2004 December 08 Wednesday
Need A CT Scan In Canada? For Your Sake I Hope You Are A Dog

A Canadian friend just called to say his dog was going in for a computerized tomography (CT) scan. From the day that the specialist decided the dog should get a CT scan to the day he takes the dog in for the scan is only 6 days. Also, the time from visiting a regular vet to seeing a veterinary specialist who ordered the CT scan was a week and a half. This is in Ontario province. The dog will be scanned after hours on a machine that during the day scans humans. My friend knows I follow stories about waiting times in socialized medicine and suggested the obvious comparison. Well, some quick Google digging turned up a Fraser Institute report from 2003 which shows that Canadian dogs have it better than Canadian humans when a specialist visit and a CT scan are needed.

The total waiting time for patients between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, increased this year; rising to 17.7 weeks in 2003 (from 16.5 weeks in 2001-02).

“Canadians are waiting almost 18 weeks for essential medical care. And these lineups have almost doubled over the past ten years. The standard solution -- throwing more money at the problem -- is just not working. The federal and provincial governments are still failing to act in the face of international evidence that increasing patient options for private care reduces waiting times,” said John R. Graham, the Institute’s director of health and pharmaceutical policy research.

...

The waiting time between referral by a GP and consultation with a specialist rose to 8.3 weeks, an increase of 14 percent over last year (7.3 weeks).

The shortest waits for specialist consultations were found in British Columbia (6.7 weeks), Manitoba (6.9 weeks), and Saskatchewan (7 weeks). The longest waits for specialist consultations occurred in Newfoundland (12.6 weeks), New Brunswick (11.8 weeks), and Alberta (10 weeks).

...

The growing waits to see a specialist and to receive treatment were not the only delays facing patients in 2003. Patients also experienced significant waiting times for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans.

The median wait across Canada for a CT scan was 5.5 weeks. The shortest wait for computed tomography was in New Brunswick, Nova Scotia, and Newfoundland (4 weeks), while the longest wait occurred in Prince Edward Island (8 weeks).

So if my friend had needed a referral for himself to a specialist and for a CT scan he'd probably have to wait at least 3 months. As it stands now his dog is getting through the same process in less than 3 weeks.

If my friend got desperate he could always leave Canada. A drive south to New York would take Canadians to a real medical market that allows competition and customer payment for services rendered. This ability to pay for services makes provision of such services much faster, just like what a dog in Canada can get. Unfortunately, it is hard for Canadians to buy medical insurance to use in the event of a major illness. Therefore the trip south is more often an option for illnesses which are less expensive to treat and for wealthy people.

On the bright side, it is good to know that Canadians place a such high priority on quick medical treatment for their dogs.

Share |      By Randall Parker at 2004 December 08 03:21 PM  Socialism, Capitalism


Comments
Derek Copold said at December 8, 2004 3:41 PM:

There's a French-Canadian movie called "The Barbarian Invasions" which I heartily recommend. It eviscerates 60s leftism and casts a very hostile eye on the Canadian Healthcare system. It portrays one of the antagonists taking his lefty father to Burlington, VT to get a proper CAT scan because it isn't possible in Montreal. You know a system is screwed when a little burg like Burlington has better access than a large city like Montreal.

George said at December 8, 2004 6:43 PM:

Sorry, I live 'there' and work in the 'Canadian Healthcare system', which is an oxymoron. Just as in the good ol' USA, each province (state) has vast control over its own spending. Quebec (one of ten provinces) was the object of disdain by the director of Barbarian Invasions. Quebec, unlike any other province or territory, has full control over immigration and yes, certifying foreign trained doctors, etc. So it's not surprising that a dog in another province has better access.

By the way, did you know that American journalists travelling with the Pres' to Canada had their flu shots, here?

George

Randall Parker said at December 8, 2004 7:33 PM:

Geoge,

But the Fraser Institute publishes waiting times in all the provinces and even the best ones do not look too hot.

Matra said at December 8, 2004 8:13 PM:

Hundreds of Quebeckers have been killed since the spring of 2003 due to a C. difficile outbreak. Yet few here in Ontario, Canada are even aware of these deaths as our media haven't given it much coverage. Canadians pick healthcare as their main concern - far above crime and taxes - yet the strange thing is they almost all think we already have better healthcare than in the US. During the summer's general election when the Conservative Party seemed to be in front the ruling Liberal Party ran a scare campaign suggesting that the Tories would turn the country into another US, with Liberal spokesmen constantly bringing up our glorious 'free' and 'universal' healthcare. It seemed to work.
As an immigrant - though I've spent half my life in Canada - I'm constantly astounded by the things, like healthcare, which Canadians think are better here than in the US. To Canadians 'free universal' healthcare is a source of national pride, a religion, as they see it as something that differentiates them from Americans. They brag about it when in Europe - I've witnessed it first-hand - as if it's the sole difference between being Canadian and American. Indeed, polls here have shown that a significant proportion of Canadians identify universal healthcare as the defining Canadian characteristic! I can't imagine any other country with a welfare state thinking that way.

But at least Canadians are becoming aware that the situation is deteriorating so there's an outside chance the quality of healthcare here won't get as bad as it is in the UK where the deterioration of the NHS is about 10 years ahead of that in Canada. But I doubt they will succeed in fixing the problems as many of our doctors (including my own) and specialists have already moved to the US and it will take time to get more - there are only so many already trained South African doctors to poach.

Matra said at December 8, 2004 8:29 PM:

I should have made clear that the C. difficile outbreak occurred at Quebec hospitals.

Also, In Ontario, at least, healthcare is not entirely 'free' and universal. Last year I was forking out close to $100 a month for antibiotics which weren't covered by the state - though I'm in the minority in having to pay the full cost of such things. A lot of people here have started to purchase supplementary insurance plans to cover the growing number of things not covered by the government healthcare system.

Ignacio said at December 8, 2004 9:03 PM:

Better healthcare in the States than in Canada is a tricky concept too. I just had a CT scan done in the US and the price would be $1,200 if I had to pay that myself. Through car insurance, the price goes to $480 because a contractual agreement. wether it is me or the insurance that shells out the money.

That is all nice and dandy if you don't stop to think and realize that the usual charge, which already has significant overhead gets bumped another extra 60% just because.

Drug-wise, the drugs over here are absolutely insane. Following the lead of the more reasonable price, Americans are purchasing more drugs overseas, which will only increase the price of drugs in the US even more.

Don't know how to solve all this, though.

noone said at December 9, 2004 7:12 AM:

"Drug-wise, the drugs over here are absolutely insane. Following the lead of the more reasonable price, Americans are purchasing more drugs overseas, which will only increase the price of drugs in the US even more."

Drug companies spend billions developing drugs,with resulting high amortization costs.Countries like Canada think they should get our drugs for almost free,pass laws to achieve this,leaving dumb yanks to pay the cost.

"Don't know how to solve all this, though."

Already happening,drug companies are developing fewer drugs.Because of the political economics,most drug comapnies have already dropped research into anti-HIV,anti-AIDS drugs.

Abuse it,you lose it.

Bob Badour said at December 9, 2004 10:29 AM:

I suggest the US pass a law prohibiting any drug company from charging more for a drug in the US than they charge in any other country. Call it an 'anti-dumping' or an 'anti-gouging' law, and put in some retaliatory teeth for countries who steal the drugs by licensing counterfeiters.

The drug companies will just stop selling drugs in countries that legislate low prices.

It won't reduce the price of drugs for Americans, and in the short-term might even increase the price slightly. However, over the long term, it will almost certainly cost Americans less. After Canadians and Brazilians realize they are missing out on the latest and greatest treatments, they will resume their duty to help carry the load.

Frankly, I think this issue would be worth the US entering a trade war over. For almost all Americans, it literally means the difference between dying earlier and after longer periods of debilitation vs. later after greater health.

Xmas said at December 9, 2004 11:44 AM:

Bob,

There is a problem with your suggestion. In order to have the short term monopoly on a particular drug, the companies must file a patent. The patent describes the drug and how to make it.

The high cost of making a drug is from the development and testing, not the actual manufacturing. So a pharma company in another country could easily get information on how to make the latest and greatest drugs. So, if the Canadian government wants to offer a new drug, but the US company refuses to sell it in Canada, a Canadian (or Indian or Brazilian) company can supply the Canadian demand with relative ease.

US companies submit to foreign price controls for this reason. Also, they figure that making any money on a drug is better than making no money whatsoever. Plus the Canadian market is small compared to the US market, so the "loss" isn't that bad. (This logic also applies to selling drugs cheaper in poorer economies, like Mexico and Africa.)

What worries US manufacturers is all this talk about US customers buying drugs from Canada. This reimportation is illegal according to Federal law. It also worries the Canadian government, since the logic behind their price controls is so that their citizens can have access to cheap drugs. When Americans buy all of the Canadian drugs, Canadians can't buy them.

TangoMan said at December 9, 2004 12:02 PM:

US pass a law prohibiting any drug company from charging more for a drug in the US than they charge in any other country.

The faulty premise in the statement above is that there is one uniform price in the US. Drug companies do not sell their drugs to "Bob's Corner Pharmacy" for the same price as they do to a HMO serving 10,000,000 people. Many, though not all, Canadian drug purchases are negotiated by Provincial Medical Services plans and they have more market power than HMOs.

Further, just as HMOs are able to set drug preferences favoring one drug over another, so too can the Canadians. What drug company wants to see itself shut out of the market and have another drug be favored. Why do you think that the Pharmaceutical industry lobbied so hard to prevent Medicare from engaging in bulk purchase agreements?

Randall Parker said at December 9, 2004 12:28 PM:

TangoMan,

The Canadian provinces can threaten to break the patent of the US pharma companies if the companies do not come down to a lower price. The Canadian government has a legal mechanism that would allow a provincial government to do this. That is what makes the pharma companies sell for a lower price in Canada than to a US HMO.

Henri LeBeaux said at December 9, 2004 1:30 PM:

The idea that health care in Canada is free is utterly false. The tax rates in Canada are significantly higher than in the States. I would rather pay a tax rate of 25% and spend another 5% on good health care insurance, than pay 50% Canadian tax rates for the same income bracket and get 'free' health care. If one would take into account all the real costs that a citizen pays, I think one would find health care in socialist countries both more expensive and of a lesser quality.

