A reader sent me this provocative piece on Canadian healthcare, written by someone who knows care on both sides of the border. It comes from the Campaign for America’s Future website. And it is, as advertised, a “myth-buster.” I look forward to Part II.
Mythbusting Canadian Health Care Part I
By Sara Robinson
February 4th, 2008
2008 is shaping up to be the election year that we finally get to have the Great American Healthcare Debate again. Harry and Louise are back with a vengeance. Conservatives are rumbling around the talk show circuit bellowing about the socialist threat to the (literal) American body politic. And, as usual, Canada is once again getting dragged into the fracas, shoved around by both sides as either an exemplar or a warning — and, along the way, getting coated with the obfuscating dust of so many willful misconceptions that the actual facts about How Canada Does It are completely lost in the melee.
I’m both a health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border. As such, I’m in a unique position to address the pros and cons of both systems first-hand. [my emphasis –mm] If we’re going to have this conversation, it would be great if we could start out (for once) with actual facts, instead of ideological posturing, wishful thinking, hearsay, and random guessing about how things get done up here.
To that end, here’s the first of a two-part series aimed at busting the common myths Americans routinely tell each other about Canadian health care. When the right-wing hysterics drag out these hoary old bogeymen, this time, we need to be armed and ready to blast them into straw. Because, mostly, straw is all they’re made of.
1. Canada’s health care system is "socialized medicine."
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US. The only difference is that every doctor deals with one insurer, instead of 150. And that insurer is the provincial government, which is accountable to the legislature and the voters if the quality of coverage is allowed to slide.
The proper term for this is "single-payer insurance." In talking to Americans about it, the better phrase is "Medicare for all."
2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:
First, as noted, they don’t have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself in the course of a standard workday.
Second, they don’t have to spend several hours every day on the
phone cajoling insurance company bean counters into doing the right
thing by their patients. My doctor in California worked a 70-hour week:
35 hours seeing patients, and another 35 hours on the phone arguing
with insurance companies. My Canadian doctor, on the other hand, works
a 35-hour week, period. She files her invoices online, and the vast
majority are simply paid — quietly, quickly, and without hassle. There
is no runaround. There are no fights. Appointments aren’t interrupted
by vexing phone calls. Care is seldom denied (because everybody knows
the rules). She gets her checks on time, sees her patients on schedule,
takes Thursdays off, and gets home in time for dinner.
One unsurprising side effect of all this is that the doctors I see
here are, to a person, more focused, more relaxed, more generous with
their time, more up-to-date in their specialties, and overall much less
distracted from the real work of doctoring. You don’t realize how much
stress the American doctor-insurer fights put on the day-to-day quality
of care until you see doctors who don’t operate under that stress,
because they never have to fight those battles at all. Amazingly: they
seem to enjoy their jobs.
Third: The average American medical student graduates $140,000 in hock. The average Canadian doctor’s debt is roughly half that.
Finally, Canadian doctors pay lower malpractice insurance fees. When
paying for health care constitutes a one of a family’s major expenses,
expectations tend to run very high. A doctor’s mistake not only damages
the body; it may very well throw a middle-class family permanently into
the ranks of the working poor, and render the victim uninsurable for
life. With so much at stake, it’s no wonder people are quick to rush to
court for redress.
Canadians are far less likely to sue in the first place, since
they’re not having to absorb devastating financial losses in addition
to any physical losses when something goes awry. The cost of the
damaging treatment will be covered. So will the cost of fixing it. And,
no matter what happens, the victim will remain insured for life. When
lawsuits do occur, the awards don’t have to include coverage for future
medical costs, which reduces the insurance company’s liability.
3. Wait times in Canada are horrendous.
True and False again — it depends on which province you live in,
and what’s wrong with you. Canada’s health care system runs on federal
guidelines that ensure uniform standards of care, but each territory
and province administers its own program. Some provinces don’t plan
their facilities well enough; in those, you can have waits. Some do
better. As a general rule, the farther north you live, the harder it is
to get to care, simply because the doctors and hospitals are
concentrated in the south. But that’s just as true in any rural county
in the U.S.
You can hear the bitching about it no matter where you live, though.
The percentage of Canadians who’d consider giving up their beloved
system consistently languishes in the single digits. A few years ago, a
TV show asked Canadians to name the Greatest Canadian in history; and
in a broad national consensus, they gave the honor to Tommy Douglas,
the Saskatchewan premier who is considered the father of the country’s
health care system. (And no, it had nothing to do with the fact that he
was also Kiefer Sutherland’s grandfather.). In spite of that, though,
grousing about health care is still unofficially Canada’s third
national sport after curling and hockey.
And for the country’s newspapers, it’s a prime watchdogging
opportunity. Any little thing goes sideways at the local hospital, and
it’s on the front pages the next day. Those kinds of stories sell
papers, because everyone is invested in that system and has a personal
stake in how well it functions. The American system might benefit from
this kind of constant scrutiny, because it’s certainly one of the
things that keeps the quality high. But it also makes people think it’s
far worse than it is.
