The US is consumed with discussion of health-care alternatives, and in US politics it seems to be OK to knowingly tell bald-face lies, and in US media it seems not OK to call a lie by its true name. Here’s a small bit of first-hand reportage about the working of another approach to health-care.

My mother-in-law is in her late seventies, suffering from progressive dementia, has always been thin as a rail, and is strong-willed and sometimes difficult. She lives on a farm in a fairly remote part of Saskatchewan.

She collapsed at home this week and has been diagnosed with a perforated ulcer. She’s also dramatically more disoriented and doesn’t seem to see properly, so maybe there was a little stroke or some other neurological misfortune in parallel.

She was taken to the nearest hospital, which happens to be a Catholic-run institution, where she’s receiving compassionate and competent care. They’re making it easy for her husband and daughter to be near her as required.

She immigrated to Canada in the nineties and hasn’t become a citizen yet. Interestingly, Lauren tells me that quite a few of the doctors and other hospital staff are also immigrants.

The key points are these:

  • She’s getting high-quality care.

  • The costs are covered by our public-sector health insurance.

  • The facts that she’s a recent immigrant, that her income is negligible, and her prospects for long-term recovery are poor are not considerations.

  • No civil servants are in the loop.

  • Canada spends a dramatically smaller proportion of its national income on health-care than the US.

  • The American conservatives who are fighting health-care reform are filthy hypocritical lying scum.


Comment feed for ongoing:Comments feed

From: Sam J (Aug 22 2009, at 14:27)

s/Canada/Australia/g and the story is quite similar. Same for France, Ireland and the UK...

In fact it's true for pretty much any part of the civilised world I've spent more than a short amount of time in. Of course conversely, the alternative is far from civilised. In fact it can be hard to differentiate between a society which abandons those less fortunate than themselves from the savages who went before them.

Thailand have some of the best and cheapest healthcare in the world so far as I can tell too, so it's not limited to the western world either.



From: Martin Heller (Aug 22 2009, at 14:41)

Tell us what you really think, Tim. ;)


From: Derek K. Miller (Aug 22 2009, at 14:58)

It would be hard for me to have asked for better cancer care than I've received since I was diagnosed in January 2007. I'm still here, the latest Phase 1 trial experimental drug I'm on may be working, and my biggest out of pocket expense has been parking at the B.C. Cancer Agency.

What I don't understand is what the U.S. opponents to healthcare reform with a public option actually want. They like healthcare that doesn't work well for everyone and costs too much?


From: Bob (Aug 22 2009, at 14:59)

Glad to hear that your mother-in-law is receiving competent care, sorry to hear that she took ill.

I will say that your last bullet is simply a non sequitur, I know conservatives of various stripes who oppose present proposal for a variety of reasons - some economic, some for reasons such as principles of subsidiarily (where best to distribute control), some for the process in which the proposals have been moved forward, others for reasons of human rights, still others for reasons of freedom of religion.

Many have some mix of these reasons - I am of this camp.

In any case, to paint everyone who is conservative and opposed to the present reform proposals in the manner done here, well ... what's the point?


From: Alan (Aug 22 2009, at 15:04)

1. Name a major republican who doesn't believe we have problems that need to be fixed in the US (ie. is against reform). You misrepresent the arguments of those you consider lying scum. Have you read the proposed reform bills? I have and they don't achieve anything near what could be considered universal coverage and would increase our spending dramatically.

2. I can give you at two examples from my family that run EXACTLY counter to yours.

- My father was told in Toronto he had 3 months to live with cancer and after multiple second opinions, was basically given the option of hospice. We found him alternatives across the border that treated him for several months and he lived another 3 years.

- My uncle had prostate cancer and was shipped to Buffalo because the wait times in Toronto were 6 months (and he would have been beyond

- My aunt in Newfoundland was told she had some unknown issue with her knee but had to wait 6 months for an MRI to get it diagnosed because it was deemed not critical. During that wait, she could not walk or drive.

