America will never have socialized medicine.

The Hours

And the band played on

If you could point to the largest single factor in the advancement of gay rights, it would probably be AIDS. Plagues often change societies by destroying what is an old, zombie regime and replacing it with something new. That way society that embraces whatever advancements have been sitting on the back burner for a long time because the hoomans do not like change. Often, these changes are for the better. The Black Death in the Middle Ages spurred a quantum leap in individual rights and scientific inquiry that eventually became the Renaissance. Several different plagues contributed to the development of modern-day sanitation practices. Proper sewage systems probably did more to preserve life than any medical development. I keep hoping that Covid finally puts an end to “cubicle culture” which although may not be totally equivalent to serfdom, feels close enough to count. Everyone knows the word “collaboration” is nothing but a trap[i].

For gay rights, though, it was the horrifying pictures of men dying from this mysterious disease that tugged at the heartstrings of every decent society. After that it was only a matter of time before men could marry men, because what was the point of that cruelty? But the second and more important feature was dying alone, bereft of insurance, scared the shit out of Gen X. The movie “Kids” played in art theaters across the nation. HIV=death in everyone’s mind and every sexual encounter could be your last. It was traumatizing. It was scary. It actually was worse than 9/11 and the millennium bug combined. Now a whole generation got busy finding “the one” and settling down. The “sexual revolution” was over at least until modern HIV meds started working. If you ever wonder why Gen X is so nihilistic, there’s your answer.

So began the era of “pretending not to know things to be kind to people with problems.” We pretended that being a lesbian carried the same risk as being a gay man even though a famous joke at the time was. “What’s the hardest thing about being HIV+? Convincing your parents you’re Haitian.” We all knew that heterosexual people, not involved in drugs or prostitution, would stand a 99% chance of being perfectly fine after a one-night stand, but we pretended anyway because to hold people responsible for their own destruction, in light of an act of “love” was…uncivilized. The punishment did not seem to fit the crime; nature was too cruel. Unfortunately, that grace has now extended to other, less sympathetic causes like transwomen, pitbulls and black on black crime.

But back to gay marriage. In that time, there were only three ways to get health insurance: buy it outright, marry someone that had it, or get a job that provided it. On that last method, by the 90s, jobs that provided any benefits were fading fast. Temporary work, and 35 hours a week jobs, abounded. Employers would do everything they could to avoid the government mandate to provide all employees who worked over 40 hours with health insurance. Wage theft was rampant. And if you didn’t like that? Fuck you. Everyone is replaceable. It’s no mystery why everyone who could piled into graphic design, day trading and Silicon Valley. It was either get rich on options or spend the rest of your life going to the ER when things got so bad they would be forced to treat you. You just ignored the bills and parked your car in your brother’s garage so the repo guy couldn’t find it. Eventually even the credit cards gave up and if you didn’t pay one, you just got another at a 29% APR.

Even more unsettling was that, even if you made enough money to buy insurance outright, having the precondition of HIV might make you effectively uninsurable for the rest of your life. You could be denied coverage on the one reason why you might even need insurance. Bill Clinton’s passage of the COBRA legislation, laws that allowed you to keep your insurance if you lost your job, ameliorated some of the pain, but that depended on your ability to pay the premiums and by that time, they were not cheap. Even so, co-pays and a whole host of other out-of-pocket costs made it unavailable for people without jobs. Unemployment was just enough to pay the rent and often not even that in most American cities.

Or you stayed in university for as long as possible, taking out loan after loan. They provided healthcare for free, so, as long as you took some semblance of matriculation, you could retain your healthcare. You could try to find a full-time job, but you would have to take a substantial pay cut because as a Gen X kid in the 90s, you had to “pay your dues”. Unfortunately, you’d still be paying them in 2010. Maybe you could work a night job on top of your “real job” editing the tattoos out of softcore porn with this new software called “Photoshop.” That was living the dream.

Obviously, I bailed before Obamacare (sorry, the ACA) came in. I have no idea if it helped or hurt anyone. Most of the people I asked, have given me conflicting information. Part of that may be that now most of my contemporaries are mid-to-late career and the problems of youth have faded for them. Only a handful seem to need the ACA as they’ve gotten decent jobs in education or the government. The techies all make enough to buy it outright. And now that the baby boomers are starting to shuffle off this mortal coil, wages seem to be finally going (reluctantly) up, if even just a little.[ii] But Obamacare did something more important than provide low cost or no cost healthcare to single moms, it removed the ability to deny coverage to anyone with a pre-existing condition.

Let it roll

First off, it’s important to understand how insurance companies work. They are basically medical casinos. The house, aka the insurance company, is hoping you will come into its doors and make a bet that you will probably lose. When you pay, or your employers pays that premium, that is the “bet.” And when you get sick, ironically, that’s you “winning” the bet; the insurance company, barring some kind of contractual limitation, will have to pay out. However, the insurance company is betting that more people will pay more premiums than will get sick with costly illnesses. And most people will make a bet that they will probably lose. That way “the house always wins.”