Critics should be reminded that the American system is not exactly
instant-on, either. When I lived in California, I had excellent
insurance, and got my care through one of the best university-based
systems in the nation. Yet I routinely had to wait anywhere from six to
twelve weeks to get in to see a specialist. Non-emergency surgical
waits could be anywhere from four weeks to four months. After two years
in the BC system, I’m finding the experience to be pretty much
comparable, and often better. The notable exception is MRIs, which were
easy in California, but can take many months to get here. (It’s the
number one thing people go over the border for.) Other than that, urban
Canadians get care about as fast as urban Americans do.
4. You have to wait forever to get a family doctor.
False for the vast majority of Canadians, but True for a few. Again,
it all depends on where you live. I live in suburban Vancouver, and
there are any number of first-rate GPs in my neighborhood who are
taking new patients. If you don’t have a working relationship with one,
but need to see a doctor now, there are 24-hour urgent care clinics in
most neighborhoods that will usually get you in and out on the minor
stuff in under an hour.
It is, absolutely, harder to get to a doctor if you live out in a
small town, or up in the territories. But that’s just as true in the
U.S. — and in America, the government won’t cover the airfare for
rural folk to come down to the city for needed treatment, which all the
provincial plans do.
5. You don’t get to choose your own doctor.
Scurrilously False. Somebody, somewhere, is getting paid a lot of
money to make this kind of stuff up. The cons love to scare the kids
with stories about the government picking your doctor for you, and you
don’t get a choice. Be afraid! Be very afraid!
For the record: Canadians pick their own doctors, just like
Americans do. And not only that: since it all pays the same, poor
Canadians have exactly the same access to the country’s top specialists
that rich ones do.
6. Canada’s care plan only covers the basics. You’re still on
your own for any extras, including prescription drugs. And you still
have to pay for it.
True — but not as big an issue as you might think. The province
does charge a small monthly premium (ours is $108/month for a family of
four) for the basic coverage. However, most people never even have to
write that check: almost all employers pick up the tab for their
employees’ premiums as part of the standard benefits package; and the
province covers it for people on public assistance or disability.
"The basics" covered by this plan include 100% of all doctor’s fees,
ambulance fares, tests, and everything that happens in a hospital — in
other words, the really big-ticket items that routinely drive American
families into bankruptcy. In BC, it doesn’t include "extras" like
medical equipment, prescriptions, physical therapy or chiropractic
care, dental, vision, and so on; and if you want a private or
semi-private room with TV and phone, that costs extra (about what you’d
pay for a room in a middling hotel). That other stuff does add up; but
it’s far easier to afford if you’re not having to cover the big
expenses, too. Furthermore: you can deduct any out-of-pocket health
expenses you do have to pay off your income taxes. And, as every
American knows by now, drugs aren’t nearly as expensive here, either.
Filling the gap between the basics and the extras is the job of the
country’s remaining private health insurers. Since they’re off the hook
for the ruinously expensive big-ticket items that can put their own
profits at risk, the insurance companies make a tidy business out of
offering inexpensive policies that cover all those smaller, more
predictable expenses. Top-quality add-on policies typically run in the
ballpark of $75 per person in a family per month — about $300 for a
family of four — if you’re stuck buying an individual plan. Group
plans are cheap enough that even small employers can afford to offer
them as a routine benefit. An average working Canadian with
employer-paid basic care and supplemental insurance gets free coverage
equal to the best policies now only offered at a few of America’s
largest corporations. And that employer is probably only paying a
couple hundred dollars a month to provide that benefit.
7. Canadian drugs are not the same.
More preposterious bogosity. They are exactly the same drugs, made
by the same pharmaceutical companies, often in the same factories. The
Canadian drug distribution system, however, has much tighter oversight;
and pharmacies and pharmacists are more closely regulated. If there is
a difference in Canadian drugs at all, they’re actually likely to be
safer. Also: pharmacists here dispense what the doctors tell them to
dispense, the first time, without moralizing. I know. It’s amazing.
8. Publicly-funded programs will inevitably lead to rationed health care, particularly for the elderly.
False. And bogglingly so. The papers would have a field day if there was the barest hint that this might be true.
One of the things that constantly amazes me here is how
well-cared-for the elderly and disabled you see on the streets here
are. No, these people are not being thrown out on the curb. In fact,
they live longer, healthier, and more productive lives because they’re
getting a constant level of care that ensures small things get treated
before they become big problems.
The health care system also makes it easier on their caregiving
adult children, who have more time to look in on Mom and take her on
outings because they aren’t working 60-hour weeks trying to hold onto a
job that gives them insurance.
9. People won’t be responsible for their own health if they’re not being forced to pay for the consequences.
False. The philosophical basis of America’s privatized health care
system might best be characterized as medical Calvinism. It’s
fascinating to watch well-educated secularists who recoil at the
Protestant obsession with personal virtue, prosperity as a cardinal
sign of election by God, and total responsibility for one’s own
salvation turn into fire-eyed, moralizing True Believers when it comes
to the subject of Taking Responsibility For One’s Own Health.
