We Could Call It 'Fee for Service'

Yesterday the Supreme Court of Canada struck down Quebec's ban on private health coverage, concluding that it violates the province's Charter of Human Rights and Freedoms. The challenge was brought by a patient who waited more than a year for a hip replacement and thought he should be allowed to get faster service by paying for it. He was joined by his doctor, who would like to charge people for treating them. To an American, the fact that these are considered radical propositions in Canada is rather startling, but so is the fact that a Canadian court would overturn economic regulations as a violation of human rights.

Comments

[David Woycechowsky]

TO RCD:
Looks like the laff is on me!!

[Phil]

To an American, the fact that these are considered radical propositions in Canada is rather startling . . .

I've seen these kinds of attitudes from Canadians before. I used to be regular poster on the Straight Dope Message Board, and another reg, a fiercely proud Quebecois, used to bust this kind of stuff out all the time. He thought, for example, that it should be illegal for people to send their children to private schools, because it was antidemocratic and might allow some children to be better-educated than others. He also thought that there should be, like, hostelries set up where people who didn't want to have like, jobs, man, but wanted to write poetry or paint daisies all day could live and be clothed, fed and sheltered on the public dime,

[John]

This might not be a case of La Belle Province going Libertarian on us.

What if you are a Montr?al Canadien and you blow out a knee after taking a Toronto Maple Leaf into the corner?

Are you going to wait a year for surgery? Or are you going to go to a private doctor and have it done the next day?

(Your mileage may vary, depending on if the NHL exists any more.)

[The Wine Commonsewer]

You know, Jacob is right. That is a startling bit of news.

[jc]

He also thought that there should be, like, hostelries set up where people who didn't want to have like, jobs, man, but wanted to write poetry or paint daisies all day could live and be clothed, fed and sheltered on the public dime

In America, we call that SCHOOL.

[hm]

ok, where are all the folks who love to state they lived in Canada or in Europe (cause we all get really impressed when we hear that) who swear it only takes 2 hours for a hop replacement.

[Agammamon]

I lived in Europe and can tell you that you're lucky if anything is open two hours a day, let alone get an operation.

[thoreau]

I know that the Canucks have a long way to go on economic freedom, but it's kind of embarassing that in the same week that one of our courts upheld an expansive interpretation of the commerce clause, one of theirs upheld economic freedom.

No, I'm not saying Canada is better (yet) but ain't it embarassing for us when we take one step backward while they take one step forward?

[g.a.]

I was talking to a Canadian friend of mine about their national healthcare. I told him that when I was working in Vancouver, some of the people I talked to were less than impressed with the system, and that they said anyone who could afford it crossed the border for treatment. His response was that those people just didn't want to wait in line like everyone else, and that any problems with the system can be solved by more funding. This statement was from a man who's only income has come from Canadian government grants.

[MP]

violates the province's Charter of Human Rights and Freedoms
Sounds like they are flexing their own version of the Ninth amendment. Good for them.

And from the article...
"...about do you pay, you know, a couple hundred dollars for a diagnostic test and then do you go to the publicly funded system for the treatment that is required as a result of it"
As opposed to what? Waiting months for the state to give you a "free" test?

[David Woycechowsky]

Further thoughts:

It seems possible that this decision is a good one from a true libertarian perspective.

What I mean is that meaningful competition, on both the supply and demand side, is the touchstone of capitalism. Lots of producers relative to the number of consumers acting independently. Anything less may be a free market, but it ain't capitalism.

Of course, competition doesn't happen in the large portions of the healthcare market that the provinces of Canada monopolize. What is less understood is that the health insurance market in the US doesn't exhibit competition either. Too few suppliers. Too little independent action. A big part of this problem is that health insurance is still called "insurance" even though it is really large consortiums of doctors and their generally neccessary services, rather than a hedge against an extraordinary risk.

Is there competition in the healthcare market in the US? Ask an average 35 y.o. couple (no kids) what they are paying for medical insurance. then ask a 65 y.o. couple. How many orders of magnitude difference in the monthly payment? I'll give you a hint: 0. Something is rotten, competition-wise.

getting back to the CDN Court decision, they are clearly trying to get the insurers to compete with the government. At last, somebody competing somebody again.

Furthermore, Paul Martin has promised to fix the waiting times, which means that he is promising to compete. Now all that has to happen is that Paul Martin has to keep his promise and not begin to collude with the private "insurance" trust in Quebec. Oh, rats. I just saw a small flaw in my plan.

[Mad Scientist]

You know, one of my neighbors here in California recently had a heart attack and ended up with about $250,000 in medical bills. He's 55 and had no medical insurance (read genius). So he pleaded poverty and was forgiven, I'm not kidding here, every single penny of his medical bills by the hospital, the ambulance company, and 2 different doctors. This left him with expenses of about $400 a month for a bunch of perscription drugs (reduced to $200 when he went to generic meds). He's now on some state-subsidized plan and his insurance costs are about the same as mine even though I'm 20 years younger and have never had a heart attack, and this asshole has the nerve to complain about the high cost of health care in this country. He's a British ex-pat and he loves to tell everyone about how great the medical systems are in Britain or Canada. The other day I tried to explain to him that Canadians have to wait forever to get simple procedures done and frequently they just come down to the U.S. and simply pay for it here. He flatly denied that any Canadian had ever done this because their system was so superior. I'd really like to stuff his ass in a box mail him back to London.

Partially, I'm just venting, but I really REALLY don't understand his behavior. Where do people get the idea that everyone else owes them something?

