Friday, December 11, 2015

The Varieties of Pride


Pearl said...

Jay: interesting comments about the differences between the U.S. and Canada presently. I don't live in Toronto but in Burlington which is a half hour to an hour's drive to Toronto depending on the heavy traffic which consists of many people living in Burlington and working in Toronto. Housing is expensive in Toronto due to the focus on building condominiums which are more profitable than lower cost housing for the inhabitants hence the commuting problems that clog the highways. And as for the attitudes to the arrival of the Syrian refugees, there are muted resentments among differing groups that come from various countries who often bring their prejudices with them but are kept under wraps somewhat. My daughter lived in a low cost building in Toronto that housed many Muslim families she was friendly with. After 9/11, she noticed that the women who usually went shopping in the daytime had disappeared and were going out on errands at night so that they would no be seen and perhaps be insulted by others and blamed for the catastrophe. She also lives in a condo now next to a Jewish center with a pool, exercise classes, etc. which have a guard at the door now because of threats during the Middle East crises. She also does not discuss politics with anyone there not knowing what their opinions may be which could lead to an argument. The various ethnic immigrant centers carry their historic attitudes with them to Canada but mostly civility
prevents any serious blow ups though they have happened, usually during specific crises in their countries.

I think allowing the refugees from Syria to come in will be a good choice to teach people how the rest of the world behaves and so far Canada has a good record with their regulations and rules regarding immigration. It remains to be seen how it will work out when the full numbers will be accepted and be integrated.

I consider myself and family very fortunate to be living in this country and hope Trudeau will have the courage and foresight to do things right and become an example of what works here and could in my birthplace. We have many weaknesses here that should be looked into which were neglected during Prime Minister Harper's 9 years in office and hope they will be addressed now.

Bill Sprague said...

... nice essay. and truthful. and every doctor I ever knew who was from Canada wanted to come to the US because THEY COULD MAKE MORE MONEY here! Where's that at? Is that truthful?

Pearl said...

Bill: Some years ago many doctors here did go to the U.S. for higher salaries although they did well here. But then reports began coming in of problems with unpaying patients, getting involved in the endless paperwork required and other shortcomings which inhibited their work and money making dreams and that has now abated. Since I have not read of any further desertions and especially where doctors in the U.S. are fed up with dealing with the current system I doubt much of that is occurring. However many doctors here are still argumentative when negotiating with the government but there are legitimate concerns about the differences between higher educated and higher paid doctors as opposed to the lower echelon of family doctors, etc. I suspect these differences occur in the U.S. as well, especially when doctors salaries as in Medicare, etc. are regulated.

There have been attempts by various U.S. funded organizations to set up doctor's offices here but they did not work out and were not made welcome. We do have problems with doctors as in the U.S. who have had many complaints by patients, or did not have good records of their work or become sexually involved with patients who complained. These problems are investigated but not always come to the best conclusions. Same as in the U.S.but it is harder to get more money by sending in false reports to the government than in the U.S.I believe.

Jay you should have the last word on these questions from Bill and,do doctors in Canada have to take out huge insurance coverage to cover any negative reports by patients to cover themselves which requirement often forces doctors to quit in the U.S?

Jay–Ottawa said...

I'm lucky to be a citizen of both countries. Of course, I'll be paying through the nose again come April by having to file forms and cough up dough for the tax men on both sides of the border. Dual citizenship ain't cheap, especially if you're one of those middleclass types Karen just wrote about hanging on by his fingernails––well OK, fingertips.

As for the medical situation here and there, I have no deep, comprehensive and up-to-date view to impart, except on one emphatic point noted below. A few weeks ago I posted a comment on one aspect of the situation up here. Politicians in both countries keep shorting doctors and hospitals, and it isn't long before administrators and their health workers feel the pinch, even to the point of essential staff, like nurses, being laid off while the number of patients needing care increases. Why? Because the rich aren't taxed enough just about everywhere. Yes, I feel the Bern up here.

In the US, as everyone knows, some docs stopped treating Medicaid patients years ago because they (the docs) were loosing money caring for the poor who were supposedly "covered" by Medicaid. Year after year Congress continues to short all of healthcare in the US to the point that doctors have begun refusing Medicare patients as well. Reimbursement rates to frontline providers are simply unjust. Socialists like me don't dig boutique practices, which are being set up on both sides of the border.

As long as I'm able to drive––or be driven by Goodwife of Jay––I'll continue to work both sides of the fence thanks to docs still accepting my Medicare and the Canadian system, which is far more democratic (socialist?) and which even covers permanent residents (those who are not yet citizens). My best advice, however, no matter where you live is to not get sick.

