Our “media” rarely gives libertarians air time, and the vast majority of the time when they do, they identify them as conservatives.

There’s nothing wrong with internet discussions that get “intellectual”, so long as we remember that there is also a real world out there. That said, I don’t believe change is brought about by pragmatic middle of the road approaches. That just brings more of the same with a few small tweaks; i.e. conservativism. I’m not a conservative, I have no desire to be such. I advocate liberal change.

The key difference I would point out is that the Constitution specifically authorizes a military; not a federal healthcare system.

I think if that is your image of Canadian medicine, you are very much misinformed.

Either the statistics often provided in the media, from Canadian government sources, are wrong, or your clinic is atypical. If the average is 4 months, then some, of course, have to be shorter, and some longer.

As for that about choosing one eye over another, I don’t think that kind of thing ever happens in Canada.

Not everything is about Canada. In England there is a huge outcry right now because a patient with Macular Degeneration that is still operable will only get the treatment for one eye, not both. This is fairly typical for choices made for me by someone else.

When problems over treatment get mentioned in our media, it is usually due to the government having not approved of a particular treamtent or drug, usually because it is either still in early stages or too costly.

So, a government bureaucrat should be able to make those choices in my place? This is why the UK decided to only save one eye, by the way. Insisting that couldn’t happen in Canada is foolish, it obviously could and you would have no recourse that I can see.

VRB:

This is if you would step off your highly intellectually perfect pedestal and admit human fallibility.

Interesting, it is precisely because of human fallibility that I do not want government bureaucrats making choices about social services, medicare, Social Security and so forth. I’m curious why you resort to this tack at this point rather than continuing to address the points we were discussing?

As for electronic record keeping, our office bought it without any subsidies – start up cost about $20000, with annual maintenance at $5000. I am not sure if we can quantify finacial savings, especially in the short term, but we did not just get this system to benefit us. Our doctor, and everyone other physcian I know, was not motivated to enter the medical profession for money (although it does pay well), but for a desire to help others. There are a lot of other easier ways to make money. A doctor wants to see the best treatment possible for their patients, and this is another tool to help them get there. I think doctors are more generally reluctant to go to electronic records for reasons other than costs, such as avoiding change to their routine.
As for security and privacy issues, this has not been a concern for our patients, but our system is considered to be well-protected. Funny enough, as part of a health group we are affiliated with, we ask patients to sign up for a program that allows us to share patients medical information with other doctors in our group, and I think of the 2700 or so people we have asked, only 2 or 3 have turned us down citing privacy, and these are all crazy people. In return all our patients get to all a 1-800 number and be able to talk with a doctor after-hours, which has helped to cut down on emergency room visits.

Would I be correct in thinking that every hospital will have a limit to any charitable work they do – I would assume that they are not going to go after a homeless person for cash he does not have, but if you do have a job (albeit lowpaying) you will have to pay for their services?

Many of our hospitals are religious charities, for example: Catholic Healthcare West, Adventist, Providence Health & Services and Franciscan Medical, to name a few. They often provide free, or very low cost, healthcare, senior care, immunizations, etc. In fact, I just attended a fund raiser for a catholic healthcare system that was raising money for their senior services hospice and assisted living programs. These programs receive NO government funding at all. They use means testing to charge their beneficiaries.

That said, if you need to go to an ER for services and you have a job, the hospital will bill you. If you don’t pay the bill, they will send it to collections. I don’t say this is a great way to do things, in fact it’s a pretty bad way to do things. But, socialized, government provided medicine is a solution that also is bad. You want to make the cost of a doctor’s visit affordable without having to wait 18 weeks to see a specialist, or having to decide which eye will be saved and which won’t? Bring free markets back into the equation. The reality is that semi-socialized or completely socialized solutions ensure over-utilization of scarce resources. The cost must be paid somehow, and the results in Canada, the UK, France, Germany, etc. are plain to see. Government bureaucrats making decisions for all of us based on what they believe is best.