3. Get educated.


From: David Megginson (Aug 22 2009, at 15:05)

The U.S. is such a polarized political environment on all sides that the public good rarely comes into the debate (except as empty rhetoric). Like the Democrats did when they were out of power, the Republicans are looking for any weakness they can exploit to attack the presidency.

In this case, the Republicans have two strong allies: the healthcare industry, which diverts a mind-boggling percentage of the U.S. GDP, and seniors, who already have free healthcare and don't want to risk higher taxes or reduced care to share their benefit with anyone else.


From: Charles Ditzel (Aug 22 2009, at 15:09)

I'm in complete agreement with Tim. Having watched my Canadian friends deal with Canadian Healthcare - I was in awe on (a) how well it worked and (b)the almost non-existent client paperwork (a simple Care card is presented). It is well run (not that there aren't issues ) and it deals with entire population's health - not a fraction of the population. The American debate on healthcare has been co-opted by a right-wing, self-serving minority.


From: Dylan (Aug 22 2009, at 15:10)



From: Ron Bischof (Aug 22 2009, at 15:29)

An anecdote and ad hominen slander constitute an eloquent argument for a single-payer health care system?

Where's the reasonable, principled debate?

Overhauling health-care system tops agenda of Canada's doctors. "We all agree that the system is imploding…".


From: pwb (Aug 22 2009, at 16:00)

The Canadians I know who spend a lot of time in the USA almost all agree that US health care is better. US healthcare drives the vast majority of medical progress that fortunately gets transferred around the world.


From: John Cowan (Aug 22 2009, at 16:58)

health-care-in-exactly-25-words is the best explanation I've seen. The 25 words are "All of us put our money into a big pot, and when you have medical expenses, you take some money out of the big pot."

Insurance companies are people who run private pots and skim off some of the money. They, and people they have paid off or deceived, are the scum you mention.


From: Peter Keane (Aug 22 2009, at 16:48)

@folks taking exception to last bullet point:

Note what it says: "The American conservatives who are fighting health-care reform" not "all conservatives who have disagreements w/ current plans." Many conservatives *want* reform and will fight *for* reform. Tim refers here to the nasty campaign of distortions & lies propagated by some. I agree wholeheartedly and appreciate the perspective from up north.


From: Aguido (Aug 22 2009, at 18:14)

The plural of anecdote is not data.

And governments? Are people who put the money into the pot, skim off a little for the bureaucrats to allocate it (and their mates in nearby bureaucracies who need bailing out due to poor past decisions), a little more for the favoured constituencies (which may or may not be something to do with improving health, or might be a jobs program for the local MP's supporters), and allocate the rest according to where it will cost the least/get the most votes for the current parliamentary majority party.

I'm in Queensland, Australia. Held a Medicare card for twelve years, and private health insurance for six. I'll tell you which of the two wastes more of the money I put into them, and it's not the one run by the public sector.

You don't have to care about my anecdote, no, but if you're engaging with that attitude why should anyone care about yours?


From: lskrocki (Aug 22 2009, at 18:40)

Thanks for the post, Tim. Hoping your mother-in-law recovers quickly.


From: Scott Johnson (Aug 22 2009, at 19:27)

Let's not forget that the American doctors, with their large lobbying associations, are also filthy, hypocritical, lying scum.


From: Ben Trafford (Aug 22 2009, at 19:44)

To counter pwb's point, above, as a Canadian who lived in the U.S. on and off for several years, and had many reasons to experience the system there...

It sucks. Plain and simple. The wait times were longer. The doctors were okay, but the nurses and support staff were wholly incompetent bottom-feeders, by and large. The quality of life in the hospitals was disturbing -- overcrowded and unclean, by and large. They failed to diagnose a condition which has ended up causing me -years- of grief.

And I was paying big bucks for the best healthcare someone in my tax bracket could afford.

My experiences in Canada have been almost wholly positive, by comparison.

And to the rest of you -- when Tim says "lying, hypocritical scum," I'm pretty sure he's referring to the elected Republicans who like to make Americans think that their medical system is the best in the world, leads all notable advances (an oft-quoted myth repeated in these comments) and that anything else is a socialist plot that will lead to some sort of dystopian Soylent Green fantasy world.


