Sunday, December 10, 2017

How does the US health care system measure up to others?

My wife, my daughter, and I have been in Canada now for twelve years, but I can no longer imagine life without Medicare.  I have become a Canadian, through and through.  Or, just maybe, I always was but didn't realize it until I was 48 years old.

Here's what I believe:  Access to essential medical care is a basic human need and I believe it is a human right.

And, I might add, I have absolutely nothing but the highest praise for the medical care we've received here in New Brunswick.  We've had excellent and prompt care from specialists (oncology, radiology, dermatology, and neurology), from our family doctor, and from blood clinics and emergency services.  Our experience may not be typical, but it is my first-hand experience.  It's what I know to be true.  New Brunswick's Medicare system is far from perfect, I know that, but flaws in the Canadian system do not "prove" that the American medical system is better.  

Canada's health care system is truly excellent.  But eight years ago, during the debate on the Affordable Care Act, Senate Minority Leader Mitch McConnell (R-KY) made in a speech on the Senate floor in which he insisted that Americans will not accept a health care system like those of Great Britain, Canada, and New Zealand.  Really?  I think he's wrong about the American people.   I know he's wrong about the "terrible" health care systems of the three countries he picked to compare with that of the US.  Actually, though, it wouldn't matter what three countries he picked, since in every other developed country in the world, health care spending is lower than it is in the United States, and results are better than those of the United States.

But Mitch McConnell chose Canada, New Zealand, and the United Kingdom to make his point.  That wasn't an "error of judgment."  It was a display of ignorance.  It was a very stupid thing to say.  But he did it and, so, let's look at some measures of the quality of health care in those three countries, and compare them to the same results for the United States.  

Let's start with per capita health care spending, how does the US stack up against the other three?

United States: $9,451
Canada: $4,608
United Kingdom: $4,003
New Zealand: $3,590

And total health care spending as a percent of each nation's GDP:

United States: 17.1%
New Zealand: 11.0%
Canada: 10.4%
United Kingdom: 9.1%

Infant mortality rates (the number of children, per thousand who were born live, who die within their first year of life)

United States: 6.5
New Zealand: 5.7
Canada: 4.9
United Kingdom: 4.2

The probability of a newborn making it to age 65:

Canada: 82.3%
United Kingdom: 81.5%
New Zealand: 80.9%
United States: 77.4%

Life expectancy at birth for the total population (male and female), considered a good indicator of overall health.  The gap in life expectancy between Canada and the U.S.  continues to widen.

Canada: 82.2 years
New Zealand: 81.6 years
United Kingdom: 81.2 years
United States: 79.3 years

And, my own favourite statistic, expected number of healthy years of life?

Canada: 72.3 years
New Zealand: 71.6 years
United Kingdom: 71.4 years
United States: 69.1 years

Sunday, December 3, 2017

US Health Care: Paying too much for too little

On 26 June 2008, in testimony before The President's Council on Bioethics, Dr. Steffie Woolhandler, a primary care physician, stated:

Now, it turns out that medical bankruptcy is, as I said, half of all personal bankruptcies. Millions of people each year are affected by medical bankruptcy, but 76 percent of people who were in medical bankruptcy in our study had health insurance at the onset of the illness that bankrupted them.

So insured people have an issue, too, if they have a prolonged, serious illness. They can't work. They have lots of co-payments, lots of deductibles. They can end up in bankruptcy, as well.
Dr. Steffie Woolhandler is also an Associate Professor of Medicine at Harvard and co-director of the Harvard Medical School General Internal Medicine Fellowship program.  Her testimony was removed from the government website by the current Presidential Administration, but you can still view an archived copy on the Internet Wayback Machine.

Most Americans don't realize how badly flawed the medical system is in their own country and how many Americans go without adequate medical care as a result.  Even though the US spends more on healthcare, both per-capita, and also as a percentage of its national GDP, than any other developed nation in the world.  According to the OECD, health-care spending in the US was 17.7% of US GDP in 2011 (the chart below is for 2009).  That's far more than any other country, nearly 50% more than was spent by the next highest country on their list. 

