June 2, 2008

"Hardcore addicts have no less right to the best health care than anyone else."

Life in Canada:
Ottawa is wrong to appeal a British Columbia Supreme Court ruling that extended a government-funded safe-injection site for junkies. Instead, it should have done its duty and resolved the case once and for all.

Asked to rule on a narrow case - the legality of the experimental safe-injection Insite drug program in Vancouver's seedy Downtown Eastside - the highest B.C. court on Tuesday instead went wide.

Unexpectedly, it ruled that Canada's drug law encroaches on provincial jurisdiction over health issues - and contravenes the country's Charter of Rights and Freedoms into the bargain.
Now, there's some federalism.

31 comments:

rhhardin said...

If they'd get access to average health care, it might cost less.

Leave the best health care for the rich. What's the point of being rich?

Trooper York said...

This is great. Tatum O'Neil is moving to Canada. Sweet.

PatCA said...

Everybody has a right to everything.

paul a'barge said...

Apparently in Canada people have a right to inject heroin but no right to criticize Islamist terrorists.

What a country of morons.

Eli Blake said...

Well, Canada must be doing something right.

On a per capita basis, they have less crime, fewer people in prison and they also live longer than we do. They also spend about 11% of their GDP on health care vs. 18.3% for the U.S.

Jeremy said...

Eli, it's probably the heroin. Or the bilingual traffic signs. One or the other.

How come those metrics can be attributed to Canada "doing something right?" Do you extend that logic to individuals? As in, wealthy people are healthy/wealthy/lower-conviction-rate because they're doing something right whereas poor people are sick/poor/incarcerated because they're doing something wrong.

LarsPorsena said...

Eli:

The last stats I can find on Canada to US immigration is 2004 where the number is
22,439. The last stats I can find on US to Canada immigration is 10,942 in 2007.

Now, do the math and convert in into terms of immigrants per 1000’s of population.

Why are all these Canadians running away from paradise?

TMink said...

Eli wrote: "They also spend about 11% of their GDP on health care vs. 18.3% for the U.S."

They should. You expect to pay less for a Focus than an Expedition.

Trey

vbspurs said...

What a country of morons.

That's silly. Ontario and the small sliver that is Ottawa are not Canada. Calgary has a lot in common with mainstream American culture, and I fancy they and other provinces are the first to resent the eastern ones because of their overarching power.

BTW, my boyfriend is Canadian, so I didn't take too kindly to that remark for personal reasons.

Cheers,
Victoria

Eli Blake said...

Three answers with one post:

jeremy: You're confusing individuals doing something right with a society doing something right. However, you are correct that wealthy people do have lower crime rates, better health and are less likely to be incarcerated. The last of these is directly correlated with being able to hire a good lawyer (like O.J.) but the first two are indeed a function of wealth. Most people convicted of crimes get their start as a juvenile, and wealthy people are less likely to live in places where their kids may end up in gangs or in trouble, and as we've been discussing, wealthy people in America can pay for health care while poor people often have little choice other than to be sick and try to earn a living anyway.

larsporsena:

Not hard to figure out why Canadians are migrating to the U.S. The same reason why people from Minnesota move to Florida, especially for retirement. If you can't figure out why that is, then go retire in Alberta, and by the following February you'll know why.

Honestly, when did you ever hear of someone moving someplace else because "Our heroin addicts get free syringes."

Trey:

Two problems with your car analogy:

1. Our supposedly 'superior' health care system isn't giving 'superior' results (i.e. we don't live as long as people in other industrialized countries, nor do we have as good health by most measures. Our infant mortality rate is apallingly bad, to the extent that it is closer to a lot of former Soviet republics than it is to Western Europe.

and

2. Some people buy a Focus because that's what they can afford. The problem with the America health care system is that if you need an expensive medical procedure done, you have no choice-- there is only expensive, expensive and expensive. It would be like being on a Chevrolet budget and being told that all you can buy are Cadillacs, Mercedes and Rolls Royces. I suppose you could not buy a car in that case, but if it is a procedure like cancer treatment or a heart transplant what you are really saying then is 'pay for it or die.'

Daryl said...

The headline to your post is misleading.