From: Jim Ancona (Aug 22 2009, at 19:46)

Tim, I wish your political opinions were as measured and well-argued as your technical ones. "Filthy hypocritical lying scum" is not an argument.



From: Charles (Aug 22 2009, at 21:18)

@Jim Ancona

You're right that Tim's last key point was not an argument. It is more of a conclusion based on the previous facts he presented. However, that does not invalidate the rest of what he said.

Additionally, I think he is speaking as a Canadian citizen who is tired of the ad hominem attacks being lobbed at Canada and the rest of the world whose health care systems differs from the US's by politicians and pundits seemingly hell-bent on stopping any discussion of reform on political grounds.

Speaking as a US citizen, I know I'm tired of lies that have dominated the discussions. Lies told with apparently no fear of consequences. In the face of that, I think Tim's response is at least proportionate and probably more merciful than his intended targets deserve.

Having said that, there is plenty of room for reasonable people to disagree, but I haven't really seen many reasonable people affecting this debate in a significant way. It's quite embarrassing, but I comfort myself with the knowledge that most nations' domestic politics are at least as acrimonious, vicious, and stupid. But it would be nice if we didn't insult our neighbors while conducting our "deliberations".


From: dr2chase (Aug 22 2009, at 21:55)

The plural of anecdote is not data, but the data (CIA world factbook, similar sources, find them all at says the following:

We in the US spend more on healthcare per capita, and a greater percentage of our GDP, that any other country. The others, who all spend less, spend whacking hunks less.

We, in the US, have a life expectancy at birth that is years shorter than many (about 20) other "large", "modern" countries. We have an infant mortality rate that is scandalously high.

All the other countries, have universal care, achieved in a variety of ways. I have heard that Obama's proposal most resembles Switzerland, which is a shame, because that's neither the best nor the cheapest health care (France would be better).

The data is all there, and it says that we in the US spend vast amounts of money for inferior, immoral, results. No doubt there are other causes contributing to this, but one way to get some attention paid to "other causes" is to centralize the problem and make it unavoidable. (And if you think it IS some other cause, I invite you to poke around nationmaster to see if you can prove your case -- they have obesity stats, just for example, but you have to be careful about which ones are self-report and which are doctor-report.)

Remember, the plural of anecdote is not data. I do not give a rat's ass about some stranger's opinion about how money is wasted, or stories about someone's Canadian friends -- show us the numbers, or you're just an intentionally ignorant ass.



From: Ben Trafford (Aug 22 2009, at 23:22)

On anecdotes vs data, since it seems to be coming up a whole bunch:

Anybody can sift through tremendous amounts of data to come up with whatever statistics support their worldview. One of the problems with modern living is that we're frequently overwhelmed with this data, to the point that it becomes meaningless. It's merely codified opinion.

At some point, personal experience and the related stories of others gives us a basis upon which to decide which numbers we really want to investigate. I have no desire to sift through, for example, the numbers that tell me U.S. firearms policy is sane -- I know I've never felt safe there, and that I know a lot more Americans who've been shot at than anyone else I know in the international community. That experience leads me to have more faith in the various presented statistics that fall somewhere closer to the experiences I've had or had shared with me.

I'd suggest that a mix of anecdotal evidence plus stats is a good way to figure out the truth of a matter.


From: Ben (Aug 22 2009, at 23:57)

I am neither Canadian or American. The only experience I have of this debate is that which I have read in the media.

My perception is that there is a very vocal part of the population in the US that instead of bringing proposals to the table to reform healthcare seems determined to derail the whole process.

This minority seems to be galvanised by the Republican Party and its supporters.

Everyone has known that healthcare reform in the US is necessary. When Bill Clinton tried to push through reforms they got derailed. George Bush did little to reform healthcare while he was in power.

Rather than trying to destroy healthcare reform (which it appears is what is happening at the moment) those that don't like Obama's plan should be bringing their own plans to the table and in a point by point basis show how they can better achieve the aims that Obama is trying to attain, in a different way.

Arguing that the status quo is OK is simply not good enough and I see no reason why it should be maintained.


