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March 08, 2010

Comments

Isn't it also being reported there is an alternate version of this story where she's traveling to Juneau instead?

Speaking of ironies, the Canadian PM recently flew to Florida for heart surgery because the Canadian procedure, being a bit outdated, involved breaking bones and he didn't want to undergo that particular procedure.

Speaking of ironies, the Canadian PM recently flew to Florida for heart surgery because the Canadian procedure, being a bit outdated, involved breaking bones and he didn't want to undergo that particular procedure.

Not ironic at all. If you've got the loot, the US health care system usually offers great, state of the art treatments (amongst the best in the world, if not the best - depending on the particulars).

But if you don't have the money, you're usually sh*t out of luck (hence Grayson's crude depiction of the defenders of the status quo as the "Don't get sick" plan).

This is why you don't see a lot of working class and middle class Canadians crossing the border to the US. They either can't afford the treatments, or at least would prefer to be treated for free in country.

However, you do see a lot of Sarah Palin types (before her recent fame/fortunes) going north.

You betcha!

i never understood how a brain could come to that argument. "oh our health care system is so awesome that australian ministers are coming HERE!"

no. our doctors are awesome. our facilities are awesome. our system, which they don't use, is not.

McKinney, a couple of problems with your comment:

1. The Canadian PM did not fly down to Florida for heart surgery, it was the Premier of Newfoundland, and,

2. It seems that the American procedure, like the Canadian procedure you refer to is a bit outdated when compared to the Miami Method pioneered by Dr. Lamelas of the Mt. Sinai Medical Center in Miami. Dr. Lamelas has even designed some of his own implements and has better outcomes than any other surgeon in the world for this procedure.

3. I think it would only be ironic if you can find quotes of Danny Williams banging on and on about how the Newfoundland health system is the best in the world and then choosing to go to the US himself.

Yukoner--you are correct, it was the Newfoundland guy.

Eric--the reason why our system is so far superior (and is much more widely used by Canadians than you'd concede, although I don't know where to go for stats) is that it is market-driven, which is the polar opposite of what you get in a nationalized system, where the economic burden is so great there is no money left over for innovation much less a reasonable degree of surplus capacity (so that patients don't wait months for surgery, etc.).

McKinneyTexas's comments on health care always remind me of that Eddie Murphy ice cream skit from Delirious.

Except in health care today your ice cream drops you.

Eric--the reason why our system is so far superior (and is much more widely used by Canadians than you'd concede, although I don't know where to go for stats)is that it is market-driven, which is the polar opposite of what you get in a nationalized system

Well, where do you go for stats? The links in this post detail American use of Canadian medical facilities. Why don't you provide other links?

Otherwise, you seem confused. The purpose of health care reform as proposed is not to "nationalize" the system. In fact, Canada hasn't even really "nationalized the system." A public option would more closely model reform on the French model, where INSURANCE not actual health care is provided by the government.

However, we're not even going that far. We're basing our reform on the Swiss model, where not even is CARE not nationalized, but insurance is left to the private market, with certain restrictions.

But even still, through medicare and medicaid, the US government provides a lot of "nationalized" insurance.

where the economic burden is so great there is no money left over for innovation much less a reasonable degree of surplus capacity (so that patients don't wait months for surgery, etc.).

But this is belied, again, by facts. Doctors in "nationalized" systems like the UK pioneer innovations all the time. In the US, many if not most of the more useful innovations and drug breakthroughs are made under government funded studies (less rogaine and cialis, and more disease treatment).

As for wait times, how long do you wait for a procedure if you don't have insurance, and can't afford the procedure out of pocket?

Hell, even with insurance, there are often wait times in the States.

Eric--the reason why our system is so far superior (and is much more widely used by Canadians than you'd concede, although I don't know where to go for stats) is that it is market-driven, which is the polar opposite of what you get in a nationalized system, where the economic burden is so great there is no money left over for innovation much less a reasonable degree of surplus capacity (so that patients don't wait months for surgery, etc.).

Which is why the US system pays more money for poorer results.

Sorry, but try doing research and not using ideology for arguments. (Don't wait for months for surgery. Heh. Heh heh heh. That's a good one).

"Hell, even with insurance, there are often wait times in the States."

There is a certain amount of denial of facts in some of this discussion. No one said NO innovation comes from the UK, no one said you NEVER have to wait in line in the US.

However, every analysis says that the US has the most ADVANCED medicine in the world (not all of the advanced medicine). The most and latest of techniques and equipment available to the broadest set of patients.

The analysis also says that Canadians have longer wait times for less advanced technology and techniques.

Measured by outcome this isn't always a bad thing, but lets not make the rational arguments for other potential systems seem less valid by denying the facts.

Cite, Marty. The comparisons I'm familiar with do not always compare apples to apples.

"(Don't wait for months for surgery. Heh. Heh heh heh. That's a good one)."

Why is that funny? Except for purely cosmetic surgery, and certainly for critical surgery, the wait times in the US shorter than Canada.

To be clearer, we should be specifying best outcomes and so forth. Such behavioral outcomes such as bankruptcy from medical conditions and lack of coverage entirely can be excluded from measurement, but they most certainly skews the overall picture.

"Cite, Marty."

Google wait times and read any article on the first three screens. Every one will be about Canadian wait times. Some things are just true. In fact, the UK has even moved its wait times ahead of Canada since the turn of the century.

However, every analysis says that the US has the most ADVANCED medicine in the world (not all of the advanced medicine). The most and latest of techniques and equipment available to the broadest set of patients.

"Every analysis" is a pretty high bar, I'm going to assume you meant something more like "many studies", or even "some studies".

Can you show us some studies that demonstrate that the most and latest techniques and equipment are available to the broadest set of patients in the US as compared to other, similar nations?

In what measures of health care is the US superior to, frex, all other OECD nations?

And, how did US superiority come to be?

And, can a useful correlation be drawn between that superiority and how it came to be, and our relatively more market-based approach to providing and paying for health care? As opposed to any of the other possible causes.

All of that's many steps short of your claim, but I'd settle for it as a starting point.

Thanks -

If I have no health insurance in the U.S., or even if I do, and little money, and I suffer from the same heart problem our Canadian friend has, will this Florida hospital let me through the door.

I suspect the U.S, to its credit, also builds the most advanced sailing yachts in the world. I'm glad sailing yachts aren't the cure for expensive, life-threatening diseases.

