The label says that by 12 months babies are ready for a wider variety of foods. Called Lil Crunchies in the Graduates line, the baby junk food includes cheese puffs, vegetable puffs and fruit puffs.
A large Canadian study has found that people who got the seasonal flu shot last year were more likely to get H1N1 this spring than people who didn't get the shot. The report is not yet peer-reviewed, but reports of the report are causing Canadian officials to rethink their flu shot policy. However, the researchers should have expected that certain biases would provide this result, without implying that the seasonal flu shot somehow causes H1N1:
1. People who get the seasonal flu shot are more likely to get flu Some people never get the flu, because of natural immunity or because they don't spend time in close proximity to infected people. These people are much less likely to get flu shots.
Conversely, some people are much more prone to getting sick, due to poor health, close proximity to infected people, or whatever. These people are much more likely to get the flu shot.
So in the sample group, you would expect more people who got the flu shot to get this new strain of flu. That doesn't mean that the flu shot caused the flu.
2. People who get the flu shot are more likely to be diagnosed with H1N1 This past spring, most people who got sick with H1N1 got mild cases. Most were probably not even diagnosed. The people who were diagnosed with H1N1 are probably those people who go to their doctor more often. People who go to their doctors more often are more likely to get the flu shot. Therefore, of the people who got H1N1, those who are diagnosed are more likely to have had the flu shot. -- Correlation does not imply causation.
This sort of research can suggest lines of laboratory research, but it means little without the research. And yes, that applies to all the other statistical health studies we read about in the newspaper.
Unfortunately, immunizations have become the hot topic of people who are paranoid about the medical profession: people who hate doctors, or mistrust science in general, or think BigPharma is manipulating health issues to boost profits.
As for myself, for most of my life I got the flu every year, usually getting sick as a dog and missing a full week of work or more. Every year since 1997 I've had a flu shot and in that time I haven't had the flu. Ontario has now decided to delay seasonal flu shots till after the H1N1 shots, and that increases my likelihood of getting the flu. So I feel I have a personal stake in this. For those who don't want to get flu shots - fine; as long as they stay away from other people when they get sick, they can do what they like. But as a public policy, flu shots work, and shouldn't be delayed until the middle of flu season on such a questionable and preliminary study.
Okay, I've spent some time in the past documenting how much better and cheaper Canada's health care system is than the US system. But that's not the real question.
The real question is: Why is Canada's health care system worse than many developed countries other than the US? Compared to the US, we look great; compared to the OECD average, not so much. Canada's per capita health care costs are higher than many OECD countries. Compared to countries that provide universal health care, we fall behind on many indicators of heath care quality.
Instead of worrying about the mess in the US, we should be solidly focused on looking east and west for ideas about how to improve health care. In an ideal world of continuous excellence, we would be having a public discourse (in newspaper articles, phone-in shows, debates with friends, the legislature) about all the ways we can improve. Sure, Harper is not interested in improving health care - he wants it to fail so he can privatize it - but health care is provincial, and our provincial governments are in many cases more enlightened than our current federal government.
So to reduce the price of medicine, why not restrict advertising? We used to restrict advertising on booze and cigarettes. It seems like a sensible solution to drug costs.
I was listening to Davis in a December 17, 2007 episode of The Current that I downloaded from the CBC podcast site. If I heard her correctly, the average cost of a new drug is $800 million, and half of that is marketing costs. If we want to control the cost of life-saving medicines, we could restrict the costs of the companies that make them.
A counter argument might be that the drug companies advertise because it increases their revenue. It also creates inefficiencies in the system. For example, when the patent runs out on a drug they make a minor change, re-patent it and advertise the hell out of it, trying to make it seem like something new.