TangoMan said at December 9, 2004 2:55 PM:

Randall,

Indeed, they can threaten do break a patent, but only at great cost. They rely on market pricing. If they regularly broke patents there'd be mayhem with intellectual property issues across the board. Don't get me wrong, I'm quite open to being corrected on this issue, but the only threat, or incident, that I'm aware of is during the Anthrax attacks in the US, the Canadian gov't order Cipro doses for all Canadians, and Bayer couldn't meet the order so the Canadian gov't placed an order with Apotex, a Winnipeg generic supplier. The gov't got hammered from both sides. The socialists pointed to the power of patents, while the conservatives pointed to the breaking of the law. The way I understand it the gov't thought there was a national emergency and acted. Bayer says it had enough Cipro on hand, and the gov't says that Bayer had told them that they didn't. In the end, the patent was upheld, and Bayer promised to deliver within 48 hours of a crisis.

I actually tend to believe the gov't story on this and here's why: I can't see a gov't minister talking to Bayer, knowing that they can supply the drug and then setting out to violate patent law by having it made as a generic. This was a time of high crisis and Bayer probably overplayed their hand. Maybe Bayer had promised the drug to the US. Should people die, if it is a time of crisis, in order to uphold patent law. I don't think so. Bayer got called on this months later, after the crisis had abated, and both sides moved to a reasonable compromise. Bayer could increase its production in order to meet the future Canadian call, while still honoring its existing commitments, and the gov't could uphold patent laws and demonstrate that they are just as serious as other countries in maintaining a favorable IP climate.

In the end, when you have 10 negotiating bodies dealing with drug manufacturers, they've got a lot of clout. This is the same thing that Wal-Mart does in order to get low prices. It squeezes the manufacturers for a lower price and threatens to find substitute goods. Drug companies are always free to decline to sell to Canada, knowing that their competitors will sell a similar drug, for the marginal cost of manufacture, which will be below the sale price to Canada. The Canadian volume helps the bottom line. No threats of patent busting needed. The Veteran's Administration does the same thing!

Randall Parker said at December 9, 2004 3:19 PM:

TangoMan,

The stuff Wal-Mart buys is way more substituteable.

Also, you miss the key point that if, say, Longs Drugs won't pay the price that Pfizer charges for Celebrex then Pfizer can sell to thousands of other internet and bricks-and-mortar stores to reach the same customers. The provincial governments of Canada essentially hold a distribution monopoly and can tell the pharma cos that they won't buy at all. In fact, many drugs are available in the United States that are not available in one or more Canadian provinces. It is that ability to prevent the drugs from reaching the market at all that gives Canadian governments more power than other mass purchasers of drugs.

Canadian citizens get drugs at prices that are below market. So Americans pay the money that funds the drug development that Canadians (and most of the rest of the world) benefit from.

TangoMan said at December 9, 2004 3:59 PM:

The provincial governments of Canada essentially hold a distribution monopoly and can tell the pharma cos that they won't buy at all.

They do for the drugs that they pay for. They don't for the drugs that aren't part of their coverage policies. I'm not completely up to speed on this, but as I understand it Canadian pharmacare only covers some people (I'd guess the elderly) and the rest have to pay for the drugs themselves and the gov't isn't involved in those transactions at all. Now it's up to the drug retail chains to get the best price.

In fact, many drugs are available in the United States that are not available in one or more Canadian provinces.

That kind of blows your thesis out of the water, doesn't it? The drug companies chose not to sell to Canada at the price that Canada was willing to pay. Canada didn't violate their patents. In fact the Canadian citizen is the loser because they don't have a choice. What I don't understand is why the drug can't be sold in Canada at whatever price the Pharmaceutical company choses and have the company decide not to sell to the gov't but only to the private marketplace. I wonder if there is a linkage between licensing the drug for sale in Canada and having to sell to the Canadian gov't? Probably not, because this would be a restaint of commerce in violation of trade laws.

It is that ability to prevent the drugs from reaching the market at all that gives Canadian governments more power than other mass purchasers of drugs.

I agree that this is a powerful combination of powers - regulatory and purchasing. However, don't confuse or comingle the issues raised upthread. I need to see evidence that Canada is threatening to break patents. What I see is the Canadian public denied choice if a deal isn't reached. The harm falls to the Canadian public because the gov't feels it knows best what is in the better interests of each consumer. Hogwash.

If someone you know wants to engage in self-destructive behavior, alcoholism, and they don't break any laws, then what's the problem. The Canadian gov't is denying choice to its own citizens. Perhaps in their calculus, they feel that the gains from strong price negotiation make up for the losses incurred from lack of choice. That's their calculus though. Americans value choice more than the lowest price for the greatest number of people.

Canadian citizens get drugs at prices that are below market.

Nope. A market price is what a buyer and seller agree to. The Canadians get their drugs below American market prices. So too does the Veteran's Administration. There is no coercion by the Canadian gov't. Show me a documented case of coercion and I'll retract that line of argument. Automobiles are also marketed at differential prices around the world. There is also a healthy cross-border arbitrage market in cars.

So Americans pay the money that funds the drug development that Canadians (and most of the rest of the world) benefit from.

I agree. I've looked into this issue and from the literature I've reviewed, the pharma industry seems to realize that they can't charge American level prices uniformly around the world, in large part because of differing wealth levels. The US is the wealthiest country in the world and can more afford to pay the higher drug costs than poorer countries like Canada, Spain, Brazil, Algeria, etc. If you look at the actual statements of the drug companies, this differential pricing is not a big source of angst for them. What's boiling their blood is that cheaper Canadian drugs are crossing back across the border and ruining a perfectly balanced system.

What needs to be done is one of two things. 1.) Charge all nations the same price for their drugs, or; 2.) Tighten import/export restrictions as a condition for differential pricing. Option #1 will actually lead to a degradation of uniform IP law and generics will flourish in the ensuing patent busting game. Option #2 is more likely and it'll fall on the Canadians to be the bad guys by restricting export of drugs, rather than the American gov't limiting imports and depriving it's own citizens of cheaper drugs.

Of course, there is always the suicide pact option, which is to redistribute wealth more equatibly in the world's wealthiest nation. LOL. I don't look too favorably on this option, but in fact, the inability of some of the poorer Americans to pay the prices for the drugs is really the core of the issue. It's not the upper middle class and the wealthy that have the problems. Poorer people in Canada, if they get their drugs from the gov't list, get those drugs at a more affordable price because they are subsidized by the redistributive Canadian taxation and spending policies and by the pricing power of gov'ts as large buyers.

Randall Parker said at December 9, 2004 5:13 PM:

TangoMan,

No, the reasons for unavailability of drugs in Canada are more complicated. One reason the provinces hesitate to approve drugs is that then they have to pay for them (and the British have the same sorts of internal deliberations where new drugs are delayed entry to market because of high expected costs to the NHS). So they decide at times that some drug is not sufficiently efficacious. The decision is not entirely scientific. They are trying to keep their costs down. Patients who would otherwise want to pay for those drugs out of their own pockets are not even given the choice - unless they drive South of course.

Canadian retail chain drug prices: No, it is my understanding that drug prices for drugs purchased by the chains are set by the provincial governments. I do not think the pharma cos have the right to bargain with the chains in Canada.

It is also my understanding that the provinces signal to the pharma companies what they would be willing to pay for some new drug and in the cases when that price is so low the pharma companies decide it is not even worth the regulatory costs to try to get the drug approved in Canada. Is that price controls?

I've read articles on this a year or two ago. So these memories are faint.

Tom West said at December 9, 2004 8:36 PM:

Indeed, Canadians are attached to their healthcare system. A million plus (5% or so of the population) just voted Tommy Douglas, father of medicare, as the winner of "The Greatest Canadian" contest. It really is a matter of perspective. For Randall and many Americans, it is appalling that the wealthiest of Canadians can't obtain better medical treatments than anyone else. For many Canadians, it's appalling that a substantial fraction of Americans can't get reasonable medical care.

It's all a matter of whether you're concerned about the wealthiest or poorest 20%, or about the maximum or minimum medical care available. To be honest, it pretty much applies to the American and Canadian perspectives on lots of things. As a Canadian, I tend to look at how the 20% percentile of the citizenry of a country is doing as a means of judging that country's success. Most Americans, I suspect, look at the fact that the 80% percentile of Americans are fantastically wealthy compared to the rest of the world, and judge America the most successful.

For me, I think we've got a nice niche. We've got a medical system that I've never had cause to complain about (although indeed you can find long wait times for certain processes) (and yes, I've had a child suffer a life-threatening medical condition), and the fact that almost all Canadians rely on the system means that government's feet are always held to the fire by the taxpayer. For those who really feel the need to jump queue and have the means, the USA is right there to provide care at cost. We've got the second tier, but its just far enough away not to cause the damage that a two tier system often causes on the first tier. (It's easier for government's to neglect funding for the primary tier if you know that many are using the second tier.)

One last factor: By taking many of the medical decisions out of people's hands, it means that dollars are more sensibly spent (for the most part). For example, it is not uncommon for doctors in the USA to spend hundreds of thousands of dollars to extend a very old person's life a few days because the adult children cannot say "let my father die". To be honest, I wouldn't expect anyone to do so. In Canada, one is simply told that nothing more can be done. It is a lie (of sorts - nothing *will* be done), but it allows rational medical decisions to be made without inflicting a life time of guilt on the person making the choice. Of course personal responsibility advocates will be appalled, but honestly, I think it makes for happier people, and it allows Canada to spend rather less on healthcare than the US while maintaining standards that are at least comparable. (And often, if you use averages, better...)

Randall Parker said at December 9, 2004 9:27 PM:

Tom,

But the Canadian fallacy is that they are getting great medical care. The statistics about outcomes argue otherwise. Half of American states have longer cancer survival times than Canada's best province British Columbia. I am lucky I do not have to risk Canadian cancer treatment.

Frum suggests comparing Northwestern US states and Western Canadian provinces that have similar ethnic makeup (as different ethnic groups get cancer at different rates in the first place) and other characteristics for cancer fatality rates. See these tables and compare Colorado, Idaho, and Utah with the Canadian Western provinces. For instance, Utah and Alberta have almost identical cancer incidence rates at 307 and 312.8 respectively but the male case fatality rates are .3456 and .43798 respectively. British Columbia scores lowest in case fatality rates of all Canadian provinces and yet it is worse than almost half the US states.

