgery.) We then had the challenge of trying to get the $20000 back.

      My parents and other relatives live in the UK. I have several aunts who received (free) hip replacements within weeks of their doctors referring them, my father has had (free) a pacemaker/defibrillator with remote monitoring by telephone line. When he needs a checkup he and my mother are both driven to the hospital and then home again, by the Health Service, since they live so far from the hospital (about 50 miles).

      My father once was taken ill when visiting us here. He was insured for the US, and provided the details to all. The first aid squad billed $6000 for the trip to the ER, the ER billed something in excess of $20000, and various others billed another $10k or so. The insurance company paid all the bills it received, but collectors for some of the providers kept calling me. I would give them the insurance details, but they had no procedure for billing an overseas insurance company. The billing staff were unable to call overseas, or to send letter mail overseas, and even if they had been permitted probably would not have known how to code to whatever the requirements of a UK company might be.

      I fail to see how the US system can be held up as superior even to the UK, despite more than twice the share of GDP being spent. Doctors in the US have less satisfaction, and in primary care work longer hours for less money that their UK counterparts. At least part of this is because despite standardised codes and electronic claims forms each insurance company is free to make its own variations from the standards, and most of them do. This delays or eliminates actual payments to providers. When my wife (an MD) queried one of the claim rejections the insurance clerk declined to say how the insurance company wanted the treatment coded wiith the words ‘That’s for us to know and you to find out.’
      This ‘hassle factor’ won’t go away under Obama’s proposal.
      There is a long way to go.

    • My experience with this is as an American parent who has a child going to McGill U. in Montreal. He pays about $400 per year for access to Canadian healthcare.
      I also had a sister who was a nurse at the Mayo Clinic, which provides health care, cash on the barrelhead, for rich people. One of her patients was the Shah of Iran, another was Mickey Mantle, in to trade in his alcohol-ravaged liver for a fresh one. Well, he’s rich, right?
      Canadians can certainly come to the U.S. for treatment, just as Americans can go to Costa Rica, or Thailand. Medical care is a global commodity, and money talks.
      This does not speak the the problems of people who don’t have money to do their talking for them. In the U.S., those people are simply not heard, until they become “poor.”

    • ECKs & Joy: Single Payer health insurance in Canada works about as well for Canadians as your single payer legal insurance for clients needing pro bono lawyers and your public school education system in parts of Atlantic Canada.

    • Beth, a question: Who paid for your schools, your subways, your roads, your city water, your police force, your bridges and tunnels, your parks, your Indian reservations, your flood dikes, your many prisons, your courts, your census, your waste management, your currency, your copyrights, your audits, your spying agencies, your amateurish elections, your forest management, your brilliant Library of Congress, your silly space agency, your fisheries management, your lovely Peace Corps, your parole officers, your veterans, your TVA, your customs and borders, your postal system, your weather service, your bloated military required to kill assassins creeping up your shores, your firehalls, your departments that test for toxicity of thalidomide, mercury, and 2,3,7,8-tetrachlorodibenzodioxin, which you dropped onto the countryside of Vietnam? It’s hard to believe that Beth is an MD. Education is a wonderful thing, she should try it.

    • Sorry Carl, but we have all the rights you listed: freedom of speech, freedom of religion, the right to own a rifle… The others you allude to you deceitfully didn’t mention. Of course you don’t have the right to a nuclear tactical device so your unable to defend your paranoid self from your paranoid government. You also don’t have the right to simple and fair elections (see 2000 Bush vs. Gore). BTW, the House of Commons decides everything in Canada, similarly to how it is done in say England. The Senate has no power it’s just where political cronies are rewarded, kind of like your Supreme Court, you know, the one that undemocratically decided the 2000 election. As far as recall, I live in B.C. and we can recall our elected officials and we can propose legislation by referendum.
      Last time I checked America is where all the corrupt lobbyist-bought politicians lived. You threw away any checks on the robber barons running the entire show. Money is king in your media-controlled rotting roman empire. I have no idea if you have lower taxes but is that something that a citizen-minded person is proud of? The Danes have one of the highest tax rates in the world and some of the best social care that exists along with some of the best health and longevity. It’s a pity they are not crying out for assault weapons though.