[KipEsquire]

Meanwhile, in the U.S. child welfare officials seized a 12-year old girl with cancer via an Amber Alert (!) to force her to undergo radiation therapy against her parents' wishes.

Not sure that forcing access is much of an improvement over preventing access.

[Jerry Aldini]

I'm in Alberta, and this decision is thin, thin gruel for libertarians. I don't think you Yankees have any idea.

This, from P.203 of the dissent (but unrebutted in the majority opinion, and absolutely true):

"While we do not accept that there is a constitutional right ?to spend money?, which would be a property right, ..."

[MP]

Where do people get the idea that everyone else owes them something?
joe

(sorry...cheap shot...couldn't resist...I'm a bad boy...)

[stubby]

Colby Cosh - great blog, fine writer - has some more on the decision, including this delicious bit (emphasis mine):

[UPDATE, 4:38 pm: It occurs to me that some of you who didn't follow the case while it was still sub judice may not know that Dr. Chaoulli argued this case personally before the Supreme Court. It's got to be one of the greatest David-v.-Goliath stories in the annals of Commonwealth law: with help from a few lawyers and private clinics, he took on and beat five attorneys-general, ten senators, the Canadian Labour Congress, and the complete Choir Invisible of received opinion. This New York Times piece from a fortnight ago has a chuckle at the doc's expense, pointing out that he "flunk[ed] out of a Montreal law school a few years ago, after he incessantly challenged professors in the classroom and in exams with his novel legal interpretations." Who's laughing now, bitches?]

[strat]

Perhaps the Supreme Court should send the Quebec?ois people copies of Vonnegut's "Harrison Bergeron".

I have a sinking feeling they wouldn't "get it."

Montre?al may well be my favorite city in North America, but I don't know how anyone could live there.

P.S. for the webmaster - Your software filters out characters required to spell "Montreal" and "Quebecois" correctly.

[Alan]

So Thoreau thinks "Canucks have a long way to go on economic freedom." Actually, it's the economically very unfree Chinese who will blow the fat, lazy Yanks out of the water in the not too distant future. The economic determinism of true-believer libertarians will be a bit less seductive from the bread line, I suspect. Meanwhile, I hope we Canucks don't succumb to American-style health care, which can be summed up as "Your health? Who cares?" Like much else about current American culture, American health care is a pig that needs a lot of lipstick.

[kevrob]

Two points:

Cosh's post is great, but those who have been reading the Punk Rock thread must scroll down and read his tribute to AC/DC.

Alan, if the U.S.A. disappeared into another dimension tomorrow, neither Canada nor Europe could maintain the pharma or medical technology advances they so readily make use of that result from the American R&D, regulatory and patent systems.

Tell me, did Og the Caveman have a "right to healthcare" before medicine was even invented? He sure as hell had a right to discover that willow bark soothed a headache, and to trade that knowledge, and the bark, too, to his neighbor Ook if he felt like it. So too have a modern patient and healer have a right to do business, and the government getting in their way is unjust.

Kevin

[David Woycechowsky]

Kevin,
Canada and most of Europe both have longer life expectancies than the US. Unless and until the US figures out a way to change that bad fact, I'd say that Canada and Europe have something to teach the US as far as healthcare goes, rather than versa vice.

[Phil]

Third, the evidence shows that the introduction of private care facilities has an impact on the quality of public care facilities. Private facilities tend to 'cherry-pick' the easiest and most profitable cases for treatment, leaving the public system to deal with more expensive cases.

Um . . . so what happens when the public system has to treat both the cheap and the expensive cases? I can't imagine that people who would choose the private system then go untaxed, so not treating those people actually frees up resources to devote to the harder cases. Seriously, this point makes absolutely no sense.

[Alan]

I once met a Czech immigrant who had lived in the U.S. for a time before coming to Canada. "The U.S.," he said, "is a great place if you're young, healthy, and white." I suspect most free-market libertarians fall into those categories and lack the imagination to grasp the enormous role luck has played in their lives.

[kwais]

Wow, it would seem Joe has some competition!

[LisaMarie]

"I suspect most free-market libertarians fall into those categories and lack the imagination to grasp the enormous role luck has played in their lives."
This is not a story I share with every random stranger, but when people start preaching at me about how lucky I must be since I'm a libertarian, it's hard to sit still. I'm young and white, but not exactly healthy. "Luck" gave me a lifelong chronic illness that will require drug therapy and probably periodic surgery for as long as I live. "Luck" led me to enroll in a clinical trial seeking better treatment and try an experimental drug, a trial that ended when it was discovered that the drug might cause the development of a fatal degenerative neurological disease. "Luck" got me the doctor's appointment I have next week to screen me and every other trial participant for said disease. And that still does not make it someone else's responsibility to pay for my health care, or that of my spouse (which comes out of OUR pockets). What exactly is is that I lack the "imagination" to grasp here?

[Alan]

Some free-market libertarians are just stupid.

[David Woycechowsky]

Imagination: can you imagine yourself without a college education? without a decent high school education? without having had the social opportunity to meet a productive spouse? Can you imagine yourself aborted in the womb due to economic pressures? Can you imagine yourself behind the counter at a fried chick'n restaurant worrying about getting decent care for an unexpected illness?

These are challenges of imagination difficult in rough positive correlation to the wealth of one's parents during childhood (rather than in proportion to youth or paleness of skin).

