not to make a big deal of it or anything Socialized Medicine: The Canadian Experience

by Pierre Lemieux

The Canadian public health system is often put forward as an ideal for Americans to emulate. It provides all Canadians with free basic health care: free doctors' visits, free hospital ward care, free surgery, free drugs and medicine while in the hospital -- plus some free dental care for children as well as free prescription drugs and other services for the over-65 and welfare recipients. You just show your plastic medicare card and you never see a medical bill.

This extensive national health system was begun in the late 1950s with a system of publicly funded hospital insurance, and completed in the late 1960s and early 1970s when comprehensive health insurance was put into place. The federal government finances about 40 per cent of the costs, provided the provinces set up a system satisfying federal norms. All provincial systems thus are very similar, and the Quebec case which we will examine is fairly typical.

One immediate problem with public health care is with the funding. Those usually attracted to such a "free" system are the poor and the sick -- those least able to pay. A political solution is to force everybody to enroll in the system, which amounts to redistributing income towards participants with higher health risks or lower income. This is why the Canadian system is universal and compulsory.

Even if participation is compulsory in the sense that everyone has to pay a health insurance premium (through general or specific taxes), some individuals will be willing to pay a second time to purchase private insurance and obtain private care. If you want to avoid this double system, you do as in Canada: you legislate a monopoly for the public health insurance system.

This means that although complementary insurance (providing private or semi-private hospital rooms, ambulance services, etc.) is available on the market, sale of private insurance covering the basic insured services is forbidden by law. Even if a Canadian wants to purchase basic private insurance besides the public coverage, he cannot find a private company legally allowed to satisfy his demand.

In this respect, the Canadian system is more socialized than in many other countries. In the United Kingdom, for instance, one can buy private health insurance even if government insurance is compulsory.

In Canada, then, health care is basically a socialized industry. In the Province of Quebec, 79 per cent of health expenditures are public. Private health expenditures go mainly for medicines, private or semi-private hospital rooms, and dental services. The question is: how does such a system perform?

The Costs of Free Care

The first thing to realize is that free public medicine isn't really free. What the consumer doesn't pay, the taxpayer does, and with a vengeance. Public health expenditures in Quebec amount to 29 per cent of the provincial government budget. One-fifth of the revenues come from a wage tax of 3.22 per cent charged to employers and the rest comes from general taxes at the provincial and federal levels. It costs $1,200 per year in taxes for each Quebec citizen to have access to the public health system. This means that the average two-child family pays close to $5,000 per year in public health insurance. This is much more expensive than the most comprehensive private health insurance plan.

Although participating doctors may not charge more than the rates reimbursed directly to them by the government, theoretically they may opt out of the system. But because private insurance for basic medical needs isn't available, there are few customers, and less than one per cent of Quebec doctors work outside the public health system. The drafting of virtually all doctors into the public system is the first major consequence of legally forbidding private insurers from competing with public health insurance.

The second consequence is that a real private hospital industry cannot develop. Without insurance coverage, hospital care costs too much for most people. In Quebec, there is only one private for-profit hospital (an old survivor from the time when the government would issue a permit to that kind of institution) but it has to work within the public health insurance system and with government-allocated budgets.

The monopoly of basic health insurance has led to a single, homogeneous public system of health care delivery. In such a public monopoly, bureaucratic uniformity and lack of entrepreneurship add to the costs. The system is slow to adjust to changing demands and new technologies. For instance, day clinics and home care are underdeveloped as there exist basically only two types of general hospitals: the non-profit local hospital and the university hospital.

When Prices Are Zero

Aside from the problems inherent in all monopolies, the fact that health services are free leads to familiar economic consequences. Basic economics tells us that if a commodity is offered at zero price, demand will increase, supply will drop, and a shortage will develop.

During the first four years of hospitalization insurance in Quebec, government expenditures on this program doubled. Since the introduction of comprehensive public health insurance in 1970, public expenditures for medical services per capita have grown at an annual rate of 9.4 per cent. According to one study, 60 per cent of this increase represented a real increase in consumption.1

There has been much talk of people abusing the system, such as using hospitals as nursing homes. But then, on what basis can we talk of abusing something that carries no price?

At zero price, no health services would be supplied, except by the government or with subsidies. Indeed, the purpose of a public health system is to relieve this artificial shortage by supplying the missing quantities. The question is whether a public health system can do it efficiently.

As demand rises and expensive technology is introduced, health costs soar. But with taxes already at a breaking point, government has little recourse but to try to hold down costs. In Quebec, hospitals have been facing budget cuts both in operating expenses and in capital expenditures. Hospital equipment is often outdated, and the number of general hospital beds dropped by 21 per cent from 1972 to 1980.

Since labor is the main component of health costs, incomes of health workers and professionals have been brought under tight government controls. In Quebec, professional fees and target incomes are negotiated between doctors' associations and the Department of Health and Social Services. Although in theory most doctors still are independent professionals, the government has put a ceiling on certain categories of income: for instance, any fees earned by a general practitioner in excess of $164,108 (Canadian) a year are reimbursed at a rate of only 25 per cent.

