cwmatz asks:

From what I understand, socialized medicine in Canada works and doesn’t have major issues. (Correct me if I’m wrong.) Couldn’t the US base a health care system on that instead of trying to make our own and messing it up horribly?

Yes, it does.¹ Yes, you could.² Maybe you should.³ But you won’t, and that’s probably the most important answer of the four.

1. Of course it has issues – every health care system does – but the issues facing it are hardly unsolvable ones and not system-killers. Overall it’s mostly a stable healthcare system with some flaws, just like most healthcare systems. [↩]
2. Universal enrolment in Medicare. It would cause transition pains in the short term, but it would work in the long run. [↩]
3. Pure single-payer insurance, as Canada’s system is, isn’t the most efficient system available to choose from. In terms of absolute dollar expenditures per capita, a nationalized health system such as the UK’s is cheapest. In terms of value-for-dollar-spent, you’re probably looking at France’s public/private hybrid as being the best method available. In terms of easiest transition from the current American system, Germany’s managed care fund system would probably present the smoothest overhaul. Of course, they’re all superior to the American model and that’s what counts. [↩]

So far the revival of V has been fairly reliably dull and nonsensical, but this week’s episode brought the first throw-the-remote moment when Our Heroes discover that a key part of the alien invaders’ plan is… flu shots. In what may be the most needlessly convoluted plan in the history of convoluted plans, the Visitors, or “Vs” because apparently “Visitors” takes too long to say (and just FTR, Internet, it’s not “V’s”; learn to pluralize correctly and keep that apostrophe in its holster) introduce some sort of vitamin shot that promises to do all kinds of wonderful things. Our Heroes naturally are suspicious, but discover that the miracle drug is in fact just a blind for the real threat: a chemical to be added to flu vaccine that causes people to die horribly (and I mean horribly: the “test subjects” look like they’ve suffered spontaneous combustion, not a bad drug reaction.) Of course, it seems likely that after the first couple of deaths a) the contaminant will be discovered and b) people will stop getting flu shots, meaning that at best this whole elaborate plan will kill a few dozen people. Or is it actually an insidious alien plot to spread the flu and increase absenteeism, thereby hurting our productivity at this already fragile economic time?

To be honest I don’t really care, and I’m already bored of talking about V. What does interest me is the persistent fascination with vaccines among conspiracy theorists of all stripes. It’s the one thing paranoid right-wingers and paranoid left-wingers have in common: a conviction that vaccination is somehow bad, though the reasons why it’s bad vary somewhat. Now, of all the health innovations of the last few hundred years, vaccines and antibiotics have to be pretty near the top in terms of improving public health (general  antiseptics and reliable supplies of clean drinking water would be the only competition I can think of.) Vaccines are probably the more important of the two because antibiotics are primarily of use in a) curing venereal disease and b) surviving trauma and surgery — both worthy causes, but not really that significant on a population-wide scale. If you want evidence, look at the Spanish conquest of North America: the conquistadors had been more-or-less inoculated against smallpox (mostly by having survived it as children, or being exposed to it and developing antibodies while reacting asymptomatically), while the defenceless Aztecs died by the millions. Or look at the persistent use of milkmaids as icons of beauty in Western art: it’s not just because they look so fetching covered in cow manure, it’s because exposure to cowpox protected them from smallpox and the associated “small pocks” that marred the face of nearly every other person in Europe. (Next time you’re reading one of those epic fantasy novels with the embossed covers, try to imagine every single character’s face with little scars, pits and boils. Your desire for time-travel will drop substantially.)

So what is it about vaccines? Why are people so willing to believe anything bad about them, no matter how flimsy or nonexistent the evidence? (There have, it’s true, been a small number of bad or tainted vaccines distributed, but on average vaccines are still much safer than, say, cars or hamburgers.) Some of it is probably just reflexive post-’60s anti-authoritarianism — if the government, or doctors, or scientists, or any other authority figure wants you to do something, it must be bad — but vaccines are a special case. (We don’t see a similar resistance to antibiotics, for instance; in fact parents insist on getting antibiotics prescribed for children’s ear infections even though the evidence shows they have no positive effect whatsoever and help spread antibiotic resistance in bacteria.) The method of delivery no doubt has a role to play as well: taking a pill has little emotional resonance, but having something injected into you has an instinctive ick factor, with connotations of violence, poisoning and penetration. But the biggest reason, I think, is the power dynamic involved. Even though a doctor prescribes antibiotics, we control the act of ingesting them. Vaccines, on the other hand, are administered to us — and for most of us, our main experience with inoculations is as children. What inspires more terror in an elementary school than “shot day”? Unlike visits to the dentist, which are a solitary trauma, inoculations are often done in large groups, encouraging an “us” versus “them” feeling. Just as children fantasize that their real parents will someday whisk them away to the life of splendour and luxury they deserve, or that ice cream will eventually be deemed healthy and spinach poison, so too do we find it easy to believe that this awful experience — given to us “for our own good,” like so many childhood horrors — is part of some evil plot. We knew it all along.

