OK. Granted, it was a question shouted by a Canadian comedy show host as Palin was heading for her tour bus. But anyone who was running for the second highest office in the country just a year ago ought to be media savvy enough to know when to employ the “smile and nod” response to questions that deserve more thoughtful answers than one has time to give. (Especially if one has been burned before.)
Of course, that would require actual thought, which in turn might require actual knowledge about differences between our health care system and Canada’s. And Palin chose an answer that reveals how little she knows about subject.
Sarah Palin inadvertently stepped into Canadian politics earlier this week when she told the crew of a CBC comedy show that America’s northern neighbor should “reform its health care system and let the private sector take over” the country’s medical services.
Comedian Mary Walsh of the comedy show This Hour Has 22 Minutes, a sort of Canadian Daily Show, stormed a recent Palin book-signing in Columbus, Ohio, and said to the former Alaska governor: “I just wanted to ask you if you have any words of encouragement for Canadian conservatives who have worked so hard to try to diminish the kind of socialized medicine we have up there.”
The question was tongue-in-cheek: Walsh’s character, Marg Delahunty, may be a conservative, but the CBC’s comedy show is decidedly not.
Walsh was pushed out of the Borders outlet as Palin tried to answer the question, but later, in the parking lot outside, Palin told Walsh that she should “keep the faith because common sense conservatism can be plugged in there in Canada too. In fact, Canada needs to reform its health care system and let the private sector take over some of what the government has absorbed.”
Again, Seriously, Sarah?
Palin does have a point, of a sort. But she’d have done better to suggest that the U.S. health care system give some free market concepts a try — like competition, as Mike Papantonio held forth on Fox News.
If Sarah Palin knew anything about the Canadian vs. U.S. health care, she’d know that Canada’s system outperforms ours in some pretty important ways (along with France’s and the U.K.’s). She’d know, for example that we’re dead last (no pun intended) among 19 industrialized nations when comes to deaths that might have been prevented with access to timely, quality care.
If Sara Palin knew anything about Canadian vs. U.S. health care, she’d know that despite paying twice as much for our health care system, we get far less for our money than our northern cousins. She’d know that we pay a higher price than Canadians in terms of outcomes — from live birth rates to life expectancy, where Canada out does us. (And so does the U.K., and France.)
Is Sarah Palin knew anything about Canadian vs. U.S. health care, she’d know that Canadians don’t experience what we call “job lock” in this country, living in fear of losing or changing their jobs and thus losing or diminishing their health coverage.
If Sarah Palin knew anything about Canadian vs. U.S. health care, she’d know that our northern cousins have no equivalent of the phenomenon we call “health-care exile,” which basically applies to Americans who left the country for personal or professional reasons — marriage, job opportunities, to care for aging parents — who can’t return to the U.S. because their dependents (children, spouses, etc.) are effectively uninsurable in our system.
If Sarah Palin knew anything about Canadian vs. U.S. health care, she’d know that all Canadian citizens have insurance for hospital and doctor visits, with no co-pays or deductibles. She’d know that on our side of the border some 46 million Americans have no health insurance, over a million more are underinsured, and their ranks are growing every day.
If Sarah Palin knew anything about Canadian vs. U.S. health care, she’d know that while Canadians do have to wait for elective health services, they get urgent care immediately. She’d also know that Americans have long waits too — in emergency rooms across the country.
If Sarah Palin knew anything about Canadian vs. U.S. health care, she’d know, more specifically that long waits for elective surgery don’t add up to “rationing” (as conservatives like to claim when maligning Canada’s universal health coverage). She’d know that while 27% of Canadians report waiting four months or more for elective surgery (note: not urgent procedures) compared to only 5% of Americans, about 24% of Americans report that they have gone without medical care because of cost, compared to only 6% of Canadians. She’d know that’s because we ration care based on urgency and need, while we ration based on cost.
If Sara Palin knew anything about Canadian vs. U.S. health care she’d know that Canadians’ health care system yields stories like Sarah Robinson’s who suffered a gall bladder attack while in Vancouver.
