Sometimes it’s a good day

If there’s anyone in the Canadian political system who’s reading this and wants to make me an extremely happy guy, it’s really not that difficult. I’m a simple man who enjoys the finer things in life – a nice meal, a pint of good beer, a productive day at work, time spent with close friends… it doesn’t take a lot. What puts me over the moon is when politicians legislate like liberals and act like grown-ups.

Liberal ideas – promoting equality and long-term progress through evidence-based policy – are ideas that I can support. For reasons that surpass understanding, it is rare to see someone get tough with liberal ideas. Not tough in a macho, bullying kind of way, but tough in a “I believe in this, and am willing to fight for it” sort of way. Too often, perfectly defensible liberal ideas get bulldozed by threats of political ramifications or hurt feelings. However, there are rare moments when the planets align and politicians get tough on things I agree with, and those days make me happy.

Today is a very good day. [Read more…]

Health care by the numbers

Once again I feel the need to reiterate that my comments about health care are personal opinions only, and do not reflect anyone’s positions but my own.

Part of the reason I am so opposed to the private delivery of health care is that the market tends to work on a principle of caveat emptor – let the buyer beware. The problem with this generally-sound skeptical principle when it is applied to health care is that people are not “buyers” of health care, nor can they said to be “consumers” in the same way as someone walking into a hardware store or restaurant. A hefty proportion of our interactions with the health care system are in times of crisis, meaning that it is unreasonable to expect us to do the kind of cold, rational calculus that one might expect of someone choosing a realtor or a bottle of fine scotch.

Congruent with this issue of need-based service consumption is the incredibly high bar of education required to understand how the health care system works. Most people are capable of understanding a basic supply chain, and can usually navigate the hoops needed to ensure they don’t get screwed on a car loan or a warranty on their stereo (although not always, which is why we have consumer advocacy and protection groups). The kind of education needed to understand health care is, to put it mildly, extensive. Regardless of which country you live in, health care systems are often fragmented and convoluted. Even those who work within the system have difficulties navigating it – how could a lay person possibly expect to do better? This question becomes more acutely important when you consider the fact that those laypeople are in crisis while trying to do it.

It is for this reason that we are best served when treatment decisions are made based on the evidence, as interpreted by people who are educated enough to understand it. While it seems unfair that your medical care might be guided by someone you’ve never met, it is far preferable than being pressured into decisions you don’t understand – particularly at a time when you are particularly vulnerable to either manipulation by outside agendas that may not have your best interest in mind, or when you are psychologically less able to make rational, informed choices. While patients must have the right to make the ultimate choice about their care, we are best served as individuals and as a system when the choices available to us are based on the best evidence rather than our own ‘best guesses’.

Well, maybe not if you ask this guy: [Read more…]

Health care dollars, health care sense

This will be one of my (rapidly becoming less) rare posts in which I discuss something I’m actually qualified to talk about – health care and economic allocation. The reason I do this so rarely is that I emphatically do not wish to have my blogging here confused with my day job. Nothing that I have written here should be seen as reflective of policies or attitudes endorsed by my employer, any university I have been or may become affiliated with, nor any person other than myself as a private individual. While I recognize that this kind of disclaimer carries no legal weight with it, I just want it to be as clear as possible that my comments on health care are as affiliated to my professional life as my comments on racism or religion are – not at all in any way.

With that out of the way, it’s not an accident that I landed in the line of work I am in. I am curious about science and always have been; however, I am also passionate about the idea of publicly-administrated health care and the need to fight for its sustainability. I strongly believe that not-for-profit health care delivery funded by the public sector is the best method of delivery, and that if we approach the challenges inherent in the idea (i.e., waiting lists, resource scarcity) through evidence-based decision making, then we will have far better outcomes than a privately-funded scheme.

To this end I have pursued (and achieved, to a certain extent) some measure of fancy book learnin’ on the subject of useful models for health care delivery and the issues surrounding the way we allocate health care resources. The problem with the way we (I am referring explicitly to Canada here – the American system is a whole other bag of stupid that I have attempted to tackle elsewhere) deliver care here is that it is based on a model that establishes hospitals as the best method of providing service. At the time the relevant legislation was passed, hospitals were where one would expect to go for the most common types of ailments. However, in the past few decades the burden of disease has shifted away from infectious and acute causes toward chronic and end-of-life ones. The system, which should have shifted along with it, did not.

Why is this a big deal? Because it means we are burning money: [Read more…]

Nation will rise against Nations

It is difficult to be Canadian sometimes. We pride ourselves (well, most of us at least) on being tolerant, forward-thinking people. Part of our national neurotic need to be seen as distinct from our American cousins pushes us to be more collective, more restrained, more self-effacing; a contrast to the stereotype of our indvidualistic, brash and assertive southern neighbours.

The reason this stance is difficult is because of the cognitive dissonance present in seeing ourselves as progressive and inclusive, and yet becoming increasingly aware of the abhorrent way we have treated our most-maligned minority group: First Nations and other aboriginal people. Whereas slavery is America’s admitted national shame, Canada has not yet donned the sackcloth and ash required to atone for our past (and current) sins. We saw a dramatic manifestation of those sins this morning.

It is not enough to simply allocate increased funding to First Nations communities, or to issue public apologies for past mistakes (although both of those are helpful in their own way). We need to instead change the narrative we have about the relationship between the nation of Canada and its First Nations across the country. High-profile discussions like this may yield some hope: [Read more…]

Canada doesn’t have a race problem – Attawapiskat edition

Canadians have a reputation as being polite and rather passive. I am not sure what in our history has given us this docile stereotype, or if it is even actually true that Canadians are more well-mannered than our American cousins. What I do know is that there is no faster way to completely invalidate the myth of Canadian civility or progressiveness more quickly than bringing up the fraught relationship between the government of Canada and our First Nations people.