Mary Warner, in the previous post about healthcare:

I’m one of the millions of Americans already benefitting from Socialised medicine. I’ve been on Medicaid since last Summer. Before that, I’d gone a few years with no insurance at all, which was very difficult as I have pre-existing conditions and some expensive prescriptions. But even so, I’d much rather have the US scrap all mandated insurance, and abolish the most of the regulations we currently have, and try to return to an actual Free-Market system. We have far too much Socialism in this country already, and letting the Government into everybody’s private medical concerns would just let them continue to erode our freedoms even farther, I think. This could very well hurt myself, I know, possibly severely. But what’s right for society, and what’s most beneficial to oneself, are not necessarily the same thing.

You’re all going to gang up on me over this, aren’t you?

There shall be no ganging! For I am one, and therefore I shall not gang.

Look, I get that libertarians recognize – correctly – that the United States is not a classical free market when it comes to healthcare. But as many a writer has pointed out better than I could before: a perfect free market in healthcare cannot exist, because in order for a free market to operate properly, consumers and sellers need a perfect amount of information, or at least something close to it.

You can’t get that in healthcare, mostly because medicine is so complex that doctors actually have to specialize in sub-areas of it to have a realistic shot at doing their jobs properly – forget about you, the non-doctoring schmuck, being able to accurately determine which treatment is best for you, even if you spend whole days on the internet. You can’t do it; even doctors mostly have to make educated guesses for the serious stuff. And that’s before you get into the idea of effective cost. Do you feel confident taking the $1000 surgery over the $1500 surgery? Christ, I wouldn’t – but that’s not a rational decision based on the relative skill of the surgeons, it’s just the root assumption that the more expensive surgeon is the better one, which isn’t necessarily true and how could I tell?

(I’ve had people seriously inform me that they know how good hospitals are based on the politeness of the staff. I mean, polite staff are nice and all, but I will pick “staff more likely to save my ass” over “staff more likely to ask me if my pillow is fluffy” ten times out of ten.)

On top of that, it’s not a free market because for the majority of serious treatments, you don’t have the opportunity to refuse. If you need chemotherapy and it’s two thousand bucks, you are not going to sit back and say “well, I’m gonna wait for the spring sale.” You spend the money. And you spend it right away. Because you’re a captive to the necessity of care, and therefore you are not a rational, discerning consumer.

And on top of that, you need some form of regulation because, hey whoops, healthcare is really expensive. There are exactly two ways to lower this cost and neither one of them is “competition.” The first way is for government to mandate how much healthcare costs, typically by employing all the doctors, or alternately by telling doctors what they can charge. The UK goes the employment route; Japan, Canada, and most of Europe goes the dictating-prices route.

The second way is through massive risk-pooling. The concept of insurance is simple: everybody pays a little into a collective fund against the risk that something bad happens to them. If something bad happens to you, the people who did not have something bad happen to them’s money goes toward fixing your something bad. This way, everybody pays a little, rather than somebody going bankrupt because of the bad thing (and since that bankruptcy can have ripple effects, in the long run it’s better to help them anyway, so it’s basically win-win).

But that concept doesn’t work for health insurance, because unless everybody dies a tragic instantaneous death or is healthy as a horse till the age of 98 and then dies peacefully in their sleep, what happens is that eventually everybody will get old and need to access health insurance – and the old people who use health insurance the most are also the biggest drains on the system. Thus, the only way health insurance works is if the healthy, young majority subsidizes the old, sick minority, on the theory that eventually they too will be old and possibly sick and will want the young people of tomorrow paying their way. And so on, and so forth. But this only works if the young people pay into the health insurance system – which (beyond maybe catastrophic health risk insurance for those inevitable bus crashes) they have absolutely no selfish incentive to do, because they are young and healthy and don’t really need health insurance to cover their yearly physical.

