Archive for the ‘healthcare’ Tag

Rants. A Long, Vaguely Coherent Rant.

I feel a rant coming on. And I think I’m just going to run with it – to purge out everything that might come out, so if this reads like a rambling stream of consciousness type post, well, either enjoy, or don’t read, whatever suits.

Dear America:

What the hell is wrong with you people? How are your election campaigns this… disturbing?

I’ve been trying to understand the mindset of the Republican voter for a very long time, especially in the context of the red/blue state thing. I don’t get it. I can’t wrap my head around it at all. The only way that Republicans can get any support, obviously, is by getting people who are so poorly informed that they can’t see that their interested are not represented by the GOP to vote for them. I guess xenophobia, scapegoating of the poor, and outright lying really do work. And it’s amazing, as an outsider, to see it happen. Nothing stuns me more than watching the right rail against the “liberal media”, which is just a giant myth that they’ve created. In their mind, in their narrative, “liberal media” means any outlet that will not simply spin a story exactly the way they want it. They seem to lack a basic understanding of what actual journalism, which I think is a dying art, is all about – to look at the story from as many angles as possible and to report it accurately. There’s no such thing as “conservative news” or “liberal news”. Or rather, there shouldn’t be.

I console myself a bit by realizing that generally, the worst of the commentators (regardless of their alignment on whatever political spectrum you want to use) are really only ever preaching to the choir. If you’re listening to the screed of the likes of Rush Limbaugh, it’s not like you’re an informed, intelligent, politically pragmatic character. In all likelihood, you’re listening to him, because the message – the racist, anti-woman, xenophonic, right wing message is already something you believe. I’d like to think that a rational person hearing Limbaugh for the the first time would simply laugh and say, “What’s this guy’s problem?” or dismiss it as some sort of poorly executed satire. But I guess I’d be wrong.

To me, though, it makes no sense why their ideas would get support. The reality of conservatism is that it absolutely needs low information voters. It needs ignorant, easily manipulated minds who can be sold a vision of an alternate reality that they then think voting Republican (or any conservative party, since it could happen anywhere, it’s just the USA is such a great ilustrator, and probably the worst case of  it) will actually give them access to this world. Americans, as I understand it, grow up believing in the “American Dream”, the idea that hard work will make you successful. The grow up with the idea that they can become one of the so-called “one-percent” if they just work hard at it. It’s a lie. Well, not totally. They may well just end up lucky, but most of those people, they come from old money. The best way to become rich and powerful in the USA is to be born into it. Joe Sixpack, the ignorant, Rush-listening trailer trash living in the backwoods of Georgia? It’s not going to happen for him. And voting Republican, as he likely does, is only going to help ensure it doesn’t happen for his kids, or their kids.

Conservatives, for all their bluster about hard work, initiative, and personal responsibility, seem to view the working family as some kind of parasite, or drain on the system. This has never been put out more clearly to the American electorate than last week when Romney’s “47%” video emerged. Who are those 47% who don’t pay taxes? Senior citizens who paid taxes all their working lives and now are living on the Social Security they contributed to. Young families who’ve availed themselves of tax credits and other fiscal incentives to keep them prosperous (which were lauded by the likes of St. Ronnie Raygun himself), and people who work for minimum wage or just above it – the people who clean your schools and offices, who work unskilled labour jobs, who serve you food, do your laundry, pump your gas, and so on. These people are the invisible underclass on which the prosperity of the richest depends.

I don’t want to start sounding Marxist or anything, because I’m not. In broad terms, capitalism, individual initiative, and free markets have for the most part been responsible for providing those of us lucky to live in the industrialized world the great standard of living that we have. In fact, even many of the poorest dregs of American society are still far, far better off than most of the world. I’ve been in Afghanistan for almost eight months now. Think you’ve seen poverty? Think again. And things here aren’t even as terrible as they are in some places in the world. The concept of a social safety net, as miserable an existence as they may well be in North America, does not exist in most of the world. People starve to death, freeze to death, try to eke out some sort of existence in most of the world. However, there’s a definite class division. And the idea of social mobility – that you can earn your way into the sort of upper crust that goes to $50,000/ticket fundraisers to hear politicians mock half the population of a country? That’s a fairy tale. It’s possible, but so unlikely that you’re better off trying to win the lottery. And on that subject, winning the lottery only proves the point more. Even having money can’t get you into that circle. If you didn’t have the right parents, go to the right schools, and so on, that’s a world that simply is not open to you.

That’s not to say there’s no point to working hard. My father was an immigrant. Granted, he came from England, and was likely a few steps ahead of immigrants today – he looked like Canadians, spoke the same language (albeit accented), and shared a cultural heritage with them. But he came to Canada with a few dollars, a job offer, and that’s about it. He didn’t have an advanced education. Never went to university. He left school as a teenager and started working, and realized that England in the 1960s was a bleak place. He got married, worked, saved, had a family, and is now enjoying a modest retirement. Well, less modest than many. While I was growing up (I’m 32 now), most of my friends’ mothers didn’t need to work for their family to enjoy a decent standard of living – or worked part-time, as my mother did. It was not the norm as it is now. I went to school with many children of very recent immigrants – tradesmen, many of them, or autoworkers. They worked hard and pushed their kids hard to succeed so they could have a better life. And it seems, mostly, like that worked. Now I have to wonder.

That said, the days of going and getting a good paying job without a lot of education seem to be gone. North America is deindustrializing. It’s no shock. The industrial revolution has spread to the developing world, and with cheaper labour costs, it simply doesn’t make sense not to globally rationalize production. That leaves North America (and perhaps, to a lesser extent, Europe, as manufacturing seems to remain very viable in countries like Germany) to figure out what to do next, economically. Here, we should be focused on what we’ve always been good at – innovation, development of new, better ways to live life and do things, invention, research, and developing knowledge-based industries. If we don’t stay ahead of the curve there, we’re going to be in for a world of hurt. It’s often noted that Chinese and Indian universities are churning out engineers at a far higher rate than North America, and soon, innovation will all come from them. That giant underclass? It’ll become all of us, because you can’t base an economy on selling hamburgers to each other (I can’t remember who I got that line from, but it’s not original, and if you know, let me know so I can attribute it properly).

How does a party manage to succeed on a platform that’s entirely based on ideas that not only have failed in the past, but that don’t even sound reasonable or logical?! Romney’s “platform” seems entirely based on the same tired ideas. “Let’s give big tax cuts to rich people, so that they’ll create more jobs.” Of course, since he is one of those plutocrats, who was born into the right family and is insufferably out of touch with the average American, he’s going to benefit from that, but let’s leave that aside. Why do people think that this will work? Even if there’s any merit to the Laffer Curve, the concept the idea is based on – it all depends where on that curve (it’s actually a parabola) you are. There’s no reason to believe it will work all the time.

And then there’s the GOP’s ideas about healthcare. They clearly live in a dreamworld. Only what, yesterday(?) Romney actually said something like, “Everyone has access to healthcare, they can go the ER.” The most expensive form of care available, only available as a last-ditch intervention? This is a brilliant plan. So our folks (30+ million of them) who don’t have health insurance are expected to go get emergency treatment. Then they’ll get the staggering bill, and they won’t pay. So who picks up the cost of this incredibly expensive, too late care? Everyone. Because prices go up while hospitals try to recoup the cost.

This. Makes. No. Sense.

This is the whole problem in the healthcare debate. You want to save money? Make sure everyone has access to care, to good, effective, preventative care. That won’t guarantee that everyone will use it, but over time, it will save money. It works in pretty much every other industrialized country, since they all manage to spend less public money on healthcare, and yet insure everyone.

