Quotulatiousness

February 28, 2026

Just when you think Canada can’t get worse … it gets worse

Unlike most other Anglosphere countries, Canada does not have a resurgent right wing in domestic politics — we barely have a right wing at all — and the governing Liberal Party is constantly trying to steal sitting opposition MPs to achieve a majority of seats in Parliament. It’s no wonder that Alberta’s separatist movement has been active the last few years. In case you still have an optimistic view of Canada’s present and future, here’s a long “state of Canada” post from John Carter that will probably increase the numbers signing up for free euthanasia (“MAID” in Canadian):

The US is now leading Canada 3-0 in international hockey. If you count the Stanley Cup as an occasional international match, a Canadian team hasn’t won since 1993. For a country that has long practically defined itself as the Hockey Nation, this is especially humiliating. Given the continual year-round repetition of the Elbows Up mantra, this is the kind of thing a Roman augur would have interpreted as a portent of divine disfavour.

Months, you say? Oh dear.

Consistent with that interpretation, Canada’s recent humiliations have not been limited to sportspuck losses. What follows is a snapshot in time, headlines from a country beset by interlocking economic, demographic, spiritual, and political crises, a country which has not had good news in so long that it has forgotten what optimism even looks like.

Item: Canada recently watched the worst school shooting in Canadian history, and the second-worse mass shooting after the infamous 1989 Montreal Massacre in which “Mark Lepine”1 shot 14 female engineering students. The shooting took place in Tumbler Ridge, British Columbia, a small rural village in the country’s north, and claimed the lives of 10 people including the shooter, his mother, his brother, and several students. Dozens of others were injured. It soon turned out that the murderer was a trannie whose brain had been twisted into a psychotic pretzel by psychedelics, legal weed, SSRIs, and the gender woo he was force-fed at school, at home, and on Reddit. This has led to it being referred to as the Tumblr Shooting. Naturally, both the Royal Canadian Mounted Police and the Canadian media went out of their way to respect the shooter’s pronouns in all reporting and official communications. The media even made sure to give the shooter an AI filter glow-up, so that he could be remembered as the pretty girl we all know he really was deep down inside.

After a desultory and hilariously unsuccessful attempt at scolding the public that the problem wasn’t trannies, but guns or whiteness or something (blessedly, they couldn’t say “men” this time), the Canadian media just dropped it, though not before the government flew the flag at half mast.

Which is how this happened.

Item: A former school board trustee in Chilliwack, British Columbia, was fined $750,000 for failure to respect pronouns. Shooting up a school is bad, but misgendering is unforgivable.

[…]

Item: A xeet went viral in which a leaflib tried to fact check an American poster making fun of 18-month MRI wait times by pointing out that she’d only had to wait six months, prompting widespread mockery from incredulous Yanks.

Pennsylvania, which has about 1/3 of Canada’s population, has more MRIs than all of Canada put together. The Canadian mind cannot comprehend, etc.

Item: Euthanasia via Canada’s Medical Assistance in Dying (MAiD) program now accounts for 1 death in 20 in Canada. The overwhelming majority, around 96%, of MAiD recipients are white, despite white Canadians comprising 86% of Canadians in the elderly demographic that dominates assisted suicide participants.

Since 2016 over 76,000 Canadians have been killed by MAiD. Moreover, the program is accelerating: the death toll in 2024 was the highest on record at 16,499. Annual death tolls have risen by around a few thousand every year since the program started, with no sign of stopping. Canada is expected to hit 100,000 MAiD deaths by summer.

Item: While most MAiD victims are elderly and infirm, this is not true in every case. Recently it came out that a 26-year-old man was euthanized, simply because he was depressed over his diabetes-induced blindness. His family allege that he doctor-shopped until he found one who would kill him (she has apparently killed several hundred others).

MAiD was originally billed as an easy, painless out for people with terminal illnesses, a dignified death that would spare them a few months of pointless agony. It’s now being extended to people whose imminent death is not reasonably foreseeable. Several Canadian Armed Forces veterans have been offered MAiD in lieu of treatment for injuries sustained in the course of their service.

The primary goal of MAiD is almost certainly to reduce pressure on Canada’s overstretched public health care system whilst simultaneously reducing the fiscal burden of pensioners on the federal budget. Someone looked at the financials, and concluded that unfunded liabilities were going to bankrupt the country when the boomers reached their 80s. Therefore the government is talking them into killing themselves. However, while they’re at it, they might as well expand the program to hasten demographic replacement within the younger sectors of the population pyramid.


