Letter to Ed Schultz
I listen to American current events on the American Armed Forces Far East Network radio station here in Tokyo, known locally as “Eagle 8-10” because it is found at 810 on the AM dial. During the summer time when I had less work and more free time at home I was able to listen fairly regularly to the American health care debate played out alternately on the liberal and then on the conservative talk shows plus the mainstream reporting of National Public Radio. An abridged version of the liberal Ed Schultz Show is re-broadcast here on weekdays after the 6:00 p.m. news, followed by National Public Radio, then followed at 8:00 p.m. by a re-broadcast of an abridged Rush Limbaugh conservative talk show. I love to hate Rush Limbaugh and then listen some more to hate him some more. It’s like picking at a scab, or using my tongue to play with a loose tooth. He often churns my stomach and then I have to take breaks lasting up to a few weeks before going back. He is very entertaining! But I worry that his listeners forget that he is essentially just a radio entertainer. The same is true of Ed Schultz whom I like much better because of his left lean, but who, like Rush, is equally a radio entertainer. He is comparably bombastic while lacking the frightening, malicious vehemence of far right Obama opponents like Rush.
What we have in Canada is public health insurance with private health care.
Listening to Rush during this whole U.S.public insurance health care debate got me sweating. I could not sit still any longer and listen to the Canadian - or the British, or the French or the Japanese - health insurance program maligned. (It reached its peak in the last week of September when I listened to Rush describe Canadian health care as “that death machine.”) How can U.S. critics of our (provincial) programs get away with impunity with outright, bold-faced lying, deliberate misrepresentation and low-brow scare-mongering? And, just how stupid are people to fall for it? So I wrote an E-mail to Mr. Ed Schultz by way of providing ammunition to help him sock it to the freaky right-wingers. The bulk of that letter I incorporated into this story.
America is an embarrassment. It is rich and powerful with a populace who are simultaneously broadly and deeply stupid - or, ignorant, I forget which. I habitually equate ignorance with stupidity and then stupidity with immorality, based on the proposition that human beings can be said to have a moral obligation to be intelligent. And although I know that ignorance does not equal stupidity, it remains my fault for associating the two even when I know better. But ... there you have it.
The last thing I want is to have capitalists in charge either of my health insurance or my health care.
On this one issue of public health insurance, the Obama mandate to overhaul that country’s health care system is undeniable after last year’s election, and it is another great opportunity for Americato rise from its embarrassingly third world status in public health and join the best countries of the world. There have been other health care reform opportunities in the past all of which died in the face of, or were killed by stiff bi-partisan opposition, and President Obama is finding it no less difficult today even with his party presiding over a majority in the legislature. It is a statement about how divisive and polarizing the matter is, and also a statement about the ability of the vested interests of the status quo to beat off challenges.
By every category of measurement, America is a public health third world nation: in terms of general public health, primary care, emergency care, life expectancy, infant mortality, maternal death in delivery, basic inoculations, sexually transmitted diseases and other easily preventable disorders, family planning, accessibility, cost, etc. Guaranteed universal health care would elevate Americato become a superior society. It would also provide Christians - liberals and conservative Baptists, fundamentalists and evangelicals of every denomination who have so often shown their fantastic concern for humanity with their noses in women’s genitals over the anti-abortion debate - the opportunity to demonstrate an equal degree of Christian love of their fellows by championing health care for all who require it. But tellingly, in the public health insurance/care debate the Christians who have been so politically active when it comes to supporting conservative politicians and the single issue of abortion are astonishingly silent. For me, their silence is a moral and intellectual condemnation and exposure of their moral vacuity.
I understand that many Americans might be more afraid of the devil they don't know than the devil they do, and therefore fret tremendously over changes to the (dysfunctional) health insurance system that they have and are familiar with. But once a public health insurance program is in place and their entire population enjoys universal coverage then they will quickly come to wonder why the heck they didn't do it before. That’s always the way with big changes. At first they generate panic, but afterwards things settle down - leaving home for college, moving overseas, changing house, joining the Army, taking a new job, accepting a major promotion, etc.
In Canada, health care, like education, is a provincial matter, not a federal one. Each province has its Health Minister to administer its own public health insurance plan which is basically the same as what prevails in other provinces. The health insurance is public, or socialized, universal and mandatory. But the health care itself is private, a matter between patients and their doctors. We are free to choose any doctor we please, and to change if we want - which can become a problem in places experiencing doctor shortages. Government does not interfere with, control, dictate, limit or ration health care. (An American acquaintance asked me once, “What about experimental treatments?” and I asked “What about them? Why would a doctor prescribe an experimental treatment?” I think I still do not understand the question.) Using our plastic health cards like credit cards, doctors bill the government for services provided and they make a good living at it. That way the government can help control the costs, while ensuring universal access. The last thing one wants is a capitalist company running the insurance or even the hospital. Government does not limit, dictate or control doctors' salaries, numbers of patients, or locations of practice.