Aside from catastrophic illnesses being eliminated in the West by vaccines, new drugs, and an awareness that there’s something really bad about smoking, there are ways that insurance companies rig the table. They won’t cover certain illnesses or activities that they consider “risky.” For instance, no insurance company will cover my bicycle if it’s stolen in the city where I live. The insurance company knows it will most likely be stolen, and there is nothing I can really do about it because bike thieves are extraordinarily clever, and the police will do nothing. Even if I complain, I am told I am being heartless and silly by commies that don’t care until they find out that their Radwagon has the vapor pressure of nitrogen. So, if I have a bike, it’s at my own risk as far as the insurance company is concerned. That way they limit their exposure to risk. If you look at any standard insurance contracts, there’s probably a long list of exclusions that prevent the company from having to pay out in extreme circumstances. Imagine the shock homeowners must feel when they realize that their “Pitbull resembling” dog is not covered by their insurance if it rips out someone’s neck.

Insurance companies will also not cover therapies and drugs not proven to work. That $2 million stem cell technology might be very promising for your “orphan” condition[iii], but good luck getting Cigna to pay for it. Maybe the inventor will give it to you for free if you agree to be part of the trial. If you are already on death’s doorstep, might as well. Nevertheless, Aetna refusing to cover a three-year-old for a faint hope drug that may extend her life for three or four weeks makes for good clickbait.

But one of the best ways of cutting costs is to kick out the people who have pre-existing conditions. Their “win” is already baked into the cake; they are the card counters of the insurance world. Sooner or later or even immediately the company will have to pay for anti-viral, transplants, and insulin. Insurance companies need to limit the number of people that is and so they will exclude those conditions and anything flowing from them while still agreeing to cover other incidental things. Obamacare put an end to that. Gen X celebrated. And then Luigi Mangione shoots Brian Thompson.

While Obamacare seems like a government scheme, it is still just a provider management system for the same private insurance companies as before. No government would be insane enough to throw approximately half a million workers out of a job, or disrupt a full one and a half percent of the GDP. These companies still needed to make payroll and now there was going to be a gaping hole in the budget, caused by the forcible acceptance of the money sinks that were people with pre-existing conditions. And unlike Medicaid and Medicare, private companies could just bail. As it was, there was and is currently, a patchwork of different insurance companies covering various different states. Insurance companies have to be licensed in every state that they operate. These licenses require that the insurance company offer certain minimums, above and beyond what Obamacare mandates, so it’s not always economically feasible for these companies to go into this or that state. Not all companies operate in all states.

Several concessions were made to the companies to garner support for the bill or not to leave the most expensive states. For one thing, government money was given to the companies to cover people who could not afford the premium, a sort of Medicaid but with an expensive middleman. Secondly, insurance companies could still premise their rates on the condition of the enrollee, which included age, location and whether they smoked or not.[iv] There was also a string of very contentious cases hinging on whether employers had to, based on the scheme, pay for insurance that provided coverage for abortions, an Obamacare mandate. The notorious Hobby Lobby case set the standard on when the government could force an entity to go against their closely held beliefs. The result: it couldn’t.[v]

But perhaps the most contentious case was the one concerning the “individual mandate” or as it’s better explained, a mandatory payment that a person would have to pay if they didn’t buy any of the plans on offer by these insurance companies. The central question revolved around whether the individual mandated counted as a tax or not. If it was a tax, then the government was allowed to impose it, if not, there was no precedent for punishing people for purchases they refused to buy and beyond the scope of government jurisdiction.

Through some tricky statute interpretation, Chief Justice John Roberts saved the mandate, but not before damaging the perception of political impartiality that he feels he has so carefully curated. It could have also been he was afraid of violence. The public, especially the “hard done by” part, were all in and supporting a ridiculously popular president. This is the same president that received a Nobel Peace Prize for doing absolutely nothing but getting elected. He then immediately turned Libya into a failed state, strafed the Middle East with thousands of drones, and deported millions of undocumented migrants with nary an objection.[vi] The pressure on the judges must have been enormous.

SCOTUS shouldn’t have bothered. Obamacare for all its charms was too expensively top-heavy to bear its own weight. The programs weren’t nearly as robust or as cheap as promised and Americans stopping buying them or found themselves too poor to afford them, opting for other ways of getting healthcare or returning to the emergency room in times of trouble. The individual mandate stuck in the craw of both libertarians and the lower middle class as it finally kicked in after Obama became a lame duck president. Eventually, unable to get rid of the mandate entirely, Donald Trump zeroed it out and there it remains, a shadow of what was intended, and a possible cause of the shooting of Mr. Thompson.

Obamacare was never cheap, but the mandate brought home the idea that someone, somewhere had to pay – and they had to pay A LOT. Subsidies rose and caps were removed as Americans complained that they hadn’t gotten what they voted for, cumulating in the passage of “enhanced subsidies” that were embedded in the “American Rescue Plan” and the ironically named, “Inflation Reduction Act.” Unsurprisingly, handing out free money had the opposite effect and now those subsides are set to expire at the end of 2025. Fans of Mangione may blame “greed” but if “Obamacare” proves anything it’s the old adage that there’s no such thing as a “free lunch” or a free cataract surgery. Economics, ever “the Dismal Science,” remained undefeated.