[Alan]

Tarran,

You remind me very much of an old-line stalinist proagandist. Any functioning economy will fare badly in comparison with your free-market libertarian utopia. Your implication that I'm a racist because I observe that one's chances are better in the Land of the Free if one is white is similarly reminiscent of stalinist arguing tactic. Don't deal with facts. Attack the motives of the skeptic who raises them.
I am under no illusions that reality can intrude on your true-believer serenity, but God preserve us from the implementation of your dogma.

[Alan Rutkowski]

A Canadian discovered insulin, too.

Adult Stem Cell Miracle Breakthrough Reported in Canada

With Carl Limbacher and NewsMax.com Staff
For the story behind the story...

Tuesday August 14, 2001; 2:20 p.m. EDT

Adult Stem Cell Miracle Breakthrough Reported in Canada

In a development that could halt the political momentum behind embryonic stem cell research, a scientist working at Montreal's McGill University has made the first-ever discovery of human stem cells in the skin of adults.

The findings of Montreal Neurological Institute researcher Freda Miller, first published Monday in the scientific journal "Nature Cell Biology" are generating "huge" interest in the scientific community, according to the Montreal Gazette -- though the American media has by and large ignored the miraculous breakthrough.

"The dream scenario would be to take someone with spinal cord injuries, say an 18-year-old, take a biopsy from their skin and use that to treat the injury in the same patient," Miller told the Gazette, which noted that her discovery may even facilitate the regrowth of human organs.

Before Miller's find, scientists believed that adult stem cell research would never be as productive as the embryonic variety, since adult stem cells are found only in the brain and bone marrow.

"(Skin-derived stem cells were) just not on the radar screen in terms of the way any of us were thinking," Miller told the Gazette. "The idea of lots of stem cells in different tissue is a very, very new one. Can it be true that you could get a stem cell from one place and it would make another kind of cell? We didn't believe it ourselves."

The medical implications of Miller's discovery are "enormous," the paper said, especially as they relate to the embryonic stem cell debate in the U.S.

"Opinions vary but the prevailing view in North America seems to be that obtaining stem cells from human embryos, even to cure diseases, is considered immoral. The embryo is destroyed in the process."

But Miller's research opens the door to a world of new, far less controversial possibilities.

"We gave it two months," the Montreal scientist said of the research into skin-derived stem cells. "But it worked right from the beginning. Every step of the way it's been an 'I can't believe that it's true' experience."

The McGill University research team found that its isolated cells began growing in grape clusters and duplicating "at an amazing speed" -- once every two or three days.

What's more, the skin-based adult stem cells were able to produce different types of cells.

"It was almost a hybrid or a more promiscuous version of those adult stem cells," Miller told the Gazette, adding, "It's very exciting."

Still, despite the enormous scientific and medical potential of the McGill University discovery, more than a day after the Gazette report, the U.S. media continues to ignore the story.

In its Tuesday edition, the New York Times, for instance, was still touting the wonders of embryonic stem cell research, with a front page story on the progress made in Britain.

In the U.S., only the Washington Times and the Christian Broadcasting Network have covered Miller's findings.

[Alan]

Could you true-believer free-market libertarians take a momentary break from your giddy expectation that the Canadian health care system is going under and give me an example of a functioning libertarian society anywhere and what its health care system looks like?

[kevrob]

Canada and most of Europe both have longer life expectancies.... David W.

Easily explained by two factors: in the U.S. aggressive treatment of prematurely-born infants, who wouldn't make it almost anywhere else, and in other countries are written off as stillborns. This is also an element of the U.S. having a higher than expected infant mortality rate. Some of these kids don't live too long, but we try to save them, even if it hurts the stats.

The second is the poor health of our underclass, many of whom are racial minorities, despite their eligibility for government-paid care (Medicare, free emergency room visits, free immunizations, etc.) Comparisons to smaller, more homogenous populations are invidious.

...give me an example of a functioning libertarian society anywhere and what its health care system looks like? - Alan

Well, if we could ever get around to establishing Libertarianism In One Country, we would. For some reason, statists get into a huge froth about the idea that someone might create a redoubt of freedom in the world.

And, go tarran, and go isdildur, you rawk!

Kevin

[Alan]

Kevrob,

Your close kissing cousins, the stalinists, promised paradise once they overcame all the evil forces that kept sabotaging communism, too. Not one example? Wow! You libertarians really put the G in gullibility, eh?

[David Woycechowsky]

The second is the poor health of our underclass . . . despite their eligibility for government-paid care (Medicare, free emergency room visits, free immunizations, etc.) Comparisons to smaller, more homogenous populations are invidious.

This is problematic to me. It is one thing to say that the government shouldn't have to send you to high school or pick up your trash or dole out pork or whatever. However, here we are talking about people's lives, specifically the shortness versus longness of people's lives. I think government can, should and does have authority and even a duty to act in a way that maximizes this life expectancy stat. It is a real important and telling stat to me, notwithstanding the cultural differences, such as the preemie diffs you allege.

Now I would hope, assume and believe that this stat would be increased by decreased government. However, if there is a choice to be made, I'd pick increased life expectancy over libertarianism.

[Alan]

For all that is wrong with American culture, American pragmatism is much to be admired. You nutbar political zealots are marginal, and your co-nationals are too busy watching reality TV to bother with you, so you're not really theatening. I find you mildly entertaining.

[kevrob]

Aside: To prove that not all Canuckians are cementheads, as I was reading tarran's post, MTV2 was playing a live version of Rush's Tom Sawyer.

No, his mind is not for rent
To any God or government...

Kevin

[David Woycechowsky]

If you are willing to sell liberty for the mess of pottage that is even-more-socialized medicine, then I pity you.

Why do you think that socialized medicine is the most effective to increase average life-span?

