They took ur helth curr!

I will honestly never know how it was that conservatives got this reputation as being “fiscally responsible”. People who fancy themselves politically savvy centrists will often describe themselves as “socially liberal, fiscally conservative” as though that was a superior approach to just calling themselves “moderates” or something. Nuanced it may in fact be, but a point in their favour it is not. Classical fiscal conservatism is, at its heart, an argument that the state should interfere with economic matters as little as possible, and even then only to encourage the development of private industry through competitive markets and maintaining standards of fairness.

Since the days of Margaret Thatcher and Ronald Reagan, however, fiscal conservatism has come to mean “get the government out of the way” by “starving the beast” and basically denying the possibility that public control over any industry is anything other than a surefire path to failure. It’s not enough to maintain fairness – it’s an absolute necessity that government be powerless not only to participate in markets, but to also demonize the possibility of intervention when things are clearly headed for calamity.

Specifically, this attitude has reared its disgusting and self-centred head in a discussion over the provision of health care to refugees. The basic underlying philosophy of publicly provided health care is to ensure that people are able to access medically-necessary services based on their need for those services, rather than a market-based approach that prioritizes those who have superior ability. Yes, it happens to be anti-capitalist, but it has the side benefit of being more fiscally responsible, since people aren’t putting off illness management until it’s too severe for them to ignore it. Refugees, people literally fleeing to Canada for fear of persecution in their home countries, often have greater need (particularly for psychological care, a particular bugbear of mine). The public health care system, it therefore seems to follow, should respond with greater provision of services.

Not if you’re a “fiscal conservative” though: [Read more...]

Crommunist on ‘Obamacare’ – an interview with Jamila Bey

I had an opportunity last week to talk to atheist and PoC issues commentator and activist Jamila Bey on her show The Sex, Politics, and Religion Hour on Voice of Russia Radio. We were discussing the recent Supreme Court Ruling on the Affordable Care Act, derisively nicknamed “Obamacare” by idiots.

Listen to part 1

Listen to part 2

Once again this qualifies as one of those times when I step firmly outside of the usual subject matter of this blog, but health policy is the kind of stuff that makes my socks roll up and down.

Some important things that I failed to articulate well during the interview: [Read more...]

Obamacare ruled constitutional

In case you somehow missed it, the United States Supreme Court has ruled, in a 5-4 decision, that the Affordable Care Act (derisively dubbed ‘Obamacare’ by its opponents) does not violate the Constitution and will still carry the force of law.

For a rundown of the decision, check out Ezra Klein’s blog:

“The bottom line: the entire ACA is upheld”

That’s what SCOTUSBlog wrote moments after the Supreme Court announced its ruling on the health-care law. But it wasn’t upheld in the way most thought it would be. The decision was 5-4, with Chief Justice John Roberts siding with the Court’s liberals, and Justice Anthony Kennedy casting his vote with the conservatives.

This will be covered, in many quarters, as a political story. It means President Obama — and Solicitor General Don Verrilli — are popping the champagne. It means that Mitt Romney and the Republicans who were fighting the health-care law have suffered a setback. It will be covered in other quarters as a legal story: It is likely to be central to Roberts’ legacy, and perhaps even to how we understand the divisions in the Court going forward.

To read the full decision for yourself (it’s only 193 pages – go nuts), click here.

For a simplified explanation of what the law does, and why people opposed it in the first place, check out this great thread on Reddit.

For my reaction, please consult the following .gif of Ron Swanson: [Read more...]

Good because it’s good

So maybe this makes me a ‘centrist’ (a label I abjure because my conception of a ‘centrist’ is someone who can’t make up their damn mind), but I don’t see myself as being particularly partisan. A political party or movement wins my allegiance because I agree with their ideas today, not because I agreed with their other ideas yesterday. The whole phenomenon of “my father voted Republican, his father voted Republican, and right or wrong I’ll vote Republican too” seems equal parts idiotic and insane to me. Of course, voting Republican period seems idiotic and insane to me, so whatever.

This morning I talked about my approach for Canadian health care reform, which is nowhere near as big a political football as it is among our southern cousins. The ideas I put forward, as far as I can tell, don’t belong to any political party. They could be spun as products of either conservative thinking (“it’s time to stop throwing away hard-earned taxpayer money on a bloated bureaucracy that doesn’t deliver for Canadians. Let’s reign in spending by eliminating government waste!”) or liberal thinking (“we must find a fair and equitable way to deliver health care that focuses on providing the right service to the right person at the right time!”). The ideas aren’t good because Bob Rae or Thomas Mulcair thinks they’re good (or because Stephen Harper thinks they’re bad), they’re good because they’re good.

In the same way, I find the fight over the Affordable Care Act in the USA to be patently absurd. Aside from the fact that it is a massively watered-down version of a good law, there’s really not much in there to dislike: [Read more...]

Doctor Crommunist’s health prescription

Okay, so I am not a doctor (yet), but I do spend my 9-5 hours working as part of Canada’s health care system, and I do have a couple of degrees in which health policy played a pretty significant role, so I’m going to take this opportunity to make one of my (thankfully) rare digressions away from the typical subject matter of this blog and talk about health care.