Oh, Canada

It would seem, to an outsider, that Canada has unlocked the Davinci code when it comes to healthcare. Long vaunted as the key moral accomplishment over the Americans, Canadian healthcare offers a simple, elegant solution to the troubles of even the most ardent capitalist. Healthcare should be immune to the principles of economics as everyone needs it, of course. How can one put a price on life? What kind of monster does that? Of course, the implication in this argument, heard in Canadian cocktail parties and the office of the Prime Minister is that *this* great achievement is what separates Canadians from those heathens to the south.[vii]

I have to admit: my experience with Canadian healthcare has been nothing but positive. I have had a major, but routine surgery that has dramatically increased the quality of my life. I had a baby and from conception and after, I have continued to have a robust health, dental, and social safety net that have ameliorated my misgivings from coming here and spending every last dime I had to do so. A friend of mine, someone who has had HIV since the eighties, told me, “We are the most spoiled HIV patients on the planet.” He continues to live in a subsidized building, his medications either free or a fraction of what they would cost had he had to find them somewhere in the USA. He is surrounded by a robust network of government funded charities and NGOs. As I get older, and am now beset with the problems that come with aging, despite the formidable cost in rent, I do wonder if I will be able to return to my homeland as intended, so dependent I have become on the system. It will at least sustain me until I get too expensive and they can offer me “assisted dying” –which they will try to pass off as “dignity” instead of what it truly is: cost cutting.

The Canadian system has many advantages. For one, it is there, whether I am sick or well. It is there whether I am employed or not. It does not require me to find a new doctor that is “in network” if I change jobs. I also do not have to fill out reams of forms like I did in New York, writhing in pain in the emergency room, manned by nurses who look like they’d literally anywhere in the world than managing a room filled with reeking, addicted, barely conscious men. (Although I get a fair share of those where I am too. The only difference is race and their violence level is much lower in Canada.) My surgery went fine. My childbirth was attended by almost a dozen different doctors, nurses, and students, which I found calming. I figured the more eyes on me, the better. I was given numerous referrals for hearing, dental, breastfeeding, parenting, 24-hour nurse hotlines, and childcare for me and my baby’s health, all which were free. I like my doctor, an old school Welshman who doesn’t use a computer but carries the casual gravitas of someone who has seen everything. While I don’t feel he is too aggressive, when something is important, he will jump on it. He’s happy to provide any note for my work or travel letters I need, which over the covid era were several.

But my experience is not typical in a lot of ways. For one thing, I live in a well-populated city with plenty of options when it comes to doctors, clinics and hospitals. There’s a major university here as well that does all kinds of research and where clinical trials are taking place all the time. There are specialty outreach services for a whole plethora of health conditions and disabilities. There are the drugs, widely available both by prescription and off label. And there are, of course, unlimited opportunities for exercise; biking, swimming and hiking all falling distance from my door, 365 days a year if you don’t mind getting a little wet. There’s no lack of ability to “touch grass” even though I may be allergic to all of it.

No, the beauty of the Canadian system is its simplicity. Were I not the cynical person I am, I would spend no time worrying about whether I could get medical care or not. I have been assured, repeatedly, that Canadian healthcare is as good as it gets. Why, if I was in America, I’d probably just die, right? But unlike many of my Canadian peers, I have participated, as an adult, in the American system and I have an ability to do something they cannot: compare.

For one thing, despite having several open ERs, I have still spent probably days in hours waiting for healthcare. Before I had my surgery, I would go to the ER on a semi-yearly basis to wait out my attack sitting up in the waiting room. I still needed to go; they needed to take my blood and make sure I didn’t die. But it didn’t make it any less painful and the pain went on for hours. Eventually, the pain would pass, and I would be told to go home, now exhausted and no better than I was the last time. Finally, on the third pass, the hospital told me in no uncertain terms that I had to stay there so they could cut out the vestigial organ that was causing me such trouble. It had become infected, and I could turn septic and die. I was, of course, glad to finally be rid of it, but in the USA, they probably wouldn’t have waited until I was on death’s door before deciding it had to come out.

My roommate in the hospital room was an old, demented lady that only spoke Cantonese. She had had some kind of surgery already, but whatever drugs they had put her on had wired her awake for days. She babbled on, sometimes screaming for hours endlessly. I was able to endure it for most of the beginning of the stay, as she was taken in and out multiple times, but by the time the surgery was over five hours later, she was still wide awake and babbling loud enough to be heard down the hall. It was now 1 am in the morning and I clearly needed to sleep. Faced with my talkative roommate, and no where else to go, they put me in a room with two men, all of whom had been incapacitated by their own problems. We couldn’t see each other, there were curtains everywhere, but one annoyingly moaned for a while and called out to the nurse until I finally passed out exhausted. At least I wasn’t sleeping in the brightly lit hallway.[viii]

The next day was no better. Trapped as I was in the bed, they offered me a bedpan. Knowing I was surrounded by men, I immediately got stage fright. Finally, I called the nurse in and said to her, “Listen, I’m going to get up and walk to that bathroom and use it like a civilized person.” It’s actually encouraged for people to walk around after this kind of surgery so the nurse told me if I thought I could do it, she would unhook my IV. I made it standing, but I know I would have rather crawled my way there than have gone to the bathroom with nothing but a curtain separating me from two strange men. I managed to get out of there a few hours later, but while I was there, no one attended the bathroom in our room, and it showed.