I don't know enough about the pharmaceutical industry to argue this completely, but my thinking is... In labor law we have the concept of essential services; why not extend that concept to products? If I am unable to strike because I'm a nurse, why not say that there are also extra sorts of restrictions on the companies that make the drugs nurses hand out? Some life-saving drugs costs thousands of dollars a year, and not everyone has health insurance. In fact, it's a wonder that private health insurers aren't agitating to reduce drug costs. We in Canada have already reduced them by having better bargaining power with drug companies, but drugs are still arguably massively over-priced.
The pandemic du jour, now that H1N1 has lost its ability to scare the pants off us, is bubonic plague, which has recently cropped up in a very small way in China. To read some news reports, you'd think it was the first case of bubonic plague since 1350.
Actually, it's not that uncommon. For example, bubonic plague is endemic in the Usambara Mountains (Lushoto District) of Tanzania. I have visited the area... there were no travel advisories against doing so, at least in the mid 90s. A recent study of the sparsely populated area found that in the period 1986-2002, "there were 6249 cases of plague of which 5302 (84.8%) were bubonic, 391 (6.3%) septicaemic, and 438 (7.0%) pneumonic forms." Plague has been there for decades and illness from it is a seasonal phenomenon, like flu (although it's more deadly).
I mention this only because media seems to get stuck on a topic and ends up distorting reality - like making it seem that crime is rising, when it's actually falling; or clobbering us with every instance of abductions of pretty white girls, which are actually pretty rare.
A recent poll found that Canadians are feeling more positive about the US: 68% of Canadians view the US favorably, compared to 55% two years ago.
This surprises me, because our little country is taking a mighty drubbing in American political circles and media these days. They have decided that our approach to health care is shite. It's not just the health care lobby and Republicans who are describing Canadian health care as a failed system: even many pro-reform Democrats are saying ignorant, negative things about Canadian health care.
Americans aren't just critical of our health care system. They're not just disdainful. To hear some pundits, our health care system is the boogie man: the health care equivalent to the Axis of Evil. We're the North Korea of the health care debate - the Iran, the Sadaam Hussein, the Hitler. We're the Red Menace. Our health care mistakes must be avoided At All Cost.
If you believe US television, Canada is a hotbed of commie craziness where zombyized citizens sit in hospital hallways, desolate in cracked plastic chairs, waiting for death while government bureaucrats shuffle stacks of paper and discuss union action. And we have crap quality drugs, too. Even so-called balanced stories leave the impression that wait times for medical procedures are peculiar to Canada, while in reality there are wait times in both systems.
The only safe haven for sick Canadians, according to many pundits, is the free world's leader and beacon: the United States, where we flock by the million to buy the best health care in the world.
My second cousin Bubba in Memphis even called my mother to ask how we survive it.
There isn't any reasoning with the Canada-bashers...
But fortherecord: the World Health Organization has ranked Canada significantly higher on both the level of health care service and the overall health of citizens.
The life expectancy in Canada is 80.7 years, compared to 78.1 in the US. For every 1,000 live births in Canada, 5.0 infants die; in the US, it's 6.7. A recent study found that 92% of Canadians are happy with their primary health care.
Government-run health care is also much more cost efficient. Canada spends US$3,895 per person on health care; Americans spend US$7,290. Narrowing that down to government spending, the Canadian government spends US$2,120 and the US government spends US$2,724 per person. And no, the discrepancy is not due to malpractice, which accounts for less than half of one percent of US spending. Universal health care hasn't left us without doctors: there are roughly the same number of doctors per capita in Canada and the US (2.2 per thousand in Canada; 2.4 per thousand in the US).
Compared to Canada, "U.S. residents are one third less likely to have a regular medical doctor, one fourth more likely to have unmet health care needs, and are more than twice as likely to forgo needed medicines." The US has 45 million uninsured citizens and 16 million who are under-insured.
All indicators prove that Canada has better health care than the US. And yet Canada has nowhere near the best health care in the world: most European countries do a better job than we do.