They’ll insist that health, like salvation, is entirely in our own
hands. If you just have the character and self-discipline to stick to
an abstemious regime of careful diet, clean living, and frequent sweat
offerings to the Great Treadmill God, you’ll never get sick. (Like all
good theologies, there’s even an unspoken promise of immortality: f you
do it really really right, they imply, you might even live forever.)
The virtuous Elect can be discerned by their svelte figures and low
cholesterol numbers. From here, it’s a short leap to the conviction
that those who suffer from chronic conditions are victims of their own
weaknesses, and simply getting what they deserve. Part of their
punishment is being forced to pay for the expensive, heavily marketed
pharmaceuticals needed to alleviate these avoidable illnesses. They
can’t complain. It was their own damned fault; and it’s not our
responsibility to pay for their sins. In fact, it’s recently been
suggested that they be shunned, lest they lead the virtuous into sin.
Of course, this is bad theology whether you’re applying it to the
state of one’s soul or one’s arteries. The fact is that bad genes, bad
luck, and the ravages of age eventually take their toll on all of us —
even the most careful of us. The economics of the Canadian system
reflect this very different philosophy: it’s built on the belief that
maintaining health is not an individual responsibility, but a
collective one. Since none of us controls fate, the least we can do is
be there for each other as our numbers come up.
This difference is expressed in a few different ways. 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. You can have them if you want them; but
reasonable and compassionate people should be able to take the larger
view.
The bottom line: When it comes to getting people to make healthy
choices, appealing to their sense of the common good seems to work at
least as well as Calvinist moralizing.
10. This all sounds great — but the taxes to cover it are just
unaffordable. And besides, isn’t the system in bad financial shape?
False. On one hand, our annual Canadian tax bite runs about 10%
higher than our U.S. taxes did. On the other, we’re not paying out the
equivalent of two new car payments every month to keep the family
insured here. When you balance out the difference, we’re actually money
ahead. When you factor in the greatly increased social stability that
follows when everybody’s getting their necessary health care, the
impact on our quality of life becomes even more signficant.
And True — but only because this is a universal truth that we need
to make our peace with. Yes, the provincial plans are always
struggling. So is every single publicly-funded health care system in
the world, including the VA and Medicare. There’s always tension
between what the users of the system want, and what the taxpayers are
willing to pay. The balance of power ebbs and flows between them; but
no matter where it lies at any given moment, at least one of the pair
is always going to be at least somewhat unhappy.
But, as many of us know all too well, there’s also constant tension
between what patients want and what private insurers are willing to
pay. At least when it’s in government hands, we can demand some
accountability. And my experience in Canada has convinced me that this
accountability is what makes all the difference between the two systems.
It is true that Canada’s system is not the same as the U.S. system.
It’s designed to deliver a somewhat different product, to a population
that has somewhat different expectations. But the end result is that
the vast majority of Canadians get the vast majority of what they need
the vast majority of the time. It’ll be a good day when when Americans
can hold their heads high and proudly make that same declaration.
Now I’m well understood about the complete Canadian health care program, and it’s quiet interesting to follow all the ten tips and plans thanks for sharing this valuable Canadian information.
There is one major reason Canada has a workable and efficient system and the U.S. does not. American politicians are on the take. They receive millions of dollars in campaign contributions from the insurance industry to keep the system broken, and they perform their jobs exquisitely.
Jack Lohman
http://MoneyedPoliticians.net
This is a GREAT resource, so let’s all do our part to put it to good use, ok?
I’ll post it on our health reform website here in Massachusetts, http://www.defendhealth.org and send the link out around the country asking other health justice activists to do the same.
Kudos to the author, Sara Robinson (and if you are curious to find out more about her, as I was, here’s this http://www.groupnewsblog.net/2010/06/about-us.html
Thank you to Campaign For America’s Future firstly, and also to Maggie here at HealthBeat, for putting this up on their sites and then pushing it out to the masses.
This is a great example of a tool that anyone can use in the grassroots education & mobilization that we’ve gotta be doing — with enthusiasm — day in and day out to be ready for the big push toward fundamental health system reform in ’09.
“Of all forms of inequality, injustice in health care is the most shocking and inhumane.”
— Martin Luther King, Jr.
“If you’re not part of the solution then you’re part of the problem”
— Bobby Seals
Take action now at http://www.HealthCare-Now.org
Interesting post, thanks. As you might have guessed, I have a few questions.
1) Where would the Canadian ‘single-payer’ system be without the US at the southern border? A) Is it not true that the Canadian system bargains as a whole for lower wholesale drug prices from companies? Those companies still need to make $$, and so US citizens pay the difference. What would happen if the US tried the same thing? B) Where would Canada be without the release valve of being able to cross the border for MRIs (your example) or testicular cancer surgery (Tom Greene of MTV fame), among others?
2) What % of the Canadian budget is spent on defense? Which parts of the world have the Canadian citizens paid taxes to protect with a nuclear umbrella? If the US were to fall militarily, where would that leave Canada and its health care system?
3) While I do think that your personal view of the Canadian system has value, I would like to see data backing up the various claims made in the post. What are the wait times for various procedures, broken down by geography or whatever? There were a number of other assertions for which I would like to see some evidence.
