The End of Health Care
Ivor Shapiro’s eloquent article (“Life, At What Price?” November) is a welcome antidote to the ideological rantings and hasty judgments that dominate media discussions of health care. It forces us to stare into the abyss that lies between what is technologically feasible and what is practical and affordable.
Like many researchers and health care policy analysts, Shapiro is preoccupied with finding an acceptable approach to rationing care and focuses on the famous Oregon experiment. Several Canadian efforts have been launched to answer the “what should be covered, and what should be excluded” question. Such initiatives are honourable in intent and often heroic in their labours. All, like the commissions established to prune services from medicare coverage in Ontario and Alberta, are doomed to failure on two fundamental and related counts: logic and justice.
The logic of in-or-out coverage decisions is that some services are useful and others are not. But in health care, services are almost never always useful or always useless. A drug that does nothing for 98 percent of people with a certain problem may be vitally helpful to a small minority. Therapies that are widely helpful may harm a few.
It is impossible to make aggregated, categorical decisions without discriminating, for or against, certain conditions and denying some people the most useful treatments. Covering services categorically is often a recipe for waste and overuse; excluding them categorically is certain to disadvantage people with legitimate needs and a reasonable chance of benefit. Fairness is the inevitable casualty of this approach.
Instead of seeking categorical wisdom, we should acknowledge that resource rationing is inevitable and develop a common understanding of limits and entitlements for making difficult, but person-specific decisions. Entitle me to a certain amount of public funding, and let my providers and me decide the best mix of services. This cannot be algebraically precise, but it is more transparent than what we do now, and it avoids the arbitrariness of in-or-out coverage. There will always be tough cases that defy every reasonable rule. But a just system should be flexible enough to deal with them humanely.
Adjunct Professor of Health Policy
University of Calgary
Missing from public policy discussions on health care, including the recent first ministers conference, are the stark issues raised in “Life, At What Price?” These are extraordinarily difficult questions that our society can no longer avoid answering. Given present health care costs—and the future trajectory is even more alarming—this single social policy area threatens to overwhelm other essential needs (education, foreign aid, infrastructure, etc.). While it is difficult to consider the value of life in utilitarian terms, your article correctly points out that if health care for the aged has become as much about postponing death as enhancing life then, clearly, it has diverged from its original purpose. Certainly, Jeremy Bentham’s “happiness-making” calculus, which considers the relative values of pleasures and pains, and Utilitarianism, by John Stuart Mill, offer important guides to this discussion. I would add to them, however, the “situational ethics” articulated by Simone de Beauvoir, Sartre, and other existential philosophers. Many of us baby boomers find ourselves in the “situation” of dealing with aging parents whose quality of life is diminishing, in some cases rapidly. It is incumbent upon us to seize this moment in time, to relive the highlights of our upbringing, and to speak frankly with our parents about the most humane approach to their dying years. Sometimes dark humour will overtake this discussion, but it can be a form of most preventative medicine. It can allow our elders to focus on the miraculous achievements of their lives and, in so doing, prepare them for a peaceful death. Living wills which clearly stipulate that no heroic medical treatments or attempts are necessary because the patient has lived a full and complete life, represent a genuine contribution to society, and one that can make the aged feel that their entire lives have been devoted to giving.
Death in the Amazon
Your article on diamond mining in Brazil (“Rough Justice,” November) is a cautionary tale for the Canadian North. Like in Brazil, diamond mining in Canada began with a massive rush to stake land, much of it traditionally used by aboriginals. In one northern community, prospectors flew in and began staking the backyards of startled residents. There are now two diamond mines in operation in northern Canada, and two more have been approved. While some attempts have been made by both federal and territorial governments to ensure local people benefit from these mines, much remains to be done.
There have been benefits in the form of jobs, contracts, and other spin-offs, including agreements with aboriginal governments providing cash payments. Balanced against these, however, are the social costs. There is a growing drug problem and, further exacerbating community tensions, the income gap between rich and poor has grown. Regarding the environment, lakes have been drained to mine the diamonds, with unpredictable downstream effects. Furthermore, there are no long-term plans in place for restoring exhausted mines to nature.
The Brazilian legacy will be repeated in Canada if our government does not ensure that local populations benefit from diamond mining and that the environment is protected.
Research Director, Canadian Arctic
Yellowknife, Northwest Territories
Flanagan and Company
Thanks to Marci McDonald for her in-depth exposé (“The Man Behind Stephen Harper,” October) connecting the dots from Leo Strauss to whatever sort of party Stephen Harper now leads—a question that may be answered following the upcoming policy convention. By contrast, we’ve known for years what David Orchard stands for, and where he wants to take Canada. Some actually find his clarity and consistency appealing.
Many in the Orchard camp chalked up Peter MacKay’s betrayal to crass and breathtaking political expediency. How little did we realize we were victims of “noble lies” justified by ruling elites employing Straussian political principles. Mr. MacKay may not be as complex a man as Mr. Harper.