This is something for Canadians to brag about?

I see the Canadian belief in the superiority of their medical system as caused by their desire to feel in some way morally superior to their richer and more powerful southern neighbor. But their self deception for the sake of self esteem is causing real harm to their own population. They ought to choose a different topic to feel morally superior about.

As for the argument about denial of care: There are hundreds of thousands and perhaps even millions of Canadians who can not get their own general practitioner. They have to show up in hospital emergency wards to get care just like poor Americans do.

Why the difficulty getting a doctor? Canada has a low ratio of doctors to population.

In 2001, Canada reportedly had 186 doctors per 100,000 people. The U.S. had 276, Belgium 395 and Norway 413.

Ontario has a lot of physician vacancies.

TORONTO ON / January 15, 2004/ - In 1996, sixty-eight Ontario communities were short 100 family doctors. Today, 118 communities have 665 physician vacancies affecting one million Ontarians, according to Ministry of Health and Long-Term Care Underserviced Area Program statistics.

You also suffer from a smaller selection of drugs. Some provinces approve only half the drugs that get approved at the Canadian federal level.

Bob Badour said at December 9, 2004 10:53 PM:

Do you folks not read before you post?

I suggest the US pass a law prohibiting any drug company from charging more for a drug in the US than they charge in any other country. Call it an 'anti-dumping' or an 'anti-gouging' law, and put in some retaliatory teeth for countries who steal the drugs by licensing counterfeiters.
...
Frankly, I think this issue would be worth the US entering a trade war over. For almost all Americans, it literally means the difference between dying earlier and after longer periods of debilitation vs. later after greater health.

What do you folks think I mean by the above?

Given a choice between selling to a market a tenth the size of the US market regulated to a fraction of the US price or selling to the US market at top dollar, the drug companies will shut Canada off as quick as can be. When Canada gets someone else to provide the drugs instead of the patent holder, the US needs to start turning the trucks around at the border to send the cars back to Oshawa and the steel back to Hamilton.

Oh, and I doubt any province negotiates the wholesale price for Shopper's Drug Mart's drugs. Legislate them or regulate them maybe, but I suspect Shopper's negotiates its own prices.

Tom West said at December 9, 2004 11:07 PM:

I'm not certain about bragging about anything. Happy with? Reasonably. Happier than with the alternatives? Definitely.

Essentially, I think we're getting 90% of the care for about 70% (60%?) of the money. The problem is that last 10% is *expensive*. Quite frankly, medical science is moving quickly, but coaxing that extra 1/2 year of life expectency cost a *lot*.

As for approval of drugs, to be honest, there's an awful lot of marginal (but real) improvements that cost a *lot* of money. The government saves a lot of money by not approving them, again at small but real health cost.

From this table, it looks like the US spends $4,887 per person and Canada spends $2,792 (all figures in US dollars). Given the difference in expenditures, I think the Canadian system does reasonably well. Of course, Canada could never sustain American levels of expenditure given the difference in our per capita earnings.

The Canadian medical system certainly has its problems, with the shortage of GPs being a major one, and long wait times for CT and MRI being also worrisome, but then it's (as always) a matter of tradeoffs. People who look at the Canadian system and *don't* see any problems are as foolish as those who look at it and see only disaster. (Just as I find it sort of irritating that people point to the flu vaccine problem as a symbol of problems with the American health care system, as if somehow it couldn't just as easily happened to any other country.)

Again, if the Canadians are generally happy with the level of healthcare, *and* it manages to cover almost everyone so we don't have to feel as if we're abandoning the poor, I'm not quite certain why you feel it necessary to regularly attack it. It's like there's something ethically wrong with being willing to have higher taxes for greater redistribution... It might not maximize the total amount of wealth in the economy, but if the general consensus is positive, who are outsiders to criticize? Of course, America is in the tought spot in that American internal policy tends to influence everyone else, so they kind of get it in the neck as everyone feels entitled to comment :-).

Anyway, I somehow doubt that socialism and moral decay (those gun hatin', gay lovin' Canucks!) is going to creep into the US and infect it. And as for the annoying righteousness that Canadians will all too often show (beam in one's own eye and all), well, given that America does have it all, I'd figure it could just sit there and ignore the annoying meeping. After all, I've always been taught that being secure in one's superiority means *not* having to demonstrate it to all and sundry.

Bob Badour said at December 9, 2004 11:32 PM:

Tom,

I am a Canadian. I am one of those millions of unfortunates in Canada who Randall mentions who have or had trouble getting a family doctor. It took me almost 6 years to get a family doctor after I moved to the Golden Triangle area.

Throughout that period I was in the top quartile of earners in Canada, and I was outright denied medical care. I was forcibly prevented from spending my own money, which I had, to pay for medical care. I do not find that appalling; I find that obscene.

Don't pretend for an instant that Canada denies no substantial fraction of Canadians reasonable medical care. Canada does deny millions of people reasonable care.

You have concocted some fantasy over who receives the bulk of spending in the Canadian medical system and how the Canadian system saves money. I have been around Canadian families who were forced to decide on life support for their loved ones. It is no easier in Canada than anywhere else. Nor is the decision handled by the hospital or by the medical practitioner.

The bulk of spending in the Canadian system goes to drug addicts, alcoholics, their abused and/or neglected children and their other victims. It costs a lot of money to revive an overdose in an emergency ward. It costs a lot of money to treat the ensuing diabetes, hepatitis, heart disease, liver disease and various complications from addiction and malnourishment. That doesn't even count the trauma cases from car accidents, fires, assaults etc. caused by this cohort.

Randall Parker said at December 9, 2004 11:39 PM:

Tom,

One of the reasons medical care costs more in the United States is that it is a service provided with labor right where the service is delivered. The US has higher salaries. Goods can be imported into Canada and the US from China and Japan. Or goods can be (and of course are in huge volumes) exported from the US to Canada and vice versa. So the ratio of costs of services to goods is higher in the US than in Canada.

Unless that first point about market labor costs is adjusted for a comparison of dollars spent doesn't show anything useful. This is why percentage of GDP is more often used.

As for the other causes of higher medical costs in the US: Yes, the last year of life has something to do with it. But also our own individual demand for medical care is not as well restricted by government and you admit that your government limits the ability of people in Canada to consume medical care. Well, is that wise? Waiting lists have an impact on youger people. If you have to wait for months to get, say, a new knee or a new hip due to a car accident that means less time functional, less time not feeling pain, less time working. Simply sitting in a waiting room to see a doctor exacts a cost in lost free time or time lost from work. Reducing medical expenditures can increase costs in other areas. So there are real costs including economic costs to a system with long queues.

How useful are polls about medical care? Medicine is supposed to treat sick people. Most people are not that sick. People in their 20s are mostly very healthy for example. Even the vast majority of people get thru their 40s without getting cancer or heart disease. You say "if the Canadians are generally happy with the level of healthcare". Well, a majority might be when polled. But, to take myself as an example, I go many years between visits to the doctor. So a poll that asked me for my own judgement of US medical care based my own direct personal experience about the quality of medical in the United States is not terribly useful. If you go polling people and most of them do not need much medical care then how is a poll result a measure of what a medical system is really supposed to do?

Why do I find it necessary to attack Canadian medical care? Because American socialists and left-liberals keep citing it as an example that we ought to emulate. The myths about it need to be exploded to keep it from spreading.

Bob Badour said at December 9, 2004 11:57 PM:
I think we're getting 90% of the care for about 70% (60%?) of the money

Tom, you are deluded and ignorant of the basic facts -- even after Randall posted links to some of them above.

We are not getting 90% of the care. Those without family doctors in Canada get 0%. At the moment, they are still a minority even if numbering in the millions, which is why one can always find plenty of idiots in Canada willing to spout ridiculous statistics like yours above. All you can really say is so far it has worked for you so you are happy and are willing to vote to sustain it. It will get sustained as long as 50% + 1 feel as you do.

If you had the perspective of having had no family doctor, you would probably want to flee this ungodly dominion as badly as I do.


flu vaccine ... [could have] just as easily happened to any other country

Um, helloooooo! It did happen in another country.


Again, if the Canadians are generally happy with the level of healthcare, *and* it manages to cover almost everyone

You admit that your position is predicated on a fallacy. It does not cover almost everyone, and I find it absolutely obscene for the government to forcibly prevent those not covered from paying for it on their own.


I'm not quite certain why you feel it necessary to regularly attack [Canada's socialized medicine.]

Because the socialist idiots south of the border are actually stupid enough to want to impose it upon themselves while forcing Randall along for the ride.


I somehow doubt that socialism and moral decay (those gun hatin', gay lovin' Canucks!) is going to creep into the US and infect it.

Sadly, this pernicious blight has already made significant inroads into the American electorate.

Randall Parker said at December 10, 2004 12:11 AM:

Bob,

Your pharmacies are selling you price-controlled drugs.

See here

Prescription drugs are roughly 40 percent cheaper in Canada because of government-mandated price controls. Dosanjh said U.S. demand so far has not created any drug shortages in his country.


See here

Canadian provinces buy drugs in bulk from pharmaceutical companies at prices that are roughly 40 percent cheaper because of government-mandated price controls.

All Canadian drug prices are regulated by the Patented Medicine Prices Review Board.

Essentially, the coalition wants our drug prices to be set by the PMPRB or one of its sister agencies. The PMPRB, whose full name is the Patented Medicine Prices Review Board, is a creature of the Canadian government. It dictates the maximum price that can be charged for a new drug when it is introduced into Canada. The individual provinces then keep prices from rising with inflation (or with changes in exchange rates), so that prices steadily fall behind free-market levels.

The PMPRB does not work alone. It links Canadian price ceilings to European controls. Each European nation has its own price control system, and there are lots of links among those systems. The Netherlands, for example, sets prices at the average price in Belgium, France, Germany, and the United Kingdom. Portugal demands the lowest price in France, Italy, or Spain. Greece wants the lowest price in Europe, period.

You Canadians had better hope the US does not implement Canadian-style drug price controls because if we did you'd get far fewer new drugs in the future.