Or are all commodities alike in their importance?

Could the Canadian also go to France or Switzerland for these procedures? I ask that question sincerely; I don't know the answer.

I hope our Canadian friend recovers fully and returns to Canada and proposes that the Canadian medical insurance system be upgraded and funded adequately so that next time he can stay close to home.

It would have been funny if the airline he flew to Florida demanded a fee to pee. Imagine the poor guy's added discomfort if he'd forgotten his wallet.

Yet another great idea from privately financed air travel.

Marty: Wait times differ for procedure. Some are actually longer in the US.

But I see you don't want to answer this question:

Further, and most importantly, how long do you wait for a procedure if you don't have insurance, and can't afford the procedure out of pocket?

Meaning: some amount of wait time is due to the fact that there is not a class of Canadians that are denied access to these treatments.

"wait times" and "market driven" are red herrings.

Herring is good for you. The fat in herring prevents heart disease.

The most and latest of techniques and equipment available to the broadest set of patients.

Really? Broadest set? I'd like the link to that study.

"Meaning: some amount of wait time is due to the fact that there is not a class of Canadians that are denied access to these treatments."

Absolutely true. See I knew someone would quit trying to argue the facts and recognize the obvious. In the US we spend all of our time talking about the cost of healthcare. In Canada we spend all of our time talking about wait times. They are the symptoms of the same problem reflected in the two solutions.

I made no claims as to which was preferable, for people with time to wait and no way to pay Canada is much better.

People with no way to pay and in a hurry are caught between the rock and the hard place, although both systems provide excellent emergency life saving care for these people.

People with money and in a hurry may go to the US, or get private care in Canada.

Don't be surprised if McKinneyTX and Marty come back with a link to some Fraser Institute report that extols the endless virtues of for-profit health care delivery while completely (and intentionally) misrepresenting the pros and cons of Canada's current universal program. The org is a right-wing/neoliberal think tank dedicated to furthering the complete unravelling Canada's social safety net and the establishment of a free market paradise here in the Great White North. Opponents of US health reform tend to zero in on their handy repository of pro-market propaganda in order to denigrate the virtues of socialized medicine.

(Also, plz to be not allowing derailers to derail this thread until it becomes an ignorance-infused referendum on my country's extremely popular health care system. Oh, and belated thanks for the blogrolling. I heart ObWi forever.)

Marty:

Except for purely cosmetic surgery, and certainly for critical surgery, the wait times in the US shorter than Canada.

Cite? Especially a cite that actually compares apples to apples please. Specifically comparing the average wait times for the ENTIRE population of the US versus Canada. I've seen some that conveniently do not include the uninsured in the US and/or those on Medicaid. Funny eh?

Google wait times and read any article on the first three screens. Every one will be about Canadian wait times. Some things are just true.

Yes, some things are just true, like that you will get a lot of articles about Canadian wait times. This does not mean that surgery wait times in Canada are longer than in the US for the population as a whole.

OK, I took the Marty challenge. I Googled "wait time medical procedure".

And he is correct, many of the top hits are about wait times for medical procedures in CA. Apparently Canadians are pissed because they believe they have to wait too long for medical procedures.

So, how long is too long? From one of the top hits, the Wiki page on Canadian health care:

Health Canada, a federal department, publishes a series of surveys of the health care system in Canada based on Canadians first hand experience of the health care system.[52]

Although life threatening cases are dealt with immediately, some services needed are non urgent and patients are seen at the next available appointment in their local chosen facility.

The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 3 months.[52]

The median wait time for diagnostic services such as MRI and CAT scans [53] is two weeks with 86.4% waiting less than 3 months.[52]

The median wait time for surgery is four weeks with 82.2% waiting less than 3 months.[52]

Another study by the Commonwealth Fund found that 57% of Canadians reported waiting 4 weeks or more to see a specialist, broadly in line with the current official statistics; 24% of Canadians waited 4 hours or more in the emergency room.[54][55]

Life-threatening: immediate.
Specialist physician: median time four weeks.
Diagnostic tests like MRIs or CAT scans: median time two weeks.
Surgery: median time *four weeks*.

24% waited four hours or more in the ER, which I assume implies that 76% waited less than four hours.

This information is filed under "criticisms".

Feel free to compare and contrast with US experience. Feel free to confine your comparison to people in the US with insurance, because if we include folks who are not insured at all, the US doesn't have a freaking chance.

And, of course, what stands out in all of the hits I read was that the links were to pages sponsored by Canadian government health agencies, providing benchmarks and guidelines for bringing wait times down, describing the funds that have been spent to do so ($5.5 billion since 2002), and describing what measures are being put in place to improve the situation.

In Canada, the dialogue is about the nature of the problem and how to solve it.

In the US, the dialogue is about death panels and socialism.

Show me the studies that show how the *most and latest techniques and equipment* are available to the *broadest set of patients* in the US as compared to other, similar nations.

Don't forget the broadest set of patients part, please.

Show me one.

I'm not saying they aren't out there. I just want you to bring the homework if you're going to make the claim.

Show me *one freaking study*.

thanks -

Oh, now, mattt, you have to admit that Canadians are hoping for Obama's plan to succeed just so they can come south and get even better care than they've previously gotten south of the border. Just ask Google.

Mattbastard,

Perhaps I could link to that and any number of other studies (some by the provinces themselves, e-health in Ontario or the Alberta Health system). I actually, as evidenced here, try to avoid linking to studies that can be interpreted as trashing Canada or the US. Challenges exist in both systems. I have been treated in both and had issues and good things in both. But my associates in Canada spend a lot of time bemoaning the lack of ability to be as innovative as their US peers, sometimes people they went to school with in Canada.

Adorn that last with winking smileys as needed.

Marty,

Given your acknowledgement of the fact that the 45 million uninsured are left out completely, and the fact that even for millions of the already insured, their insurance won't cover certain procedures, how do you justify this asked by Russell again:

the most and latest techniques and equipment* are available to the *broadest set of patients* in the US as compared to other, similar nations

In Canada we spend all of our time talking about wait times.

What you mean "we", kimosabe?

Canadians have longer wait times? Canadians have less advanced procedures and equipment? Easy answer: spend 50% more money per capita in their health care system. They'd still be spending less than the US does per capita. Their "system" would still be cheaper -- and no Canadian would have to wait for any medical care, not even the most sophisticated kind.

Cheaper, just as prompt and sophisticated, and accessible to everybody. But oh noes: socialist!

