Sunday, December 31, 2017

Five American myths about the Canadian Health Care system

Several years ago, during the heated debate over the Affordable Care Act or "Obamacare" (which, as my wife pointed out to me, is not a "heath care" program, but is a "health insurance" program) I compiled a list of myths I've heard propagated about Canada's universal single-payer health system.

By far the most prevalent myth about the Canadian health care system is that it is government-run. That is a gross misunderstanding, but a common one.  The health care system in Canada is not run by the government; it is funded by the government; and there is a huge difference.  Nearly all health care in Canada is provided by private providers and administered by private or non-profit organizations.  None of the four hospitals whose services we've used are administered or owned by the government; they merely bill the government for services rendered under the provincial Medicare program.  The provincial government (not federal) is their primary client for billing purposes only.  Medical provides just have to abide by the Canada Health Act of 1984, which basically guarantees every Canadian resident equal access to all "medically necessary" health care services, without co-payments of any kind.

Americans badly need a health care system like the one we enjoy in Canada; where doctors and hospitals have one customer for billing:  their provincial government.  The Canadian government, certainly at the federal level, does not concern itself with health care provision.  

Myth:  Medicare is a Canadian-wide federal government program.  Canada's Medicare system is not a federal program, and is not administrated by the federal government; it is provincial, and service varies, coverage varies, taxes vary, between provinces.  In some provinces, people pay insurance premiums for Medicare; in New Brunswick it is free, but here we don't have prescription drug coverage under the age of 65 (I have employer-provided supplemental insurance coverage for medications).  The only thing the federal government has to do with Medicare is to set "guidelines" for the provinces to ensure that every Canadian resident has equal access to all "medically necessary" health care services, without co-payments of any kind, under the auspices of the Canada Health Act.  Incidentally, access to medical care is a right of all human beings under the 1948 UN Universal Declaration of Human Rights, which was written, incidentally, by a New Brunswicker, John Peters Humphrey.

Myth:  Wait times for medically-necessary procedures are long in Canada.  I know there are horror stories, I've heard them too, but I'm not aware of anyone, personally, who has gone without badly-needed medical treatment ... elective surgery can have long waits.  If you have a need to see a  medical specialist, at least in New Brunswick, you go immediately in most cases. That's my personal experience, in this province.  
As for waiting linefor health care ... how many Americans wait the remainder of their natural lives for necessary medical procedures?  Far too many.

Myth:  Government bureaucrats, not doctors, make medical decisions in Canada.  It is important that every one understand that, in Canada, the only people who are allowed to make decisions about who gets care are physicians.  In the United States, by contract, HMOs and other private medical insurers do indeed make decisions about who gets what care (it's probably more appropriate to say "who gets denied the care they need).  In Canada, medical decisions are left entirely up to doctors, and there are no requirements for pre-authorization whatsoever.   If your family doctor says you need an MRI, you get an MRI.  In the U.S., if an insurance administrator or HMO rep says you are not getting an MRI, then you're not getting  one regardless of what your doctor thinks — unless, of course, you pay for it out of your own pocket.  I bet you there are far more Americans paying for necessary medical procedures out of their own pockets than there Canadians who find it necessary to do that.

Myth:  The government "manages" patient care in Canada.  Another misconception among Americans is the government of Canada "manages" patient care.  That's a gross misunderstanding, but a common one.  The health care system in Canada is not run by the government; it is funded by the government; there is a huge difference.  Medical treatment is solely the responsibility of doctors, not the Medicare system and its administrators.   This is complete unlike Health Management Organizations (HMOs)  in the US, where, essentially, a corporation DOES make medical decisions.  In Canada, a doctor's relationship to his patient is a professional medical one only; and doctors bill the government for services rendered under Medicare.  The doctor isn't forced to deal with insurance claims or payment collections.  It's much better that way.