The larger issue is the appalling level of public discourse in the United States. The odious health care debate is just one example. Another example: This deeply racist country elects its first black president, and when a distinguished black scholar who's a friend of his is roughed up by cops in his own home, Obama is pilloried for speaking up about it?!
But I'm not interested in that right now. What I'm steamed about is why Canadians aren't mad as hell about this relentless slagging of our health care system. Sure, we'll never convince them south of the border, but there should be a furious dialog in this country about being the target of ignorant and malicious defamation of our national character. We are damn lucky that most of the time Americans forget we exist; we can't let them redefine our reality. That American koolaid is something we don't want to drink.
I'm finding it difficult to support Barack Obama in part because I like John McCain. McCain is pretending to be more right-wing than he is to win over the Republican party, but his stance on issues is really quite moderate, as he has demonstrated for years.
The opposite is the case with Canadian politics. Stephen Harper is a wolf in sheep's clothing, or sometimes just a wolf. He is a right-wing fundamentalist Christian like nothing we have ever seen. He supports capital punishment, opposes abortion, and wants to gut the social safety net. He has been held back by his minority status, but even so he has done enormous damage to our country with his policies to send more people to prison, his gutting of funding to women's organizations and arts groups, his pro-war foreign affairs strategy, and his politics of polarization.
There is no question in my mind that we have to do whatever we can to turf out this negative, scandal-ridden group of ideologues and elect Stephane Dion.
To me, the battleground we should fight the upcoming election on is the preservation of our system of universal health care. The Harper government came out last week with their latest plan to introduce two-tier health care. They must be stopped.
We already, of course, have two-tier health care. Any Canadian can easily go the US and buy health care. What the Conservatives want to impose is subsidized private health care. Queue-jumpers want a bargain.
We have a health care system that is the envy of the world. It works. It's affordable. Harper - on ideological grounds - wants to dismantle it completely. He's trying to wiggle his foot into a crack, pull off a piece of it, and start the decay that will make the whole system unfeasible. We can't let him get a toe-hold.
Being a dual citizen, I may have two federal elections to vote in this fall. I'm ambivalent about one, but I have no doubts about the other. Harper is a bad leader and it's time to throw him out.
I recently wrote about Hillary laying down the gauntlet in her concession speech, saying that she would fight to ensure Americans had universal health care - "no exceptions and no excuses".
Why did Obama name Elizabeth Edwards? Is it a gesture of support for Hillary or a slap in the face? If it was meant to make Hillary supporters happy, it is uncharacteristically inept.
It's starting to bother me that Obama isn't making a move to unite the party. Everyone gave Hillary grief about waiting four days after her defeat to endorse Obama (even though past candidates have received no grief for waiting up to four months) but I'm starting to think Obama should get some grief for not immediately reaching out to Clinton supporters. It's not that he needs to make concessions; it's that he needs to make a gesture. Not doing so indicates a disturbing arrogance. There's nothing worse than a sore winner.
In her speech today suspending her campaign and endorsing Obama, Hillary said:
We all want a health care system that is universal, high quality and affordable so that parents don't have to choose between care for themselves or their children or be stuck in dead-end jobs simply to keep their insurance. This isn't just an issue for me. It's a passion and a cause, and it is a fight I will continue until every single American is ensured - no exceptions and no excuses.
With this statement, Hillary declared her determination to achieve universal health care for Americans - "with no exceptions and no excuses" - even though Obama opposes universality. In fact, during the campaign Obama released a series of ads attacking Hillary for seeking universality. More than one carried the slogan "Hillary's health care plan forces everyone to buy insurance, even if you can't afford it." Paul Krugman estimated that under Obama's plan, at least 23 million Americans would remain uninsured.
Everything else in her speech was aimed at subsuming Hillary's political machine into Obama's to help him become president. On this one issue did she defy him. And I think that gives us a little ray of insight into her goals.