From: pwb (Aug 23 2009, at 00:14)

Sorry, Jeff, I don't believe you. It's indisputable that wait times in Canada are generally longer. And if there is one thing that most people agree on it's that hospital nurses are very good.


From: Bob Aman (Aug 23 2009, at 01:16)

"The American conservatives who are fighting health-care reform are filthy hypocritical lying scum."

Quoted For Truth.

It was one thing when they were talking about fighting health care reform because they claimed to be worried that the deficit was already too high, but now that there is discussion of taking the public insurance option off the table and replacing it with non-profit insurance co-ops, they're still indicating opposition despite the fact that the new proposal would be largely budget-neutral.

I can only conclude that their opposition at this point is opposition for opposition's sake. The disingenuous nature of the whole thing really bothers me.


From: Jim Ancona (Aug 23 2009, at 10:58)


Actually, none of Tim's post was an argument. The first part was a datum, an anecdote, but an interesting one, to the extent that it contradicts some of the caricatures of the Canadian system. The rest was just name-calling.

If Tim is concerned about the quality of the debate (and I think he is), it seems to me his cause would be better served by trying to improve it by making real arguments.


From: dr2chase (Aug 24 2009, at 06:06)

<i>It's indisputable that wait times in Canada are generally longer.</i>

I'll dispute it, if only to produce a link to data. Says who?

And further, wait times for what? Elective surgery is one thing, life-threatening is another. Always keep an eye on the dead bodies -- despite the alleged wait times, the Canadian system (which may well include something other than just medical care, but if so, what?) results in longer expected lifespans. It's crazy to claim that we've got something better, when we blow that fundamental metric, especially when we spend as much money as we do, especially when we don't even care adequately for our entire population.


From: John (Aug 24 2009, at 10:32)

Tim - you should really stay away from making political statements. Your generalizations against conservatives (there he goes again) are getting quite boring.

At least get educated about the health care bill before lambasting everyone who's against it. Good grief...


From: John Turnbull (Aug 24 2009, at 10:42)

My anecdote: treatment for lymphoma in Omaha (well-known center for this disease) and in Vancouver. Technique and quality -- almost identical.

The difference is that in Omaha I was treated because I could afford it, in Canada I was treated because I'm unhealthy.

Comparative metrics such as wait-time are meaningless because the two systems have a different intent. One covers some, the other covers all. If the US chooses not to accept a collective responsibility for all then some will have a system that can be judged on price and quality. So far they're not getting what they pay for.

@John Cowan - Yes and yes. There is no need for private capital in a generalized insurance plan and no reason to reward shareholders because there is no risk.


From: Milton (Aug 24 2009, at 11:39)

So Alan (Aug 22 2009, at 15:04),

From your perspective and experiences, and in keeping with the tenor of the original, post you would need to say:

"The American liberals who are fighting for health-care reform are filthy hypocritical lying scum."


From: Gary Murphy (Aug 25 2009, at 05:49)

We can contribute the most to this discussion by writing our elected leaders. I reposted my letter on my blog:

It may give you some ideas. Do write the letters.


From: Paul Prescod (Aug 25 2009, at 09:28)

Even as a happy Canadian health-care consumer, I take a bit of issue with Tim's last bullet point.

It's certainly true that there are a variety of reasons to argue against universal health-care, and some are down-right Machiavellian.

But there are also principled arguments from the likes of Ron Paul. I don't endorse the argument, but in that case I respect the integrity of the arguer.


From: Nicolas Krebs (Aug 31 2009, at 13:47)

"The American conservatives who are fighting health-care reform are filthy hypocritical lying scum." (Tim Bbray)

Why "hypocritical"? They have likely being told since their birth that public health insurance is socialist, european and un-american.

"We in the US spend more on healthcare per capita, and a greater percentage of our GDP, that any other country. The others, who all spend less, spend whacking hunks less." (dr2chase)

Look at the chart in .

"The difference is that in Omaha I was treated because I could afford it, in Canada I was treated because I'm unhealthy." (John Turnbull)

No comment.


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