Sunday, February 15, 2009

Texas Health Care

In which Aviatrix is frightened by the medical care industry and the Monsanto Corporation.

I'm waiting for the customers to need me to work, so I'm watching a lot of TV. I know House is available on cable in Canada, but it seems to be on every channel here, so I'm watching it, and I'm growing to like it. And then there are the ads.

Most of them are for prescription drugs or healthcare. Numerous ads are for cancer care centres, knee and hip surgery, and other sorts of medical care. The medical centres look on TV like holiday resorts. I know someone who is self-employed in Canada and has cancer. She is too ill to work so, being self-employed, has no money coming in. Her friends got together and had a fundraiser for her, to keep the rent paid and the groceries bought. I'm glad she doesn't have to pay for medical care. Hers is not as fancy as the resorts on TV in Texas, but I think she is getting good care. It's unsettling seeing the ads, because I take health care for granted. It's like seeing starving children in ads for NGOs doing overseas aid. Something you don't like to think about. I suppose people who live here are inured to the constant medical advertising, and to the fact that they could be wiped out financially by an illness that they recover from physically. A healthy strong young person can recover from terrifyingly traumatic injuries and go back to work, but how do they manage when they recover with usable limbs but crippling debt? Medical costs in the US make buying a car for your teenager look like a petty cash expenditure.

"Levitra does not protect against HIV/AIDS," warns another ad. Who the heck would think boner pills prevented sexually transmitted diseases? I can't fathom the logic.

I buy some cheese at the grocery store. It says on the side that it is "Made with milk from cows not treated with the growth hormone rBST." I'm glad of that. Bovine growth hormone isn't approved for use in Canada, so it seems scary and foreign. I'm only exposed to it down here. Right under that declaration is another one. "The FDA has stated that there is no significant difference between milk from rBST-treated and untreated cows. The difference is that my government thinks the increase in production is not worth the risk, while the US government requires even those producers who don't use the hormone to assure the consumer that the government thinks it's okay. Probably only the cows suffer from it, but absent all other evidence, which government am I going to believe, the one that pays for health care or the one for whom private health care constitutes part of the GDP?

There was freezing rain forecast this afternoon, but it didn't happen.


Colin said...

You pay for health care one way or the other. Either you pay taxes to your government and they provide it, or you pay premiums to a health insurance company and they cover the bills, or you tithe a church and they all get together and pay your bills, or you pay them outright yourself.

In the United States the populace chose not to have the government pay for it. More importantly, the decided not to have the government decide what health care would or would not cover.

They might be changing their minds on that soon.

dpierce said...

> How do they manage when they
> recover with usable limbs but
> crippling debt?

By invoking the great financial reset: Bankruptcy. In the "good old days" (five years ago), even after a bankruptcy, you could still turn right around and get a loan for two cars and a house. Probably not the case today.

But yeah, in the US, you're expected to build a support system around yourself other than mother government -- be it work, family, church, or otherwise. Colin is right, things may change over the next decade, but it'll never be free.

The constant ads for various drugs and treatment centers are unsettling. It gives you the impression that either 1) probability is THAT high for disease or 2) the network expects that show's audience is likely a high target for disease. On the other hand, if you have a particular problem, it's probably comforting to be surrounded with information and awareness.

Luke said...

You don't see the conflict of interest in a government that has the power to both set the food safety rules and to decide what conditions deserve health care? I prefer an FDA paid to be adversarial -- that much concentrated power scares me.

But, as I'm discovering, Canadian policy is often dictated by vocal minority groups. (See your near-persecution of Catholics, for instance. Very Cromwellian.)

Jim Howard said...

I tire of this kind BS. You in Canada have the United States to pay the research costs for your drugs and to provide specialists when your system can't. In the United States people over 55 can get organ transplants. Not in the UK or Canada. There is a huge conflict of interest because the government comes out money ahead if you die near the end of your working life.

