Archive for the ‘Canada’ Category

Setting the Record Straight: More from our Canadian Cousins

Written by Robert Justin Lipkin on August 28th, 2009

Listen to some more. Finally, Canadians are fighting the slanderous characterizations of the Canadian health care system by U.S. insurance companies and other ideologues. As stated, medical care is a human right, not an economic product to be evaluated simply in terms of the bottom line.  We, Americans, would do well to heed the advice of out northern cousins.  But we also need more help from Canada in setting the record straight about its own system and pointing out the systematic attempt on the part of those Americans opposing health insurance reform to distort, obscure, and simply lie about the Canadian system.  Click here for more.

Health Care: Canada v. the United States

Written by Robert Justin Lipkin on August 28th, 2009

From the Canadian Medical Association Journal

August 24, 2009

America, embrace health care reform

If power, wealth and talent alone determined how a nation serves the needs of its people, the United States would be second to none in health care. Yet America’s health care system clearly ranks behind those of Canada and most other developed countries. The precious opportunity that US President Barack Obama’s health care reform proposals offer to Americans is currently threatened by partisan disunity, which could once again deny Americans the quality and accessibility of health care that they should receive.

Canada’s “socialist” health system is the favourite whipping boy of antireform lobbyists, who employ fear-mongering and myths about rationing, waiting lists and lack of choice to persuade the American public to accept their status quo as better. As Canadians, we agree that Canada’s health system is not perfect. We have said so many times in CMAJ. Nevertheless, it takes only a few comparisons to show how much better Canada’s health system is than that of the United States — and how much Americans could hope to gain from embracing reform.

Consider the following statistics, taken from the Organisation for Economic Co-operation and Development’s health data for 2006.1 We start with the most basic outcomes any health care system is supposed to optimize: life and death. The life expectancy of an average American is nearly three years shorter than that of an average Canadian (78.1 vs. 80.7 years). That survival gap starts from the moment of birth: infant mortality is higher in the US than in Canada (6.7 vs. 5.0 deaths per thousand live births). Yet the US economy spends — or increasingly, borrows — more than half again as much for health care as does Canada’s (16% vs. 10.1% of the economy). And despite spending so much more, Americans get to see their doctors a third less often than Canadians (3.8 vs. 5.8 doctor visits a year).

While these differences result from many factors, the inescapable truth is that, compared to Canada, America is achieving poor value for money from its health care system, and that is killing Americans. The potency of that truth is the reason why antireform lobbyists are now turning to attack Canada’s system.

As Republican strategist Dr. Frank Luntz puts it, the opposition’s strategy rests on “health care denial horror stories from Canada.”2 Yet the attacks are so absurd and full of fantasy that they would be laughable — if not for the fact that many Americans believe them. Canadians do not, in fact, conduct euthanasia on our elderly; If we did, then Canadian life expectancy would hardly be longer than American.  There is no such thing as a “death panel,” neither in Canada’s health care system, nor President Obama’s reform proposal.  Nor is it true that in Canada, the system imposes a government bureaucrat between a patient and their doctor to decide what care to provide.  On the contrary, that is a routine feature in America’s system, where doctors and patients struggle endlessly with insurance company “bureaucrats” for payment.

The only accusation that has even a shred of evidence, albeit heavily misrepresented, is that Canadians face waiting lists for health care.  But that does not mean Canadians routinely die waiting for tests and operations, because the lists are for elective procedures, such as joint replacement surgery, and not for emergency or life-saving care.  Prioritizing actually helps ensure the serious cases are seen first.

We cannot condemn strongly enough the intellectual dishonesty of the lobbyists and politicians whose distortions of Canada’s health system camouflage their appalling rejection of reform for uninsured and underinsured Americans. All 32 million Canadians are insured. To be sure, some are unhappy to wait and some are denied treatments it would be better they had; no system is perfect or pleases everyone.  But even the least fortunate Canadian is better off than the 47 million uninsured Americans, for whom no treatments are covered and for whom the wait is forever, unless they can afford to pay the health care bills.

If America wants to improve its citizens’ health — as it must — then some negative attitudes need to be turned around.  Here are some.

