Health-care tale from abroad

The good news is that many Americans (such as Ezra Klein, kinda) have fallen out of love with the Canadian system as a model for health care, after they've gotten a decent look at it. Others (such as this example) haven't:

I'm not saying that Canada's approach is perfect. I am sure that it has its troubles, too, but it looks to me that they are doing a better job of caring for their citizens and that we could learn a thing or two from their approach.

However, north of the border, passions are aflame due to the decisions of an administrator of health care in the country. I remember weekends in Montreal where emergency room wait-times exceeded 24 hours. Danny Williams, premier (equivalent of governor) of Newfoundland decided in was in his interest to avoid the Canadian system:

An unapologetic Danny Williams says he was aware his trip to the United States for heart surgery earlier this month would spark outcry, but he concluded his personal health trumped any public fallout over the decision.

Later on, Williams defended his decision, because "this was my heart, my choice and my health". The premier of each province is responsible for administrating health care in his province and is presumably more familiar with his/her system than any other person. Yet Premier Williams -- like Canadian Prime Minister Brian Mulroney years ago -- ducked out to Florida for care he didn't want to get in Canada.

Living in Canada for about six years, I can't and won't blame either one of them one bit. Wait times were atrocious, medical technology obsolete, and understanding of medicine too often questionable. Now, I am fortunate to be in the 84% of Americans who have health insurance. Before that, I was in the significant number of Americans in the remaining 16% who chose not to have it because I was in decent enough physical health.

Of course the system needs reform, for many reasons. However, whatever form that takes I hope it isn't the kind that gives some 30% of Americans better health care, and drives the other 70% to the point where they get care outside of the country if at all possible.

This isn't the way to do it

For anyone still agitating that Democrats in the House must vote to push the Senate version to Obama's desk, let me remind them of two consequences:

1. It makes the "Nebraska exception" law. It was embarrassing enough that it was even in a bill (heck, even Senator Nelson was trying to backtrack it) but now the Democrats will write it into the books. This follows us into November and beyond.

2. The law hits people with medium- to high-value health plans with a 40% tax on those plans. Let me repeat this -- people with a good health plan will pay a 40% tax on the value of that. Some of those people are rich, lawyers and stockbrokers, etc. And it is virtually every cop, firefighter, nurse, doctor, and teacher in the country. Five groups that are middle-class and provide enormous union muscle and money to politics (of particular use in the wake of today's Supreme Court decision). If Obama and Pelosi decide that members of those five groups should pay hundreds, if not thousands, more in tax, there will far fewer Democrats on the rolls, at the polls...and in office.

Finally, anyone who still says that placing a new financial burden on the poor ("individual mandate") is synonymous with extending coverage, you're lying to yourself. You may as well just force all Americans to buy a computer, and announce who you've expanded Internet access around the country.

Three years ago, if someone you were asked which political party would force all Americans to buy health insurance from HMOs without a public option, place a huge tax burden that disproportionately affects government workers, and carve out a special exception for Nebraska...would you have said the Democrats? Amazing how people eagerly lower their standards.

Collection of thoughts....

• It sure is strange to read high-profile blog posts and receive nationwide blast emails asking for help to move the vote in Massachusetts. After a lifetime of being taken for granted by American Democrats, it is a bit odd to be the receiver, not driver, of help. I'm not saying I want to be New Hampshire, where presidential candidates offer to scratch my a-- every day for two months, but it is nice.
  
  
• Fact is, though, Coakley's a rotten candidate. After accepting the primary victory, she (and her team) seem to have gone into hiding. I've gotten zero mail from her, and nothing on the phone. Then again, it says something for these high-charging political consultants that my cell number has been my sole number for over 5 years, and nobody in the political universe has gotten their hands on it yet.
  
  
• Obama lied to me. After promising not raise taxes on any family making under $250,000 Obama is backing a plan that would entail a tax hike. Obama backs a plan that would put a 40% excise tax on "Cadillac health care plans". My health care plan somehow qualifies, and my family makes less than a fifth of this $250,000 limit. Then again, my mistake must be in choosing public service that offers decent benefits to compensate for the low pay rate of qualified workers. I'd have been better off as one of those investment bankers who receive tender care from Obama.
  
  
• It's crap like that that's leaving Coakley on the ropes. That, and the whole not-campaigning thing.
  
  
• A local bank has come up with a cutesy campaign urging people to have a "game plan" for their retirement. The cutesy poster is accompanied by the traditional "x and o" format of a football play. Unfortunately for these geniuses, anyone the least bit versed in football recognizes the play as a Hail Mary -- the long-shot play you uncork only in desperate circumstances. Doesn't anyone in the banking world play Madden?
  

Kerry pushes feds to provide lethal "medicine"

Picked up in many places this month (and today on Daily Kos) is the surprising and decidedly un-liberal maneuver John Kerry is doing relative to the health care reform proposal. Members of the Boston-based Church of Christ, Scientist refuse medical care in favor of prayer, a practice that is described in the Washington Post:

Prue Lewis listens as they explain their symptoms... Then Lewis -- a thin, frail-looking woman from Columbia Heights -- simply says, "I'll go to work right away." She hangs up, organizes her thoughts and begins treating her clients' ailments the best way she knows how: She prays....Christian Scientists call it "spiritual health care," and it is a practice they are battling to insert into the health-care legislation being hammered out in Congress.

