(no subject)
here's an (un)healthy dose of public healthcare argument, for those interested.
Editorial
Lessons from Alberta
The Medicare Advantage
March 3, 2006 | National Office | Topic(s): Health, health care system, pharmacare, Public services & privatization | Author(s): Armine Yalnizyan & Danielle Martin | Publication Type: Editorial
Alberta Premier Ralph Klein likes to call his contribution to politics the "Alberta Advantage".
Unfortunately, if he gets his way with Alberta's health care system, only the financially advantaged will partake in his version of the Alberta Advantage. The rest will be truly disadvantaged.
The Alberta government's latest proposal to allow people to buy private insurance for medically necessary services and let doctors "double-dip" between public and private payment flies in the face of the best evidence available around the world while breaching cherished Canadian values.
It violates the principle that people should access to healthcare based on need, rather than ability to pay; and it ignores the opportunity for true improvements within the public system.
Mr. Klein's musings on this subject have become almost commonplace. What is odd about these salvos is that they run counter to Alberta's own history and experience.
In the past and still today, Alberta has been a proven showcase for the Medicare advantage.
Back in 1970, Alberta became the first province to expand the newly minted Medicare principles beyond doctors and hospitals when it introduced Canada's first publicly-insured drug program for seniors, based on the clear benefits of risk-pooling and a single-payer system. The case was so convincing, other provinces followed suit.
Fast forward to 2005, and again Canada was seeking answers for how to improve Medicare. The Alberta Hip and Knee Replacement Project capitalized on Medicare's economies of scale, procedural specialization and streamlined information flows to dramatically decrease wait times for joint replacements. The average time from a consultation with a family doctor through to actual surgery fell from 82 weeks to 11. Against the rising voices of the naysayers, the success of this venture happened strictly in the publicly insured system, not by letting people jump the queue.
Looking for other home grown success stories? Strategic chronic disease management techniques at Calgary's Capital Health Authority have produced faster access to care and better health outcomes for people with diabetes.
So why would Alberta abandon Medicare now?
Clearly the "private insurance" or "two-tier" route chosen by Klein late in his career is one blinded by the glare of ideology, not driven by the engine of pragmatism.
Instead of trying to offer faster services to the small number of people who can afford to pay for them, Klein should focus on continued improvement of the publicly-funded system.
A focus on improving Medicare brings together two fine Canadian traits: fairness and practicality.
Improving publicly-funded services is the right thing to do, because it helps everybody, based on their need, not their ability to pay.
Improving publicly-funded services is the smart thing to do, because the evidence shows that is the most cost-efficient way to run a healthcare system.
Klein and others who favour private insurance have cited the high cost of healthcare as a reason for privatization. He's right about one thing: healthcare is expensive.
The growth of chronic disease, the aging of the population and soaring drug costs all mean we will be spending more money on health care over the coming decades. This is true in all industrialized countries, no matter what the mix of public and private funding. For any healthcare system to be sustainable, we will need to get better at preventing illness and managing costs.
What the Alberta plan misses is the fact that a system with multiple insurers is more expensive than a single-payer system. Witness the American system, in which 25 cents of every health dollar goes towards administrative costs. Canada's publicly administered health systems average 2 per cent overhead costs.
To abandon a single-payer system, the most cost-efficient method of insuring citizens in this context makes no sense.
Klein comes from a part of the country that prides itself on its no-nonsense rugged approach to life. He may be reaping the windfall from the advantage God put in Alberta's ground; but just because he's sitting on top of a multi-billion annual surplus that is burning holes in his province's pocket is no reason to make people pay more and jeopardize public health care.
These reforms may prove to be the most dangerous political experiment of Premier Klein's entire, daring career.
Framed as a "necessary" response to cash-strapped public systems and choice-hungry "consumers" of health care, it won't be long before Canadians begin to realize that putting in place advantages for the already-advantaged doesn't help advance healthcare in the least.
Alberta's free spirit has helped drive experimentation and seek innovation in health reforms. But Alberta, like all other Canadian jurisdictions, keeps coming back to the Medicare Advantage.
There's a lot to learn from what's going on in Alberta, and repercussions for us all. In the end, Klein's latest experiment is bound to come back to Medicare, based on overwhelming evidence and long-standing Canadian values. Albertans should settle for nothing less.
Armine Yalnizyan is a health economist and Research Associate with the Canadian Centre for Policy Alternatives.
Danielle Martin is a family physician and health policy analyst. She sits on the Health Council of Canada.