First, the US$1 trillion that the Obama administration says it will cost to cover America’s uninsured over 10 years is not a burden; per capita, it is a screaming bargain. Canada spends about US$156 billion each year to cover fewer people than America’s uninsured. For Congress to hesitate at the outlay is penny-wise and pound foolish, when economic studies suggest that the cost of not investing could be greater still, owing to lost productivity and lost jobs, provided that expanded coverage goes hand-in-hand with cost-containment measures.3,4 Still, when Congress last year dropped US$700 billion at a sitting to bail out Wall Street, it is hard to understand why a lesser amount for public health insurance provokes so much anxiety.

Second, all health care systems ration care — including the US system. The only cruelty in rationing health care comes in doing it the wrong way. When America’s private insurers routinely refuse to cover persons having pre-existing health conditions, that is the worst kind of rationing, aimed mercilessly at those who need medical care most. In Canada, nobody is denied coverage for pre-existing conditions, and there is no cut-off age. Instead, Canada aims to ration medically futile treatments. Where we occasionally make mistakes is in rationing new treatments that in hindsight prove to be useful, not futile. In Canada’s deferential culture, we correct such mistakes slowly by pressuring the public insurer. In America’s litigious culture, suing the public insurer is likely to correct such mistakes more rapidly. That difference, we believe, is likely to make rationing fairer in American than Canadian hands.

Third, certain members of Congress need to get over the bogeyman of “socialist” medicine. Thinking about the military may help. All of America’s closest NATO allies, including those, like Canada, who fight alongside the US in Afghanistan, receive “socialist” medicine back home. Furthermore, when Americans join the military, they qualify for public, government-run health insurance that provides access to care at Veterans Administration hospitals. When Texas Republican Congressman Louie Gohmert described Canadian health care as “a bureaucratic, socialistic piece of crap,”5 was he also implying that America’s soldiers are getting bureaucratic, crappy care?

Fourth, freedom-loving Americans who value making their own medical and economic choices ought to be outraged at how the status quo restricts their choice and freedoms. Because private insurance plans are usually provided through one’s employer, changing jobs often means losing existing coverage and having to re-qualify for new coverage (if one can) under a new plan — a risky move.  Private insurance has become the freedom-destroying leash that ties Americans and their families to jobs with less pay or satisfaction than other opportunities that might exist. Canadians, in contrast, can change jobs in our universal, portable public system and stay insured throughout.

Fifth, and perhaps most importantly, America has reached an economic tipping point where the “public option” is inevitable, if only because households (read: voters) find the current system’s costs unsustainable. Canada’s first meaningful foray into public insurance happened in 1940s Saskatchewan, when public anger boiled over as health bills forced families — including many in the middle class — into bankruptcy. That same tragedy is replaying in America, where more than half of personal bankruptcies are medically related.6 This number will only worsen as health costs rise in America, as the population ages and as the US dollar loses ground as a reserve currency. Even if Congress and President Obama fail to achieve a public insurance option this year, in the long term the smart money is against any political party whose name becomes attached to these personal medical bankruptcies.

If Americans find the courage to embrace change, they could enjoy health care that is second to none. Canada’s example has many positive lessons — and a few negative ones — to teach reformers. Lamentably, in the current partisan circus playing out on Capitol Hill, analysis is short and sophistry of the Louie Gohmert variety is long. America must move beyond this if it ever hopes to be able to provide the best care for all its people.

Amir Attaran LLB DPhil
Associate Editor, Editorials

Matthew B. Stanbrook MD PhD
Deputy Editor, Scientific

Paul Hébert MD MHSc
With the Editorial-Writing Team (Ken Flegel MDCM MSc, Noni MacDonald MD MSc and Laura Eggertson BA)

Cite as CMAJ 2009. DOI:10.1503/cmaj.09-1511


What’s Wrong with Canadians?