If people are guaranteed health insurance coverage they will not have to procrastinate on medical care decisions out of fear of economic bankruptcy. They are free to procrastinate for other reasons.
American rightist alarmism that shrills warningly about rationing of care for the elderly or disabled, and doomsaying about some kind of Obama eugenics initiative fly contrary to the very principle of public health insurance, which is designed to provide more care to more people, not the opposite. Contrary to a public health insurance plan, the idea of capitalist, profit-driven health care like what Americans boast about is a nauseating notion because the motivation of a capitalist entity is profit.
In August 2009 former Alaska Governor Sarah Palin made headlines by screeching about what she called proposed “death panels” in the Obama health plan that would implement a eugenics program by limiting medical care to the elderly and infirm. Well, her position was not without foundation, but still the entire episode was a freaky sideshow by a freaky woman who, I believe deliberately, misrepresented the issues for her own agenda. First, it makes sense to consider end-of-life issues, and the earlier the better. Second, since 1990 in American hospitals and nursing homes for the elderly have been mandated to advise patrons about end-of-life issues and in 2008 the U.S. Congress included such counseling as part of seniors’ introduction to the Medicare program, to no complaint from conservatives. And, third, it is a mistake - in Palin’s case a contrived strategy - to confuse the matter of end-of-life counseling and care with either health care cost controls or with euthanasia. I think the “death panel” fear more easily grows in an environment like America where profit has priority, health insurers and hospitals are in business to make profit. It’s easier for Americans to believe in money than in people, and so they do.
But back to the matter at hand. If people are guaranteed health insurance coverage they will not have to procrastinate on medical care decisions out of fear of economic bankruptcy. They are free to procrastinate for other reasons, like I do. Also, people will be more apt to seek medical care early, before their conditions become serious and/or untreatable - which will also be more expensive. These failings by the current American system of health insurance and care contribute to its low quality of life profile compared to other major developed countries.
In the matter of health cards I am fortunate because my Ontario Health Insurance Plan (OHIP) card is one of the first generation of plastic cards (before which we carried slips of paper). It never expires. It does not need renewing, and it does not bear a photo I.D. The newer generation cards bear the holder’s photograph and need periodic renewing like a drivers’license or a passport. But the first generation cards, like mine, are grandfathered and destined never to be renewed - unless I lose it and need to get a new one, in which case I will be issued with the current renewable variety.
Health insurance and health care are not cheap, and they are certainly not free. So I hate it when I hear anyone - especially Canadians - talk about "free" health care. We pay for it through higher taxation than what they have in the U.S., higher sales tax than what you see in the U.S., and through pay check deductions similar to automatic income tax deductions, according to a formula that calculates one's age, income, marital status and number of dependents.
Canada does not lack health insurance/health care debate. Some people are not satisfied with the social health insurance plan and lobby for a private option. In Ontariosome doctors “opted out” of the OHIP plan, preferring to set their own fees and conduct their own direct billing, until Bill C64 forcibly mandated the OHIP fees universally. My father was one of those doctors. He remained “opted out”after passage of Bill C64 into law in the early 1980s and he continued with his own direct billing. But his fees were fixed by the government’s fee schedule. Canada does not have any of the interference in the debate by interest groups like what stokes the fires of debate in America and, in fact, I think that if any government - even a conservative administration like what we have now - seriously tried to roll back public health insurance then the government would fall. Canada is a social democracy, not a capitalist republic, and like Japanese we tolerate a lot more government interference in our lives than what Americans think they do.
Even as a long-term resident of JapanI remain eligible for health insurance coverage in Canada because I continue to pay income tax there. But, sadly, dentistry is not covered, which is why I have my dentistry done in Japan, where it does fall under the public health insurance program.
It is true that some Canadians travel to the U.S.for medical care. But it is like being hit by lightning, meaning that it is so rare that when it does happen, everyone knows about it. It is also true that Canadian provincial governments will pay the costs of medical treatment for their citizens if the treatments are unavailable at home.
Finally, I worry that the strong interest groups in U.S.politics will warp even the simplest, most straight forward and beneficial health legislation so badly that even I would oppose it. By refocusing the debate from health insurance to health care conservatives have already done it.
Listening to and reading in the press here about the ranting, raving, frothing-at-the-mouth conservative critics of public health care I wonder at the U.S. ability to take something so simple and make it impossibly complicated. I despair for their national cultural tendency towards obstinate, narrow-minded psychopathology. And I worry, because what happens in America reverberates elsewhere. Sadly, I think that if the Obama government is able to pass public health insurance legislation the costs of it will still be pushed sky-high by infernal interference from interest groups like pharmaceutical and insurance companies.