  1. Née Gamil Gharbi, a detail the Canadian media successfully kept from us for decades as it didn’t fit their narrative that “men” are the problem, rather than men from … certain places.

February 17, 2026

QotD: Britain treats asylum seekers significantly better than their own citizens

Filed under: Britain, Bureaucracy, Government, Health, Media, Quotations — Tags: , , , — Nicholas @ 01:00

The Government’s own website explains, in the plainest words, how the asylum system works. It is a document of quiet enormity, a polite statement of how the British State treats foreigners as clients and its own people as expendable. On the page Asylum Support: What you’ll get, the Home Office writes: “You can ask for somewhere to live, a cash allowance or both”. The housing “could be in a flat, house, hostel or bed and breakfast”. There is no means test, no investigation of savings, no five-week delay before payment. The guarantee is absolute: “You’ll be given somewhere to live if you need it”. If meals are included, the allowance falls from £49.18 per person each week to £9.95, but the entitlement remains. The allowance is placed automatically on a prepaid debit card — the ASPEN card — and reloaded weekly.

The page continues: “You’ll get extra money to buy healthy food if you’re pregnant or a mother of a child aged three or under”. The payment is £5.25 per week for pregnancy, £9.50 for a baby under one, £5.25 for children aged one to three, plus a one-off £300 maternity grant for anyone expecting a child or with a baby under six months. Even when asylum is refused, support continues: “You’ll be given somewhere to live and £49.18 per person on a payment card for food, clothing and toiletries”. Only those who decline the accommodation lose the card.

Medical care is covered in full. “You may get free National Health Service healthcare,” the Government states, including “free prescriptions for medicine, free dental care, free eyesight tests and help paying for glasses”. Children are guaranteed a place in a state school and “may be able to get free school meals”. The terms are so generous that the NHS issues a dedicated HC2 certificate for people on asylum support, giving them automatic exemption from all prescription and dental charges, free eye tests and optical vouchers, and even help with wigs and fabric supports.

Compare this to the treatment of the people who pay for it. A British worker who loses his job must apply for Universal Credit, then wait at least five weeks before receiving a payment. Any advance must be repaid out of later instalments. He must show that he is seeking work, accept appointments and interviews, and risk sanctions if he misses them. He is scrutinised as a potential cheat. An asylum claimant is treated as a recipient of moral debt, requiring no proof of worthiness.

When the native taxpayer falls ill, he must pay £9.90 per prescription unless he qualifies for a limited exemption. He may buy a “pre-payment certificate” to spread the cost, but the charge remains. Dental treatment on the NHS costs £27.40 for a check-up, £75.30 for a filling, £326.70 for a crown or denture, and many cannot find an NHS dentist at all. Asylum seekers, by contrast, present their HC2 certificate and pay nothing. If the citizen asks the council for housing, he is told that the waiting list is full, that he is not a “priority case”, and that the private rental market is his problem. The asylum applicant, by the State’s own words, is “given somewhere to live if you need it”.

None of this is accidental. The cost of asylum support in 2023–24 was about £4.7 billion, according to the Home Office’s own figures, of which £3 billion went on hotel accommodation. In 2024–25, the bill fell slightly to £4 billion, but £2.1 billion of this was still for hotels — an average of £5.7 million every day. The National Audit Office has found that the ten-year accommodation contracts, first priced at £4.5 billion, are now projected to cost £15.3 billion. Between April and October 2024 alone, £1.7 billion was spent on housing and managing asylum seekers. The Financial Times has estimated the total annual cost of the asylum system at roughly £4.8 billion. The number of people receiving asylum support — housing, cash or both — now stands at over 100,000.

The figures expose a transfer of resources on a colossal scale. What is presented as “humanitarian duty” has become a domestic welfare state for foreigners, sustained by British workers who receive less support in return for greater taxation. The British State can house every migrant but not every nurse, find free dental care for the undocumented but not for the elderly, provide optical help for those who have just arrived but not for those who have paid into the system all their lives.

Marian Halcombe, “Britain’s Welfare Empire: A State that Feeds Strangers and Starves Its Own”, The Libertarian Alliance, 2025-11-05.