Front and center in the effort to purloin public money for this religious practice is Senator John Kerry (D-MA). Approving this destructive practice in government health care is a ridiculous divergence from best practices. I gather that the public option would be funded by Americans who choose to enroll, thus dodging any real church and state separation concerns. Of much greater concern is that many Christian Scientists have been criminally charged for allowing family members to die of curable diseases this way (a couple was convicted of involuntary manslaughter in Massachusetts in 1993). The last thing we need is the federal government implicitly improving such a lethal practice.

I just can't understand why Kerry would want to promote a religious practice that has had the practical effect of killing innocents. Along with Orrin Hatch and the late Ted Kennedy, Kerry made sure this provision made it into the Senate version of the bill. Though the church is based in the Senator's (and my) state, his obligation is to all citizens of the Commonwealth, and the country. This isn't just the church-state question as UniversalHub flags it. Much worse is the idea of a pseudo-liberal Senator pushing the government to provide, promote, and support a practice that results in the deaths of innocents -- the exact opposite of what health care reform is supposed to do. And the opposite of the kind of clear thinking that John Kerry was elected to exercise.

A process, not a product

Remember back in the dark days of the Bush presidency, when most progressives would have given anything to make a public health-care regime happen? Yeah, now that we're there, the tune has changed. With an initial bill -- not even near final bill status -- to read, people are hitting the brakes. People I admire (the indefatigable Deb Butler, and Martha Coakley) are finding this or that provision that is disagreeable in the bill, and declaring that the whole thing should be shot down. Perhaps we'll do better next time we try, which would probably be around 2027 or so...

Go ahead and knife the current effort if you want, but if this bill is killed don't expect anyone to try again for a while. Obama has expended gigantic amounts of political capital on this and needs to build some up. Rahm Emmanuel, Nancy Pelosi, and Chuck Schumer are some of the sharpest vote-counters since LBJ. The ombre of Ted Kennedy still hangs over Congress. In the wake of a failed attempt at reform, there'll be many more Republicans in Congress come 2011. Right now is the moment -- if we don't take it, it will not return probably for a generation.

Health care reform is a process, not a product. Canada passed its current health care regime into law in 1984, and they still tinker with it almost weekly. The CBC has mountains of reports of health care improvements, studies, and reports. Canada's system is a work in progress, and so would our system be. Don't doubt that in two years, before the health care system is actually implemented, that Stupak would be lasered out of the system by a smart bill weaving through a pro-choice Congress. Don't be surprised that in four years defects will appear in the system that will need shoring up.

It's a work in progress, if we get there. But first we need something to work on, and that "something" is this bill. Because righteous indignation ain't gonna take care of your cancer when you can't afford a doctor; this bill will.

Scot LeHigh tries other fields

After reading Scot's evident confusion over the legislative process, where voting to push a bill on isn't the same as voting for the final bill, I wonder how things would go if LeHigh had to analyze other fields. This what Scot said about Capuano's vote:

Oh my. For Capuano’s sake, let’s hope the congressional health plan offers coverage for candidates who become so dizzy from turning political somersaults that they suffer self-inflicted injuries to the foot.

Of course, Capuano's position hasn't changed -- he's pushing for health care reform, even if that means changing the button he pushes on his voting thingy at different stages of the process. Something apparently too complex for LeHigh to understand.

So let's ask Scot about football:

Oh my. Belicheck keeps changing his mind about Tom Brady. In one drive alone, he flip-flopped three times! Brady threw the ball...then he didn't. Then he did again. How is any football fan to have confidence in Belicheck if Belicheck can't decide whether Tom Brady should throw the ball??

Scot on the stock market:

Oh my. My stockbroker sure seems to be dizzy. Just three months ago, he told me to buy a stock. A month ago he said to "hold" it. Now today he wants me to sell. I've learned a lot about my stockbroker this season...and it's not good.

Scot on medicine:

Oh my. My doctor sure is out to lunch. I went to see him yesterday and received a flu vaccine. Yesterday, the vaccine was a good thing. So I saw him this morning for another shot, and he said no! Aren't vaccines a good thing? That flip-flopper in a lab coat better not turn me down tomorrow...

Scot on being a pedestrian*

Oh my. The guy walking down Beacon Street in front of me is making me dizzy. For the last two blocks, when he's gotten to the curb, he's kept walking. Suddenly, on this key issue, this key block -- he stops! This idiot better get out of my way, because consistency is what counts no matter the situation, and I'm crossing the street right now no matter what this guy thinks...

*Granted, there's likely no better word to describe LeHigh's writing as pedestrian...

Coakley on "kill the bill" side

Martha Coakley does deserve credit, I suppose. Rather than run a play-it-safe campaign typical of a front-runners, I have to agree with Massachusetts Liberal that Coakley certainly embraced risk by saying she'd have voted against the health care reform bill. Her vote isn't against health care reform, but rather the Stupak Amendment that would prohibit funding of abortion as part of this system:

Attorney General Martha Coakley said yesterday that she opposes the landmark health care bill approved by the House Saturday because it contains a provision restricting federal funding for abortion.