      • hipsabad: Yes, you have on paper many if not most of the freedoms we have but you have also restrictions on your freedoms that we don’t have. You have freedom of speech, but then your public figures and public officials have the right to suppress opinions through defamation laws that we don’t have. You have the right to freedom of religion, but you also subsidize religious schools to a degree of government entanglement with religion that our First Amendment would not allow: there is no wall of separation between religion and government in Canada such as we have. And your long gun registry and restrictions on hand gun ownership would not be allowed by our First Amendment. A politician like your former PM Brian Mulroney would be in jail if he had been our President and accepted a bribe from an arms dealer as Mulroney admitted he did while Prime Minister. And there is no winner take all in our electoral process such that minority parties absolutely lose all patronage when they lose control of the government. It is possible in our system for one party to control the legislature and the other party control the White House. Our Supreme Court reflects legislative intent; our President proposes men and women to our highest court, and our Congress disposes of them through approval or rejection. Your appointed Senate is a political body, like ours, but it is not elected by the Canadian voters, as our Senators are elected by the American people. Your Senate is kind of a House of Lords, except there are no hereditary Canadian Senators as there still are some hereditary British Lords. Finally, you have some very corrupt bureaucrats and politicians at the provincial and federal levels of government. Unlike our politicians, Canadian political corruption is whereby your officials enrich themselves dispensing patronage in “private member’s bills.” Sure it’s not illegal. But it sure seems to defeat the idea that politicians are elected to ‘serve the interests of the people” not to stuff their pockets with money. What I witnessed in my time in Canada was an eye-opener. I found that like sheep, Canadians follow their shepherds whither led to the cleaners or shearing house. Above all you trust your government, unlike us Americans who never fully do.

    • The proof is in the pudding: The American political system is perfectly suited to the aims of the plutocracy that is slowly enveloping the U.S. The middle class is shrinking, the moneyed class – what were robber barons in the 19th century – is winning. This is a beacon for the world? The world’s already been there: Rome, Renaissance Italy, 16th C. Spain, 19th C. Russia, etc.

      These comments have strayed far from the topic of relative merits of medical care between the systems in our two nations and so I should cease. We really should be quoting Aristotle, Machiavelli, John Locke, Hobbes, Hume, John Stuart Mill, John Dewey, and John Rawls as they have devoted much more serious time to these concerns.

    • Beth, if this were 150yrs ago and we were talking about public sewage and the ability to have running water come from your faucet, it’s apparent that you would’ve argued that you have your own private outhouse with a deep hole that you clean yourself and a well for water that you run buckets to and from so you don’t need to pay for anyone else’s sewage or water, correct? What’s mine is mine, right?

      But aren’t we all better off with a public waterworks system??

      If you don’t get the concept of single-payer, it’s ok. What we’re doing is removing the For-Profit Insurance aspect of healthcare. Follow the money. Eventually, their lobby arm trickles down to guys like Carl who troll these message boards and attempt to argue against gravity.

    • Gee, drew/hipsabad/Ecks: Great minds think alike! But if the only value in these dialogues is for you to claim the superiority of health care in Canada over America, we’ll learn little from one another’s different experiences. A defense of Canada’s health care system is not a basis for objective evaluation of it. If Canada’s system were actually better than America’s you wouldn’t have to promote it to us—-we would have already adopted it. But there are many national health insurance programs, None of them are absolutely superior. But we appreciate Canadian suggestions, I assure you, for our own. If only that appreciation were reciprocal when we offer suggestions for Canadians.

      • There goes Carl again, pulling directly from his Insurance Lobby talking points on how to scare the public away from a single payer system.

        Carl, I’ll ask again, can you name me the most profitable Health Insurance Companies outside of the US??

        You know why Carl can’t answer this? Because the US is the only country with For-Profit Health Insurance. That’s where all the rising costs go and anyone that says otherwise is like Carl and a pawn of the Insurance lobby who gets paid to deceive, spread misinformation and scare America into keeping the status quo. The US system supports Insurance Companies where Fat Cats sit atop the Board of Directors and their sole mission is to increase shareholder wealth.

        Single Payer = Death of Insurance Companies. Why do you think they’re spending so much money to keep status quo in this country? Public Option = Death to Insurance. Single Payer = Death to Insurance. Follow the money and see who benefits…

        • Carl may be wrong about a lot of things, but insurance company profits aren’t the primary reason why everything costs so much in the States… You could make them all non-profit tomorrow and it wouldn’t change the math a LOT of itself. Most of the extra cost is in doctors and hospitals being able to charge more… the reasons for this being so are complicated and have to do with the profit motive and the amount of relative information and power they have in a competitive system relative to dozens of fractured individuals and insurance companies.

          • You are right about the rising costs. The beauty of a single payer system or in Canada, the provincial systems, is that they can negotiate and also determine just what they will pay. The hospitals and doctors would like it to be different, and they actually could opt out of provincial insurance payments, but choose not to. They would have to be out for a year, and for every patient – not be able to accept Ontario Hospitalization Insurance (OHIP) from anyone for a year.