January 2, 2026

“The report is a wonderful, almost pristine, example of pure Expertism, the perfect blend of scientism and bright red euphemism”

Filed under: Cancon, Health, Media — Tags: , , — Nicholas @ 05:00

Despite our decade-long vacation from economic development, common sense, and growth, there appears to be one key area where Canada is a world-beater: inventing euphemisms for physician-induced death:

“See that guy over there, Mugsy?”

“Yeah, boss.”

“He needs to be provisioned.”

“You got it, boss.”

I have a small collection of euphemisms for killings, curious deaths and murder. Most of them are comedic, like Wodehouse’s “handing in his dinner pail”. You know the serious ones: expedited, eliminated, liquidated, liberated (from Real Genius), handled, disappeared, etc.

So you can imagine how thrilled I was to discover a new one, invented by Canadian doctors: provisioned.

You are provisioned when a doctor slips you the needle or some pills, on purpose, to send you instantly to your Particular Judgment. (The doctors will get theirs at later dates, and boy wouldn’t you like to be, as they say, a fly on the cloud for those.)

Doctors — white-coated physician killers, we can call them Rxecutioners — are increasingly enjoying collecting paychecks to kill Canadians.

According to the official “Sixth Annual Report on Medical Assistance in Dying in Canada“, 16,499 ex-Canadians were produced, or rather provisioned, in 2024. Some 22,535 applied, but 4,017 of them cheated their Rxecutioner by dying early. Can you picture the dejected look on the killer-doctor’s face, his needle poised, poisoned and dripping, only to find his customer left without him? Sad.

These numbers were up from 2023, but the rate of growth of killings (provisionings) has slowed; it was 6.9% from 2023 to 2024. If that deceleration stays about the same, Rxecutioners will put some 17,500 under in 2025. And slightly more than that in 2026.

“The vast majority (95.6%),” of those slaughtered, “identified as Caucasian (White)”. Rxecutioner provisionings are the one area where Canadian rulers allow Whites to excel. Incidentally, what’s with “identified”? Maybe Canadian rulers will let people identify as different races.

But never mind all that. The report is a wonderful, almost pristine, example of pure Expertism, the perfect blend of scientism and bright red euphemism. All should read it.

September 3, 2025

QotD: The distance between NHS PR and NHS reality

The uncritical national admiration, approaching worship, of the NHS has required the subliminal acceptance of a certain historiography: before the NHS, nothing; after it, everything. Before 1948, the poor received no treatment but were left to fend for themselves when they were sick, and more or less, to die. After 1948, the ever-solicitous state system looked tenderly after the health of the population from cradle to grave.

It wasn’t difficult to promote such historiography by using horror stories from the past, stories which were perfectly plausible because almost any conceivable system will give rise to such stories. If, per impossibile, a new system were to replace the NHS, it would not be difficult to justify it by reference to horror stories, whether or not the new system was better. A war of anecdotes, while always gratifying to the human mind, is not the way to decide important questions such as the superiority or inferiority of a system of health care. Only anecdotes that also illustrate statistical trends or truths are valuable in such a context.

The statistics are not favourable to the NHS, at least if one chooses reasonable standards of comparison, namely other European countries. The results are not disastrous, but they are not good either. The NHS has failed even in its egalitarian goal: the gap between the health of the richest and poorest in society has only grown under its dispensation. And yet the belief in its levelling effect persists.

The propaganda in favour of the NHS has been so successful that it now accords with the sentiments of the population, a triumph that no communist regime achieved despite herculean efforts at indoctrination. The triumph has been achieved without compulsion or violence and ought to be an interesting case for political scientists who study the successful inculcation of political mythology. Of course, the danger of such a study would be that it might induce doubt or cynicism about other political mythologies, and we all need such mythologies to live by.

Theodore Dalrymple, “Worshipping the NHS”, New English Review, 2020-05-07.

August 1, 2025

QotD: The self-serving mythology of Britain’s NHS

… it is a matter of common experience that members of the middle classes are far better able to derive benefits from the system than the lower classes. They complain where the lower orders swear, and bureaucrats are aware that articulacy is a more dangerous enemy than assaults on staff can ever be.

The interesting question of why the NHS should continue to hold the affection of the British people, when it is at best mediocre in its performance and frequently unpleasant to deal with, is one that should be of interest to all political scientists. The answer is not pleasing to those who believe in human rationality.