But we’re not seeing this discussion in American politics. Instead, we’re talking about personhood, slut-shaming, and how ridiculous the idea of improving access to contraceptives is. All bullshit issues. And all generally aimed at women, who it seems conservative men seem to think they can make decisions for. Again, common sense should prevail. Oh, you’re pro-life (read: antichoice)? Don’t like abortion? Great, then why don’t you get behind making comprehensive sexual health education available to everyone, and access to contraceptives simple. That will reduce the demand for abortions! But of course, this doesn’t make sense to these people. They’d rather try to push “personhood amendments” and actually seem to believe that criminalizing abortion (which they’re not helping demand for by making it harder for people to prevent pregnancy!) will make it go away, instead of pushing it into shadows with real consequences to those who decide they have no other option. Nonsense. Sheer lunacy.

This brings me back to my original question. Who the hell supports these people and why? Why is it that the “47%”, who overwhelmingly seem to live in Red States which mooch federal tax money off of Blue States, are voting for a party which seems to despise them. What do they see being offered to them? What is to gain for them in supporting a party that thinks that people who find themselves unemployed, or who want to further their education but don’t have rich parents to fund it for them, or who are raising a family are just freeloaders? And that “47%”? It’s not a static population. It’s fluid. People pass through periods of unemployment for brief moments, generally. They may get tax credits for having kids and learning lower income for other brief moments. In fact, I’d wager the only people who stay in that bracket a long time are senior citizens, availing themselves of benefits they paid toward for their entire working lives.

The Red/Blue thing always makes me laugh. Want to piss off a rabid Red State Republican? Highlight that California subsidizes their state. They love to rant about how California is “broke”. At the state level, their fiscal position is a mess, thanks in large part to stupid populist ideas like Proposition 13, but also due to some of the demographic challenges they face. And yet, they send far more money into the Federal Treasury than they get back. Where does that federal tax revenue go? To prop up Red States. This is the perverse fiscal reality. And if they don’t believe you, there’s myriad sources that will support it. From notoriously liberal sources. Like, er, The Economist. In fact, just Google. There’s plenty of sources.

So what’s the way forward? The way I see it, it’s pretty simple. First, drop this horseshit talk about yet another war. Sorry right-wing Americans, you don’t get to complain about the national debt (by the way, You Built That!) while at the same time crying for war with Iran to protect the interests of a third party. Wars are incredibly expensive, which is why the Bush Administration was so keen to keep the Iraq War off the budget books. And stop talking about “uncertainty” as though electing a plutocrat who doesn’t have a plan is going to fix that. What is dragging down the economy is demand slumps. It’s pretty simple. People who feel unsure about their future employment prospects put off purchases because they don’t want to deplete their savings, or they don’t want to take on more debt for them. Less demand means companies need less labour, which causes unemployment to grow. It’s a rather vicious circle.

So, what can be done? Well, let me take you back to Macroeconomics 101. We start with a simple equation:

Y = C + I + G + NX

Y is GDP (or national income, more technically, in some books). C is consumption (consumer spending). I is investment – capital investment, essentially. G is government spending. NX is net exports. Pretty simple identity.

That whole thing also can be used to assess something called Aggregate Demand. That’s what’s dragging down the US economy. And probably a lot of other places. So how to we spur more demand? How do we make people feel more confident to open their wallets and buy durable goods, or go out to dinner more, or travel, or otherwise just put money into the economy? What could be done?

Well, the US (and everywhere else) has something called an Infrastructure Deficit – that is, a valuation placed on the amount of work needed to be done to maintain or upgrade infrastructure. Roads, bridges, railways, ports, all sorts of things. All these things are vital to the function of the economy. Remember “you didn’t build that”? The out-of-context remark that the GOP seized on? Among other things, like education, President Obama was talking about that infrastructure. In the United States, this deficit is in the trillions. So, let’s flesh this out. What would happen if the government, instead of handing yet more tax cuts to the rich, instead plowed money closing this gap?

Yes, they’d have to borrow the money. But that’s not manifestly evil. Hell, if the Republicans are cool with borrowing money to go to war, they should be cool with borrowing money to invest in economic growth. And if not, well, why listen to them?

Doing this work would require the employment of a large number of people. Some of the jobs will be unskilled, simple construction jobs, and to jobs producing raw materials. Some will go to engineers, skilled tradesmen, etc. Regardless, that will put money in people’s pockets. They’ll feel some security, and they’ll start spending money. They’ll eat out occasionally. They’ll buy coffee while they work, beers on Friday night. They might actually feel secure enough to buy a new car, or replace their washing machine.

And then something awesome kicks in. It’s called the multiplier. See, each of those businesses that those workers are now patronizing, they’re seeing demand. They’re making money. And they’re either paying wages to workers they need, or maybe it’s a sole proprietor who now too feels some security to start spending a little. Estimates on the size of the multiplier vary, but somewhere between 1.25-1.40 seem common. So gradually this growth in demand will becomes self-sustaining. As the infrastructure deficit closes, you’ve got some demand that’s replacing it.

But why’d I put that equation up? Well, the “I” is often the problem. Critics of stimulus will readily point out that private capital investment can be “crowded out” by government spending. Except that right now, “I” is low. Firms are sitting on their cash because they don’t see much value in investing in capital they don’t need. So crowding out isn’t likely to be a real problem. There’s just not much to crowd out.

Doing this – basically Keynesianism – requires an understanding that the money borrowed now equals future obligations to be collected through the tax system. That’s where Keynesianism breaks down for people – and why I argue it’s never actually been done – Keynes said that spending to stimulate the economy in bad times was important – but he also highlighted that you need to use the surpluses in boom times to retire that debt or save for the next bust. That doesn’t happen. Surpluses in Canada were used to give tax cuts to people (with little stimulative effect) instead of to retire the national debt back before the last big crash. Then the government made some big stimulus investments and leveled the economy out, but ran massive deficits that are harder to recoup because raising taxes is a lot less easy to do.

If we actually had an informed citizenry, this might be something that could be debated, discussed, shaped into something resembling a plan that most reasonable people could support. Then, if the US had a legislature that actually cared about doing its job rather than just trying to jockey for position in the next election (again, not likely), maybe they could actually work together to craft a solution and push it through. I’m pretty sure what the vaunted but oft-misquoted or misrepresented Founding Fathers were going for looked a lot more like that than that blind partisanship to the detriment of the national interest that pervades ow.

Unfortunately, I’m too cynical to believe that’s actually possible. I know that Joe Redneck Sixpack will not be swayed from his moronic talking points, because thinking for himself requires an effort he’s not prepared to make. I know that the media won’t be able to sway people either. And I know that most people just won’t put the thought it takes to write something like this into choosing which box to put the X in or what lever to pull or however it is you folks decide elections, so we’re stuck with a system that’s horribly broken. Or are we?

Whither The Centre?

For some reason, I guess because I’m some kind of masochist, I tend to insert myself into all sorts of debates and discussions over politics.  Canadian politics, American politics, whatever – they all fascinate me, and if there’s one thing that’s becoming clearer and clearer over time, it’s that all politics is indeed local – everything matters, because we’re all really connected.

When I was a first year university student, I read Benjamin Barber’s article (since expanded into a book), Jihad Vs McWorld.  It was a very good explanation of the competing forces which we were just coming to be understood as “globalization”.  That article was six years old by then, but seemed to me very insightful.  I had started to understand those impacts during the brief travels I managed to do before and during school, which doesn’t seem to be a habit I’ve carried on with enough, though hopefully that will change.  Anyhow, if you’ve never read the article, do so – it’s worth a read.  It talks a fair bit about the ideas of confederalism and trying to define the role of a nation-state in this new world.  We’re seeing the same sort of thing now when we take a look at NATO trying to define a role for its future post-Cold War.  That, I suppose, is a whole other matter.