[Alan]

Tarran,

You use way too many words per thought, but the key admission buried in your verbosity is that no functioning libertarian society exists to provide evidence for your utopian theories. I know that evidence is likely an alien concept for an evangelizing true-believer, but the lack of it may explain why the Libetarian party has never attracted the numbers that even the old American Communist party managed to garner. If the stalinists committed crimes, it's because they actually came to power. Nonetheless, your dogmatic faith in economic determinsim is very akin to theirs.

[kevrob]

Why do you think that socialized medicine is the most effective [method] to increase average life-span? - David W.

I don't. Methinks you didn't understand my allusion. The mess of pottage accepted by Esau in trade was of transient, even trivial value, compared to the birthright he unwittingly passed to his brother Jacob (Israel).

Next thing you'll be hoping that we'll have a big victory in southwest Asia, just like that old Greek King, Pyrrhus of Epirus, had over the Romans.

Kevin

[Alan]

In a completely free-market economy, one can have as much positive freedom as one can buy. Even in a mixed economy, the wealthy are freer than others to do many things such as send their kids to elite schools, take long vacations, or drink expensive scotch. Alas, genetics can limit the freedom of even the wealthy. Take the ability to make concise, cogent arguments, for example. For that, you need to be smart. (Nothing personal, Terran).

[kwais]

This may be the best thread ever

[David Woycechowsky]

Oh, I get it now. Its sort of like the 8 song ep I recorded a couple years ago called "Mess Of Pottage."

http://www.markprindle.com/bribery/farces.htm#mess

[kwais]

Alan,

Why do you think that minorities are poorer that white folk in the US?

Is is because the US is a free market system, and they are incapable of competing?

Or is it because some government regulation, now or at an earlier time has held them back?

I am thinking that a third possible answer would be that people are inherently racists, and due to the way people are, minorities do not have a chance. If this is the case, why do people hold those racist views?

It would be because one of the original two choices. Pick one.

[David Woycechowsky]

Anyway, your references to ever-more-socialized medicine kind of confused me. To clarify: I stated that increasing average lifespan is an acceptable state end or cause to me.

Things I Did *Not* Mean To Imply By This:

(1)Socialized medicine is the way to go.

(2) Increased lifespan is the only acceptable state end or important individual liberty.

(3) Increased lifespan imperatives should always trump other state ends.

(4) A state action that is purported to increase lifespan should always be put into law because they would want to do it if it wouldn't work.

Again, to be clear: statements (1) to (4) are all things I *disagree* with. If I had wanted to advocate socialized medicine as my most preferred healthcare solution I would have done so in clearer terms.

[Alan]

Here's a little libertarian intelligence test (Terran, don't try this). Come up with one logically compelling reason why the strong should not dominate the weak. Take your time.

[kevrob]

OK, Dave. Truce.

Anybody who has a link to fyodor on his band's website has to be somewhat cool. 🙂

Your continued reference to "state ends" does trouble me a bit. This may not apply to you, but I've found that frequently statist critics of libertarianism gloss over our objections to unjust means, in their rush to attain these ends. Even among some soi-dissant free marketers, there are some enamored of utilitarianism to the detriment of ethics.

Kevin

[kevrob]

Answering Alan:

`Cause living in a society based on voluntary cooperation would be more fun, less stressful, more open to friendship, freer from fear and more prosperous.

Kevin

[isildur]

Oh, I get it! Alan's not interested in talking about socialized medicine. He wants to attack libertarianism itself, and wants people in this thread to defend it.

Hey, news flash, pal: this is a LIBERTARIAN magazine's website. Everyone here takes it as a given that you've done the basic homework to understand libertarianism. Your post @12:39 strongly indicates that you haven't.

Nobody's saying you have to agree with libertarianism. But at least don't make yourself look like a chump, and read the material before you start shooting off your mouth.

In any case, coming here and saying 'libertarianism sux' is somewhat like going to a Radiohead message board and declaring 'Radiohead is the worst band of the decade,' and expecting people to take you seriously and debate the point with you.

In other words, you're not changing anyone's minds here (because your arguments are sophomoric, and they're things everyone here has seen before -- the question @12:39 in particular. And you're not even providing entertaining counterpoints, the way Joe often does, because you're not discussing any particular policy recommendation, but rather just spewing anti-libertarianism.

There's a technical term for someone who goes to an internet forum and attacks the core thesis upon which that forum operates. It's 'troll'.

And trolls are best ignored, particularly when they, like you, have nothing to say that we haven't all heard a thousand times before.

[isildur]

And just so I can't be accused of evading a question, no matter how invidious:

There are two ways in which one could mean 'strong dominate the weak'.

First, one could mean that the strong compel the weak to act in certain ways via force, fraud, or the threat of force or fraud. In a libertarian society, the use or threat of use of force and fraud are illegal, and would therefore be punished.

Second, one could mean that the 'strong' is strong because he is more capable and more competitive than the 'weak'. He might 'dominate' in the sense that he outperforms a weaker competitor in a given field. If you believe that being outperformed is being 'dominated', and should be treated as immoral or illegal, I submit that Reason Magazine is the wrong place for your rantings. I suggest taking them first to the International Olympic Committee, which you can find at http://www.olympics.com.

[Alan]

My goodness, isildork, you sound just like a nun who's upset that the convent has been invaded.

You flunked the intelligence test.

There is no logically compelling reason why the strong should not dominate the weak. If you don't think that's an intellectual problem for libertarians, your powers of thought are weak, which may explain your libertarianism in the first place.