            Cost containment, health resources allocation, hard decisions, basic insurance and sometimes disgruntled clientelle, but everyone in Canada is covered.

        • Drew – while I am loath to defend insurance companies, which as a group have behaved deplorably, the main problem is not exorbitant administrative costs. Yes, the administrative costs are too high but removing excess admin costs (by whatever means you choose) shaves only a few percentage points off our total spending. Addressing excess admin costs is a good idea, but it is not sufficient to fix our problem.

          Our health care spending problem is not the amount we spend today, but the amount we will spend in 10-20 years based on current growth rates. So the true problem with insurance companies is their inability (or unwillingness) to control costs.

      • A majority of Americans would currently not choose to switch to the current Canadian health care system, but the overwhelming majority of those Americans have zero experience of the Canadian health care, and really don’t know much about it. So when you ask them “would you want the Canadian health care system?” What you’re really asking is “would you turn in the system you know and are familiar with for this one that you know nothing about other than there are rumors of enormous waiting times.” It’s not surprising they say they don’t want it.

        On the other hand if you ask them if they want something close to Medicare (which they ARE familiar with, and which is very similar to the Canadian system) then all of a sudden they overwhelmingly and resoundingly say “yes.”

        I’ve said this before Carl, but I know you’re not a very good listener, so I’ll say it again: I’m not a particularly big supporter of the Canadian health care system. I’m just as happy with the French or British or Swiss one, whatever. I’m just an enormous critic of the present American system – not because Americans are bad people, but because it completely fails to provide a considerable portion of the American population with basic and necessary health care. That, of itself, is a condemnation that no amount of handwaving pronouncements of “freedom” or accusations of national bias can overcome. Millions of Americans are suffering badly who don’t have to. That is the bottom line, and any defense of the American status quo is a defense of that suffering.

        • Ecks/Joh Hogg/Drew: Am I to suppose that you’ve taken a poll of American knowledge of Canadian Health Care insurance? Where is the poll? But Americans, if the latest polls on what our kids know about our history or civics is any indication, don’t know much about a lot of things.
          ( http://www.sullivan-country.com/nf0/ep/history.htm).
          And no doubt their parents don’t know a great deal about American health care, medicare or medicaid, or fee-for-service insurance options either. But I have direct experience with the Canadian system. I know some of its reported lapses in the Canadian media and in media published documents from Canadian elected officials in “question periods” in National Parliamentary debates. And as I’ve indicated in previous posts, I never said that you are a big supporter of the Canadian system, but the difference between us is that you don’t offer specifics why you aren’t, and I do specify my critiques of it with actual references and facts. I’d advise you to leave your universal critiques of American health systems to the pulpit, and leave your sweeping generalizations out of a rational dialogue. It’s not effective argument. To claim that “any defense” of the American system is “a defense of (American) suffering” is simply faulty generalization, as some of us have taught our students in English Composition 101. “Any” can’t account for exceptions. And I believe that American health care needs much reform to take care of the needs of many segments of our population. But Medicare isn’t all bad or all good either; and it too could use a great deal of reform, as could Canada’s system of provincial health insurance. Please consult the problems raised in the Canadian press, for instance, of Canadian health insurance coverage of mental illness, addictions, soft tissue injury in accidents, children unable to develop mentally (severe cases, as defined in Canada, of “autism” and Alzheimer patients with spouses and a home but no private insurance, not even for funerals!). And also see the caps on medical malpractice in Atlantic Canada. I know something directly and specifically about the coverage glitches or lapses I’ve just mentioned in Canada, and I know that in the States some of our federal medicaid and state health coverage is better for the afflicted people and their families than the Canadian services. Were you to defend the superiority of the Canadian system in those areas over those in many states of the USA would be a defense of Canadian suffering. One size does not fit all. Like everyone else, when I want something from my government, I don’t mind if my government taxes me and you for me to get it. But I’m sure you would want to be consulted before the government imposes a tax for something that largely benefits me. And when you want my government to tax me for something you want, I want my government to ask me whether the tax is okay with me. I don’t work for American health insurance companies. I have nothing to do with them except to pay for their services when I find one that appeals to me. It’s my free choice. And that’s the difference between Canada and the USA. Canadians don’t have a choice about the national-provincial health insurance esp when it comes to many health afflictions needing specialist attention. I don’t see that Canadians were ever asked what they wanted in all the provinces. Like so many government dispensations there, Canadians simply had no choice or say in Atlantic Canadian provinces but to accept the health insurance that the federal government gave them. If ever you have the chance to come upon homeless families in a stroll one summer evening through Toronto, downtown Vancouver, Calgary, Montreal,or Halifax, ask them why haven’t they taken advantage of Canada’s national health services? Be sure to report your findings here. As I’ve said, the US is just beginning it’s quest for a fair comprehensive system of national health care for our citizens. Much like our quest to put a man on the moon, there will be many glitches, many false starts, and a great deal of trial and error at the state level. But in the end we will have state health insurance programs that serve the needs of Americans. It may be multi-payer in some cases; in other cases it may be entirely single-payer. But it won’t be what Canada, European countries, the Arab Gulf States, or, sigh, what Israel offers its citizens, but it will be one that most Americans don’t mind paying taxes to have.