If I tell you that higher education softened my conservative views, I guess I’ll play into some sort of sick right wing stereotypes about liberal education.  Truth is, while I went to a very, very liberal school, I didn’t really start to really think like a centrist until a while after I was out of school in the real world and started to realize that all those monetarist, conservative “theoreticals” are just that, and they don’t really seem to work.  And I guess I realized that before a lot of people, because what I’m seeing unfolding in the world suggest it.

What happened to the idea of a rational, pragamatic centrist movement?  In the US, the only people I’ve seen claiming the label of centrists are really right wingers trying to sell themselves a little softer.  In Canada, the reasonably centrist Liberal Party of Canada just got totally wiped out in the recent election, and the “Progressive Conservative” Party no longer exists.  Although Prime Minister Harper doesn’t strike me as having some incredibly insidious right wing agenda, he also learns a fair way to the right, more than perhaps I’d consider acceptable, and even worse, some of the clowns in his party are far less ambiguous about it.

The problem is, as I see it, we have a whole lot of challenges to deal with.  Climate change, regardless of the degree to which you accept the anthropogenic nature thereof, is something that is going to impact the world somehow – it’ll change migration patterns, it’ll impact food supplies, it will impact everyone in some way.  The global economy is another problem – casino capitalism as it were has impacted us certainly.  The world’s largest economy sits in a country that faces massive budget deficits and complete unwillingness to overcome the polarization in politics in such a way as to actually make any progress.  There’s no rational voice in the centre trying to balance out the two highly polarized sides in any debate, and so there’s deadlock.

Why do we have to talk only about tax cuts, tax hikes and spending cuts and not look at other ideas?  More importantly, why is there no discussion of combining various approaches in the US for example to solve problems?  Obviously, taxes have to rise in some form in the USA, it’s just a matter of time.  Despite the claims of various pundits on the right, America does indeed have a revenue problem.  It does have a spending problem too, and that will take a lot of effort, it’ll take some pain I’m sure to fix it effectively, but it must be done in some form.  What astounds me is the denial of realities that healthcare reform as it’s been initiated by the Obama Administration will likely help while actually improving healthcare outcomes.  I’m also surprised (not really) that no one seems to grasp that massive, massive military spending cuts in the USA are going to be necessary to make any progress.   Those cuts will have to come from capital procurement primarily, and allowing the force to shrink via natural attrition.

What I don’t get is why people aren’t demanding better from politicians, demanding actual reasoned discussions.  I guess that advantage we had in Canada when we went through this in the 1990s is that our Parliamentary system allows the government of the day to just get on with things without having to constantly battle the opposition.  Score 1 for us.  Obviously there’s no way to make changes to that, but where are the voices starting up to the Professional Left and the Theocratic-Fascist-Corporatist right?

The Spectacle That Is Politics

Politics of all sorts have been rather interesting lately.  First, there’s been the failure of Manitoba MP Candice Hoeppner’s Private Member’s Bill C-391, which was designed to finally scrap the Long Gun Registry.  It made it through two readings before a number of New Democratic Party MPs were persuaded to switch sides and defeat it by the narrowest of margins.  One of them, Peter Stoffer, is an MP from Nova Scotia, and the number of angry letters in today’s Halifax Chronicle-Herald is interesting.  His riding will be one targetted in the next federal election campaign I’m sure by the Conservative Party.

I’m annoyed C-391 failed, mainly because there are simply no good arguments for the registry that justify spending any further money on it when there are other programs that could be persued in its stead that might actually improve public safety, but I think I’m more annoyed that it’s revealed the true dark underbelly of Canada’s political system currently, and shown that while Stephen Harper is the best guy to be running the show right now, he’s really not great, and should count himself very lucky that there is no credible alternative to him for the time being.

For all his efforts this summer, much to the chagrin of the aforementioned Mr. Harper, Michael Ignatieff is just not resonating with a lot of Canadians (except maybe those damned “Toronto elites” that MP John Baird hates so much), and that suits me fine, as it means that the status quo of a relatively powerless Conservative minority will last.  I’m okay with that.

The next big PMB that seems like it’ll come up for debate is Gerard Kennedy’s C-440, which basically neds the Immigration and Refugee Protection Act to allow American deserters to qualify for refugee status in Canada.  This is probably the most alarming development to me lately.  Since the Iraq War in the US started, there’s been quite a few American military personnel who have deserted and made their way to Canada, where they have tried to claim refugee status.  So far, none of them have been accepted, and they have no reasonable prospect of doing so unless the definition of “refugee” is significantly altered.  Some have been deported already, and prosecuted in the normal maner in the United States, others have not.

So, let’s be clear.  A deserter from a volunteer military in a liberal democractic country like the USA – someone who was not conscripted or otherwise impressed into service – should absolutely not be considered a refugee, period.  The definition of refugee in Canada is taken from the UN Convention Relating to the Status of Refugees.  A refugee is a person who, “”owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country”.

A deserter is not someone facing persecution.  They face prosecution for the crime, but that is not justification for another country to offer them refuge, particularly when desertion is an offence in Canada as well, under Section 98 of the National Defence Act.

These so-called “war resisters”, all of whom joined the military knowing (or at least, they ought to have known) the risk that military service entails, the possibility of being deployed to a serve in a war zone, whether they agree with the politics of the war or not, have no business in Canada.   They are owed nothing by us, and to bend our rules to process these people is an affront to the process of aiding legitimate refugees.

So, C-440 must fail, and any politician who supports it in any way better not be asking for my vote as they will not get it.  It’s an insult to anyone who has accepted unlimited liability in military service, who has made any sort of sacrifice as such, that some selfish fool who doesn’t want to live up to their end of the bargain should be allowed a pass.

As if Canadian politics isn’t interesting enough of late, there’s the brewing shitshow in America.  I am rather interested to see what will happen in the mid-term elections in November.  My father was musing last night that he wants to make sure he’s at his place in Arizona on November 2 to see the results and listen in on the conversation.  I have to think it’ll be interesting.

I don’t get what the hell this “Tea Party” movement is going to accomplish.  It seems that “their” candidates are nothing but utter wingnuts, people whose only credibility seems to be some hatred of the status quote and little or no knowledge of anything to do with the challenge of running a country.  Most astounding is their disdain for, or avoidance of the democratic process – such as interaction with the media.  In a democratic society, the media has a role to play in getting candidates’ messages out and in holding them to account for what they say.  The recent antics of two of the chief wingnuts, Delaware’s Christine O’Donnell and Nevada’s Sharron Angle are prime examples.  Both seem to avoid any sort of media contact out of a fear of “gotcha questions” – like, as one pundit put it, “What is your plan when you get into office?”.  O’Donnell comes off as a puritan religious nutter, and Angle, well… she’s certifiable I think, the shit this woman has said in the past makes me astounded that anyone would take her remotely seriously.

Of course, if you think the Republicans have a rational plan for anything, take a look at their “Pledge To America”  and see what you think.  I had a hard time taking it seriously, except for the ideas of not intermixing different policies into single pieces of legislation or tagging controversial matters to “must pass” bills in order to shoehorn them.  This is a feature of the American legislative process I’ve always been appalled by.

The Pledge offers no credible solutions, and sticks to the same nonsense that the GOP has parroted for ages – tax cuts create jobs, a healthcare reform act that won’t work, and so on.  It is the most empty set of policy ideas ever, designed to trade on the fear and lies they’ve promoted since they lost the last election.

For his part, President Obama has failed – not in policy accomplishments – he has gotten a lot done – but he has utterly failed to show the value of his presidency to Americans – he’s not made any real political capital on them.  He’s tried to be nice when the GOP haven’t, and now he really needs to go on the attack, he’s started a little bit, attacking John Boehner (what’s with that guy’s obsession with tanning, by the way) directly, and so on.  He needs to show average Americans that GOP policies are bad for them, and he needs to get on that quick.