The impact of such price controls, according to a study released by the Manhattan Institute Center for Medical Progress, is the complete destruction of the future of medicine. Under the new Medicare drug benefit, the government will increase its share of drug purchases threefold, from 20 percent to 60 percent. If the government applies Medicaid or VA price controls to the Medicare drug benefit, it will reduce real drug prices by 67.5 percent, reduce research and development spending by 39.4 percent, or $372 billion, over the next decade and cost Americans 277 million life-years.
Randall Parker said at December 10, 2004 1:35 AM:

Most Western countries regulate drug prices and therefore America develops most of the new drugs.

Americans pay 108 percent more than the French and 118 percent more than Italians for the same drugs, the largest gap found in the study, but only 58 percent more than the Swiss, the country with prices closest to those in the United States.

Canada sets its prices at the median level of the countries it surveys. U. S. buyers pay 75 percent more than Canadians for drugs.

...

"These nations with the lower prices have government-mandated price controls that have clearly hurt the ability of pharmaceutical companies in those countries to create new medicines," said spokesman Jeff Trewhitt, adding that the United States produces 60 to 70 percent of the world's new drugs

The drug price gap between the United States and Canada is widening.

One reason that drug prices tend to be lower in Canada is that prices for drugs that are still under patent—and therefore have no generic substitutes—are regulated by the federal Patented Medicine Prices Review Board (PMPRB). This Board establishes the maximum prices that can be charged in Canada for patented drugs. The PMPRB has been credited with keeping average annual price increases for patented drugs at or below zero since 1992. In addition, Canadian drug price levels fell from 123 percent of the median drug price level for seven industrialized countries (France, Germany, Italy, Sweden, Switzerland, the United Kingdom, and the United States) in 1987 to 101 percent of the comparator median in 2002. During that same period, the average U.S. prices for patented drugs rose from 36 percent above to 67 percent above average Canadian prices.

Canada can free ride on America but America doesn't have anothe country to free ride on.

The only reason why price controls on drugs work in Canada is because Canada is what economists call a "free rider," someone who takes advantage of a cost that someone else is paying. In this case, the cost is drug research and development, most of which takes place in the United States. Almost none is done in Canada because drug companies cannot make a profit there due to price controls. Indeed, Canada's total spending on drug research is barely enough to bring one new drug to market each year.

American money funds the drug development that helps the rest of the world.

A recent study by Frank R. Lichtenberg of Columbia University found that new drugs, launched between 1986 and 2000, increased the average worldwide lifespan by nearly nine months--or three weeks for each of those 14 years. That average includes everyone, even people not taking the drugs--so those who did take them benefited a great deal more. U.S. medical research is keeping the rest of the world healthy.

Would such investment take place in the U.S. if we had Canadian or European drug prices? Of course not. Look at Europe itself. It dominated the global drug industry before adopting price controls. Now Europe makes fewer than one-fifth of the top-selling medicines. As for Canada, its drug industry is practically nonexistent, spending less than one percent of what the United States spends on R&D into new medicines.

From 1990 to 2003 the ratio of drug research between Europe and America shifted from 1.7 in Europe's favor to 1.4 in America's favor.

In 1990, European pharmaceutical firms outspent American firms on R&D by approximately 8 billion euros to 5 billion euros ($7 billion to $4.3 billion). In 2000, U.S. firms outspent European firms by 24 billion euros to 17 billion euros ($20.9 billion to $14.8 billion). Even traditional European firms, notably GlaxoSmithKline and Novartis, have moved many of their most essential operations to the United States.

Note that this shift occurred even as the Soviet Union's collapse added a large population to the more relatively more market-oriented portion of Europe and the EU dropped many internal barriers to trade and investment. Another way to look at the figures is that America's drug research spending went up by almost a factor of 5 while Europe's went up by a little more than a factor of 2.

Tom West said at December 10, 2004 5:58 AM:

Throughout that period I was in the top quartile of earners in Canada, and I was outright denied medical care. I was forcibly prevented from spending my own money, which I had, to pay for medical care. I do not find that appalling; I find that obscene.

I'm not denying it is a very serious issue. Perhaps the most serious issue facing Ontario. The leftish Canadian perspective would be again that the situation is a tradeoff - both systems deny some percent of their population anything but emergency care (although walk-in clinics are available in urban areas in Canada, and you're one the hook for the substantial bill in the US). The meat of the question is "if the percentage who don't have access to primary care in Canada is *less* than it is in the United States, does it matter about the earnings of the recipients?" Should it? I suspect that for most Canadians, the answer is no. In other words, more wealth does not automatically deserve more health.

The bulk of spending in the Canadian system goes to drug addicts, alcoholics, their abused and/or neglected children and their other victims.

One, I'm not certain that this is indeed the case. I'll try to dig up the numbers, but I remember the rather astounding fact that even in Canada the wealthy managed to command more health services despite the equality of the health system. Not unexpected, really - and of course the correlation was vastly shallower than it would be south of the border. However, more to the point, our medical system does not distinguish the "worthiness" of its recepients (at least officially, see previous sentence).

You have concocted some fantasy over who receives the bulk of spending in the Canadian medical system and how the Canadian system saves money. I have been around Canadian families who were forced to decide on life support for their loved ones. It is no easier in Canada than anywhere else. Nor is the decision handled by the hospital or by the medical practitioner.

In general, I was speaking about times when expensive medical treatment was required for the slightest prolongation of life. Indeed, if you are talking about long-term life support, I imagine the choice is much the same. However, I was speaking with respect to medical costs. We do avoid the worst case of having to choose between financial collapse of one's family and questionable medical treatment to prolong life of the elderly.

In total, would adapting an American system actually improve the average health of our citizenry? I strongly suspect no. Expenditures are pretty much as high as we can comfortably go, and by increasing the inequality in the system, I think we'd see global efficiency go down. We'd spend a lot more to add a few months of life expectency at one end while a larger number at the other end would lose significantly more life expectency. The big question then becomes "are we willing to see medical care quality for a large number decline in order to see medical care for a smaller number rise?" I suspect that Bob would judge the putative worthiness of the recipients and say yes, most Canadians would say no.

Sadly, the obvious solution, allow people to kick in their own dollars, cannot be done without considering the effect on the entire system. A second "you-pay" tier has generally caused a decrease in funding of the primary tier because many of those who tend to be loudest are also wealthiest. When it's you or your children's medical care that the poor are receiving, you tend to work hard to see that they receive good care.

Bob, the purpose of not being able to spend your own money on medical care is not to prevent you from obtaining it, it's to prevent the vast majority from seeing their medical care decline.

To be honest, I think the USA as second tier works as well as any second tier could. It's far enough away, but not *too* far away for most Canadians.

My post is getting too long - I'll address others in a second post.

Tom West said at December 10, 2004 6:36 AM:

Unless that first point about market labor costs is adjusted for a comparison of dollars spent doesn't show anything useful. This is why percentage of GDP is more often used.

This is true to a limited extent. Salaries are also decided by the medical system chosen. For example, the American system itself essentially mandates very large doctor's salaries. As percentage of GDP, I think that's silly. To take the absurd case, spending half of GDP in India is still going to be not enough dollars to get decent medical care. More specifically, if we went to an American system, I think we'd have to spend close to the American totals to get close to American results, and even then we'd get less (for geographic/population concentration reasons).

As for the other causes of higher medical costs in the US: Yes, the last year of life has something to do with it. But also our own individual demand for medical care is not as well restricted by government and you admit that your government limits the ability of people in Canada to consume medical care. Well, is that wise? Waiting lists have an impact on youger people. If you have to wait for months to get, say, a new knee or a new hip due to a car accident that means less time functional, less time not feeling pain, less time working. Simply sitting in a waiting room to see a doctor exacts a cost in lost free time or time lost from work. Reducing medical expenditures can increase costs in other areas. So there are real costs including economic costs to a system with long queues.

Absolutely. Again it's tradeoffs. The trouble is that for every dollar you add to the system to increase "worthy" (however you want to define it) operations, you increase the amount spent on "unworthy" operations. As the amounts go up, the ratio of worthy to unworthy goes down. But it never reaches 0 (or at the other end, 1). To reduce those waiting lists, we'll have to add to our taxes substantially. *Unless* of course, we're talking about only spending the money on "us" and not "them". However, it's pretty obvious Canadians in general reject the idea of health care being dependent on wealth.

If you go polling people and most of them do not need much medical care then how is a poll result a measure of what a medical system is really supposed to do?

Well, I'm not sure how else to judge it. Remember, health care expenses come directly out of our pocket. Should the sick get to mandate whether our taxes are so high that we can't buy our house? One of the real attributes of a Canadian system is that it doesn't allow individuals to make that choice. It's one of the costs, but one most Canadians are willing to accept (and to be honest, I do think we're in the sweet spot, despite the unfortunate experiences of Bob - no system will be free of unhappy stories).

Why do I find it necessary to attack Canadian medical care? Because American socialists and left-liberals keep citing it as an example that we ought to emulate. The myths about it need to be exploded to keep it from spreading.

I suppose. Personally I like the idea of two systems running in parallel. It allows both systems to examine what they are trading off in real detail. I abhor choices made in a vaccuum. And, in a greater sense, it allows people to migrate (slowly) to a system that better suits their temperament. I htink both Canada and the US benefit from this.

We are not getting 90% of the care. Those without family doctors in Canada get 0%.

Come on Bob, quit the hyperbole. We're all rational adults here. At worst, your situation is no worse than the uninsured in the USA, except when you do get emergency care, you're not going to go bankrupt. Your situation was bad, no doubt. However, I don't think it invalidates the entire Canadian medical system. It does, however, mean the heat will be on the government to try to do something about it. (It's difficult because medical students don't want to become family practitioners - not that there's no money for people who do want to become such practitioners.)

U.S. medical research is keeping the rest of the world healthy.

Absolutely. Those who fail to acknowledge that the American system benefits Canada are foolish. On the other hand, I think that those who think that *us* adopting the American system would benefit *us* are also wrong, although it's really a matter of weighing those who would benefit against those who would lose out.

It's like economics - a perfect market might maximize total wealth, but the distribution is very unequal - so much so that most of us would not want to be part of it. Canadians in general are willing to accept a lower amount of total wealth for greater equality. We're also very happy to boost our total wealth by selling to the wealthy American economy who can accept greater inequality.