The pundits have been opining that Hillary has been using her photo finish power to force Obama to give her the vice presidency, or the supreme court, or some other big job. I think it's more likely that what Hillary wants is to finish what she started in 1993 and obtain health care for all Americans. It's more than a Herculean task - it's the sort of monumental achievement that might use up the entire career of a great person. And she seems ready to give it her all.
Now that's a legacy to make the vice presidency seem pretty trivial.
(Note: Thanks to my friend Ellen for pointing out that Hillary broke with Obama on this issue. It sailed right by me when I first listened to the speech, and all the pundits also seemed to miss it.)
The next US president will inherit a deficit that will make it nearly impossible to enact any new policies and a war that will make it nearly impossible to correct the deficit. He or she will probably also walk into a recession that will require enlightened economic management.
Seven years of spectacular mismanagement have left such a pile of deferred problems and crises that most of the new president's time will be spent digging out from under and cleaning up the messes. And many of the problems depend on each other. As one example: the current world financial system, unofficially called Bretton Woods II, is based on emerging economies keeping their exchange rates low to support exports to the US. US consumers now represent 35% of world GDP. The system was unsustainable from the start, and as the US currency collapses it threatens all involved - perhaps most of all the vulnerable Chinese economy, which doesn't have the domestic demand to support its production. We need to create a new economic order and it's not going to be easy. The defacto dollar standard and even US position as world superpower is at stake.
In a recession, economic issues are social issues. When the economy suffers, the poor suffer most of all, and layoffs create more and more of the poor. Much as I support an enhanced social safety net and income redistribution, in a recession the size of the pie is more important than the shape of the slices.
Similarly, solving the US health care dilemma is about a lot more than assuring universal coverage. Health care costs are so out of control in the US that the US government spends more per capita on health care than Canada does, and still leaves out tens of millions of people. Health care costs have created a crisis in Medicare as boomers retire.
On top of all that, there's a brewing crisis in the middle east; an environmental crisis; US financial market regulations that require a vast overhaul; an immigration problem; and, oh yes, the probability of new terrorist attacks. No doubt I've left out dozens of vital issues.
Given this, what we need in the next president is someone with good values - social justice, economic prosperity, rule of law, environmental improvement - but whose emphasis is on good management and getting things done. To my mind, the best candidate is Hillary Clinton - but I respect Barack Obama as a choice as well.
One thing that bugs me about the universal health care debate in the US is the assumption on the part of many of the participants that the Canadian system is no good and should not be considered.
This, I believe, is due to a PR campaign by the health care industry in the US to discredit the Canadian system. Or better put, the Canadian system got trashed as part of the attempt to discredit universal health care in general.
It's true that Canadians love to complain about their health care. Health care could always be better, and there was a period of a few years when we had significant problems with wait times.
But our metrics are good. Canada beats the US on key indicators such as infant mortality and expected lifespan. Canadian women are not more likely to die of breast cancer than Americans, even when the wait time for a surgical procedure was a little longer. And while the Canadian system is much cheaper to run, the Canadian system is also more extravagant: Canadian hospitals tend to be cleaner, resulting in less superbugs and other side-effects of hospital stays; after-care is better; and so on.
The problems with the Clinton and Edwards plans are that (as far as I can see) they don't address two main areas.
(1) They don't address the issue of incredible inefficiency in the current US system, caused by too many profit-takers and too much red tape. Health care costs in the US aren't just a little higher than Canada: they're astronomically, mindboggingly higher. There is an impending crisis due to the retirement of baby boomers, but it is not due to inadequate funds in Social Security: it is how Medicare will be able to fund the health needs of retiring boomers at the current high cost of medical care.
(2) They don't address the issue of putting too many life-and-death decisions in the hands of people whose jobs are to cut costs. I have a cousin who was nearly denied a life-saving transplant because she was considered too ill to survive it (that was 10 years ago, and she's doing very well).
