This Week:

Quote of the Week

Context Club Up and Running

Tax Cut Consequence of the Week: Justice Delayed, Denied

Taboo Language and Polite Flak
Canadian Health Care: Principles and Myths

Greetings,

Last issue I asked if anybody was longing for me to do a retrospective or a look ahead on the occasion of the recently-passed 100th issue of Nygaard Notes. Nobody responded, indicating to me that the average Notes reader is about as interested in nostalgia and ceremony as I am, which is very little indeed. As in my personal life, I usually think that there is too much going on in the moment to spend too much time in the past or the future. How Zen, eh? So, we're done with that. I'll ask again when we hit issue #200.

Despite the fact that I do not consider a Canadian style single-payer health care system the best way to meet the health needs of the population -- I lean toward a socialized system, myself -- I still think it is worth learning a little bit about the health care system in our neighbor to the North. For one thing, there has been such effective propaganda put out about Canadian health care that people believe all sorts of crazy things about it. In addition, I believe that any structural change in the health care "system" in this country – which in my view is inevitable – will likely be based in large part on a Canadian-style single-payer system, for better or worse. So this week and next Nygaard Notes will offer Part 2 and Part 3 of the three-part series on Canadian health care that I started in the last issue.

I don't know if all of you have made resolutions to reduce your letter-writing, or what, but I haven't received much mail lately. I miss the feedback, and look forward to hearing from you!

Solidarity,

Nygaard

"Quote" of the Week:

"American foreign policy in a Republican administration should refocus the United States on the national interest...There is nothing wrong with doing something that benefits all humanity, but that is, in a sense, a second-order effect."

- President-elect George W. Bush's national security adviser, Condoleezza Rice, as quoted in the January 14th Star Tribune (Newspaper of the Twin Cities!)

On the same day, the Star Trib's lead headline on the front page read: "Most Accept Bush As Chief."

Context Club Up and Running

Well, Nygaardians, a lot has happened in the TWO weeks since the last issue of the Notes. The best thing is that the Context Club has had its long-awaited first meeting! Our inaugural meeting, on the 6th of January (a day that will live in infamy!), was attended by 6 history-making individuals. Meeting number two, on the 15th, saw the number increase to 8. Is that too many? Just right? Will we split into two? We just plain don't know yet.

The main point here is that we have tentatively come up with an initial structure, and I want to very briefly let all of you Nygaard Notes readers in on what is happening so you can decide if these meetings might be of interest to you. If they are, get in touch with me and I will put you on the special Context Club mailing list.

We will be meeting every week, alternating between weeknights and weekdays. At the moment that means Monday nights and Saturday afternoons, but that will change with the seasons. (I mean, who wants to go to a meeting on a Saturday afternoon in the spring?)

For now, the Context Club is meeting in two-hour sessions, one hour of which is sort of a free-for-all, during which everybody chips in their two cents worth about something they have heard or seen over the past week, or maybe we talk about events of the day, or maybe we just get to know everybody else.

The second hour of each meeting will be spent discussing various aspects on a general theme that is decided upon by the group. We plan to stick to a theme for 3 or 4 months (or until we get sick of it, or something) and we will have assigned readings that will be suggested by group members to be read before each meeting. These readings go out to Context Club list members only, so get on the list if you want to see them.

That's all for now. See you at the meeting!

Tax Cut Consequence of the Week: Justice Delayed, Denied

One of the consequences of the current tax-cut mania is that poor people are being denied access to legal help. In the New York Times ("All the News That's Fit to Print") for January 17th appeared an article entitled "Shortage of Lawyers for Poor Nearly Stops the Wheels of Justice." In it we learn that "there have never been enough lawyers in New York to represent the poor in family and criminal court, as the law requires. And things are getting worse."

It turns out that New York has not raised the rates they pay attorneys who represent poor folks since 1986. It now pays lawyers $25 per hour for out-of-court time and $40 per hour in court. Around the country, the going rates in the private sector range from more than $100 per hour up to well over $600 per hour.

It's no surprise, then, that the 230,000 people who have their cases filed in Family Court each year often get sent away when they appear before the court without a lawyer present. Lawyers in New York's Family Court system are now "refusing new assignments" until they get a raise. This doesn't seem too greedy given the "deplorable situation" cited in a recent report which concluded that "a lawyer with average overhead costs would actually lose $9.75 an hour" should they choose to continue representing poor folks in the New York Family Court.

The primary federal source of funding to provide legal representation for the less-than-wealthy, the Legal Services Corporation, currently receives only half the funding that they received in 1981. The funding cuts have been so severe that they now don't even know the "nature and scope" of the legal needs of indigent people around the country, but it's not good. In the words of the LSC document pleading with the Congress to restore just a fraction of their lost funding, "Though a comprehensive assessment has not been performed, there is plenty of anecdotal evidence from all LSC-funded programs to show the need for legal services far outstrips the resources available. Due to this, each program turns away hundreds or thousands of eligible applicants each year."

Meanwhile, the new Bush administration is cranking up the volume on their call for tax cuts, made possible by further spending cuts.

Taboo Language and Polite Flak

Two weeks ago, in the context of speaking about Senator Wellstone's universal health care bill, I said that I thought a system of socialized medicine might be worth looking at. This is an example of the type of comment that will likely keep my writing out of the corporate media for at least the next five centuries, since it marks me as being "unrealistic," "utopian," or just plain "loony." And those are the POLITE flak that any mention of socialized medicine would likely receive if it were to miraculously appear in the mainstream press.