Lastly, I consider people who think we can get cheap drugs without a long term cost are misguided. *But*, I will point out that overall happiness isn't going to decrease. Most of us are not unhappy about not living to 150. It's all in the comparisons. If such drugs weren't available, we wouldn't be unhappy by their absence. So, by making the drugs more widely available at the expense of research, we're not only increasing global happiness (because people who couldn't get them now will), but we're *not* decreasing long term happiness, because people (in general) don't mourn non-existent drugs... Just a thought :-).

Tom West said at December 10, 2004 6:44 AM:

Just so we have some figures about the scale of the no family doctor crisis in Canada, this gives some idea of the scale.

Relevant paragraphs:

A total of 14% of Canadians, or 3.6 million people, are without an FP. Of that number, 1.2 million have searched unsuccessfully for an FP. "It's a significant number," said Marc Hamel, a senior analyst at Statistics Canada and the survey's chief. The other 2.4 million Canadians have not been looking.

More than twice as many men as women indicated that they had not looked for a doctor. Most of those who had not looked were in the 20–34 age group.
"We see there are differences between those who have a doctor and those who don't," said Hamel. "For instance, women are less likely to have a mammogram or Pap smear test if they don't have a regular physician. We also found people were less likely to have their blood pressure checked when they didn't have a regular doctor."
Although it seems to be harder to find an FP in rural areas than urban centres (5.5% of rural dwellers reported difficulties v. 4.5% of urbanites), Howard points out that the discrepancy is not as great as most people believe.

Interesting and grave - but not (in my mind anyway) something that mandates the replacement of our medical system.

noone said at December 10, 2004 9:11 AM:

"In Canada, one is simply told that nothing more can be done. It is a lie (of sorts - nothing *will* be done), but it allows rational medical decisions to be made without inflicting a life time of guilt on the person making the choice. Of course personal responsibility advocates will be appalled, but honestly, I think it makes for happier people, and it allows Canada to spend rather less on healthcare than the US while maintaining standards that are at least comparable. (And often, if you use averages, better...)"

So you would support a Canadian Groningen Protocol...........(http://www.grandforks.com/mld/grandforks/news/world/9890729.htm)


"We've got a medical system that I've never had cause to complain about (although indeed you can find long wait times for certain processes) (and yes, I've had a child suffer a life-threatening medical condition), and the fact that almost all Canadians rely on the system means that government's feet are always held to the fire by the taxpayer"

.......even if it meant the death of your own child "for the greater good"?
Far less costly to society to euthanise your sick child than cure it(and yes,I use "it" deliberatly).And after all,no reason for you to feel guilty,you abdicated power to "experts" to make the decision for you.

This is what appalls us primative yanks,your attitude to your health system and human life is indicative of a deeper moral rot in your society,a rot we have as well,just not so deep yet.But where our social immune system seems to be kicking in,you seem to have cultural HIV.Your government clearly regards you,and you clearly regard yourself,as a possesion of the state.If it's in the state's interest to cure you,well and good,but if the state decides not,will you march to the grave proudly claiming "at least we're "Not-America""?
Do you *really* want to leave these decisions in the hands of people too incompetent to teach 6 yr olds to read and write?

And no lectures about barbaric execution of criminals till you stop the savage execution of defenceless innocents.

Bob Badour said at December 10, 2004 9:46 AM:

Tom,

The leftish Canadian perspective would be again...

And the rational, intelligent perspective would be that your vote is an obscentity because you vote to perpetuate obscenities on your neighbours provided you are comfortable. This is exactly the sort of "tyranny of the majority" that so worried the Founding Fathers of the United States of America.

I strongly suggest you take some time to actually study some economics, political science and systems of governance. Perhaps a few Federalist Papers and some Hayek would do you well. As it is, you are doing nothing but regurgitating the socialist pap fed to you to garner your obscene vote.

although walk-in clinics are available in urban areas in Canada

Walk-in clinics are nothing but a slap in the face to those in Canada without a family doctor. One cannot get real treatment there because real treatment will require referrals to labs or to specialists, which in turn require follow-up. Doctors at walk-in clinics who are "not taking new patients" refuse to write referrals unless you have a family doctor to perform the follow-up.

You are speaking from a position of complete ignorance to someone with six years of direct experience. Quit talking out your ass!

if the percentage who don't have access to primary care in Canada is *less* than it is in the United States

PROVE THAT IT IS LESS! Your position is based on complete ignorance and uncritical acceptance of "the big lie."

does it matter about the earnings of the recipients?

In so far as it requires an obscene abuse of the state's monopoly on violence to prevent the affluent from spending their own money according to their own desires, yes, it absolutely does matter. Your vote is an obscenity as long as you vote for the obscene. Your lack of morality and the harm it causes anger me.

I suspect that for most Canadians, the answer is no.

As long as Canada is full of sheeplike morons who prefer to accept the socialist pap they are fed than to exercise their own intelligence, I agree. The majority of Canadians will continue to vote for obscenity and feel pride for doing so.

The presumption and hubris here nauseate me.

One, I'm not certain that this is indeed the case [that the bulk of spending goes to addicts etc.]

I am certain.

I'll try to dig up the numbers, but I remember the rather astounding fact

I won't hold my breath.

our medical system does not distinguish the "worthiness" of its recepients

You are wrong. The free market imposes no decisions of worthiness on consumers. When our medical system shuts out people for not having a family doctor, it does distinguish the "worthiness" of recipients. It finds those without a family doctor unworthy.

You seem to argue the absurd position that the arbitrariness and irrationality of the Canadian (central planning) "worthiness" decision somehow makes it superior to one where the consumer is the only decision maker. What utter nonesense! The system you vote for is evil, and your justifications for doing so are insane.

We do avoid the worst case of having to choose between financial collapse of one's family and questionable medical treatment to prolong life of the elderly.

Frankly, Americans avoid it too. They have DNR's there just like we have here, and the next of kin make decisions for the incapacitated. In general, even in the US, it is the insurer who pays the price. And I note that you have changed your position from one of avoiding the cost entirely to one of the family avoiding the cost.

Given that Canadian families avoid the cost irrespective of the price, I would argue that Canadians on average demand more resuscitation than Americans.

In total, would adapting an American system actually improve the average health of our citizenry?

Absolutely and without question. Only an economics ignoramus would think otherwise. However, a partisan ideologue will say otherwise even while knowing better. Which are you?

The big question then becomes "are we willing to see medical care quality for a large number decline in order to see medical care for a smaller number rise?

Only if we accept your self-evidently fallacious axioms, and I do not.

Bob would judge the putative worthiness of the recipients and say yes, most Canadians would say no.

Bob is very capable of speaking for himself. You have inflated Bob's opinion of his neighbours by many orders of magnitude. I no longer think that any but a tiny minority of Canadians have the intellectual capacity to make rational choices or to draw rational conclusions. You are a prime example.

Bob, the purpose of not being able to spend your own money on medical care is not to prevent you from obtaining it, it's to prevent the vast majority from seeing their medical care decline.

Horseshit! The purpose of the government's obscene abuse of its monopoly on violence is to prevent the ignorant and the stupid from seeing through the big lie! And so far, it seems to be working well. It's buying your vote.

It's like economics - a perfect market might maximize total wealth, but the distribution is very unequal - so much so that most of us would not want to be part of it.

Economics: A subject area in which you seem to have perfect ignorance, and yet you seem quite eager to impose the effects of your ignorance on your neighbours against their will. Shame on you! Let your neighbours speak for themselves and let them speak how it counts: from their own pocketbooks.

Absolutely. Again it's tradeoffs. The trouble is that for every dollar you add to the system to increase "worthy" (however you want to define it) operations, you increase the amount spent on "unworthy" operations.

Only the immoral, the stupid or the ignorant would want a bureaucrat chosen by their neighbours making decisions over their own worthiness. A free market makes no such decisions for the consumer. The consumer decides for himself or delegates the decision to the bureaucrat of his own choice.

Bob Badour said at December 10, 2004 9:48 AM:
we're in the sweet spot

Sweet for you, you fucking asshole. Who the fuck are you to prevent me from spending my own money as I see fit?

Bob Badour said at December 10, 2004 10:25 AM:
Come on Bob, quit the hyperbole. We're all rational adults here.

No, you are not! You ignore valid statistics while making up your own on the spot. You argue from a position of complete ignorance on the basis of axioms that are already proved false!

Those are not the actions of a rational adult no matter how much anyone tries to reassure you that they are!

However, I don't think it invalidates the entire Canadian medical system.

Evil is evil. Denial of evil is worse. Asking others to share your denial is even worse still.

It's difficult because medical students don't want to become family practitioners - not that there's no money for people who do want to become such practitioners.)

If that is true, why has Ontario had to forcibly restrict the number of graduating family practitioners? Do you care at all about actual facts? Or are they mere inconveniences to whisk away at the wave of a hand?

although it's really a matter of weighing those who would benefit

And who the fuck are you to make my decisions for me? Your arrogance does not qualify you to make my decisions especially in light of your ignorance and irrationality. I am an intelligent man in possession of greater information of my own situation. Nobody is as qualified as me to make those decisions. Not you. Not the Province of Ontario. Not anyone but me. How dare you?

not (in my mind anyway) something that mandates the replacement of our medical system.

I would find that more reassuring if I had any confidence whatsoever in your mind.

Bob Badour said at December 10, 2004 10:34 AM:
A total of 14% of Canadians, or 3.6 million people, are without an FP. Of that number, 1.2 million have searched unsuccessfully for an FP. "It's a significant number," said Marc Hamel, a senior analyst at Statistics Canada and the survey's chief. The other 2.4 million Canadians have not been looking.

So, 14% of Canadians are denied medical care. Two thirds of those are blissly ignorant of their plight because they are young and healthy having no need of medical care.

The U.S. Census Bureau has reported that the number of uninsured Americans rose by 1.4 million to 15.6

I would suggest the percentages are comparable especially given the margin for error in such things. I would also suggest that a like proportion of uninsured Americans are blissfully ignorant of their plight for exactly the same reasons.

Ignacio said at December 10, 2004 11:07 AM:

"Drug companies spend billions developing drugs,with resulting high amortization costs.Countries like Canada think they should get our drugs for almost free,pass laws to achieve this,leaving dumb yanks to pay the cost."

I don't agree with the way patents are handled internationally, but that is only part of the problem. There are pharmaceutical companies in Europe developing drugs too, and drug prices are not nearly as exhorbitant as here. Even for simple antibiotics. It is not all about the yanks, or stealing from the yanks.