It purports to establish a ridiculous principle (that no matter what you deliberately do to your body, you're entitled to the best health care)

But in fact the case only establishes a very reasonable principle (that we aren't going to prevent addicts from having a safe way to inject; we aren't going to increase the risk they will get HIV/hep/etc. in order to discourage them from doing drugs)

The people who are opposed to safe injections want exactly that.

You just quoted some breathless dicta full of sound and fury, signifying nothing.

LarsPorsena said...

"Not hard to figure out why Canadians are migrating to the U.S. The same reason why people from Minnesota move to Florida, especially for retirement. If you can't figure out why that is, then go retire in Alberta, and by the following February you'll know why."


They move away from a perfect social safety net because of the weather?

Jeremy said...

Eli,
Thanks for the response. I understand the differences. Typically, in non-conservative circles we don't blame poor people's poverty/etc on them simply having done something wrong. We attribute it to more nuanced, or indefinable causes: institutional racism, cyclical violence, poor education, the Man, etc.

Yet on a societal level you seem to be willing to make the sweeping claim that lower crime rates, lower incarceration rates and more disposable income are all simply attributable to a single payer health care system that provide free needles to addicts. As though, if America were to implement a similar plan, we too could acheive lower crime, etc.

The reality is, I suspect, much more complex, nuanced than that. Those specs you mentioned can be attributed in some way to everything from the poverty rates of immigrants, to military spending, to historical values of gun ownership, interaction between ethnic groups, political structure: constitutional monarchy vs representational democracy, weather, home ownership levels, religion, national oil production, etc, etc.

It's just too easy to point to one thing and say, "Well that must be the answer."

vbspurs said...

Eli wrote:

On a per capita basis, they have less crime, fewer people in prison and they also live longer than we do. They also spend about 11% of their GDP on health care vs. 18.3% for the U.S.

My potential future father-in-law just came home from having an operation in Canada. He was in a ward with 4 other people, and hadn't received anaesthesia for his original exploratory exam. He had gone in originally for a some tendonitis pains and was prescribed anti-inflammatories and rest (not the battery of tests which would've been the case in the US, thus catching his condition in time).

Sure, mistakes happen all the time, but when the tax-payer is the sole party responsible for funding socialised medicine, don't be surprised if doctors are not given the green-light for "frills".

BTW, you mentioned some great stats to shore up your point about Canada. Here are some others.

Canadian population total: 32,000,000

Canadian immigration 2004 total: 235,824.

What's 235,000 people? A good 3 months at the Mexican-American border?

Sure, it's easy to compare systems as disparate as Canada and Norway (pop. 4 million) which have limited immigration, and whose citizens don't mind 15%-and-up taxes on goods.

But that's not America, and it never will be.

Cheers,
Victoria

Sofa King said...

On a per capita basis, they have less crime, fewer people in prison and they also live longer than we do. They also spend about 11% of their GDP on health care vs. 18.3% for the U.S.

...and they have 1/5 the number of black people.

Correlation is not causation, lies, damn lies, statistics, etc.

Your "point" is facile.

Simon said...

Eli Blake said...
"Honestly, when did you ever hear of someone moving someplace else because 'Our heroin addicts get free syringes.'"

There are no free syringes. There are syringes that the user provides, and there are syringes provided at the expense of the taxpayer - and you do hear of people moving to avoid higher taxes, a fortiori when those taxes are spent on frivolous projects.

HeatherRadish said...

They also spend about 11% of their GDP on health care

And when that budgeted money is used up, clinics close their doors until the beginning of the next fiscal year.

If that doesn't faze you, ask yourself why Canada keeps airlifting pregnant women to the U.S. to give birth...

montana urban legend said...

So what are you trying to say, vbspurs? You seem to link in a single statement: reimbursement, medical errors, defensive medicine and government funding. I might actually know something about these things, as might you (I'd have no way of knowing absent a deeper discussion), but if you're trying to backhandedly imply that single payer (or any government funding) necessarily leads to medical errors, I'm not sure that CMS would agree with you. Here's why:

http://medicalconnectivity.com/2007/05/23/feds-to-stop-paying-for-medical-errors/

http://nashville.medicalnewsinc.com/news.php?viewStory=1741

In about a year or so, we'll probably be able to go to an Institute of Medicine website and see if they won't have some good data on the role government will have played in likely drastically decreasing medical error rates. And you can bet it wouldn't have involved this trade-off of expenditures that it sounds like you're positing.