Aside from any possible arguments for or against a fully-socialized medical system, doesn't it seem odd that the very idea is so other-worldly sounding? Some people to whom I have mentioned the idea tell me that they don't even know what it means. I say this is odd because it's not as if we don't already have "socialized" systems in place in this country. The construction and maintenance of our highways and streets, for example, or our water and sewer systems, are fully socialized – meaning that ownership and control is fully in the hands of public entities – and nobody outside of the Libertarian Party or the Christian Coalition would accuse the United States of being a Communist, or even a Socialist, nation.

Yet, when it comes to health care, the mere mention on this side of the border of a single-payer system such as the one in Canada, invites accusations of being a socialist. The Canadian system, by the way, is not at all a "socialized" system, despite what you may have heard. The payment system is socialized, but most physicians are self-employed practitioners who enjoy a high degree of autonomy, with more than 90% being private practitioners who are generally paid on a fee-for-service basis.

One of the lessons here is that whenever you read or hear someone talking about "socialized medicine" in Canada, they are likely either 1) Ignorant, or 2) Lying. And those are the POLITE comments I could make about them...

Canadian Health Care: Principles and Myths

I mentioned in Nygaard Notes #101 that the Canadian system "is referred to as a ‘national' health care plan in that all provincial and territorial hospital and medical insurance plans are linked through adherence to national principles set at the federal level." One of the striking things about the Canadian system is that it is explicitly based on these five easy-to-understand principles, which not only are well-known to a good number of Canadian citizens, but are very widely supported. For the record, here is a quick summary of those principles, which are stated quite clearly and simply in a couple of pages of the 1984 Canada Health Act, Chapter C-6:

• PUBLIC ADMINISTRATION: The health insurance plan of a province must be administered and operated on a non-profit basis by a public authority accountable to the provincial government.
• COMPREHENSIVENESS: The plan must insure all medically necessary services provided by hospitals and physicians. Insured hospital services include in-patient care at the ward level (unless private or semi-private rooms are medically necessary) and all necessary drugs, supplies and diagnostic tests, as well as a broad range of out-patient services. Chronic care services are also insured, although some payment in respect of accommodation costs may be required by patients who more or less permanently reside in the institution.
• UNIVERSALITY: The plan must entitle 100 percent of the insured population (i.e., eligible residents) to insured health services on uniform terms and conditions.
• ACCESSIBILITY: The plan must provide, on uniform terms and conditions, reasonable access to insured hospital and physician services without barriers. Additional charges to insured patients for insured services are not allowed. No one may be discriminated against on the basis of income, age, health status, etc.
• PORTABILITY: Residents are entitled to coverage when they move to another province within Canada or when they travel within Canada or abroad.

Nygaard Notes Quiz: What are the principles upon which the health care system in the United States is based? (Warning: This is a trick question.)

Myths #1-5 About Canadian Health Care

Myth #1: The Canadian health care system does not work as well as the U.S. system. ABC News recently referred to Canadian health care in general as facing "a very serious situation." Statistics do not back this up. Canadians live longer than Americans, have a lower infant mortality rate, have more nursing home beds, and more nurses. Canadians have higher survival rates for most cancers. The United Nations Human Development Index, which ranks countries according to their citizens' education, access to health care, and average income, has ranked Canada at the top of the list for the past seven years. The United States, with a per capita national income almost 30 percent higher than Canada's, ranks third.

Myth #2: Long Waits for Care There are no waits for urgent care or primary care in Canada. There are waits for specialist care and elective surgery, stories of which are widely reported in the U.S. press. These stories may or may not be true, but there is no reliable data that would allow us to assess whether the problem is system-wide and prevalent, or merely anecdotal.

Myth #3: Health Care is Rationed in Canada Health care is rationed in every nation of the world, since no nation provides unlimited resources for health care. The difference is in how those resources are allocated. In the United States health care is rationed by ability to pay, with decisions often made by private entities such as insurance companies or HMOs. In Canada, every province manages its own health care spending based on a democratic process that assesses both the system's ability to pay and the citizens' needs for care. Decisions about the acquisition and distribution of expensive high-tech equipment, for example, are based on demonstrated need balanced against desires to avoid unnecessary duplication or under-utilization.

Myth #4: Taxes in Canada Are Too High Personal income taxes are higher in some classes in Canada than in the U.S., and lower in others. Canadian Social Security taxes are lower than in the U.S. Overall, tax revenues as a percentage of the national income are higher in Canada than in the U.S. However, this fails to take into account the value of social benefits, such as family allowances, tax credits, and health care. When those are factored in, the average after-tax and after-transfer income of Canadian workers is actually about 0.1% higher than in the United States. A recent study by Standard and Poor concluded that if the costs of private-sector health and education services, which are principally publicly-funded in Canada, are added to the US tax bill, there is no difference in the overall tax burden.

Myth #5: Canadians Are Pouring Over the Border to Get Health Care Fewer than 0.1% of Canadians surveyed in 1998/99 reported receiving health care in the United States. Studies suggest that many of those treated were long-term visitors, such as "snowbirds" ages 65 and over who spend winters in the U.S.

Myths # 6-?? will appear in next week's Nygaard Notes.