Thus, the concept of mandated insurance and/or universal participation. This is the other way that every country in the world with a decent healthcare system lowers costs. It works, and so the right-wing in America is predictably shitting a brick over the idea that it be proposed.

Heksefatter:

I’d like your take on [American] health care reform

Right now a lot of the kerfuffle is essentially a tempest in a teapot, because all of the kerfuffle is essentially about the public option. But here is the thing: if the public option could be measured in terms of flavourful condiments, flavorless oil being “most capitalistic” and a bottle of hot sauce labeled SUPER SUICIDE DEATH GENOCIDE SAUCE XXXXX DO NOT USE EVER WE HAVE WARNED YOU BECAUSE OUR LAWYERS MADE US WARN YOU being “most socialistic,” the public option would be, I dunno, mayonnaise. Or possibly Miracle Whip Lite.

This is because the public option has gotten so watered down at this point it is beyond stupid. To sum up: at present, it will be a government-run corporation which cannot draw on government funds to remain solvent and cannot charge artificially lower rates to be convenient to the populace at large. All it really promises to do that other insurance companies will not do is this: they promise to not screw over policy-holders. And that, that alone, has insurance companies terrified. This should tell you something.

And because of the kerfuffle over the public option and stupid Palin bullshit about death panels, the actual meat of the proposed legislation isn’t really getting discussed. These come in two flavours: the new rules forcing insurance companies to be a little less fuckersome (but not nearly so tightly regulated as in, say, Germany or the Netherlands) and the insurance subsidies for low-income families. The former are necessary and probably aren’t strict enough. The latter are necessary as a short-term means to increase coverage, but don’t address the real problem of American care, which is basically that America spends too much money on goddamn everything in health care for reasons that are almost entirely artificial, and it is bankrupting the country.

But it’s a first step, and I think a lot people boosting these policies regard it as a first step. (Not the more conservative Democrats, of course, but conservative Democrats aren’t entirely sure about whether or not we should use fire, let alone governmental answers to insurance costs.) Of course, that’s exactly why Republicans are screaming bloody murder: they know it’s a first step too. Which leads Democrats to say things like “there’s nothing inherent about these acts that will create government-run healthcare.” Which is true, but not really, you know?

So I been paying all sorts of attention to the whole American healthcare debate, by which I mean MGK pays attention to it and when we go out for beers he is all “healthcare this Republicans that” and I am all “dude drink your beer” and he is all “but this affects our own healthcare policy you know” and I am all “does that mean we have to get the swine flu?” And then he looked at me for a long time and sighed. Later it turned out that we don’t have to get the swine flu, we just are encouraged to get the swine flu shot. Which is different! But that’s why our healthcare system is the best, I guess. You poor Americans have to go line up and get the swine flu. We get a shot. We have eliminated the middleman.

(How do they do that? Do they have, like, a sick guy who coughs in your face? I bet I could make it more efficient. Like, maybe you shake pepper on the sick guy’s face and he starts sneezing. I bet he could infect maybe ten or twenty people at a time if they did that. I should be an efficiency expert.)

Anyway so far as I know what the problem is, is that Republicans have problems with the government making people line up to get the swine flu because they are all “well people could die” and the Democrats are all “not if we limit the role of government to a very small amount so you like us better!” and the Republicans are all “banana muffins to you, buddy, we ain’t getting no swine flu.” Anyway there was a vote tonight and the Democrats passed a bill in Congress, which I guess is the Swine Flu For All (And Highway Reconstruction) Act of 2009. But one Republican voted! Joseph Cao, of Louisiana. You’d think his name sounds like “cow,” but Vietnamese people pronounce it like it’s a G instead. I know that because I went to Wikipedia.

Now here is the thing about Wikipedia. After the vote everybody was editing Joseph Cao’s Wikipedia page. Like, the Republicans were saying he was Satan and the Democrats were saying he was Santa. And I wanted to edit his page because I thought the page didn’t make it clear enough that his name doesn’t sound like “cow.”

So I wrote

Anh “Joseph” Quang Cao is a New Orleans lawyer and the current U.S. Representative from Louisiana’s 2nd congressional district. He is a member of the Republican Party. His name does not rhyme with “cow.” Well, it does, but it sounds like “gow” instead.