I know it's hard to have for many people to have a discussion that recognizes all the variables involved in it, but I'll give you the benefit of the doubt when it comes to understanding the rationale for why doing so might not be an exceptionally good idea this time, this year, when it comes to this topic.

TMink said...

Eli, thanks for the discussion!


It is interesting to note that two of your points have a single causation: underweight births. Underweight births of infants typically happen to mothers that are too young to be having children. Those children have a much higher mortality rate and also bring down the average length of life. These births are a huge healthcare problem in many ways but the issue is rarely discussed because the poor and minorities have children too early and discussing the issue and the issues of personal responsibility and self control that it bring up are very touchy in PC times.

And those factors leading to low birth weight have NOTHING TO DO WITH HEALTHCARE! They are the consequences of poor choices. We have wonderful prenatal options, but none of them work if the expectant mother does not come to the doctor or has no business being preggers in the first place.


Interestingly, 7 of 10 Canadian provinces send men with prostate cancer to America for treatment! In Europe, prostate cancer death rates go as high as 40% while the rate is closer to 5% here in America! The reason being that early detection and fast treatment solve most of the prostate cancer problem. Socialized medical systems are not good at early or fast sadly.


I am not really with you on the second point you make. I can go to a clinic and pay a little out of pocket, go to my PCP and my insurance will cover it, or go to the Mayo Clinic and pay for most of it myself, or I can ignore the problem. Those are choices. In a country with national healthcare, your choices are to wait for the service or ignore the problem.

I like the choices here.

Trey

Revenant said...

Well, Canada must be doing something right.

If "being almost entirely white and Asian" counts as "doing something right" then, yeah, they're doing something right.

PatCA said...

Canada did at least one thing very right; they situated themselves next to the friendly US, which pretty much picks up the tab for military/defense costs for its friends.

The US spends almost 4 times as much as Canada for military expenditures, in
% of GDP.

Revenant said...

You know, many people like to point out how much "America" spends on health care versus how much "Canada" spends on health care, and compare the life expectancies of the two nations. But that's a bit silly, because America doesn't cover everybody. If you spend $0 treating somebody and they drop dead at an early age, that might be tragic but it isn't a failure of the health care system.

The valid comparison is between Canadians and Americans with health coverage. When you compare Americans with health care against their corresponding Canadian demographic, you find in most cases that the American lives longer (there are exceptions in some categories, black men especially). In other words, while we spend more than the Canadians, do, the people the money is actually being spent ON get more out of it.

To get a truly accurate comparison, of course, you'd have to somehow deny Canadians access to American medicine... but that's not really possible.

montana urban legend said...

Well geez, Revenant. You know, it would be really easy to stratify out differences in expenditures between individuals with health care coverage and those without, but there's this little problem. It's the fact that hospitals, at least as I understand it, can't really get away with denying emergency care to anyone all that easily. Now emergent care is great, assuming you don't mind not having the resources to prevent something little from becoming catastrophic, but Bush agrees that at least it means you're covered. And when the indigent are put in the position of having to rely on exorbitantly costly emergent care, health care facilities have to get that money from somewhere. All sorts of "financially more desirable" consumers have to pay as a result. So as much as conservatives would like to wish away or seek to carve out the contributions of the indigent on the proportion of per capita GDP devoted to health care, short of denying emergent care, it's financially meaningless to do so. And conservatives would hate to seem morally uncompassionate or to speak in financially meaningless terms now, wouldn't they.

I think that as much as any interest group or ideologue would like to distort the issue of health care economics, that the time has come for resolving this issue in a socially constructive way is becoming undeniable.

vbspurs said...

I know it's hard to have for many people to have a discussion that recognizes all the variables involved in it,

I guess one variable I should reveal is that both my parents are medical doctors, and moved from their countries' nationalised health care to practise in America's privatised health care community.

It's not an uncommon thing. Medical students around the world claw, pray and sacrifice small animals for a spot in American medical schools.

For whatever reason, not so much to Canadian medical schools. Gee, wonder why?

Cheers,
Victoria

montana urban legend said...

"'I know it's hard to have for many people to have a discussion that recognizes all the variables involved in it,'

I guess one variable I should reveal is that both my parents are medical doctors, and moved from their countries' nationalised health care to practise in America's privatised health care community."