I can see that the US is never going to accept a fully socialized health care system. But a modified Canadian system - government-funded health care for all with the addition of private pay-as-you-go clinics - seems to be the ideal choice for the US. That is essentially what we have currently in Canada, because 95% of Canadians live within 100 miles of the border.
When France opposed the US invasion of Iraq there was an unbelievable backlash in the US. (We all remember "Freedom fries".) Jokes abounded (and still do) about the French. Some of them were even pretty funny. But it seems likely that they originated in the office of Karl Rove or his ilk, in the now all-too-familiar scenario of the Bush administration striking back at its political opponents.
Recently, however, France's reputation is on the rise. As the Bush administration continues to bomb, torture, wire-tap and generally act like a bunch of murderous thugs, France is emerging as a state of enlightenment that is taking a lead in progressive international affairs.
Michael Moore helped with his portrayal of France in his new film SiCKO. France appears as the most evolved form of democracy in the world - where the state runs more for the benefit of the people rather than overemphasizing the wishes of lobbyists and political donors (as most of us western "democracies" do). French people have the best health care in the world, the strongest employee protection laws, and so on. (And no, the capitalist system did not collapse.)
This week France has been in the news twice in high profile cases. First, Cecilia Sarkozy, wife of the newly elected French president, negotiated a deal with Libyan president Moammar Gadhafi to free Bulgarian medical staff who were facing the death penalty in Libya. (It makes you think that Libya must have been desperate to find a solution to the mess, and that the rest of the world must have been negligent, if Libya was so willing to release the prisoners after speaking to such an unofficial source.)
Then we learn that President Sarkozy named Bernard Kouchner as his new foreign minister - that's the same Kouchner who founded Doctors Without Borders - and in his first week in office, Kouchner convened a summit which led to EU troops mobilizing to help ease the suffering in Darfur. Everyone else seems to be just wringing their hands. (The UN is considering deployment, but is said to be "years away" from being able to send troops.)
I think it's time we all start paying a lot more attention to France, and think about using it as a role model. (In the French press today: a law has just been passed that no income tax will be charged on wages paid for overtime.) Here are some English-language sites I've bookmarked:
I really enjoyed SiCKO. Like most Michael Moore films it's engaging and thought-provoking. The movie goes beyond condemning US health insurance, so my reaction as a Canadian was not smug complacence. The real message of the movie is that the people should have more power in society, a theme that applies to Canada as well as the US. (We especially need stronger employment regulations, a theme I tend to harp on about.)
Those who don't agree with Moore will call the film propaganda, and that's not unfair. His arguments are emotional, to say the least. But boy is he effective. Tonight on CNN I saw uncredited shots from the movie of confused people in hospital gowns dumped on skid row (some US hospitals kick patients out of their beds when they can't pay, no matter what physical state they're in). Anderson Cooper said, "We have been reporting on this issue for over a year and a half." Well I sure missed it. And haven't you noticed that all of a sudden you're hearing about how well France runs things? That's straight out of SiCKO.
I remember the left-wing films of my youth. Many leftist activists would twist any issue to try to bring about their ultimate goal - the revolution, the downfall of society, and the start of the socialist utopia. Leftist films frequently were just a pack of lies and conspiracy theories spooned out to the gullible. It was like there was a worm in the movement making things rotten and reducing credibility. (Nowadays the Right has taken over the role of uncredible ideological extremist, and the Left has taken over the role of pragmatist - even to the extent of being fiscally conservative. Funny old world, isn't it?)
Moore isn't like those old Marxist lefties. Agree or disagree, he is working honestly and transparently to make his case for what he sees to be a better world. And I tend to agree with him. When he says, "How did we become like this?" with a note of despair, you know he's speaking from the heart.
The only Moore film that didn't hit a right note with me was Bowling for Columbine, which was confused and uncredible. (I don't think Canadians will ever quite forgive him for saying that we don't lock our front doors - not that we wouldn't want to live in a crimeless state, but it just ain't so.) And his ultimate conclusion for why there is so much crime in the US - the nightly news - was just silly.