And I felt I had contributed. And then they changed it back! I figured they thought I hadn’t been clear. So I wrote

Anh “Joseph” Quang Cao is a New Orleans lawyer and the current U.S. Representative from Louisiana’s 2nd congressional district. He is a member of the Republican Party. He does not like cows. In fact he has nothing to do with cows. If cows can read Wikipedia, you should go read some other article. Like, one about milk. That would make sense.

And they changed it back again. I was starting to get a bit ticked off, so I wrote

Anh “Joseph” Quang Cao is a New Orleans lawyer and the current U.S. Representative from Louisiana’s 2nd congressional district. He is a member of the Republican Party and is a lifelong member of the “Just Say No To Cows” campaign. He is lactose intolerant. Do you get that, cows? Do you feel the thunder?

Of course they change it back, because Wikipedia is clearly biased in favour of cows. Maybe those folks at Conservapedia had it right after all! But I didn’t want to give up. So I wrote

Anh “Joseph” Quang Cao is a New Orleans lawyer and the current U.S. Representative from Louisiana’s 2nd congressional district. He is a member of the Republican Party. He hates cows so much he once stabbed a cow to death with a letter opener. In cow language, he is known as “Great Savage Fury From Above.” He has never met a cud he would willingly chew.

I’m sure you can guess what happened next. So I went to Conservapedia but they don’t just let anybody edit their open-source-coded online encyclopedia, apparently. So I grudgingly went back to Wikipedia and tried one more time.

Anh “Joseph” Quang Cao is a New Orleans lawyer and the current U.S. Representative from Louisiana’s 2nd congressional district (cow population: 0). He is a member of the Cow-Murdering Party. In his secret lair beneath the catacombs of Washington, he works relentlessly to protect us all from the menace of the cow. He may have adopted a secret identity to do this more effectively. Beware, cows! Your doom is at hand!

Then Wikipedia sent me a polite email suggesting that maybe I should start a Wikia page if I had such strong feelings about cows but I sent one back saying “no, it’s not me, it’s the Congress guy who hates the cows,” and they haven’t gotten back to me but my editing privileges seem to have been temporarily suspended. Stupid Wikipedia!

So I’ve been getting email after email after friggin’ email from nerds who have decided that this blog is the official “government policy for nerds” blog and who want me to talk about healthcare again. Which, cool that I have a niche and all, but yeesh, how much can you talk about healthcare really?

Seriously. At this point anybody who cares at least knows the base statistics that inform the health care debate, and those that don’t can be easily pointed to those facts if they care to read them. This is the problem: the debate – like so many debates in the United States nowadays – has come down to people who care about facts, and people who care about the scary fantasies they pretend are facts. That the second group is fed these scary fantasies by self-interested parties is really besides the point.

Are you disappointed that Obama has publicly said that there might not be a public option in whatever healthcare bill gets passed? Not unreasonable, but what the fuck did you expect? The American governmental system is one that is fundamentally designed to preserve the status quo: there are dozens of checks and balances, all of which allow one side to stop the other in its tracks. Massive seismic shifts in public policy can only happen with enormous shows of public support.

This is what the teabaggers and birfers and socialist-criers understand: being willing to shout in public matters. Yes, discussion of facts in a rational matter is good; it would be wonderful if human nature universally led us all to appreciate sober contemplation as being of the utmost merit in civic debate. Unfortunately, we live in the real world where this has almost never been the case, and wishing that it were so doesn’t change the fact of the matter.

Lemme change track for a second. Look at these guys here.

These are lawyers in Pakistan. In 2007, when Pervez Musharraf suspended the Chief Justice of the Supreme Court, the lawyers in Pakistan saw that this was the potential end of the rule of law, which was A) bad for their careers but more importantly B) disastrous for the stability of the country and the rule of law. So the lawyers went out in the streets and rallied and shouted, and things changed. Not to say that Pakistan became a dreamy place or anything, but those lawyers managed to get a result. Oh, and they did it on the definite risk of death. Not the “some crazy militia guy might shoot at me maybe possibly” risk. The “soldiers WILL shoot at me oh yes definitely” risk. So really: you don’t have an excuse.

Where’s the massive pro-health-care rallies? Where’s the Million Single-Payer Supporter March? Okay, so that’s a shitty name, but come on: there’s got to be somebody reading this who might be able to start organizing something like that. And if there isn’t, there should be – and by that I mean not that there should be someone of that caliber of organizational ability reading this, but that there should be someone reading this who should be able to discover said talents. Far stupider people than the average reader of this website have managed organizational feats that are not insignificant.