Health plans in the US are, generally, provided through your employer. Very few people purchase their plans directly. Over the years, people have demanded health plans that cover everything and demanded that they be insulated from the true cost of such plans. Whether that cost is paid by the employer or the government doesn’t particularly matter, what does is the removal of the consumer from the market place. The inevitable consequences are obvious when such choices are made. The failure to see that it is not an either/or question is the norm, of course.

Actually, Adam is fairly correct when he says that you can’t easily compare Canada and the US, as a general rule. With about 9 times the population of Canada, that alone makes it difficult. On simpler statistics, such as infant mortality, it is possible to make comparisons. On the much more complex questions you pose, not really. You are suggesting that we can compare entire economic systems directly and I would suggest that statistics and chaotic systems show that we cannot.

As far as issues such as childhood immunizations go, no child in the US should ever not be immunized. If they cannot afford to pay for the immunizations, parents can take their children to the local social services office and get the immunizations for free, or very low cost (not actually free, they are paid for with tax money).

While the conversion process of going from paper records to electronic ones is certainly not a simple and easy endeavour, we are seeing on a daily basis real improvements and efficiencies here. In the end, it is leading to improved health care for our patients. Now, while electronic record keeping is widely used in countries like the Netherlands, less than 1/5 of family doctors have them in Canada, and about 1 in 10 in the US do. I think that governments need to encourage this use among doctors, which ultimately involves subsidization and other incentives, otherwise it will take far, far longer, to have doctors sign up for it.

In other words, although it is not cost effective and doesn’t pay for itself, the government should spend my money on electronic record keeping? If it was cost effective, healthcare would adopt it. In fact, most hospitals are going down that road, or already have, in the US right now. A doctor’s office, on the other hand, probably cannot afford it yet without tax subsidies. Those tax subsidies are part of the increased cost of healthcare. The issue isn’t whether the US (or Canada, for that matter) has the infrastructure to implement electronic health records. It is whether it is cost effective, or not. Included in that calculation should certainly be the potential for privacy and security violations, which you appear to ignore.

I should state that I do work as a medical secretary, for a family doctor, so I have an understanding of the complexities of working in the health care industry. In our practice, the doctor handles the billing paperwork, and I would say he devotes about 2-3 hours a week on this. We have a few patients who are outside of OHIP, the provincial health plan we all use, perhaps 3 or 4 people a week – these include visitors to Canada, a few refugee claimants, and people who live outside of Canada, but come here for medical services (we have a couple of patients who live in the Carribbean, but when they come up here to visit family or for business, will also come see us to have a check-up). Also OHIP does not cover every service – for example we charge patients $10 for a sick note, and if you need an exam as part of getting a license to drive a truck (the big rigs, not a 4×4 or anything like that) the going rate is $100. But this is a real minor part of our practice, and the doctor just handles it all as a cash payment (we dont take credit cards or debit payments).

I also want touch on your claim Adam that it is impossible to compare countries on health care. I respectfully disagree here – first off, countries are compared on a wide variety of social and economic factors, for example productivity, and the governmental and business communities agree that they can be considered accurate in a general broad sense. Life expectency and infant mortality are standard benchmarks around the world – everyone considers them important, everyone country wants to improve them (hopefully!), and its relatively easy to measure them. While the US might have unique characteristics, that can be claimed for every other nation on earth (by your reasoning their is no way we could compare Canada to Sweden, or even Norway to Sweden). Moreover, sure the US is a big country in terms of population, the differences between it and other Western nations, like Canada, UK, Germany, France, Australia, etc., over matters like ‘industrialization, GDP and immigration rates’ dont vary widely at all. Furthermore, we also share a lot of the same social and cultural characteristics and influences. Instead of thinking that a comparison would be like apples to oranges, I would think it is more like comparing Navel oranges to Valencia oranges. Also, by claiming that the US is so different from other nations it effectively allows for one to avoid dealing with problems and importing solutions used in other countries by saying ‘we are not like them, so it can’t work here’. Instead of emphasizing differences, we should all look to the similarities with each other, and use this as a base to improve each other’s respective systems, in this case health care. For instance, in many parts of western Europe they have extensive use of electronic records by family physicians (we started this at our own practice last year). While the conversion process of going from paper records to electronic ones is certainly not a simple and easy endeavour, we are seeing on a daily basis real improvements and efficiencies here. In the end, it is leading to improved health care for our patients. Now, while electronic record keeping is widely used in countries like the Netherlands, less than 1/5 of family doctors have them in Canada, and about 1 in 10 in the US do. I think that governments need to encourage this use among doctors, which ultimately involves subsidization and other incentives, otherwise it will take far, far longer, to have doctors sign up for it. These kind of incentives are still not available in my part of Canada, although they are just now being implemented, and I would hope to think that in some parts of the US, state or local governments are encouraging the practice. I don’t see what differences exist between the US and other countries that would prevent American doctors from doing this – you certainly have the infastructure for this, having computers, reliable internet access, and a well-educated health work force that could easily adapt to electronic records. I would think it would be very difficult to successfully implement this practice to Ecuador, or rural parts of India, but certainly not the US or any other western nation.