If we in the United States adopted your system, then neither of us would have anywhere to go when the wait time exceeds our life expectency, or when we are past the age where our governmental masters decide justifies the expense of keeping us alive.

And for heaven's sake, do you think the U.S. government spends nothing on health care?!?

If you don't like in Texas, stay the heck out!

Anonymous said...

I grew up part of my life in Texas and still visit my parents and family there. I've enjoyed these posts as I've had similar reactions, particularly to the walking issue. My friend from Spain (who was in Texas working as a pilot) was stopped by the police for walking one day. He was just out for a walk (although it is hot he is from Southern Spain and is used to the heat) and the police thought this highly suspicious. I took the advice of Jim Howard and got the heck out. :) Still find the people friendly, though and the BBQ wonderful so I do occasionally visit.

I lived in Spain and Canada, working in the health care system and I have to say that I much prefer the Spanish system, it is a two tier system with both government paid health care and a private system for those who wish to pay for speedier service, etc. That said, Canada's system (at least in downtown TO) worked phenomenally and I even had a few American patients (married to Canadians, of course and eligible for treatment). But it will be very difficult to convince Americans of this, as it just doesn't jive with the American way. And that's fine for them. It is yet another reason I choose to live abroad.

Anonymous said...

@Jim Howard - you comment made me laugh: "If you don't like in Texas, stay the heck out!"

How about: "If you don't like what she has to say about Texas, QUIT READING HER BLOG!"

Thanks for making me laugh.

jinksto said...

Hmmm... ignore the abusive folks please Miss. Healthcare has been a big issue down here of late and both sides are still pretty touchy about it.

I think you probably walked into the middle of a bar fight without intending to. :)

I continue to appreciate your unique perspective on the US way of life. It's always amazing how such close neighbors can differ in so many fundamental ways.

Where being without government sponsored health care frightens you many of us fight it for all we're worth. We hate the very idea of living on handouts from the government and want very much to reduce it's size. At it's core it's a philosophical debate I think but some of the discussions can take on an almost religious fervor.

Anonymous said...

I didn't realize the flood of medical ads was a US only thing. I thought the whole western world was being urged to "ask your doctor if $x is right for you". The ads are one more reason watching commercial TV is unpleasant, as it's like they're trying to sell you a disease along with the cure. Who knew "restless leg syndrome" was such a big problem?

I'm with you on the bovine growth hormone, never buy the stuff. I'm glad I at least have the choice.

US Health care is a huge political and philosophical hot-button, with charges of "socialism" and "mediocrity" on one side and "health care only for the rich" on the other. @jinksto, a "bar fight" indeed. I hope we can enjoy Aviatrix observations without dragging her into the fight.

Jim said...

One of the advantages of living in Canada is that the cable systems remove the advertisements from the US channels, and substitute Canadian advertisements. Which means we miss the 60 second commercials for some drug-of-the-week that have 30 seconds of "small accelerated voice" telling you how the dang drug is going to maim you.

Rather funny, actually.

It sucks to miss the Super Bowl commercials - but you can get them on YouTube.

Jim aka SS

Aviatrix said...

Jinksto, thanks for explaining the strong reactions. I'm glad you can see such posts as simply 'what your world looks like to me' and not as a political argument for or against government-funded health care, free pop refills or airport identifiers that aren't a jumbled mess of zeds.

I'll specifically answer one comment, because it seems misplaced. Catholics are persecuted in Canada? I think Catholicism is a solid and accepted part of Canada. Nine out of 22 Canadian PM's have been Catholic, the first one elected in 1892. There are both Catholic and Anglican cathedrals in the cities. I don't know of any derogatory words for Catholics and have never heard of someone being denied employment or housing or anything on those religious grounds. Maybe someone might have been teased for having so many brothers and sisters, but I think that's something, like Jewish mothers, that is an acceptable target. There is lots of discrimination against Sikhs and Muslims, but I suspect that is more about people being brown-skinned than about their choice of worship. I have seen a Canadian small town newspaper editorial that implied that Catholics were somehow destroying the moral fibre of the community, but the logic involved was unclear. I think the previous week moral fibre was threatened by men holding hands, and the week after by leaf blowers.

