The Great Conversation

Thanks to my recent post about Health Care, I was able to have some very nice discussions about it (mostly in the comments of the post). It was fun, and certainly not over, but I thought that it might be fun to post them it here so that you could all read it if you are so inclined.

This first one is from some friends that we met in Maine that are currently living in Canada. It was really neat and interesting to hear their perspective.

Hey Courtney–

Will Butler here. Greetings from Will and Jenny!

First things first, we are very jealous of your New Mexico digs. Up in Montreal we got 6 inches of snow yesterday. Oof.

Second things second, I wanted to start commenting on the political posts you make. I like reading your point of view, though my own is very different, and I thought it would be fun to start a conversation. BUT–if you find my responses annoying, or if they’re killing your mojo, by all means let me know and I’ll stop commenting.

Third things third–healthcare!

I’ve lived up in Canada for the last five years (to make money working in a rock and roll band–what more American reason could there be for living in Canada?). There are numerous annoyances to living in Canada, but health care is not one of them. By and large Canadians seem very happy, and even proud, of their health care system. Like Heather B posted above, there are no doubt failures of the system. I can’t refute her anecdotal evidence–I can only supply anecdotes of my own. Everyone I’ve talked to has expressed satisfaction with the system by and large–there are petty grievances (a friend who nail gunned himself in the leg has some tales of emergency room annoyance), but those stories I suspect pop up in every system. There are also a number of studies out there comparing the US to Canada, but it’s often difficult to tell whether a study is any good or not. The gist of what I’ve read seems to be that GREAT American healthcare is better than great Canadian healthcare, but that GOOD Canadian healthcare is better than good American healthcare, if that makes any sense. America gets a few more As and a lot more Fs, Canada gets more Bs. Canadians are healthier and live longer, but it’s hard to show direct evidence of why.

In the Canadian system, there are often waits, but there is a parallel private system. For instance, I needed an MRI on my knee about 6 months ago–I could have waited six months for the scan, but I chose to go to a private clinic and pay for the MRI out of pocket.

Now, I’m not necessarily advocating this system for the US. Canada is about a tenth the size of the states (it has slightly less people than California), and people here are more similar to each other–there’s a less wide range of rich and poor people. And people pay a ton more taxes. I am just mentioning it as an example where socialized medicine works, and where people are largely happy with the results. Keep in mind that “Big Government” in Canada really isn’t that big. Yes, it is far more intrusive than the Federal US Government. But it is such a different nation. People are willing to pay higher taxes (obviously not all people, but in general), because the government more closely resembles their values–because the whole thing is so much darn smaller. Everything is easier with 270 million less people to worry about. Socialized medicine here really is about providing care to everyone–providing care to the poor and needy as much as the rich. The fellow who put forward Medicare here was a socialist, yes–but he was also a Baptist minister, and he was the first high ranking politician in Canada to argue for a Bill of Rights in their Constitution (this was in the 1950s–they’re a bit behind the times here). He was voted “The Greatest Canadian of All Time” in a contest run by the CBC (I mean, such contests aren’t necessarily all that relevant, I just put it out there to show that a lot of Canadians think he’s great, and not some Stalin type)

But seriously, enough about Canada.

The other thing I wanted to bring up was Section 1233 of the Healthcare bill. I just read the section (it’s a little lawyerly–but still readable), and this is what I get out of it. The section talks about “Advance care planning” consultations. Which could mean anything. But I’ll continue. The law says (p. 424, lines 23-24): “‘advance care planning consultation’ means a consultation between the individual and a practitioner.” And then later the law says (p. 428, lines 6-11): “A practitioner described in this paragraph is a physician…and a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.” So, straight up, the consultation consists of a talk between a patient and a doctor or nurse. So, to me, it sounds as if there are no social workers or government employees involved (unless, like, it’s an army doctor).

The rest of the section defines what takes place in an Advance Care Planning session. Mostly, it has doctors (or nurses) advising people of their legal rights, and advising them how they can best have their wishes carried out at the end of their life. Much of it talks about how to properly assign someone to make decisions for you, should you reach the point where you can no longer make decisions for yourself.