Americans spend nearly twice as much as the average developed (rich) country ... but they die 1.7 years earlier.  You find something wrong with that?  Any reasonable person does.

With so much wealth spent on health care ... are Americans healthier than people in Switzerland, Germany, Canada?  In what way could that be measured? Perhaps by life expectancyInfant mortality rates? Prevalence of obesityHeart disease death rates?  

It's not that health care in the US is bad, actually, it is the best available anywhere.  The problem is that the system is so inefficient that Americans pay far more for their health care than is, apparently, necessary.

Nearly half the counties in the US don't have a single ob-gyn providing maternity care (source).   In a for-profit health care system, doctors go where the money is.  In the US, where health care is apportioned by ability to pay, some people get the best care in the world, and immediately.  Millions go without.  Many put off necessary health care they can't afford.  Many die in "waiting lines" for health care they will never get.

What Americans have been doing for generations doesn't seem to be working anymore.  Is there a better way?   A reasonable person has to wonder.

Friday, December 1, 2017

"the Truth shall make you free"

For the first 48 years of my life, I paid almost no attention to current events or politics. Like sports, those were things I didn't discuss with others.  I didn't feel I knew enough about any of those to have a strong opinion, and I didn't have the time or the inclination to learn more than I already knew.  I was happy living like that.

I voted, of course, that was expected of me.  For for 30 of those years, I voted Republican in two different Deep South states (Tennessee and Alabama) ... as a conservative Protestant Christian, I really didn't have to consider how I'd vote or even really care.  I just did as I was expected to.

And then ... ok, what the hell happened to my America when I wasn't watching?  It seemed to turn to shit overnight.

And I suddenly found myself struggling to understand things I never cared about before ... and what I learned turned my comfortable world upside down.  The list of things I was absolutely wrong about was long.  Every day, it seemed, I discovered some new fallacy in my understanding of the world.  Cold War propaganda had worked like magic on me.

I learned this: if you are interested only in the truth, you have to avoid the US mainstream media almost completely. Not that the truth doesn't surface in the US media; it's just much harder to discern. What's truth, and what is "spin"?  You can't tell anymore.

A good rule of thumb is this; if it's a mainstream news outlet based in the US, it almost certainly slants the truth ... to the right, to the left; does it matter which? The US news media plays to an audience that believes that the truth is whatever they want to hear. Americans tend to search out "news" sources that tell them the most comfortable lies.

The fact is, though, most people don't care to know the truth anymore. They think (like I once did) that they already know it. That's a "willful ignorance" and its societal suicide. Head–>Sand.

One good way to verify which are good news sites is to find a significant news item and see who carried it; and, if you're not sure it's true, watch it to see if it is revealed as factual ... or as a fabrication.

And be sure to read non-US news sites. Trust me on this: if you had been paying attention to non-US news sources in January, 2003, you would not believe that "before the invasion of Iraq, everyone thought it was the right thing to do." There was a serious debate about it, then, though most Americans (including myself, living in rural Alabama) were not even remotely aware of it. 

For what it's worth:  those who questioned the Bush Administration and the "evidence" they presented to justify the invasion of Iraq were right to do so. 100% right.  One month before the US invaded Iraq (a tiny defenceless country that posed no threat the US), a future presidential candidate spoke these words in a speech at Drake University in Des Moines, Iowa:

"I firmly believe that the president is focusing our diplomats, our
 military, our intelligence agencies, and even our people on the wrong
 war, at the wrong time.  Iraq is a divided country, with Sunni, Shia 
 and Kurdish factions that share both bitter rivalries and access
 to large quantities of arms."

Yes, there were Americans saying the right thing, the problem was that too many Americans weren't listening ... they were caught up in a lynch mob mentality.  Were those who predicted America's failures in its foreign invasions able to see into the future?  Of course not.  Did they know something the rest of us couldn't know?  Nope ... they were only stating truths that were evident to those who hadn't already made up their minds, and were willingly blind to reason or truth.