When we have had discussions here about healthcare (prompted by the ACA), I fell back on research I did more than 20 years ago for a piddling degree. My conclusion then, as it is now, is to give the doctors pretty much what they want and let them practice their trade. I'll even go so far as to give Big Pharma, the second pillar of the Big Three, a pass, except of course for outrageous, absurdist types like Turing Pharmaceutical.

However, the third pillar of the US system, the private health insurance industry, must be bound and dragged to a crossroad, where a wooden stake with a pointy end will be driven through its heart. The plan by Physicians for Social Responsibility will take it from there, resulting in much better and much cheaper healthcare for every last one of us.

My guest post was really about something else. It's not often you'll hear me cheering for a party or a government. Today is an exception in light of what the Liberals and Trudeau are doing for the exhausted refugees from Syria and other parts of the world. God bless them all. And if there is no God, then let us at least rise out of our easy chairs to applaud them and support them in this national undertaking.

Pearl said...

Thanks Jay.

AHA! No wonder everything you say makes sense. I was wondering what was wrong with you. You are a SOCIALIST!!!!! A living breathing socialist who is permitted to go around spouting your beliefs and not hit by lightning from above. And furthermore, you are honestly paying your taxes in TWO countries? A rare breed indeed. You must be cloned at once.

Kat said...

When we have had discussions here about healthcare (prompted by the ACA), I fell back on research I did more than 20 years ago for a piddling degree. My conclusion then, as it is now, is to give the doctors pretty much what they want and let them practice their trade. I'll even go so far as to give Big Pharma, the second pillar of the Big Three, a pass, except of course for outrageous, absurdist types like Turing Pharmaceutical.

Are you serious? Please name any healthcare system that does not do cost/benefit analysis when deciding which services/medications to cover. Giving them whatever they want is a recipe for disaster and I am most definitely not speaking only of a financial disaster. Pfizer is hardly any better than Turing pharmaceutical. And do you really believe that doctors lose money on Medicare patients or are not reimbursed highly enough? I know they whine about the reimbursement rates all the time. Yet they manage to do quite well, thank you.

Kat said...

Actually, the US comes closest to the "giving them whatever they want" model.

Jay–Ottawa said...

Kat, pardon the shorthand, above, in making my point with clenched teeth, If you want me to come up with an ideal healthcare set up, I'm quite capable (with my pick of consultants) of filling in square yards of draftsman's paper to map out a wonderful system. (Hillary '93 move over.) But, when thinking tactically, I find that's not the first challenge before the common woman and man in the US.

(1) I'm not in thrall to the doctor guild, although we all know personally of some saints in their ranks. I'm not going after them, even though they are capable of balancing their saint quota with the SOB type on any day of the week.

(2) I'm not impressed with the dedication and integrity of Big Pharma, but because I and others need some of their concoctions (because they do help me to stick around), I'll cut them lots and lots of slack, for the time being.

(3) The third dragon on the horizon is the most dangerous That's Big Health Insurance, which has since forever been gouging doctors, patients and government the most and delivering the least service or product.

Only a mad dictator would attempt to raze the whole system (1, 2 & 3) and start over from scratch. We'll need insider allies to succeed in abolishing the most rotten part of the system; and we'll never succeed if we declare war on three fronts simultaneously. First, deal with the main impediment to good healthcare. That's Big Health Insurance.

We CAN'T do without doctors (and their associates on the front line). We CAN'T do without medicine. We CAN do without profiteering health insurance, just as other countries do, often admirably. Physicians for Social Responsibility has developed many side issues during its life as an institution bent on reform, but their central goal is to first take down private health insurance. Can we at least agree on supporting PSR?


Kat said...

Jay-- so you are proposing a single payer system but without the payer having the ability to negotiate prices?

Jay–Ottawa said...

Kat - If I were king I would install single payer before any jobless health insurance executives had time to assassinate me. And, yes, I would be real friendly with the front line medical people in negotiations (docs, nurses, techs––anyone who deals directly with patients in the clinical setting). Give me a little wiggle room for my favorites in court.

Science (all the major disciplines, not just biology) would be heavily supported.

If you read my ultra nuanced comment about Big Pharma, however, you'll see that I would be plotting my next moves against them with my chief negotiator for that sector, Ralph Nader. He's demonstrated for decades his firm stance against their abuses. But I would not draw and quarter Big Farm as I did Big Insurance.

Kat said...

I never said that single payer systems don't work well. They do compared to the US. (there are also many systems that incorporate insurance companies too- but they keep them on a tight rein.) What I said is no system just give doctors and drug companies (and medical device companies, and durable equipment suppliers and health care facilities, and the myriad other service providers) whatever they wanted. I don't believe I said that doctors are not necessary.
I really have a hard time swallowing the idea that if payments were increased this would translate to more nursing staff.

Kat said...

Besides science being heavily supported I would wish to see drug companies out of the research business. It is detrimental to our health and our pocketbooks.