Not surprisingly, income controls have had a negative impact on work incentives. From 1972 to 1987, for instance, general practitioners reduced by 11 per cent the average time they spent with their patients. In 1977, the first year of the income ceiling, they reduced their average work year by two-and-a-half weeks.2

Government controls also have caused misallocations of resources. While doctors are in short supply in remote regions, hospital beds are scarce mainly in urban centers. The government has reacted with more controls: young doctors are penalized if they start their practice in an urban center. And the president of the Professional Corporation of Physicians has proposed drafting young medical school graduates to work in remote regions for a period of time.

Nationalization of the health industry also has led to increased centralization and politicization. Work stoppages by nurses and hospital workers have occurred half a dozen times over the last 20 years, and this does not include a few one-day strikes by doctors. Ambulance services and dispatching have been centralized under government control. As this article was being written, ambulance drivers and paramedics were working in jeans, they had covered their vehicles with protest stickers, and they were dangerously disrupting operations. The reason: they want the government to finish nationalizing what remains under private control in their industry.

When possible, doctors and nurses have voted with their feet. A personal anecdote will illustrate this. When my youngest son was born in California in 1978, the obstetrician was from Ontario and the nurse came from Saskatchewan. The only American-born in the delivery room was the baby.

When prices are zero, demand exceeds supply, and queues form. For many Canadians, hospital emergency rooms have become their primary doctor -- as is the case with Medicaid patients in the United States. Patients lie in temporary beds in emergency rooms, sometimes for days. At Sainte-Justine Hospital, a major Montreal pediatric hospital, children often wait many hours before they can see a doctor. Surgery candidates face long waiting lists -- it can take six months to have a cataract removed. Heart surgeons report patients dying on their waiting lists. But then, it's free.

Or is it? The busy executive, housewife, or laborer has more productive things to do besides waiting in a hospital queue. For these people, waiting time carries a much higher cost than it does to the unemployed single person. So, if public health insurance reduces the costs of health services for some of the poor, it increases the costs for many other people. It discriminates against the productive.

The most visible consequence of socialized medicine in Canada is in the poor quality of services. Health care has become more and more impersonal. Patients often feel they are on an assembly line. Doctors and hospitals already have more patients than they can handle and no financial incentive to provide good service. Their customers are not the ones who write the checks anyway.

No wonder, then, that medicine in Quebec consumes only 9 per cent of gross domestic product (7 per cent if we consider only public expenditures) compared to some 11 per cent in the United States. This does not indicate that health services are delivered efficiently at low cost. It reflects the fact that prices and remunerations in this industry are arbitrarily fixed, that services are rationed, and that individuals are forbidden to spend their medical-care dollars as they wish.

Is it Just?

Supporters of public health insurance reply that for all its inefficiencies, their system at least is more just. But even this isn't true.

Their conception of justice is based on the idea that certain goods like health (and education? and food? where do you stop?) should be made available to all through coercive redistribution by the state. If, on the contrary, we define justice in terms of liberty, then justice forbids coercing some (taxpayers, doctors, and nurses) into providing health services to others. Providing voluntarily for your neighbor in need may be morally good. Forcing your neighbor to help you is morally wrong.

Even if access to health services is a desirable objective, it is by no means clear that a socialized system is the answer. Without market rationing, queues form. There are ways to jump the queue, but they are not equally available to everyone.

In Quebec, you can be relatively sure not to wait six hours with your sick child in an emergency room if you know how to talk to the hospital director, or if one of your old classmates is a doctor, or if your children attend the same exclusive private school as your pediatrician's children. You may get good services if you deal with a medical clinic in the business district. And, of course, you will get excellent services if you fly to the Mayo Clinic in Minnesota or to some private hospital in Europe. The point is that these ways to jump the queue are pretty expensive for the typical lower middle class housewife, not to talk of the poor.

An Enquiry Commission on Health and Social Services submitted a thick report in December 1987, after having met for 30 months and spent many millions of dollars. It complains that "important gaps persist in matters of health and welfare among different groups."3 Now, isn't this statement quite incredible after two decades of monopolistic socialized health care? Doesn't it show that equalizing conditions is an impossible task, at least when there is some individual liberty left?

One clear effect of a socialized health system is to increase the cost of getting above-average care (while the average is dropping). Some poor people, in fact, may obtain better care under socialized medicine. But many in the middle class will lose. It isn't clear where justice is to be found in such a redistribution.

There are two ways to answer the question: "What is the proper amount of medical care in different cases?" We may let private initiative and voluntary relations provide solutions. Or we may let politics decide. Health care has to be rationed either by the market or by political and bureaucratic processes. The latter are no more just than the former. We often forget that people who have difficulty making money in the market are not necessarily better at jumping queues in a socialized system.

There is no way to supply all medical services to everybody, for the cost would be astronomical. What do you do for a six-year-old Montreal girl with a rare form of leukemia who can be cured only in a Wisconsin hospital at a cost of $350,000 -- a real case? Paradoxically for a socialized health system, the family had to appeal to public charity, a more and more common occurrence. In the first two months, the family received more than $100,000, including a single anonymous donation of $40,000.