To me, this seems like a good thing. It seems horrifying to me to stand at the bed of a loved one who is ill and unconscious and argue with my family over what kind of treatment they want. And not just life and death decisions, but all medical decisions–whether to try an experimental drug that might work, but might have horrible side effects, or whether to take the patient back to their house and have less options for care, or to keep them in the hospital (but maybe they hated hospitals….). It would be much better–NOT to pull the plug–but to have someone designated–BY the sick person, before they got to this point–to make decisions on behalf of the person. For instance, if one of my great aunts wants to be kept alive at all costs no matter what her state, it would be good for her to know how to legally say this, so that NOBODY can pull the plug on her if she doesn’t want it to happen. Because she won’t, sadly, be awake for the decision. Likewise, I have had family members say to me that if they are in a vegetative state, and they have no readable brain function, they don’t want anyone to take heroic measures to save their life. This is their decision–and I hope they put it in good, legal writing, so that the family doesn’t have to argue about it if, God forbid, such a thing should ever come to pass.

So, to me, it seems like Section 1233 is a good thing. In an ideal world, this section of the law wouldn’t be necessary. Because such talks with your doctor should take place, and people should always make preparations for the unthinkable (like, it’s always good to have a last will and testament). But the sad part is that people don’t know about the complicated legal situations that arise (and it’s sad, too, that such legal situations are so complicated in our system–but that’s what we got), and so the wishes and desires of the sick and dying are being ignored, or even worse, fought over in a way that tears families apart.

Oof! Sorry to end on such a downer, but that’s all I got!

Hope all’s well with you and yours, and say hi to Lucy and Emma and Spencer and the new fellow (though we haven’t met yet) and Matt for us.

Will

Hey Will and Jenny! So good to hear from you! You planning on coming to the Southwest anytime soon?

Comment away, I always enjoy a respectful discussion (though I’m sure a few of my sarcastic remarks don’t count as respectful, I guess it depends on the mood I’m in and how long I have been putting of posting about a subject, if I ever get brave enough to post about abortion, it’s sure to be a doozy!) Unfortunately I get entirely too many nasty emails from people that do nothing but attack me and my beliefs rather then actually defending the other side. Conversation is great! Not enough people have actual conversations about important issues, they just want to tear down other people.

You are right, every system has more than it’s fair share of grievances. I remember having a what they thought kidney stone a few years back and I went to the ER because I was vomiting everywhere. They gave me something for the pain, I stopped throwing up. Then they took some blood tests, a CT Scan and X-ray. I say they “thought” it was a kidney stone, because that is what all of the symptoms showed, but there wasn’t actually anything from the tests they did that indicated it. They sent me home with an Rx for vicodin (which I didn’t end up taking because it made me sick and Ibuprofen worked better) and then I got a bill for $5000. It took us nearly a year to pay that off. We only had emergency insurance at the time with a 10,000 deductible. Not an ideal situation, but you can bet I made sure to drink plenty of water and take care of myself better from that point on. Matt remembers having an X-ray taken of his knee, the doctor charged us, the X-ray tech charged us and the hospital charged us for use of the room AND they charged us twice for one radiograph because it had both knee’s in it even though it was just one radiograph! We called, made a stink and they dropped the charge for the second one. So by no means is our system perfect. Everyone has their hands in your pockets. But oddly enough, we found out from the ER doc for my kidney stone, that the doctors aren’t the one’s charging so much. It’s the hospitals. And sure enough, when I got my bill, the doctor only charged a couple hundred. And yet it is the doctor everyone accuses of being the culprit.