(I sometimes think that internet social media have seriously harmed any chance that people have of effecting real change because it’s so easy. You join some social cause group on Facebook and get to feel like you’ve made a difference – but you haven’t. You’ve just gotten the warm glow of activism without any of the work. I understand the appeal – I mean, I’m lazy too – but people have to realize that Facebook’s uselessness is actively pernicious and that elected officials have learned that 150,000 people on a “WE WANT THIS THINGY MISTER GOVERNMENT” Facebook group will result in exactly zero changed votes on election day.)

And the thing is that Obama told you all this in advance. Remember right after the election? He specifically said “you’re going to have to keep on me to make sure I hold up my end of the bargain.” He wasn’t talking about people pushing him – he doesn’t really need to be told that governmental delivery of care is to the general good. He was talking about making it clear to the Kent Conrads and Ben Nelsons and other assorted corporate Democrat cockwads of the world that he was riding at the front of a thunderstorm. Unfortunately, there was no thunderstorm. There was barely a brief summer squall.

The lunatic right-wingers disrupting town hall meetings understand – on some level, perhaps not consciously – that they hold the minority viewpoint.¹ That’s why they shout so loudly. Volume is passion, and elected-type people understand that for every person who stands up, there are ten or twenty more who share their views and will act when led in that direction. (Of course, in the case of the townhallers, this is actually not the case, but usually it is.)

That’s what’s needed: a massive rally or series of rallies. And I mean big. Civil rights marches big. And they need to be focused on the issue at hand, which is health care. No “FREE MUMIA” signs. No talking about climate change, much as I would like that to be important too. Have your rally be ONLY about health care, and the need for a comprehensive system, be that Canadian-style single payer or French-style multiple regulated risk pools or German-style health funds or British-style actual socialized medicine. Yes, some of the media will try to ignore such a rally, but the important thing is that this isn’t 2002 and the bulk of the United States is not expressly devoted to a bad idea.

The anti-reform crowd have a morally bankrupt message; in terms of health care the United States is rapidly progressing to third world country status. Use that: if they want to talk about the evils of Teh Socializm, you talk about the needless suffering and death caused by the current healthcare system in the United States. If they want to talk about rationing, you talk about the rationing that already exists. If they want to talk about taxes, you talk about selfishness, because that’s what the free-trade-health-care movement is: it’s institutionalized greed.

And for crissake, if you want something to happen, don’t just talk about it on your blog.²

1. I would dearly love the opportunity to debate some right-wing talking head about government care. Come on, it writes itself: “On this side, Glenn Beck. On the other side, an honest-to-god Canadian.” [↩]
2. Which, I know, but I’m a foreigner and therefore it would look bad if I organized a rally for you. Although my rally would have Rex the Wonder Dog logos. [↩]

When I got the word that I was admitted to the MGK Legion of Super-Bloggers (Check it out! Shiny new flight ring!), I thought long and hard about what I could bring to this mightiest of blogs that it didn’t already have.

It was while adjusting my knickers in the lift on the way back from the petrol station that the thought hit me like a runaway lorry: “Bloody hell– I’m in Britain! Right then, let’s knock out a huge pile of bollocks about that.”

This is, after all, the nation that spawned Alan Moore, David Lloyd, Neil Gaiman, Bryan Talbot, Warren Ellis and Paul Cornell into the world– to say nothing of Terry Pratchett. And everything they say about Britain is marvellously, disgustingly true.

However, disconcerting things have been happening here of late. A scant ten years ago, we were all scandalised by the Lord Chancellor’s announcement that he would now wear trousers rather than breeches and stockings. Word on the street was: Dude, you make over £200,000 of our money per year. You wear what we tell you to wear. Also, you fight crime! Have the grace to do it in tights!

And now, we hear that people who speak with the Queen — for example, to thank her for doing such a fine job as Canada’s head of state– no longer have to exit the room walking backwards. This would be fine if the reasoning behind it were “The Queen is an adult and can cope with seeing people’s butts. Indeed, she rather likes them. The only butt with which she has hitherto been familiar is the Duke of Edinburgh’s, and quite frankly, it no longer amuses her.” But no: they’re changing it because they’re afraid they might get sued if some idiot injures themselves. People have been moonwalking out of royal audiences since the bloody Magna Carta, and has anyone sued yet? Of course not! Anyone idiotic enough to reveal that they fell on their arse in Buckingham Palace, let alone launch a lawsuit about it, doesn’t deserve to call themselves British.