The health event was new to me, but pretty garden-variety as ER visits go. I had my first gallbladder attack. Not life-threatening, just the worst pain I can remember being in since the last time I was in labor. It started up just before dinner Tuesday night. At 2 am Wednesday, still awake and in worsening pain, I found my keys and shoes, stumbled down to the car (leaving the rest of the family sleeping), and drove the 25 blocks down to the hospital.
Four things in particular stood out about the hours that followed — things that show just how different medicine is when the patients trump profit as the main priority, things that Americans need to understand if they’re going to see through the chaos of this moment to the kind of future that’s possible.
First, the waiting time between walking in the door and being admitted was literally about 45 seconds. American conservatives have filled people’s heads with images of Canadians packed into old, worn-out, badly-lit, overcrowded emergency rooms bustling and echoing with writhing, moaning souls enduring waits that can stretch to days. Sorry to blow the fantasy, but last night, I walked into a newly-remodeled, gently-lit, serenely quiet lobby that I had completely to myself. There wasn’t another human being in sight. Even the receptionist had apparently taken a break.
…Second: You don’t realize how much politics — in this case, the war on drugs — has warped medical care until you see how differently non-American doctors and nurses deal with pain management. Since Canada sees drug abuse as a social problem, not a law enforcement one, it’s stubbornly resisted several ham-handed attempts by the American government to get it to crack down on doctors who persist in seeing codeine and morphine as useful medications. While Health Canada does keeps tabs on individual doctors’ prescribing habits, docs are given vastly more discretion in managing their patients’ pain than their US counterparts are. If you’re hurting, the docs here will calmly and generously prescribe painkillers — good ones, serious ones, the yummy kind that really do the job. (And yeah, I guess that would explain why the whole ER ward was so eerily quiet, too.)
So it was that, minutes after my arrival, the ward nurse tucked me in and hooked me up to an IV drip with saline and anti-nausea medications. “Would you like some morphine with that?” she asked, in the same casual and pleasant voice with which a waiter might offer you cream for your coffee. My inside voice, battered after a long evening of agony, jumped up and hollered: “YESSS! Oh, HELL yes!” My outside voice sweetly smiled back: “That would be lovely.” In moments, eight hours long hours of accelerating pain finally subsided — and I went to sleep, waking only occasionally from my opiate bliss to find myself being wheeled out for this test or that as night turned to morning.
…Finally, the last thing I noticed about last night was something that wasn’t there. I’m talking about that little meter in the back of my head, the one that whirred and spun and ticked off every charge from the minute I walked into an American ER until the minute I walked out again. The IV. The X-rays. The box of Kleenex, the Tylenol, and the barf pan. The crappy food (if you’re lucky enough to get any). Even with good insurance, the co-pays alone on eight hours in the ER could bust the family grocery budget for the next three months. That big number hanging over my head was always a real distraction from dealing with whatever crisis actually put one of us there. No matter what the presenting condition was when we arrived, I always seemed to have a bad case of heartburn when we left.
Contrast that with last night, when my glorious morphine dreams were completely untroubled by the sound of that mental meter. By the time they checked me out at 10:30 am, I’d had a whole bank of diagnostic tests, including a long and detailed ultrasound exam that found twin bouncing baby gallstones. The ER then handed me off to an internist for further exploration of the issue. (I see her next week — it’s already set up.)
No bills. No worrying about how to pay for the surgery, either — that will be covered, too. The morning nurse (the fabulous and charming Trish) pulled the IV. I got dressed, picked up my purse, and left. And that was it. No pain. No worries. No heartburn.
In fact, if Sarah Palin would know a hell of a lot more than she does — or probably cares to — Canadian vs. U.S. health care, if Sarah Palin read Sara Robinson’s posts on mythbusting Canadian health care (parts one and two).
If Sarah Palin knew anything about U.S. vs. Canadian health care, she’d know their system also yields stories like Ian Welsh’s.