[Alan]

"In a libertarian society, the use or threat of use of force and fraud are illegal, and would therefore be punished." --isildork

Who will do the punishing? Suppose the fraudulent violator has raised a private army to protact his or her terrain. Who will stop him or her? Sorry, you probably heard this a thousand times. Have you ever bothered to answer it?

[isildur]

Sorry, Alan. You just demonstrated to everyone here that you are not worth responding to. Nearly every one of your posts has been an ad hominem attack. This indicates that you have nothing to say worth listening to.

Which isn't surprising, but usually trolls here don't state it so clearly as you have.

[Alan]

Isildork, Isildork, I've asked specific questions and responded to your points. Now, instead of answering me, you say I should be ignored. That's not the behavior of an intellectual searhcer for truth; it's more appropriate to a cultist who has the "truth." C'mon now, stop acyting like a Moonie. Who will punsish violators in Libertopia? Put on your thinking cap, eh?

[kevrob]

Dave W.'s examples:

Food purity laws are one.

The government regulatory regime that derives from the progressive era isn't one I would have picked. I'd have preferred private certification of the safety of products, on the Underwriter's Laboratories and/or Consumers Union models, backed by the tort law system. I would allow prosecution for straight-out fraud: e.g., if you claim that your bread is made from "100% whole wheat flour" and it is, in fact, adulterated with sawdust, be prepared to go to criminal court, and to get sued by your customers. [The smart thing to do would have been to have labeled your loaves: "Now with added FIBER!" 🙂 ]

Murder (well, anti-murder) laws are another.

Here you are making a category mistake. An individual or group seeking to end the life of an individual is a direct violation of rights, and if there's one thing minarchist libertatians* think governments are for is the defense of individual rights, especially against the initiation of force and/or fraud. We may have difficulty sometimes deciding who is a rights-holder (slavery, abortion), but once someone is included in the club, their fifth amemdment right to life must be respected.

Generalized "public health" goals are not the government's business. It would be a good idea if Washington and our state politicians would stop advancing poor health by their interference: tobacco subsidies, dependence on sin taxes for revenues, and the messed-up tax laws that spawned our employment-bound health insurance industry come immediately to mind. The 1990s reforms of the welfare system have done some good, as the unwed teen pregnancy rate has finally dropped.

Kevin

* anarchists are a whole `nother thing.

[Phil]

The US is simply too rich to be so far down in the lifespan statistics. The answer may not be socialized medicine, but it sure-as-heck isn't denial or degradation of the importance of life as a thing to be preserved.

What exactly is the qualitative difference between living to 79 in Canada vs. 77 in the U.S.?

As an aside, asking a question to which you then respond to an answer with, "Sorry, there are no correct answers to the question" is called "poisoning the well," and is sort of a sign of being an idiot.

[David Woycechowsky]

Phil: I didn't say that there were no correct answers to my question. I just took one option off of the table (I will call it the disrespect-life option). Because I left open an infinitude of possible correct answers to my question, I didn't "poison the well" as you define the phrase.

Looks, like you are the idiot after all.

[Phil]

I apologize, David: That second part was not directed at you, but at Alan, and I should have been specific about that.

[David Woycechowsky]

Kevrob,

Do you or don't *you* think that lifespan would be longer under a libertarian healthcare system?

I do.

However, you seem to be avoiding this practical, real-world question.

Libertarianism: good or bad for average lifespan? Whaddya think?

[Phil]

As to your point, the U.S. is "so far down" if one is looking at literal numerical rankings, but going by the WHO's numbers, the U.S. and the UK are separated by less than a year in terms of life expectancy from birth: 77.43 vs. 78.27. So, again, I'll ask, what exactly is the qualitative difference between living to 77 years and 5 months in the US, and 78 years and 3 months in the UK, that it's something we in the US should be tearing our hair out trying to solve?

Even when looking at the highest-ranked liberal western democracy, Switzerland, the US only falls behind them by 2.88 years, so the same question applies. You rarely, if ever, hear anyone saying the Switzerland should be doing what it can to make its health-care system, and its citizens lifespans, be more like Andorra (3.2 years more life expectancy than Switzerland), after all. And you never hear opprobrium directed at the Netherlands (78.68) for not being able to achieve what they do in Singapore (81.53).

While there are legitimate questions to be examined concerning the efficiency of the US healthcare system, I am not convinced that the life expectancy criterion is one of them.

[David Woycechowsky]

Phil,

I am not sure how to answer. Some libertarians put an awful lot of primacy on freedom to contract. Others on right to self defense. I put that kind of primacy on life expectancy (although I also attach substantial to freedom to contract and right to self defense and many other liberties).

One way to resolve these kinds of differences is finding a way to maximize freedom of contract and life expectancy and all the rest at the same time.

However, I am sort of sensing an attitude here that libertarianism in healthcare would be expected to shorten lifespan. If my spider senses are working correctly here, this perceived libertarianism=shorter-life attitude surprises me and I don't know what to make of it.

[kevrob]

Libertarianism: good or bad for average lifespan? Whaddya think? - David W.

It might be better, it might be worse. For example, new medical procedures and drugs might get to market quicker in a libertarian economy. On the other hand, healthy young men might snuff themselves at a higher rate by taking to risky behaviors that our activist government currently discourages. I'm not sure if that last will happen. I don't expect a revival of the code duello, but it could happen. If a population develops a rash of broken limbs it could mean that there is something wrong with nutrition provided to its children, or it could mean that more people have taken up snow skiing, motorcycling and other hazardous endeavors. I am mindful of Aaron Wildavsky's famous point that, as we perceive advances in safety, we adjust our actions so that our preference for risk stays about the same. (One shorthand for that would be: Seat belts and airbags encourage speeding and reckless driving).