The affection represents the triumph of rhetoric over reality. This rhetoric contains an implicit historiography, in which the pre-NHS era is akin to that of jahiliyya, the era of ignorance before the advent of Muhammad, in Islamic historiography: in short, that there was no healthcare for most of the population before the NHS. This historiography has for decades been continuously and successfully insinuated into the minds of the population. It has been Britain’s pale imitation of totalitarian propaganda. Intentionally or not, Boris Johnson recently reinforced the mythological status of the NHS. And when, in the present crisis, retired doctors such as I were asked to return to work if they were able, it was to help the NHS. This was like asking a soldier to lay down his life for the sake of the Ministry of Defence. It says something about the credulity of the public that the response to slogans like “protect the NHS” was dull compliance, rather than outraged demands as to why it wasn’t protecting us.

I suspect also that the sheer unpleasantness of the NHS is reassuring to the British population. It evokes the Dunkirk spirit: we are all stranded on the beach of illness together. And if we cannot all live in luxury, we can at least all die in squalor. Justice is served.

Theodore Dalrymple, “Empire of conformists”, The Critic, 2020-04-29.

June 30, 2025

QotD: Britons and their NHS

Anecdotes, neither positive nor negative, are not the way to assess the performance of the NHS or any other healthcare system. But I suspect that I am not alone in finding it distinctly difficult, intimidating and unpleasant even to get to see a doctor (though I am middle-class and tolerably prosperous).

I have to run a gamut of procedures to do so and face a receptionist who treats me as a fraud trying to get something to which I am not entitled, and I have no practitioner whom I can call my doctor. The NHS has crowded out private competition, and the nearest private doctor is 25 miles away. Suffice it to say that, if I want to see a doctor, it is easier, quicker and more pleasant for me to go to France than to the health centre about 300 yards from my house in England.

I cannot in all honesty say, however, that my health has suffered in any measurable way as a result of this unpleasantness, because my health is good and I am not a doctor-botherer. But it does reveal something about Britain that is not true in France: in our dealings with the NHS, we are a nation of paupers who must accept what we are given by grace and favour of the system. It may be good or it may be bad, but we have to accept it.

Furthermore, under the NHS doctors themselves are becoming ever less members of a liberal profession and ever more executors of orders from on high, with little leeway to consider whether these orders are good or bad in the case of the individual case before them.

This is a problem in all systems in which a third party pays for patients’ treatment, but it is particularly acute in a highly-centralised and dirigiste system such as the NHS, in which uniformity is the goal, even if it be uniformity of error. And increasingly, it creates an atmosphere of technical, managerial and ethical conformity.

Theodore Dalrymple, “Empire of conformists”, The Critic, 2020-04-29.

May 20, 2025

QotD: The autohagiography of the NHS

The propaganda in favour of the NHS has been more or less continuous since its foundation in 1948, though it has become ever shriller, as propaganda tends to do, as it departs further and further from reality. Indeed, one might surmise that the purpose of propaganda in general is to forestall any proper examination of reality in favour of simplistic slogans convenient to political power.

I grew up, for example, in the inculcated belief that the National Health Service was, according to the slogan of the time, “the envy of the world”. Millions of people believed this, and indeed it was an assertion heard for many years whenever the subject of health care came up. The slogan was last wheeled out in any force in 2008 for the 60th anniversary of its founding.

Oddly enough, it never occurred to the people who repeated the slogan to examine the basis of the claim. Who, exactly, were the people doing the envying — not just one or two of them, but en masse? It is no doubt true that immigrants from very poor countries were pleased enough to receive care under the NHS, comparing it with what they would have received at home. But is it really much of an achievement for a developed country to have health care better than that offered in Somalia or Bangladesh?

A war of anecdotes, while always gratifying to the human mind, is not the way to decide important questions such as the superiority or inferiority of a system of health care.

It never occurred to those who repeated the “envy” slogan to look to comparable countries across the Channel or North Sea to see whether, in fact, those countries had anything to envy. In fact, between 1948 and 1975, even Spain under Franco performed better in the matter of improving the health of the population than did Britain. In most respects, in fact, Britain lagged or limped behind other countries, always in the rear and struggling to catch up.

What eventually struck me, then, was the willingness of so many people to repeat and believe a slogan without any compulsion whatever to do so, and without the slightest inclination to examine its truth — indeed without any awareness of the need for such an examination. There was no oppressive force to prevent or deter them from intellectual inquiry, but they preferred the comfort the slogan offered to the effort and possible discomfort of finding the truth. The NHS, or rather the idea of the NHS, played the role of teddy bear to a population with many anxieties.