Even if you did sustain serious injury while backing slowly away from the Queen (hands where she can see ‘em, Canuck), we do have a National Health Service in this country. This means that you and your dented posterior will be whisked away to the nearest hospital, where you will be kept waiting for ages, drooled upon by drunken maniacs, subjected to blankly unhelpful attitudes and finally either grudgingly patched up or left to die on a gurney– but it will be FREE. In America, you’d get a lugubriously worded letter from your insurance company listing the multitude of reasons why being left to die on a gurney isn’t covered, and now you are both dead and broke (congrats.)

For those who missed the most recent silliness: US right-wing rag Investors’ Business Daily says in an editorial [now heavily re-edited] that Stephen Hawking “wouldn’t have a chance in the UK” because apparently they’d have let him die in order to cut costs; multiple people point out that Hawking was in fact born in the UK and lives here; Hawking himself says the UK’s health system has done just fine by him, thanks. He’s 67, carries the entire cosmos around in his head, and is mightily, awe-inspiringly British.

For if there is one thing which defines the British character, it is endurance. Whether the thing endured be tights-induced discomfort, royal etiquette-induced arsebruises or the small matter of the next nation over being wankers to you for centuries, your British person will keep calm and carry on. That’s what got us through two World Wars, up Mount Everest and frozen into a stiff-upper-lip-flavour ice lolly somewhere near the South Pole. Mmm, tasty.

(Nota bene: when the Queen awards Chris his MBE for Services to Awesome, I recommend he exit the room backwards so that he can watch her weeping as he leaves.)

Personally, I have only shallow thoughts on the American health care debate. Any attempt on my part to articulate a response to the notion that Paris Hilton could possibly deserve better health care than a factory farm-raised chicken, never mind an actual human being, immediately devolves into a scream of impotent fury. So here’s what some other people are saying about the current situation:

“When I was a kid growing up, we never talked about health care. Why did America become obsessed with health care the past twenty years or so? And you know what else we didn’t talk about when I was a kid? Black people. Good times, good times…” – Peggy Noonan

“OK, they’re distracted, quick, give me my bonus.” – Anonymous Goldman-Sachs executive

“My husband Ted and I are diabetic, unemployed, and have no health insurance, and we don’t want the government forcing us to get health care, no way. Just the other day I was saying to Ted, I said, ‘You know what we’ve got too many of? Feet.’” – Gun and fried Mars bar enthusiast Luanne Woodard

“So who do I have to free to get some media coverage around here?” – Kim Jong-il

“Hey, who’s the bartender and who’s the white house Chief of Staff here? That’s right, so do your goddamn job and give me another shot, liquorchimp! …So like I was saying, we’re totally gonna kill all the old people. I mean, it’s not like they’re our base, so fuck ‘em. This is off the record, right?” – Rahm “Spaceknight” Emmanuel

“Let me get this straight: they show up at public events, try to derail real discussion of the issues by being loud, belligerent assholes, and get on the news? Unbelievable. They stole my bit.” – Westboro Baptist Church minister and flamboyant gay activist Fred Phelps

“Jesus Christ, Mom. I’m like a year old and have downs syndrome and even I know that’s bullshit.” – Trig Palin

“Iz in ur Oh-Arr, yoothanizin ur gramma.” – Universal Health Kitteh

“They’re actually having a debate about this? What the fuck is wrong with them?“ – Pretty much every non-US citizen in the entire world

Mike asked:

’d rather hear what you think of the bashing Canada’s health care system has been getting all summer long in the American media. Has anyone gotten anything right about it in the US? Anything particularly egregiously twisted out of shape, or even outright made up? Face it: in the world of comics geeks, you’re the top go-to wonk on this subject.

I HAS A NICHE

Ahem. Anyway, the list of things “egregiously twisted out of shape, or even outright made up” by politicians and theoretically-journalists in the United States about the Canadian health care system is fucking legion. It never seems to goddamn end, and let me tell you: as a Canadian, I speak for just about all Canadians when I say that this is one of the things that really pisses me off about Americans (who are generally quite a decent bunch, all things considered), because the root assumption Americans make when they say that Canadians have shit healthcare and die waiting in line and so forth is that we are a nation of idiots who don’t know any better, considering that we live right next door to the capitalist paradise that is American health care. That this sometimes comes out of ignorance makes it no less rude.