4) What are the relative numbers of physicians from Canada who train in the US and vice versa? Being in the US, I am exposed to Canadians who are unhappy with the training system there. Are there those from the US who choose to train and ultimately practice in Canada? Also, what proportion of physicians practicing in Canada were trained in the US or abroad (and yes, I’m aware that there are FMGs in the US as well)?
As for the points made regarding physician debt, and any use of the word ‘free’. None of that is so. You are paying for physicians’ educations as well as any and all health care spending. The fact that your employer picks up the tab so that you don’t have to write the check is immaterial.
In the end, I think that what this argument boils down to is one of philosophy and economics. The economics have been discussed ad nauseum, and perhaps we can discuss those issues in the future. For now, I would like to point out that America was founded on principles of limited government and personal liberty. If you peruse the Constitution you will find no provision specifically delegating to the federal government the power of providing health care to anyone. What you will find is a provision that any powers not specifically delegated to the federal government are reserved to the various States and to the People (to paraphrase the eloquence of the Founders).
If proponents of Universal Health Care would like to make it a reality, I wish that they would do it the right and honorable way. I wish they would follow the example set by prohibitionists and the original income tax proponents…by working to add an amendment to the Constitution delegating this specific power to our federal government. To do otherwise is to contribute to the destruction of our founding principles.
Great article. I like how one reader responds with concern for Canada not having a large military budget. It’s amazing how many Americans have not heard Eisenhower’s speach on the military industrial complex. Americans just keep buying these lies about where we should spend our money.
Folks keep leaving out another elephant in this room – Malpractice. Were the voracious US trial lawyers reined in, a real conversation about “best practices” could ensue. Until then …
The core issue to me has always been this: the insurance industry brings little, if any value to healthcare, yet takes a huge share of money spent. It’s parasitic, and to my mind is the best argument for a single-payer system. I never want to speak to another insurance company to insist that a child on a mechanical ventilator will, in fact, require more than twenty-four hours of care authorization.
This might address some of the issues raised by other commentors:
Doc99 – Malpractice is addressed at length in Sara’s article, see Section 2: “Canadian doctors pay lower malpractice insurance fees… Canadians are far less likely to sue in the first place, since they’re not having to absorb devastating financial losses… the awards don’t have to include coverage for future medical costs, which reduces the insurance company’s liability.”
Terry – Glad you brought up the Eisenhower quote. There’s a must-see documentary film “WHY WE FIGHT” that came out about a year or two ago on w/footage of Eisenhower’s speech where he attempts to warn the country of what he saw as the soon-to-be insatiable appetite for capitol of the US military industrial complex…
Tom – for facts and facts and more facts from OECD, WHO, and more about the economics and organization of the Canadian Health Program and other coutry’s programs, you will find many links at the American Medical Students Ass’n website here http://amsa.org/uhc/international.cfm
and at Physicians for A National Health Program website here
http://www.pnhp.org/facts/international_health_systems.php
Health Plans, Jack, Ann, Tom, Terri, Doc 99–
Thank you all for your comments.
Ann, Health Plans–I agree, Sara is a wonderful find. And Ann, thank you for the links.
Tom: I agree that there is a pretty clear philosophical difference here: Some people believe that all Americans have the right to health care–that health is necessary to “life, liberty and the pursuit of happiness.”
Others think that healthcare is a privilege, not a right. If you can’t afford it, this is your problem–taxpayers shouldn’t have to provide it for you.
As for healthcare vs. military spending, I agree with Terri. Take a look at Eisenhower’s warning abou the growth of our military
industrial complex.
Finally, we do have lots of evidence about Canadian healthcare that shatters many of the myths. I don’t have time to look it all up for you now. But you might begin by looking at this health affairs article:
Here’s the abstract: “Throughout the 1990s, opponents of the Canadian system gained considerable political traction in the United States by pointing to Canada’s methods of rationing, its facility shortages, and its waiting lists for certain services. These same opponents also argued that “refugees” of Canada’s single-payer system routinely came across the border seeking necessary medical care not available at home because of either lack of resources or prohibitively long queues.”
It turns out that this is a myth.
“This paper by Steven Katz and colleagues depicts this popular perception as more myth than reality, as the number of Canadians routinely coming across the border seeking health care appears to be relatively small, indeed infinitesimal when compared with the amount of care provided by their own system.”
The article is extremely well-evidenced and is titled “Phantoms in the Snow.”
It ends by saying: “Despite the evidence presented in our study, the Canadian border-crossing claims will probably persist. . . . Debates over health policy furnish a number of examples of these “zombies”—ideas that, on logic or evidence, are intellectually dead—that can never be laid to rest because they are useful to some powerful interests.23 The phantom hordes of Canadian medical refugees are likely to remain among them.”
Jack–You’re entirely right about the power of the lobbyists and their campaign contributions in this country. They keep these myths alive.
Terri-You wrote: “Americans just keep buying these lies about where we should spend our money.” I agree.
And the Eisenhower speech was great. Unlike GWB he understood the full cost of war.