True enough, many individuals may have experienced deficiencies in the service — long waiting times, offhand or disagreeable interactions with the bureaucracy, etc. But like Russian peasants of old who believed that the Tsar knew nothing of the oppression which they suffered, and would have put an end to it if he had known, the British continued to believe that the National Health Service had been born with original virtue and that the defects they experienced were exceptions. Repeated scandals of gross neglect or sub-standard treatment were shrugged off in the same way. And in a certain dog-in-the-manger way, the British were inclined to believe that if the NHS was unpleasant to negotiate, at least (being more or less a monopoly) it was equally unpleasant for everyone. Fairness and justice were equated with equal misery. Anyway, being ill is always unpleasant, so what did anyone expect?

Theodore Dalrymple, “Worshipping the NHS”, New English Review, 2020-05-07.

April 23, 2024

Justin Trudeau’s legacy may not be something he ever wanted (or imagined)

Tristin Hopper outlines some of the attitudinal changes among Canadian voters during Trudeau’s term in office, with opinions shifting away from things we used to consider settled once and for all. Canada’s Overton Window is moving (relatively) quickly:

Front view of Toronto General Hospital in 2005. The new wing, as shown in the photograph, was completed in 2002.
Photo via Wikimedia Commons.

It’s been among the most volatile and untouchable third rails in Canadian politics: The adoption, at any level, of a private health-care system.

In the last federal election, a Conservative statement about “public-private synergies” was all it took for Deputy Prime Minister Chrystia Freeland to brand it as a right-wing assault on the “public, universal health-care system”.

But a new Ipsos report shows that “two tier health care” is not the threat it once was.

Among respondents, 52 per cent wanted “increased access to health care provided by independent health entrepreneurs”, against just 29 per cent who didn’t.

Perhaps most shocking of all, almost everyone agreed that private health care would be more efficient. Seven in 10 respondents agreed that “private entrepreneurs can deliver health care services faster than hospitals managed by the government” – against a mere 15 per cent who disagreed.

“People understand that the endless waiting lists that characterize our government-run health systems will not be solved by yet another bureaucratic reform”, was the conclusion of the Montreal Economic Institute, which commissioned the poll.

As Canada reels from simultaneous crises of crime, affordability, productivity, health-care access and others, it’s prompting a political realignment unlike anything seen in a generation. But it’s not just a trend that can be seen in the millions of disaffected voters stampeding to a new party. As Canadians shift rightwards, they are freely discarding sacred cows that have held for decades.

If Canadians are suddenly open to health-care reform, it helps that they’ve never been more dissatisfied with the status quo. The past calendar year even brought the once-unthinkable sight of the U.S. being officially called in to bail out failures in the Canadian system.

November 4, 2023

QotD: The munificent benefits of big government

So, the things that capitalism produces have fallen in price over the past couple of decades. That’s the pure and unadorned free market capitalism that is. The things where we’ve a managed sorta capitalism have still fallen relative to wages. The things where the government is rather more responsible for production – education and healthcare – have risen in price with respect to wages.

This is the argument that government should run more of the economy of course.

No, don’t laugh, it is. Because these things are rising in price is exactly why, so the argument goes, government must regulate and control more, so as to lower the price.

Tim Worstall, “Ain’t Capitalism Great? Price Changes Over The Last 20 Years”, Continental Telegraph, 2019-07-13.

October 26, 2023

“… despite all the evidence, British people still believe the NHS is the single best thing about Britain”

Filed under: Britain, Bureaucracy, Health — Tags: , , — Nicholas @ 03:00

The picture Jess Gill paints of Britain’s National Health Service is equally true of Canada’s various provincially run socialized medical systems, and largely for the same reasons:

Not actually the official symbol of Britain’s National Health Services … probably.

It’s clear that Britain’s National Health Service is failing. 7.6 million people are on a waiting list, and 41% of them say their health has gotten worse while waiting for treatment. Compounding the problem, the UK has significantly fewer hospital beds, doctors, nurses, CT scanners, and MRI units than the OECD average. Furthemore, the UK has the second-highest rate of treatable deaths in Western Europe.

Yet despite all the evidence, British people still believe the NHS is the single best thing about Britain. From the country clapping outside their houses to “thank our NHS” during the Covid-19 pandemic, to the Prime Minister and the Leader of the Opposition attending a mass ceremony to celebrate the NHS’s 75th anniversary, praise for this institution is everywhere.