"Already happening,drug companies are developing fewer drugs.Because of the political economics,most drug comapnies have already dropped research into anti-HIV,anti-AIDS drugs. Abuse it,you lose it."

That goes both ways. When a company changes the name of a medicine to extend their rights a few more years, that is abuse as well. When (right at the end of the ownership period) they make a pill that you used to swallow, to now dissolve in your mouth (no other improvements) to extend the rights, that is abuse too. When an improved version of a pill enters the market with several years of delay, just to pick up right after the previous medication's rights end, that is abuse.

That is legal, you may say. But so is what they do in Canada, under their legal system.

And if you want to call that free market, then it all boils down to the end users of the USA choosing not to assimilate a development expense that the whole world benefits from. Also a corporation, pharmaceutical or not, is out there to make money, not just some altruistic organization. While a substantial part of the profit goes to development, stockholders want their share as well.

Randall Parker said at December 10, 2004 11:33 AM:

Ignacio,

I have already posted in this thread data on the shift of pharmaceutical research from Europe to America. Even the pharmaceutical research that is still done in Europe is done mainly to make products for the far more profitable American market. Price controls in Europe and Canada greatly decrease the incentives for developing drugs.

Yes, it is about stealing from the Yanks. We pay market prices and those market prices pay for the development of most drugs. Everyone else free loads off of us. You can't deny this without willfully ignoring how markets work and without ignoring copious quantities of empirical evidence.

However, it is not just about stealing from the Yanks. By imposing price controls the Europeans and Canadians hurt themselves in the long run. If Canada and Europe let drug prices rise then there'd be much more drugs on the market 5, 10, 15, and 20 years from now.

When an improved pill comes out after an existing pill goes off patent how is that an abuse? There is nothing to stop a person from using the off-patent pill. Would you rather the pharma company not develop the improved pill? If so, why? Do you oppose progress?

You seem to be justifying theft by saying that the targets who are stolen from are bad. But you miss the point that this theft by price controls reduces the number of drugs developed and therefore hurts anyone who will need better drugs 10 or 20 or 30 years from now.

Matra said at December 10, 2004 12:12 PM:

My local paper's recent coverage of the news that we're getting a new doctor is emblematic of of our doctor shortage problem in Ontario - approximately one million don't have a doctor and many (myself included) have to travel 30 miles or more to see the family doctor they do have. The paper has a full profile of the new doctor starting on the front page and continued into the inside pages. She's being treated like a celebrity and a saviour to the town. The town I live in is mostly middle and upper-middle class, fairly cosmopolitan with a thriving artist community, ethnic restaurants, good schools - including private ones - plenty of parks etc, very little crime and within commuting distance to Toronto yet we still are having trouble getting doctors to live here. I wonder how difficult it must be for poorer working class towns several hours drive from a city to attract doctors. Yet we still get all this propaganda about how our society looks out for the people at the bottom. It's mostly bullshit for well-off Canadian 'nationalists' to feel smug and superior to our neighbours to the south. The sad part is the propaganda is so good the average person falls for it. Most of the people I mix with are like myself immigrants, mostly British, Indian, and Indo-British and they generally have more experience in the US than the average Canadian - who thinks Buffalo and Detroit are the norm. They don't seem so impressed with Canadian healthcare but, of course, nor do they have the same identity hang-ups and inferiority complex towards Americans that most English Canadians have.

noone said at December 11, 2004 5:35 AM:

"That is legal, you may say. But so is what they do in Canada, under their legal system"

And what Hitler did was legal under his law,a defence put forward at Nuremberg and declared invalid.(and I just invoked the H word,I feel shame).

Bottom line,national health systems ration health care based on the future tax revenue of a person,if the cure costs more than the projected tax income,you're left to die.

Tom,you're not a citizen,you're a dairy cow in a stall being milked for tax revenue.You think the system benefits you,because it's willing to take care of you(while screwing you're neighbors) when you are most able to care for yourself.But when you need care the most,when you're sick or elderly or otherwise no longer profitable,you'll be butchered for hide and tallow.

Tom West said at December 11, 2004 6:56 AM:

Wow...

noone writes...

So you would support a Canadian Groningen Protocol? (Child euthanasia)

No. I consider there to be a big difference between withholding expensive and in the end almost certainly useless medical services and taking action to end a life. Are they both part of a continuum? Of course. But choices like this have to be made whenever there are scarce resources available, which is almost everywhere. Remember also that under an insurance system (which most Americans live with), the choice to give expensive medical treatment means that rates rise, leaving more people uninsured and lowering healthcare as a whole. There is *always* a tradeoff. I cannot help but notice that in the following emails, *no one* is willing to acknowledge that. No acknowledgement of the costs of *their* choices. Odd, because you cannot rationally choose a system unless you are aware of both the benefits and the costs.

..even if it meant the death of your own child "for the greater good"?

Of course not. But then, *every* system will sacrifice someone. Would you be willing to have your child's killer walk free on a legal technicality? No, of course not. But would you want to live in system where the right of trial is absent. Of course not. Don't pretend that the American system or every other system *doesn't* sacrifice someone's child...

If choosing a system is moral rot, then we're all smelling pretty badly...

Bob writes lots :-)

I'm not going to tackle every point. First, let me acknowledge that you were badly treated by our present system. However, I would not consider a single person's (or even many people's) tale of tragedy from the United States to invalidate their entire system. I'm going to assume from your posting that you're a Randist (at least you use the key phrases). If that's the case, your choice of economic system is a moral choice, and I'm not willing to debate religion here. The scary part here is that as with many theists, you intimate that people have no right to choose a different system because any other system is immoral. So much for democracy. (I know, once people have been freed from the shackles of their brainwashing, they'll see the light...)

why has Ontario had to forcibly restrict the number of graduating family practitioners?

That was over 10 years ago. They're now reversing course. Unfortunately, like any system, Canadian or otherwise, doctors can't be manufactured instantly. Is this a distinctly Canadian (well, Ontarian) problem? Yes. It is a cost of the system that we've chosen? Yes. Is this problem completely invalidate our medical system. In my opinion, no.

Sweet for you [beep] [beep], you [beep]. Who the are you to prevent me from spending my own money as I see fit?

First, I believe Canada is in a sweet spot for the health of Canadians taken as a whole. Who are we? The Canadian people as a whole. And as for spending your own money, well, you're already prevented from spending your money in all sorts of ways. Tried buying drugs, guns or prostitutes lately? There's also nothing preventing you from obtaining care in our "second tier", the United States. However, there are laws that prevent *physicians* from *accepting* your money.

Randall writes...

By imposing price controls the Europeans and Canadians hurt themselves in the long run.

The same can be said for a lot of things. If we reduced the re-distribution in our economy, we'd probably increase our total wealth for everyone in the long term. However, we'd be (in our opinion) continually sacrificing our present forever. Tomorrow never comes. If our goal is to maximize happiness for our population over the long term, we're better off with the higher re-distribution. (Once out of poverty, people's economic happiness really only depends on comparison with others around them.) Barring disaster, people as a whole will be less unhappy, and noone mourns the growth that doesn't exist in the future. (Unhappy because you aren't earning a millions dollars a year because our ancestors were inefficient? No, neither am I. Would you be happier if you *and every one else* earned a million dollars a year? No.)

Of course, this becomes more complicated as soon as you have an adjacent country who does choose a path of greater growth. Now unhappiness increases as we compare ourselves with it even if there is no change in our circumstance. Darn that USA. It's lowering global happiness :-)! Sure, I'm being silly, but there is a kernel of truth there. Happiness does not always equate with greater growth or progress. It's the comparison that matters to happiness.

Randall Parker said at December 11, 2004 11:41 AM:

noone,

Canada's system is not so efficient that it very precisely gives more medical care to those who are net taxpayers than to those who no longer are. Instead of giving more medical care to the higher income workers it denies medical care to anyone who isn't able to find a general practitioner. A bum living off the dole in Toronto has better access to medical care than an upper income engineer in Guelph.

The problem with the use of politics to deliver all medical care is that then medical care becomes good enough to satisfy those who are healthy enough to have little contact with the medical system. A lot Canadians who have always been fairly healthy - and especially the young - can be deceived by high sounding moral posturing by Canadian politicians. Look at the Canadians who defend their system here. They do not know anything about the statistical comparisons that have been done comparing case outcomes. They get fooled by their politicians trotting out far less relevant figures (e.g. average life expectancy) that are a function of many other things aside from medical care.

Government-provided medical care in Canada would be better if Canada didn't happen to border on the United States. If Canadians couldn't be fooled by appeals to nationalist superiority they'd take a much more critical look at their system. As long as they take (unjustified) satisfaction that their system is better than the US system their politicians can deceive a majority about the quality of the care they have available to them.

Randall Parker said at December 11, 2004 11:50 AM:

Tom,

You seem to be missing the moral argument against your system: By denying individuals the ability to work to save money to pay for medical care you are denying the ability of the individual to take care of one's self. You make the individual helpless. You simultaneously do not provide any help for some of those helpless individuals.

Denying medical care to some of the most productive and biggest wealth creators means you are basically making them into milk-producers. Never mind that they studied long hours for years and worked long hours for years rather than act irresponsibly. Never mind that they make the lives of the rest of the population much better. Never mind that they provide the bulk of the tax revenue that makes it possible for the less talented, the bums, the lazy and irresponsible and criminals to get medical care. Your system takes from the best and, depending on where the best live, you give them about as much medical care (or less) than American inner city ghetto dwellers get.

Your system is disgusting. It is morally repugnant. A system that treats some of its most productive and responsible people in such a fashion is anti-life.

As for your focus on the short-term: How irresponsible. Tomorrow does come. And the day after that and the day after that stretching into an enormous future. It is anti-life to focus so heavily on the present at the expense of the future.

Randall Parker said at December 11, 2004 11:56 AM:

Tom,

The cost of the American choices? Yes, some people get better care than others. But the same happens in Canada. Also, as is demonstrated by case outcomes you get poorer average health care.

If high health care quality for everyone was such a moral imperative then Canada's system should be much more heavily funded. But you admit that what appeals to you about Canada's system is that the percentage less you spend is larger than the percentage decrease in total care that your system delivers. So you are a utilitarian who wants low costs in the short run.