I bounced back quickly, but I definitely got the impression that I had had a budget experience. Oh well, you get what you pay for. Perhaps, this wouldn’t have been so uncommon in an American hospital, but I don’t ever remember sharing a room with anyone when I was there, much less two males. Obamacare also encouraged hospitals to shift to private rooms if possible. In any case, it was still preferrable to the stories becoming more common coming from outside the city. Before the pandemic, people were waiting for days in the emergency rooms across the country. There were reports that people slept in hallways, their belongings piled on their gurneys as they waited for care which took days to come. And there have even been some reports of people dying in the waiting rooms and that’s the ones they have managed to keep open.[ix] The pandemic has strained facilities to their breaking points. In some cities, the ERs are closing overnight, forcing people to travel miles more when travel time can be a matter of life and death.

This is, of course, additional to the problems that the Canadian healthcare system has always had - long waits to see specialist and to get services like MRIs, a critical shortage of doctors and nurses, especially in the outlying areas where no one with real skills ever wants to live, poor health conditions of the poor on the reservations or simply just too far out in the bush, drug shortages and supply failures, and of course, the horror show of incompetence that is the safe supply/decriminalization regime in BC which has turned the downtown into Bedlam.

Tell me lies, tell me sweet little lies

Safe supply isn’t the first ideological system-wide failure of Canada’s healthcare. The gold standard of Canadian medical incompetence is the blood supply scandal that almost ruined the Canadian Red Cross and killed scores of people with AIDS in the late 80s. While countries like America and Europe scrambled to deal with the terrifying scourge, Canadians did the most Canadian thing ever: they ignored it in order to be nice.

The first cases of AIDS in North America were diagnosed in June or July of 1981. The origins of AIDS is murky. Some suggest that it was the practice of eating monkeys in Africa[x] that caused the mutation of another virus to jump to humans. Others suggest poor sanitation practices in the post war era in Africa brought about the scourge, but there seems to be no debate about the fact that the disease originated in Africa. It’s also hard to know who brought the disease to North America, although there’s some consensus that it was a flight attendant, known as patient zero. Sometimes it struck right away, and sometimes it laid dormant for years, infecting lovers and spouses and children. And it got time, lots of it, as governments and health authorities tip toed around the issue, mostly because it spread primarily through the population of gay men.

In January of 1983 a meeting called comprised of the American Red Cross, the Center for Disease Control, the National Institutes of Health, the Food and Drug Administration, the American Association of Blood Bankers, the National Gay Task Force, and other blood banking and public health organizations came to the conclusion that to ask gay men about behavior would be, in their words ““intrusive”, “unethical” and might “institutionalize a stigma on groups already prone to prejudice and persecution.” [xi] What was more the Workgroup was concerned that men would be “reluctant” to disclose their homosexual behavior and therefore, would not be effective.[xii]

However, some organizations got wise early on to possible transmission routes and its potential to spread. In July of 1983, the American Association of Blood Banks and the Council of Community Blood Bankers issued a statement recommending that there be some screening of donors because it suspected – but did not know for sure – if AIDS was transmissible through blood transfusions. The recommendation didn't focus on gay men at the time, it simply asked if the donors were in “good health.”

By March, they had started to change their minds. It was clear by now that AIDS could be transferred by a blood transfusion. Still, without any way of testing or treating donated blood, the health authorities had to rely on the self-reporting of the donors. Groups in the United States were starting to press the issue in a serious way, and on March 4th, The American Public Health Service Committee recommended that the donors be given pamphlets describing high risk groups. The United States’ FDA followed that up with more recommendations to screen for symptoms. And a week later, the American Red Cross began to distribute pamphlets that described these high-risk groups. The goal was, of course, was to initiate the self-screening of blood donors by asking questions related to sex and sexual behavior.

Canada, however, did not change with the tide.[xiii] Whether it was out of concern for the well-being of homosexuals or a belief that only people who displayed active symptoms of the disease could transmit the disease, it wasn’t until over a year later that the Canadian Red Cross finally included symptoms of AIDS on their donor pamphlets. Still, not until November of 1985, – a year and a half later and the same year blood could finally be tested for HIV – did the Canadian Red Cross finally tell donors not to give blood if they were in a high-risk group. In the two and a half years since the first warnings, the disease spread among unsuspecting blood recipients and their sexual partners. 800 people died from the mistake.[xiv]

The whole scandal probably deserves an article all to itself, but the failure of the Red Cross to stop the spread of a lethal disease is something that would see people jailed and sued out of existence for malpractice in the United States. While people complain that tort law cases make the cost of doing medical business higher than in Canada, the silver lining on that cloud is that even a hint of mistake can make people double and triple check their work. That added test, that is unnecessary for 99% of the population and doctors only order it to avoid being sued, is still a lucky break for that one “bad patient” that might have a rare syndrome. But in Canada, the grounds for lawsuits are limited, the doctors protected by an aggressive cartel of lawyers who are hired by the state insurance program, and even a lawsuit is successful, the awards are lower than anything that an American would receive.