The number one improvement I would seek is the reversal of the WWII-era decision to treat employer-provided health insurance as a non-taxable fringe benefit, while those who must pay for it with their own money must do so with post-tax dollars. This dodge to get around wartime wage-and-price controls has had perverse effects on everything from labor mobility to the competiveness of certain U.S. industries, and while Medical Savings Accounts and similar workarounds for both the employed and the self-employed have done some good, wider reform is needed. When and if the patient becomes the customer, rather than the HMOs or PPOs, we might be able to get a handle on medical pricing.

Kevin

[Alan]

All functioning economies have problems with health care. A free-market libertarian economy has no problems with anything because no such economy exists. Entertaining the possibility that a free-market libertarian economy can work is a far cry from having a fervent faith that it will work. Libertarians that hold such a faith are cultists. As a cult, libertarianism is interesting only as a sociological phenomenon.I think it may fill a void left by the decline of religion.

[LisaMarie]

David,
I really don't know what would happen to lifespan under a libertarian system. However, suppose it's shorter because people, given freedom of choice, make poor health choices (fat, lack of exercise, smoking, not getting screened for preventable diseases, etc) that result in shorter lifespan. Would you advocate a system where people have less freedom to make choices in order to maximize lifespan? I ask because I think your question about life expectancy may be more related to the differences between health choices that people in two different societies make than the presence or absence of socialized medicine. A healthcare system can only do so much about the consequences of choices individuals make about their health.

[tarran]

Wow! discussion's still going strong.

Well a few points:

The studies attempting to quantify the effectiveness of various countries' medical systems tend to be inconclusive in that they tend to suffer from sampling bias. In otherwords, it is very hard to ensure that all variables not associated with the medical system are identical. If my memory serves, attempting to compensate for or eliminating the differences in economic power, urbanization etc tends to improve the U.S. standing with regards to the rest of the world.

However, the fact that we appear to be in the same ballpark is pretty impressive, in that most of the socialized medical systems tend to supply about 440 doctors per 100,000 of population, and the U.S. government maintains a much lower population. COGME, for example called 273 doctors per 100,000 population a "glut," and worked diligently to keep the number from climbing higher.

Much of the U.S. is suffering from shortages of doctors, and yet medical schools turn away at least 10X as many qualified applicants as they accept. So we have a shortage of doctors, and every year thousands of people who wish to become doctors are not permitted to enter the field because the government limits the class sizes of medical schools.

Obviously this is a failure of the free-market :-).

BTW Alan, gosh you sound like a hardcore Tory - if it hasn't been done before, it must not be tried. 🙂

OK joking aside, why are you so scared of us? You have a Canadian email address, and as such I believe that the internal politics of the U.S. should have minimal effect upon Canada.

Certainly, even if our policies where a recipe for disaster to those who adopt it, it would be of great benefit to Canada. I mean, we believe in unilateral removal of tariffs! Free crossborder trade! You guys could still keep our stuff out of your country with a protectionist policy and still sell to us without retaliation!

We believe in a non-interventionist foreign policy. This translates to less aggravation for Canadian foreign policy.

If we do turn the U.S. into an economic disaster, then our productive people will move someplace nicer, like Canada. So your economy would benefit from the expansion of its pool of skilled workers.

I would expect you to be cheering us on, yet here you are, wasting a perfectly good summer weekend tethered to your keyboard, calling us names. This conversation seems to be quite important to you. I am begining to suspect that you fear we will put our policies in place and succeed. Yes, that would be a disaster wouldn't it? A society that is built upon voluntary cooperation instead of violent compulsion. How horrible!

Alan, you seem very concerned about the idea of powerful people oppressing the weak. So, how in a socialized system do you keep such people from acquiring positions of power and abusing it?

I am really interested in seeing your answer.

Oh, that reminds me, I really liked the elegant way you called Isildur Isildork. I'm sure it convinced a few people to come round to your way of thinking. Now that voice of measured reason, Michael Medved likes to refer to us as "losertarians." You should work that into a future post. I'm sure you'll win lots of converts with that one. 😉

Thanks again for the entertaining posts. Your comments gave me quite a few belly laughs when I read them this evening.

Hope you have a pleasant evening.

[Alan]

Terran,

I would never say something shouldn't be tried; nothing should be embraced with evangelistic zeal until it's been tried. Listen to yourself. You're talking about making converts.

[David Woycechowsky]

Note to Kevrob, Lisamarie and Phil,
On a corny note: Thanks for your thoughtful answers to my questions. I disagree with parts, but the candor and clarity is helpful.

[Alan]

Tarran:

It is hardly a startling observation that the strong dominate the weak. Smart, good-looking peole always have an edge. In any system, the stupid are at a disadvantage. You seem to think that an unfettered free-market system will provide maximum freedom. In fact, the most important freedom is not freedom from contraints--no government interference--but the positive freedom to act. In this sense, the wealthy are always freer than the poor, the intelligent freer than the stupid, and so on. There is no logically compelling reason why this should not be so.

In the real world, the problem of the strong dominating the weak has never been solved, but it has been mitigated. Your illusory advantage, like that of most utopian zealots, is that the real world is not perfect, while your fervidly imagined paradise is. I thought you might stretch your imagination enough to emcompass a little imperfection. How will the weak fare in Libertopia?

