A nation's health care system reflects the values of that society

This editorial appeared in Newsweek magazine 11 years ago.  It expressed the viewpoint that a country's health-care system reflects the societal values that predominate in that country.  Examples are provided. That article is still relevant and it is still available online.

 

UNIVERSAL HEALTH CARE IS A MORAL CHOICE

http://www.newsweek.com/univer sal-health-care-moral-choice-7 9223

The design of any country's health-care system involves political,

medical, and economic decisions. But the primary issue for any

health-care system is a moral question: should a rich society provide

health care to everyone who needs it? If a nation answers yes to

that moral question, it will build a health-care system like the ones in

Britain, Germany, Canada, France, and Japan, where everybody is

covered. If a nation doesn't decide to provide universal coverage,

then you're likely to end up with a system where some people get the

finest medical care on earth in the finest hospitals, and tens of

thousands of others are left to die for lack of care. Without the moral

commitment, in other words, you end up with a system like America's.

 

 

I was 48 years old when I immigrated to Canada in 2005, along with my wife and daughter (who was 14 at the time). Canada had a new conservative government when we moved here, and "privatization" of the health care system was a hot topic. The "Obamacare" debate in the States caused a lot of Canadians to educate themselves about our own health care system. And that education has been of immeasurable value to  Canadians.

 

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

 

We've been in Canada now for 15 full years; we have used three different hospitals, emergency services, and specialists in genetics, gynecology, and oncology.  We have nothing but praise for the medical care we've received.  

Waiting lines for non-essential medical care have never been a problem for us, not in this province, but I have heard stories of people having to wait for some procedures.  

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

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

Two-thirds of all bankruptcies in the US are the result of medical expenses.  That's over 500,000 Americans who go bankrupt due to medical bills each year. The number of medical bankruptcies in Canada is precisely zero.  What is that worth to any society?

Just Read: Dark Mirror: Edward Snowden and the American Surveillance State (2020)

I just finished reading Barton Gellman's book Dark Mirror: Edward Snowden and the American Surveillance State which was published last May.  

Wikipedia calls Baron Gellman "an American journalist and bestselling author known for his reports on the September 11 attacks, on Dick Cheney's vice presidency, and on the global surveillance disclosure."  

Barton Gellman knows Edward J. Snowden personally.  I read his book for the answers to three questions:  1) what did Edward Snowden reveal to the American public? 2) Why did Snowden reveal these previously concealed truths? and 3) is Edward Snowden a hero, or a traitor?

The book is large, with an extensive section of notes.  It was a challenging read.

This is what I learned.

What did Snowden reveal ?

The first of the Snowden documents that was publicly released was a Top Secret, compartmented presentation from the National Security Agency, only one month old.  Under the cover name PRISM, it was revealed that the NSA was siphoning data from tens of thousands of accounts from the American-based internet giants: Google, Facebook, Yahoo, Microsoft, AOL, Skype, YouTube, Apple, as well as a service called Paltalk.

Another NSA report revealed that the NSA's acquisitions directorate sent millions of records every day from internal Yahoo and Google networks to data warehouses at the agency’s headquarters at Fort Meade. In the preceding thirty days, the report said, field collectors had processed and sent back 181,280,466 new records—including “metadata,” which would indicate who sent or received emails and when, along with content such as text, audio, and video. 

The National Security Agency had secretly broken into the main communications links that connect Yahoo and Google data centers around the world. By tapping those links, the agency has positioned itself to collect at will from hundreds of millions of user accounts, many of them belonging to Americans

The NSA harvested millions of address books at data crossing points around the world. Many of them, inevitably, belonged to Americans. The web did not respect geographic boundaries. Just because collection happened abroad did not mean the data was foreign.

During a single representative day, the NSA’s Special Source Operations branch collected 444,743 email address books from Yahoo, 105,068 from Hotmail, 82,857 from Facebook, 33,697 from Gmail, and 22,881 from unspecified other providers, according to an internal PowerPoint presentation. Those figures, described as a typical daily intake, corresponded to a rate of more than 250 million address books a year. 

American accounts were certain to be scooped up. The NSA believed the law entitled it to pretend otherwise. When information passed through “the overseas collection apparatus,” the official told me, “the assumption is you’re not a U.S. person.” That was indeed the formal rule. In the absence of specific information to the contrary, according to the court-approved targeting rules, “a person reasonably believed to be located outside the United States or whose location is not known will be presumed to be a non–United States person.”