This is only one instance of health services that could have been covered by private health insurance but are being denied by hard-pressed public insurance. And the trend is getting worse. Imagine what will happen as the population ages. There are private solutions to health costs. Insurance is one. Even in 1964, when insurance mechanisms were much less developed than today, 43 per cent of the Quebec population carried private health insurance, half of whom had complete coverage. Today, most Americans not covered by Medicare or Medicaid carry some form of private health insurance. Private charity is another solution, so efficient that it has not been entirely replaced by the Canadian socialized system.

Can Trends Be Changed?

People in Quebec have grown so accustomed to socialized medicine that talks of privatization usually are limited to subcontracting hospital laundry or cafeteria services. The idea of subcontracting hospital management as a whole is deemed radical (although it is done on a limited scale elsewhere in Canada). There have been suggestions of allowing health maintenance organizations (HMO's) in Quebec, but the model would be that of Ontario, where HMO's are totally financed and controlled by the public health insurance system. The government of Quebec has repeatedly come out against forprofit HMO's.

Socialized medicine has had a telling effect on the public mind. In Quebec, 62 per cent of the population now think that people should pay nothing to see a doctor; 82 per cent want hospital care to remain free. People have come to believe that it is normal for the state to take care of their health.

Opponents of private health care do not necessarily quarrel with the efficiency of competition and private enterprise. They morally oppose the idea that some individuals may use money to purchase better health care. They prefer that everybody has less, provided it is equal. The Gazette, one of Montreal's English-speaking newspapers, ran an editorial arguing that gearing the quality of health care to the ability to pay "is morally and socially unacceptable."4

The idea that health care should be equally distributed is part of a wider egalitarian culture. Health is seen as one of the goods of life that need to be socialized. The Quebec Enquiry Commission on Health and Social Services was quite clear on this:

The Commission believes that the reduction of these inequalities and more generally the achievement of fairness in the fields of health and welfare must be one of the first goals of the system and direct all its interventions. It is clear that the health and social services system is not the only one concerned.
This concern applies as strongly to labor, the environment, education and income security.5

A Few Lessons

Several lessons can be drawn from the Canadian experience with socialized medicine.

First of all, socialized medicine, although of poor quality, is very expensive. Public health expenditures consume close to 7 per cent of the Canadian gross domestic product, and account for much of the difference between the levels of public expenditure in Canada (47 per cent of gross domestic product) and in the U.S. (37 per cent of gross domestic product). So if you do not want a large public sector, do not nationalize health.

A second lesson is the danger of political compromise. One social policy tends to lead to another. Take, for example, the introduction of hospital insurance in Canada. It encouraged doctors to send their patients to hospitals because it was cheaper to be treated there. The political solution was to nationalize the rest of the industry. Distortions from one government intervention often lead to more intervention.

A third lesson deals with the impact of egalitarianism. Socialized medicine is both a consequence and a great contributor to the idea that economic conditions should be equalized by coercion. If proponents of public health insurance are not challenged on this ground, they will win this war and many others. Showing that human inequality is both unavoidable and, within the context of equal formal rights, desirable, is a long-run project. But then, as SaintExupery wrote, "Il est vain, si l'on plante un chene, d'esperer s'abriter bientot sous son feuillage."6

1. Report of the Enquiry Commission on Health and Social Services, Government of Quebec, 1988, pp. 148, 339.
2. Gerard Belanger, "Les depenses de sante par rapport a l'economie du Quebec," Le Medecin du Quebec, December 1981, p. 37.
3. Report of the Enquiry Commission on Health and Social Services, p. 446 (our translation).
4. "No Second Class Patients," editorial of The Gazette, May 21, 1988.
5. Report of the Enquiry Commission on Health and Social Services, p. 446 (our translation).
6. "It is a vain hope, when planting an oak tree, to hope to soon take shelter under it."

Mr. Lemieux is an economist and author living in Montreal.
minnesota_chris a friend of mine, from Manitoba, complained that her father had to wait months for a heart procedure. Which made me think, does she think that her father should get a heart operation faster than a poor guy? 040421
pete if it wasn't for socialized medicine both of my grandmothers, and my only surviving grandfather would be dead right now. my mom and two aunts would have the thyroid disease, and i may have never been able to do anything physically because of my asthma caused by those who can afford it pumping shit in to the atmosphere with the SUV's and many plane flights on trips to places i will never be able to visit, from the coal from the power plants they own, from the factories they refuse to make environmentally friendish because it costs them too much. they pay for what they cause as much as we pay for what we are afflicted with.

canadian health care is (1) cheaper per capita then the flawed american system, remember you have a higher gdp than us, and we don't mind the public sector, it is very well likely what is keeping quebec in canada and provides us with countless employment oppurtunities. (2)political comprimise, as your article calls it, is only bad if we are obsessed with profit over personal health. and (3)inequality is preferable when the rich care to stay that way.