Here's a review for V for Vendetta, for those interested
V for Vendetta (review)
Trickster in a Garden of Evil
I'm paralyzed: I've been sitting in front of the computer for what feels like hours trying to figure out where to begin, and I still can't get my head around how profoundly awed and moved and overwhelmed and terrorized and rejuvenated I am by V for Vendetta. It's been 24 hours now since I stumbled from the theater where I saw the film -- my friends and I were the last ones out cuz we were too stunned to move and so we sat through all the long credits and then as the lights came up and then as the cleaning people came through making those harrumphing noises that are meant to invite you to leave -- 24 hours during which I saw another two films and did a lot of non-V for Vendetta-related writing, and my brain is still so in Vendetta overdrive that surely it is gonna asplode.
(Note to self: See movie again. About a dozen times. Surely that'll exorcise it from my head.)
I'm paralyzed, too, because I'm a geek, and advocate of the geek though I may be, polite society has its hooks deep enough into me to cause me to second-guess myself and go, Hey. Wait. It's just a silly movie about a guy in a mask, right? Maybe I'm just being a silly girly geek for gettin' all weak in the knees for a comic-book movie.
[beat]
But no, goddammit. Movies are where we -- the big cultural we -- bare our fears and desires, and that's not always pretty but it is always true. And superheroes are our mythology, the Stuff That Matters that we ourselves made today, not the hand-me-downs (though some of the hand-me-downs still fit pretty good), and it's too damn bad if the geeks are the only ones who realize that. Movies are religion and superheroes are our pantheon of bickering demigods who toy with us or champion us, and Vendetta is important not for its powerful political statements but because it can be powerful in its politics, because what is powerful and what is political about it is primal: it strikes us in a way that feels deep-down right.
The caped and masked man known only as V is the hero/antihero of Vendetta, and he is -- thrillingly -- Batman and the Joker all at once; he's Luke Skywalker and Darth Vader. As he makes his first appearance, preventing one crime while in the midst of committing his own, swooping in, theatrical and flamboyant, brandishing wicked knives as well as wicked words... well, the feeling is kinda like how Roy O'Bannon summed up the experience of being train-robbed at gunpoint by a gorgeous, wise-cracking, inherently nonviolent but nevertheless heavy armed criminal: "Scared? Kind of excited, too? All mixed up?" (That V is so dreadfully enchanting is down to the amazing Hugo Weaving [The Lord of the Rings: The Return of the King, The Matrix Revolutions], who wields body language like a weapon and that magnificent voice of his as if it had magical power. Which it does. I don't care if you're gay or straight, male or female: if you don't fall at least half in love with V just because of that voice, then you're probably not breathing.) The creepy rictus of V's mask is repulsive, yet the melodious poetry coming from behind it is beguiling... melodious poetry to accompany a bit of the old ultraviolence. This is a man who has danced with the devil in the pale moonlight.
Evey (Natalie Portman: Star Wars Episode III: Revenge of the Sith, Closer, simply fantastic), to whose aid V has come, feels the push-pull of attraction and repulsion, too, maybe not then, but later, when they meet again, and she gets wooed into becoming a part of his plotting. By the time much later when his mask no longer seems creepy but tragically now seems very much like his face and not a way of hiding it, other creepiness has been, well, unmasked in him... and V worms his way into a mythological place that feels even more fundamental: Is he not just from the time before Satan and God parted company but before the time they were two separate beings? Or is he something so enlightened that he is a clever postmodern resynthesis of the two?
What he is for certain for Evey at first and then for everyone in the end is an ur trickster, a snake in a Garden of Evil, terrifying but seductive, offering the particular knowledge of freedom, in all its frightening, well, free-ness. For they all live, you see, in a totalitarian England only 20 minutes into the future, where the populace has allowed itself to be cowed by fear of terrorism and plague into a censored, suveilled, intolerant submission by the dictator Adam Sutler. (Much is being made of the irony of John Hurt [The Skeleton Key, Hellboy] in the role -- he's gone from Winston Smith to Big Brother; the more ironic casting is Weaving, who's gone from man-in-black tool of the oppressor in the Matrix trilogy to man-in-black freedom fighter here.) And while no arm of authority escapes V's rapier wit and rapier, um, rapiers -- politicians, police, press, and priests all take hits -- it is the people, the hoi polloi, who are V's real target. Not to hurt or humiliate but to wake out of their coma. He publicly blames them for allowing their nation to fall into such a sorry state, these people who snort with derision (in private) when they're lied to by their rulers but take it anyway and do nothing about it. And he means to shame them into action with a promise to complete the act that Guy Fawkes -- another freedom fighter termed terrorist because he was on the wrong side; V's mask is a caricature of Fawkes's face -- attempted on November 5, 1605: he will blow up the Houses of Parliament.
