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…]

British Columbia flooded with drug money

The great challenge of being politically conscious is to remain critical (one might say ‘skeptical’, although I don’t think that word means the same thing in this context that we usually mean) of propaganda and showy announcements. Whether you think politicians are cravenly trying to pull a fast one on the populace, or if you’re like me and think that politicians simply begin to think in propagandist terms, the sign of a person who is cognitively engaged with politics is the ability to parse both the positives and negatives from political announcements.

To give you an idea of the way in which I wrestle through the political landscape, here’s an example of a recent development that I found particularly interesting: [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…]

Physician, kill myself

Anyone who follows my Twitter feed will be familiar with my habit of occasionally spontaneously going on rants about how much I love my city. I really do – we have a mayor I can respect, we have a proud tradition of social activism, we live in greater harmony with our natural environment than most cities our size. Despite its faults, Vancouver is a great place to live. Similarly, despite the fact that I don’t hold our government in terribly high esteem, I do rather like the province of British Columbia. Lots of hydroelectric power, natural custodianship, and abundant natural beauty. We got it like that.

But I am pretty confident that I have never been more proud to live when and where I live that I do after hearing this news: [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.


“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…]

The power of Dr. House

I was recently reflecting on a fact that I usually ignore: I am in excellent health. That’s not to say I’m in excellent shape (I’m not), but I am able to live a more or less ‘normal’ life completely free of any infirmity. I don’t have any recurrent pain, difficulty sleeping, food allergies, mental distress, social anxiety… basically I’m kicking ass at life. When I consider what the reality is for many people, even if I restrict my thinking only to those in North America, I am still coming out ahead of a good chunk of the population who has to interact with the health care system in one way or another.

It is somewhat ironic that I make a living researching ways to improve the health care system, but that the only time I actually interface with it is when I go to the office. The irony expands a bit when I think of the myriad of ways in which people’s ill health makes working either an impossibility or a real difficulty. Even with a publicly-funded health care system, there is a severe economic consequence associated with illness. This association diminishes somewhat in white-collar jobs (unless you have some kind of injury that interferes with cognition, or a mental illness that makes knowledge work difficult), but your health is the foundation of your entire life if you work in a trade – a busted knee or a broken finger means the difference between working and starving.

Interestingly, the relationship between health and wealth works in the other direction as well. While the correlation between education/income and health are well-understood in the realm of health research, the evidence supporting causation is somewhat less robust. However, the picture is getting a little clearer: [Read more…]

Americans: not as dumb as I thought

I have to admit something to my American readers: I have a complicated relationship with your country. I kind of see America like a big brother who’s kind of a screwup. Lots of talent, but makes poor decisions – gets drunk and picks fights, but then once he’s bailed out of jail he goes to the library and comes up with a brilliant get-rich quick scheme. And then blows all of the money on drugs. He gets into abusive relationships instead of dating that perfectly nice and cute girl (who is the one that keeps bailing him out of jail), because he likes ‘bad girls’. He’s powerful and brilliant, but erratic and dangerous.

American people, to draw large, sweeping, and unfair generalizations, seem to be willing to put up with a lot more bullshit than I would think is rational. Part of that is the fact that they believe a lot of bullshit about “American exceptionalism” and Manifest Destiny and the shining city on the hill and “leaders of the free world” and “model of freedom for the whole world” all those myths that were sort of true about a half-century ago. The remainder, however, baffles me. To think that the same country that produced the Ivy League also produced Rick Santorum’s presidential campaign is a fact that makes me have to have a little lie-down.

To put a point on it, I don’t think much of the American electorate. After the last election here in Canada I don’t really think much of the Canadian electorate either, but there’s no chance that Herman Cain would lead a national opinion poll here. I have to believe that. However, I may have to revise my impression of Americans upward slightly: [Read more…]