Immediately upon bringing up reserves, or federal cash transfers, or treaty rights, or ceded lands, even the most self-effacing and convivial Canuck is likely to start frothing at the mouth and denouncing the “culture of poverty” or the “laziness” and “corruption” that apparently runs rampant through every single First Nations community in the country. It’s amazing how quick my fellow countrymen are to lay all blame for the problems affecting our indigenous peoples at the feet of the victims.

A commenter last week remarked how much better the relationship seemed between Canadians and our First Nations, compared to Americans and their aboriginal populations. I decided not to step on the point too hard, because I knew that this week I’d be talking about this story: [Read more…]

Lowering tide sinks some boats more than others

“A rising tide raises all boats” is a common bromide found in political lexicon. If you ask a liberal, the phrase is meant to illustrate the fact that improving public services benefits the rich as well as the poor. If you ask a conservative, the phrase is meant to illustrate the fact that programs designed to benefit the creation of wealth through private sector innovation will have ripple effects that increases wealth in the population at large. Whichever interpretation you favour (be it the liberal one or the incorrect one), I suppose the point of convergence is that making economic improvements has broad-reaching benefits for many levels of society.

The problem with this aphorism is that it simplifies the ‘rise’ far too much. It gallingly neglects the fact that not all of those boats are raised the same amount. Ideally, programs that are designed to raise boats will do so in a roughly equal way (or, better, in an equitable way based on merit). The reality is that, depending on the nature of the program, some boats get catapulted into the stratosphere while others just bob in place. The increasing disparity in incomes that is currently part of the focus of the Occupy movement is evidence that it is possible to raise some boats while letting others get capsized.

The other side of this problem is that the discrepancies in rise is mirrored when tides drop: [Read more…]

Vox populi, pox dei

Which, in my pidgin Latin, translates into “the voice of the people is the pox of god”.

One of the weird, seemingly counterintuitive things about Canada is that despite having no official segregation of church and state in our Charter, religion is more or less absent from the larger issues our government deals with. We don’t have national fights about crosses at memorials or references to God in our national anthem. References to a deity are more or less absent from our various Throne Speeches (commonwealth readers will understand this phrase – Yankees should think of the State of the Union), and doesn’t play a major role in our elections except in the most bizarre ways.

Which is why when a high-ranking federal minister appears in an article about the Vatican, it’s always an interesting story: [Read more…]

This is kind of cool

It has become a nearly incessant complaint to bemoan the disillusionment and lack of participation of young people in politics. It is certainly a statistical reality that voter turnout is at an all-time low. Aside from a small number of people who are involved in the skeptic movement, most of my friends are relatively apathetic when it comes to politics (although I no longer really qualify as ‘youth’). Most disturbing is the fact that uninvolved youth grow up and turn into uninvolved adults. Apathy is a poison pill for democracy, since only zealots remain to show up on election day.

Many hypotheses are thrown around – from cynicism borne by the state of the media, lack of knowledge about how the political system works, distrust in government altogether. It’s certainly a disturbing thought. Which is why I am happy when I read stuff like this: [Read more…]

To deceive and project

I spotted a pretty clever tweet a few weeks ago that went something like: “Police are beating you for slight or nonexistent legal transgressions? Wow… shocking!” – Black people. The joke being, of course, that the kind of ham-fisted tactics that police are turning against peaceful protesters have been leveled against black people, particularly young men, for decades with scarcely any comment from the majority.

That’s one of the galling facets of privilege – it completely skews what your view of ‘normal’ is. Faced with stories about cops brutally beating young black men, many people reacted with incredulity. “I’ve never seen an officer hit someone. Are you saying that all cops are racist? I find that hard to believe.” I had a similar conversation with a friend when we both saw a police officer pull over a young black man driving in a nice car with dealer plates. When I cynically observed that the driver’s first mistake was driving a nice car while being black, my buddy expressed his disbelief, saying that dealer plates come with certain restrictions, and that he didn’t see it being a case of racial profiling.

I can certainly understand the instinct to dismiss these kinds of stories as exceptional or delusional. Five years ago, if you had told me that police were infiltrating political groups to drum up phony charges against them, I’d have called you a lunatic. Then again, five years ago I wasn’t reading stories like this: [Read more…]

Thoughts on the state of the occupation – update

So I’ll confess I sounded a bit maudlin on Monday when looking at how things were shaping up for the Occupy Vancouver movement. I don’t know that my mood has changed much since then, but I have some new insights.

As some of you know, the city was granted an unjunction to remove all persons and structures present on the lawn of the Vancouver Art Gallery so that the city could ‘clean’. I put this in quotes because I sincerely doubt the city’s intention to remove anything other than protesters they don’t like. Antipathy toward the movement has been turned up as the movement has progressed. Some of the blame for this can probably be laid at the feet of the protesters themselves, who failed to articulate the reasons why the occupation itself was necessary. The majority of fingers, however, can be pointed at the ridiculously one-sided media coverage it has received.

There was no shortage of people capable of articulating the ideology of the occupation at the site. There were passionate, coherent, well-informed people running sound equipment, organizing marches, working at the library and info tents, plus volunteer medical staff always within earshot. What the media has done instead is consistently focussed on the more flamboyant members of the group. I am not so cynical as to consider this an intentional campaign of misinformation by a media that wishes to maintain the corporate status quo. At the same time, however, considering that this criticism is leveled at them regularly – to the point where protesters have stopped talking to the media at all – makes me think that they are either just really stubborn in their stupidity, or that there is indeed an element of intentionality: [Read more…]