That’s not the only way that Canada cuts it’s cost when it comes to healthcare. The cures and treatments it offers are limited in the same way as they are by American insurers, and sometimes even more strictly. Canada’s immigration system will prevent sick, disabled or old foreigners from immigrating if it thinks they present a burden to the system. And Canada negotiates drug prices with big pharma, demanding a discount which until recently was bankrolled by Americans paying premiums and $1000s for the same drugs. Should Americans stop doing that, it could be a considerable cause of concern for Canada. As it is now, it is illegal to import drugs to the USA from Canada, no shipper will take them, and you could be arrested for trafficking, depending on the drug. But this is an American issue, the Canadians can’t really stop what the Americans decide to tolerate. Should they decide to allow the “reimportation” of drugs from Canada, you would see an immediate freak out.

While it didn’t get any press in the America, Canadians started to panic when Bernie Sanders led a pilgrimage of Americans across the border to purchase insulin.[xv] Canadian doctors and government authorities began to become very concerned. There is a limit to the amount of pharmaceuticals that drug companies are willing to sell at cost. If Americans come up and start buying up these discounted drugs, what incentive would Merck or GSK have to continue to offer Canada it’s discount? If Canada supplied just 10% of Americans with the prescriptions they needed, it would completely run out of drugs in less than a year. Now, I guess Canada could always buy more but the problem is pharmaceutical companies are now basically giving everybody the discount, not just the negotiated discount with the Canadian government. Big Pharma would have no choice but to raise the price of drugs on EVERYONE, costing Canadians millions of dollars, to reflect that new reality.

Medicare is the largest buyer of all drugs from Big Pharma by a country mile, so they are heavily incented to give the Americans whatever they want. Despite this, the GOP and libertarians have resisted calls to use that bargaining power to cap the prices of drugs. Americans are willing to suffer a lot to maintain the freedom of not just themselves, but the companies they fancy they will create “someday,” maybe. Price caps smack of communism and that’s a yellow brick road to hell. It is possible that the murder of Brian Thompson might finally be showing the top limit to that sort of tolerance.

The Trump administration announced in his first term that he was going to sign an executive order that would force pharmaceutical companies to sell drugs in Americans at the same rate they sold them to other countries and allow Americans to import drugs from, or rather re-import drugs from other countries where they could be bought much cheaper. The idea was that that pharmaceutical companies were making so much money that they would just lower the price for Americans. He has now, in his second term, done so.

But the EO doesn't say the pharmaceutical companies have to sell it at a particular price, it just says it has to be the same price, or rather the same price as the cheapest negotiated price for whatever other country. If Canada has the cheapest price, then the American price has to be the same. There's absolutely nothing stopping pharmaceutical companies from raising the price of drugs in Canada or other European nations and in fact will be incented to do so, equalizing the cost of drugs across the world. Unless AI magically makes drug development cheaper, or manufacturing of drugs, many of which are done in China, gets cheaper, there’s no reason or way for Big Pharma to dip into its pockets to find some spare change and take the haircut for the sake of Canadians. So, it remains to be seen if drugs sold in US become cheaper than the drugs sold overseas or become more expensive, or some combination of both. Whatever happens, you can practically hear the creaking of the Canadian healthcare system. Little wonder the Canadians are looking to murde… *cough* offer death with dignity to their most expensive patients. The dismal science remains undefeated.

With tangerine trees and marmalade skies

I wish I could tell my fellow Americans that I found the solution to their healthcare problems in Canada. I would love nothing better than to say there is some sort of Shangri-la to the north, where insulin and blood pressure medication magically grows on trees like medicinal maple syrup. I am bitterly disappointed to report it does not. While Americans are slaving away inventing half of all the new drugs and therapies in the world, the northern blue-eyed sheiks simply trade oil and lately, Chinese influence, for the privilege of free riding on Americans’ naivete. Unfortunately for me, as I am apparently going to go down with the ship, Americans are starting to catch on. Good goin’, elbows up. Thanks for that.

But drugs aren’t the only way the rest of the world uses America as its medical sugar daddy. Americans also provide public access and free use to any number of government agencies that do everything from ensuring the safety of a new cure for erectile disfunction to monitoring Ebola in the Congo. The NIH, FDA, CDC, and of course, my Gen X favorite, the NIMH with its brilliant rats, all provide free valuable information to the rest of the world at the low, low cost of three trillion dollars for the American people. That $3,000,000,000,000 if you want to see all the zeros. And just like the 1980s advisories to maybe tell gay men they need to go get money for their fix somewhere other than the blood bank, they offer it all for free. To add to that, up until two minutes ago, the American taxpayer was also funding universities and other research facilities to the tune of billions of dollars. It’s too bad they seemed more interested in intersectional studies of transgendered potato mice than curing cancer. Thank goodness DOGE put an end to that.