America's system spends more for the short-term and more for the long-term. America's system is therefore more pro-life.

Tom West said at December 11, 2004 3:09 PM:

Randall, I think we're at the heart of the disagreement here, and I doubt we can go much farther. Your horror of our system is based on the fact that it refuses to treat the wealthy better than the poor (subject to reality checks as mentioned in previous articles). I (and I think a strong majority of Canadians) consider it a virtue. It has weaknesses (like the doctor shortage), but those weaknesses can and are being addressed. The American system has what many would consider weaknesses (like the uninsured), but there is strong opposition to addressing them.

A system that treats some of its most productive and responsible people in such a fashion is anti-life.

Randall, I think that equating wealth with moral worth is a peculiarly American custom (I could be wrong). Frankly, I might be a 90th percentile income, but I doubt I work a lot harder than the recent immigrant that is working two or three jobs to support his family. Is there a particular reason that giving him the same level of medicare is anti-life?

They get fooled by their politicians trotting out far less relevant figures (e.g. average life expectancy) that are a function of many other things aside from medical care.

Interestingly enough, those "other things" are in general part and parcel of the general perception that guides the Canadian health care system. One doesn't exist without the others. The same precepts that we all have an equal right to medical care are what provide a society that values redistribution and services enough to help alleviate the other social circumstances that lead to higher mortality rates.

If high health care quality for everyone was such a moral imperative then Canada's system should be much more heavily funded. But you admit that what appeals to you about Canada's system is that the percentage less you spend is larger than the percentage decrease in total care that your system delivers. So you are a utilitarian who wants low costs in the short run.

Of course. Spending $250,000 to allow someone to live an extra month is $250,000 that cannot be spent on a variety of measures to make people's lives better (education, preventitive health care measurses, housing for the poor, scientific research, etc, etc.). Medical care is not the only component of "life".

Also, as is demonstrated by case outcomes you get poorer average health care.

Happily for you, that factors only those who can actually *get* that medical care. And oddly enough, your statistics tend to focus only on upper-middle class white Americans. Why am I not suprised.

As for your focus on the short-term: How irresponsible. Tomorrow does come. And the day after that and the day after that stretching into an enormous future. It is anti-life to focus so heavily on the present at the expense of the future.

I was trying to make a point. Tomorrow might come, but you never change the model because there's *always* tomorrow. And what is "anti-life" or "pro-life" anyway? It reeks of shadowy political movement. ("Sorry, Jones was been liquidated. He was found guilty of anti-life.")

I'll ask you straight out - what is the point of society? What should government try to be doing? My answer is that it should be trying to maximize the happiness of all of its members, balanced with maximimizing the minimums (A society with 90% 1's and 10% 0's is worse than a society with 100% .7's). A successful society is one that manages these goals and continues to do so for the long term. Clearly, wealth and medical care are only a means to the end of happiness, not a goal in and of themselves.

Now, I'll have all the Canadian nationalists up in arms when I say that the Americans are not actually all that far from the Canadians by this particular measure. They're actually quite redistributionist if you look closely (and they have one or two programs that we'd be wise to copy). It's just they like to conceal this fact. However, I do feel that by *my* happiness measure, Canadian society is in general somewhat more successful than American society, with medicare being but a single (large) component.

However, let me re-iterate that believing as I do that *no* society is ideal for all humanity, I'm rather happy that people can move from Canada to the USA and vice-versa. This allows people to find a society that best suits their nature.

Randall Parker said at December 11, 2004 5:21 PM:

Tom,

But not all Canadians get the same level of medical care. The virtue in your system of not giving less care to poor people is cancelled by giving less care to those who do not have G.P.s, by having lengthening waiting lines for treatments, and having less state of the art therapy. As a result your average outcomes are worse.

Also, we have emergency room treatment guaranteed and Medicaid and other programs for poor people. We also have government funding of medical care for all old folks.

You say:

your statistics tend to focus only on upper-middle class white Americans

Huh? How so? In order for half the states have to higher cancer cure rates than all Canadian provinces then that has to be happening because of better treatment over a wide range of economic classes. Your average care is lower than ours. You keep managing to avoid the evidence on this and claim that American care is only better for the upper class. The evidence strongly suggests otherwise.

Also, you do not withhold money from medical care to fund research. Canada has less research going on, adjusted for population size, than the United States.

The point of society? I do not understand the question. Society is the product of a lot of people interacting. It is not a purpose in itself. Do you mean what should be the purpose(s) of government? Well, rights protection is purpose number 1. My view is that individuals should pursue their own happiness and government should not try to make sure everyone is happy.

We do not hide our redistributionist programs. Canadians seem oblivious to those programs because the programs are pesky details that get in the way of painting America as a heartless brutally competitive society.

Meanwhile, how do you morally justify Canadian freeloading on American funding of such massive amounts of medical research and drug development? Don't Canadians have some obligations to balance their taking with more money to fund more development?

Tom West said at December 11, 2004 8:09 PM:

We do not hide our redistributionist programs. Canadians seem oblivious to those programs because the programs are pesky details that get in the way of painting America as a heartless brutally competitive society.

Agreed to some extent, but I've met a lot of Americans who were also quite suprised at the size of the redistributions. I'm not certain why it doesn't get more play. And yes, Canadians are oblivious to many of these programs.

The virtue in your system of not giving less care to poor people is cancelled by giving less care to those who do not have G.P.s

A point that we are trying to address. A GP shortage is a result of poor government policy 10 years ago. It is not a fault that is inherent in our system (as seen by the fact that other provinces don't face the same shortages...) Hopefully the actions that the gov't faces will start seeing results over the next several years. (And yes, this is not a problem that can be fixed quickly. No manufacturing GPs.) Not unlike a free market system, one can swing from excess to labour shortage and back again.

Meanwhile, how do you morally justify Canadian freeloading on American funding of such massive amounts of medical research and drug development? Don't Canadians have some obligations to balance their taking with more money to fund more development?

I don't think these things work like you think they work. Research is not charity. The scientific results of the research may benefit non-participants, but the benefits of research extend vastly beyond the direct obvious results. You yourself have commented on how the drug companies have more or less migrated to the US because of this. The secondary effects of research have, in all likelihood, more than paid for itself. It's why I'm quite pro-research in Canada. However, the research that we do in Canada we do because we *choose* to do it. It certainly doesn't entail any obligation (moral or otherwise) on anyone else to perform research even if they are benefiting from Canadian discoveries.

The point of society? I do not understand the question.

And that would explain much. I'll have to say that I don't think it coincidence that no gov't today has such a narrow goal as merely protection of rights. I'd be very suprised is such a society was viable in the long term. I'm not certain most of the population would feel it was in their best interests, in which case you're looking at revolution. However, I've stretched way off topic, and to be honest, probably taken this topic as far as its worth going. Many thanks. I'll look over the previous articles on health care to see where or why Canadian rates are lower. Certainly I have no doubt that Canadian health researchers look at the same data in an effort to improve our system (without spending the big bucks...)

Randall Parker said at December 11, 2004 10:49 PM:

Tom,

I doubt that only Ontario has access problems. All of the provinces in Canada have much lower ratios of doctors to population than the Uinted States and some other countries. I quoted a source for that above. I also came across some per-province numbers and they all were lower than the United States average. Norway has twice as many doctors per population.

Also, since your doctors are not incentivized to work more hours (OHIP has income limits on doctors) they do not see as many patients. You could have more people seeing G.P.'s right now just by paying doctors to see more patients. But better to let people go untreated than to let that happen.

As for research and charity: Some research is government-funded. Canada freeloads on both the commercially funded and government funded research of America. I'm really not sympathetic to claims from Canadians that they have morally superior "universal access" health care. It is not universal. It is obviously lower in quality. And Canada freeloads off of American government-funded and commercially funded research.

Mark Campbell said at December 12, 2004 1:08 PM:

On this topic:

http://timworstall.typepad.com/timworstall/2004/12/our_wonderful_n.html

a blogger after your own heart

Bob Badour said at December 13, 2004 9:47 PM:
There is *always* a tradeoff.

You don't seem to comprehend the processes by which free markets work to maximize the public good. No central planner will ever have as much information about my situation as I do myself. Therefore, I can allocate my health care resources the most rationally.

Yes, I make tradeoffs. But I am making my own tradeoffs based on all the available information and my own values. And I do not impose my tradeoffs on others.

You have said nothing to address the obscenity of taking my money to pay for someone else's healthcare while forcibly preventing me from allocating any of what's left for my own.

I am a human being, which means I have rights. Property rights are the basis of all rights. Without property rights, no other rights can meaningfully exist.

When you argue in favour of destroying my property rights, you argue in favour of self-destruction. Because without my property rights, you have no rights. I find your position myopic in the extreme and intellectually dishonest.

Why don't you just admit that you are okay with your own slavery provided you get a cut from your neighbours' enslavement and leave it at that?


No acknowledgement of the costs of *their* choices.

I find your criticism absurd. I am asking only for the right to pay the price of my own choices.


Odd, because you cannot rationally choose a system unless you are aware of both the benefits and the costs.

Um, hellooooo! I can rationally choose to spend money on my own healthcare. It's my money and my health.


But then, *every* system will sacrifice someone

Untrue. A free market system allows only for self-sacrifice. Evil regimes impose sacrifice on their subjects. Freedom does not.


Would you be willing to have your child's killer walk free on a legal technicality? No, of course not.

Yes, I would. In fact, I would prefer to let a killer walk (for now) than to risk aquittal on shoddy incomplete evidence. Much better to have a chance at an eventual conviction than to face the horror of the double jeopardy rule after new evidence comes to light.

Thankfully only a handful of families in the West have had to accept murderers walking free, and I have tremendous compassion and admiration for those families because they do.


But would you want to live in system where the right of trial is absent. Of course not. Don't pretend that the American system or every other system *doesn't* sacrifice someone's child...

In the scenario you gave, a criminal sacrificed the child and not the system. The criminal's evil does not taint the mercy of the law.


If choosing a system is moral rot, then we're all smelling pretty badly...

Only choosing immoral systems--like the one you choose--counts as moral rot.


a single person's (or even many people's) tale of tragedy from the United States to invalidate their entire system.

I draw your attention back to where you wrote: "For many Canadians, it's appalling that a substantial fraction of Americans can't get reasonable medical care."