Written by Robert Justin Lipkin on August 11th, 2009

For the life of me I can’t figure out why Canadians tolerate their government-controlled, socialized health care system. Americans would never tolerate waiting years for emergency surgery, government controlled physician-selection, paying exorbitant prices for prescription drugs, and a plethora of additional evils.tmpphpstmdWx[1] So what’s wrong with our cousins to the North? I suppose the problem began with Tommy Douglass, the premier of Saskatchewan in the 1950s who started such an evil system in his own province.  But why did the entire nation follow such madness, especially when they have  the exemplary model of a health care system to their south of which 80% of their southern cousins approve?  OK, OK, I’ve distorted some of the above information. Many (most?) Canadians would revolt if their health care system were transmogrified into our health care system. But then why are Americans lied to?  Does anyone know a balanced treatment comparing the virtues and vices of both Canadian and American health care systems, which includes such facts as these: (1) The United States spends 16% of its economy on health care but ranks 37th in the world in satisfactory health care, (2) Canada spends 17% on administrative costs, but the United States spends 31%, (3) In Canada waiting to see physicians can be longer than in the United States as can waiting for non-emergency surgery, (4) Over 40 million Americans have absolutely no health care, and when they get sick and go to the emergency room, their health care treatment costs everyone a small fortune, oh yes, I almost forgot, (5) In Canada everyone is covered under its health care system.  (See what taking health insurance companies out of the mix can do?) If anyone has a citation to an impartial comparison of the Canadian and American systems, I’d welcome receiving it at: Thanks in advance.

What is Single-Payer Health Health Care?

Written by Robert Justin Lipkin on July 27th, 2009

Single-Payer health care systems vary but share similar features. For example, the Canadian single-payer system is the source of health care funds generally derived from taxes of various kinds. In Nova Scotia, hefty taxes on alcohol provide the funds to support the province’s health care. Unlike so-called socialized medicine, the Canadian system retaintmpphpo4mhvb[1]s private physician, hospitals, and clinics. Any Canadian can seek treatment from any provider they choose. All Canadians are entitled to this health care. Since Canada spends 50% on individuals as America, there are some waits for non-essential conditions. But the extravagant waiting periods claimed by the American insurance companies is simply a distortion of the system. If the United States spent what it now spends in a single-payer system, all Americans would be fully covered and there would be virtually no waiting at all. Forty million Americans have no health care.  How could that be a sane health care system?. The theory is that competition among private insurance companies will drive down prices. In practice, however, since profit is the bottom line in private insurance companies, such companies spend large administrative funds dedicated to denying coverage. Because private insurance companies seek healthy individuals, most healthy Americans find little fault with private companies. But wait until you’re sick and see how forthcoming private insurance companies are with their policies of pre-authorization and recission. These facts are available for anyone inclined to seek them out. Here’s a primer on single-payer systems for those interested.  The bottom line is that no profit driven industry can wave profit for quality products or care. That makes them especially unsuited to be the model in health care. Check the facts out for yourself. But evaluate those presenting the facts.  Health insurance companies have no motive to be truthful in explaining single-payer systems simply because the villains in this health care debate are the health insurances companies.

Unbounded Ambition: Thy Name is Ignatieff

Written by Robert Justin Lipkin on December 8th, 2008

Michael Ignatieff, an early Canadian supporter of Mr. Bush’s invasion of Iraq, is now setting his sight on the leaders225px-ignatieff-1.jpghip of the Liberal Party. Consider the report in the Globe and Mail: “Toronto MP Michael Ignatieff launched a bulldozer charge at the federal Liberal leadership on Sunday, campaigning for the party’s parliamentary caucus to elect him immediately as an interim replacement for Stéphane Dion.  . . . Mr. Ignatieff’s organizers said Sunday night they had the support of at least 55 of the party’s 77 MPs, including Mr. Dion’s most vocal supporter, suburban Toronto MP Bryon Wilfert, and MP Maurizio Bevilacqua, who chaired the 2006 leadership campaign of Mr. Ignatieff’s major opponent, Bob Rae.  . . .  In addition, leadership contender Dominic LeBlanc flew to Toronto Sunday night to meet with Mr. Ignatieff. He is widely expected to drop his leadership bid and pledge support to Mr. Ignatieff on Monday, along with a group of Atlantic MPs and senators.  . . .  The plan calls for Mr. Dion to be ousted Wednesday followed by a vote that would likely install Mr. Ignatieff at the helm as interim leader. At a second-stage process — almost certainly the leadership convention currently scheduled for May — the party either would confirm him as leader or turn to his only other declared opponent, Mr. Rae. “To read further click here.