Sorry for rambling. I really enjoy the conversation here. one last question: how are flu shots handled in the US? Do you pay for them, or are they covered by your Federal or State governments?

You assume that what you think is moral is every bodies idea of true moral values.

No, actually. I simply don’t believe that you should impose your morals on me.

What I am saying that if most people thought what the government was doing was immoral then I think there would be more outrage.

Like all the outrage against Jim Crow laws prior to 1955, or so?

It is very easy to not sign up for medicare or Social Security.

Really? How do I keep the government from taking my money for SS taxes?

Ask at random, if they would approve of means testing and you will hear, I am entitled to get my money back.

In other words, most people don’t think it’s moral to take their money and give it to someone else. They only find SS palatable because they believe they are getting their money back.

They don’t realize that after two years or sooner they have gotten back what they put in.

If this were true, SS would not be in financial trouble as retirement age folks increase in number.

Morality is defined as what is the “good.” You are the one who says it is stealing. That is the nature of government, if not then you as an individual would be responsible for defense of your property and there would be no purpose for government.

I always thought moral was defined as good too. Funny thing, though, is you appear to be defining moral as good for some people, even if it is bad for others. That’s an interesting definition of moral. You also appear to be of the mindset that the government, by the mere virtue of receiving 50%+1 of the vote, should be able to do things which are not moral for individual citizens to do. It is moral for an individual to defend their life, liberty and property, ergo it is moral for the government to defend my life, liberty and property. Robin Hood was a criminal when he stole from the rich to give to the poor.

When you are taxed, your money will most certainly go to benefit someone other than you, even if the things government do are most basic. This is why I say that William’s analogy is false. I think one would want anarchy, if it were true.

Not at all. I can think of many ways that we could provide funding for government activities that do not involve income taxes. In fact, our government did just that for the first 130 years, or so, that it existed. Washington, Nevada, Alaska and many other states seem to work just fine without income taxes. Are there necessary, moral, functions for government? Yes, there are. Defending the country from attack, protecting my life, liberty and property from foreign and domestic enemies, interacting with the governments of other countries, providing a basis for trade and currency, those seem to be moral functions of the government. Do they include a military that can invade other countries, a social services institution that can regulate our daily life, police forces capable of defeating many of the world’s armies, and so on? I don’t believe so. Do you?

BTW, since I am an older person, could I use William’s analogy to say you are stealing my money, because I paying for a military that protects you.

You could, indeed.

Morality is defined as what is the “good.” You are the one who says it is stealing. That is the nature of government, if not then you as an individual would be responsible for defense of your property and there would be no purpose for government. Perhaps that is how you see it, that government has no purpose. When you are taxed, your money will most certainly go to benefit someone other than you, even if the things government do are most basic. This is why I say that William’s analogy is false. I think one would want anarchy, if it were true.

Moral values in a society are not necessarily right or wrong, but what would be good or bad for that society. It might conflict with our personal or religious values.

…just like slavery and Jim Crow in the South, Hitler’s Germany, hyper-moralistic Islamic theocrats and so on.

VRB, the type of democracy that you are advocating is not only misguided, it is dangerous, as history has shown time and time again. Question for you: would you think differently if, “for the good society”, a majority voted to inordinately deprive you of life, liberty or property?