          • Carl, you are right that one size doesn’t fit all, and I don’t care who we imitate. I don’t even need to defend the provincial Canadian health care systems. I need my car mechanic to be able to have insurance. I need my friend whose child has a chronic disease to afford insurance for his whole family. I need my friends who have had cancer to not hear in the middle of treatment, that they have reached a cap. I am not kidding.
            I don’t need to tell them – “Well, if you had pulled yourselves up by your bootstraps you could have afforded this like my husband and me…” Of course, I don’t, but that is the implied message when health care becomes a luxury I get and others don’t.
            And when my friends cry, they don’t need to hear pretty speeches about freedom for the individual, why should we be made to help someone who didn’t put this altogther, etc.
            We need a way to contain costs, hold down huge lawsuits so malpractice insurance doesn’t become outlandish, insure everyone including the young healthy 20 somethings who think they won’tneed insurance until later, keep any insurance company from cherry picking only the healthy and leaving the rest for some government program, – sounds like single payer systems to me!

            • Joy Hogg: Yes, one size doesn’t fit all, but one time doesn’t fit all either. And we in the USA are wrestling with the costs, as former Vermont Gov. and former Democratic Party Chairman Howard Dean, MD, said, the freedom of MDs to charge excessive fees for their treatments. It’s the same problem patients with insurance caps or no health insurance from Prescription Drug Companies. These collectively form a elephantine size political problem. But the way to eat an elephant is in little bites. One promising direction seems to be in resolving the issues of health responsibility for nurses. As you’ve probably notices, MD’s make terrible nurses. And you probably would not want to be diagnosed and monitored for cancer by only a nurse. But when a doctor’s office charges for its services, it usually does not matter whether the nurse, the doctor, or both see you. There is a flat rate charged, either you, your insurer or the government. But nurses who have been trained as physician assistants (nurse practitioners) are well qualified to independently treat a number of maladies, as well as to monitor their treatment and write prescription medications for the treatment. We need to seriously examine the present division of health care delivery for reforms to the labor system, for instance, the schedule of compensation for health services. We may wish to reduce the health care compensation to health providers for treating ills that are either incurable or long-term conditions( mental illness, addictions, diabetes, etc.) as opposed to one-time treatments, say, a broken limb from an accidental fall. But in all cases we want a government single payer health insurance for those who cannot afford health care insurance in cooperation with the government and private insurance companies for health care. We have to mandate health and burial insurance coverage, whether part or whole governmentally insured, as we have for the last 200 years for Seafarer/ Merchant Seaman’s Insurance for our commercial and government Sailors. And I hope it’s a better system than Canada’s when we decide on our health care system for all Americans.

          • Hey Carl Senna, now you’re doing a fine grandstanding show of hypocrisy. Sounding more like a desperate, confused politician in the land that spends more for health care per GDP than any in the world yet somehow does not have the healthiest population as a result. Those damn socialist countries whip them again. Places where, as you say, no one can speak freely and must submit to church. Places like Germany, Holland, Switzerland, Sweden, Denmark, Iceland, Australia, Canada. You really should get out more often. Same goes for your parochial politicians. Mind you, our current Prime Minister suffers from the same insularity. On the other hand you’re right: None here can carry assault weapons to the supermarket. Sadly, no armed discount on groceries.

            ‘Sweeping generalizations’? Give us a break. Here’s some of yours:
            “If Canada’s system were actually better than America’s you wouldn’t have to promote it to us—-we would have already adopted it.” Ha! Really? Why? Cause you’re so damn blessed with the good sense the rest of the world lacks?

            “there is no wall of separation between religion and government in Canada such as we have.” Ha! Tell that to a Republican presidential candidate. You do know that the founding fathers were all ‘good, god-fearing bible readers’ don’t you? Like I said before, see how far you get running for US president and claiming to be an atheist. Canadian voters don’t concern themselves about those things, except perhaps if they live in ‘little texas’, i.e. Alberta, where our current PM comes from. Mind you, things are changing: the effect of being a thinly spread mouse living next to an elephant means that we are showered 24 hours with the cheap myths of your gross media spectacles, and thus sip the same Rupert Murdoch kool-aid.