i have mostly given up caring about politics, but some things rile me. like private health care.
Strideo <_< . . . yeah, and a mean evil rich person stole my breakfast and gave me a wedgie this morning
pete thanks strideo.. that was a first class perversion of what i was saying *rolls eyes and moves on caring to leave political bullshit behind* 040421
Sixstop Okay, sparky. Let us consider the "total perversion" of what was already a shaky grasp not only on logic, but on the English language. Whatever life critical health care your grandparents received isn't clarified, so I throw that out, but "the thyroid disease" the matrons of your line is a little nebulous so lets look at some experts info from Causes of any of the different thyroid diseases include radiation, unbalanced diet, certain illegal drugs, or a side effect of a thyroid cancer operations. I'll give them the benefit of the doubt and strike out any lithium consumption just because I'm nice, and you haven't mentioned any cancer in the family or living conspicuously close to a nuclear power plant, so we'll rule those two out. All that remains are things that pretty much everyone in the continent could possibly face. Not only that, there is no cure, only lifestyle changes, so if they ever had it diagnosed, they've still got it.

As far as your asthma from people pumping gas, why don't you move to Georgia where there is serious air pollution that is generated by the most powerful enterprise on the planet every March thru May. That would be mother nature, and the polution is pollen that blankets the region easily outweighs all other airborn pollution generated by manufacturing and industry annually. The counts reached 6000 this year, and stayed above 4000 for weeks. The populace still, for some strange reason, despite the smog and pollen pollution, aren't dropping dead or running screaming for inhalers. . .

And what's with the line about planes going to places you'll never see? I think Strideo was right on. What has your jealousy of people who fly places you'll never see have to do with socialised medicine? Or is that something else you've convinced yourself everyone should be entitled to? And who is 'they' who own coal power plants? Maybe if environmental weenies would shut up about things they want to scare people with to convince voters to elect them, maybe we'd have more NUCLEAR power and not have to rely upon combustion power generation. . .maybe even not depend on mideastern crude as much.

And "pay for what they cause and much as we pay for what we are afflicted?" That doesn't even make any sense.

As far as the per capita income cost of health care, let us also consider that this is because the American medical system pays for private research in the billions into drug development. No government money for research there; straight up capitalists invest in the research & development of drugs to treat cancer, aids, genetics disease, you name it. This headwork is what allows socialist medicine bodies to thrive as cheaply as you brag because they don't have to deal with the problem. If socialised medicine is so great, why don't socialist nations ever have the newest treatments and on the cusp of breakthroughs?

And your public sector? The one where an entire city wants to become independant but not pay off any of the radical socialist state debt they've accrued?

And your rich envy really shines with the last part. Inequality is preferrable when the rich prefer to stay that way, eh? So we must punish them for having more than you? Way to close that logic gate there, sparky.

No-one has a right to health care. Most especially people who abuse their bodies. The fat, the suicidal, the drug addicted, the anorexic, the mentally and socially broken, the emotionally frail. None of these people have a right to health care for free any more than the crippled, the disabled, the deformed, diseased, sick or wounded.

The idea of socialised medicine starts with one premise; you have the right to take something at the expense of another.

There is no justification of this you will be able to lay down here of that broken premise. And FORCING you to accept the government as your health care giver is facist. You complain about the rich conspiring, but this is a true revealing character of the socialised government organisation. THEY want all the money so they can spend it and expand government and stay in power. They FEAR privitization because some doctor might come along and be able to do it better, faster, and cheaper. Free competition is POISON to them.

But you've already been condition to think you're entitled to something you're not because of government schools. You're trained to think that rich people must be punished because they've taken from someone who deserves it more somewhere. Your government school has neatly succeeded in endoctrinating you to believe the government knows how to do things better than you the individual no matter what. As Alan Keyes, a great American, said; "Do we really think that a government-dominated education is going to produce citizens capable of dominating their government, as the education of a truly vigilant self-governing people requires?"

. . .you know, I don't know why others like to rag on American's as ill educated when clearly the Canadian government schools needs some English refreshers. . . .
notme 040422
p2 perhaps when it first started
canada's socialized_medicine was great
but the plan is flawed
and will break down under its own

don't like statistics?
too bad
unless you'd like to argue
based on vague generalizations
and unsupported hearsay

the question here is
how to measure "good" health care
if by good, you mean free for all
you are mistaken
it is not free
it is paid for by taxes
canadians pay a higher income tax for a reason
if you mean more advanced
you should know that canada does very little medical research
my favorite quote on this is:
"In healthcare as in defense, Canada piggybacks for free on Americas costly efforts."
if you mean more available to everyone
let me quote some more of those dreaded statistics:
"Every year Canadas leading free-market think-tank, the Fraser Institute, compiles waiting times across Canada in a report called Waiting Your Turn. Here are some highlights from this years [2002] edition.