--TP

Marty: Why is that funny? Except for purely cosmetic surgery, and certainly for critical surgery, the wait times in the US shorter than Canada.

It's funny because there is no systematic collection of data on wait times in the US, so you really have no idea what you're talking about and couldn't cite any evidence to back up your claim, anyway.

Other countries with national health care systems have systematic national and local recording of wait times, and make that information public. So mad patriots in the US who want to believe your godawful health care system isn't lingering down there in the Third World basement, pick out bad examples and compare with what self-serving advertising is made available in the US. Naturally the advertising figures come out looking better than the clear and systematic data.

But I get better health care and pay less for it than you do, Marty: just as Canadians do.

Why is it a kneejerk reaction by right-wingers to fake out a pride in your awful system, rather than actually want to improve it?

Perhaps I could link to that and any number of other studies

Yes, perhaps you could. Your choice.

"In Canada we spend all of our time talking about wait times.

What you mean "we", kimosabe?"

I live in both places

Slarti: But my associates in Canada spend a lot of time bemoaning the lack of ability to be as innovative as their US peers, sometimes people they went to school with in Canada.

It's amazing how people who live in countries with national health care systems feel free to complain about how their health care system could be improved.

Oddly enough, national health care systems tend to respond well to complaints by their owners/users about how they ought to be improved.

Whereas notably, McKinneyTexas, Marty, and you yourself, don't feel at all free to complain about the really horrific failures of your own health care system, or speculate about how this failing system could be improved. Now why would that be?

Tony makes an excellent point as well.

Canadians spend a lot less on their health care. So if they spent more, they could probably cut down on the wait times. We, on the other hand, spend much more and have interminable wait times for the un- and under-insured.

"It's funny because there is no systematic collection of data on wait times in the US, so you really have no idea what you're talking about and couldn't cite any evidence to back up your claim, anyway."


It is true that the only places collecting wait times today are the most sophisticated IDN's.

The reason is that it hasn't been necessary until the last ten years as the IDN's and hospital networks have begun to evaluate whether it would be better to actually have wait times rather than an oversupply of advanced equipment.

Slarti: But my associates in Canada spend a lot of time bemoaning the lack of ability to be as innovative as their US peers, sometimes people they went to school with in Canada.

Interesting. It's almost as if someone else said that.

The fact is, the US system will continue to offer the extremely expensive state-of-the-art procedures and drugs that it always has done. America is full of wealthy people willing to pay for those kinds of things, and they will continue to pay for them. Nothing about that situation is touched by any of the health-care reforms. There is no government takeover. There is no prohibition on private practice. There is no law against having health insurance that covers expensive interventions.

And that's basically a good thing. What is an expensive intervention available to a few wealthy people today becomes a commonplace available to everyone in a decade or two - once the patents run out, experience with the technique or drug drives cost-saving innovations, cheaper alternatives are derived, mass-production of the equipment involved takes off, etc. Your free market at work. It's great.

I'm all for tiers of health insurance, all for doctors making available new kinds of interventions on a fee-for-service basis, all that stuff.

The problem we have right now is not a lack of expensive interventions. The problem we have now is that, 1) the products on offer are getting more and more expensive without offering much more in the way of benefits, and lack of standardization, lack of competition, and barriers to market entry mean that no low-cost entrants are coming along, so the whole "tiered offerings" thing isn't working, and 2) a lot of people and in particular, a lot of people who really need healthcare, just can't afford the bottom tier of health insurance anyway, because of certain unavoidable aspects of the current health insurance market, in particular the adverse selection problem, which is related to the ability to deny coverage based on pre-existing conditions, and changing that requires a healthcare mandate to avoid adverse selection death spirals.

Even if you're inclined to do so, saying to the uninsured "You can't afford it, tough luck" doesn't work because we all wind up paying anyway, and in really stupid, inefficient ways - reducing someone to poverty so they can go on Medicaid is a lot less efficient than just making sure they had healthcare so they didn't go broke in the first place; treating someone in the ER when something minor becomes a crisis is a lot more expensive than treating them in a doctor's office in the first place.

None of that has anything to do with high-end care in this country. A lot of the people who currently have no health insurance are going to get coverage under the reforms that will not be gold-plated health insurance, and will not cover a lot of expensive interventions. That's okay because right now they have nothing at all. But that change will not affect existing plans that cover expensive interventions, and it will not in any way affect the ability of wealthy Americans to pay for those on a fee-for-service basis.

Of course, the claim that it will reduce you to negotiating with a government bureaucrat about what is covered is a crowd-pleaser. Not true, but good 'n' scary. What would be good is if the people who find that kind of thing scary took a good look at what the bill actually does, at which point they should realize that the claim that it's a government takeover is a load of crap, and the resistance to it has a lot more to do with the insurance industry's lack of desire to be properly regulated and wealthy people's desire not to pay even a little bit more tax.

No government takeover. I mean, there isn't even a continuation of the precedent set by Medicare and Medicaid that the government can be the insurance provider when it's providing the funding, as it will be with the subsidies. This is as market-friendly a reform as any market fan could wish for. I'd prefer a bit more government intervention (like a public option), but I think the market-driven approach will work extremely well even without it.

That moderate Republicans are voting against something that takes the most market-friendly possible approach to insuring the uninsured ought to ensure electoral doom for them for the foreseeable future once the things gets rolling. To me it's bizarre that they are fighting this tooth-and-claw to get a minor advantage in the next election instead of taking the long-term view. This thing is going to be as beloved as Social Security within 10 years. People love their universal healthcare in other countries and severely punish parties that threaten them.

Why is it a kneejerk reaction by right-wingers to fake out a pride in your awful system, rather than actually want to improve it?

'Tis a puzzlement, isn't it, Jes? But the longer the debate drags on, the more I keep coming back to John Holbo's excellent insights into the nature of contemporary American conservatism. And especially to this passage:

The thing that makes capitalism good, apparently, is not that it generates wealth more efficiently than other known economic engines. No, the thing that makes capitalism good is that, by forcing people to live precarious lives, it causes them to live in fear of losing everything and therefore to adopt – as fearful people will – a cowed and subservient posture: in a word, they behave ‘conservatively’. Of course, crouching to protect themselves and their loved ones from the eternal lash of risk precisely won’t preserve these workers from risk. But the point isn’t to induce a society-wide conformist crouch by way of making the workers safe and happy. The point is to induce a society-wide conformist crouch. Period. A solid foundaton is hereby laid for a desirable social order.