If you are Catholic and were mistreated by someone during a visit to Canada, I'm sorry and surprised to hear that.

Aviatrix said...

Jim Howard, you posted before I refreshed.

If it helps you any, I work for a Canadian company and we're on contract to another Canadian company that does very specialized analysis which they'll resell to a multinational company. So we're putting Canadian dollars into local restaurants, hotels and FBOs and y'all can spend them on health care, cheese (huh, cheese?) or guns at your leisure.

If the ten to one ratio you refer to is immigration applications country-to-country then divided by population, it's exactly equal. I guess in the summed opinion of people who want to change countries, we have two different ways of doing things that make different people happy.

Sorry if I come across as angry, whinging or bitching. That isn't the intention of the blog.

Luke said...

Aviatrix, it's a bit more than just personal intolerance -- though that has certainly happened as well. Look up the details of Alphonse de Valk's investigation by the CHRC. (I won't even get into how scared I am by the power of that quasi-governmental organization and its kangaroo tribunal.)

Anonymous said...

Fact: Drug companies spend $2 on marketing for every $1 spent on research.

It's not about finding a cure... it's about finding a money making treatment.

Greybeard said...

Government VS. private-
Here's why Jim Howard and yours truly get irritated in these discussions-
(And by the way, WHO started this bar-fight?!)
Some years back, Washington, D.C. Mayor Marion Barry was secretly videotaped in a bedroom with a female (other than his wife) while snorting cocaine. He subsequently went to jail for a short term.
Out of jail, he once again ran for office and was elected! During this term his constituents realized why this idiot was caught with a prostitute using illegal drugs and finally sent him packing.
Now, although he is better looking and waxes more eloquently, we seem to have elected a similar man to the most powerful position in the free world.

Powerful government allows fools like this one to have way more control over my life than I would like. Like JH and many of his Texas neighbors, I'm absolutely sure I can take better care of me than the Marion Barrys of the world can.
So for the record Jim, I think your points are pointed and accurate. Thanks for airing your opinion.

Anonymous said...

I had to grin reading this post, which is apparently the opposite reaction of some other Americans here.

I was chuckling because not too long ago I was sitting in a bar in Canada talking with my coworkers (quietly) about how we can't fathom having to rely on the inefficiencies of a government for something as important as health care. We were very glad that we didn't have to deal with the taxes and long waiting periods associated with nationalized health care, and instead had the freedom to pursue our own health care coverage. We were speaking quietly, of course, because we didn't want to insult any of our Canadian hosts sitting at the tables nearby.

It makes me smile to think that at the same time a Canadian crew was likely sitting in a Texan restaurant talking about how strange it was to be in a country without nationalized government healthcare. There is balance in the continent!

Jim Howard said...

Greybeard, howdy.

You and I both know that the 70% of Americans who have health insurance would revolt if forced into a UK or Canadian style style system, and that the healt hcare these Americans receive far exceeds the wildest dreams of anyone in the UK NHS system (I speak from first hand experience) and probably Canada.

Likewise, in the US the truly poor and retired people have a good system, and they enjoy the benefits of competition denied to their friends in Canada.

There is a group of about 10-15% of Americans who earn enough to not qualify for government health care but don't have private insurance. These folks need something, but even many of them would reject the nanny state system.

But really, I don't get mad about discussing health care. Reasonable people can differ.

I get mad at the enormous hypocrisy of foreigners who come here to work and then complain that we don't run our affairs the way they do at home.

When an American goes abroad and makes the least suggestion that they way they do things over there could be improved then that American is subject to instant and intense personal attacks on him and his country.

Yet these same foreigners, often from countries where it is all but impossible for an American to get a green card, think nothing of trashing the United States which is willing to let them work and live with us.