But all this means is that America is just a gigantic locomotive pulling along the socialized medical care in the rest of the civilized (and sometimes uncivilized) world. America can’t stop doing that and keep the train running any more than Thomas the Tank Engine can take up being the caboose. The whole parasitic system would collapse, and the truth would be laid bare. This idea that Americans have – which both Bernie Sanders and the Canadians refuse to disabuse them of – that they can have their cake and eat it too when it comes to health care is just not true. It was **never** true. Not ever even in the slightest. But politically and ego driven nonsense has convinced Americans that some magical solutions exist. Well it doesn’t, not if you want the cure for cancer or ALS.[xvi] And the British or the Canadians sure as fuck aren’t going to invent it just like they didn’t create a safe Covid vaccine[xvii] or the Mars Rover. That day in December on the streets of Midtown, New York, this fantasy killed someone.

The paragraphs above are why I don’t have many friends. Canadians certainly don’t want their prize accomplishment be exposed as a fraud; they’ve invested considerable energy into their identity as smarter and more moral than Americans because they have socialized medicine, such as it is. But this conceit is now coming back to bite them in the worst of all possible ways. America has made an incredible investment into the world by providing things like information, discovery, and defence. It needs to see some sort of ROI.[xviii]

Instead, America’s products are tariffed at extortionate rates or even totally barred from the markets. Americans overseas are so reviled they’ve resorted to putting Canadian patches on their backpacks (As I am reminded persistently.) The are called names like “racist,” “sexists” and (up until Israel stole all the thunder) “Imperialists” as if Trump’s suggestion of becoming a state was akin to a declaration of war. And while a considerable number of Americans might even agree with this, an even more considerable number don’t – and they elected Donald Trump. If I can give any advice to my Canadian friends, it’s this: Trump has already exposed your lie when it comes to drug costs and ordinary Americans are now talking about how the rest of the world has to “pay their fair share.” If Canada gets offered a deal, *ANY* deal, they should take it. To continue to wait and throw a tantrum is to tempt an even worse outcome. As Lord Vader put it, “I am altering the deal. Pray I don’t alter it any further.”

Love me, love me, tell me that you need me

If Americans really want to have a Canadian style socialist healthcare, there are a few things they are going to have accept. I’m not sure Americans are ready for that. One is, that they will have no privacy. The Canadian government doesn’t actually provide healthcare; just like in the USA, it pays private actors for it. It just doesn’t pay them that much because it sets what it is willing to pay. Since salaries for trained doctors are so much lower in Canada, there’s every reason in the world for a Canadian doctor to immigrate to the USA, which is happy to have them, despite what Democrats and immigration hawks might tell you. To cut down on doctor’s costs, however, and make it easier to treat people in the most efficient way possible, the government acts as a clearing house for all your medical information. If you have some kind of illness your government is going to know. And it can be used against you.

In 2010 Lois Kamentiz was denied boarding a LA bound plane in Pearson’s airport because she had been flagged over a 2006, 911 call where her partner reported her as being suicidal. In another case, in 2013, Ellen Richardson was also denied entry due to her hospitalization for depression the previous year. Of course, generally, custom officials of any country can deny entry of foreign nationals for any reason, this is a border constant in the world, but the fact that there is no HIPPA shield to protect you in a socialised medical world might give someone pause.

The next thing is access to new or experimental drugs. Private insurers have the flexibility to make up their own minds regarding what drugs they do or do not want to cover, but the government is required to maximize bang for buck, and it usually will choose the most conservative position possible. No one ever got rewarded for taking risks and failing and certainly not governments. If you are used to getting a certain name brand drug, maybe there’s something about that makes it work better for you, kiss that goodbye because whatever is on the right schedule is what you are going to get. And if you have to pay $300 a month for Ozempic because you aren’t diabetic…yet… well, that’s not very free now is it? Americans will still have to pay for things. They will still have to pay for the dentists, and glasses, and medication and cpap machines. There are just as few mental health resources in Canada as there are in the USA with predictable effects. And drugs might not be any cheaper now that everyone has to pay the same price all over the world. If you have an orphan or fast-moving condition, you are probably dead unless you can get to the states.

I’m sure there’s plenty of people out there that would be nothing but happy to hear that you can’t sue over single hangnail or being permanently paralyzed from the neck down, but in a socialized system, you hope for a lot of good luck. You won’t be raking in the ducats for damages if you just had a rare condition that your doctors just didn’t catch. Or maybe your doctor actually did make a mistake – but that was the risk that you knew of and BTW we can’t afford to pay out the 1 or 2% of the time the doc fucks up, so I hope you like living on disability for the rest of your life. You’ll have to take it for the team because nothing is perfect. Oh, and the government will lock you up in a cage if you don’t get a vaccine or you have a false positive Covid test. There’s nothing you can do about it. [xix]

But perhaps the biggest problem with Canadian healthcare is the waiting. Just like I had to go three times to the ER, and spend hours waiting there, many Canadians wait for months maybe even years for treatment that in America they could get the same day. They wait for beds in the hospital; they wait for diagnostic tests. They wait for MRIs and mammograms and sonagrams. They wait for doctors and specialists. They wait and they wait and they wait and sometimes they just don’t make it. Because while America may allocate healthcare based on money, Canada allocates it based on time. Wait long enough, and you *might* make it. Or it might be worse. You might have diabetes by then. *Then* you can have the Ozempic