The First Steps In Reform Getting Closer!

I’ve spent probably far too long today watching the House of Representatives debate on the Senate bill.  During the last two days it seemed that the Democrats were getting closer and closer to the 216 votes that are needed to pass the bill.  I think CNN reported it fairly early today, probably before I went grocery shopping actually.  (That, incidentally, was my one “accomplishment” today), everything else was a write-off).

I find the whole Stupak/pro-life nonsense a little baffling, but that’s probably at least in part the Canadian in me that sees no point in that debate.  It’s just basically over within Canada, only the nutty extreme right wing still goes on about it, and the rest of us just see that there’s better things for our politicians to worry about.  Just listening to the baffling bullshit that is spewed by these people astounds me, but fortunately they’ve been gotten on side by the executive order promised.  I don’t see any issue with that concession either, really, as long as it doesn’t restrict access to abortion overall.  Whether it will or not isn’t something I’m in much of a position to assess, it’s not something I know much about.  Ultimately, as well, it’s a minor issue in comparison to the accomplishment of getting this bill passed.

Now it’s winding down, the Republicans are blustering away with the same bullshit ranging from innocuous whining to ridiculous blusters about “totalitarianism” and “socialism”.  I’ve got a laugh from the fact that some lobby group is running ads on CNN still that prattle about the “Deem & Pass” concept that has long since been dropped.

It’ll be interesting to see the response from the right.  It’ll be hilarious, I suspect.  They’ll whine and bitch, and before long, they’ll accept the fact that the bill makes things better – though not perfect.

More on Kent Pankow & Ridiculous Right Wing Statements

Kent Pankow’s story is really drawing a lot of attention in the US, and I found what seems to be the source of it, on popular right wing blog HotAir.com. Here’s their posting on the story.

http://hotair.com/archives/2010/03/10/another-tale-of-government-run-health-care-success/

Again, this post erects a strawman comparison of the current reform proposals in the United States, which bear no resemblance to Canada’s system, and throws around the “government takeover” lie that opponents of reform are using in their typical strategy of lying and fearmongering to block any sort of meaningful change.

Again, this blog cherrypicks the story and has no interest in looking at comparative experiences in the United States.

But that’s not the real gem. Oh no, it gets better than the tired rhetoric.

Here’s the killer:

“Some will say that the runaround happens in America, too, with private insurers. And they’d be right. [warriorbanker’s note: that’s probably the most honest thing I’ve heard a right winger say about healthcare] However, people in America have the ability to move to different insurers when they get lousy service, and still get treatment in their own country. They don’t have to flee across an international border to get medical attention.”

Really?

Really? You actually believe that?

Let me get this straight. Let’s assume I’m suffering from a pernicious cancer like glioblastoma multiforme, which has a tragically low five year survival rate and requires either surgical intervention or extremely expensive chemotherapy to treat. The usual chemo treatment is Temodar, which is not a cheap drug (though I think comparatively it’s cheaper than Avastin). Googling Temodar brought up a few sites with American cancer patients and their families discussing struggling with the cost of copayments for the drug. So it’s not as though it’s a rosy picture even without Avastin, which as I mentioned in a previous post, is a sort of “silver bullet” against cancer, it was described by one doctor as the penicillin-level discovery of our time.

Anyhow, back to this insurance claim made by hot air. Suppose I was the theoretical patient I described. My insurer goes to battle with me about the treatment options. Before they would be likely to approve Avastin I’d likely have to go on Temodar and show no progress. The FDA’s approval of Avastin to treat GBM (it’s here: http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm149364.htm ) seems to suggest that it has to be used after other treatment is not effective. I may not be reading that right, though. I’m not a doctor. I’ll get to another point about the FDA in a moment though. So suppose I conclude I’m getting “lousy service”. Hot Air’s Ed Morrissey suggests that I have the ability to move to a different insurer. If you believe that, we need to talk about some real estate opportunities I have to share with you.

Private insurance companies are in the business of making money. That’s what they do. That is their single crucial interest. They do so by trying to take on as little risk as possible, matching premiums to expected payouts, and trying to get as much information as possible about a person before they take them on. That’s why they have pre-existing condition exclusions, which me in this hypothetical state would face. No insurer would EVER take on someone who’s already got GBM or probably any cancer – at least not without excluding coverage for the treatment of that cancer – or anything that could be considered linked to it or its treatment. Like, well, just about anything. Cancer drugs have a lot of really, really nasty side effects – and even minor ones like diminished immune system resistance to simple conditions. Some cancer treatments can actually be essentially carcinogenic. A cynic I know described her chemotherapy radiation therapy as “poison that will hopefully kill my cancer before it kills me”. It’s not hard for an insurer to assess just about anything a cancer patient could claim as being related to pre-existing conditions.

So, the idea that one can shop their insurance is rather ludicrous. By the time one comes to the conclusion that their insurance is “lousy”, it’s probably far too late to shop around. Never mind that if you’re in a group plan, which is tax advantageous and helps get around eligibility rules in the United States, you’re not going to get a choice of who your insurer is – your employer will determine that. This idea of being able to shop insurance around that HotAir is suggesting is what some might call “horsefeathers”. I’m blunt, I’ll just call it bullshit.

What about fleeing across international borders? Americans don’t have to do that? Actually, that’s also not necessarily true. Medical tourism in the US is big business already, and it’s growing. Here’s some great stories:

http://www.businessweek.com/globalbiz/content/mar2008/gb20080312_835774.htm

http://www.aishealth.com/ManagedCare/BluesNews/BLU_WellPoint_Medical_Tourism.html

And there’s probably hundreds more sites – these are insurers trying to get people to use overseas services. As costs soar, people will try to keep their premiums down by electing progressively less coverage with higher deductibles/copayments, and that’s likely to push more of them to look at going to Thailand, to India, to other countries to use lower cost services. That’s what the right thinks is an okay system (while they seem to deny it actually even happens? So much for that claim, I don’t think I need to go any further.

Back to the FDA to close out my post. Remember Mr. Pankow, and how the problem is that his treatment for his GBM isn’t being covered by his provincial health insurance because it’s not an approved treatment in Canada yet? Well, it’s not like it’s a huge disparity. Avastin was only approved for treatment of gliomas in the US in May 2009. Not exactly ages ago. While I’d like to see Health Canada have a better process to use research data from the USA to expedite its own processes, there’s processes and they exist for a reason. The sad part of them is that they trap people waiting for the approvals like Mr. Pankow. That’s why I hope that there’s some retroactive coverage for him. Again, I wish him much strength and success in his challenges.

When You Have Nothing Else, Use Fallacy!

Today on Twitter I picked up quite a few new followers. One of them was a Twitter account promoting TwiceRight, a right leaning blog in the USA. Whenever I get emails about new followers, since I don’t have an unmanageably large amount, I tend to check out their recent tweets to see what they have to say. One from this account jumped out at me, linking to a blog post that claimed to “prove” the nonsensical allegation of “death panels” in systems of universal healthcare – specifically in Canada. With great interest I checked out the post.

It was a deceptive and idiotic telling of the rather sad tale of Kent Pankow, an Alberta man who suffers from what sounds like an extremely rare but pernicious form of brain cancer called glioblastoma. My knowledge of brain cancer isn’t particularly extensive, but is slightly enriched by having contributed to fundraising efforts for The James Fund For Neuroblastoma Research, in memory of James Birrell, a child from my former hometown of Peterborough, Ontario. James fought and eventually lost a battle with another form of cancer that is relatively rare, such that drug companies don’t put a lot of research into developing treatments for it. As I understand it brain tumours are difficult to deal with surgically as they spread fast and can be difficult to access.

