Ezra,

On #9,

First: Canadians tend to think of tending to one's health as one of your duties as a citizen. You do what's right because you don't want to take up space in the system, or put that burden on your fellow taxpayers. Second, "taking care of yourself" has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if you're contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while they're still small and cheap to fix.

Third, there's a somewhat larger awareness that stress leads to big-ticket illnesses -- and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, there's a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use.

I think this does explain a lot of why you can only take comparative health systems analysis so far. The culture described above doesn't resemble anything remotely similar to US views on society vs. individual. You can argue a chicken-and-egg phenomenon, which I suspect you may, but it just doesn't seem that our society could have a health system function effectively based on what's best for the general good. It'd be asking for a lot from health care reform to both improve the system and simultaneously change our cultural outlook at the same time.

Ezra,

wisewon is right, how dare you compare our culture with other countries? Haven't you forgotten that we have a whole party set up to ensure that people don't have to pay to pick up the tab for lazy (insert name of minority group here)?

Also, what are you doing posting on heathcare again? I thought Nate pointed out that you are uninformed and have such an obvious stake in getting universal healthcare that anything you say must be dismissed.

I live in Canada. It's frustrating to read all the nonsense and exaggeration about the Canadian system that typically (mis)informs the U.S. debate. Sara Robinson does a pretty good job of setting things straight. One thing Americans should keep in mind: whatever the problems with the Canadian system, very few Canadians would trade it for anything of the U.S. type. The general view is: the Canadian system definitely needs to be improved, but the fundamentals are sound. Any politician running on a platform that included dismantling the system would kiss goodbye to their chances of getting elected. Even conservative politicians know that. There's a general election campaign on in Alberta right now, and the first promise of the right-wing government was to eliminate monthly health-care premiums. (Alberta is one of three provinces with such premiums -- see Robinson's point #6.)

On that point #9 -- 'medical Calvinism' -- the undeniable element is the pious bullshit from the right that condemns the poor and sick as moral failures.

(The irony being that Tommy Douglas was a man of the kirk.)

The culture described above doesn't resemble anything remotely similar to US views on society vs. individual.

Cultures do change. Legislation effects some of those changes.

You may see people with Dixie flag decals in the south, but they're generally not of the mindset that 'black folks is for owning' or that segregation is just the way things should be.

Yeah, it's asking a lot for healthcare reform to influence cultural change. Tommy Douglas did it. Nye Bevan did it.

I'm confused: Canada is a single-payer system, and yet (as Ms. Robinson admits), there a long waits for some procedures and tests. If Canada's truly a single-payer system, why do these shortages exist? Why isn't somebody building MRIs to meet the demand? What's the mechanism by which the single-payer system is restricting access to certain services? Does the health system drag its feet on paying for certain procedures? Does it reimburse at a ridiculously low level, so that only the highest-scale service providers can profit? Or is it that the health system actually owns certain pieces of capital equipment, in which case it's not really a single-payer system?

This Candia place sounds cool. However, it doesn't sound much like Canada to me, not that I'm a. Canadian or b. an expert on health care. However, I can guarantee you one thing that I know from the British health care system; socialism is for third world countries. If you don't begin as one, you end up as one.

socialism is for third world countries. If you don't begin as one, you end up as one.

Yeah. Sweden. Fifty years of socialism, and it's a living hell.

TRM, the mechanism that holds back production of MRIs is likely that the procincial health insurer does not find better health outcomes from increased use of MRIs.

Also, "Hope Muntz", we place a certain premium on this weblog on good-quality writing. Your post starts with a flame about a typo, ends with a mindless cliche, and doesn't make any sense in the middle. I suggest you be a little more conscientious about your writing style, next time.

Hope Muntz,

Nice comment over at Calculated Risk
"Bankers Plead For Bailout":

"ferg writes:
This plan makes no sense. Why should the taxpayers bailout the lenders and investors?

Because this is a capitalist country?

If we were socialist, we'd pay for things like children's health care. Since we're not socialist, we'll pay to bail out the bankers and investors instead."

There's this argument put forth by Republicans, or is it Conservatives, or are they the same thing....anyway people who belong to this club of ideas keep saying that individuals should be able to decide how to spend their own money, and not the government.

Why can't someone influential make a catchy phrase that argues this same idea on the money people dish out to health insurers?