But of his oeuvre, Moore has produced three marvellous, world-changing films: Roger & Me, Fahrenheit 9/11 and SiCKO. And on the basis of SiCKO, I'd say he's getting better and better.
A year or so ago people were saying that off-shoring had peaked. The argument was that companies were starting to realize that North Americans did a better job. Or that all the best Asian professionals were already hired and so wages were rising there. Or that companies couldn't cope with the problems of time difference and the need to travel half way around the world on a regular basis.
But the decline in hiring off-shore didn't happen. And now even if it did it wouldn't matter much because Asian countries are developing their own indigenous companies in a broad range of sectors. If North American companies didn't hire Asians, then Asian companies would just under-sell them. The only way to stop the internationalization of labor would be to go back to high tariffs. That's not a winning proposition in any event, but it is unfeasible in the current situation because China, Japan and Korea own so much US debt.
The internationalization of the labor market has happened and it's here to stay. I once thought my job (software technical writer) was immune because the software market is still mostly English and hey - English is my native tongue - but in my company a large part of the writing team is in Singapore. I heard on As It Happens tonight that even journalism jobs are being out-sourced to Asia, and that Reuters has had over a hundred business reporters in Singapore for years - writing about North American business.
All that brings me to the purchase of Chrysler by Cerberus. Some people are arguing that Cerberus is a strip-and-flip specialist, but there's more to it than that. The private equity company makes its money by buying a company that is nearly insolvent, restructuring and making large cuts to the company, and eventually selling it for a profit. Cerberus is dead serious about restructuring companies and it has a lot of management expertise.
Cerberus is not a new investor in Detroit, probably because the US car industry is, in general, completely in the crapper. The Detroit Free Press writes, "In southeast Michigan, Cerberus already has purchased a controlling interest in General Motors Corp.'s finance arm, GMAC, as well as Michigan auto suppliers CTA Acoustics in Madison Heights and GDX Automotive in Farmington Hills. It has offered to invest $3.4 billion in parts giant Delphi Corp., which is in bankruptcy. And earlier this month, a judge gave auto supplier Tower Automotive, also in bankruptcy, preliminary permission to sell nearly all of its assets to Cerberus for $1 billion."
It's like this: The unions and the government have been holding their finger in the US car manufacturing dyke for years, keeping change at bay, maintaining not just high salaries and benefits for workers but also lousy workmanship, lousy design, and second-rate management. Not to mention a steadily eroding workforce as the companies crumbled. The resistance to change also extended to not reforming health care in the US, taking out some of the many profit-takers who contribute to the crippling health costs of unionized companies.
And that's all over now. Cerberus is a private company that doesn't have to disclose its doings to the SEC and doesn't have to answer to shareholders. It isn't going to follow the old car manufacturing paradigms. The future for Chrysler is far different than if Frank Stronach had been successful in his bid.
Change is coming. Not just to US car manufacturers, but to all of us who earn a salary in a rich western country. And isn't that what we always said we wanted? - Better education in developing countries. Equalization of pay scales around the world. An end to the western countries hogging all the world's wealth?
I recently read an article called Office workers risk blood clots in BBC News, and the thought crossed my mind that this is an excellent reason to be a smoker: you get to get up every hour or so and take a little walk, stretch your legs, reduce the risk of deep vein thrombosis. You also rest your eyes, have a mental health break, get to know your coworkers... it seems likely that smokers are happier, more sociable, more laid-back workers with lower rates of certain health conditions. There are people who smoke moderately (4 or 5 cigarettes a day) who might not even be hurting their health. But of course medical stories will never mention such things because they don't want to promote smoking.
But if medical research isn't objective and scientific, then what is it? Just a mouthpiece for things we already believe? It seems too often to be just that. At the worst extreme, organizations fund research that confirms their viewpoint. Hence, all those stories that red wine is good for you are funded by the French government; the Dutch are behind the pro-chocolate studies; and we all know about drug research that doesn't turn up problems with new drugs.