Those leaders were right.  100% right. And so was Scott Ritter.

Saturday, November 18, 2017

Stop the War! (1968)

Watching the 10-part (18 hour) documentary The Vietnam War on PBS, I was struck by what a large contingent of delegates at the 1968 Democratic nominating convention in Chicago raised signs in protest of the war ... and these were political party delegates ... mainstream Americans ... part of the system.

Vietnam, don't forget, was also a Democratic Party war.

What struck me was that, 50 years ago, the opposition to America's immoral (and illegal) war had definitely gone mainstream.  

And that is something that has changed dramatically in the half-century that has passed.

Americans today are far more passive in accepting an endless series of wars, known to be based largely on outright lies (as was Vietnam, which was the salient fact that was exposed in The Pentagon Pagers).  Americans are more than happy to yield their American value system (supposedly something for which they'd die) and all their civil liberties for empty promises of relief from fear.  Cowardly?  In the extreme.

Mainstream Americans today, regardless of which side of the political divide they stand, act like sheep; and neither political party has a monopoly on cowardice.  That's the one thing Americans share.

A tightly-controlled US press ensures that.

The uniformity of opinion molded by the media is reinforced through the skillfully orchestrated mass emotions of nationalism and patriotism, which paint all dissidents as “soft” or “unpatriotic.” The “patriotic” citizen, plagued by fear of job losses and possible terrorist attacks, unfailingly supports widespread surveillance and the militarized state. There is no questioning of the $1 trillion spent each year on defense. Military and intelligence agencies are held above government, as if somehow they are not part of the government. The most powerful instruments of state control effectively have no public oversight. We, as imperial citizens, are taught to be contemptuous of government bureaucracy, yet we stand like sheep before Homeland Security agents in airports and are mute when Congress permits our private correspondence and conversations to be monitored and archived. We endure more state control than at any time in U.S. history.
And yet the civic, patriotic, and political language we use to describe ourselves remains unchanged. We pay fealty to the same national symbols and iconography. We find our collective identity in the same national myths. We continue to deify the founding fathers. But the America we celebrate is an illusion. It does not exist.

– Chris Hedges

      Chicago, 1968

Tuesday, November 14, 2017

The staggering cost of empire

How much does it cost the United States to maintain its global empire and domestic security state? The following table summarizes defense-related costs in the US federal budget since 2003 plus supplemental spending (OCO=Overseas Contingency Operations, basically a un-allocated "slush fund). These numbers do not include other costs (such as the Department of Homeland Security, veteran's care and interest payments). The actual amount that Americans spend on their endless wars exceeds $1.2 trillion every single year.

The real costs of these wars, though (and the US is now involved in seven), are the "opportunity costs" ... what could have been done with that money?  What good could been done with that money?

Look what a sorry return Americans got for all those lives (over 6,251 American soldiers) and dollars spent (between US$4 and $6 trillion in Iraq and Afghanistan alone).  Fifteen years ago, I believe Americans chose a truly pathetic way to think and to live.  And now they're stuck with their wrong choice; the nation in involved in seven long-term wars it cannot win. Who can accept the astonishing stupidity of it, the utter mediocrity of a society that aspires to do nothing more, nothing better, with its tremendous wealth?

Maybe roads, schools, bridges, railroads, and dams don't matter as much as conquest and empire.  Maybe child development, education, old age security, unemployment benefits and health care don't matter as much as tax breaks for the ultra-rich.  But I choose to believe otherwise.  And my choice is one I can easily live with.