A few other points:

Canada is effectively a two-tier system, because 95% of Canadians live within 100 miles of the US border. Canadians always have the option to pay for health care in the US.
Current US health care may result in shorter wait times and more money for new equipment, but the Canadian system results in cleaner hospitals and better post-surgical care.

Given the vast sparsely-populated areas of Canada it is never possible to provide equal health care to every region, but there is a huge attempt made at providing good care for the north and other sparsely populated regions.

The best plan for the US may be a plan that is like Canada's (universal, government-sponsored private care) but with a second tier of user-pay care available for those who can pay for it. (The Canadian single-payer system is very efficient and cost-effective, but I don't see a single-tier option being acceptable to Americans.)

People don't want to go to the doctor or the dentist (maybe dentist resonates a bit better) even if its for free. At least not old people who end up getting all the invasive procedures and operations that make up the heavy costs of the health care system. Free vertebra screws anybody?

Having read the article, my NUMBER ONE reason for opting for single-payer from now is:
"One unsurprising side effect of [not struggling with 100 insurers] is that the doctors [in Canada are] more up-to-date in their specialties."

In any doctor level profession -- maybe even with bloggers -- you can spend half your life keeping up with what's new. American doctors dealing with 100 sets of rules and fighting 100 sets of care deniers, cannot keep up with their specialties they way they really want to...
...what can you, mandated policy supporters, ever say again in favor of your position -- except maybe the craven fear of insurance company lobbying? Just add undertraining to overcharging to your plea for single payer and you should have no trouble selling Medicare for All ever again.

"However, I can guarantee you one thing that I know from the British health care system; socialism is for third world countries. If you don't begin as one, you end up as one."

Since when was Britain a third world country or even close to it? I don't see Britain as perfect, but there are parts of American that a damn sight closer to the third world than any place I have ever seen in England!

that "people won't be responsible for their own health if they're not being forced to pay for the consequences."

The phrase I've heard used at a couple of HSA presentations I've attended is "people have to have some skin in the game to care about the consequences of their health."

It's health - my skin, my lungs, my heart, my skeleton, shoot my whole freaking body is in the game. I just don't want to go without necessary treatment because I can't afford it.

this was a horribly misleading article. wait times here in canada are atrocious. many doctors won't work extra hours because they're billing hours are capped by the gov't. many people here in ontario (canada's largest province incl. toronto - that alone has 10% of can.'s population) don't have a family dr.. new dr.s interview prospective patients to see if they want them. i have friends & family who've gone thru this process.
our system is horribly wasteful & underfunded. buffalo, n.y. alone has more mri machines than ontario. philadelphia has more mri machines than all of canada. doctors here can't even invest their own $ to build a lab to do blood tests, mri's etc. because that's private investment!! only gov't health care investment is sinless. our gov't doesn't have the $ to invest either. so we wait... & some of us die.
a good friend of mine was hit by a car 6 months ago while walking. his family dr. refused to refer him to a specialist. he waited almost a month to get an ultrasound (forget an mri) when they found blood clots in his leg. only then did he get to see a specialist. (if u try to see a specialist anyway, ur dr. may refuse to treat u in the future.) now he can't have surgery until the clots are gone. he can't sue because of our no-fault auto ins. even though he was a pedestrian when he was hit. he's been working from home to try to keep afloat.
another friend took his 9 yr-old daughter into an emerg room because they thought she had appendicitis - they waited for 10 hrs. b4 a dr. even looked at her. try waiting for 10 hrs. while ur little girl is in agony!
socialism is a disease. there are almost no conservatives left here. profit is a dirty word. dr. paul hollander (u mass @ amherst) said that those who admired communism (a form of socialism) were mainly those who lived outside the system while the critics lived inside it.
believe me, the last thing u need is more unionized workers in a monopoly system.

shorter drew: No links, no verifiable facts, no capital letters and no clue. Lots of B.S., though. A proud day for teh Internets.

Looks like you have one of our right-wing trolls north of the border who got tired of hangin out on Canadian progressive blogs.

For the record, Drew, there has never been a "socialist" federal government in Canada, period. End of story. Anyone who studies economics and politics will also tell you that Canada is nowhere near a socialist or communist system.

If anything, we're based on a Keynesian system.

As for the horror stories you list, no one denies there are some problems up here, but if you ask the people given the choice between the 2 systems, 80% or more will pick ours over the US system. That's been the case for years.