My master’s thesis (which was a rather shabby affair) was partially focussed on the issue of wait times for critical services. Those of you who live in civilized developed countries will be familiar with this concept already. Those of you who live in the United States will probably need a refresher. Because there exists a finite pool of resources in the world, when a large group of people want to access something that is a one-at-a-time thing, there is a good chance that some people will have to wait. In Canada, because we have a publicly-funded medical care system, we run into wait times as the inevitable consequence of more people wanting a thing than the system has the capacity to provide.

I have, incidentally, discussed why Canada’s system is not only more fair but more economically sound than the American system in a previous post that I encourage you to read. [Read more...]

Something… weird happened last week

Anyone who is at least passingly familiar with the political landscape of the United States right now knows that the Republican Party has declared open season on women’s reproductive rights. From the much-derided all-male hearing on women’s contraception (and the resulting Limbaugh clusterfuck) to the very serious breaches of both personal autonomy and medical ethics happening in various states, there seems to be a concerted effort to roll back women’s access to health care. Add to that the fact that the government was nearly shut down because Republicans refused to allow any federal funding to go to Planned Parenthood, their reluctance to recertify the Violence Against Women Act, and the picture becomes pretty clear: Republicans have decided that American women are on their own.

Of course we have our own version of the Republicans forming the government here in Canada. As I noted shortly after the election, the Republican North Party is actually a stiched-together and very uneasy coalition of actual legitimate fiscal conservatives and the backwoods knee-jerk reactionaries that exist in every country to some degree, and said this: [Read more...]

Today’s policy boner

So I have a shameful secret to divulge: I get viscerally, enthusiastically, quasi-orgasmically happy about evidence-based policy. Some people get a little thrill in their nether regions when their favourite celebrity is on TV, or when their sports team wins an important game, or when their favourite band announces a new album. All of those, to me, pale in comparison to the rock-hard excitement I get when someone does something really cool in policy research.

So (and he knows me personally, so please don’t repeat this or it’ll get weird) Dr. Aslam Anis, you’ve given me a boner:

Prescribing heroin instead of methadone is more effective and less costly in treating street drug addiction relapses, a new analysis suggests. It was a collaboration with UBC, the University of Montreal and the Northern Ontario School of Medicine.

“We gave them option of trying methadone or diacetylmorphine [heroin] under medically supervised conditions, and we found people who were getting diacetylmorphine were retained in treatment much, much longer, so they had a much better outcome,” said study head Dr. Aslam Anis, director of the Centre for Health Evaluation and Outcome Sciences at St. Paul’s Hospital in Vancouver.

(snip)

“Our model indicated that diacetylmorphine would decrease societal costs, largely by reducing costs associated with crime, and would increase both the duration and quality of life of treatment recipients,” the study’s authors concluded. While the clinical trial was based on a year’s worth of data, the researchers considered different timeframes — such as one year, five years and over a lifetime— in their analysis. [Read more...]

Empowered Health: Week 2

So the Vancouver Sun is still forging ahead with it’s largely useless feature called Empowered Health. The general bent of the pieces seems to be that a healthy diet and an active lifestyle are good ideas (whoops, spoilers!), but as is the pattern with woo-friendly journalism, they sneak in a bunch of counterfactual nonsense in there as well under the guise of “alternative” practices. They are an alternative – an alternative to stuff that might actually work.

Let’s forge ahead, shall we? [Read more...]

Both sides of the coin

Most people who support a woman’s right to choose when to have children call themselves just that – pro choice. While most rankle at the lazy characterization of “pro-abortion”, I’m personally okay with it. I am for abortion access. I think every time someone makes the choice to have a child it should be celebrated, and every time someone decides that now is not the right time, that’s a smart move too. I feel no sense of moral panic at the consequences of my stance. Anyone who would use abortion as birth control (the religious right’s nighmare scenario) isn’t someone I want raising a child, not even as some kind of twisted form of ‘just deserts’ punishment.

As I’ve explained before, it is wildly inaccurate to call the opposite side – the anti-choice side – anything else. They’re not “anti-abortion”, since restrictions on abortion do not reduce the overall number of abortions. And they’re not “pro-life”, because when women seek out abortion services outside of a licensed medical practitioner, the results can be fatal: [Read more...]

Empower Health: Week 1

So last week I noticed, with more than a little consternation, that the Vancouver Sun has begun publishing a feature it calls Empower Health:

Better health is not a destination. Your health is a journey of small steps, things you can do to improve your mental and physical well-being.

Empowered Health is a new locally produced television program that shows you the path to better health with weekly tips on eating better, improving your fitness and navigating the minefield of the health care system and the dozens of complementary and alternative therapies and practices.

Those of you who don’t know much about Vancouver aside from the excellent work that the Vancouver Skeptics do here may be unaware that it is a city full of woo-woo nonsense. One can’t walk a city block without stumbling over a reflexologist or a chiropractor or some other snake-oil peddler trying to separate fools from their money. Because Vancouver has a large population of young, well-educated and upwardly mobile people, it has succumbed to the stereotypical west-coast syndrome of buying wholesale into “alternative” practices. Add to that a large immigrant population bringing practices from their countries of origin and a well-developed sense of fascination with anything “exotic”, and you have a perfect recipe for this kind of hucksterism.

Now, ordinarily the only thing I read the Sun for is local news and Canucks coverage, but I figured I wouldn’t be doing my duty as a local skeptic if I didn’t take a swing at the glass jaw they’re dangling out there. So I will try, every week, to digest the claims made in these articles. [Read more...]