Seen this way, those 45 million-plus Americans with no health insurance whatsoever aren't a bug, but a feature (albeit a feature to be extolled only in certain very limited venues). Fear of falling keeps people* in line, and keeps them from getting too soft, too comfortable, and too demanding.

That's as good an answer to Jes' question as any I can come up with.

*Other people, that is; you know, the kind who need to be kept in line. As Holbo points out in the linked essay, the conservative is always serenely certain that s/he already has the right stuff and doesn't need any further toughening up, thank you very much.

I'm curious -- which province do you live in when you are in Canada, Marty? And what is your official citizenship/residency status?

"The thing that makes capitalism government control good, apparently, is not that it generates wealth more efficiently than other known economic engines. No, the thing that makes capitalism government control good is that, by forcing people to live precarious lives, it causes them to live in fear of losing everything and therefore to adopt – as fearful people will – a cowed and subservient posture: in a word, they behave ‘conservatively’ gratefully."

Thus providing the government further leverage to control their lives.

Slarti, sorry to have confused you with Marty.

Marty: It is true that the only places collecting wait times today are the most sophisticated IDN's.

So you did realize your claim that wait times in the US are shorter than in Canada was completely meaningless? Good to know. Why, then, did you persist in defending what you knew all along was a completely meaningless assertion?

Indeed, given that you knew what you were saying was meaningless, why bother saying it in the first place?

Marty: "I made no claims as to which was preferable...." Nonsense. The implication was unambiguously clear.

Marty again: "People with no way to pay and in a hurry are caught between the rock and the hard place..." Absurd. This is essentially true everywhere unless you are so filthy rich that you can have your own fully staffed private hospital nearby at your beck and call.

Mattt, the answer to the first is Ontario. The second is, its been a number of years and close to having to renew but I couldn't tell you exactly. I get to live here to work basically.

It seems that the American procedure, like the Canadian procedure you refer to is a bit outdated when compared to the Miami Method pioneered by Dr. Lamelas of the Mt. Sinai Medical Center in Miami

Specifically, similar procedures are done in Toronto and Ottawa, but not in Newfoundland (nb Newfoundland is a very rural place, this is like someone going from Montana to LA for healthcare). I don't know if the exact same procedure is done in Canada tho.

the reason why our system is so far superior (and is much more widely used by Canadians than you'd concede, although I don't know where to go for stats)

So you don't *know* it in the sense of having the information, you *just know* it because it fits in with your preconceptions. This virtually guarantees that you're immunized from new information changing your viewpoint- after all, you already *just know*.
There's a good wikipedia article comparing the two systems, including a section on cancer. Of course, there are also groups dedicated to skewing the stats, so if you prefer to reinforce your preconceptions rather than challenging them Im sure you can google for those as well.

"Indeed, given that you knew what you were saying was meaningless, why bother saying it in the first place?"

Because outside this blog it is a pretty unquestioned and uncontested statement. Even in Canadian and US medical circles. Sorry for the lack of cites. You could find me a cite that questions it as common information and I will quit saying it.

Marty: No, the thing that makes capitalism government control good is that, by forcing people to live precarious lives, it causes them to live in fear of losing everything and therefore to adopt – as fearful people will – a cowed and subservient posture: in a word, they behave ‘conservatively’ gratefully."

I've tried to respond to this, but all I can really think to say is: Marty clearly doesn't know anyone in the US who has clung to a job they hate for fear of losing the health benefits keeping them alive (I live outside the US, and I know several); and he doesn't know anyone at all in the UK, if he thinks we adopt a "cowed and subservient posture" either to the government of the day, or to the NHS.

"Thus providing the government further leverage to control their lives."

That post was nothing but an insulting descent into baseless propaganda and bespeaks an obscurantism that would make any Trotskyite proud.

"Marty clearly doesn't know anyone in the US who has clung to a job they hate for fear of losing the health benefits keeping them alive "

Sure I have, and am a fan of having HCR, but people cling to jobs they hate for lots of reasons, I suspect even in the UK.

Marty: Because outside this blog it is a pretty unquestioned and uncontested statement.

"Outside this blog"? You mean, in your own little world?

It's a meaningless statement, Marty, as you yourself acknowledged, because the US does not collect systematic data on wait times.

You may not hear this meaningless claim challenged or contested, but that would be because you appear (outside this blog) to move in very limited circles.

It's still meaningless. To make a comparison of wait times, you need to collect data - and the US simply doesn't do it.

So basically, you made a claim you knew was meaningless because you usually get away with doing so?

Marty, I'm sure you thought that was a devastatingly clever take-down, but come on. You could at least make a minimal effort here.

Holbo's comment was germane to the discussion at hand precisely because living without health insurance is living "precariously." And one of the benefits of reform is that it will make many people's lives less precarious, because whereas they didn't have health insurance of any kind, now they will. The lives of people with health insurance are less precarious than the lives of people without it. Are we at least in agreement on that?

And yet some people seem to find the very notion of making people's lives less precarious objectionable. (Or they take your tack, which is to simply ignore the existence of those 45 million people entirely.) Why could that be?

And you come back with a "response" worthy of a high school freshman with a poster of Ronald Reagan on his bedroom wall. Please.

Thus providing the government further leverage to control their lives.

By that token, a massive, faceless health insurance company "controls my life" right now, in order to make money off me. And that's preferable to you because...well, because someone's making money off me, apparently.

Oops, Marty. Didn't see uncle K's post. Long live the permanent revolution.

On another matter, where is the highly praised competition in our healthcare? Insurance companies don't compete and are exempt from anti-trust; drug and medical device firms get absurd and socially expensive patent protection; the AMA and our immigration authorities restrict the supply of doctors; and they don't compete on price....where are the TV ads? Further, a great deal of the public health infrastructure (physical plant) is built with public funds or with the aid of public financing.

But no. You demand, yes DEMAND, the instant alleviation of your health problems and/or fears.

Thanks, Marty -- I figured it was probably Ontario. Wait times for certain elective procedures tend to be a particular nuisence here, thanks to cuts/'reforms' made in the mid-90s under the Harris provincial govt (following transfer payment cuts from the then-Liberal federal govt that slashed health care funding to the provinces by a substantial amount).

No one said NO innovation comes from the UK, no one said you NEVER have to wait in line in the US.