Those Canadians are hypocrites because in their own system a similar fraction of Canadians cannot get reasonable medical care. I recall when the fraction of American's without health insurance was quoted as 13%, and Canadians at the time pointed to that figure to invalidate the free market system. Well, Canada now denies health care to 14%, but you try to play down the figure and pretend it is not significant.


I'm going to assume from your posting that you're a Randist (at least you use the key phrases).

Do you mean Ayn Rand? Never really read any of her stuff. I am a rational human being who is reasonably well read on history and systems of governance. I understand what rights are and why they belong to the individual and not to the state.

Over the years I have known him, Randall has influenced my thinking a great deal. He is much better read than I am, and I suppose I might have picked up some of Rand's vocabulary through him.


First, I believe Canada is in a sweet spot for the health of Canadians taken as a whole. Who are we? The Canadian people as a whole.

Which is why I want to escape this evil dominion. The Canadian people do not respect my most basic of human rights. It is clear they deny my right to property in such a way as to deny my right to life. The idiots! Don't they realise that rights are universal while economic outcomes are not?


buying drugs, guns or prostitutes lately?

The prohibitions on some illegal drugs are 1) universal and 2) arguably reasonable to protect the rights of other individuals. The government does not tax me to provide crystal meth to some people while prohibiting me from buying it for myself.

While I am not a consumer of guns, I find restrictions of gun ownership from free, law-abiding citizens a denial of a basic right to protect oneself. Again, I agree that Canada has no respect for human rights on this issue.

While I am not a consumer of prostitutes, I can see both sides of the prohibition/legalization argument. I note that Canada has the worst system imaginable: Canada neither prohibits prostitution nor provides a safe workplace for prostitutes.

In fact, I would go so far as to say Canada does more to ensure the humane treatment of pigs on pig farms than the humane treatment of prostitutes.


There's also nothing preventing you from obtaining care in our "second tier", the United States.

How do you know? Nothing obliges the US to let me enter their country for any reason.

In any case, your argument is specious. You are arguing that, under ideal circumstances, the Canadian prohibition on me seeking medical treatment is no more than an enormous hurdle. In truth, the prohibition for those without family doctors occupies the continuum between enormous hurdle and impenetrable barrier.


However, we'd be (in our opinion) continually sacrificing our present forever.

Who is "we" ? You don't speak for me any more than you speak for any other Canadian.


our goal is to maximize happiness for our population over the long term, we're better off with the higher re-distribution.

Yeah, worked wonders for the Ukrainians back in the 1980's, now didn't it?


(Once out of poverty, people's economic happiness really only depends on comparison with others around them.)

You might want to live in an egalitarian utopia, but everybody who has ever lived in a system designed to achieve that result found the experience unpleasant. Your beliefs are ruining Canada.


noone mourns the growth that doesn't exist in the future.

Tell that to the Mexicans mourning the future growth their ancestors foreswore. Or the Cubans mourning the future growth their ancestors foreswore. Or...


Would you be happier if you *and every one else* earned a million dollars a year? No.

I would be happier in a system that rewards my economic contribution according to my ability and to my willingness to contribute and that allows me to dispose of my own property as I see fit--especially when I want to use my property to protect my own life.


Happiness does not always equate with greater growth or progress.

What does growth or progress have to do with my right to property and to life? Canada denies me both those most basic of human rights. Since I am incapable of choosing ignorance to achieve bliss, I am unable to have any real happiness in this system--hence my desire to flee at my first opportunity.


Your system is disgusting. It is morally repugnant.

Unfortunately, too many of the slaves are too stupid or too self-interested to notice their own enslavement.


Your horror of our system is based on the fact that it refuses to treat the wealthy better than the poor (subject to reality checks as mentioned in previous articles).

Are you totally impervious? My horror of our system comes from observing that it refuses to treat the wealthy at least as well as the poor. Many crack whores in Regent Park had better health care than I did for many years, and I was forcibly prevented from using my own means to get equal treatment.

The Canadian system is arbitrary and utterly irrational. And yes, I find that insanity horrifying. Universality was always a myth, and you seem to want to cling to that myth.


I (and I think a strong majority of Canadians) consider it a virtue.

You and a majority of Canadians embrace evil with pride. You and a majority of Canadians disgust me. Consensus does not erase evil or stupidity.


It has weaknesses (like the doctor shortage), but those weaknesses can and are being addressed.

Horseshit! The problem gets worse every year and will continue to get worse every year. You are on the road to serfdom, and you refuse to see it.


The American system has what many would consider weaknesses (like the uninsured), but there is strong opposition to addressing them.

Many of the uninsured in the US have made an economic decision on spending. I don't see any weakness in that. A significant percentage of those making that decision may pay for the choice with their lives. But then again, a significant percentage of those who choose to ride motorcycles likewise pay with their lives.

In fact, I see the ability to forego insurance as a strength because it encourages each to contribute and to weigh their choices well.

The problems in the US healthcare system have less to do with healthcare and more to do with American judges tossing out a thousand years of tort precedent.


Randall, I think that equating wealth with moral worth is a peculiarly American custom (I could be wrong).

Randall did not equate wealth with moral worth. He equated productivity, contribution and responsibility with moral worth. The correlation with wealth is secondary; although, most would expect a causal relationship between the above virtues and wealth in a free society.

Many would point to the fact that freedom rewards morality as yet another indication that freedom is good.


Is there a particular reason that giving him the same level of medicare is anti-life?

We have already established that Canada does not provide the same level of medicare to everyone, and we have already established that Canada refuses to allow the immigrant to reward himself and his family with better medical care for all his hard work.

Are you capable of forwarding a single argument that is not specious? You converse with thinkers here, and your arguments have to stand up to more than a quick glance. Sounding pleasant without substance or validity will not suffice.


Interestingly enough, those "other things" are in general part and parcel of the general perception that guides the Canadian health care system.

I think you are impervious. Randall referred to the proof he already provided that health outcomes are better in the US than in Canada when comparing like with like. Perhaps if you quit the specious handwaving for a moment or two, you might clue into that.

Good intentions with bad outcomes are worse than worthless.


Spending $250,000 to allow someone to live an extra month

Relevance? You have not established that this is an issue in either system.


Medical care is not the only component of "life".

I agree it is not the only component of life. It is only a very important one with direct bearing on life. I would like to have the right to buy my own food too. And the right to choose my own entertainment. In Canada, I lack these rights; although, I am permitted to buy food and entertainment.


statistics tend to focus only on upper-middle class white Americans. Why am I not suprised?

If one wants to compare a like population with Canada, one is pretty much required to focus on whites or whites and asians. I strongly disagree with the 'upper-middle class' part, though. And if you are trying to suggest that Randall dislikes anyone on the basis of race, then you are a bigger imbecile than I already think.


My answer is that it should be trying to maximize the happiness of all of its members, balanced with maximimizing the minimums (A society with 90% 1's and 10% 0's is worse than a society with 100% .7's)

That's all well and good except for the 5000 years of empirical evidence showing government wholly unsuited to the task. My answer is: Government--all government--exists to hold a monopoly on violence. A desirable government will wield that monopoly with great reluctance and only on the basis of necessity. Since the dire power of that monopoly will tempt the worst among us, we need to place effective limits, checks and balances to prevent its abuse.


A successful society is one that manages these goals and continues to do so for the long term.

Equality of outcome requires oppression and abuse. Forced equality of outcome is evil.


They're actually quite redistributionist if you look closely

I believe I already observed that the moral rot has made significant inroads into the American electorate.


with medicare being but a single (large) component.

That's all well and good for you until your family practitioner gives up family practice to open a Bernstein weight loss clinic, and you find yourself locked out of the healthcare system. I don't suppose you have sufficient foresight to plan any contingencies for that.


I've met a lot of Americans who were also quite suprised at the size of the redistributions. I'm not certain why it doesn't get more play.

That's easily explained by the usual socialist manipulations of the media. Hard to scare people into buying into socialism if classical liberalism seems to have their major concerns covered.


It is not a fault that is inherent in our system (as seen by the fact that other provinces don't face the same shortages...)

I see a couple faults in your logic. 1) The frailty, irrationality and inefficiency of central planning is the fault of central planning. 2) The other provinces do face the same shortages.

The 14% figure you cited is distributed throughout Canada. If it were only Ontario, the same number of people would mean somewhere between 30% and 50% lack family doctors.


Hopefully the actions that the gov't faces will start seeing results over the next several years.

I can just see someone 70 or 80 years ago saying: "And now that those idiots Lenin and Trotsky are gone, hopefully, Stalin will get the results everyone expects to see." Your hopes are delusional when all empirical evidences suggests exactly the opposite outcome.


Not unlike a free market system, one can swing from excess to labour shortage and back again.

The former soviet union never really swung back; it just kept going until collapse. Why do you expect socialism to work any better this time? In fact, I have yet to see socialism improve anything. It's just slower at getting worse in some places than in others.


It's why I'm quite pro-research in Canada.

Nobody asked whether your are in favour of research like being in favour of nice weather.

You were asked how you justify Canada's freeloading and lack of research. Canada freeloads off American research by holding a gun to the pharmaceutical companies' heads to demand cheap drugs. As a result, Americans pay even higher prices to pay for the research that does happen and a lot of research just doesn't happen. How do you morally justify this theft?


Certainly I have no doubt that Canadian health researchers look at the same data in an effort to improve our system

Yep, and elves build the toys for Santa while the tooth fairy leaves coins under children's pillows.

Bob Badour said at December 23, 2004 5:27 PM:

Good news from Canada!

Having survived a tragic sleeping accident last week, I discovered OHIP delisted chiropractic meaning it is now fully in the free market.

DaMan said at April 23, 2007 7:56 PM:

If you need a ct scan visit http://www.findprivateclinics.ca/Radiology/CT_Scan/80-0.html. You can search a list of private clinics that do CT Scans and filter by location.

Chris said at December 19, 2009 4:33 PM:

The latest for an MRI average wait time is now approximately 146 days - according the current Canadian news broadcasts. Makes we wonder if we have made the kind of progress we would all like to see since this post was originally made in 2004!

Bob Badour said at December 19, 2009 6:02 PM:

Progress? Canada doesn't progress. Canadians are proud of their stupidity and cling to it in desperation.


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