"Median waiting time for radiation treatment for breast cancer in province of Ontario: 8 weeks
"Median waiting time for angioplasty in the province of British Columbia: 12 weeks
"Median waiting time for radiation treatment for prostate cancer in province of Quebec: 12 weeks
"Median waiting time for cataract removal in the province of Ontario: 20 weeks.
"Median waiting time for cataract removal in the province of Saskatchewan: 52 weeks.
"Median waiting time for a tonsillectomy in the province of Saskatchewan: 80 weeks."
80 weeks for a tonsillectomy!?!?!
true, these are statistics from 2 years ago
but i doubt things have changed all that much
and if you mean good in terms of cost
that cost is kept down by paying doctors and nurses less
this has caused an exodus of health care professionals from canada
as well as the inability of doctors to afford expensive equipment in their offices
resulting in a lower quality service

p2 one more thing
about the "cheaper per capita"

"The gap between Americas spending on patient treatment and Canadas is not as big as the raw percentages might suggest. For example, Americas 14% figure includes the cost of the vast American medical research program. The budget of the National Institutes of Health alone - $27 billion in fiscal 2003 is larger than the total healthcare expenditures of the provinces of Ontario and Quebec combined. (The provinces are the main funders of Canadian healthcare; Ontario and Quebec are the two biggest provinces, home between them to more than half of Canadas population.) Canada does little medical research."
p2 and another thing
if you think canada's socialized_medicine
has equalized health care for everyone
you are sadly mistaken
rich canadians do not wait weeks for an operation
they fly into america and get it done when they need it
the ones who suffer are the middle class
who cannot afford to fly to another country
and also pay for the surgery
what ends up happening
is an increase in disparity
in the level of health care
between the rich
and everyone else

ps- with my fiancee's family history of breast cancer
i'm sure as hell glad
i don't live in ontario
"hi, eh?
we've found that you have breast cancer developing, eh?
you can get your first radiation treatment
in about 2 months, eh?"
Smurf I swear to god if you say Eh one more time!! 040423
Smurf Don't use Canada as an example for Current Day Socialized Healthcare. We're going through a bit of a rough time at the moment and it's not as good as it used to and could be.
Don't think that just because it's flawed at the moment that it will stay that way and don't think that just because it's flawed in canada It won't work anywhere else.

And Not All Canadians Say EH!
nomme 040423
nomme times are tough.
the canadian system needs improving, yes. but that doesn't mean it can't or won't work in the future.
the real problem, as far as i can see, is mismanagement of funds. there is, and has been, a lot of corruption in government.

i believe everyone has a right to healthcare. i think everyone should be taken care of.

p2 not all canadians say "eh"?
you mean like
not all southern california skies are covered by smoke?
and like
not all american girls are obeses?
and like
not all western horizons in ohio are blocked by the colt factory?

what's even more hilarious
is that you can only respond to "eh"
what about the words around it?
my main point is the 2 months of waiting
while the cancer continues to grow
and you throw a hissy fit
about the use of "eh"

and don't tell me i can't use canada
as an example of current day socialized healthcare
1) it is the current day
2) canada has socialized healthcare
it is *indeed* an example of
current day socialized healthcare

but you should also note
i never said it was representative of all socialized healthcare
every blathe i made
was very specific about being about canada
i am not prone to making unfounded generalizations
i never even said all canadians say "eh"

my whole point
was to respond to your question
under "americans"
you seem to be content
pointing out problems in america
but when i point back
suddenly you get all defensive
you called americans ignorant
and yet you don't know the state
of your own healthcare system

to paraphrase that long haired dude
who walked on water
"let you who is without
ignorant countrymen
and problems in government
cast the first stone"
p2 from:

"And lest one thought that Americas health care crisis is unique in the industrialized world, it ought to be noted that countries which recognized decades ago that health care was a social responsibility, are faced with their own dilemmas."

"Their universal health care systems are overwhelmed by exploding costs and demographic trends that seriously put into doubt their long-term financial viability. The chart below shows the demographic challenges of three selected economies by the year 2025, compared to their historical data in 2000."

"Meanwhile, Japans system of socialized medicine has contained costs, but at a heavy price. For example, 26,200 patients in the United States were reported to have received implantable defibrillators in 1996 compared to only 100 in Japan. In most of Europe, it has become clear that health care is a scarce commodity and that blanket coverage will bankrupt the system."

this is a pro-socialized healthcare article
p2 "Some cosmopolitan readers note that other single-payer systems, Germanys usually, deliver more satisfactory results than do Canadas and Britains. Thats true precisely because the German system is much more decentralized and offers more choice (and demands more responsibility) than do Canadian Medicare or Britains NHS. Some socialized healthcare systems are more socialized than others, and the more socialized they are, the worse they do." 040424
Smurf Wow you're getting a bit rialled up.
Just a sec i'll read through it all before responding....
Smurf ok
1. I'm not canadian. I just live there at the moment.

2. Never said anyting directly to you so don't take it so personally, My post in 'America' was meant to be humerous so don't get pissy about my generalization. I'm well aware that America is a big place and it's not all the same.

3. You say that every post you made was very specific to Canada, and yet you treat the problem as if it's with Socialized Healthcare overall. Not sure how that works.