Even though it’s self-evident the emperor has no clothes, the NHS is treated like a sacred cow. This begs the question: why are people so loyal to a system that is clearly failing them?

There is a prevalent conspiracy theory that the NHS is being intentionally underfunded by the Conservative Government so that the resulting poor outcomes will provide justification for them to privatize it and transform it into the American model of healthcare. This theory is pushed by the establishment: from senior members of the British Medical Association, journalists, and Members of Parliament.

This theory achieves two things. One, it shifts blame for poor outcomes away from the NHS as a system itself and toward the politicians in power. Two, it frames the debate with the assumption that privatization is a bad thing, causing any meaningful reform to be met with fear mongering.

This narrative has caused a massive issue for opponents of the NHS as there are multiple levels of misleading rhetoric. The fact of the matter is that the Conservatives are not privatizing or underfunding the NHS. Furthermore, whether it be a fully privatized system or even the mixed system as seen in other European countries, free-market reform would significantly help patients and doctors.

February 8, 2023

“Smoking has been a net gain for the Treasury ever since King James I started taxing it heavily in the 1600s”

Christopher Snowden asks whether we should believe the consistent claims of public health advocates on how much things they disapprove of (smoking, drinking, etc.) “cost” the taxpayer:

If smoking costs the taxpayers £173 billion, then how much does widespread forced feeding of office pastries cost?

If you say that a certain activity costs society £10 billion a year, most people would assume that if that activity disappears, society will save £10 billion a year.

They might have different ideas of what “society” means. Some will assume that the £10 billion is a cost to taxpayers while others will assume that some of the cost is borne by private individuals and businesses. But the majority will, quite reasonably, assume that the cost is to other people, i.e. those who do not participate in the activity.

And nearly everyone will assume that the £10 billion is money in the conventional sense of cash that can be exchanged for goods and services.

But when it comes to estimates from “public health” campaigners about the cost of drinking/smoking/obesity, all these assumptions would be wrong. Most of the “costs” are to the people engaged in the activity and they are not financial costs. Taxpayers would not pay less tax if they disappeared. In general, they would pay more.

Last month I mentioned an estimate of the “cost” of gambling in the UK and said:

    These studies have no merit as economic research. They are purely driven by advocacy. The hope is that the average person will wrongly assume that the costs are to taxpayers and agitate for change.

The main aim of these Big Numbers is to convince the public that heavily-taxed activities place a burden on society that exceeds the tax revenue, thereby justifying yet more taxes and prohibitions.

In the case of smoking, this has become more and more difficult. Smoking has been a net gain for the Treasury ever since King James I started taxing it heavily in the 1600s. Today, as the smoking rate dwindles and tobacco duty rises ever higher, anti-smoking campaigners have got their work cut out duping non-smokers into thinking otherwise.

Tobacco duty brings in about £12 billion a year. For years, groups like Action on Smoking and Health (ASH) used a figure of £13.74 billion as the “cost of smoking”. This came from a flimsy Policy Exchange report which included £5.4 billion as the cost of smoking breaks and £4.8 billion as the cost of lost productivity due to premature mortality. Neither of these are costs to the taxpayer. They are not even external costs, i.e. costs to non-smokers.

Last year, in a review commissioned by the Department of Health, Javed Khan came up with a figure of “around £17 billion” as the “societal cost” of smoking. This included “reduced employment levels” (£5.69 billion) and “reduced wages for smokers” (£6.04 billion). Again, these costs fall on smokers themselves and are not external costs. They are, in other words, none of the government’s business.

Last week, a report commissioned by Action on Smoking and Health (ASH) pulled out all the stops and announced that the cost of smoking to Britain was now — wait for it! — £173 billion. Go big or go home, eh?

February 3, 2023

A spectre is haunting Ontario politics: the spectre of [Shock! Horror!] American-style healthcare!

Filed under: Cancon, Government, Health, Media, Politics, USA — Tags: , , , — Nicholas @ 05:00

Everyone in Canada has heard alarming stories of people in the United States being presented with five- or six-figure bills for hospital care, and any hint that one of our provincial healthcare systems might move in that direction scares the pants off almost everyone. Politicians know this well, and salivate at the chance of deploying charges that their opponents favour “American-style” changes to our system because it’s a guaranteed vote-winner. None of it has to be true — very few Canadians know much about US systems aside from the horror stories — but it’s always effective.