The post tries to make much hay of the “Alberta Cancer Board”, suggesting, falsely, that “… countries with socialized health care have “boards” for different sectors of disease”. I don’t know what a sector of disease is, but that’s not the important part. I don’t know of any other disease or condition that has a similar management system in Canada, at least. And of course, as I’ve discussed before, Canada doesn’t have “socialized health care”. We have socialized health insurance. Most of our healthcare is delivered by private sector actors – our primary care physicians, our specialists, diagnostic services, etc etc are all private sector actors. The difference between us and the United States is that virtually everyone here has coverage under a universal health insurance plan. Anyhow, back to “boards” In the case of Alberta, the Alberta Cancer Board has been folded back into Alberta Health Services, but I looked at an analogue I was fairly familiar with, Cancer Care Ontario. Who are they? Well, here’s their page, I’ll let them answer. http://www.cancercare.on.ca/about/who/ They note their responsibility it to continuously improve cancer services. Given that cancer is pretty widespread – and is actually just a blanket term for more than 200 different diseases, requires intensive treatment, and has a lot of research ongoing, it makes sense that provinces have agencies that coordinate the management of care and prevention programs.

Similar programs seem to exist in other provinces, including Nova Scotia where I live. They have generally the same mandate – coordinate resources, design and improve standards of care, collate and disperse knowledge to all stakeholders. Nothing about that sounds particularly insidious, despite TwiceRight’s claims. In fact, I’m quite happy that given the toll cancer takes, our healthcare system has created such a mechanism for addressing it more effectively in every possible case. If anyone sees any reason that this is actually a bad thing, I’d love to hear it, but I can’t seem to find anyone besides TwiceRight who does, and their argument is more a case of misrepresentation and insinuation than any sort of representation of facts.

Back to Mr. Pankow. TwiceRight omits the contextual explanation for the man’s plight. They claim – and they word it such that they are making clear they have no facts, “The cost to remove Pankow’s brain tumor was too expensive, they would rather have him be on meds for a couple of weeks and die than get the surgery.” They then assert “it’s not rocket science”. I am in no position to comment on why the surgery wasn’t done in Alberta and why there was the 16 day lag that TwiceRight and other articles refer to. The difference in my case is that I won’t speculate on the reason. The fact that TwiceRight does just shows more of a lack of integrity, but you’ve probably figured that out already. In any case, as a result of this predicament he sought treatment at his own cost at the Mayo Clinic.

The bigger part of the problem involves a drug called Avastin, an incredible anti-cancer drug. I’m familiar with it because it’s the primary reason a very good friend of mine’s mother is alive today. She was diagnosed with colon cancer several years ago and told to expect the worst, until she got into a research trial group and the drug worked its magic. Avastin is approved for treatment of a few different cancers, but in Canada, not for the treatment of brain cancers – yet. In the United States, it is, and it’s part of the protocol that Mayo is coordinating with Mr. Pankow’s doctors in Canada to treat his condition. That’s the terrible, horrible grind that Mr. Pankow finds himself in – Avastin is working, but it’s also costing him $9,000 a month because it’s not approved for his condition and therefore not covered by his insurance. This is one of those terrible bureaucratic nightmares that can crop up in any sort of insurance system. Interestingly, TwiceRight’s blogger contradicts himself here, seeming to assert that Alberta Health is withholding treatment because of cost, but then noting that had he had colon, lung, or breast cancer it would have been paid for… because the approval process for those cancers is complete.

Health Canada is in the approval process, but the wait is surely agonizing. In the meantime Mr. Pankow has a complaint before the Alberta Human Rights Commission regarding what he regards as discrimination. I believe from what I read of the story that he has a good case, and that in the end he should receive a decision in his favour. His lobbying effort is to get an exception to waive the cost of his Avastin therapy until such time as a decision is rendered, and they’re frustrated that the Alberta Government hasn’t done so. I can’t disagree with that position at all, either.

The real problem with this story, or rather, with its use by TwiceRight. It’s basically a sort of straw man against health care reform, and I’ll suggest that it’s disingenuous for at least two reasons. First, look at TwiceRight’s last paragraph. “Which is why we need to address health insurance not health care in this country. (emphasis in original). Well, the only viable health care reform option in the USA right now deals almost exclusively with insurance, not the continued tired drone about “government takeover”. They then descend into the normal canards about portability which have been addressed broadly elsewhere as being likely totally ineffective in dealing with insurance costs and access.

They are correct about how a more liberal response would sound. This tactic of pointing at Canada as a great big straw man for fighting reform is getting worn out, and it’s ridiculous. In fact, that Mr. Pankow lives in Canada and has the ability to at least fight for coverage would seem to put him ahead of the game, in comparison, let’s say, to Ben Martin (http://www.bensfight.org/). Or to the various patients of the disease profiled here: http://www.yasg.com/bios002.html, and their struggles to maintain their insurance coverage and fund their treatment. What if Kent Pankow lived in the US and his relapse was treated as a pre-existing condition, leaving him with basically no recourse whatsoever? A few minutes on Google reveals that glioblastoma multiforme is a tragic disease for many people, regardless of where they live, but to read that second link and see the added stress that battling insurers causes makes you really have to rethink the argument presented.

To sum up, as I’ve gone on long enough, the case of Mr. Pankow highlights my main assertion about the Canadian healthcare system. Like most systems, it’s not perfect, but I don’t think I’d like to trade my coverage here for anything in the USA under its current system. The fact that even those with insurance face difficulties fighting their conditions shows me that universal healthcare has tremendous advantages in so many ways. I wish Mr. Pankow well in his fight, both with cancer and to improve our system, but hope I have been able to make a reasonably compelling case for why the political hay being made of him (or rather, attempting to be made) is just another fine example of the desperation of opponents of the effort to improve healthcare access in the United States – of their willingness to use fallacious arguments and deception to support their claims.

Incidentally, Mr. Pankow has a trust fund for donations to support his care in the interim while his case works itself through the system, with any surplus going to glioblastoma research, and those interested in his case can make donations by following the instructions on the site.

On labels – and my own views

Frequently, when engaged in what I consider to be discourse spiralling off the rails, I find people who can no longer defend their position and cannot withdraw with some manner of decorum like to throw out labels and expletives and end. Sometimes I accept this as inevitable, sometimes I feel like I want to push on to make clear.

My Twitter profile describes me as a “recovering conservative”. I actually got that, sort of, from a Tori Amos T-Shirt. I think it’s a line from a tune but cannot think of which song it is that contains the line. No matter. It gets the point across at least.

Amusingly enough, when it’s Canadians I’m talking to, people tend to think I’m fairly sharply right-leaning. American right wingers in particular label me a liberal (or their more juvenile variations of the word). Not surprising then that I like to think of myself as a pragmatic centrist. I have views that fall all over the spectrum. So the purpose of this entry, started as I wait in line to get my car washed, is to try to set out some of my points of view and perhaps that’ll help those who choose to read this. I’ll go through a myriad of major issues and try to let you now how you can expect me to argue on any of them.

Origins are a good place to start, to give you some context as to where I came from. I grew up in a fairly wealth suburb of Toronto, Ontario, Canada. My father, who immigrated to Canada in his early 20s from England, worked for one of the Big Five banks. My mother is from Cape Breton Island, Nova Scotia. She came from a working class family, who lived a modest life. She left Cape Breton to work as a nurse, a career she practiced until being forced into early retirement after a car accident.

My mom’s family was Roman Catholic, but religion wasn’t much to her. I got baptized in an RC church as is the custom primarily, I think, to appease her parents. My father is non-religious. I know he believes in something – or rather – that he did as he was a Master Mason before I was born. He’s actually mused about joining a lodge again, but that’s another matter.