I would be interested to see if there is a study comparing the diets, physical activity and use of herbal or otherwise old fashioned remedies of Canadians vs Americans. I wouldn’t be at all surprised if the reason they are healthier and live longer is that in general they just live a more healthy lifestyle. Eating right and exercising is 90% of the battle. If everyone did that, we would only need catastrophic care. Do you happen to know if there are any farm subsidies like here? In my opinion cutting farm subsidies would be one big way to cut down on medical costs. If we would let our farmers make their living on growing actual food that people can eat rather than corn that has to be processed (and hence stripped of any nutritional value) order for us to eat it. Corn syrup anyone? Corn subsidies get more than twice what any other farm subsidies get (including tobacco, I love that we are subsidize tobacco farmers, talk about counter productive!) In 2009 those involved in corn production received nearly four billion dollars. Corn is in everything from batteries to salad dressing to toothpaste. Cut the farm subsidies, starting with corn and tobacco if we can’t do it all at once, instead of adding more regulation in order to curtail the effects of the subsidies that the government enables. Sure we need some corn. I like my tortilla chips just like the next gal. But do we really need so much that we are inventing ways to use it? HFCS in vitamins? Really? We’re trying to keep people healthy here. I just wish they would focus more on quality rather than quantity. Have you guys seen King Corn and Food Inc? You guys would really like them.

You can see the numbers for the farm subsidies here.

http://farm.ewg.org/progdetail.php?fips=00000&progcode=corn

246.7 billion since 1995. That’s a healthy chunk of our deficit right there. 246.7 billion (plus interest) that we could have saved if we hadn’t interfered with the free market. First we paid them to throw away food because there was too much, then we pay them to grow certain kinds of food (that people can’t actually eat) and think that is better? You may think I’m rambling but I promise I’m not. We are spending billions and billions of dollars to make food that contributes to obesity, diabetes, heart disease and a host of other things that are clogging up the medical system. Corn is cheap, so that is what food producers buy to make food out of. The reason Doritos, McDonalds and soda are cheap is because the government pays for the ingredients. The fact that we have to have specialists in childhood type 2 diabetes shows that the whole “let’s pay farmers to make cheap food that is bad for us” thing isn’t working. And since I’m pretty sure farm subsidies is something that most liberals are against (I know that because most of the food documentaries are transparently partisan), I’m pretty sure that is something we can agree on :) Basically we need to make it possible for the fresh fruits and vegetables to be MUCH cheaper then the chips and dip.

Harry Reid just suggested that among other things we cut farm subsidies in order to help balance the budget and I absolutely love that idea (not so much of the cutting defense spending though suggestion though, I’m all for cutting defense, but not without a plan first).

On a side note, I’d also be interested to see if there is a correlation between the rise in obesity and the rise in autism and/or if the rate of rise in autism in the US is the same worldwide. I wouldn’t be surprised if it’s much higher here and if there is virtually no autism in tribal communities that eat exclusively raw produce and hunted meat. I’m just speculating, I’m no scientist.

I didn’t know that Canada had a parallel private medical system as well. That is interesting. Not to be nosy, but how does it work for you living and working in Canada but not being a Canadian resident? Do you pay taxes that would go towards medical? If so, didn’t it bug you to essentially have to pay for your knee MRI twice? Once in taxes and once out of pocket to the private doc? I’m not trying to be ornery, I’m just curious. I know it bugs me to pay property taxes on a house I don’t live in and for a school my kids don’t go to. I know that I homeschool and live out of state, so it’s kind of different. But it’s the same as if I sent them to private school in Maine. I would be paying the property taxes, which goes towards public school admin, and I’d also be paying the tuition for the school I would be using. But even though I wouldn’t want to send my kids to the public school because of poor education, or violence or one of the many other problems with the public school system, I wouldn’t be able to stop funding that school because the public school gets it’s money from taxes. And if I don’t pay my taxes, I loose my house or go to jail. And just like education, the fact that there is a parallel system in Canada implies that the current system is insufficient.

Don’t misunderstand me, I am NOT anti-education. I believe that education is one of THE most important things for a person to get. I just think that the private sector can do a better job then the public. The same for health care.