And yes, I know Canadians can be and often are just as guilty of the same behaviour in reverse, myself included. There is one underlying difference, though, which is this: when it comes to health care, we’re right (or at least more right), and America is wrong. We cover all of our population for less money per capita than America does, and by most metrics we deliver relatively equal or better health outcomes. Yes, sometimes people wait for elective procedures, but they get taken care of eventually.

All of this is ignored when Americans lie or, at best, cherry-pick data to make the Canadian health care system – which is not perfect by any means, but is really a perfectly decent health care system, really – seem like the seventh circle of Hell. For example, there’s this link, which purports the “superiority” of American health care. It’s been mad-linked on all the right-wing blogs the past few days. Let’s go through it.

STUPID WOMAN AT THE PRESS CONFERENCE THING: “Hey, my billion-year-old mother got a pacemaker five years ago and she’s still alive because of it even though the doctors said she was too old to get a pacemaker and didn’t want to do the surgery because she might not survive. What do you say to that, huh?”

OBAMA: “That your billion-year-old mother got fucking lucky, and it’s not my job to pay to make sure she has the chance to be fucking lucky.”

Cory Morgan, author of yesterday’s aforementioned witless post about being opposed to funding gender reassignment surgery, has responded in similarly witless fashion. Suffice it to say he starts off with a reference to Comic Book Guy on The Simpsons – fresh and original! – then goes into a comparison between transsexuals and comic book fans which I am sure had his blog audience rolling in the aisles, except all the comments I see on it seem to be from people I know found him through me and they aren’t so much his audience as they are a newfound crop of antagonists. Although I’m fairly sure he’s happy to get any attention he can manage.

But I don’t really care about his insults about being a comic book fan (OH NOES, THE RIGHTY BLOGGER SEZ I AM A SEXLESS NERD, MY LIFE, IT IS LAID BARE). What I do want to briefly take issue with is this:

A line gets crossed when one is asking me as a taxpayer to fund their pursuits however. I do not and never will support public funding for surgery that simply is not medically required.

Gender reassignment surgery – even in private care situations – is not handed out willy-nilly because of the enormous liability issues it presents (and it is right and proper that those liability issues exist for such a serious, life-altering elective procedure). That’s why there are only eight to ten surgeries performed in Ontario per year.

And those surgeries are medically required, the same as pharmaceutical therapy is often required for those with mental health issues. Does Cory Morgan take issue with poor people being prescribed anti-schizophrenic medication? Anti-depressants? Mood stabilizers? After all, it’s entirely possible for people to function – for a given definition of “function” that is not very functional, but oh well – without those drugs, which artificially alter one’s neurochemistry to an extent that the differences between it and surgery are merely semantic.

They will just be, at the very least, chronically unhappy, anxious, and depressed. But they’ll be alive!

And transgenderism isn’t simply a mental health disorder. Know how I know that? Because we used to classify it as one, and tried to “cure” transsexuals of wanting to be a different gender, and it didn’t work. It simply resulted in greater anxiety and depression, and their psychological costs fiscally outstripped many times over what the surgery would have cost. Where gender reassignment surgery is necessary – and, again, it is worth noting that it is only necessary in a tiny number of cases – it is considered so because it is the best way to ensure that the patient enjoys the maximum and highest quality of life that is available to them, the best way to reduce their suffering and anguish to a minimum.

I would further note that my experience in this area is far from academic, because a friend of mine is transgender. She (male-to-female transsexual) actually works at one of the comics shops I frequent, which I am sure would make Cory giggle over his comparison once more. (Although I’m pretty sure she gets laid more than he does, and also has better clothing sense for that matter.) I’ve known her long enough that I knew her when she was still using her male name reluctantly, because she was scared of how people might react if she used her chosen female name, and when I confirmed by asking her if she was transgender, I said “so why didn’t use just tell me to call you (female name)?” and her expression was visibly relieved.

That relief is something for which that people should not have to work. That is why gender reassignment surgery is indeed medically necessary in certain cases. People deserve the right to feel comfortable in their own skin, and if medical intervention is necessary, then so be it.

So last week here in Ontario, the Health Minister announced that sex-reassignment surgery would once again be covered by our public health system, ten years after the Mike Harris Tory government delisted it and forced the required procedures into private care.