Actually, the former is EXACTLY what McKTX said: the economic burden is so great there is no money left over for innovation

"No money" means "no money," unless there's some ambiguity I'm failing to see.

Of note: Among the last ten years' worth of Nobel Laureates in Medicine, fully half come from outside the US. But I'm sure their American colleagues are doing all the REAL work.

Because outside this blog it is a pretty unquestioned and uncontested statement. Even in Canadian and US medical circles. Sorry for the lack of cites. You could find me a cite that questions it as common information and I will quit saying it.

You know what? This is horsesh*t. Lazy-ass horsesh*t.

I could find you a cite, and I did. Handed it to you on a platter. After exactly one minute of googling I provided a cite that gives actual wait times for Canadian medicine.

Here they are:

Life-threatening: immediate.
Specialist physician: median 4 weeks.
MRI or CAT scan: median 2 weeks.
Surgery: median 4 weeks.
ER: 76% less than 4 hours.

Those are the wait times that Canadians are b*tching about. They would be absolutely normal, if not delightful, to most Americans. They'd be like heaven to the 15% of us who have no f**king health insurance at all.

Yes, there are lots of links, because there's a lot of discussion in Canadian press and government about how to improve them.

I wish to god the public discussion in this country was one tenth as substantive.

If you want to google the conversation about American health care, you have to google for "death panel".

Seriously, you're bringing nothing to the table here other than your own prejudices and parochial opinions.

Why the hell should any of us care what you have to say on the topic?

Thus providing the government further leverage to control their lives.

Tell it to the freaking 46 million people who have no health insurance at all, or the almost 1 million people who have been bankrupted by medical bills, or the 45,000 people a year who die unnecessarily because of lack of access to medical care.

Give you liberty or give them death.

Seriously, from here:

every analysis says that the US has the most ADVANCED medicine in the world (not all of the advanced medicine). The most and latest of techniques and equipment available to the broadest set of patients.

The analysis also says that Canadians have longer wait times for less advanced technology and techniques.

To here:

You could find me a cite that questions it as common information and I will quit saying it.

In what, a half dozen comments?

We could put 100 cites in front of you and you wouldn't quit saying it. You'll say it again in this thread, you'll say it again the next fifty times the topic comes up.

And it'll all be your freaking opinion, based on what your buddies all say.

Meanwhile people in this country have *no freaking health insurance at all*, all so folks like you and McKinney don't have to wait as long as a Canadian for a CAT scan.

No, the thing that makes government control good is that, by forcing people to live precarious lives ...

Yup, there's nothing like free primary and secondary education, workplace safety standards, federally insured bank deposits, unemployment insurance, and all the other things libertarians whine about to make my life feel precarious.

How bout we all pony up for her retroactive abortion

"Seriously, you're bringing nothing to the table here other than your own prejudices and parochial opinions.

Why the hell should any of us care what you have to say on the topic?"

You don't have to care about my opinion at all, but you can't refute my personal knowledge and experience that forms my opinion with median times that you don't seem to understand.

Lets see, "The median wait time for diagnostic services such as MRI and CAT scans [53] is two weeks with 86.4% waiting less than 3 months.[52]".

Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn't sound as good that way, huh?

And, in Ontario, they also work the system by making anyone the doctor wants to have one within the two weeks stay in the hospital until they have it, that is their prioritization scheme. Makes you feel better that they are prioritized, but still doen't seem like a great system.

I am not the one bashing a system here, you are. Your stats are good with me, as I pointed out in the beginning. I have read all of them, by LHIN, by hospital, by doctor. The MRI and CAT scan machines in Canada are on average x years or more older than in the US, they have fewer per capita, etc.

You say you went and got the stats, great, because they should tell you that in government supplied healthcare you don't measure cost, you measure wait times based on the budget limitations the government imposes.

No matter how many of the variations of the F-word Russell throws in, it doesn't change the facts, the ones he posted.

It also doesn't change my informed opinion that a significant number of medical professionals would tell you that doing research, or even working in the research hospitals, in the US is better than in Canada, because the medicine is more advanced.

It also doesn't mean anyone forgot that many in the US aren't covered by insurance, there wait times for non life threatening care is infinite, that wouldn't change the median but would certainly lower the percentage to get treatment within 3 months.

I don't qualify for all your vitriol Russell, ease up.

You don't have to care about my opinion at all, but you can't refute my personal knowledge and experience

The plural of anecdote isn't data.

It also doesn't change my informed opinion that a significant number of medical professionals would tell you that...

And neither is that.

Well, and a certain percentage of people waiting a while for a CT scan does not necessarily indicate anything that would affect quality of care at all. I had a CT scan of my head a couple of years ago, and even though I was able to get an appointment within a few weeks (this is with Kaiser Permanente), it really wasn't that urgent, and waiting a couple of months would've been fine. I was about 30, I was just having some severe headaches, there were no other indications, it was purely precautionary. What's the evidence that people who really need a CT scan have to wait a long time in Canada? If their system for prioritizing puts off people who aren't urgent in favor of fitting in all the people who are urgent, what's the problem?

And while I appreciate we're talking about Canada vs. the US here, the actual healthcare bill under consideration wouldn't grant the government the sort of control that would affect whether CT scans were available. It's nothing like the Canadian system.

It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it.

The word "might" carries an awful lot of freight in that sentence.

--TP

Uncle K, after that great Holbo quote": Seen this way, those 45 million-plus Americans with no health insurance whatsoever aren't a bug, but a feature (albeit a feature to be extolled only in certain very limited venues)."

See also the GOP on how unemployment benefits are bad, (After all, they let folks look for a half-decent job, sometimes, briefly, rather than having to grab the first one that comes along, however low-paying & crappy.

Also - Marty, re your reworking of said quote . . . just FAIL. Now, with more strikeouts and replacements you could have at least made the standard conservative argument about how gov't providing valuable services to make people's lives more secure makes them gratefully dependent on gov't . . . which sounds pretty good right around now. But yeah, as it stands, no.

Marty: It also doesn't change my informed opinion that a significant number of medical professionals would tell you that doing research, or even working in the research hospitals, in the US is better than in Canada, because the medicine is more advanced.

Perhaps, but that's not even remotely what you were originally claiming.

Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn't sound as good that way, huh?

About eight years ago I was diagnosed as potentially having a irreversible neurodegenerative disorder. I had excellent insurance -- thanks to my then-union -- so that wasn't the problem. The one teensy problem was the wait time: nine f***ing months.