Doc 99– Actually Sara didnt’s ignore that elephant. She addressed the malpractice issue here:
“Finally, Canadian doctors pay lower malpractice insurance fees. When paying for health care constitutes a one of a family’s major expenses, expectations tend to run very high. A doctor’s mistake not only damages the body; it may very well throw a middle-class family permanently into the ranks of the working poor, and render the victim uninsurable for life. With so much at stake, it’s no wonder people are quick to rush to court for redress.
“Canadians are far less likely to sue in the first place, since they’re not having to absorb devastating financial losses in addition to any physical losses when something goes awry. The cost of the damaging treatment will be covered. So will the cost of fixing it. And, no matter what happens, the victim will remain insured for life. When lawsuits do occur, the awards don’t have to include coverage for future medical costs, which reduces the insurance company’s liability.”
What is interesting is that in the U.S. she blames, not malpractice attorneys, but the high cost of our system which creates false expectations (docs should be able to save everyone; there never should be any mistakes) and encourages suits.
Whatever Eisenhower might have said in a speech, you’ll at least agree that he helped to build our ‘military industrial complex’, right? After all, he was President for part of the Cold War wherein we built up a huge stockpile of nuclear weapons and such.
I have to say that I feel a little like people aren’t really reading what I write. Without making any value judgments, I pointed out that the US has spent a lot of money keeping nice, pretty utopias like Canada and Europe safe from the rougher nations of the world. Whether or not you or I think this is appropriate, the fact remains.
Finally, here’s the problem with health care as a ‘right’. In my view (now, here’s an opinion) nothing can be a ‘right’ if it costs money. If you look at what our Founders considered a Right, I think you’ll find that they mostly involve one person leaving another person alone. The Right to Life, Liberty and the Pursuit of Happiness, for example. I have the right to Life in the sense that you are not allowed to kill me. Liberty, similarly, requires only that you leave me alone. The Pursuit of Happiness is just that…the right to pursue happiness without artificial barriers so long as you don’t harm others in the process. I fail to see how it is the government’s role, as defined by the Constitution (which, btw, does not include the LL&PoH phrase) can be construed to include taking my money and giving to other people. I have raised this issue before in another set of comments, and it has not yet been addressed. I’d be interested to hear what you all have to say.
Which leads me to my final thought tonight. I am tired of people attributing to me things that I have not expressed. Maggie wrote, “Others think that healthcare is a privilege, not a right. If you can’t afford it, this is your problem–taxpayers shouldn’t have to provide it for you.” Yes, I think that taxpayers should not have to provide anyone health care…THROUGH TAXES.
Here’s where I think that Conservatives are more compassionate than Liberals. I think that it is my responsibility, me-personally, to help my fellow human beings. I give to charities that I think do the best job distributing my money to people who need it. I, as a small-government-conservative, take that on as my personal responsibility. On the other side of the aisle, big-government-liberals want to cede personal responsibility to the government because they, in my opinion, do not trust their fellow human beings. So, which side is more compassionate? Is it the side that argues for coercive government power to force people to ‘care’ for their fellows, or is it the side that takes personal responsibility for their fellows even in the face of a large personal tax burden?
Tom,
I like that there is a libertarian voice on the blog. Keeps us all honest and gives another point of view. Dont disappear.
I want to relay a story to you. I just got home tonight after a long day at the hospital. I spent some time caring for a sweet 25 yo woman. Graduated from a good college, paid her way, has some serious debts, but clearly has a bright future. She just started a job at a well known business establishment on the UES of NYC this week. Her health benefits kick in in 6 months.
She came to the ER toxic as hell with what I suspect is new onset inflammatory bowel disease. She did not ask for it, it just struck. I had a medical student with me during our discussion (this was eye opening for him as he usually hears about “medicine” only). Anyway, as she was hysterical crying about her financial prospects and bills, here are her two options:
1) remain hospitalized and get her procedures and biopsies done. Receive a massive bill and hope to negotiate a bundled down sum.
2) Leave the hospital, and pay FFS for procedures, etc. She must pay cash on the barrel in the private world, or wait several weeks for our GI clinic.
Oh yeah. Fill prescriptions regardless that are expensive and unwieldy after she is discharged.
Frankly, it broke my heart. All I could think of, and I dont care if you are on the right or left side of the aisle, this is real life, is how the hell did we get to this place.
You might have a snappy retort, and feel free, but your words were not the tonic I was looking for. Somehow, I dont think Jefferson or Adams had this in mind, no less Ike.
Anyway, such is life.
Brad
Tom, fair enough. You wrote:
” Which leads me to my final thought tonight. I am tired of people attributing to me things that I have not expressed. Maggie wrote, ‘Others think that healthcare is a privilege, not a right. If you can’t afford it, this is your problem–taxpayers shouldn’t have to provide it for you.’
“Yes, I think that taxpayers should not have to provide anyone health care…THROUGH TAXES.”
Tom continued: “Here’s where I think that Conservatives are more compassionate than Liberals. I think that it is my responsibility, me-personally, to help my fellow human beings. I give to charities that I think do the best job distributing my money to people who need it. I, as a small-government-conservative, take that on as my personal responsibility”
Tom: First, you are right. While you have said that healthcare is not a “right” that taxpayers should have to support, you never said that it is a privilege.