4. No idea who 'That long haired dude who walked on water' is. Does he have a name?

I'm still reading...
Smurf I make plenty fun of Canadians too so don't get no ideas that I'm anti-American like some other people up here. 040424
Smurf I admitted in my first post that Canada's healthcare was f***ed up. 040424
sixstop Well, if you won't say its broken. . .I will. Socialised medicine is a broken concept from the beginning.

Maybe if there is a paradigm shift or event horizon in medicine. . . .then perhaps the idea becomes realistic. . .

Until then. . .mother nature is likely to continue throwing us curveballs like AIDS which we, after almost 25 years STILL have no reall progress against, except a possible vaccine we're not sure works, and a generation that thinks condoms will prevent everything.

Thank you social programs for that nonsense.
p2 1) so what do you consider yourself?
you obviously don't consider yourself an american
because you refer to americans
as "they" under "americans"
and yourself
as one of "we" right here
as in "we're going through a bit of a rough time"

2) hating america has become a global pasttime
even among some americans
so i may be a little over sensitive
but then again
was your blathe under "americans"
meant in the same humor?
i doubt it

3) every post prior to 040424
was clearly labelled "canada's socialized healthcare"
since your response
i took it upon myself
to look into other countries
and have found them wanting as well
in fact
i'll go one further than sixstop
and say the system is flawed
not based on social programming
but by human nature
and the same is true for communism
it's a nice idea
but it'll never work in a practical manner

4) that would be the big j-man
that's right
j to the e to the s-u-s
even as an american atheist
i know the story of walking on water
that's where the term
"doubting thomas" came from
and casting the first stone
refers to when a group wanted to stone to death
a woman who had commited adultery
there's more to the story
but i don't need to get into it here)
Smurf Don't say communism can't work, and don't say Socialism can't work, after all no one's even tried it yet! 040427
Strideo Hmmm. Then I guess you've never heard of a fellow named Mao Tse-tung?
Smurf Hmmm, good point, it's working so far though, china is the third country into space and, aside from some strict censorship and the overwhelming population, it's a fairly decent place to live. 040428
p2 <isth>of course
because the measure of the greatness of a country
is its space program</isth>

if you ever decide to identify with a nationality
i hope it's not american
because you would add to the argument that

i could easily argue how great china is doing & how it's related to the country becoming more capitalistic
and list other attempts at communism & socialism which you claim hasn't been tried yet
and basically make it obvious that you don't know what you're talking about
as i have done with socialized_medicine
but perhaps its time for you to learn how to look things up on your own

btw, the following statement is true of any country:
"aside from its problems,
it's a great place to live"
may i assume that you've lived in china before
or would that be too logical?
sixstop highly illogical 040429
p2 if he claims to know
what it's like to live in a country
it must be
because he's lived there before

either that
or he's just full of it

seems logical enough to me
Smurf I lived in China for 11 months, Didn't mind it one bit.

Aside from that you have no arguments, you just critisize my own, if you insist on calling me an idiot, please proove that you are not.
p2 easy
i don't make the statement
that there have been no attempts at communism
after having lived in china for 11 months
i'd be an idiot
p2 btw
i gave you the benefit of the doubt
and didn't start off assuming you were an idiot
but you sure convinced me after a while
with such gems like:
"don't use canada as an example for current day socialized healthcare"
"don't say communism can't work, and don't say socialism can't work, after all no one's even tried it yet"
"aside from strict censorship and the overwhelming population"
and let's not forget
"freedom [...] in my opinion, it's also over rated"
sixstop like i said. Highly Illogical 040430
Smurf true communism hasn't been tried yet, this is true, just read the Communist Manifesto and you'll realise this.

Secondly, Don't quote part of my posts, quote all of them or not at all else you miss the meaning!
You've made no point in all of your last posts, just tried to manipulate my own words to make me seem dumb, I don't know why you don't like me, I don't care why you don't like me, BUT SHUP UP! because you've got nothing on me, I wouldn't be surprised if you told me you were a politician, that's exactly what your acting like.
Smurf I'm going to ignore any furthur posts by you, unless you say something meaningfull. 040501
Smurf I'd like to appologise to the blather board for taking up so much space on pointless bickering, I shouldn't have responded at all. 040501
Smurfette P2 you got burned 040501
geezer 3rd Degree burned 040501
unhinged weed 040501
p2 you're right
this doesn't belong here
see: smurf
sixstop yeah joo gotz t0tt2//y pwned.

. . .yeah. . .
Strideo Watching P2 and Smurf debate was like watching someone try to get a one armed dimwit out of a tree.

P2 just had to wave.

"Secondly, Don't quote part of my posts, quote all of them or not at all else you miss the meaning!"

Quoting your opponent in a debate is a perfectly acceptable way to point out a difference in opinion. Besides its not like we couldn't find your other posts and I don't think those quotes are really out of context (that would be assuming there was a context to begin with, you know, like an actual arguement.)

"I don't know why you don't like me,"

Gee, could it be because you were insulting his nationality, his ideas, and his intelligence with all that anti-american rhetoric?

"I don't care why you don't like me, BUT SHUP UP! because you've got nothing on me, I wouldn't be surprised if you told me you were a politician, that's exactly what your acting like."