Doesn't sound as good that way, huh?

Thank god the diagnosis was in error and I was able to regain my equanimity and (arguably) intellect. Because if it had been, that would have been nine months of irreversible brain damage given to me by the squanderings of the Best Healthcare System In The World(tm).

Finally:

Because outside this blog it is a pretty unquestioned and uncontested statement. Even in Canadian and US medical circles.

I work in healthcare IT and I've never heard anything of the sort. What I've heard is that the high-end care in the US is the best in the world, a statement with which no-one disagrees. Beyond that, your remark is utter crap; while there are a few who will make the claim that the US system has the best care in toto, a) they're generally referring only to the insured (where the question becomes much more complex), and b) to say the claim is controversial is an understatement.

[It's also false, fwiw, but that sadly seems not to be germane to the present conversation.]

I have read all of them, by LHIN, by hospital, by doctor.

Where do you come by that information? Not because I'm calling you out on it, just because I'd like to see it.

There isn't a lot around for US quality of care, and I'd like something better than anecdote to work with.

The best thing I've found is this, which puts the American system on average better than the Canadian system for wait times, but with such weird outlying data (average wait time to see a GP in Boston MA -- 63 days) that it's hard to say what "on average" means.

The wait time for hip replacement surgery in CA was particularly crappy, with 50% of CA hospital admins saying someone over 65 had a 50% chance of waiting more than six months.

That sucks.

From other stuff I've read, as regards wait times, both the US and CA appear to be more or less equally sucky when compared to France, Germany, or some other EU nations.

The bottom line, to me, is the number of people in this country who have no insurance at all, or insurance that is inadequate to address any significant illness.

This country is astoundingly, prodigally rich, unbelievably rich, and there are people who live here who don't go to the doctor when they're sick, because they can't afford to. Or who are driven into bankruptcy when they do get sick, even when they have insurance. And a lot of those folks are working folks.

I'm not talking about marginal down-and-out types, I'm talking about people with jobs and kids.

I appreciate that we have some of the best, most state of the art medical technology and practice in this country. I also appreciate that that is inaccessible to millions upon millions of us.

It should not be that way.

I don't qualify for all your vitriol Russell, ease up.

Fair enough, my apologies.

Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn't sound as good that way, huh??

Uh . . . there's an awful lot that needs to be unpacked here before you can hang your hat on this. I'd imagine that where MRI or CAT scan: median 2 weeks intersects with Life-threatening: immediate, the latter might get you bumped up the queue.

Some more points of view:

Should Canada privatize?

A Canadian doctor looks at American health care.

Analysis of wait times for elective surgery in OECD countries

If you live in Canada and you want a hip replacement, it kinda sucks.

If you live in the US and you have really good health insurance, Bob's your uncle.

If you live in Canada and you plain old get sick, you have no worries.

If you live in the US and you don't happen to have good health insurance, or health insurance at all, you're likely screwed.

Calling all cleek! Italics in aisle 8!!

It also doesn't mean anyone forgot that many in the US aren't covered by insurance, there wait times for non life threatening care is infinite, that wouldn't change the median but would certainly lower the percentage to get treatment within 3 months.

You certainly seemed to be forgetting it earlier in your comments, Marty. What percentage of Americans do you think are in that infinite-wait category for MRI/CAT scans, and how does that affect the comparison to the Canadian waits you're so concerned about?

"Where do you come by that information? Not because I'm calling you out on it, just because I'd like to see it."

I don't get it that way, but the Ministry of Health has a website with most of this info on it here. Like most, i am not sure how frequently the stats are updated.

You don't have to care about my opinion at all, but you can't refute my personal knowledge and experience that forms my opinion with median times that you don't seem to understand.

One doesn't refute an opinion. However, I think that your opinions would do well to try to adjust themselves to fit around facts rather than vice-versa. And if you've got something to add other than insults that will expand our collective understanding of "median times", just jump right in.

The same thing happened on the cap gains thread- you have an opinion, some numbers etc don't jive with that opinion, you call the numbers crap and say that your opinion is (touchy-feely time) just as valid as everyone elses.

Do you have any idea what that actually means? It means 14% of people who might need an MRI/CAT scan to detect a fatal disease wait more than three months for it. Doesn't sound as good that way, huh?

If they use a system that's blind to the need of the patient, then that would be true. But as someone with extensive family in Canada, I know that this is not true.
As someone with *claimed* experience with the Canadian medical system, you ought to know that this is not true as well.

"The same thing happened on the cap gains thread- you have an opinion, some numbers etc don't jive with that opinion, you call the numbers crap and say that your opinion is (touchy-feely time) just as valid as everyone elses. "

Funny, Thats exactly how I feel this went, what is odd is that the discussion, mine and Russells was about whether the numbers were good or not. That requires interpretation or, opinion.

50% greater than 2 weeks with 14% still not done at 3 months doesn't sound great to me. Some number of those under two weeks were life threatening (meaning diagnosed immediately life threatening) so some number over 50% of diagnostic tests were schedule out over the next 3 months plus. Seems long to me and longer than my experience in the US, but consistent with my experience in Canada.

I am not sure what your objection to my opinion is other than you disagree.

The combination of citing healthcare availability statistics with a refusal to acknowledge the problem of the uninsured strikes me a bit like this:

REPUBLICANS: Behold, the Edumatron 9000 mechanical educator! It graduates high school students in the top 30% of the country and only costs twice as much as human teachers!

EVERYONE ELSE: Cool! But wait.. it appears to feed the poorest 10% of students directly into a wood chipper. And then uses them to make hamburgers for lunch for the others. That seems ... I don't know ... bad?

REPUBLICANS: You won't find results like these in any other country, nosirree! This machine is state of the art all-American engineering and it's going to give our kids the boost they need for the future!

EVERYONE ELSE: ...but the woodchipper?

REPUBLICANS: 22% of students get a 1500 or better SAT score, and 4% get a perfect 1600!

EVERYONE ELSE: That's great, really, but does it have to kill quite so many poor people?

REPUBLICANS: No other country has an education system like this!

...

And so on. I mean, I'm all for neato stuff in healthcare that deliver good results. I just don't see why this has to involve letting so many people die, here in the richest country on the planet.

Can whoever fixes the italics also post the magic incantation [1], so the rest of us can learn it?


1. Escaped, of course.

Did that really work?