Nevertheless, to complete the account of the demise of this country’s founding party, you might shine your light on the pullers of Mr. MacKay’s strings.
T. David McComb
Marci McDonald’s excellent article on Tom Flanagan was much needed. The Canadian news media paid little attention to Flanagan, despite his important role in the last campaign and the likelihood that he would have held an important position in the pmo if Stephen Harper had been elected. McDonald errs, however, in calling Flanagan and Harper libertarians. A libertarian believes that the state has no business telling citizens how to live their lives. Consequently, libertarians support same-sex marriages, the decriminalization of marijuana, as well as opposing government social security programs. Neo-conservatives believe in eliminating government support programs, but definitely want to tell people how they should lead their lives. Libertarians often feel very uncomfortable about supporting neo-conservative parties.
McDonald also fails to expose the myth that Flanagan and the Calgary School somehow speak for the West. They do speak for Southern Alberta, but the party they support represents a minority in the West. Equally untrue is the claim made by Alan Kornberg that people would not be outraged by these ideas if they came from the University of Toronto or McGill. These ideas outrage most people regardless of where they originate.
Marci McDonald’s unsettling description of the process whereby the University of Calgary’s political science faculty was populated by right-wing Americans was food for thought. I couldn’t help but hope that this could be orchestrated in reverse. Just imagine legions of left-leaning Canadian thinkers infiltrating American institutions!
Does Gerald Caplan (“The Genocide Problem,” October) really believe that genocide can be prevented by academics presenting papers at conferences, analysts trying to determine why people murder people, and policy wonks—sheltered from the reality of death—trying to figure out better ways to deal with ancient hatreds?
In 1953, I served in the Nigerian Special Constabulary when the Kano riots broke out. Southerners doused northerners in gasoline and set fire to them. Northerners hacked southerners to death. A small number of constables—all white—tried to stop the killing and looting, with very little success. Then the government flew in African soldiers, who strung up barbed wire, set up machine guns, and said they’d shoot to kill anyone who crossed the lines. That stopped the killing but not the hatred between the various peoples in Nigeria, a country “invented” by the British that is now home to 250 different ethnic groups.
An African once told me, “We’d rather be badly ruled by our own people than well ruled by you whites.” He has got his wish. African tensions have to be addressed by Africans. Other countries can help them if they are invited to do so. Of course, it’s much easier for the middle-class liberals to revel in guilt (the gift that keeps giving) than to go to Africa and work with people who are striving to enhance life there.
There are plenty of people in Africa doing the tough, difficult work of bringing people together to work for common goals. They don’t have time to go to seminars, give lectures, or present papers. They are deeply committed to bettering the human condition. Time, energy, and resources would be far better spent giving these people what they need, rather than fueling the genocide studies industry.
Halifax, Nova Scotia
I salute Mr. Caplan for an excellent article and, above all, for his courage and tenacity in looking hard and long at this recurring phenomenon of group bestiality. Leaving aside the politics of prevention, intervention, etc., what I take personally from this sad story is that under the “right circumstances,” I too could take to the streets wielding a sharpened spade or a machete. What I want to know, understand, and experience vicariously through fiction or reportage, is how a person living peaceably in a functioning community could become inflamed to the point of joining mobs and hacking their neighbours to pieces. It happens every day. I’d like Mr. Caplan, or someone else, to outline credibly how one could “progress” from live-and-let-live to lunacy.
Mr. Caplan’s “Ridiculously Brief History of Rwanda” was also very helpful. Would he consider writing similar capsule histories, particularly for the Darfur tragedy, which continues to mystify me?
North Saanich, British Columbia
Gerald Caplan offers a sensitive and moving report of his encounters with genocide. However, Caplan seeks the roots of genocide in “the very nature of our species,” which is problematic. If we view genocide as an expression of our nature we lose the analytic specificity that makes genocide so puzzling. It’s also questionable whether a fixed human nature exists except as a construct, justifying our basest inclinations as natural, and facilitating the political distinction between natural and unnatural that in the past has provided a rationale for genocide itself. (To be fair, Caplan does note the significance attributed to “certain circumstances.”)
Caplan, like many others, also attributes our failure to prevent genocide to a lack of care and interest. Both explanations are simplistic. Even Samantha Powers, whom Caplan cites,documents periodic groundswells of indignation that were squashed or ignored. Perhaps the problem is not lack of interest or will, but mutual and collective repression of the unthinkable. The language Caplan employs—“hellish,” “traumatized,” “hopelessness,” “shameful betrayal,” “paralyzed,” “enormity”—suggests as much. Is it any wonder that we use all sorts of intellectual and emotional devices to repress these awful feelings? The problem is not that we lack the will to prevent genocide; the problem is that we have yet to truly confront it. We are caught between a truth we cannot acknowledge and a responsibility we cannot evade.