Even when the analysts explicitly described intercepted files as useless for intelligence purposes, the NSA retained them. The contents had an intimate, even voyeuristic quality. They told stories of love and heartbreak, illicit sexual liaisons, mental health crises, political and religious conversions, financial anxieties, and disappointed hopes. They included medical records sent from one family member to another, résumés from job hunters, and academic transcripts of schoolchildren. In one photo, a young girl in religious dress beamed at a camera outside a mosque. Scores of pictures showed infants and toddlers in bathtubs, on swings, sprawled on their backs, and kissed by their mothers. In some photos, men showed off their physiques. In others, women modeled lingerie, leaning suggestively into a webcam or striking risqué poses in shorts and bikini tops.

All of those examples were from non-targets.

Why did Snowden reveal what he did?

History has not been kind to the belief that government conduct always follows rules or that the rules will never change in dangerous ways. Rules can be bypassed or rewritten.

Within living memory, Richard Nixon had ordered wiretaps of his political enemies. The FBI, judging Martin Luther King Jr. a “dangerous and effective Negro,” had used secret surveillance to record his sexual liaisons. A top lieutenant of J. Edgar Hoover invited King to kill himself or face exposure.

Snowen wrote: “While it is discouraging to think that you cannot be completely safe, the fact that I’m walking free today, the fact that I’m still able to communicate with you, it shows that there are cases and there are circumstances where if you do things right, if you do things carefully, you can win. Not because you’re invincible but . . . you can literally win. You can beat them. One of the very interesting things about doing the right thing is you have no trouble sleeping. You have untroubled nights. It really hasn’t been the giant nightmare people assume it would be. For me, in terms of personal satisfaction and accomplishing the mission, the mission is accomplished. I already won. As soon as the journalists were able to work I got everything I wanted. I didn’t want to change society. I wanted to give society the opportunity to change itself."

Hero or traitor?

The dynamic is beginning to change now. We are shifting it. We’re basically reclaiming spots and making parts of it more private again. Edward Snowden shifted popular culture. He brought about legal, diplomatic, political, and legislative challenges to the prevailing model at the NSA. Alongside all that, and perhaps most significant, came demand for greater resistance in the private sector against NSA bulk surveillance techniques. Security and privacy became marketing points for the internet giants. Google accelerated its plans to encrypt all its services for consumer and business customers.

“I am not convinced that shadowy figures pose a greater threat

to security than information control, total surveillance, and

permanent national militarization.” — Edward Snowden

How does the US health care system measure up to others ?

​My wife, my daughter, and I have been in Canada now for 15 years, and I can no longer imagine my life without Medicare.  I have become a Canadian, through and through.  Or, just maybe, I always was Canadian, but didn't realize it until I was 48 years old.

Here's what I believe:  Access to essential medical care is a basic human need and I believe it is a human right.

And, I might add, I have absolutely nothing but the highe​​st praise for the medical care we've received here in New Brunswick.  We've had excellent and prompt care from specialists (oncology, radiology, dermatology, and neurology), from our family doctor, and from blood clinics and emergency services.  Our experience may not be typical, but it is my first-hand experience.  It's what I know to be true.  New Brunswick's Medicare system is far from perfect, I know that, but flaws in the Canadian system do not "prove" that the American medical system is better.  

Canada's health care system is truly excellent.  But eleven years ago, during the debate on the Affordable Care Act, Senate Minority Leader Mitch McConnell (R-KY) made a speech on the Senate floor in which he insisted that Americans will never accept a health care system like those of Great Britain, Canada, and New Zealand.  Really?  I think he's wrong about the American people.   I know he's wrong about the "terrible" health care systems of the three countries he picked to compare with that of the US. 

Actually, though, it wouldn't matter what three countries he picked, since in every other developed country in the world, health care spending is lower than it is in the United States, and results are better than those of the United States.

But Mitch McConnell chose Canada, New Zealand, and the United Kingdom to make his point.  That wasn't an "error of judgment."  It was a display of his ignorance.  It was a very stupid thing to say.  But he did say it and, so, let's look at some measures of the quality of healthcare in just those three countries, and compare them to the same results for the United States.  

Let's start with per capita health care spending, how does the US stack up against the other three?