Frederic Bastiat says it well in “That Which is Seen and That Which is Not Seen”. Here he is speaking of government supported theater and arts, but it also applies to medicine

“But, by a deduction as false as it is unjust, do you know what economists are accused of? It is, that when we disapprove of Government support, we are supposed to disapprove of the thing itself whose support is discussed; and to be the enemies of every kind of activity, because we desire to see those activities, on the one hand free, and on the other seeking their own reward in themselves. Thus, if we think that the State should not interfere by taxation in religious affairs, we are atheists. If we think the State ought not to interfere by taxation in education, we are hostile to knowledge. If we say that the State ought not by taxation to give a fictitious value to land, or to any particular branch of industry, we are enemies to property and labour. If we think that the State ought not to support artists, we are barbarians who look upon the arts as useless.
Against such conclusions as these I protest with all my strength. Far from entertaining the absurd idea of doing away with religion, education, property, labour, and the arts, when we say that the State ought to protect the free development of all these kinds of human activity, without helping some of them at the expense of others, – we think, on the contrary, that all these living powers of society would develop themselves more harmoniously under the influence of liberty; and that, under such an influence no one of them would, as is now the case, be a source of trouble, of abuses, of tyranny, and disorder.

Our adversaries consider, that an activity which is neither aided by supplies, nor regulated by Government, is an activity destroyed. We think just the contrary. Their faith is in the legislator, not in mankind; ours is in mankind, not in the legislator.”

As an example on how people can do so much better than the legislator, back in 1886, Grover Cleveland was asked to appropriate $10,000 (which would be a little less than a quarter million in today’s dollars) to texas farmers who had all lost their crops. While he sympathized with the farmers, he says (http://mises.org/daily/3627)

“And yet I feel obliged to withhold my approval of the plan as proposed by this bill, to indulge a benevolent and charitable sentiment through the appropriation of public funds for that purpose.

I can find no warrant for such an appropriation in the Constitution, and I do not believe that the power and duty of the general government ought to be extended to the relief of individual suffering which is in no manner properly related to the public service or benefit. A prevalent tendency to disregard the limited mission of this power and duty should, I think, be steadfastly resisted, to the end that the lesson should be constantly enforced that, though the people support the government, the government should not support the people.
The friendliness and charity of our countrymen can always be relied upon to relieve their fellow citizens in misfortune. This has been repeatedly and quite lately demonstrated. Federal aid in such cases encourages the expectation of paternal care on the part of the government and weakens the sturdiness of our national character, while it prevents the indulgence among our people of that kindly sentiment and conduct which strengthens the bonds of a common brotherhood.”

In asking for the private citizens to aid in helping the farmers, rather then forcing them to help via taxation, ten times the amount was raised for the farmers than was asked for by congress.

People WANT to help those less fortunate, but we can’t if we are taxes so much that we become the less fortunate.

Another question, do Canadian Provinces have provincial laws? Are some laws in BC different from the laws in Quebec or does the Federal (is it Federal in Canada or is it another word) government call all of the shots. You make a good point about Canada being smaller in population and less varied in demographics. Which is why I think that states should have more control over what regulation is and isn’t necessary. The 10th amendment to the constitution says The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people. The needs in Maine are far different from the needs in New Mexico. One example would be gun ownership. New York and California have really restrictive gun laws, which is fine I guess, if that is what the people of New York and California want. Here in the Southwest, however, we have huge number of hunters, there are more large plots of land that are owned, more dangerous wild life as well being right on the border of the most dangerous city in the world (Juarez) and the home of the US kidnapping capital (Pheonix). People here in the Southwest want to be able to hunt for their food, keep deer and other pests out of their gardens and property, and protect themselves from dangerous animals (human and otherwise). If for example, the majority of gun use in NY is tied to gang violence and homicide, I could understand if most of the people in NY want to make it harder for people to arm themselves (I don’t know if that is the case for gun use in NY, I’m just giving an example). But here, it seems like everyone is a hunter, so it would hardly be appropriate for the legislators in NY to dictate our gun laws.