I find this behavior boorish in the extreme.

Unknown said...

Here in the dear old UK, we pays our taxes and are entitled to "free" healthcare......BUT you'll struggle to find an NHS Dentist, or NHS opthalmic services(other than an eye-test) -the Gov't sanctioned choice of low-price/free frames are obsolete, 3 rd. world rejects.

For some strange reason, perfectly good sunglasses and reading-glasses are on sale with reasonable quality frames ,under £5.00 -yet for stronger prescription /bifocals, it will be a minimum of £100. 00

With health -care we DO have the alternative of private insurance and "top-up of privately bought drugs is now allowed to supplement NHS care....this is new, following a scandal where people were refused treatment due to cost or non-approval, the Government stance having been "if you do want other,private ,treatment, you won't get ANY Gov't. funded treatment or hospitalisation."

Rather like our education system....people paying for private-sector, cannot opt out of paying the taxes for the public sector...the "rich" pay twice!

By all accounts, the French state-system is absoloutely superb!

dpierce said...

@globalgal - I guess it goes both ways. At my last employer, a consultant I worked with moved his family from Canada because he knew his newest baby's upcoming birth was going to be difficult, and he and his wife were "afraid" to have the birth in Canada. Our marketing manager also moved from Canada to have a procedure done that Canada wouldn't pay for (it allowed him to be able to stand for more than 15 mins again). The level of service impressed him so much he became a citizen.

@Jim Howard - I would hope that 70% of Americans would "revolt" over a great many things that Washington imposes on us, but it doesn't happen. Despite the dour news of late, we are relatively fat & happy with a high standard of living, and such a population is loath to revolt against anything at all. Take away the Internet, restaurants, and cable TV if you want to see a revolt.

@nobody in particular - I work with Brits daily, and have no direct experience with their system, but hear the tales every week (not always bad, but some stand out)...

A consultant in his early 30s spent the day looking absolutely morbid. We finally fished out of him what was wrong. He was going to his 3rd visit to the dentist about a sore tooth. He claimed if they couldn't fix it in 3 tries, it had to come out. The next time I saw him, it was gone. Granted, we put a lot of value in dental cosmetics, but it just seemed a bit extreme for a guy this young in a customer-facing position to have a missing front tooth.

About a year ago, I had a weird cramping sensation in my chest that scared me enough to go see my doctor (turned out to be a spasming muscle). The next day, I was on the phone with my British colleagues, two of which absolutely thought I was lying (!) because I "claimed" to get in to see my doctor the day after I reported a problem. I'd never considered this a big deal, but it seems four weeks is a normal wait.

Since I've learned (by asking too many nagging personal questions like a typical American) that anybody who could afford it took out private insurance. That was telling.

Our system is far from perfect, and nobody should suffer w/o some standard of healthcare. There are good ideas to be adapted from all civilized countries. I'd love to reform it and education. I consider part of the mission of protecting healthcare doing anything I'm reasonably able to keep it (and most things) out of the hands of the government, which acts with a heavy hand guided by incompetence. The government has proven themselves incapable of administrating and managing even simple things -- healthcare is far beyond their skill and ethics. But it will slip toward government in the current climate, bit by bit.

nec Timide said...

This is an interesting conversation to be having on an aviation blog. For some years Canadian airspace and air traffic services have been provided by a private corporation. The relatively small movements towards a similar privatization in the US have been met with fierce resistance and complaints of incompetence of the private service providers.

I won't claim to know the first thing about US health care delivery, cause I don't. I will point out that Canada doesn't have a national health system. Health care is one of the things that falls under provincial jurisdiction. About the only thing the federal government can do is throw money at the provinces and hope they spend it wisely. This has proven a difficult proposition. It also isn't free. Many things that aren't covered by a provincial system can be paid for out of pocket or by insurance obtain through employers, unions or privately. Or one does without.