Even at its best, medical research is skewed too much by the beliefs of researchers. Here's another story from recent press: Soft drinks clearly associated with diabetes - report (from the New Zealand Herald). This article starts, "A review of published studies shows a clear and consistent relationship between drinking sugary (non-diet) soft drinks and poor nutrition, increased risk for obesity -- and increased risk for diabetes. There is no denying that sugar-loaded soft drinks are having "a negative impact on health," Dr Kelly Brownell, director of the Rudd Centre for Food Policy and Obesity at Yale University in New Haven, Connecticut, said in a telephone interview."
Actually, there is a lot of denying it. A study that finds that people who drink soda pop are more likely to have health problems does not tell us at all that soda pop causes health problems. In fact, the likely culprit is that people who tend to drink soda also tend to have other habits that lead to health problems. Like they're more likely to eat meals at fast food restaurants, or they drink less milk, or they're less likely to be interested in diet. Or maybe it isn't the sugar intake that causes the diabetes but diabetes that is causing the sugar craving. Or another condition that causes both - perhaps even a mental condition like depression or plain old teenage angst (overeating as a slow form of suicide).
But okay, okay, it's pretty likely that drinking large quantities of sugary pop (which is high in sugar) is going to have an effect on your blood sugar, and because it's high calorie it's probably connected to weight gain, but did the study prove these connections? Not at all. This study didn't even bother to measure how much sugary pop was drunk, so there's no indication that it was consumed in harmful quantities. How are we going to learn anything new if we just keep "proving" what we already believe to be true?
(By the way, I neither smoke nor drink sugary soda pop, so please don't take this post as an argument for either of them.)
Along with the problems of the way the data is analysed, there are problems with the way it's collected. Why do we have thousands upon thousands of short-term, small studies? Why doesn't our government take most of its funding for medical research and put it into one huge long-term study? It could then make the information available to everyone in a huge database - as it does with economic data.
Broader data collection might reduce some of the biases that occur in research design. Factors that were considered irrelevant might emerge as worth looking into. Where possible, throw in DNA, family history, information about every place the individual lived, and a lifetime of medical data.
For specific issues, researchers could prepare add-on studies. The goal would always be to have as large a sample size, and long a time frame, as possible, so data collection would often go on for longer than the researcher's own time frame.
Allowing many people access to the data would lead to much better, more objective analysis. It would also allow for much better reviews.
I mean universal health care vs. private enterprise, of course.
To focus the debate, let’s just call it Canadian health care vs. US health care.
Too often this debate assumes that every difference in health care between the two countries is based on the financing scheme of the health system, and that every problem either country encounters would be fixed by switching to the other scheme. I reject those assumptions.
There are cultural differences between the two countries that reflect in their approaches to health care. Somebody should do a study or something, but here’s my guess (apologies for cultural stereotyping). Canadians are more cautious and more patient. They want cleaner hospitals and longer hospital time after surgery, but they'll put up with waiting lists and they don’t need the most cutting edge equipment. Americans, on the other hand, want immediate care, and they want the latest procedures and equipment. They can put up with the highest incidence of hospital staph infections in the world, and they can take being booted out of bed the day after major surgery.
Each system has its own strengths and weaknesses. Both provide high quality care, and neither is the clear winner in quality of care.
The one thing that lets me raise Canada's glove in victory is the cost of delivering the care. For exactly the same care---the same medical test, the same drug, the same operation---regardless of who pays for it, Americans pay a whack more dough than Canadians. Why is this? The middle man. There are a ton of profit takers in the US: the company that owns the hospital, the HMO, the company hired to fill out all the forms for the HMO. Canada’s creaky old government-run system is, based on hard dollars and cents, a whole lot more efficient.
Oh yeah, and also everyone is covered with no fees.