Where did the myth come from that sex is the province of the young (“Answers to Common Questions about Sex and Ageing,” October)? You poor sods, you must be in your forties. You must be baby boomers. But take heart, sex is a life-long pleasure and pastime. The thrill wanes in the thirties and forties, when moms and dads are battling teenagers, building businesses, and exhausted by nine o’clock. But empty-nesters can finally relax and enjoy each other, without fear of interruption or pregnancy. Free at last! As for their physical appearance, well, of course it’s “disgusting” to the young and beautiful! That’s not who the aged are meant to attract. But a man or a woman with a history, with a life! Such feeling! Such folds! Oh, you have so much to look forward to!
Vancouver, British Columbia
Barbara Nichol’s article dresses up agist stereotypes and slurs, casting them as funny. It is a depressing read. Among the grin-provoking bits is a Fortune 500 executive who complains that his aging wife now resembles “award-winning news anchor Lloyd Robertson.” “Dr.” Nichol explains that “as we age and hormone levels rebalance, men and women begin to take on characteristics of the opposite sex.” An old woman confesses that her rear “looked like
someone had been kicking me in the ass with pointy boots.” Actually, someone should do that to the editor of The Walrus and the author of this malevolent piece.
It was very touching to see those poet photos (“How Beautiful We All Were…,” October) in The Walrus. John Newlove was my stepfather. He met my mom in 1963 and moved in soon after. In that photo he is thirty-two, and a few short years from winning the Governor General’s Award for poetry, for his book Lies. We had just moved across the country from Terrace, BC, to Toronto. I believe the photo was taken in the kitchen of the house we rented at the time, at 242 Woodbine Avenue in Toronto, at the edge of The Beaches (not at a farm as indicated in the opening paragraph). John died this past Christmas in Ottawa, where he and my mother Susan had lived since 1986. He was, as Margaret Atwood says in her notes, “a complete loner.” Well, he always had us, and my sister Tamsin, close to home and heart.
Linda McQuaig provides a fascinating example of how a naive, idealistic, and star-struck journalist can be utterly seduced by a charming but ruthless dictator (“Sundaes with Chavez,” October). While Hugo Chavez may well project the image of a cool free-spirited crooner, perhaps Ms. McQuaig should have investigated beyond her ice-cream sundae to examine why murderous plain-clothed, pro-Chavez thugs have indiscriminately fired automatic weapons at peaceful demonstrators, including women and children. While democracy may not prevent the election of leaders with dictatorial ambitions, it should certainly protect those who express their views from being slaughtered in the streets.
Did it not strike Ms. McQuaig as incongruous that her socialist hero, and champion of the working poor, lives comfortably in a “gleaming white palace” with “gold-trimmed furniture and elaborate chandeliers”? Her heroic depiction of Chavez’s Academy-Award-worthy performance in a 2002 “coup” fails to remind readers that he suspended the Venezualen constitution and rewrote it it to consolidate and extend his own power.
If we want Canada to be a classless society then education is the tool to get us there (Sightings, October). I believe that education should be available through one, and only one, publicly funded system. The proliferation of private schools, mostly religious or ethnic, contributes to further divisions—class and otherwise—in our society.
In regards to Ken Alexander’s article, I found it unfortunate that he chose to use the charter schools movement in Alberta as an example of creeping inequality within the Canadian education system. Charter schools were developed in order to ensure that all children have access to a positive learning environment and that the education system continues to try new approaches to reach its students. Such schools are geared toward gifted children who the regular stream of public education fails to challenge. The danger in failing to challenge gifted students is that extraordinarily bright pupils become disinterested in school early on, and often fail to develop a work ethic, one of the most important keys to education.
Nobody seems to have a problem with remedial programs that cater to children less able to learn in traditional settings; so why discriminate against children who are too smart to learn in traditional settings? Mr. Alexander’s use of the quote “Separate is inherently unequal” from the Brown v. Board of Education decision was used out of context in this case, in direct contradiction to its original intent. While I agree with the concept of preserving equality in education on the whole, Mr. Alexander should be careful not to break the world down into black and white.
Sherwood Park, Alberta
Barry Peterson believes that The Walrus should stop trying to entertain us and just be serious (Letters, September). If such a thing ever came to pass it would be a woeful shame. The Walrus is a general-interest magazine and as such it has the freedom to explore a very wide range of subjects. The editors can, as Mr. Peterson pointed out, inject awareness of various social issues into the minds of the Canadian public. However, they can also raise awareness of Canadian artists, provide commentary on cultural trends, and still find space for purely entertaining poetry and humour. I wish to be exposed to all aspects of Canadian culture, not just those requiring serious discussion. I hope that The Walrus continues on its current course.
“The time has come,” The Walrus said, “to talk of many things.” Send us a letter, an email ([email protected]), or a tweet, or post on this website. Comments may be published in any medium and edited for length, clarity, and accuracy. Mail correspondence to: 411 Richmond St. E., Suite B15, Toronto, Ontario, Canada M5A 3S5