Myth:  Doctors in Canada work for the federal government and draw civil servants' salaries.  Nearly all health care in Canada is provided by private providers and administered by private or non-profit organizations.  None of the four hospitals we've used are directly administered by the government:

  • The Dr. Georges-L. Dumont Regional [francophone] Hospital is run by the Vitalité Health Network, (or Réseau de santé Vitalité, if you prefer), which employs 7500 people about about 500 physicians in this province, none of whom are government employees.
  • The Stella-Maris-de-Kent [francophone] Hospital in Sainte-Anne is also run by the Vitalité Health Network.
  • The Moncton [anglophone] Hospital, is run by the Horizon Health Network which employs 13,000 people, and over 1,000 physicians in this province, none of whom are government employees. 
  • The IWK Health Centre in Halifax is 100% privately-owned and funded by a charitable foundation called the IWK Health Centre Foundation (be generous, please, with your tax-deductible contributions).
Americans badly needed a health care plan like Canada's; a single-payer, universal health care plan that is not run by the government.  Unfortunately, Obamacare is not it.

Wednesday, December 20, 2017

The majority of people have always been "sheeple"

I moved my family to Canada, from rural north Alabama, in October 2005, largely because my antiwar views made me the target of hate in my community, but more importantly, because I no longer recognized the people I lived among. Not because they changed, suddenly, but because (at the age of 48) I saw them for what they really were, and what I risked becoming.

I spent the first four decades of my life in six different Bible Belt US states. The only thing that made me different from others was the fact that I refused to become part of a lynch-mob bent on vengeance. I stood by my values; and for that, I was forced out of the tribe.

I had to grow up and face a hard fact.  I had spent most of my life believing there was only one way to live; that the generations who preceded us have shown us that way; and any departure from it was, by definition, simply "off-course". To the extent that I deviated from the norm, I considered myself a basically recalcitrant person; maybe not evil, but not as ideologically pure as my good Southern Baptist Christian conservative neighbours, family, friends ... it was with great astonishment that I watched every one of those "good" people betray values they claimed to hold sacrosanct. It was at a very advanced stage of life that I understood that what passes for principled living for most people is just a matter of conformity.

I love living in Canada. I am glad that I will die here.

And the political system in the US? One of my biggest regrets in life is having trusted it, and involving myself in it. What a waste of time and energy.

Most people, in every culture, in all ages, have been obedient followers of the established authority – sheeple.   That's never gonna change.

That's not a new notion, by any means.  I read it recently in the first of a two-volume set I bought in a local used bookstore of H.G. Wells's The Outline of History (1920)  ... here it is:

There was a process of enslavement as civilization grew; the headmen and leaderly men grew in power and authority, and the common man did not keep pace with them; he fell by imperceptible degrees into a tradition of dependence and subordination.

On the whole, the common men were fairly content to live under lord or king or god and obey their bidding.  It was safer.  It was easier.  All animals – and man is no exception – begin life as dependents.  Most men never shake themselves loose from the desire for leading and protection.  Most men accept such conditions as they are born to, without further questions.

In [James Henry] Breasted's Religion and Thought in Ancient Egypt (1912), he gives various stories and passages to show that before 2,000 B.C. there was social discontent, but it was a naive unrevolutionary discontent.  There are complaints that men are treacherous and that judges are unjust.  Rich men are capricious and exacting and do not pity and help the poor.  There are quarrels about the scale of payment, and strikes against bad food and health conditions.  But there is no question of the right of Pharaoh to rule nor of the righteousness of riches.  There is no challenge to the social order; never do the complaints materialize into action.

– Volume 1, H.G. Wells The Outline of History (1920)

It was safer.  It was easier."

At no time has it ever been more apparent to me that most people are incapable of being anything more than the servants of the established authority.  And it was foolish to even believe they have a desire to be anything more; anything better.

We are where we are because people are what they are.  Not because of corrupt leaders.  Canadians know that.  America's leadership is a reflection of what the nation has become.  The leaders are merely a reflection of the greater society.  Essentially unprincipled.

Don't waste your time trying to change that natural order.  It may sound trite, but be the change you want to see in the world.  That's all any of us can do.

Change yourself.  

Sunday, December 17, 2017

National health care systems reflect a society's values

I was recently sent a scanned copy of this editorial which appeared in Newsweek magazine 6 years ago, in which the viewpoint was expressed that a country's health-care system reflects the societal values that predominate in that country.  Examples are provided. That article is available online.