            “you have some very corrupt bureaucrats and politicians at the provincial and federal levels of government.” “Canadian political corruption is whereby your officials enrich themselves dispensing patronage in “private member’s bills”” “elected office is foremost a career job to boost one’s lifestyle and pension.” Ha! Do the names Rod Blagojevich, Ray Blanton, Edwin Edwards, Nixon’s vice-president Spiro Agnew, George Ryan, Randy Cunningham, James Traficant mean anything to you? All politicians that had bribery convictions, extortion or just plain theft attached to their ‘careers’. Or how bout the quintessential American example, Budd Dwyer who shot himself in public before cameras to avoid prosecution for bribery? How about the money launderer, Tom DeLay? Then there’s some past giants of corruption, like Huey Long and Boss Tweed. And this doesn’t even include illegals like Cheney, John Mitchell, Haldeman, Erlichman, nor the Reagan ‘guns for hostages’ participants, Oliver North, John Poindexter et al. It’s obvious that in any country public officials can go bad, but you seem to sweepingly generalize your accusations toward Canadian cities!

            “Canadians follow their shepherds whither led to the cleaners or shearing house.” Yes, Americans are never sheep-like in their responses. For example the bleating politicians and public that swallowed the WMD fabrications for invading Iraq. The Roman public loved it when their wars brought plunder; not so much when the Emperor plundered their own treasury in prosecuting futile ones.

            “Above all you trust your government” Ha! Whither this?

            “it will be one that most Americans don’t mind paying taxes to have.” How can you possibly know that? For one thing, Americans are changing, world conditions are changing. One year Americans vote out all the Republicans for soaring costs of mismanaged wars and massive economic implosion; two years later, they vote them back in. Doesn’t sound terribly level-headed to me.

            In your defence, I will say that your last long comment attempted to be more constructive, approached more particular concerns and seemed more open to issues. Cheers!

          • And now you’re back to being pretty much reasonable. Yay!

            You want details, how about these. The US currently has 40-50 million people who don’t have health insurance. Medical care is the single most common cause of personal bankruptcy in America. The US currently spends nearly twice as much per person as Canada and the rest of the developed world, yet all this extra spending produces mortality and morbidity outcomes that aren’t particularly better (adjusting for initial health), and are sometimes a little worse.

            I don’t deny that the Canadian system is riddled with flaws, and that Canadians spend a lot of time and energy griping about their health care (pretty much everyone does, it’s part of the human condition near as I can tell), but all of the problems that you have listed with Canada’s system (and for sure they are real problems) pale in magnitude compared to the ones I’ve just listed for America. Seriously, go back and look at your complaints, and ask if any of them compare to high rates of personal bankruptcy and just over 10% of the population living without insurance of any kind.

            I’m not particularly concerned that America move to a Canadian style system – or a British one, or an Israeli one, or their own version. I don’t really mind whether it ends up with a single payer,a government run system, or a heavily regulated set of competing private firms. In fact, I hope that the US really CAN come up with something better than Canada has. That would be great news for hundreds of millions of people, and you’d have to be an enormous jerk NOT to want that. Unfortunately I’m not very optimistic for its prospects at present, as one of the major parties seems far more interested in screaming “socialism” and throwing fits about no new taxes never ever ever, and trying to block even ideas that they have supported in the past when the other party tries to carry them out. That’s a major impediment to real change. I wish the USA the absolute best of luck in spite of this portion of its population that is so [insert-epithet-of-choice] that it seemingly does its damnedest to try to block any real change or improvement from coming through.

            • I wish we would keep to the problem of affordable health care and quite going off on long discourses about “socialism, capitalism, corruption, etc.” If you have a sick person in your family and no health care, you are not interested in those distracting arguments. Only those sitting pretty with health insurance care about those arguments, becuase they are not in panic.

              While we have been discussing, Canada’s federal government has decided to fund studies about a new treatment for one of the problems with M.S. – the closing of veins or CVVS treatment to open them and let the iron buildup in the brain receed, hopefully. The provincial system in Saskatchewan, which has a large cluster of MS, is already funding this.

              This is how their system works. It is not based on profit. If the studies show little effect, the provinces and government will no longer fund the study and CVVS liberation treatment which is available in the states, for thousands and thousands of dollars, will not be provincially funded. The Canadians will grumble both ways, but are second in the world after Australians for happiness, according to a recent poll.

              Get off your political smoke screen discussions. If you have studied these other country’s systems, talk about the good and bad in them.