[Alan]

David:

You end on an extremely corny note. Libertopians prefer a marginality where their nonsense can confer the status of guru. In any wider context, it immediately marks them as crackpots. Why curry their favor with silly compliments?

[Don]

Alan,

Calculating healthcare costs on a per capita basis is iffy; Americans have higher accident and other injury rates (mostly due to demographics: blacks, for example tend to have much higher injury rates). Furthermor, the 100,000 or so Canadians who opt for quality US healthcare are effectively increasing the "per capita healthcare costs" of the US, while reducing those of Canada.

But I don't blame you for defending Canadian healthcare. When your country has one claim to fame and it is actually a pile of crap, I understand your defensivness.

David Woycechowsky,

The quality of healthcare isn't the most important factor in average lifespan. Consequently, average lifespan is a poor indicator of the quality of healthcare.

There was a recent study of English vs US healthcare; US won on every count except for cost (although the way cost was measured was flawed; see my response to Alan above). Patients were about 9 times more likely to die in an English hospital.

[Don]

A free-market libertarian economy has no problems with anything because no such economy exists.

The US in the early 1800s was essentially free market, and the growth rate was exceptional. In fact, prior to the New Deal, the US was closer to a true free market than to anything else.

Germany early 50s approached a free market ideal, and the growth rate was exceptional.

Free markets work.

[Alan]

Don:

I thought Canada's current claim to fame was not following the Americans into Iraq. Talk about a pile of shit. All those thousands of wounded and maimed American soldiers get some sort of state-subsidized medical care, I'll bet. National chauvinism is not the most endearing American trait. I should think you anti-state free-marketers would try to hide it a little. You seem to love your state only at its worst.

[Alan]

Don:

I would love to send you and your ilk back to the 1880s. You'd have so much fun helping your state kill and dispossess the indians. Canada's West was won with much less state intervention.

[Alan]

Canadian-led project generates database with medical annotation available to the public

Scientists at The Hospital for Sick Children (HSC) have compiled the complete DNA sequence of human chromosome 7 and decoded nearly all of the genes on this medically important portion of the human genome. The research, which involved an international collaboration of 90 scientists from 10 countries, publishes in the online version of the scientific journal Science on April 10, 2003.

Two years ago, a draft (or fragmented) human genome DNA sequence was published by the public Human Genome Project, and separately by Celera Genomics. To coincide with celebrations of the 50th anniversary of the discovery of the structure of DNA, the DNA sequencing phase of the Human Genome Project will be declared completed in April.

"In a massive study, we combined all information in public and private databases, including data generated by Celera Genomics, as well 15 years of our data and analyses to generate what we believe is the most comprehensive description of any human chromosome. Chromosome 7 is often referred to as ?Canada?s chromosome? because of this country?s major contribution to the mapping and identification of many important disease genes on that chromosome over many years," said the study?s lead author Dr. Stephen Scherer, a senior scientist at The Hospital for Sick Children and an associate professor in the Department of Molecular and Medical Genetics at the University of Toronto (U of T).

"This is the first time that a significant effort has been made to incorporate medical observations with DNA sequence as part of genomic research, which will make it accessible and useful to health-care professionals and researchers outside of the genomics field," said Dr. Johanna Rommens, a study co-author, interim head of the Genetics and Genomic Biology Research Program at HSC, and an associate professor in the Department of Molecular and Medical Genetics at U of T.

There are 23 pairs of chromosomes in the human genome and each person inherits one of each set from their parents. The chromosomes encode genes that control all aspects of human development including some behavioural characteristics.

This study revealed that chromosome 7 contains 158 million nucleotides of DNA (5 per cent of the genome) and 1,455 genes (of the estimated 28,000 protein-coding genes in the human genome), some of which cause diseases such as cystic fibrosis, leukemia, and autism. The project also describes discoveries of sites along the chromosome where invading viruses integrate, ?fragile? regions prone to breakage, areas called ?gene jungles? and ?gene deserts?, as well as primate-specific genes.

In the study, all medically relevant landmarks along the chromosome were identified, including the several hundred chromosome breakpoints where disease-related mutations occur. The breakpoints found in autism patients were used to pinpoint specific genes associated with the disorder.

The information generated by the chromosome 7 project has been established in a publicly accessible database that can be used to facilitate disease gene research. For example, a physician can enter the genetic deletions found in a patient and the known phenotypes (manifestations of the genetic mutation) are identified. The chromosome 7 database is available at http://www.chr7.org (the site is publicly accessible after the journal embargo lifts).

Dr. Martin Godbout, president and CEO of Genome Canada said, "This work represents an unprecedented Canadian contribution to the Human Genome Project. More importantly, it exemplifies how genetic, genomic, and clinician scientists in the public and private sectors worldwide can work together in a common goal to understand the human genome and its role in health and disease."

[Alan]

"History will likely regard 3TC?, next to insulin, as Canada's greatest contribution to medical therapies in the 20th century," says Dr. Mark Wainberg, president of the International AIDS Society.

The 3TC? story began in 1986, when three Canadian researchers joined forces to create BioChem Pharma, which they hoped to turn into a leading research-based Canadian biopharmaceutical company. Ambitiously, Drs. Francesco Bellini, Gervais Dionne and Bernard Belleau turned their early attention to HIV/AIDS.

At the time, the only HIV/AIDS antiviral product on the market was Retrovir? (AZT?). But by 1989, the Canadians had discovered a promising compound, BCH-189. To move things forward, they partnered with UK-based Glaxo, now Glaxo Wellcome, and together they developed 3TC?, which is sold as Epivir?. As Dr. Dionne explains, "We decided that to give people living with HIV/AIDS access to the product as soon as possible, and to minimize risk, it would be much better to partner with a large company."