V for Vendetta is not, however, about the snarky, take-that lefty liberal soundbites that pepper the film -- such as "people should not be afraid of their governments; governments should be afraid of their people" -- so much as it's a reminder of those ideals. Vendetta doesn't pretend that it invented ideas like religious tolerance or small-d democracy or being unafraid to speak your mind... but neither does it hide how angry and scared it is that such things seem to have been forgotten. With their screenplay Andy and Larry Wachowski (the boys who brought us The Matrix) massage the background scenario of Alan Moore and David Lloyd's graphic novel to account for the intervening two and a half decades since V for Vendetta began as a monthly serial -- if the past is prologue, we are living in this new Vendetta's prologue today. And they did it so cleverly (as Moore and Lloyd did with their version from their 1980s perspective) that to complain that the politics of the film are unfair is to concede its fairness -- to protest the hints of Bush and Blair, of contemporary America and England in this dystopian future is to admit them, and to say the film condones terrorism, as V's acts are labeled, is to say that oppressive regimes do not deserve to be brought down.
But it is a braver thing to have made this movie today than it would have been to have done so 15 years ago -- London was not blanketed with surveillance cameras when Moore and Lloyd finished their Vendetta series in 1988; America did not have secret prisons then. The film (quite an accomplished first feature by Wachowski prot?A9g?A9 James McTeigue) is an act akin in intention if not in scale to V's plan to blow up Parliament.
The preview crowd I saw V for Vendetta with was one of the stillest movie audiences I've ever been among -- we were all utterly riveted by every moment of the film. At the very least, what we have here is an instant new classic on a par with The Matrix, one that will not just become a source of in-jokes and snarky references, new patches of goodies to sew into the tapestry of geek culture, but a movie that will become metaphoric for the geek experience, like The Matrix has. At the very best? Perhaps its wakeup call will be heard, and the promise of its bone-deep subversiveness will be fulfilled, and it will blow up some figurative Houses of Parliament.
Then again, maybe it's just a silly movie about a guy in a mask...
viewed at a semipublic screening with an audience of critics and ordinary moviegoers
rated R for strong violence and some language
official site | IMDB
Editorial
Lessons from Alberta
The Medicare Advantage
March 3, 2006 | National Office | Topic(s): Health, health care system, pharmacare, Public services & privatization | Author(s): Armine Yalnizyan & Danielle Martin | Publication Type: Editorial
Alberta Premier Ralph Klein likes to call his contribution to politics the "Alberta Advantage".
Unfortunately, if he gets his way with Alberta's health care system, only the financially advantaged will partake in his version of the Alberta Advantage. The rest will be truly disadvantaged.
The Alberta government's latest proposal to allow people to buy private insurance for medically necessary services and let doctors "double-dip" between public and private payment flies in the face of the best evidence available around the world while breaching cherished Canadian values.
It violates the principle that people should access to healthcare based on need, rather than ability to pay; and it ignores the opportunity for true improvements within the public system.
Mr. Klein's musings on this subject have become almost commonplace. What is odd about these salvos is that they run counter to Alberta's own history and experience.
In the past and still today, Alberta has been a proven showcase for the Medicare advantage.
Back in 1970, Alberta became the first province to expand the newly minted Medicare principles beyond doctors and hospitals when it introduced Canada's first publicly-insured drug program for seniors, based on the clear benefits of risk-pooling and a single-payer system. The case was so convincing, other provinces followed suit.
Fast forward to 2005, and again Canada was seeking answers for how to improve Medicare. The Alberta Hip and Knee Replacement Project capitalized on Medicare's economies of scale, procedural specialization and streamlined information flows to dramatically decrease wait times for joint replacements. The average time from a consultation with a family doctor through to actual surgery fell from 82 weeks to 11. Against the rising voices of the naysayers, the success of this venture happened strictly in the publicly insured system, not by letting people jump the queue.
Looking for other home grown success stories? Strategic chronic disease management techniques at Calgary's Capital Health Authority have produced faster access to care and better health outcomes for people with diabetes.
So why would Alberta abandon Medicare now?
Clearly the "private insurance" or "two-tier" route chosen by Klein late in his career is one blinded by the glare of ideology, not driven by the engine of pragmatism.
Instead of trying to offer faster services to the small number of people who can afford to pay for them, Klein should focus on continued improvement of the publicly-funded system.