              I think a single payer system, designed by each state, with power to negotiate fees and costs, is the way to go. There should be incentives for the docs to accept the state insurance – like in Canada, where the pay and lack of collecting issues is worth it for the docs. Canadian docs can refuse provincial insurance, but cannot take a single patient provincial insurance for the rest of a yar. Cannot cherry pick.

              I have heard friends talk about the confusion of the many many choices and plans here in the U.S. Imagine if you were old and dealing with the complexity we have here. Even my husband and I are challenged as we try to navigate our medical insurance options for retirement soon, being 62 and not yet eligible for Medicare (single payer system we all want on but don’t mention).

              Let’s get off the high horses and down to the ground where people are suffering and going bankrupt – and not because they are defending some principals. It is because they can’t afford, didn’t bother to buy, were denied, put it off, capped out or just couldn’t believe it would happen to them and made a dumb choice not to have any.

              Joy

    • hipsabad: The difference between Canada and us is that our political crooks get caught more often than yours. Sure, we make lots of mistakes at the polls, just as Canadians do, but having lived in both Canada through 3 Prime Ministers, as an American who could not vote there, I found that your members of the legislative assembly and municipal government of many Atlantic provinces during my stay there to rank right down there with convicted influence peddling Illinois Governor Blagoyovich, Detroit Mayor Kwame Kiplatrick, and the others you name. The list of Canadian politicians involved in bribery and payoffs is much too long to list here, but Brian Mulroney, Jean Chretien, and counting down in rank is a good place to begin. And they are only the ones who admitted taking bribes, or payoffs in kind, for personal favors. I have worked with several elected officials in New England and the Deep South in the USA, and some of them were involved in serious political scandals (and a few were convicted!), but some of your MLA’s, MPs, and Senators, as American humorist Mark Twain once said of our Congress, are also Canada’s native criminal class. And that doesn’t even account for some of your bureacratic logrollers. But that’s our democracy. It tastes good, but you don’t, as Winston Churchill once remarked, want to see it made. But there’s a reason Canadians living in the States with rare diseases prefer to be treated in the USA, as do many Canadians who come to our Lahey and Mayo Clinics, our Faulkner Hospital Pain Center in Boston, John Hopkins and Cornell Medical Center, Peter Bent Brigham and Massachusetts General Hospitals, and our other Harvard Medical School affiliates. We are second to none in most areas of medical health, including dentistry. Our problem is how to deliver health care at a price patients who need our first rate services can afford. We’re still making that sausage, and it ain’t a pretty sight to see. But what is clear is that we don’t want Canada’s system of health care, inadequate as ours presently is, and we damned sure don’t want your system of government. We want to catch our political crooks, or have a way to recall our bad apples in government, including the impeachment of our judges when we catch crooks among them as well. The last crooked justice in Canada, Drew Stymiest, the only provincial judge to be convicted in Canada’s history, in the Miramichi Hospital fraud case, was forced to pay $219, 000.00 for theft as an officer of the Miramichi Health Authority in 2006. (http://web.me.com/medicaljustice/pdf/fraud/miramichi-judge-stymiest-hospital-directors-in-new-brunswick-guilty-of-fraud.pdf) and (http://www.nationalreviewofmedicine.com/issue/2006/04_15/3_policy_politics04_7.html) But that illegality was so obvious that the perp couldn’t have walked not even in Canada. It was such a glaring exception to the corruption in your government that many outsiders were astounded. But even a broken clock has the correct time twice a day.
      As Ecks and Joy Hogg note, Americans have plenty to complain about. But under our system of government, unlike Canada’s, we’ve got direct means of changing both our health care system and our government. Our freedom, we believe, is not free, but it trumps what you in Canada espouse as a virtue called”order.”

      • Carl, I guess we’re going to have to agree to disagree. You say Canada is more corrupt than the US, and your evidence for this is a bunch of personal anecdotes and blanket assertions.You say that Mulroney would have been recalled for corruption in the US… Maybe. Maybe. But Reagan sure as heck wasn’t. Bush II sure as heck wasn’t, and he was an out and out war criminal (in the technical sense of ordering war crimes – torture and illegal wire tapping that had to be retroactively authorized by congress being the two examples where the facts of the case and the raw illegality isn’t even ambiguous) and they sure as heck don’t seem to be in jail for this troubles. In fact, Reagan is on his way to full-on deification by the American right. And Chretien is probably a bad example for you as his government WAS booted from power with extreme prejudice when his scandal came out (well the liberals were).