And I am completley willing to believe that you are happy to conribute, voluntarily, to contribute to heatlhcare for the poor.
But the fact is that right now, many Americans cannot afford healthcare. And most Americans are not willng to contribute to healthcare for their less fortunatnneighbors–and those who are willing to pitch in are not willing to contribute nearly enough.
.
This helps to explain why we rank last, worlde-wide, in “preventable deaths.”
That is also explains why infant mortality rates and maternal mortality rates (while giving birth ) are much higher in this country when compared to other developed countries.
That’s really great that you give to charities Tom. I wonder how many people out there would donate 33% of their income to charities if there were no taxes. Beyond that, I wonder when they’re going to create a “highway” charity that could maintain the interstate highway system.
I think conservatives like the whole “charity” canard because they like feeling superior to other people and forcing the poor to rely on explicit handouts would make them feel even more ashamed of themselves than the poor currently do relying on things like Medicaid and Food Stamps.
Brad,
I hear you about the heartbreaking stories we all get from spending time in medicine. I may be but a 4th year med student, but I’ve paid attention and I have at least a beginners understanding of what the real world is like. None of my arguments are meant to belittle people’s difficulties or suffering. My point is that the easiest solution (voting to use other people’s money against their will) is not, in this case, the correct solution.
As for the Founders not ‘having this in mind,’ I’m sure you’re right. They likely never would have supported the ridiculous malpractice awards that have contributed to the high price of medical care and insurance. They, from my reading, would never have supported the uncaring attitude of The People that leads some in this space to conclude that there is insufficient good will out there to help those in need. Nor would they ever have supported the Welfare State that has greatly contributed to this huge dependence on the government.
Mike C,
I agree that people would likely not voluntarily give 33% of their income to anything of their own volition. However, I disagree that 33% would be necessary. Giving to a private charity means less overhead (government is extremely inefficient). If I give $1.00 to, for example, a food bank then that organization can take my pretax $1.00, use $0.15 to pay the utilities and buy whole sale food for the needy. The government, on the other hand, takes my $1.00 in taxes, spends ~$0.30 in administrative costs, and then gives cash equivalent to the needy, which they then use to buy retail food. So, we actually get more good/dollar out of a private donation than we do through taxes. Oh, and nobody is infringing on my rights or trampling the Constitution in the process.
As for the idea of shame…maybe it’s not such a bad thing, in reasonable doses. People who feel shame at taking handouts are, in my experience, much more likely to work hard to get back on their own two feet than those who have given up and become a ward of the state. But maybe that’s just my experience.
Maggie,
You claim that “most Americans are not willing to contribute to healthcare for their less fortunatnneighbors”. That may be true…but I am willing to bet that it would be much less true if “most Americans” were not having 1/3 of their paychecks taken by the federal government. Now maybe they’d all run out buy wave runners and snowmobiles if the income tax went away, I don’t claim to be able to predict the future. But, I have faith in the American people. I believe that faced with suffering in their own neighborhoods, people would reach out and help. That combined with tort reform and the power of efficient private charities would go a long way towards providing people with what they need while not destroying the fabric of the Republic.
Tom, Brad, Mike C,
Thanks for commenting.
Tom–I always have problem when people bring up the Founding Fathers’ beliefs as a standard for what we should believe about “”rights” today.
The Founding Fathers believed that people had
a right to own slaves.
The Founding Fathers believed that people had a right to beat their slaves, rape them slaves etc, as they saw fit.
The Founding Fathers believed that only men who owned land should have the right to vote.
One might defend the founding fathers by saying, well at that time, everyone believed in slavery.
But that is not true. At the same time, many men in other parts of the world, were denouncing slavery–especially in England .
And of course England made slavery illegal long before we did.
You also write: “But, I have faith in the American people. I believe that faced with suffering in their own neighborhoods, people would reach out and help.”
Have you spent any time in a large American city in the past 15 or 20 years? Have you noticed the homeless people begging on the streets? How many people have you seen stopping to bring them hot food, clothing, bedding–or, heaven forbid,
to invite them to sleep in the lobbies of their apartment buildings?
Finally, I find it troubling that you are planning on becoming a doctor and don’t have more of a response to Brad’s story –except to go back to the old conservative theme:
what’s wrong with our healthcare system is malpractice suits. Those sky-high malpractice awards and settlements equal less than
one half of one percent of our total health care bill.
Mike C.–The real reason conservatives like to talk about private charity as the solution to poverty is because their main agenda is to shrink government, whenever, wherever possible.
Without government, unbridled greed could rule the world.
Brad–
Your story is a very good example of how just about anyone can be struck down by our health care system–no matter how
responsible they are.
I disagree with you on only one point: Tom is not a libertarian. He is a conservative. The aim of the conservative movement in this country is to privatize government, cut taxes, and abolish regulations. Whatever they say, this is the agenda.
The underlying goal: to
accumulate and preserve wealth in the hands of a small percentage of the nation.
This doesn’t mean that I want Tom to “go away,” btw, I just want to make the political differences clear. I believe that in a capitalist society, we need government to do the many things markets won’t do.