I started in Montessori School when I was three, and when the time came to go on to “regular” school to start Grade 1, my parents decided to enrol my in a Catholic School. Without getting too into the weeds, in Ontario, due to some bizarre historical reasons, There is a publicly-funded Roman Catholic Separate School system, and that’s where they decided I was going, as they felt the school was the better option. You might have the idea of a parochial school being taught by nuns and that sort of nonsense, but that’s actually not really at all what it’s like. It’s more or less like any other school, with a little catechism mixed in. In any case, even as a kid I didn’t really buy into the religious nonsense, and it certainly wasn’t reinforced at home so it didn’t bother me much.

I took no real notice of religious anything as a kid, until I was about 10 or 11. The world was a changing place then, and that’s when I started watching the news as things like the fall of Berlin Wall, the collapse of the Soviet Union, and that sort of thing happened. I was also a voracious reader – of history, or science, of all sorts of things. I started to realize that fairy stories about gods and so on were basically nonsense – a part of the evolution of the species, perhaps, but one no longer needed.

I rejected religion completely and finally in Grade 8, which is when you make the Sacrament of Confirmation. Rather than doing the course of study required to prepare for it, a sympathetic teacher instead had me study all sorts of religions, which was actually quite enlightening. The next year I started high school, and went into a regular public high school.

I gravitated toward a lot of right wing ideas initially. Even to some extreme ideas at first, because it was easy to be targetted as a white kid in a multicultural city when you started to wonder if you could live as well as your folks did. Canada was slowly emerging from a severe recession, and it looked like the future was pretty bleak. Blaming newcomers for our perceived miserably bleak future was easy. Fortunately, it didn’t take me long to see the stupidity of those ideas, and I realized that being surrounded by so much from all over the world is actually amazing. Toronto is a phenomenal city to grow up near for that reason – you can find literally everything there as long as you know which neighbourhood to go to.

As I got to high school the views I hold now really started to gel. I became a very staunch social liberal in most cases. I took up an interest in debate then, arguing heavily for legalization of marijuana, for example – but also against pointless efforts are gun control, and so on. I believed that the idea of fiscal conservativism, but that government should largely not interfere in people’s private lives – but I also saw what I would later learn more explicitly in university, about how the free market is not perfect, that it doesn’t deliver socially optimal outcomes, and that the reason we created governments and societies is that we realized a need to organize certain social structures.

Into university I started to get involved in politics, becoming a member of the Progressive Conservative Party, provincially and federally. At that time, the effort to “Unite The Right” was in full force, and I found myself immersed in those of the more right wing ideas, and as a Red Tory I started to feel unrepresented. When the merger of the Reform Party and Progressive Conservative Party of Canada happened, I gave up my membership and watched as the social conservatives from the Reform side get more and more clout in the party. I think that’s when I started to adopt the “recovering conservative” label. During university I joined the Army and politics didn’t mesh so well with it so I just stopped really caring, other than to vote.

So I guess I could now go into a few of the issues that tend to be top of conversation, and you can slot me into whatever pigeonhole you feel like slotting me into.

Religion: Well – this is pretty clear. I’m a fairly fervent atheist, though I fit mostly into what has been labeled the “weak atheist” camp. I don’t really care about what most people think in terms of religion. If that’s what you need to get through the day, I feel a little bit of pity perhaps, but that’s fine. If your beliefs don’t in any way interfere with my life, or you have respect for those who reject religion, then I’m fine with you. I’ve actually had some very, very enjoyable discussions with religious people, including Chaplains in the military, and even pastors in some cases – of course, progressive, decent ones. The people I hold in complete contempt and have no issue grappling with (because honestly, it’s pretty fun at times) are the evangelical nutcases that I really fear gaining any sort of political power. The rich irony of these people bleating about freedom, liberty, and so on is priceless, when the reality is that they crave some manner of theocracy that will be the end of freedom. I fight their influence because it has to be fought. It’s evil and malignant. The people that want to displace science from classrooms, give mythology equal footing with reality, who want to put theology into government and rewrite history to support that aim – these people are enemies of liberty, of freedom, of society, and I hold for them nothing but contempt.

Government “size”, taxation, etc.: I believe in relatively limited government. I don’t see any reason that government should grow infinitely, but at the same time I accept that it is vital. A basic course in economics reveals that free markets are prone to fail for a variety of reasons and that’s why we have governments. I believe in progressive taxation, keeping corporate taxes low so long as income flows into personal incomes and is taxed there, and in effective regulation of markets. Since externalities are not priced into markets effectively, the tax system and legal system must be employed to attempt to do so.

I do not accept the assertion that governments are necessarily inefficient or wasteful, or at least, that they are any more of these things than corporations can be. That being said, governments should only involved in sectors where there are market failures – healthcare being chief among them. If you’re reading this blog though, you’ve probably already figured that out – I’m a staunch supporter of universal healthcare because economically it makes sense. The evidence is pretty clear.

Climate change: See previous blog entry. Denying this is like supporting creationism. Just plain fucking stupid. We can debate to what extent it’s anthropogenic until we’re blue in the face, but the facts remain clear. There is piles of science that shows how severe the problem is – and there’s basically nothing credible opposing it. Ironically, I believe there’s a good “Pascal’s Wager” type argument to be made for doing something about it. We have basically nothing to lose by getting on the problem – and it gives North America the opportunity to reinvigorate our economy, because the old “manufacturing” economy is not coming back. Innovation is what will preserve us.

Marriage equality: gays have been able to marry in Canada for a few years now. What impact has that had on my life, or the general public? None. None whatsoever. Like most controversial issues where wingnut people expect doom, nothing happened. Pretty simple.

Gay Rights In General: I like Pierre Trudeau’s POV. “The State has no business in the bedrooms of the nation.” The ideas that right wing people have about homosexuality are so insane I can’t even really understand how they formed them. I love, in particular, the assertion that homosexuality is a “lifestyle choice”. It makes perfect sense that someone would choose to live a life that invites persecution, social ostracism, etc. The idea that they can be “cured” is even more pathetically laughable, given that organizations dedicated to this sort of tomfoolery are constantly embarrassed by being “outed”. Similarly, I’m glad to see the end of Don’t Ask Don’t Tell. This policy is just lunacy, and the arguments supporting continued discrimination are pathetic.

Abortion rights: I’m pro-choice. Like most issues, this is simply none of the government’s business. I find the anti-choicers’ ability to make up new and more ridiculous arguments in favour of their POV a little humourous, and a little sick. I particularly love ignorant Christians from the south now playing the “black genocide”. As if they really care about that. Brilliant. I’d suggest a read of Freakonomics if you want to see a more disturbing, if direct, explanation of impact of Roe Vs. Wade. In Canada, we just scrapped laws about the issue. Again, the sky didn’t fall on us.

Gun control: I don’t see anything wrong with law-abiding, decent citizens owning firearms. I enjoy shooting recreationally and own guns. I comply with the laws of the land, but in the case of Canada’s laws, I think they’re also stupid. The long gun registry in particular is probably the most ridiculous bureaucratic structure there is. It is of basically no value, and it stole $2 billion from Canadian taxpayers, money which could have been used for actually fighting crime in some manner.

That being said, the shit that goes on in the US is ridiculous. Open carrying as a form of protest just makes me shake my head. Handguns as an accessory is just fucking stupid, and that’s all there is to it. I don’t have as much a problem with concealed carry, but even that seems foolish. There’s something stupid and juvenile about needing to carry around a pistol.