A focus on improving Medicare brings together two fine Canadian traits: fairness and practicality.
Improving publicly-funded services is the right thing to do, because it helps everybody, based on their need, not their ability to pay.
Improving publicly-funded services is the smart thing to do, because the evidence shows that is the most cost-efficient way to run a healthcare system.
Klein and others who favour private insurance have cited the high cost of healthcare as a reason for privatization. He's right about one thing: healthcare is expensive.
The growth of chronic disease, the aging of the population and soaring drug costs all mean we will be spending more money on health care over the coming decades. This is true in all industrialized countries, no matter what the mix of public and private funding. For any healthcare system to be sustainable, we will need to get better at preventing illness and managing costs.
What the Alberta plan misses is the fact that a system with multiple insurers is more expensive than a single-payer system. Witness the American system, in which 25 cents of every health dollar goes towards administrative costs. Canada's publicly administered health systems average 2 per cent overhead costs.
To abandon a single-payer system, the most cost-efficient method of insuring citizens in this context makes no sense.
Klein comes from a part of the country that prides itself on its no-nonsense rugged approach to life. He may be reaping the windfall from the advantage God put in Alberta's ground; but just because he's sitting on top of a multi-billion annual surplus that is burning holes in his province's pocket is no reason to make people pay more and jeopardize public health care.
These reforms may prove to be the most dangerous political experiment of Premier Klein's entire, daring career.
Framed as a "necessary" response to cash-strapped public systems and choice-hungry "consumers" of health care, it won't be long before Canadians begin to realize that putting in place advantages for the already-advantaged doesn't help advance healthcare in the least.
Alberta's free spirit has helped drive experimentation and seek innovation in health reforms. But Alberta, like all other Canadian jurisdictions, keeps coming back to the Medicare Advantage.
There's a lot to learn from what's going on in Alberta, and repercussions for us all. In the end, Klein's latest experiment is bound to come back to Medicare, based on overwhelming evidence and long-standing Canadian values. Albertans should settle for nothing less.
Armine Yalnizyan is a health economist and Research Associate with the Canadian Centre for Policy Alternatives.
Danielle Martin is a family physician and health policy analyst. She sits on the Health Council of Canada.
Here's a review for V for Vendetta, for those interested
V for Vendetta (review)
Trickster in a Garden of Evil
I'm paralyzed: I've been sitting in front of the computer for what feels like hours trying to figure out where to begin, and I still can't get my head around how profoundly awed and moved and overwhelmed and terrorized and rejuvenated I am by V for Vendetta. It's been 24 hours now since I stumbled from the theater where I saw the film -- my friends and I were the last ones out cuz we were too stunned to move and so we sat through all the long credits and then as the lights came up and then as the cleaning people came through making those harrumphing noises that are meant to invite you to leave -- 24 hours during which I saw another two films and did a lot of non-V for Vendetta-related writing, and my brain is still so in Vendetta overdrive that surely it is gonna asplode.
(Note to self: See movie again. About a dozen times. Surely that'll exorcise it from my head.)
I'm paralyzed, too, because I'm a geek, and advocate of the geek though I may be, polite society has its hooks deep enough into me to cause me to second-guess myself and go, Hey. Wait. It's just a silly movie about a guy in a mask, right? Maybe I'm just being a silly girly geek for gettin' all weak in the knees for a comic-book movie.
[beat]
But no, goddammit. Movies are where we -- the big cultural we -- bare our fears and desires, and that's not always pretty but it is always true. And superheroes are our mythology, the Stuff That Matters that we ourselves made today, not the hand-me-downs (though some of the hand-me-downs still fit pretty good), and it's too damn bad if the geeks are the only ones who realize that. Movies are religion and superheroes are our pantheon of bickering demigods who toy with us or champion us, and Vendetta is important not for its powerful political statements but because it can be powerful in its politics, because what is powerful and what is political about it is primal: it strikes us in a way that feels deep-down right.
The caped and masked man known only as V is the hero/antihero of Vendetta, and he is -- thrillingly -- Batman and the Joker all at once; he's Luke Skywalker and Darth Vader. As he makes his first appearance, preventing one crime while in the midst of committing his own, swooping in, theatrical and flamboyant, brandishing wicked knives as well as wicked words... well, the feeling is kinda like how Roy O'Bannon summed up the experience of being train-robbed at gunpoint by a gorgeous, wise-cracking, inherently nonviolent but nevertheless heavy armed criminal: "Scared? Kind of excited, too? All mixed up?" (That V is so dreadfully enchanting is down to the amazing Hugo Weaving [The Lord of the Rings: The Return of the King, The Matrix Revolutions], who wields body language like a weapon and that magnificent voice of his as if it had magical power. Which it does. I don't care if you're gay or straight, male or female: if you don't fall at least half in love with V just because of that voice, then you're probably not breathing.) The creepy rictus of V's mask is repulsive, yet the melodious poetry coming from behind it is beguiling... melodious poetry to accompany a bit of the old ultraviolence. This is a man who has danced with the devil in the pale moonlight.