Oh don't be a baby.

"I'm going to ignore any furthur posts by you, unless you say something meaningfull."

No, really, don't be a baby.
sixstop The Fraser Institute, a Vancouver, B.C.-based think tank, has done yeoman's work keeping track of Canada's socialized health-care system. It has just come out with its 13th annual waiting-list survey. It shows that the average time a patient waited between referral from a general practitioner to treatment rose from 16.5 weeks in 2001-02 to 17.7 weeks in 2003. Saskatchewan had the longest average waiting time of nearly 30 weeks, while Ontario had the shortest, 14 weeks.

As reported in a December 2003 story by Kerri Houston for the Frontiers of Freedom Institute titled "Access Denied: Canada's Healthcare System Turns Patients Into Victims," some instances, patients die on the waiting list because they become too sick to tolerate a procedure. Houston says that hip-replacement patients often end up non-ambulatory while waiting an average of 20 weeks for the procedure, and that's after having waited 13 weeks just to see the specialist. The wait to get diagnostic scans followed by the wait for the radiologist to read them just might explain why Cleveland, Ohio, has become Canada's hip-replacement center.

Adding to Canada's medical problems is the exodus of doctors. According to a March 2003 story in Canada News (, about 10,000 doctors left Canada during the 1990s. Compounding the exodus of doctors is the drop in medical school graduates. According to Houston, Ontario has chosen to turn to nurses to replace its bolting doctors. It's "creating" 369 new positions for nurse practitioners to take up the slack for the doctor shortage.

Some patients avoided long waits for medical services by paying for private treatment. In 2003, the government of British Columbia enacted Bill 82, an "Amendment to Strengthen Legislation and Protect Patients." On its face, Bill 82 is to "protect patients from inadvertent billing errors." That's on its face. But according to a January 2004 article written by Nadeem Esmail for the Fraser Institute's Forum and titled "Oh to Be a Prisoner," Bill 82 would disallow anyone from paying the clinical fees for private surgery, where previously only the patients themselves were forbidden from doing so. The bill also gives the government the power to levy fines of up to $20,000 on physicians who accept these fees or allow such a practice to occur. That means it is now against Canadian law to opt out of the Canadian health-care system and pay for your own surgery.

I'm wondering just how many Americans would like Canada's long waiting lists, medical czars deciding what treatments we get and an exodus of doctors.

---Walter Williams
Strideo socialism and fascism go hand in hand.

after all it takes fascist rules to enforce a socialist system.
monee "...An impressive array of data shows that Canadians live longer, healthier lives than we do. What's more, they pay roughly half as much per capita as we do ($2,163 versus $4,887 in 2001) for the privilege.

Exactly why Canadians fare better is the subject of considerable academic debate. Some policy experts say it's Canada's single-payer, universal health coverage system. Some think it's because our neighbors to the north use fewer illegal drugs and shoot each other less often with guns (though they smoke and drink with gusto, albeit somewhat less than Americans).

Still others think Canadians are healthier because their medical system is tilted more toward primary care doctors and less toward specialists. And some believe it's something more fundamental: a smaller gap between rich and poor.

Perhaps it's all of the above. But there's no arguing the basics.

"By all measures, Canadians' health is better," says Dr. Barbara Starfield, a university distinguished professor at Johns Hopkins Medical Institutions. Canadians "do better on a whole variety of health outcomes," she says, including life expectancy at various ages.

According to a World Health Organization report published in 2003, life expectancy at birth in Canada is 79.8 years, versus 77.3 in the U.S. (Japan's is 81.9.)

"There isn't a single measure in which the U.S. excels in the health arena," says Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle. "We spend half of the world's healthcare bill and we are less healthy than all the other rich countries."

"Fifty-five years ago, we were one of the healthiest countries in the world," Bezruchka continues. "What changed? We have increased the gap between rich and poor. Nothing determines the health of a population [more] than the gap between rich and poor."

Gerald Kominski, associate director of the UCLA Center for Health Policy Research, puts the Canadian comparison this way: "Are they richer? No. Are they doing a better job at the lower end of the income distribution? For lower-income individuals, they are doing a better job."...

"The summary of the evidence has to be that national health insurance has improved the health of Canadians and is responsible for some of the longer life expectancy," says Dr. Steffie Woolhandler, an associate professor at Harvard Medical School and staunch advocate of a single-payer system.

Of course, some causes of death, such as homicide, wouldn't be much affected by having a single payer system. And the U.S. has "the highest homicide rate of all the rich countries," says Bezruchka.

"Other things might be differences in seat belt usage," adds Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. "We are also disproportionate consumers of illegal drugs, much more than Canada, so it's cultural."

The health of Americans would be better with universal healthcare, he says.

"But there are some things that a single-payer system wouldn't fix but which would leave one country looking healthier in the statistics."

In some respects, the healthcare system is "the tail on the dog," says Dr. Arnie Epstein, chairman of the department of health policy and medicine at the Harvard School of Public Health.