She explained her judgment that

Fighting for women’s access to abortions was more important than passing the overall bill.

The Stupak Amendment wouldn't end access to abortions, though it would probably narrow it. Abortion providers (such as Planned Parenthood facilities) could still offer the procedure in private practice under the Stupak-ed reform. Given that many Midwestern states count less than half a dozen abortion providers, that practice is already under threat. The end result would be fewer, and less accessible abortion providers.

Meanwhile, the bill which it amended would open access to health care to an unprecedented extent in American history. It would slide through a narrow, historic, window of political opportunity -- a Democratic President and Congress spending massive political capital to enact an idea that is standard practice in the industrialized world and was first proposed in this country in 1912. Millions of people would have the access to prevetitive and theraputic care they need.

Let's be clear about this -- a no vote on this health care package in the House would have killed health care reform for another generation. Bill Clinton didn't even get that far and it was 16 years before someone took a kick at the can. Voters who elected Democrats to make it happen would be disillusioned, and the next window of opportunity would likely be in the far future. Instead, Coakley would sacrifice it in the name of abortion access at the same vote when battle-hardened Democratic women such as Maxine Waters kept the push on. I suppose in Coakley's ideal world she could stand on these principles while hard-charging activists for women's rights fold in the name of progress.

I could almost understand Coakley's statement were this the final vote on the bill. But with health care reform still to go through the Senate and conference (where the Stupak Amendment is likely to die) it is a bit early to finish off the bill. Again, this is the furthest that a public health care regime has ever gotten, and I'm amazed that Coakley would be ready to kill it so far from the finish line. It's like giving up on a losing football game at halftime, and refusing to retake the field.

Update: Mike Capuano is showing his experience in Congress by refusing to announce how he'll vote on the final bill...possibly because the final bill doesn't exist yet. Capuano, unlike Coakley, did what he could and what he had to do in order to advance health care to the next -- not final -- stage. For this high-stakes high-wire act, promises are best made by those uninterested or powerless over the consequences. With Capuano, the fight for health care lives another day. With too many like Coakley, it would be dead.

PS: At the end of the day, I think it comes down to not just what is more important (better access to abortion, or any access to health care for millions) but what is more likely (a pro-choice Congress and president building abortion provision into the system post facto, or getting a second go at heath care this decade).

The bare minimmum

The four amendments that I think make a bare minimum of change we need in this thing:

Amend "High-quality, accessible health care services including support services to children and families" in "health care" to "Universal access to high-quality, accessible health care services including support services to children and families building upon the 2006 'Act providing access to affordable, quality, accountable health care'".

Amend the section "economic growth and labor" to include

We support laws and regulations that protect the right to organize workers, including employee free choice.

Amend the section "education" include:

"We support fair and comprehensive assessment of students, educators, and districts that goes beyond high-stakes standardized testing"

Amend the section "revenue and tax expenditures" to include:

"We support progressive income taxation, along the model of the United States income tax."

If you don't think the Democratic platform should include employee free choice, universal health care, fair assessment, and the progressive income tax...why do you think we need a platform at all?

(Placed as a comment over at BMG)

A true story about CanadaCare...why we don't want it here

Perhaps due to its proximity, the health care system of Canada is held up as an example by many folks left of center, from Ralph Nader to Michael Moore, and many (saner) people as well. I hope that this is due to the fact that Canada seems like a friendly efficient country, and their reputation adds a layer of integrity to the idea of a health care plan. Because heaven knows their plan actually sucks.

Fact is, Canadians aren't happy with their wonderful health care system. I lived in Canada for six years, and I can tell you from up close and personal that it isn't what it's cracked up to be. I write this post because of a recent experience of a friend of mine who lives in in Montreal.

She is a professional in the city, earning a notable salary that would command respect in the United States, and would come with a strong health care plan. She was out socializing one night, and had a bad fall, landing with her arm underneath her. Her arm in turn had landed on and broken a glass.

She was taken to the hospital. Where she sat in the emergency room for 7 hours. Seven hours before a doctor saw her. In a metropolitan emergency room. Badgering from her companion did no good.

Eventually, the doctor arrived, shuddered at the damage to her artery, and did the best he could. In a follow-up appointment, the professional said that she would need "emergency surgery" as there was concern that sensation and prehension in this arm could be gone for good.

In that wonderful Canadian health care system, in the second largest city in the country, what's the wait time for this "emergency surgery"?

Twelve days.

That's right...seven hours to be seen in an emergency room, twelve days for emergency surgery. And before you ask, Canadians understand the word "emergency" to have the same meaning as Americans do.
(Now, people who know a lot more than me about government health care plans usually prefer, say, Germany to Canada's model. Fair enough. But any liberal who idolizes Canada for its health care system is ignorant. To take another example, I saw a study in wait times in Canada that amazed me. The statistic that stays with me is this: the average wait time from seeking an appointment over cancer concerns to the first treatment of chemotherapy in the Canadian province of Saskatchewan is 11-13 months.)