United States: $11,072
Canada: $5,418
United Kingdom: $4,653
New Zealand: $4,204

2019 data, US dollars
Source: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
 

Total health care spending as a percent of each nation's GDP:

United States: 16.0%
Canada: 10.8%
New Zealand: 9.2%
United Kingdom: 10.0%

Source:  https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS


Infant mortality rates (the number of children, per thousand who were born live, who die within their first year of life)

United States: 6.5
Canada: 4.9
New Zealand: 4.7
United Kingdom: 4.3
 
Source:  https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate#Under-five_mortality_from_the_World_Health_Organization


The probability of a newborn making it to age 65:

Canada: 82.3%

United Kingdom: 81.5%
New Zealand: 80.9%
United States: 77.4%

Source:  http://www.nationmaster.com/graph/hea_pro_of_rea_65_mal-health-probability-reaching-65-male


Life expectancy at birth for the total population (male and female), considered a good indicator of overall health.  The gap in life expectancy between Canada and the U.S. continues to widen.

Canada: 82.4 years
New Zealand: 82.3 years
United Kingdom: 81.3 years
United States: 78.9 years

Source:  http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy


And, last of all, this is my own favourite statistic, the expected number of healthy years of life?

Canada: 72.3 years
New Zealand: 71.6 years
United Kingdom: 71.6 years
United States: 68.1 years

Source:https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy#List_by_the_OECD_(2016)  Health-Adjusted Life Expectancy (HALE)



Per capita healthcare spending by country

What can *I* do to help mitigate global warming?

 ​Several people have asked me the question, "What can we do about the climate crisis?" or sometimes they ask, "What are you doing, Charles?"

As Naomi Klein pointed out in her 2019 book On Fire: The (Burning) Case for a Green New Deal:  

The hard truth is that the answer to the question "What can I, as an individual, do to stop climate change?" is: nothing.

You can’t do anything. In fact, the very idea that we, as atomized individuals, even lots of atomized individuals, could play a significant part in stabilizing the planet’s climate system or changing the global economy is objectively nuts. We can only meet this tremendous challenge together, as part of a massive and organized global movement.

Individual actions are important, they are responsible, and they inspire others to do likewise.  

The fossil fuel industry wants everyone to feel guilty because they aren't doing enough as individuals; the truth is ... that just takes the guilt off their own shoulders, which is where it belongs.  Just like the tobacco industry, forty years ago, funding smoking cessation programs (for individuals).

Become part of a growing global social movement for substantive structural change.  Educating yourself is the most important thing you can do.  The essential facts about climate change are readily available, they are irrefutable, easily read, and easily understood.

And never forget that reality always has the final word.

Americans are paying too much, for too little

On 26 June 2008, in testimony before The President's Council on Bioethics, Dr. Steffie Woolhandler, a primary care physician, stated:

Now, it turns out that medical bankruptcy is, as I said, half of all personal bankruptcies. Millions of people each year are affected by medical bankruptcy, but 76 percent of people who were in medical bankruptcy in our study had health insurance at the onset of the illness that bankrupted them.

So insured people have an issue, too, if they have a prolonged, serious illness. They can't work. They have lots of co-payments, lots of deductibles. They can end up in bankruptcy, as well.

 

Dr. Steffie Woolhandler is also an Associate Professor of Medicine at Harvard and co-director of the Harvard Medical School General Internal Medicine Fellowship program.  Her testimony was removed from the government website by the Trump Administration, but you can still view an archived copy on the Internet Wayback Machine.

Most Americans don't realize how badly flawed the medical system is in their own country and how many Americans go without adequate medical care as a result.  Even though the US spends more on health care, both per-capita and also as a percentage of its national GDP, than any other developed nation in the world.  According to the OECD, health-care spending in the US was 17.7% of US GDP in 2019 (source).  That's far more than any other country, nearly 50% more than was spent by the next highest country on their list. 

Americans spend nearly twice as much as the average developed (rich) country ... but they die 1.7 years earlier.  You find something wrong with that?  Every reasonable person does.

Total Health Spending / Government / Voluntary, US dollars per capita, 2019

With so much wealth spent on health care ... are Americans healthier than people in Switzerland, Germany, Canada?  In what way could that be measured? Perhaps by life expectancy? Infant mortality rates? Prevalence of obesity? Heart disease death rates?  