Drew,
All -- I emphasize ALL -- that progressives in the USA want to switch to is Medicare for All (instead of Medicare for many) -- that's all the want -- the system that all here salivate in anticipation of getting all through their 64th year of life (I know; I'll begin my 64th year next month).

We know what Medicare is; we know what it does; we know what it costs. If Canada's system is so terrible maybe Canada ought to study our Medicare -- works like a Swiss clock for my 85 year old mother.

This is the kind of argument that makes you almost wonder if conservatives are really flesh and blood human beings. If you buy this, you have to assume the only reason why anyone would ever want to stay healthy is because they're attaching some instrumental dollar value to their health that's greater than the dollar value they would spend on treating it.

So the only thing that's keeping you from eating candy for breakfast is the fact that your eventual treatment for diabetes will be worth way more than the price you're willing to place on your candy-eating enjoyment.

Leaving aside the completely ridiculous idea that the vast majority of the country even knows the ultimate cost of their healthcare costs, or the absolute Roulette game of insurance coverage, this theory just doesn't capture of human beings relate to their bodies. It requires you to assume that people don't actually fundamentally value not being sick (or disabled!) for its own sake. Which is nuts.

>it sure doesn't seem that our attempts to motivate health behavior by dangling financial ruin have done much good.

To combat obesity (and its related health impacts), Americans will do everything short of exercising and eating well.

> "people won't be responsible for their own health if they're not being forced to pay for the consequences."
Y'know, aside from A&W, I cannot think of any fast food chains in Canada which did NOT come from the U.S.

Well, I'll be able to experience it first hand pretty soon. We're moving to Toronto sometime in the next six weeks.

Speaking anecdotally, hopefully in Canada I won't be buying any cookies from a bake sale for one of my insured coworkers who can't afford their treatment for cancer. I've done that recently for two appallingly young women (one thirtyish, the other in her early twenties).

I'm also hoping not to hear any stories from my self-employed Canadian friends about how expensive their insurance is, like I hear from my self-employed American friends. Only the ones that are doing really, really well can afford it.

I'm also hoping never to hear the phrase "pre-existing conditions" again. Ever.

Re: "The phrase I've heard used at a couple of HSA presentations I've attended is "people have to have some skin in the game to care about the consequences of their health."

It's health - my skin, my lungs, my heart, my skeleton, shoot my whole freaking body is in the game. I just don't want to go without necessary treatment because I can't afford it."

Thank you!!! for bringing up that bogus rationale devised to maintain the commercially-controlled profit-driven healthcare non-system that we have now in the U.S..

Improved and expanded American Medicare-for-all is what I'm encouraging everyone to work toward, in the grassroots and elected officials (those who aren't totally in the bag w/the hc industry). Great piece by Sara Robinson - the Part II is now up on Our Future dot org.

As we live thru the individual mandate hell here in Massachusetts (on a brighter, more optimistic note, I'm happy to report it seems to be ready to blow-up) I'd like to share a few words from individual mandate guru Jon Gruber that appeared in a recent Boston Globe article about Rhode Island's state health reform efforts that keeps care at the forefront while agressively addressing admin. spending care cost controls:

File this one under "Quotes of Note" from Jonathan Gruber, chief architect of the individual mandate policy and an appointed member of the Connector board charged with implementing the mandate in Massachusetts:

"... "We can't have real cost control without pain, without telling people they can't have healthcare they want," Gruber said."

Care, Cost Stressed in R.I. Initiative, by Alice Dembner, Boston Globe, 2/13/08

It looks as though Gruber's time in the limelight might soon be fading, and imho it can't happen quickly enough!

2/12/08 Press Release from FTCR:
"Consumer Group Finds Use of Outdated Data and Other Major Flaws In Economist's Defense of Mandatory Purchase of Private Health Insurance"

(yes, they're referring to Gruber who's a central architect of the MA Plan and has a seat on its implementation board)

You can find report at www dot consumerwatchdog dot org

(everytime I try to embed a link or just copy it in, my comment gets blocked...)

If anyone's interested in a full scoop on the Massachusetts situation I can fill you in as I just compiled a pretty thourough update and sent it out to my listserve. Let me know and I can forward it to you. ann at defendhealth dot org

I'm particularly interested in the ninth myth she identifies, that "people won't be responsible for their own health if they're not being forced to pay for the consequences." This underlies a lot of conservative commentary on on health care but it is not, so far as I can figure out, particularly true. After all, Americans pay much more out of pocket for health services, and we are much, much less healthy than residents of nations with nationalized health care.