        Coming back to a potential point of agreement, the US care system at the absolute top end (your Mayo clinics, what have you) are as good as anywhere else in the world or better. Yes. But if Ford makes one good car and a load of junkers that doesn’t make them a better car company than Toyota (quasi-hypothetical example here, not commenting on current car lineups). And saying “yeah, there are big problems, but we’ll just fix them” is an awfully big hand-wave to make some HUGE problems just happily go away in this conversation here. If you’re going to be honest, the US health care system is a mixed back with some lovely pieces in it, and a terrible tendency to leak badly and drag a considerable section of its population through a lot of mud. Maybe it will get better – maybe. And if it does you can come back here and lecture us all with far more self-righteous indignation. But until then your case is on pretty darn shaky ground.

        • Damn it Ecks, you have a wonderfully succinct way with words! I have found all of your posts to have been excellent. Kudos and thanks.

      • Carl, gotta love that Winston Churchill quote! There is also this one by Emile Cioran, “A marvel that has nothing to offer, democracy is at once a nation’s paradise and its tomb.”

        When comparing corruption between our countries, one of the elephants in the room is scale. When an empire fades, its crimes’ often involve the lives of millions. Compared to the acts of bribery, extortion, influence peddling, obstruction of justice and kickbacks, etc. all of which are odious in my opinion, there are those crimes which involve not just personal enrichment but death on a large scale for innocent people. As Ecks mentioned, Nixon was pardoned, Kissinger never tried, Reagan, Cheney, and Bush II all free of any charges or investigations. Mulroney at least went through an investigation for his acceptance of so-called ‘consultation fees’ (which he received after he was Prime Minister, BTW.) The fees were for Mulroney’s ability to ‘facilitate’ the purchase by Air Canada of European planes, i.e. the Airbus A320 instead of Boeing planes. I have nothing but contempt for Mulroney but his crimes compared to the presidents above seem paltry in impact.

        As to the various medical centers in the U.S. I don’t disagree that there are some great clinics, especially those attached to universities, where medical research is pursued. We have some good one as well, however, Canada is only 1/10th (!) your population while having a larger land mass. You can see how that might be a problem. It’s why most everything is more expensive up here. Excepting perhaps water, fish and trees.

        But that is not the issue at question. I guess if we’re going to place the two countries in comparison to ascertain which has the most corruption among its politicians we had better move beyond hearsay and into the history books for our quantitative analysis. Any suggestions?

        Lastly, in a parliamentary system every sitting member can be kicked out; all in one election if the voters were to wish it. I don’t know about you but that seems fairly ‘free’ to me. In the American system, rarely does the House, Senate and Executive get replaced like that. Your current struggle with healthcare, War Powers, and the partisan squabbles over raising the debt ceiling are examples of systemic gridlock and the watered-down ‘compromises’ that eventually come out of it. Then there’s the tradition of requiring 60 votes for a pass in a 100-member Senate. And the Senate already is an undemocratic body by virtue of the fact that states such as Wyoming or Vermont with about half a million people each have as much say as Texas and California with over 60 million people combined. Unrepresentative by a factor of 60 – 1! Now that’s some potential for taxation without representation. But worse, most politicians in the U.S. are now millionaires; that can hardly bode well for representing the perspective of that ever-shrinking working middle class. Like many countries in the world and especially in Europe, Canada actually has a party, i.e. the NDP, that has represented the social needs of the working class for many decades. Nothing’s perfect but there’s more choice available here than between the two fat cat parties south of the border.

        We could talk all day about the respective merits and demerits of the two systems; what matters are the results on the ground.

        • hipsabad: I have many Canadians I personally admire in the NDP, Liberal and Conservative parties. My philosophical problem with Canadian government rests on the idea that you remain a “Constitutional Monarchy” by virtue of your legal association with the British Monarch, something that our most important national holiday, July 4th, in the states reminds us of our special status in history. We neither have nor wish such association with Britain as you have. The idea of a monarch, someone whose privileges are legally established by virtue of birth, is anathema to us. You believed that too much power in our country was given to the individual states (e.g. our elected number of Senators, 2 for each state). And in reaction you and the British were guided by the principles of “peace, order and good government” as your legal foundation and national identity. The American principles, in contrast to Canada’s, are “liberty, equality and justice,” drawn from the document announcing our perpetual war with the foundation of privilege in Canadian and British society: We insist, contrary to your “peace, order and good government, ” that: “We hold these truths the be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed,—-That when whenever any Form of Government becomes destructive of these ends, it is the it is the Right of the People to alter or to abolish it and to institute new Government, laying its foundation on such principles and its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.” Declaration of American Independence from Britain, 1776,

          • Goodness me, Carl, I keep forgetting your most important point: America is simply the best damn place there ever was. The rest of the world just doesn’t get it. I gather that’s because they didn’t experience that special colonial scuffle with Britain you make so much of, the one that taught you all you’ll ever need. Holland, France, Britain, Denmark, Sweden, Germany, etc. they’re all wet behind the ears, but who knows, they might mature with time…

            And what’s more, as most Presidential hopefuls will tell you, America’s blessed by the hand of the “Creator”. The American writer Sinclair Lewis said that, “When fascism comes to America it will be wrapped in the flag and carrying a cross.”