Apparently so.

OK, I ended my comment with

[/i][/i][/i][/p][/i][/i]

(=where the square brackets should be replaced by angle brackets.

Marty: Your stats are good with me, as I pointed out in the beginning. I have read all of them, by LHIN, by hospital, by doctor.

But then you tried to claim that the Canadian stats were worse by comparison with US stats. And that claim was meaningless, because there are no equivalent US stats. The US government doesn't collect data on how long each person in the US seeking care has to wait for it.

And you know it was meaningless. And your only defense so far for your making a statement you knew was meaningless was that, outside of this blog, you mostly don't get contradicted when you make that kind of meaningless claim.

Is that all you got?

50% greater than 2 weeks with 14% still not done at 3 months doesn't sound great to me.

I don't disagree with this, my issue was whether that's significantly better than in the US.

From what I can find, the answer seems to be "it depends". Even leaving the uninsured folks in the US out of it.

And both CA and the US appear to have poor wait times when compared with some other, similar countries.

Greater government involvement in ensuring the availability of health care does not appear to inevitably lead to scarcity of care, poorer quality of care, or longer wait times.

And it does appear to create greater transparency and responsiveness in addressing problems in the large. The Canadian national and provincial governments' responses to wait times being an example.

American market-driven health stuff excels at providing stuff that has high profit margins.

And last but not least, 45+ million people in the US will spend at least part of this year with no insurance at all, and over half of the personal bankruptcies in the US will be due to medical costs.

45 million people is more than the entire population of Canada. It's a lot of people.

And, we pay something like twice what most other OECD nations pay.

That's what I take away from the information I've seen. So, I don't think what we're doing is working well.

So Sarah Palin's parents, when she was a youngster may have taken her brother to the closest medical treatment center for emergency medical care, creating some international incident forty years later...

As one wise person said:

"Is that all you got?"

Posted by: Jesurgislac | March 09, 2010 at 05:11 AM

"Is that all you got?"

Sadly, no.

About 44,000 people die each year in the US because they don't have health insurance. cite. Sarah Palin's "solution" to the deaths of thousands of Americans is to talk gibberish about "death panels" .

The US health care system is renowned throughout the world as the most expensive system providing the worst care of any developed country.

Yet the response to this, from patriotic right-wingers like McKinneyTex and Marty, is not "how do we do better?" but to make mindnumbingly stupid claims about how their rotten system is already better, providing you use the right metric... which entails a lot of complicated mental juggling, such as Marty holding up real Canadian national figures against imaginary US national figures and pretending he can see that the imaginary ones are better than the real ones.

Now which side of the line do you fall, Blogbuds? Too patriotic to care how many people the US health care system lets die each year?

About 44,000 people die each year in the US because they don't have health insurance.

Really! Don't more than that die that do have health insurance?

"...talk gibberish about "death panels" Don't you have "death panels"? I thought I read somewhere...

"...providing the worst care of any developed country." Jes, come on, you're better than that.

"Now which side of the line do you fall, Blogbuds?"

Most of whatever is wrong with our health system is caused by government manipulation - so obviously I'm not going to support further manipulation - especially where there is no indication that it is intended to improve 'health care'. Health care, by the way, that is the best in the universe - without a doubt.

It's sad to see the quality of argument has diminished here since hilzoy bailed.

"Is that all you got?"

No, that was all the Palins had. Jes has the NHS, although I would prefer the French system.

Not to mention them cushy commie union jobs later, and let's not forget that gummint-provided moocher-care while she was nanny of the nannystate.

Speaking of prayer, what are we going to do about the religious couple who are going to jail because they didn't seek medical care for their now-dead children, preferring prayer to their Creator instead of consulting those pointy-headed elite doctors who went to universities on either Left Coast?

Why didn't the Palins, all generations of that illustrious family, go this route?

The religious couple relied on their faith and prayer. Check. They were self-sufficient. Check. They didn't over-utilize the healthcare system, which so many believe is the reason costs are so high. Check. They didn't rely on gummint. Check. They weren't subsidized by anyone, like say, Stalin's haircuts were subsidized, which by the way, were just like Medicare, which shouldn't be cut by Democrats, but should be abolished by Republicans. Check.

What am I missing? Why aren't these parents testifying in front of Jim Demint against the demon Obamacare and in favor of the Republican healthcare plan, which by golly these parents have been living.

Would Jim Demint try to sneak them into his subsidized doctor's office (under the Federal Employees Healthcare Plan) or would he hustle them out the backdoor after testifying, perhaps with a monopoly voucher for their future childrens' appointment with the coroner.

If their children could speak, they would be the end of Obamacare. In fact, I expect Sean Hannity, that brilliantined bug smiling like Kali, will have their exhumed corpses (man, I hope it was a private cemetery, not one of them gummint collective jobs) appear on his show and stick a microphone in their faces while providing their answers in funny voices and not moving his poisonous lips.

The modern day Republican Party is a zombie psychopath abroad in the land.

I thinking right now of the end-of-life care I would like to provide Hannity, DeMint, and any number of fascist blonde Palins on FOX.

It would be cheap.

Check.


Don't more than that die that do have health insurance?

the mind reels.

Health care, by the way, that is the best in the universe - without a doubt.

Except for the 45 million uninsured. And the millions more that are underinsured. Other than that.

Most of whatever is wrong with our health system is caused by government manipulation - so obviously I'm not going to support further manipulation

Yeah, if it weren't for that government manipulation through Medicare and Medicaid, we wouldn't have 45 million uninsured and millions more underinsured.

No, we'd have more.

It's sad to see the quality of argument has diminished here since hilzoy bailed.

Yes, hilzoy was vehemently opposed to health care reform, and tended to view the problems with our health care system as derivative of government manipulation.

Riiiiigggghhhht.

Jes, come on, you're better than that.

Well, not right now - I'm coughing and sneezing and trying to get over a cold which is sitting in my nose and throat before I have an operation inside of my nose. I rang the practice I'm registered with this morning at 8am and got an appointment for 10:30: the doctor listened to me coughing, checked my sinuses for any sign of infection, and signed me off work for two weeks to make sure I get over this cold before I have the operation, and after which I'll be on sick leave, during all of which period I'm still on full pay.

I picked this practice to register with because it's an easy 10 minute walk away (actually, I can get there in less than 3 minutes when I'm feeling fit...) and has an excellent appointments system: if I had felt unable to walk that far, I would have explained that to the practice receptionist, who would have arranged a home visit from the doctor on call.