For my money, this is unequivocally a good thing. People in need of gender assignment are rare (the estimated need for these surgeries in Ontario, a province of thirteen million people, is eight to ten surgeries annually), but differing gender identity is a tragic and indeed horrifying condition. I don’t mean “horrifying” as in “disgusting,” but in that the idea of having to live one’s life knowing – not believing, knowing – that your body and entire identity are both completely flawed is one that is both thankfully alien and exceptionally terrifying to me. I am enormously grateful that my gender identity as a dude is secure and that I never, ever have to worry about deep down feelings that I shouldn’t have a dick.

But of course, there are always going to be assholes. This is nothing new. But what gets me – what really just fucking gets me – is that these juvenile fuckwits can’t just go ahead and say, straight up, “we’re bigots.” They can’t just say “you know what, I fucking disapprove of gender reassignment surgery. I think transgenderism is bullshit and people who need sex change operations are crazy.”

You know why they don’t say that? They don’t say it because they are goddamned chickenshits.

Consider the enormously stupid Cory Morgan, who prefaces his photo-essay on how he will chop a guy’s dick off for $200 (of course, there’s no question of what he does for a female-to-male transsexual – I mean, you’d think he’d come up with some amusing photo-essay involving a series of dildos! Such stunning lack of work ethic) by attempting to justify his dislike of publicly funded gender reassignment surgery on fiscal grounds:

it has been pointed out that the de-bonings will only cost around $20,000 each. That must be comforting to people dying on waiting lists in Canada’s increasingly unsustainable socialized healthcare system. I would hate to be the nurse who has to explain to somebody; “I am sorry sir, we will have to delay your bypass surgery a little longer, the operating room is occupied by a man getting his weiner removed.”

Now, first off, 10 surgeries at about $20K each is a whopping $200K per year cost to the taxpayers of Ontario, and out of the approximately $34 billion Ontario spends on health care yearly represents a staggering .0000006% percent of the total budget. Compare to the estimated $1.8 billion dollars that the province spends treating smoking-related illnesses and it seems like kind of a bargain! And, of course, Cory overlooks that performing a gender reassignment surgery requires a highly specialized reproductive surgeon, who probably isn’t going to be doing any heart surgery any time soon.

Kathy Shaidle, on the other hand, justifies her complaining about “fake twats” by first snidely mentioning that Health Minister George Smitherman is TEH GHEY, then making an appeal-to-authority argument, linking to Paul McHugh. Paul McHugh, for those not aware, has essentially kept his psychological career alive despite completely disagreeing with any treatment or diagnosis made after 1970 by becoming the poster boy for dipshits like Kathy to link to. “HE WORKS AT JOHNS HOPKINS!” they scream. Which is true. In fact, he worked at Johns Hopkins when he decided not to reveal the identities of confessed child molesters to the police and concealed incidences of child rape. But, what the heck, it was only child rape!

Shaidle and Morgan are of course both blitheringly stupid and evidence of the continuing Americanization of Canada’s extreme right wing, but it’s worse than that; they’re simply unwilling to come right out and say “we don’t like transgenderism.” Shaidle, ironically, followed up her weaselly little slam by posting once more about Mark Steyn and the horrible injustice he suffers from having people say he’s a fucking bigot. She’ll complain endlessly about how free speech is quashed in Canada, but she’s not exactly eager to get up and engage in it by saying what she really, really wants to say.

Because, again: they’re chickenshits.

Ben Goldacre writes a long, long and extremely pointed post on homeopathy and its practitioners.

Short version: he does not like it greatly!

As the American healthcare system continues to disintegrate, people are forced to make life choices that might otherwise seem foolish.

(Seriously: she has brain lesions for which she cannot get treatment. What the hell.)

Mike Smith will no doubt groan because he thinks I’m obsessed with health care policy, but I actually received this email this morning. (Admittedly, from someone who wanted to know how true it was.)

And the bit about family doctors is probably more true than the debunker gives credit for – twenty percent of the population is still a lot of people to be without a family doctor. That having been said, Mr. Anonymous Canadian doesn’t mention that the bulk of that twenty percent lives in Ontario – where healthcare cuts by conservative governments in the 1990s led to said shortage – or that over the past four years that figure has dropped because of additional hiring by the provincial governments, especially Ontario.

It hasn’t dropped to nothing, of course, because sadly there is no magical Doctor Fairy to instantly blink all the doctors we need into existence – but it is dropping.

Still, this quibble does not mean that said anonymous email is not full of the lulz.