Evey (Natalie Portman: Star Wars Episode III: Revenge of the Sith, Closer, simply fantastic), to whose aid V has come, feels the push-pull of attraction and repulsion, too, maybe not then, but later, when they meet again, and she gets wooed into becoming a part of his plotting. By the time much later when his mask no longer seems creepy but tragically now seems very much like his face and not a way of hiding it, other creepiness has been, well, unmasked in him... and V worms his way into a mythological place that feels even more fundamental: Is he not just from the time before Satan and God parted company but before the time they were two separate beings? Or is he something so enlightened that he is a clever postmodern resynthesis of the two?
What he is for certain for Evey at first and then for everyone in the end is an ur trickster, a snake in a Garden of Evil, terrifying but seductive, offering the particular knowledge of freedom, in all its frightening, well, free-ness. For they all live, you see, in a totalitarian England only 20 minutes into the future, where the populace has allowed itself to be cowed by fear of terrorism and plague into a censored, suveilled, intolerant submission by the dictator Adam Sutler. (Much is being made of the irony of John Hurt [The Skeleton Key, Hellboy] in the role -- he's gone from Winston Smith to Big Brother; the more ironic casting is Weaving, who's gone from man-in-black tool of the oppressor in the Matrix trilogy to man-in-black freedom fighter here.) And while no arm of authority escapes V's rapier wit and rapier, um, rapiers -- politicians, police, press, and priests all take hits -- it is the people, the hoi polloi, who are V's real target. Not to hurt or humiliate but to wake out of their coma. He publicly blames them for allowing their nation to fall into such a sorry state, these people who snort with derision (in private) when they're lied to by their rulers but take it anyway and do nothing about it. And he means to shame them into action with a promise to complete the act that Guy Fawkes -- another freedom fighter termed terrorist because he was on the wrong side; V's mask is a caricature of Fawkes's face -- attempted on November 5, 1605: he will blow up the Houses of Parliament.
V for Vendetta is not, however, about the snarky, take-that lefty liberal soundbites that pepper the film -- such as "people should not be afraid of their governments; governments should be afraid of their people" -- so much as it's a reminder of those ideals. Vendetta doesn't pretend that it invented ideas like religious tolerance or small-d democracy or being unafraid to speak your mind... but neither does it hide how angry and scared it is that such things seem to have been forgotten. With their screenplay Andy and Larry Wachowski (the boys who brought us The Matrix) massage the background scenario of Alan Moore and David Lloyd's graphic novel to account for the intervening two and a half decades since V for Vendetta began as a monthly serial -- if the past is prologue, we are living in this new Vendetta's prologue today. And they did it so cleverly (as Moore and Lloyd did with their version from their 1980s perspective) that to complain that the politics of the film are unfair is to concede its fairness -- to protest the hints of Bush and Blair, of contemporary America and England in this dystopian future is to admit them, and to say the film condones terrorism, as V's acts are labeled, is to say that oppressive regimes do not deserve to be brought down.
But it is a braver thing to have made this movie today than it would have been to have done so 15 years ago -- London was not blanketed with surveillance cameras when Moore and Lloyd finished their Vendetta series in 1988; America did not have secret prisons then. The film (quite an accomplished first feature by Wachowski prot?A9g?A9 James McTeigue) is an act akin in intention if not in scale to V's plan to blow up Parliament.
The preview crowd I saw V for Vendetta with was one of the stillest movie audiences I've ever been among -- we were all utterly riveted by every moment of the film. At the very least, what we have here is an instant new classic on a par with The Matrix, one that will not just become a source of in-jokes and snarky references, new patches of goodies to sew into the tapestry of geek culture, but a movie that will become metaphoric for the geek experience, like The Matrix has. At the very best? Perhaps its wakeup call will be heard, and the promise of its bone-deep subversiveness will be fulfilled, and it will blow up some figurative Houses of Parliament.
Then again, maybe it's just a silly movie about a guy in a mask...
viewed at a semipublic screening with an audience of critics and ordinary moviegoers
rated R for strong violence and some language
official site | IMDB