The design of any country's health-care system involves political,
medical, and economic decisions. But the primary issue for any
health-care system is a moral question: should a rich society provide
health care to everyone who needs it? If a nation answers yes to
that moral question, it will build a health-care system like the ones in
Britain, Germany, Canada, France, and Japan, where everybody is
covered. If a nation doesn't decide to provide universal coverage,
then you're likely to end up with a system where some people get the
finest medical care on earth in the finest hospitals, and tens of
thousands of others are left to die for lack of care. Without the moral
commitment, in other words, you end up with a system like America's.

I was 48 years old when immigrated to Canada in 2005, with my wife and daughter (who was 14 at the time). At that time, Canada had a new conservative government and "privatisation" of the health care system was a hot topic. I think the Obamacare" debate in the States educated a lot of Canadians about our own health care system.

Under the auspices of the NAFTA treaty (as skilled work immigrants) we became eligible for Medicare after a three month wait). And we have no complaints.

The Canadian single-payer health care system is often criticized for long wait times for non-emergency medical procedures.  It is true that any non-emergency surgery, though, is likely to put you on a waiting list.  But in an emergency – a real emergency – you go straight to the head of the line, if your doctors says you need a procedure; you get it.  Without waiting.

In Canada, medical decisions are left entirely up to doctors, and there are no requirements for pre-authorization whatsoever  If your family doctor says you need an MRI, you get an MRI.  I did, immediately, in August 2012, after an accident.  No "waiting list".  In the US, if an insurance administrator or HMO rep says you are not getting an MRI, then you're not getting one regardless of what your doctor thinks — unless, of course, you pay for it out of your own pocket.  Which is why far more Americans are paying for necessary medical procedures out of their own pockets than there are Canadians who find it necessary to do that.  

As this article points out, "while the U.S. lets some 700,000 people go bankrupt due to medical bills each year, the number of medical bankruptcies in Canada is precisely zero." What's that worth to a society?

Health care spending, per-capita, and as a percentage of national GDP, is higher in the US than anywhere else in the world.  It's all about profit.  Not people.  And that has become a reflection of American society.  Profit before people.  It's a recipe for failure in any society. 

Friday, December 15, 2017

Victor Jara; Chilean folk singer

I first learned the story of Victor Jara from Australian journalist John Pilger's 2007 documentary film about the United States' decades-long war on democracy in Latin and South America:

The CIA played a major role in the September 1973 overthrow of Chile's government, the government of Salvador Allende, a medical doctor, who was the first Marxist to become president of a Latin American country through open and fair elections.  The US supports democratic elections in South America only when they can control the outcome.  Americans backed Allende's successor, the brutal dictator General Augusto Pinochet, who governed Chile with a military junta, in other words, a fascist police state. 

What happened to thousands of Chileans soon after Pinochet came to power is illustrated by what happened to Victor Jara.  Jara was a popular folk singer.  Not a revolutionary ... he was  a friggin' folk singer, nothing more. 

Jara was among the 40,000 people taken to the Chile's National Stadium in Santiago the day after the coup. His treatment was the embodiment of the Pinochet government's determination to silence an entire culture. First the military cut out Jara's tongue and told him, "You'll never sing again." Then they broke both his hands and said "You'll never play the guitar again." Then they tortured him more and eventually killed him. They shot him forty-four times, according to Chile's truth and reconciliation commission. To make sure he could not inspire from beyond the grave, the regime ordered his master recordings destroyed. The culture of dissent in Chile was being deliberately exterminated.

It was not just Victor Jara they wanted to silence.  It was everyone and anyone who might dare to oppose a brutal CIA-supported regime that was absolutely determined to crush the spirits of the Chilean people.

Americans are not evil people.  If they knew even a tiny percentage of the truth about their government; I believe they'd immediately withdraw their support for the imperialist aggressive policies of their government. They simply do not know. 

America's problem is propaganda. Lies. Deliberate ignorance.

Victor Jara, a folk singer (for God's sake!)

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