Canadians don’t have “death panels” per se, there are restrictions on who gets what based on age and condition. I personally know someone with a congenital heart defect who lost his pacemaker when they had to go in and replace it. I suspect it had something to do with his horrendous cocaine habit. Now, I don’t feel sorry for him, but an American insurance company maybe would cover this if you paid it enough. Money can forgive a lot of sins in the American medical system, which is why rich Canadians fly to the USA whenever they need immediate and cutting-edge treatment. The poor just have to tough it out, get offered MAiD, or die.[xx]

But he sure found out the hard way that dreams don't always come true, oh no

Therein lies the rub because if America is the doctor of last resort, then eliminating that would condemn future generations to a less effective medical world. I would like to think that scientists, driven by the need for self preservation, would continue to research, for free, cures for new and old diseases; but everyone has to eat, amiright? And a scientist needing to make a living is going to look at the bird in the hand that’s going to pay off the student loans, even if healthcare is free. Free healthcare doesn’t pay your rent or for your groceries or your car, all of which now have a VAT tax (aka the GST in Canada) on them to pay for the free healthcare. If we don’t reward the right people with the right incentives, maybe we won’t have new antibiotics and cures for cancer. It could shove medical science back into the dark ages. Or, alternatively, the West would just have to go find our new drugs in China and India where there is no such social largesse – and we would still have to pay. Economics remains undefeated. It won’t work. And it will especially not work for the countries that have been free riding all this time on American ingenuity and skill.

Before all the libertarians and fiscal conservatives get excited, you still have a major problem: people need healthcare. It is true that having healthcare tied to your job might motivate you to be a little better at your job. “Productivity-related” healthcare may actually be the reason that Americans are outclassing the rest of the world in scientific advancement. Like forcing people to live on tips, the need to make a living to avoid Very Bad Things can be a highly motivating factor to be very good at your job. I wouldn’t say I don’t tip in Canada, but there’s nothing more soothing that going to Florida where people smile, and call you “honey” and offer you a drink before you even sit down. I don’t ever remember asking for a water refill once in my entire life in the United States.

In any case, I am loath to suggest that Americans implement some kind of social healthcare divorced from their ability to make things happen on the business front. And I suspect President Trump feels the same way. Instead, he is attempting to recoup some of that ROI in the forms of tariffs. This is a fee to be paid by the entire world in exchange for the United States continuing to track diseases, guarantee the safety of products, fund research on important questions, and develop cures for cancer, emergent viruses, and baldness. That’s in addition to the drone strikes in the north and Russia if need be. This hopefully won’t interfere with America’s booming productivity numbers that surely will skyrocket once AI becomes trustworthy and fully integrated and energy is as cheap as the dirt you will find it in. That, at least, is what I think is the plan.

The alternative is grim. There are already mobs of people marching in the streets for any variety of reasons, BLM, Gaza, but it’s important to remember the genesis of these things like the Battle in Seattle and Occupy Wall Street. The anti-globalization movements and other Gen X/Y complaints made protesting a rite of passage, and it’s only gotten increasingly violent. Where are these people finding the time, anyway? Yet young and old, they seem to have unlimited time to latch on to the new cause de jour, dye their hair strange (and if you know anything about hair, expensive) colors and march in the streets shouting inanities that they seemed to have learned from Sunny on “The View.”

What should be families raising children, too busy to concern themselves with the perennial problems on the other side of the globe are now frustrated and scared singlets, who keep looking for meaning and security in all the wrong places. Micheal Malice may joke about liberal women drinking boxed wine and taking all that Xanax, but there’s a reason they are doing that to begin with. In the most recent arrests, 60% of those arrested were women. Don’t they have kids to take care of? No. No they don’t. And that’s the problem.

If you want people to gamble on the future, you need to provide some sense that if something awful happens, there will be something to mitigate the damage. You would no more want to have a baby in a system, where you have no guarantee of income or healthcare if you or the baby needed it (and you would need it), then you would send an army into battle without setting up some sort of triage center back behind your line. I know there are probably scores of NGO services for single moms, but these are still scatter shot, voluntary, and certainly not to be relied on if…you know….want an actual plan. And what if you are married? Can you even qualify for social services if one of you loses your job temporarily? Who pays the bills in the meantime? No one is going to risk it if a likely outcome is you and your family fall off a benefit cliff.

For all of Canada’s healthcare flaws, continuity and reassurance are its most important features. People are willing to have children, and believe, even if not always true, that the system will be there if they have a problem. There are still concerns. The price of housing is outrageous. Certain foods have obviously inflated prices. There is a considerable lack of economy of scale that Americans enjoy. But overall, there was a reason I came here and stayed here to have children. I thought we could only fall so far. I was wrong, but now it’s too late to change now, and honestly, I wouldn’t have it any other way. Regardless, it looks like Mr. Trump will spur the necessary drilling that Canada needs to ameliorate its healthcare problems. In BC, the government has already passed Bill-15, intended to speed through approvals for mining and other critical infrastructure projects, effectively obliterating the concerns of environmentalists, tribal troublemakers and politicians of all parties who were objecting. Long live, fascism.