It's not that health care in the US is bad, actually, it is the best available anywhere.  The problem is that the system is so inefficient that Americans pay far more for their health care than is, apparently, necessary.

Nearly half the counties in the US don't have a single ob-gyn providing maternity care (source).   In a for-profit health care system, doctors go where the money is.  In the US, where healthcare is apportioned by ability to pay, some people get the best care in the world, and immediately.  Millions go without.  Many put off necessary health care they can't afford.  Many die in "waiting lines" for health care they will never get.

What Americans have been doing for generations doesn't seem to be working anymore.  Is there a better way?   A reasonable person has to wonder.

Resource:

U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?

January 30, 2020
https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019

Five myths Americans have about the Canadian Health Care system

Fifteen years ago, I moved my family to Canada from the United States, at the rather advanced age of 48.  I came to this country with a number of misconceptions about Canada's single-payer system of universal health care, most of all, the false notion that hospitals are government institutions, and that medical providers are government employees.  It doesn't work that way in Canada.

Americans, particularly young Americans, are looking for a medical care system like the one Canada has. Obamacare is not that system. Obamacare was just a first step in the right direction.

During the heated debate over the Affordable Care Act or "Obamacare", I spent several hours reading about it trying to understand why it was met with such fierce resistance. My wife asked me for a quick synopsis of the plan and the controversy; I explained it to her as I understood it.

"What you just described," she said, "is not a 'health care' plan at all ...  you just described a national 'insurance' plan. You said nothing about health care."

I was floored, "Whoa ... in 5 minutes, she understood what had taken me hours to comprehend." 

Because she reduced it to its core elements; she wasn't distracted by the hype on one side, and the fear-mongering on the other.

Americans don't need an insurance plan like Obamacare.  America needs an extension of its own world-class (Medicare) health care plan for seniors, which is similar to Canada’s system, funded by taxes, where doctors and hospitals have a single customer for billing: the government.  Medical services are mostly by the private sector, but there is a single customer for billing purposes: the government.

It is very encouraging that so many post-Boomer Americans are no longer afraid of the word "socialism."  Because, in that, lies the best hope Americans have for a better future.

Here are the most five most common misconceptions I've found that Americans have about Canada’s system of universal single-payer health care:

Myth:  Medicare is a Canadian-wide federal government program.  Canada's Medicare system is not a federal program, and is not administered by the federal government; it is provincial, and service varies, coverage varies, taxes vary, between provinces.  In some provinces, people pay insurance premiums for Medicare; in New Brunswick it is free, but here we don't have prescription drug coverage under the age of 65 (I have employer-provided supplemental insurance coverage for medications).  The only thing the federal government has to do with Medicare is to set "guidelines" for the provinces to ensure that every Canadian resident has equal access to all "medically necessary" health care services.  Medical providers are required to abide by the Canada Health Act of 1984, which basically guarantees every Canadian resident equal access to all "medically necessary" health care services, without co-payments of any kind.  Incidentally, access to medical care is a right of all human beings under the 1948 UN Universal Declaration of Human Rights, which was written, incidentally, by a Canadian, John Peters Humphrey.

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

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

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

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

99 years ago: Insulin first used (here in Canada)

On 11 January 1922, insulin was first used to treat diabetes.  In Canada.

Insulin had been discovered by three doctors at the University of Toronto:  Sir Frederick G Banting, Charles H Best and J.J.R. Macleod.

At that time, children in comatose states (from diabetic ketoacidosis) were kept in large wards of 50 or more patients.  Their deaths were considered inevitable and their families gathered at their bedsides during their final hours.

With nothing to lose from administering their purified insulin extract, Banting, Best, and James Collip (the Canadian biochemist who had purified the extract) went from bed to bed, injecting the entire ward. 

Before the three doctors had reached the last dying child, the first few were awakening from their comas, and the ward resounded with joyful cries from their family members.

The discoverers of insulin were reluctant, at first, to patent their process for purified insulin, but when they learned that an American company (Eli Lilly) intended to hijack and monopolize the production of insulin, they obtained a patent in the name of the University of Toronto with one condition spelled out:

The patent will not be used for any other purpose than to prevent the taking out of a patent by other persons. 

When the details of the method of preparation are published, anyone will be free to prepare the extract, but no one can secure a profitable monopoly.

And that's a story more compellingly dramatic than any war story I've heard.