A Personal Perspective on Canadian Health Care
I should add that I have firsthand experience with how the Canadian system prioritizes treatment. In 1993, at the age of 25, I became very ill with ulcerative colitis. I was hospitalized, and put on very expensive drugs. About a week after being hospitalized, the nurse watching me called in my doctors on a Sunday because I was deteriorating so fast — pain killers were no longer having any effect (i.e., high doses of morphine were not working), I wouldn’t let anyone touch me, and I was becoming delirious. At about midnight, they wheeled me into the operating chamber and took out my large intestine. While they were digging around, they found out I had appendicitis, and they took that out too. It would have burst within 2 days, and in my weakened state, it would have killed me.
Unfortunately, one of the treatments for ulcerative colitis involves immune suppressing drugs. My immune system basically shut down, my liver almost shut down, and I spent almost another 3 months in the hospital, riddled with extremely painful and crippling infections and other problems. At one point I was on 9 drugs; one of them was an antibiotic so expensive that only a single doctor in the hospital could approve it. My gastroenterologist called the treatment the equivalent of “pouring gold dust into your veins.” I wasted away, my weight dropping below 90 lbs. I often joke that I was old young: I’ve used a walker, crutches and cane.
The Universal Health Care Bottom Line
The ultimate point of my story is simple: I got the care I needed, when I needed it, and I never paid a single red cent.
Which is good, because I couldn’t have afforded to pay. I was young and had very little money. The kind of care I received, even back then, would have cost hundreds of thousands of dollars in the U.S.
If I had lived in the U.S., my parents would have faced a choice between paying for my incredibly expensive treatment or watching me die. They were both old and it would have wiped out their savings entirely and thrown them into bankruptcy. Frankly, I don’t know how they could have supported themselves. My life, at that cost, would have had too high a price. I wonder how many Americans have had to make that calculation.
But I survived, and neither I, nor my parents, was bankrupted. In similar circumstances I doubt all of those things would be true for an American 25-year-old trying to survive the same medical condition in America’s health care industry.
She would know that the U.S. health care system yields stories like John Brodniak’s.
John is a sawmill worker from Yamhill County, Ore., where I grew up. He was a foreman at a mill, he felt strong and healthy, and he had very basic insurance coverage through his job. On April 18, he was married, at age 23, and life was looking up.
Ten days after the wedding, he was walking in his backyard carrying a neighbor’s dog – and he suddenly blacked out. That led, after rounds of CAT scans, M.R.I.’s and other tests, to the discovery that the left parietal lobe of his brain has a cavernous hemangioma. That’s an abnormal growth of blood vessels, and in John’s case it is chronically leaking blood into his brain.
John began to have trouble walking and would sometimes collapse. He developed spasms and restless leg syndrome, he began to use a cane, and his mind suffered.
“He forgets stuff a lot, he bumps into things,” said his new wife, Esther Brodniak. “But he keeps things light. He jokes about it.”
Perhaps the worst is the pain – blinding, incapacitating headaches that have left him able to sleep only in short intervals. He vomits daily when the pain surges.
“The pain is constant,” John said. “It’s a 7 or 8 on a scale of 10, and then it hits the high peaks and makes me vomit.”
With John unable to work, he lost his job – and his insurance coverage. Esther had insurance for herself and for her two children (from a previous marriage) through her job building manufactured homes. But she couldn’t add John to her plan because of his pre-existing condition.
Without insurance, John has been unable to get surgery or even help managing the pain. When he collapses or suffers particularly excruciating headaches, Esther rushes him to the emergency room of one hospital or another, but an E.R. can’t do much for him. One hospital has told them not to come back unless he gets insurance, they say.
She’d know our health care system creates more stories like this one every day.
But Sarah Palin doesn’t need to know or have to know anything about Canadian vs. U.S. health care, or much else really. It behooves her not to know, want to know, or care to know, because then she wouldn’t be Sarah Palin — and I don’t mean Sarah Palin the woman, but Sarah Palin the symbol and standard bearer for a particular brand of conservatism that, while it has deep roots in American politics and history, grew so influential in the past eight years that it brought us to a point where conservative political pundits actually spend air time debating whether or not the president needs to be smart.