There’s something unsettling about a Mr. Ignatieff’s approach to politics. He seems deeply immersed in his own sense of superiority and one cannot shake the feeling that his backing of the invasion of Iraq was politically motivated. Certainly, many prominent American senators backed the invasion for the very same reasons.  But Canadian politics sometimes seems more forthright than American politics. And if that perception is even close to the truth, Canadian politicians who ape Americans should be condemned to exile from leadership of the Liberal Party.

Specifically, Ignatieff has embraced “the lesser evil” theory of fighting terrorists which embraces such tactics as indefinite of suspects, targeted assassinations, and preemptive (preventive ?) wars.  Somehow Mr. Ignatieff believes that adopting these tactics can be compatible with democratic values, especially freedom and civil liberties, but it is extremely difficult to figure out how this is possible.  And what makes this infinitely more distateful is that Ignatieff is supposed to be a champion of human rights.

Hockey: The New Gentleman’s Sport?

Written by Henry L. Chambers, Jr. on December 3rd, 2008

Sean Avery, a National Hockey League player with the Dallas Stars, has been suspended indefinitely for crude comments made about NHL players going out with his former girlfriends.  The comments were likely directed at Avery’s former girlfriend Elisha Cuthbert and her current datemate Dion Phaneuf, an NHL player with the Calgary Flames.  The comments were made the morning on the day of a game between the Stars and the Flames. Gary Bettman, the commissioner of the NHL, immediately suspended Avery indefinitely and Avery did not play in the game. 

Bettman claimed that the suspension was based on the comments and the fact that they reflected poorly on the league.  This was not Avery’s first instance of bad behavior and almost certainly will not be his last.  However, suspending a player for speaking ill of his former girlfriend and her new boyfriend hardly seems the kind of behavior that requires league discipline, even if the former girlfriend is an American starlet.

Though the comments were incredibly tacky, it is doubtful that the suspension was based merely on the content of the comments or the number of Avery’s past transgressions.  The suspension may well have been based on the mess the NHL would have had to deal with had Avery and Phaneuf been on the ice at the same time.  In most sports, fighting is prohibited and punished heavily with fines and suspensions.  To the contrary, fights in professional hockey are common and condoned, though not necessarily encouraged.   Almost any perceived transgression is a reason to “drop the gloves.”  The likelihood or near certainty that serious and dangerous fisticuffs would have ensued if Avery and Phaneuf had been on the ice together may have been too much for the league to risk. 

However, if concern over a serious fight was a part of the league’s calculus in suspending Avery, was that concern reasonable?  Certainly, one can understand that those offended by Avery’s remarks may have been looking for revenge.  However, the proper response might have been to tell the Calgary Flames and Phaneuf that even though Avery’s comments were rude and crude, payback would not be tolerated.   Of course, it is tough to send that message when a minor beating for a negligible transgression is just part of the game. 

On the other hand, it may be even more troubling if the content of the comments were the reason Avery has been suspended.  The comments, though inappropriate, are not comments regarding hockey or the integrity of the game.  Rather, they were just mean things to say to his ex-girlfriend and her new boyfriend.  If comments in that context really are reasons to suspend a professional athlete and force him to miss at least one game paycheck for his trouble, maybe hockey really is becoming the new gentleman’s sport or maybe it is just a reflection of old prideful chauvinism.   Where is America’s number one hockey mom, Sarah Palin, when we need her to unpack this cultural riddle?     