You are right that if the Canadian demographics aren’t as varied as it is here, that a socialist medical situation may work well and the majority of the population may be in favor of it. However here I don’t think it would work. The resident’s of florida, who have a much higher senior rate then the rest of the US (17.2% vs 12.9%) They clearly have different needs then Alaska with 7.6%. Mississippi is the most obese, Colorado the leanest. There is no one size fit’s all Health Care for the US, nor should there be.

Too many people make the mistake of thinking that if it isn’t regulated at the federal level, then it isn’t regulated at all. Education used to be a state issue, but since Carter instituted the USDE, it is becoming more and more of a federal issue. Education in the US is a train wreck, but no one in Washington thinks about de-regulating and un-doing the damage that Carter, Bush and Obama have done. They think they just need to take more control and everything will be ok. I believe that if it works in my house it will work in the White House. When there are so many rules and regulations in my house, we are all miserable and stressed. I can’t let my kids do everything they want (just like we can’t let our citizens to everything they want), but if I lighten up a little bit (ok, if I lighten up a LOT) then we are all happier and more productive.

If something works at the micro level, it will work at the macro level. Unfortunately, thanks to increasing Nanny-State legislation and the like, there is less and less that we are allowed to do at the micro level. The federal government is trying to regulate what kind of light bulbs we can buy for crying out loud. Now THAT is intrusive.

You are absolutely right that advanced planning consultations are not a bad idea. People should plan for the future. The problem is when the government mandates your planning. Once you set a precedent for government interference, it’s only a matter of time before what once could have been a good idea evolves into something unrecognizable. My fear (and I admit, that it is only a fear, backed only by other examples of government interference and there is no way to tell if in the future it will come to pass) is that what starts as a “meet with your doctor to discuss advanced planning” will turn into “meet with THIS ‘health care professional’ who specializes in advanced planning”. That what starts off as “we want you to plan” turns into “this is what you will plan”. Education, again, is a perfect example. The federal government “incentives” schools with money and those who accept the money are mandated not only what can and cannot be taught, but what sports are allowed to be available to the students (title 9 anyone?). Or the bail out packages for states. Some states opted out of the bail outs because they didn’t want the federal government to tell them what to do. So when the next bail out package passed, there was a provision stating that the individual states didn’t have a choice. They were getting the money whether they wanted it or not. Why would the federal government do that if not to gain control over the state? If you have another alternative as to why they would want to force unwanted or unneeded assistance I am all ears, but I honestly can’t think of any.

Obama himself said it in his press conference on Dec 7 of last year. He said “This is why FDR, when he started Social Security, it only affected widows and orphans. You did not qualify. And yet now it is something that really helps a lot of people. When Medicare was started, it was a small program. It grew.”

Now, to be fair, it was a press conference about tax cuts, but in the context of the above quote, he was comparing SS to the health care bill. This is his baby and he has a lot planned for it, he just needed to compromise enough to get his foot in the door, and then it’s really hard to keep it from escalating.

If all advanced planning consists of is advising people of their legal rights and to advising them about last wills and testaments, shouldn’t that be the job of a lawyer that specializes in medical law instead of a doctor? It would absolutely be horrifying to have to argue about the wishes of a loved one who can’t answer for themselves. And in an ideal world, everyone would prepare for the worst. But we can’t force people into preparation. The government can’t either, the only thing they can do is do the planning for them. And as the disaster that is social security has shown, the government’s planning doesn’t often work very well.

Sorry this is long winded. But that’s what I am. Long winded. Just ask anyone who stops by just to drop something off and leaves three hours later :)

Maybe I’ll do a post later on how I would fix health care if I had the power.

PS. Matt says “Hi”.

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2 Comments Add yours

  1. Donna says:

    I’m super late in the game here, but you might find the 2 segments that “This American Life” did on Health Care in the US very interesting. It was from the middle of the health care overhaul debate in 2009, but is still a great delve into health care and insurance issues.
    http://www.thisamericanlife.org/radio-archives/episode/391/more-is-less
    http://www.thisamericanlife.org/radio-archives/episode/392/someone-elses-money

    Like

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