A very intelligent and clear book on the conservative agenda: “The Conservatives Have No Clothes.”
Well done, Maggie!
Maggie,
Feel free to label me with whatever name makes you like. Conservative, Libertarian, they’re just words.
Regarding the Founders. Here’s the thing, you’re right that many of them owned slaves. Of course, it was not only in England that there were people railing against slavery. There were abolitionists in New England, Pennsylvania, etc. as well (and, of course, not all of the Founders owned slaves).
To suggest that even the slave-owning Founders were evil is to have a very incomplete understanding of these individuals. Jefferson, Washington and Franklin, for example, all explicitly struggled with the slavery issue and ultimately freed their slaves. Considering the culture from which each of those three came, the very fact that they struggled with the issue speaks volumes for their personal/moral integrity, let alone the actual act of freeing them.
Anyway, the thing is, if anyone at the Constitutional Convention had stuck to their anti-slavery guns, the United States would never have been formed, let alone survived. From my reading of history, even the Founders who owned slaves contributed to the eventual discontinuation of slavery in the US. The agreement that made slaves count as ‘3/5 of a person’ in terms of representation in the House greatly reduced the power wielded in the South, and ultimately contributed to the end of Slavery.
So, I maintain that it is correct to go back to the Powers and Rights that the Founders identified. I suppose, however, that can be argued. What cannot be argued is that the Founders established a Constitution wherein they defined the Powers to be held by the Federal Government and reserved all other Powers to the States and to the People. So, I again(!) challenge you or anyone here to show me the section of the US Constitution that delegates to the Federal Government the power to take money from the taxpayers and redistribute it to others in the form of Health Care. If you cannot identify such text, then any government involvement in the funding of health care must, by the definitions contained in our founding charter, be reserved to the States or to the People. From there we can go on and have this argument state by state based on those founding charters (as they clearly have in Massachusetts).
Finally, I’m sorry to have given you a ‘troubling’ feeling in my response to Brad’s story. Here’s the thing. Based on my understanding of the workings of our country’s government, I find it necessary to separate my thinking about the government’s rightful role from my human feelings and compassion. We are discussing here public policy. The suffering of an individual cannot be allowed to outweigh the law of the land. It’s not a pleasant thing, but there it is.
If you want to enter into a discussion of how we can provide health care for the unfortunate individual woman, fine, we can do that. I’ve mentioned a few of my thoughts and can continue along those lines in the (perhaps near) future. One thing that I will not stand for, however, is even the implication that I will be a less than ideal physician based on my political and public policy views. You do not know me nearly well enough to make those sorts of implications and I would greatly appreciate it if you refrained from doing so in the future. My response to Brad’s story was aimed at the larger public policy reasons for the high cost of health care, not what he (or I) can or should do to help that woman.
Tom:
What about the women? Or the landless? What’s the rationale for the Founding Fathers not letting them vote?
Let’s be honest. The Revolution was largely a response to King George’s Proclamation of 1763, which forbade the colonists from buying or settling on land west of the Appalachian Mountains.
John,
Yes, let’s be honest. The Revolution was set off by the English government’s mercantilist policies and the denial to the colonists of the Rights and Privileges enjoyed by English citizens. I’m sure the referenced proclamation played a role, but it was hardly the entire reason.
As for the Founder’s views on Women and suffrage. Which of the Founders beat his wife? As for voting, do you have any idea how the Constitution deals with suffrage? If you take a look, you’ll find that it demands only that:
Section 4 – Elections, Meetings
The Times, Places and Manner of holding Elections for Senators and Representatives, shall be prescribed in each State by the Legislature thereof; but the Congress may at any time by Law make or alter such Regulations, except as to the Place of Chusing Senators.
As we are considering the proper role of the Federal government here, I’m not sure what suffrage has to do with it? (Or the beating of wives, for that matter.)
Other than that, it is not appropriate to judge historical figures based on today’s standards. It is far more fair to judge them on what they did with their lives. If someone is raised by slave-owning/beating parents, and even on his deathbed frees his slaves, he has come further than most of us are likely to.
Now, I have done my best to engage you all on your own turf. Who will return the favor and find me justification for the redistribution of wealth in the form of health care in the charter that defines the powers of the federal government?
Maggie and others – I, too, had deep concern about “Tom” as a future dr (and btw he’s taking direct care of lots of pts now – mostly the poor – who don’t have an “attending” b/c that’s what 4th yr med students do. They’re cheap labor for teaching hospitals.
But a thought just occurred to me – what are the chances that “Tom” is not really a med student but is actually a “Fellow” on stipend at the Heritage Foundation?! Could it be that they have a cadre of these fellows sent out to gum up the works on progressive serious-minded policy blogs?
If this is true, does it make me feel better, or worse???
Health care most certainly is a recognized human right. Go do the research yourself if you don’t want to take my word for it.
Sooner or later most blog dialogs acquire a few libertarian commentators. They are characterized by several traits that seem to be almost universal.
1. The belief that an individual is free to act for their own personal benefit and there is no obligation to contribute to the general welfare of society.
2. The belief that private property and wealth is theirs to do with as they wish. The “it’s my money” type of claim. This makes most of them anti-tax and anti social programs.