Far worse than that is the shit with the teabaggers wanting to use their Second Amendment right to add some drama to their protests. It’s intimidation, really. Incidentally, though it doesn’t really matter to me, I don’t think their interpretation of the Second Amendment (especially since they omit the beginning part, the whole “well-regulated militia” piece) is exactly what the Founding Fathers had in mind. That’s a whole other kettle of fish.

Anyhow, if you’ve got this far, I’m pretty impressed. It least gives you an idea of who I am and why I don’t think I’m too easy to label. It’s definitely a matter of being mostly in the centre of things, and able to think critically. That’s what really matters – pragmatism.

More on Canadian Healthcare

A few people have been trying to get a lot of political mileage over the recent case of Newfoundland & Labrador’s Premier, Danny Williams, and his very publicized trip to Florida to get heart surgery.  Unsurprisingly, opponents of healthcare reform and insurance industry shills are pointing to this shocking revelation as proof of just how terrible Canada’s healthcare system really is, and citing it as a reason to maintain the USA’s terrible status quo.  They talk about “starting over”, rather than retaining status quo, because it’s more politically ambiguous – but it’s clear that these insurance company shills only want to keep delaying any reform.  It’s worth too much to them in lobbyist dollars to do anything else.

So, who’s Danny Williams, what’s Newfoundland & Labrador, and what really actually happened?

Danny Williams, who is often referred to by nicknames like “King Danny” and “Danny Millions”, is the often controversial, and apparently immensely popular Premier (Head of Government) of the Province of Newfoundland & Labrador.  His province is the newest in Confederation, having only joined Canada in 1949.  It is sparsely populated, home to about half a million.  Newfoundlanders are well known for their sense of humour, their unique accent and dialect, their hospitality, and so on.  Until the oil & gas industry took off, it was economically a very challenging place.  The collapse of the cod fishery in the 1990s, for example, was  disastrous for the province.  However, in later years, it has surged ahead, and has the second-highest GDP per capita of all Canadian provinces, behind oil & gas rich Alberta.

Danny Williams built his fortune first as a lawyer, then as a businessman, building up a cable television & telecommunications company into a huge success which he sold for a fortune.  He is a Rhodes Scholar, incidentally – a well-educated, well-spoken man.  That he wound up in politics is hardly a shock.

He became leader of the Progressive Conservative Party and a couple of years later became Premier, ending a long string of Liberal domination of Newfoundland’s House of Assembly.  He then set on a very contentious program of slashing government spending by ending some significant spending and shrinking the civil service dramatically.  They went on strike, he legislated them back to work.  This broke a significant campaign promise, but it seems that Mr. Williams was determined to accomplish what he saw as the vital business of reforms to improve the province’s fiscal position.

Williams’ masterwork, which made him so famous to all Canadians, was his bitter struggle with the federal government.  Canada has a system of fiscal equalization where “have not” provinces receive transfer payments from “have” provinces to try to increase the overall standard of living.  As Newfoundland’s oil and gas fields came online and started producing revenue, Williams fought hard to have the royalties excluded from the calculation of equalization.  A deal called the Atlantic Accord was supposed to guarantee this, but the Liberal Government in Ottawa tried to renege on their obligations.  Nova Scotia eventually joined in the fight as well, as it has developed some significant natural gas interests..  The fight got bitter, to the point that Williams ordered Canadian flags removed from government buildings in favour of just the Newfoundland provincial flag.  His popularity surged and eventually he won a settlement very favourable to the province.

During the 2008 Federal Election campaign, Williams, enjoying tremendous popularity, encouraged his province to vote “ABC” – Anything But Conservative.  Not a single CPC MP was elected in Newfoundland as a result, with the Liberal Party of Canada sweeping the polls.

Danny Williams’ heart surgery in the US was his next major controversy and the one I want to focus on.  Premier Williams was advised by his doctors that he need a mitral valve repair.  There are, from my understanding, three ways to accomplish the repair – a full sternotomy, a partial sternotomy, and a minimally invasive procedure.  Williams sought the advice of several doctors and decided that he wanted to get the minimally invasive procedure.  Given that he’s a pretty hard working guy, I don’t blame him, the quick recovery has a lot of appeal.

It’s hardly surprising that such a procedure wasn’t available in a province as sparsely populated as Newfoundland.  The reality of living in a country as sparsely populated as Canada in general is is that a lot of medical procedures require travel to centres of excellence.  That’s just a fact based on demographics.   Interestingly, most doctors Canadian media talked to about the options stated that the minimally invasive procedure is not something they commonly recommend because of the risks involved.  One stated she only offered it to young women who were seeking to avoid scars.

So Danny talked to a Newfoundlander cardiologist who suggested a doctor in Florida.  Given that he had a condo in Florida to recover at, it makes some sense that he’d see value in the idea.  Having to travel was inevitable, so why not go south to his place to get it done?

Ultimately, Williams has what most people don’t – the luxury of choice based on virtually infinite resources.  Most people don’t have that.  If the average American was in the position of needing mitral valve repair, the choice of what they’re getting wouldn’t be theirs likely.  It’d be their insurer’s.  One has to wonder what it would be…  Basing one’s assessment of comparative healthcare on the options open to someone with no budgetary concerns is a little ridiculous.

In Williams’ case, what would have happened had he not been so wealthy?  Would he have faced death and ruin?  No.  He’d have gotten the more conventional treatment without delay, wherever it could be done.  He would have received a surgery done by a cardiac surgeon who on average would do more procedures than his American counterpart, according to one news report I read.  What about waits?  Not an issue, there are no significant waits for cardiac surgery in Canada – it was one of the first areas targeted to be improved when we started reinvesting in healthcare.

What do I think of Danny’s choice?  Must be nice to be rich.  Hey,  actually, he almost did a Canadian a favour by selecting himself out of the queue, no matter how short.  I think he didn’t do the greatest job of handling the issue but have to agree with the statement he made – his heart, his health, his choice – because he had the ability to make that choice.  Does it serve as a damning indictment of Canada’s healthcare system though?  Not in my view.  Not in the least.

So what are Canadian taxes really like?

Well, I just finished doing my tax return this week, and I was not really amused to see that I owe the man a little money.  Well, in truth, it’s more like a lot of money.  I have the same issue every year – I have two sources of income.  Warriorbanker isn’t just a retarded name, it’s the truth.  I have money coming in from my day job – the banker part, though that’s not really an accurate description of exactly what I do for a living, and the warrior part from being a soldier in Canada’s Army Reserve (or more affectionately, the SWAT Team, SWAT standing for Some Weekends And Thursdays – that’s another story though).  I never quite seem to get the withholding tax straight and it usually means that I have a bunch owing at the end of the year.  I should have made a bigger RSP contribution I guess, but again, it’s been quite a year and that went by the wayside.

Anyhow, I’m a higher than average earner in Canada, my wife and I would fit definitely into the middle class.  I’m going to give you a rough idea of what the tax impact of that is like.  I’ll explain my methodology as well.  For Americans, there’s no such thing as “filing jointly” as you would know it in Canada – individuals cannot really split employment income.  There’s some tricks to do it, but I haven’t been in a position to employ any of them, and they’re not really all that effective for working folks anyhow.  I have no dependents for tax purposes, and no other fancy tax credits.  My taxable income for 2009, rounding slightly, was $80,000.  I grossed more than that, but have deductions for my Registered Retirement Savings Plan (which is basically the equivalent to an IRA) and my contribution to my military pension from the top line, because those are tax deductible – they’re also not significant amounts particularly.