The early trials produced such remarkable results that Glaxo Wellcome decided to widen access during the testing and created the largest compassionate access program in the history of any medication: 3TC? was made available to more than 45 000 people with HIV/AIDS worldwide, about 3000 of whom were in Canada.

In 1995, 3TC? was approved for commercialization in the United States and Canada, one of the fastest drug approvals in Canadian history. In 1996, 3TC? was approved in Europe and elsewhere. Today, this highly effective antiviral agent is the most prescribed HIV medication in North America and it has become the cornerstone of HIV/AIDS combination therapy around the world.

[Jim Walsh]

Any chance we can swap our Supreme Court with the Canadian one?

[Alan]

Jim:

How about swapping your President for our Prime Minister? You might get out of Iraq, and since Canadians don't tend to elect morons to high office, we'd soom be rid of Mr. Bush.

[Alan]

Serafina:

Good point. These free-market cultists often sound suspiciously like garden-variety American national chauvinists, don't they?

[Don]

National chauvinism is not the most endearing American trait.

It is, however, the most endering Canadian trait.

Sounds pretty much like the U.S. system to me,

Serafina, largely correct. Our problem is a combination of the government sponsered insurance programs and the insurance programs that are employeer funded (the latter took root due to high taxation during WW2).

except it's run more for the profit of third-party payers than it is for the providers these days.

Your these days comment is necessary, since at one point doctors did very well with Medicare, etc. Then, efforts to cut cost came into place, and doctors had to hire lawyers, accountants, buisness managers, etc. Now it's a terribly complicated thing, but it is still beter than the crap in Canada.

[Alan]

Don:

You pass on the crap in Iraq, eh? Who's taking care of the thousands of wounded American soldiers? What's medical care like in the American army?

[Don]

Alan,

No. We should have taken care of the Great White North first. Iraq could wait.

Given the USA (and USN, USAF) tendency to throw massive resources at problems, USA medical care is very good. But a relatively small group like the USA, funded by a large taxpayer base, leveraging off of civilian training and R&D, can do wonders.

[Alan]

Wounded "treated like dogs"
Mark Benjamin's investigative report on Oct. 20, 2003 for UPI, revealed that many wounded veterans from Iraq had to wait "weeks and months at places such as the Fort Stewart military base in Georgia, for proper medical help." They had been kept in living conditions that are "unacceptable for sick and injured soldiers." One officer characterized conditions for the wounded by saying, "They're being treated like dogs."

In January, 2004 Benjamin reported that the largest American troop rotation is now underway. Daniel Denning, assistant secretary of the Army, testified to the House Total Force Subcommittee, "We recognize that last fall, we temporarily lost sight of the situation. It is likely that during this period of force rotations, patient loads at some installations may exceed local capacity. The Army has developed a series of options to handle this surge."

Subcommittee chairman John McHugh, R-N.Y. said, "In October of last year a series of articles revealed that many mobilized Reserve and National Guard soldiers in a medical holdover status felt the Army was not treating them as equals to their active component counterparts. The articles described substandard living conditions at two Army posts in particular - Fort Stewart, Ga., and Fort Knox, Ky. Many of the ill and injured soldiers interviewed at these posts reported having to wait for long periods of time - sometimes weeks or months - before receiving the medical care they needed."

[Serafina]

I don't know that it's much better or worse than Canada, but the U.S. health care system is certainly fucked up. We simply ration based on who's paying (or not) rather than through a centralized system, and end up paying a hell of a lot more than we should be for it. The government system (Medicare, Medicaid, etc.) is run far more efficiently with less overhead than the private health plans seem capable of.

Employer-based insurance is one of the worst things to come about, in my opinion. It intertwines too much of a person's life with his or her employer and causes no end of problematic situations. It makes a free market in health care virtually impossible, because consumers are effectively trapped into health plans by their employers, with little opportunity to influence the decisions about their health coverage.

[Alan]

Serafina:

An American posting here who actually makes sense! Where did you come from? Do you have any idea what sort of simple-minded, true-believer cultists you've fallen in with? Good luck.

[David Woycechowsky]

Serafina: Looks like we think pretty much alike about the US system. There do seem to be a lot of people here who favor freedom to consolidate commerce over people's health and lives. I think the US system can be fixed primarily by taking antitrust measures to re-invigorate that ol' invisible hand. However, it ain't gonna get fixed by people who simply don't value poor peoples' lives very much. David.

[Alan]

What happened to that pompous windbag Tarran? I was hoping he answer me:

It is hardly a startling observation that the strong dominate the weak. Smart, good-looking peole always have an edge. In any system, the stupid are at a disadvantage. You seem to think that an unfettered free-market system will provide maximum freedom. In fact, the most important freedom is not freedom from contraints--no government interference--but the positive freedom to act. In this sense, the wealthy are always freer than the poor, the intelligent freer than the stupid, and so on. There is no logically compelling reason why this should not be so.

In the real world, the problem of the strong dominating the weak has never been solved, but it has been mitigated. Your illusory advantage, like that of most utopian zealots, is that the real world is not perfect, while your fervidly imagined paradise is. I thought you might stretch your imagination enough to emcompass a little imperfection. How will the weak fare in Libertopia?

[Alan]

Tarran:

I apologize for my bad manners.

"In a libertarian society, you are free to band with others to spread risk and pool resources."

Since no libertarian society exists, how can you be so certain about exactly how it will function. Do you entertain any doubts at all about the matter?