One (perhaps the only) benefit of having reached my 50th year is that I remember how things used to be. Health care in Canada was at one time very good. No one talked about wait times etc. The problems started after it was decided that, for a number of reasons, the demand for health care professionals would decline over time. The number of spots at medical schools were reduced. Now, many people (including my SO) don't have a GP, so a significant amount of routine medical care is provided out of Emergency Rooms. Possibly the most expensive way to do that. Ironically Texas was the most common destination for Canadian graduate nurses I knew at the time.

The people that made those decisions were in governments, but anyone who doesn't believe free enterprise can make bad decisions that adversely affect millions of people for years would have to have been living under a rock somewhere. The real problem in providing health care, air traffic or banking services is finding people who can make the right decisions.

Governments can be made to provide good services for reasonable cost but you have to make them. Private industry can be corrected by suffering huge losses or being fired. But they either have to suffer those losses, or be fired. Sometimes, in either case as we are learning, the costs to citizens can be great.

Anonymous said...

Bring back the plane talk.

If I wanted a political discussion, I would query CNN, FOX News, MSNBC, Rush Limbaugh, Rachel Maddow, etc. Why can't you take this blog for what it is: a personal observation by a Canadian pilot in which her views will be affected by your upbringing and surroundings?

PS - I love your blog and don't let any posters here interfere with your posts. There are some people on here who like what you write.

Anonymous said...

Listening to the local NPR radio station (WNED) in Buffalo at supper time tonight, the NTSB spokesman offered some more information about the last few seconds before impact of the Dash-8. It had pitched up by 31 degrees before pitching down about 40 degrees while rolling to the left by 45 degrees, then rolling right 102 degrees. The G-force in the cockpit varied from 0.75 G to 2.0 Gs. The last two radar contacts showed it at 1800 feet and then 1000 feet. The time delay between the radar contacts was 5 seconds, so it would appear that the aircraft's rate of descent was extremely rapid. The unexpected aircraft behaviour, (pitching, rolling, yawing) occured at 900 ft MSL and the impact site was at 650 ft MSL so the crew only had 250 ft of altitude to work with. In regard to the de-icing equipment, it had been in use since leaving Newark.

Anonymous said...

I'm a pilot-in-training. And I grew up in New Jersey. Coming from America, I'd like to say that your views on the state of health care in The Sates is spot on.

It's also true that in this country - some people take this as an Ego and Pride Issue. They imagine that criticism from other nations is derogatory.

Therefore, you should expect quite a few heated comments on an issue like this. Your criticism is both valid and appropriate. Some people, however, take it the wrong way. And in the end, our inability to question or failing healthcare and economy will cost us.

Anonymous said...

Why is it that a little thoughtful criticism of our system generates so much ire in response? Reading your stuff is, of course, more of a pleasure when you're doing a little aviating but even when not, little jewels like "boner pills" make it so worth while.

Anonymous said...

Well, my first thought on the "go away if you can't say something nice" comments was, if you don't like the comments on your system, stop hiring foreigners to do things you can't do yourself for the same price. But that's a pretty American sort of statement.

More interestingly, this brings up the real difference between Canadians and... well, I guess I should really say, "United Statesians"..., and that's the American idea of exceptionalism.

If some non-Canadian criticises Canada*, we don't take it too seriously. If the Germans complain about us, well, they complain about the French, too, and the French might like us on that point. We're all just one big squabbling set of siblings. But Americans seem see the world not as one country amongst any, but as America versus the "rest of the world." That some particular thing is different from America is the key point, and that it might also be different between Germany and France, or even Japan and Senegal, is not really relevant.

* I say this because I think usually, if any non-American is criticising Canada (Americans don't count for these purposes because we're close, vaguely comprehensible, and an easy target), it's probably a Canadian. There's a reason that, when the CBC ran a national contest for a Canadian catchphrase along the lines of, "as American as apple pie," the winner was, "as Canadian as possible under the circumstances.