Good, vbspurs - glad to hear it. Then I should take this to mean that you would know better than to equate Canada's system with medical errors. My apologies for implying the possibility that you might have done so when you clearly have the knowledge to keep from doing so.

And yet, at the same time, it's a funny quote you choose to post from my comment, especially when you do so in order to follow up with this:

It's not an uncommon thing. Medical students around the world claw, pray and sacrifice small animals for a spot in American medical schools.

For whatever reason, not so much to Canadian medical schools. Gee, wonder why?


I think that could be for a variety of reasons, some related to the excess money that all sorts of health care interests are able to squeeze out the American consumer and some not. Luminaries from Fareed Zakariah to Niall Ferguson have written about the relative strengths of American higher education generally - not just in medicine. So there's a reason that's not necessarily related - but related in the larger sense that we pride ourselves on that while leaving primary and secondary education to rot. So trade-offs do exist; they're just not limited to the ways in which you've related them here. And the fact is that we should be honest about them. If you think that it's so unimportant for Americans to have basic access to medical care, that allowing your parents access to quality medical schools in America to attend trumps it, then that's ok. Just say so. There's no reason why you would need to be surreptitious about that, is there? But perhaps that wasn't the point you intended to make.

And also you might want to be more reflective on the range of qualities of medical education around the world. It's not as if American medical education makes that in Paris, Germany or other Western industrialized nations look like cave man medicine. There is a range - those in America tend to be near the top (along w/some Canadian schools such as McGill AND a few European schools), followed by schools of less reknown, before getting to the bottom. Which along with those in Calcutta, could include the schools that American medical students still could attend in say St. Lucia or the Bahamas, for instance, once they run out of their preferred choices on the mainland, while still qualifying for a legitimate American medical license without having to undergo some kind of foreign graduate equivalency procedure.

Cheers,

montana urban legend said...

Also, Vic. I'm wondering what fields your parents would be practicing in, in the States. My understanding is that it's a rare physician in America who loves the managed care environment, an environment the powers-that-be created in an effort to stave off a system which is comprehensive in something other than name only. Or might your parents be those physicians who've found a way to somehow escape what virtually every physician I know speaks of as the horror of managed care? Maybe all the rest are just venting?

Silly doctors!

Revenant said...

hospitals, at least as I understand it, can't really get away with denying emergency care to anyone all that easily.

The major variable affecting life expectancy isn't emergency care -- it is preventative care. The person whose high cholesterol gets noticed early because he gets regular physicals lives a lot longer than the person who gets rushed to the hospital with a massive coronary.

And when the indigent are put in the position of having to rely on exorbitantly costly emergent care, health care facilities have to get that money from somewhere. All sorts of "financially more desirable" consumers have to pay as a result.

Emergency care to the uninsured is not a significant part of our national health care expenditures. The primary driver of costs is supply and demand; we're consuming ever-increasing quantities of health care per capita, while the pool of providers is growing more slowly.

vbspurs said...

Father, Oncologist-Haematologist. Mother, Pediatric Psychiatrist. That's all I'm willing to say on that for now, Montana.

It's only germaine since you mentioned variables, and since we're discussing the differences in patient health care in Canada.

My father, an ex-visiting Professor at U of Toronto, could tell you more, doubtlessly. I can only do so second-hand.

But I know which academic and health care version he prefers hands down.

Cheers,
Victoria

PatCA said...

Revenant,
I agree with you--we're comparing apples and oranges.

Both countries have health care; it's just rationed differently in each. In the US we "give" more medical care to those who pay for it and/or who choose employers for their health insurance. In Canada, it's rationed according to waiting lists or age. I would rather rely on myself than a bureaucrat.

BTW here's more government intervention that will screw up our system even more:

TMink said...

Pat wrote: "I would rather rely on myself than a bureaucrat."

You must be a producer rather than a consumer. Congratulations and thanks!

Producers want to be left alone to, well, produce! Consumers want people to give them things to consume.

Obviously, America needs more producers.

Trey

TMink said...

"Hardcore addicts have no less right to the best health care than anyone else."

Agreed. They also have the right, nay the consequential imperative to die younger and more painfully from their addictions than those of us who eschew harmful drug use. And they have the right to buy their drugs with their own money, with none of mine.

Trey