In The Line, Harrison Ruess makes the sensible point that there are more healthcare systems in the western world than those of Canadian provinces and our closest neighbour:

Toronto General Hospital in 2005.
Photo via Wikimedia Commons.

First, to be emphatic on this point, we need to be realistic about where our system ranks globally.

It is truly bewildering to me the lengths that otherwise smart and empathetic Canadians will go to to defend the status-quo approach to health care in Canada. The results we get, versus the money we spend, is simply not brag-worthy. The argument that our system works great, if only we threw more money at it, doesn’t stand up to scrutiny.

Is our health care okay? Sure. Decent? Probably. Is it great? Hardly. Could we do better? Yes, much. Do we need to spend more? Maybe a tad, but not likely much, if any. To wit:

    According to OECD data, on life expectancy Canada ranks 16th. On mortality rates from avoidable causes, we’re 23rd. On cancer survival rates we range from 13th down to 18th, depending on the cancer type. On the number of one-year-olds vaccinated for diphtheria, tetanus and pertussis, we rank an abysmal 37th (even the U.S. is higher here at 27th. Gulp.). One area where we do rank closer to the top is spending as a proportion of GDP, where we sit seventh.

World Health Organization (WHO) data wasn’t any more flattering, where Canada’s health care ranked 30th in overall performance despite being 10th in spending. The Commonwealth Fund ranks Canada 10th out of 11 in performance and 6th out of 11 in spending. In report after report Canadians aren’t getting the outcomes we need or want based on the money we’re spending on our current system.

Besides for reasons of nostalgia, why would anyone spend their energy defending these sorts of results? “We’re 16th! We’re 16th!” is hardly a chant you’d hear at a rally. It’s time to do better. And I get the feeling most people recognize this – certainly when you get onto Main Street.

Ipsos polling from December 2021 reported that 55 per cent of Canadians are “somewhat satisfied” with their health care, alongside 22 per cent that are “somewhat dissatisfied.” I.e. three quarters of Canadians find themselves in the middle of the road on the quality of our health care. This seems about right — mediocre support for mediocre health care. (The strongly satisfied and strongly dissatisfied were about even, at 12 per cent and 10 per cent respectively.)

But today Canadians are also, rightly, very worried. Leger polling in January 2023 showed that 86 per cent of Canadians are worried about the state of our health care.

December 18, 2022

Euthanasia, Canadian-style

Filed under: Cancon, Health, Law — Tags: , , , — Nicholas @ 05:00

In the free-to-cheapskates portion of his Weekly Dish, Andrew Sullivan considers the alarming growth of euthanasia in Canada:

Front view of Toronto General Hospital in 2005.
Photo via Wikimedia Commons.

I mention all this as critical background for debating policies around euthanasia or “assisted dying” (a phrase that feels morbidly destined to become “death-care”.) Oregon pioneered the practice in the US with the Death with Dignity Act in 1997. At the heart of its requirements is a diagnosis of six months to live. Following Oregon’s framework, nine other states and DC now have laws for assisted suicide. Public support for euthanasia has remained strong — 72 percent in the latest Gallup.

But this balance could easily get destabilized in the demographic traffic-jam to come. In 2016, euthanasia came to Canada — but it’s gone much, much further than the US. The Medical Assistance in Dying (or MAID) program is now booming and raising all kinds of red flags: there were “10,000 deaths by euthanasia last year, an increase of about a third from the previous year”. (That’s five times the rate of Oregon, which actually saw a drop in deaths last year.) To help bump yourself off in Canada, under the initial guidelines, there had to be “unbearable physical or mental suffering that cannot be relieved under conditions that patients consider acceptable”, and death had to be “reasonably foreseeable” — not a strict timeline as in Oregon. The law was later amended to allow for assisted suicide even if you are not terminally ill.

More safeguards are now being stripped away:

    Gone is the “reasonably foreseeable” death requirement, thus clearing the path of eligibility for disabled individuals who otherwise might have a lifetime to live. Gone, too, is the ten-day waiting requirement and the obligation to provide information on palliative-care options to all applicants. … [O]nly one [independent witness] is necessary now. Unlike in other countries where euthanasia is lawful, Canada does not even require an independent review of the applicant’s request for death to make sure coercion was not involved.