US Military Spending History since 2003:
FY DoD Base  BudgetDoD OCO Support BaseSupport OCOTotal Spending  
2003 $364.9   $72.5    $437.4
2004 $376.5   $91.1    $467.6
2005 $400.1   $78.8    $478.9
2006  $410.6  $124.0  $109.7   $644.3  
2007  $431.5  $169.4  $120.6   $721.5
2008  $479.0  $186.9  $127.0   $792.9
2009  $513.2  $153.1  $149.4   $815.7
2010  $527.2  $163.1  $160.3   $0.3  $851.6
2011  $528.2  $158.8  $167.4   $0.7  $855.1
2012  $530.4  $115.1  $159.3 $11.5  $816.3
2013   $495.5    $82.1  $157.8 $11.0  $746.4
2014  $496.3    $85.2  $165.4   $6.7  $753.6
2015   $496.1    $64.2  $165.6 $10.5  $736.4
2016 Actual  $521.7    $58.6  $171.9 $15.1  $767.3 
2017 Enacted  $516.1    $82.4  $175.8 $19.4  $793.7
2018 Budget  $574.5    $64.6  $173.5 $12.0  $824.6

Sunday, November 12, 2017

They took an oath to serve

A good soldier follows orders, and does not question those orders, even when those orders are immoral or illegal. They "took an oath to serve." My country, right or wrong.

A good soldier always has the excuse that "I was just following orders." That absolves a good soldier for responsibility for his or her actions.

"Just following orders." That's the excuse that was used by the defendants at the Nuremberg trials ... that their oath of allegiance to the State, and to serve as an instrument of that state, absolved them of responsibility for their own actions.  They were hanged anyway ... the judgement of the court being that we are all, individually, responsible for our own actions.  Not the State, not the Marine Corps, the First Baptist Church, or the Boy Scouts of America.  

Moral autonomy is having the freedom and possessing the courage, and the will, to make moral decisions on one's own, individually.  It's standing on one's own two feet; and sometimes that requires sacrifice. There is no freedom without the exercise of autonomy. It is not a free nation that prohibits dissent.

Moral autonomy is at the root of what is termed "character."  Character is always individual.  You don't display character by joining a group.  Moral autonomy is the ability to choose the right course of action, by oneself, without any outside pressure or influence.

Our first allegiances, as men and women of characters, should always be to our principles, and to our families, those who depend on us, not to some oath of allegiance to a State.   To put allegiance to country above our principles is to act as a tool of an authority that seeks only to enrich and empower itself at our expense; in other words, to act as a slave, rather than a man. It is not merely a choice to act amorally, without conscience, giving over our moral choice to another; it is moral cowardice to refuse to do what we believe is right, using our "oath of allegiance" to excuse that choice.

Oath Keepers and Patriots, May 1941

Friday, October 20, 2017

Tommy Douglas, born October 20, 1904

Three years ago, in preparation for Canada's 150th birthday (which is this year), an online survey was conducted by the Canadian government, in which 12,000 Canadians participated.  They produced a list of the ten Canadians who are most esteemed by the Canadian public.   Only one of the 10 is a military leader.

When Canadians were given the chance to name the greatest Canadians ever, near the top of the list (which was headed by Pierre Elliot Trudeau, the prime minister who gave this country its Charter of Rights and Freedoms), they chose a diminutive rural minister from the prairie province of Saskatchewan, a man who espoused a philosophy of collective compassion, equal access to health treatment for all, and fairness in hiring, among other things.

Tommy Douglas, the Canadian social reform politician and Baptist minister, is honoured by Canadians for one thing ... he gave Canadians universal health care.  But it is not just Canada's health care system for which Canadians honour Douglas, it is his belief that every Canadian deserves the right to have quality health care, regardless of their economic or social situation.  That has become a core Canadian principle.

Tommy Douglas was born on October 20, 1904 in Falkirk, Scotland.  If you're Canadian, please take a minute to think about how we want to perceive ourselves, and be proud of a Canada in which a man like Tommy Douglas easily ranks among the greatest and most noble citizens.

Tommy Douglas

Top Canadian Heroes

  1. Pierre Elliot Trudeau
  2. Terry Fox
  3. Tommy Douglas
  4. Lester B. Pearson
  5. Chris Hadfield
  6. David Suzuki
  7. Jack Layton
  8. Sir John A. Macdonald
  9. Wayne Gretzky
  10. Romeo Dallaire