Second Circuit Ressurrects Arar’s Rendition Case

Written by Robert Justin Lipkin on August 18th, 2008

More on the terrible treatment of Maher Arar by the Bush White House. ” Canadian torture victim Maher Arar has been given an unexpected – and very rare – opportunity to take another crack at winning redress from the Bush administration in a New York court.  . . .  The Second Circuit Court of Appeals announced yesterday it would convene at least 13 judges in December for another hearing for Arar, the Ottawa engineer, Ararwho was tortured and jailed in a Syrian prison after being whisked out of JFK Airport in September 2002, under a U.S. practice known as ‘extraordinary rendition.’  . . . A three-judge panel dismissed Arar’s lawsuit in June, but the dissenting judge said the ruling gave the U.S. government licence ‘to violate constitutional rights with virtual impunity.”  . . .  Yesterday’s decision keeps alive the possibility that Arar could still become the first rendition victim to force the Bush administration to admit its role and compensate a victim in a case it maintains was an immigration matter.  . . .  The court made its decision before it even received a petition from Arar’s lawyers to examine the suit again, a decision legal observers said was extremely rare.  . . . Even when petitioned, the Second Circuit convenes the entire bench less than once a year, based on recent records. ‘this is good news,’ said Maria LaHood, of the New York-based Center for Constitutional Rights lawyer who represents Arar.” For more click here.  The Second Circuit has provided hope that Mr. Bush can be held accountable for something.

Rendering Arar Maher

Written by Robert Justin Lipkin on October 22nd, 2007

The story of Arar Maher’s nightmare of torture, isolation, and confinement is merely one example of Mr. Bush’s disdain for the rule of law and for his callous unwillingness to empathize for other human beings. (ECA has posted comments on this story several times, here, here, and here.) Listen to the story in Mr. Maher’s own words.
Finally, this past week, members of the Congress of the United States apologized to Maher for the brutal and inhumane manner the Bush administration treated him, and yes, still treat him. Though absolved of being a terrorist by the Canadian government, the Bush administration refuses to remove Mr. Maher’s name from its terror list. Mr. Bush’s shameful conduct in this and other similar renditions is likely to affix a permanently scare on the honor of the United States.

United States v. Canada: Melting Pot v. Multicultural Diversity?

Written by Robert Justin Lipkin on August 1st, 2007

An editorial from today’s Globe and Mail states: “The legacy of slavery and segregation continues to dominate American civic life. Cities are still divided between white neighbourhoods and black neighbourhoods. Too often, still, the clerks are black and the manager white; too often, blacks kill each other over turf. Too many black children live in homes that discourage responsibility, education and work; white indifference to improving schools and neighbourhoods perpetuates the ghetto of low expectations . . . . America, we were told, is a melting pot, while Canada is multicultural. But America is becoming multicultural too, and multiculturalism may, one day, end the cold war between blacks and whites.” One wonders why similar reports aren’t often included in American mainstream media. Indeed, the controversy over whether a republican democracy’s goal should be a melting pot of multiculturalism seems to appear only in heated discussions on cable-news. The answer seems obvious: A little of both. The real question should be this: When should people from different cultures adopt the requirements of citizenship and when should they be encouraged to ignore the wider culture and orchestrate their lives according to their religious and ethnic values? And the final question, of course, is how do we distinguish between the two?

Canada’s Accountable! Why Isn’t the US?

Written by Robert Justin Lipkin on February 20th, 2007

The United Nations asked Canada whether “it can ensure that it will avoid repeating the kind of mistakes that led the United States to deport Maher Arar to Damascus, where he was tortured for nearly a year.” As ECA has said in earlier posts here and here, the Arar affair is a contrast of two wrongdoers–Canada and the United States–where the former admits its culpability and attempts to compensate and repent, while the latter admits nothing and continues to persecute Mr. Arar. This disgraceful treatment of a Canadian national is nothing less than moral turpitude on the part of the United States’ government.

The administration’s conduct is matched only by the failure of the American press to adequately monitor and report the administration’s role in the Arar affair. What prevents the American media from covering a story where the human rights of a Canadian citizen are so flagrantly violated? Is is governmental pressure? Or is it a calculated judgment that the American public is indifferent to what trials and tribulations Canadian citizens, especially those with Syrian ancestry, experience at the hands of the United States.

Americans must stand up to their government’s abuse of Mr. Arar by keeping his name on an American terrorist watch list and refusing him permission to enter the United States. What the administration is doing is done in our name and we must embrace it or petition the government to cease and desist.