Robert Kagan says it’s elitist to expect a President of the United States to be knowledgeable about national security issues:
Robert Kagan, a foreign policy advisor to McCain, derided criticisms of Palin as elitist.
“I don’t take this elite foreign policy view that only this anointed class knows everything about the world,” he said. “I’m not generally impressed that they are better judges of American foreign policy experience than those who have Palin’s experience.”
Based on the structure of the situation, it’s plausible that Kagan is just being opportunistically dishonest here and trying to say something useful to the Republican ticket. But based on having read Kagan’s work over the years, I think that’s wrong and he’s absolutely being honest. Kagan, like most neoconservatives, thinks that in-depth knowledge of foreign countries and the politics and culture of foreign societies isn’t helpful in thinking about foreign policy questions. Similarly, they believe that in-depth knowledge of theoretical and empirical work in the field of international relations isn’t helpful. Indeed, they think that this kind of in-depth knowledge is actually harmful. They prefer the judgment of people who have little knowledge of the outside world but do possess a degree of gut-level nationalism.
Since most Americans do possess a degree of gut-level nationalism and don’t possess much understanding of the world beyond our borders, it’s difficult politically to mount an argument against Kagan-style celebration of ignorance. But at the same time, the fact that a substantial swathe of the conservative policy elite thinks this way explains an enormous amount about why things have gone wrong in our foreign policy.
(It explains a great deal more, in fact, about why things have gone the way they have gone in our economic policy, foreign policy, and what could go wrong if the brand of resolute know-nothing conservatism holds sway.)
A movement in which what one believes is more important than what what knows — and in which what one believes trumps, and must always trumps, what one knows or could attempt to lean — can do no more.
If Sarah Palin knew, or cared to know, the differences between U.S. vs. Canadian health care, she’d know that while nothing in the House or Senate reform bills even remotely resemble the Canadian health care system. And she’d know that’s the biggest shortcoming in the health care reform legislation we’re likely to get.
But I bet she does know that it it will extend coverage to millions of Americans who don’t have health insurance. I bet she does know that it won’t make our health care system like Canada’s, but it will bring us closer to being like Canada and other countries where no one is without health insurance, and no one lacks access to medical care.
Whether or not it’s a crisis that millions of Americans are uninsured or underinsured, that thousands lose their health insurance every day, or that tens of thousands die every year because they lack health insurance is a matter of perspective. The same goes for the economic crisis, the foreclosure crisis, or any other crisis.
Depending on your perspective, there’s nothing wrong with hundreds of thousands, or even millions losing their homes to foreclosure. (Even if deregulating the finance sector made it easier to sell them time bombs, in the form of mortgages, that went off long after the people who really matter made an easy buck and moved on.) There’s nothing wrong with millions of people having no health insurance, and thus no access to affordable, quality care. There’s nothing wrong, because it’s all right, and there’s no need to do anything about it.
No one is against expanding health coverage on principle. As we come down to crunch time, the health-reform debate is all about money.
We can’t assume that “no one is against expanding health coverage on principle,” because it’s flat wrong. Just like there were plenty of people who were against mortgage modification on principle, and just like there were plenty of people who were against the economic stimulus on principle, there are plenty of people who disagree with expanding healthcare coverage. And they disagree with the very principle that everyone should be covered.
What Sarah Palin knows about health care reform is that it will expand health coverage to millions of Americans who don’t have it, and that it could guarantee coverage for all. And Sarah Palin “knows” that it would be absolutely wrong to guarantee every American access to quality, affordable health care. That would put us in the same class with Canada, France, the U.K., and any number of other countries where almost nobody goes bankrupt because of medical bills, holds a car wash to pay for medical care, or dies because they lack insurance.
As far as she’s concerned, Sarah Palin doesn’t need to know anything else.