To the south, the Big Beautiful Bill, is causing consternation among liberals and conservatives alike. It’s a lot of spending, very little taxation, and no one really knows where all this money is coming from. But my theory is that President Trump is gambling on tremendous growth. Growth that does not even seem possible to a lot of talking heads, but I see no other way to provide to America what she needs if she’s going to underwrite the next eighty years of peace. And there needs to be a tacit acknowledgement by the rest of the world that they can’t keep sticking American taxpayers with the check. If they need to pay a 10% tariff to keep the flow coming so they can actually cure gonorrhea, that’s what they are going to have to do.[xxi] The fantasy, that the American locomotive can tell the world to take that job and shove it is just that, a fantasy. It is just going to create a whole bunch of other problems, worse than the ones the world has now. There are no secrets the rest of the world possesses that America does not, other than they were just getting pulled along. Now there’s nothing to do but take a whole bunch more coal, shove it into the engine, and hope the train can run fast enough to outrun the sun. If it doesn’t work, I wouldn’t be surprised to see more Luigis in the future, supported by a braying mob.

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[i] Please see my essay “Falling Down” available on X and Substack for more on this.

[ii] Not fast enough IMO. The “Boomer Remover” could have removed a few more instead of letting them run again as Manchurian candidates for leftist flunkies and idiot wives.

[iii] An "orphan" disease, also known as a rare disease, is a medical condition that affects a small percentage of the population. In the United States, a disease is classified as "orphan" if it impacts fewer than 200,000 people at any given time. In the European Union, it’s defined as a condition affecting fewer than 1 in 2,000 individuals. These diseases often lack sufficient research, funding, or drug development due to the limited number of patients, making them "orphaned" by the medical and pharmaceutical communities. Examples include cystic fibrosis, Huntington's disease, and certain types of muscular dystrophy. Despite their rarity, collectively, orphan diseases affect millions worldwide.

[iv] The idea that smoking increases health costs is a failure of math. Smoking increases cancer rates, but because people die so young and quickly, it’s an open question if it’s saving anyone any money, as now people live long enough to get dementia and other expensive conditions well into old age. Often, these expenses are borne by the public purse. So what is really going on is money that would have had to be spent by the insurance companies is being shifted to the taxpayer. And while insurance companies can’t deny coverage outright, they can make it prohibitively expensive.

[v] Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014)

[vi] https://www.bbc.com/news/world-africa-24472322, https://www.newamerica.org/future-security/reports/americas-counterterrorism-wars/, https://www.migrationpolicy.org/article/obama-record-deportations-deporter-chief-or-not

[vii] The key moral accomplishment is actually Canada’s treatment of Americans runaway slaves. And it always will be.

[viii] https://globalnews.ca/news/3406842/canadian-health-care-struggles-to-find-a-cure-for-hallway-medicine/

[ix] https://www.castanet.net/news/Kamloops/552334/Emergency-room-to-close-overnight-Saturday-at-100-Mile-District-General-Hospital, https://macleans.ca/society/health/canada-er-wait-times/

[x] Maybe not just eating

[xi] Therein lied the beginning of the path to the “woke” perdition we are currently enduring now as this “kindness” rationale is applied to everything and everyone that could be considered even slightly “oppressed” even if it’s to a man convicted of rape, torture and murder.

[xii] https://www.ncbi.nlm.nih.gov/books/NBK232419/

[xiii] Canada has a bad habit of adopting the worst ideas out of the United States, only to keep clinging to them long after they’ve reached their expiration date everywhere else in the world. This is especially true if the horrible, no good, very bad idea may indicate that the person holding this idea is the “nicer” person, especially when it comes to Canadians versus the USA.

[xiv] For more information on that scandal, you can read about it here https://publications.msss.gouv.qc.ca/msss/en/document-000416/ or watch the documentary made by one of the victims here https://www.amazon.com/Unspeakable-Season-1/dp/B07Q25DPY3

[xv] https://www.cnn.com/2019/07/26/politics/bernie-sanders-canada-drugs

[xvi] Somewhere is a debate between Ben Shapiro and Anna Kasparian on the idea but I couldn’t find it. I know it’s out there though. The most notable thing is Anna’s cognitive dissonance when it’s pointed out that America invents all the drugs.

[xvii] For this paper purpose, I’m going to assume that Pfizer and Moderna created a vaccine as safe as one could create using the technology they had. As to whether it is as safe as the public will tolerate in their vaccines is another paper.

[xviii] https://www.medicaleconomics.com/view/-global-freeloading-drives-up-drug-prices-for-americans-analysis-says

[xix] https://theconversation.com/quarantine-hotels-a-history-of-controversy-and-occasional-comfort-160132

[xx] https://www.fraserinstitute.org/sites/default/files/leaving-canada-for-medical-care-2015.pdf

[xxi] https://www.livescience.com/26110-std-gonorrhea-may-become-incurable.html