Agreed, and this cuts right at the heart of what's probably the main contradiction within many conservative libertarian outlooks. On the one hand, they believe that drug prohibitions can't work because government intervention can't make people responsible about their health decisions (which is true), but then they also say that government intervention in health care will make people irresponsible about their health decisions because they won't fear the consequences. In the latter belief, they are wrong, and it's obvious when you understand the validity of the former belief.

http://www.cbc.ca/canada/montreal/story/2006/02/16/qc-healthque20060216.html

Up until 2005 Canada outlawed private insurance and care. That means you wheren't allowed to pay out of your own pocket to get something done. I know most of you are flaming socialist on this blog but that level of suffering for the common good should lead even you to question it. Has the Democrat party really turned so communist you want to out law people buying life saving care? If the poor suffer we all suffer, so noble of you all, see how long you stand strong when it is your family member that is sick.

"Calling it a new level of health care, Charest told reporters his government wants to guarantee all Quebecers in the public system that they won't have to wait more than six months for a knee or hip replacement or a cataract operation."

Ya wait times aren't that bad. Who to belive the American pushing a socialist agenda to destory our system or the Canadian Politician trying to save their own?

http://www.nytimes.com/2006/02/26/international/americas/26canada.html?ex=1298610000&en=c3dd6e768d507208&ei=5090&partner=rssuserland&emc=rss

"Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment."

It seems at the same time Ezra and others are pushing for us to model our system after theirs they are busy implementing ours.

"The country's publicly financed health insurance system — frequently described as the third rail of its political system and a core value of its national identity — is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine."

Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

"Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment."

I think Ezra has competition for blogger most uninformed about healthcare but still insist on running their mouth. Sara Robinson's Part II starts off factually wrong and runs down hill from there. What is it about being progressive and fact adverse? You post these outlandish claims that are easily rebukked and don't expect someone to call you out on it?

mwg,

Welcome to Toronto! If you need any help, you can reach me at ima.canuck@hotmail.com

I hate to burst your bubble, though: We do have bake sales to raise money to pay for surgery...for people like the African conjoined twins who were brought here several years ago and successfully separated by someone I went to high school with!

Please no nationalized health care, it will put Nate out of a job!

Thanks for the offer, Canadian Reader! I'm really looking forward to being there (but not to the move itself, let me tell you). I think the conjoined twins are a special case, though.

But let me get this straight: the American system is more expensive and costs are going up more rapidly than the Canadian system. The Canadian system is arguably in trouble, but let me tell you: the American system is going to break first.

It seems at the same time Ezra and others are pushing for us to model our system after theirs they are busy implementing ours.

It seems you have reading difficulty, Mr Self-Appointed Booster For The Private Health Insurance Industry.

Just a personal anecdote.

I live in Vancouver. About a week or so ago, I suspected an illness was developing into an infection and decided I'd better see a doctor. I left home at noon on Sunday, wandered over to the clinic about 5 blocks away, where I'd never been a patient. I presented my health card, and saw a physician within TEN MINUTES. 5 minute checkup, yes, it's an infection, here's a prescription. Wandered to the pharmacy next door, had my prescription filled in 15 minutes, and was back home well before 1:00.

Less than an hour from "hmmm... I should have that checked out..." to medicated and back on the couch. Didn't pay a nickel for diagnosis and treatment. My infection has subsided. If I had to pay through the nose for seeing a doctor, I'd still be home battling the infection with my immune system instead of antibiotics, and taking weeks away from work.

Socialism! Quelle disastre!

Ah Ricky, correcting you is getting to be a full time job. Any government regulation actually creates more opportunity for me. Every time Congress "solves" a problem I have a new product to sell. For example COBRA Administration, then HIPAA Administration, Then NY Pool Surcharge Administration. Just recently we are helping employers comply with the new MA reform laws.

Every time tax law changes accountants have more work. Everytime Insurance changes I have more work. Some analysis shows UHC would be the largest boon in the history of my industry due to the scope of the reform and likely mandate that more employers and individuals participate in the system.

I'm sure it's going to take you awhile to figure all that out Ricky and doubt you will ever grasp why someone who would persoanlly benefit financially rom reform would oppose it so I'll leave it at that.

LOL poor Ricky, here you where just trying to make a joke and come off as funny but made to look the fool.