            But to that I say, oh whatever, oh heck, oh say, can you see by the dawn’s early light what so proudly we hailed at the twilight’s last gleaming? Whose broad stripes and bright stars thru the perilous fight, o’er the ramparts we watched were so gallantly streaming? …rocket’s red glare, the bombs bursting in air…da-duh-da-da-duh On the shore, dimly seen through the mists of the deep, where the foe’s haughty host in dread silence reposes, what is that which the breeze, o’er the towering steep, as it fitfully blows, half conceals, half discloses… z-z-z-z-z-z-z-z-z-z-z-zzzzzz.

          • Carl, I agree that America does have lovely rhetoric about independence and what have you. But the reality is that wealth and power are very much handed down from one generation to the next in America. Where would Luke Russert, Meghan McCain, or George W. Bush be without daddy? Not rich and prominent or president I’ll promise you that because none of them are really that talented. (that’s a short list, it could go on on and on).

            But those are anecdotes you say? Where are the hard numbers? They’re here: http://www.religiondispatches.org/blog/2377/america_ranks_toward_the_bottom_of_social_mobility/

            In social mobility American ranks lower than Canada and most other countries (though it does edge out the UK). So yes, wealth and influence are very much handed out in the USA on the basis of being a member of the lucky sperm club. In a sense, having an official powerless monarchy is almost more honest as least it’s up front about where wealth tends to come from. Lots of Americans believe that Horatio Alger’s are the rule and not the exception, but this sadly has it backwards.

    • Ecks: As for your auto analogy to health care in Canada and the USA, analogies are the least persuasive argument against verifiable experience. Health care in both countries needs serious reform. And the USA has the more difficult task of the two countries. No doubt about it. But we have tools for reform that Canada doesn’t have. We have the capacity to exceed what you have. Best wishes.

      • Well Carl, your superior system sure built you a doozy. But I’m sure that with a few more quick referendums and recalls and primaries and suchlike you should have this universal health care system licked real soon. I’m thinking lunchtime tomorrow, maybe? And boy will that show the rest of us who only manged to do it a few decades ago. And then, by golly you can put a bit more of that famous American ingenuity to work and you should have world peace fixed up by lets say Tuesday, hunger and deprivation by, oh, Thursday, and is eternal salvation too much to ask for next week? Thanks bud, you’re a star.

        And if you ever want to talk it over, we’ll be up here to the north, same as ever, building your cars and Blackberries and trying to look after each other best we can. As you say, we’re not doing it quite perfectly yet, but hey, we’ve all got problems. Who knows, though, some day we might even start to catch up with you guys. We’re working on our very own version of the Fox news channel, did you know that? Wish us luck, your poor backward neighbours.

        Now if you’ll excuse me I’ve got some bribery and corruption to attend to. Don’t worry, it’s Canada, it’s not even illegal here, we got rid of our police years ago (they kept catching people, it was embarrassing)..

        (you’ll notice I got through that whole thing without an analogy of any kind. Just for you, Carl, special, because I know you don’t like them. We Canadians, we’re just nice like that).

    • Cheers for taking the time to discuss this, I feel can locate any facts in content and discus forum

    • Wow! Thank you! I permanently needed to write on my site something like that. Can I implement a portion of your post to my blog?

    • I think all of you are turning this into a philosphical discussion to turn it away from a healthcare discussion. How about each of you take the philosophy you have and using your principals, describe a good healthcare system? Who would have health care? How would it be paid for?

      Here is the situation. Some have, some don’t. All get sick at some point..

    • I think you all are getting trapped into arguments about the best philosopy and abandoning the actual discussion about health care. How about you take the “ism” of your choice and describe a good health care system within your philosophy?
      Here is the situation. Some have, some don’t. All get sick at some point. Some hospital, at some point, takes them in. Costs get distributed in some manner, to those that have.
      Sove this.

    • I find it interesting that in these discussions the role of the pharmaceutical industry and medical technology sector is not considered. After all, it is the power and influence of these sectors that ultimately influences the quality of any health care system. I’m of the opinion that if you want to see a good example of state provided health care look at the Brazilian AIDS program.

    • And in the end, Carl got a Tootsie Roll for the most tenacious performance. I’m sorry I couldn’t read it all for headache but did he ever actually state what his ‘verifiable personal woody’ for the Canadian system was?