So right now I'm feeling pretty ill. But that I get better care than I would in the US, and pay less for it - without a doubt.

As do people in every other developed country in the world, Blogbuds. We take for granted a standard of care that you don't.

I picked this practice to register with because it's an easy 10 minute walk away (actually, I can get there in less than 3 minutes when I'm feeling fit...) and has an excellent appointments system

Seems as good a time as any to note that under the NHS, Jes can choose just about any primary care provider she likes. And she can continue to see that provider as long as she damn well pleases.

Whereas I, as a beneficiary of The Greatest Healthcare System in the World (OO-RAH!), have to choose a provider who's in my insurance company's network. There may be GPs who are closer, or who I would prefer to see, but if they're not in the network, tough sh!t.

And of course if I change jobs next year and end up with a new insurance plan, I may have to go find a new GP, whether I like my current one or not.

And I'm one of the lucky ones.

And of course if I change jobs next year and end up with a new insurance plan, I may have to go find a new GP, whether I like my current one or not.

Look on the bright side: if your new job doesn't come with health benefits, you can choose an GP you like.

Except for the 45 million uninsured.

Posted by: Eric Martin | March 09, 2010 at 09:51 AM

Uh, 45 million ... ? Are there some Americans included in that number?

...and Jes, I'm glad you're being taken care of. If it gets serious and requires special attention - we'll gladly take care of you. We're use to being the world's safety net - at least at the moment.

Uncle Kvetch...again, most of your concerns are created by gov'mint, and certainly will not be solved by them.

Some of our challenges revolve around corporations being forced to provide health care for their workers. We need to work on changing that in the future.

Thanks for the cup of coffee.

If it gets serious and requires special attention

...then I'll be taken care of by some of the best in the world, at no extra cost.

Wouldn't want to put your crummy system under any Jesurgislac strains...

I'm glad you're being taken care of.

Thanks for your good wishes. I wish you the same - though with less confidence that it will be the case.

Some of our challenges revolve around corporations being forced to provide health care for their workers. We need to work on changing that in the future.

Simple: adopt our NHS system. No corporations are forced to provide health care for their workers: when an employer provides access to private health insurance, not only is it of better quality - our private health care providers get real competition, unlike yours - but it's done as an additional benefit, a luxury extra, not life or death.

It would be nice to think, on behalf of my American friends, that you will be changing to something better in the future...

Uh, 45 million ... ? Are there some Americans included in that number?


Don't get xenophobic on us. From a public health standpoint, it's bad policy and just plain stupid for everyone to allow a large pool of untreated individuals to exist.

Uh, 45 million ... ? Are there some Americans included in that number?

Yeah, tens of millions. Why?

Tens of millions underinsured too.

Why?

Blogbuds: Uh, 45 million ... ? Are there some Americans included in that number?

"According to the 2000 United States Census, whereas the number of naturalised citizens had increased by 71% (6.2 million to 10.6 million), the number of non-citizens had increased by 401% (3.5 million to 17.8 million) in the preceding three decades (Schmidley 2001). In 1998, about 63% of foreign-born individuals (or approximately 16.5 million) were non-citizens (Carrasquillo et al 2000)." cite It's estimated that about 45% of the non-citizens didn't have health insurance.

Yet: "In 2006, 46.6 million Americans were without health insurance. Most had incomes above the poverty level, and thus, did not qualify for government entitlement programs. More than 80 percent of the uninsured were employed or came from working families." cite

So while over half of non-Americans have the same health insurance you do, the number of uninsured Americans is greater than the number of uninsured non-Americans.

(Plus, what Gwangung said.)

... untreated individuals to exist.

Posted by: gwangung | March 09, 2010 at 11:04 AM

Uninsured, not untreated. Different subject.

Slarti, sorry to have confused you with Marty

Forgiven. To a certain extent, it's an understandable error.

Uninsured, not untreated. Different subject.

Uh-huh. Not sure you can elucidate the differences in a quantifiable way, particularly when it pertains to public health. Public health experts certainly seem to think that such a large population of uninsured is a problem for them.

Uninsured, not untreated. Different subject.

Would be in any other developed country in the world: in the US, of course, uninsured is how your system ensures people with comparitively minor ailments go untreated until their ailments get so bad they have to seek help - at which point, their treatment is much more expensive.

That's how the US manages to have the most expensive system delivering the worst care of any developed country.

Yet: "In 2006, 46.6 million Americans were without health insurance.

Posted by: Jesurgislac | March 09, 2010 at 11:17 AM

You have been misinformed. Truly, I hope you get better. Glad you have access to good treatment.

It is true that more people with health insurance die every year than die without health insurance.

This should be looked into.

It is also true that everyone on Medicare dies.

Everyone in countries with decent health care systems of one kind and another, croak willy-nilly.

And yet folks in underdeveloped countries with no insurance and dilapidated healthcare systems seem to thrive, if you look at population growth.

It turns out that the "death" tax prevents all death because folks just refuse to die and give all of their money to the gummint.

Not a single Republican, and even some Democrats, has died since the "death" tax was introduced.

If the "death tax" is abolished, all of them will keel over immediately, even and especially those on Medicare.

Those who do not seek medical care, but instead petition the Lord for appendectomies, are rewarded with life everlasting.

I hope this humble post raises the level of discourse to Hilzoy-levels.

What folks don't know is that before posting, Hilzoy would practice by shooting fish in a barrel and then falling down laughing and holding her stomach at the ease with which she was going to vanguish her interculutors.

My personal theory is that Hilzoy died from a surfeit of health insurance.

But then I'm a paranoid dyslexic -- I have a suspicious feeling that I'm following someone.

Uncle Kvetch...again, most of your concerns are created by gov'mint, and certainly will not be solved by them.

Yeah, so you keep saying. In the case of my specific concerns, the British government is doing better by Jes than our system is doing by me. She has more freedom to choose her health care providers than I do.

You have been misinformed.

Again, stated as fact, but not argued.

Carry on trolling; you're clearly not worth responding to further.

Even though I completely disagree with most of what UK, Jesurgislac and some others want, politically, they're winning the war of facts by virtue of having some at their disposal, and by requiring them as substantiation for argument.

If you're just making assertions, then you are just another Internet Assertion Monkey. You're not going to convince anyone here, including me, by resorting to I-believe arguments.

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