3. Frequent citations of key thinkers in the libertarian universe. Depending upon context these can be drawn from the economic realm (like the “Austrian” school) or from the moralistic area like Ayn Rand, or from the public policy area, like spokesmen from Cato and similar think tanks.
4. They are immune to arguments which call into question their axioms. In this way they are similar to other ideologies, especially religious ones, where the basic premises are beyond debate.
5. They are almost all youngish, white male Americans with a middle class upbringing that did not contain too much obvious social or economic deprivation. There is almost no similar school of thought in any other advanced industrial society. The reasons for this are unclear, but I’ve claimed in the past that it has to do with the large degree of financial support given to libertarian organizations in this country by a small group of super wealthy families. Without the funding the think tanks and university departments that promote the libertarian thought would not have the wherewithal to attract new adherents.
Rather than go into the reasons why the libertarian philosophy is not compatible with an advanced democratic society, I’ll just refer people to my web site where I have several essays on the subject.
The reason I bring all this up is that when an inflexible libertarian shows up in a discussion there is a tendency for others to start to debate with the person. This always involves rehashing arguments that have been covered elsewhere many, many times. You cannot win the argument (see point 4), but engaging for any length of time is sure to divert the discussion away from the main theme and allow the site to be hijacked.
My advice is to resist getting involved in debates with libertarians, but if you feel you must then make your points (once!) and move on. Otherwise you will get mired in a pointless series of back and forth remarks.
Libertarians are especially common when it comes to discussions of things like universal health care (see point 2), so one must be especially careful not to get distracted.
I should point out that libertarian objections to comprehensive social programs stem from a different position than that of the usual opponents who are usually stakeholders in the status quo in some fashion or are acting out of self-interest.
At least when you are arguing with, say, a tobacco lobbyist you know his motivation – he needs to put food on the table for his family. Libertarians see a higher calling.
Rob,
Thanks for the short treatise on Libertarians. Of course, I prefer Originalist…as in I can read the Constitution and as yet nobody has challenged those arguments. But thanks for suggesting that my arguments aren’t worth engaging. That’s a great way to run a Limited Representative Republic.
I read a bit of your website. Here’s what I get from it. You mistake ‘Libertarian’ for ‘Anarchist’. Also, you are apparently a Communist as you (again, apparently) believe that private property is a false concept. There’s a good deal more I would like to say, but in deference to the fact that this is neither my forum nor yours, I invite you to email me (mudphud11-at-yahoo-dot-com) so we can continue this discussion elsewhere…but then I suppose you’re smart enough to know that I’m not worth engaging.
Ann,
You caught me. What gave me away?
Actually, I am a med student (an MD/PhD student to be complete). But then I suppose I would need to offer proof, which is difficult in this setting.
Tom:
Not to quibble, but the English back then were “subjects” not “citizens.” The main point of emphasis is that the Founders were practical men of business who, when it came to some difficult issues, elected to punt. They were not libertarian idealogues and they built flexibility into the Constitution that has enabled the U.S. to evolve, whithin limits, over time. That’s perhaps it’s greatest strength.
Rob,
I agree with Tom. Dialogue is a good and I appreciate his candor. I can’t buy your “general theory of the libertarian mind.”
I must be slipping, I forgot to mention that when all else fails libertarians next revert to ad hominem attacks on those who would dare to point out the logical inconsistencies of their ideology.
As for those who favor “debate”, they are usually those who share the same basic outlook.
Notice I didn’t mention any names, but not so for those who favor “liberty”, they personalize things as quickly as possible. That way one gets even further from the point by having to defend themselves against slander.
I’ll summarize the debating trajectory.
1. Make absolute statements at variance to reality.
2. When countered with actual data, deny that it is correct.
3. When this fails, try to change the subject.
4. When this fails attack the speaker.
I guess it’s time for me to cite my current favorite author on how psychological makeup interacts with political leanings – Robert Altemeyer. He has a free, online book out on his web site: TheAuthoritarians.com
He has studied what he calls the “right wing authoritarian” personality type for over 40 years and finds that one of their key characteristics is the inability to adapt their views to information that runs counter to their dogma.
He distinctly excludes libertarians from his study, but I find a similarity in the way libertarians and conservatives respond to challenges to their core beliefs. This is especially true as to the inability of either group to ever “lose” an argument.
Read the book and you will save yourself a lot of time when next you feel like getting into a debate over societal axioms.
Rob,
I wasn’t calling anybody names. It just seemed like your views were similar to those of Communists. My guess is that one of your tactics is to hide behind the claim of ad hominem attacks.
I notice, also, that you have not yet addressed any of the issues I have raised.
To everyone–
This has been a lively thread–but maybe we
should get back to talking about healthcare?
Cheers, Maggie
HOW MUCH THE SALARY FOR CARE GIVING PER MONTH?
What country in the world has national health care and over 300 million people living in that country ? Do we even know if this will be a problem in America ?
Now I’m well understood about the complete Canadian health care program, and it’s quiet interesting to follow all the ten tips and plans thanks for sharing this valuable Canadian information.