"It's other aspects of the social fabric of different countries that seem to have a major impact on how long people live," he says...

The bottom line is that Canada is doing something right, even if "the reasons are not totally understood," says Kominski of UCLA..."

unhinged the fascist rules of american health insurance (quite literally 'profits over people') and the tens of thousands of americans that die every year because they can't pay for healthcare leads to socialism how exactly?

the fascist practice that insurance companies buy our government and therefore their existence leads to socialism how exactly?

the fascist (and right wing) mandate of the affordable care act leads to socialism how exactly?

i should be able to go to a doctor when i am sick without worrying how i am going to pay for it; the canadian system is not the best system in the world when it comes to socialized medicine. there are better examples.

if american healthcare is so great that canadians come here for it then why do a lot of the people in my parent's retirement community in arizona go to mexico for healthcare, especially pharma and dental?
unhinged from the book 'the fears of the rich, the needs of the poor: my years at the CDC' by william foege

'...a half-century ago, people were worried about socialized medicine without understanding that capitalism would soon take over medical care in the united states. now profit drives the system, and because of that, it is possible to violate the First Do No Harm dictate repeatedly each day. it is as if we were told in school to do no harm unless money is involved.

we stand embarrassed to spend more per capita on health care than any other country; yet, we cannot match health outcomes of the tope twenty countries around the world (!!!!). we proudly promote the marketplace as the way to deliver health care without acknowledging the vast majority of those countries have single-payer systems. are we interested in promoting the marketplace or promoting health? and isn't the burden on us to sow that the marketplace can do better rather than continuing to just say it?

the way out of this ethical dilemma is to have a single-payer system in which all are treated EQUALLY and health results become the standard for measurement. at present, the marketplace pays for process rather than outcome, and prevention is not a billable commodity. in the single-payer system, payments could highlight results in terms of morbidity and mortality. results cannot always be measured for individual patients, but aggregate results can point out which programs should receive financial rewards.

this problem is not limited to medicine. the people for whom we vote make decisions on food stamps, medical coverage, education support, and research appropriations. when they vote not to provide early education, medical care, prevention, or medicaid expansion, we as voters kill through errors or omission.

in addition, is is a false argument to say that it is other the marketplace or socialized medicine. our military is superb. it is based on a single-payer system but it is then expected to use the marketplace to acquire the commodities and systems required. medical care could use the same approach. somehow, the opponents of a single-payer system seem to imply that advocates are unpatriotic. the same argument is not made about advocating a single-payer system for the military.


the marketplaces is the other barrier, and it has failed the american public. over a half-century ago, as i was completing my training, the american medical association bombarded us with materials on the king-anderson bill, on how such efforts in political circles would reduce the freedom of doctors to make their own decisions and on the dangers of socialized medicine. never did that organization point out that the marketplace might be more dangerous to the health of americans than socialism would be. but that is exactly what happened. when profit became the bottom line, quality, equity, and OUTCOMES all suffered. compensation began to focus on process, rather than outcomes...

we simply cannot rely on the marketplace to reduce the health impact of tobacco when profits are made by selling tobacco. we cannot rely on the marketplace to reduce the risk of antibiotic-resistant bacteria. the great improvements in global health, in recent decades, are not the result of the marketplace. we should monitor the marketplace, and when it hurts the health of people, we need to find ways to correct the problem. currently, the US marketplace has allowed the price of medical care to be higher per capita than any other country, and, despite that expenditure, we cannot even be in the top twenty countries of the world in terms of health outcomes. it is an absolute embarrassment for a country that prides itself on its can-do attitude and management skills.


the facts are that health indices of the united states - life expectancy, infant mortality, and chronic disease burdens - are not as good as in other industrialized countries. and these, after all, are the reasons for having a health care system. it is in place to reduce premature mortality and unnecessary suffering, not as a way to make money on illness. that should set of alarm bells that something is not working. we spend far more per person on health care than any other country and still CANNOT match their outcomes. these facts should lead logical people to conclude that our system is not optimal.

frequently, the response from politicians is, 'we have the best health care system in the world, and we do not want to jeopardize it through socialized medicine.' they are wrong. the united states does not even make it to the top twenty countries in the world when measuring health outcomes. it is an embarrassment to realize that one-third of our health care expenditures do not go to health outcomes at all (!!!!). they instead pay for the unneeded superstructure of insurance plans and managers that proliferate when profit, rather than quality and health outcomes, is the bottom line. most of the twenty-plus countries with better health outcomes have single-payer systems. our national response is that only the marketplace can improve health care delivery. if that is the case, why don't we prove it rather than just say it? a single-payer military system still allows for the use of marketplace forces to provide commodities and services. the united states continues to lead in expanding the science base of medicine. but it falls far behind other industrialized countries in improved health outcomes, coverage of the poor, and health equity.'

amen william. afuckignmen
unhinged facts are the weapons in the battle of ideas. as william says, in a logical world, the facts he illustrates would be the death of health insurance companies.


our freemarket mythology, our rabid individualism, our corrupt politics make it seem completely impossible.
what's it to you?
who go