In calculating the tax impact, I’m not going include to the cost of my contribution to the Canada Pension Plan, which is Canada’s public pension.  CPP is well funded and assessed by actuaries to be stable, so I’m not worried about this being a loss for nothing, I’m confident it will be there when I retire.  It’s designed to replace 25% of the average industrial wage in Canada, it pays about $1,000 a month to those who qualify for the full amount.  There’s a lot of proposals on changes and enhancements to CPP, which maybe I’ll get to another time, it’s something I’m interested in.  Anyhow, the record, my contribution in 2009 to CPP is $2,118.60, the maximum, since I make well above the Yearly Maximum Pensionable Earnings.  How this impacts is kind of strange, you wind up with a non-refundable tax credit for the contributions, so I’m not including it in this exercise.  I’m also going to exclude minor things like drivers licence and plate renewals, since that’s about $100/year, if that.

So, here’s the math:

Net income: $80,000

Total income taxes: $19,200 (note: I’ve rounded both figures up to the nearest $100)

Property taxes on the condo I own: $2,400 (again, rounded a bit, down this time, which more or less makes the total picture accurate.

So, that totals up to $21,600 in income taxes and property taxes.

To keep things simple, lets add $800 onto that to cover my Employment Insurance Premium.  It’s actually $731.09.

So we’re at $22,400.  That suggests then, my net income after these items is $57,600.  But we’re not quite done yet.  There’s sales tax to figure in.  Ontario, where I lived last year, has a provincial retail sales tax of 8%, and then there’s everyone’s favourite, the federal Goods & Services Tax.  Some folks call the GST the “Gouge and Screw Tax”, but actually, its malignment is more a matter of bad marketing than bad policy.  That too is another story, but the long and short of it is that the Progressive Conservative Government of Brian Mulroney replaced the convoluted, often much higher Manufacturers Tax with the transparent GST but didn’t explain it too well.   As for the two sales taxes, Ontario is replacing this with a Harmonized Sales Tax of 13% starting later in 2010.  Nova Scotia has this system already, so it doesn’t matter to me, except that I won’t be in Ontario to pocket the $1,000 bribe the province is paying out to ease the transition.

I’ll simplify things and assume that I spend every penny of my net income and every penny of it is taxed at 13%.  This is actually rather ridiculous, because a huge chunk of that spending goes to my two largest expenses, being my mortgage payment and groceries.  The mortgage payment is, of course, not subject to sales tax, and most groceries aren’t either.  However, I want this to be as “oppressive” as possible.

So, 13% of $57,600 is just shy of $7,500 in sales taxes.  We’ll call it $7,500.  So, by this pretty generous estimate, in 2009 I paid about $29,100 in taxes.  On an income of $80,000.  That’s 36.375% all in.  If I added on the CPP contribution we come out at 39%, but as I mentioned above, that sort of comes out in the wash anyhow because of the tax credit it creates.  Remember, too, that that makes some pretty generous assumptions about the impact of sales taxes, because off the top of my head, I can tell you that about $12,000 of that goes to my mortgage payment and groceries, which again, aren’t taxed.  Taking that out brings the rate down to 34.5%

If you’re American and you think that’s really high, you may well be right – but consider that on top of your taxes, you have to pay for health insurance to get an apples-to-apples comparison.  To do that exactly wouldn’t be easy because you wouldn’t find a directly comparable insurance policy, probably.  What I can say is that when I worked the comparison last with a friend of mine who lives in the United States, and compared his tax hit + health insurance costs for a modest plan with a lot of out-of-pocket costs, we wound up taking home a fairly similar amount.  My only out of pocket expenses are for my extended insurance, which I think costs less than $20/biweekly, and out-of-pocket stuff, which is basically dentists and drugs.  Nearly nothing (actually, having two dental plans, I wouldn’t really normally have to pay anything, but the out of pocket is so small I don’t bother with the hassle of making the claim against the dental plan I get being a Reservist, it’s not worth the effort).

I hope you’ve found this interesting – you must have, if you’ve gotten this far!

Trying to clarify some issues for people…

I made the mistake, apparently, of trying to explain why allowing the sale of health insurance across state lines in the United States isn’t likely to fix the US healthcare mess.  I have never, ever met someone quite as ignorant as this guy, quite honestly.  I mean, this man just doesn’t get it.  Doesn’t understand that insurance markets do not operate like garden variety markets for good and services.  So I decided to try, via Twitter, to give the guy a crash course in insurance and basic healthcare economics.

So I started out by trying to explain the concept of adverse selection.   In simplistic terms, adverse selection is a market failure that comes from the way pricing works in insurance works.  A decision to buy insurance weighs one’s perception of the potential cost of the insured risk against the cost of the insurance.  Insurers set their prices based on statistical models on covering their potential losses .  They try very hard to determine how much of a risk any particular insured peril is.  Consider, then, a market for insurance – a community.  Insurers will have an idea of how much on average their healthcare will cost in any given year, and base their premiums on that sort of a model (I’m grievously simplifying, but just to illustrate the concept!)

Now, suppose in our market, some people smoke and some don’t.  The cost for care for those that smoke will likely be higher.  What could happen is that the price of the insurance will reflect this, and those people who don’t smoke might therefore assess the value of the insurance not to be worth the cost.  They might then decide not to buy insurance – or what could happen is another entrant to the market might show up, and offer insurance just to those non-smoking people for a lower cost.  For our original insurer, they have a problem – their average cost is going to rise because the best risks are no longer in their risk pool.  This can cause a vicious circle whereby only the higher risks remain in the pool and costs soar.

Something similar to this is what caused the end of the community rating system that was originally used by the Blue Cross/Blue Shield system in the United States – new entrants cherrypicked out the best risks and drove costs up. 

So, what’s this got to do with the cross state line idea?  Well, let me try to explain.

The savings would most likely come from differences in what’s required to be covered in various states in the the US.  Different states mandate different conditions be covered in different jurisdictions.  Ultimately, you’ll get cheaper insurance, because you’ll get covered for less.  The buyer essentially gets exactly what they pay for, after all.

Remember what I said about cherrypicking?  Well, suppose you’re in a state with relatively lax mandates.  You can offer very cheap coverage to young, healthy people for the simple reason that you don’t have to cover much and the risk to you as an insurer is low.  Your clients are generally healthy and you can fairly accurately model their risks for the relatively few perils you cover.  That’s great for young, healthy people who don’t see a need to carry much insurance.  However, if you’re older, or sicker, or considered a higher risk, you’ll see your costs likely soar, because those healthy folks are being poached out of the overall risk pool.  That’s a lot of people who’ll see their costs rise, potentially.

What about those savings?  Well, consider that in 2005 the US Congressional Budget Office studied that.  What’d they find?  Well, here’s the study: http://www.cbo.gov/doc.cfm?index=6639&type=0  Take a look at the fifth paragraph.  Here’s what it says:

“In general, health insurance that includes coverage of mandated benefits will cost more than it would if those benefits were not required. In aggregate, this estimate assumes that if only those benefit mandates imposed by the states with the lowest-cost mandates were in effect in all states, the price of individual health insurance would be reduced by about 5 percent, on average.”

Five percent.   That’s it.  Five percent.  Some magic bullet that is.

There’s another great argument for why it won’t work.  I’d go on about it, but it’s done better on another blog: http://healthpolicyandmarket.blogspot.com/2009/12/selling-health-insurance-across-state.html  Summarizing, insurers get their cost efficiencies from the networks they establish in their markets.  Without those networks, there’s not likely to be much cost advantage.  I’ve got no personal experience with this “in-network” nonsense, every single healthcare provider in Canada is my network, at least as far as my provincial medical insurance goes.  So you might by that cheap cheap policy from another state, but where will you be able to get the service?

Basically, I’m not going to write a dissertation on the subject, but I could.  The aim of this posting is to highlight the fact that insurance markets aren’t so simple as to suggest that this approach will actually address the problem.  The reader needs to go and do their own research, and maybe if I get the inclination I’ll flesh out more of this.