This is less a slippery slope than a full-on, well-polished ice-rink. Several disturbing cases have cropped up — of muddled individuals signing papers they really shouldn’t have with no close relatives consulted; others who simply could not afford the costs of survival with a challenging disease, or housing, and so chose death; people with severe illness being subtly encouraged to die in order to save money:

    In one recording obtained by the AP, the hospital’s director of ethics told [patient Roger Foley] that for him to remain in the hospital, it would cost “north of $1,500 a day”. Foley replied that mentioning fees felt like coercion and asked what plan there was for his long-term care. “Roger, this is not my show”, the ethicist responded. “My piece of this was to talk to you, (to see) if you had an interest in assisted dying.”

It’s hard to imagine a greater power-dynamic than that of a hospital doctor and a patient with a degenerative brain disorder. For any doctor to initiate a discussion of costs and euthanasia in this context should, in my view, be a firing offense.

Then this: in March, a Canadian will be able to request assistance in dying solely for mental health reasons. And the law will also be available to minors under the age of 18. Where to begin? How do we know that the request for suicide isn’t a function of the mental illness? And when the number of assisted suicides jumps by a third in one year, as it just did in Canada, it’s obviously not a hypothetical matter.

October 16, 2022

QotD: State monopolies

Filed under: Bureaucracy, Economics, Government, Quotations — Tags: , , — Nicholas @ 01:00

Competition leaves people with choices. But under the New Socialism, people will really discover what it means to be unfree when they only have this choice: work for the state and spend your falling wages on government-supplied goods — or starve. And to whom does the unhappy citizen turn when there is only one healthcare provider, one landlord, and one education system? The state monopolies under socialism offer a kind of subjugation and submission far greater than that in competitive markets. The faceless corporate decision makers that trouble professor Robin are far less sinister than government bureaucrats who can block all exit options. Imagine how poorly the Post Office would function without competition from Federal Express and UPS.

Richard Epstein, “The Intellectual Poverty of the New Socialists” [PDF], 2018.

July 23, 2022

Still living, still breathing, still walking around … but “legally dead”

Filed under: Bureaucracy, France, Government — Tags: , , , — Nicholas @ 05:00

I missed this from Alistair Dabbs last weekend, but it’s still just as concerning as it was then:

Zombies walk among us – until they need a nice sit-down, of course. It can be tiring to be undead. No wonder they drag their feet around and do all that moaning.

One such moaner is 58-year-old Michel from Montpellier. He has never stopped complaining since the postman delivered a letter one morning in June to offer him condolences on his recent death.

It was, as you might imagine, an administrative error: someone had probably clicked in the wrong checkbox or filed a request in the wrong folder. It was unlikely to be the result of a concerted Kafka-esque conspiracy to erase Michel from existence. Uncheck that box, drag the file out of the folder. It should be easy enough.

Evidently not. Once you’ve been declared dead, it sets in motion a sequence of automated digital-only procedures that sprint towards completion with alarming rapidity. You may have heard of France’s notoriety for officious paperwork and the snail-pace of its bureaucracy when you are living and breathing. But once you’re a stiff, it’s the fast lane electrons all the way.

Michel discovered that his bank accounts had already been frozen. His social security file had been closed immediately. His national health ID card was no longer valid and his top-up health insurance was cancelled.

He nipped over to his local social security office to see if they could put the brakes on the process but apparently it was too late: everything had already been done to kill him off, bar physically shoving him in a box and inviting friends and relatives around for beer and sandwiches.

Surely there’s a rollback option?

Ah now, it’s not that simple. The system architect that designed the automated process did not think of making [Alive] and [Dead] a pair of either-or radio buttons. They did not envisage a situation in which death, our ultimate existential destination, could be reversed by choosing Edit > Undo. There are no second- or third-life Power-Ups IRL. Instead, the system architect not unreasonably assumed that dying would be a one-way trip from which nobody is expected to return.

The system is not a complete disaster, though. The woman at the desk of the social security office was able to use it to find that a French national with exactly the same name and birthdate as Michel had died – albeit 4,500km (c 2,800 miles) away in Israel – and the two strangers’ records had probably been mixed up by a poorly trained official. So the error has been located. Good. Can it be corrected, please?

Yes, she said, before booking him in for a meeting to discuss it in two weeks’ time. No doubt he was also asked to bring documents that explicitly state when he didn’t die.

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