Dean Del Mastro’s lie-based campaign techniques (by jjedras) So proud for my native riding. Can’t wait to work to defeat this guy in future.

This is really, really dumb:

Alfred Apps, who faced calls from within the party for his resignation after the Liberals’ crushing electoral defeat, speaking to the Empire Club of Canada in a downtown Toronto ballroom, said his party should make the push for a “second Charter” one its fundamental long-term goals.

He also said the Liberals should adopt policies that support mandatory voting and a national voting registration drive — a process that would see thousands of newly registered Liberals take part in a “U.S. primary-style” election to select a permanent leader — and indicated he wants to move in that direction before his term expires in January.

Alf is obviously entitled to his opinion. But I think there are strong arguments to be made that:

a) The role of party president imposes some constraints on the right to express your opinion. Your role is to ensure that the party policy process functions well, and to strengthen the party. Throwing your own ideas into the ring – publicly – is counterproductive and inappropriate.

b) At this point, Alf has no legitimacy whatsoever to speak for the party. He’s a lame duck. He’s expected to resign. This kind of statement appears to put the weight of the party behind this half-baked idiocy. Surely it could wait til February. If he wants to make this kind of statement sooner, he’s welcome to resign and then do so.

c) Alf, if you wanted a membership drive, the time to do it was before the election. When you were party president. For two years.

d) The idea of expanding the charter is just incredibly dumb on its face. I know: let’s open up the constitution for entirely symbolic reasons. ‘Cause that won’t lead a whole bunch of other people to demand their own changes! Never happened before!

I know that there are people who think that calling for Apps to resign is a distraction. There are others who genuinely like the guy. But if he insists on making himself a distraction with this kind of bullshit, then certainly the first argument carries less weight.

Great collection of graphs and facts about the sustainability and outcomes of Canada’s healthcare system, particularly vis a vis the US model.

There are no words.

The final lines about “diligent MPs” really piss me off, frankly. Diligent MPs did expose this bullshit, and their reward was to have their concerns completely and totally ignored by this same editorial board.

The overwhelming lesson here is that Globe editorials are primarily rhetorical exercises designed to capture the common mood in words longer than 3 syllables. They should not be confused with honest attempts to examine the facts.

This is great news:

Historically, the relationship between the chiefs and Ottawa has been characterized by grievance and obstruction, with endless negotiations over land claims and self-governance enriching mostly lawyers. But a combination of factors appears to be shifting the debate in a different direction.

One was the apology and compensation offered by the federal government in recognition of the abuses in the residential school system. Another was the Harper government’s decision to endorse the United Nations Declaration on the Rights of Indigenous Peoples. Yet another was the growing conviction by a new generation of chiefs that the first responsibility of native leaders should be to improve the quality of life on reserves.

That improvement is long overdue. In one of her last acts as auditor-general, Sheila Fraser condemned the lack of progress in closing the gap between reserves and other communities. “In fact, it is more than a lack of progress,” she observed last month. “The living conditions of the first nations have deteriorated.”

I’d also point out that none of this appeared in the CPC platform. You win, then you get to do big things. But proposing big things is no way to get elected.

From his commencement address at Harvard Medical School:

The distance medicine has travelled in the couple of generations since is almost unfathomable for us today. We now have treatments for nearly all of the tens of thousand of diagnoses and conditions that afflict human beings. We have more than six thousand drugs and four thousand medical and surgical procedures, and you, the clinicians graduating today, will be legally permitted to provide them. Such capabilities cannot guarantee everyone a long and healthy life, but they can make it possible for most.

People worldwide want and deserve the benefits of your capabilities. Many fear they will be denied them, however, whether because of cost, availability, or incompetence of caregivers. We are now witnessing a global societal struggle to assure universal delivery of our know-how. We in medicine, however, have been slow to grasp why this is such a struggle, or how the volume of discovery has changed our work and responsibilities.

Gawande is optimistic that changes in how we deliver healthcare can help to hold down costs (and more importantly, reduce errors, bad outcomes and deaths).

The question, I think, is whether those changes can be driven by policy rather than by care providers themselves — particularly when policy is required to deliver “results” on the short time-horizons that we demand (i.e. preferably two years before the next election).

But the first challenge is getting politicians and public servants to understand that the levers they have immediately to hand — funding, salary negotiations, regulation — are pretty much irrelevant to creating effective clinical teams.

A great piece, wish there were more like it. Worth reading just to get context for this quote:

“At this point our time-warp link was damaged by a current surge which broke our chrono-commu-tator, and we have been unable to re-establish contact.”

The lifting of the CPC’s siege mentality is another structural factor that may stall the rise of permanent CPC government — and certainly permanent Harper Government:

In total, the Prime Minister has named 66 Conservatives to Cabinet, or as parliamentary secretaries. This leaves 100 Conservatives on the outside looking in — many of whom are in the process of resigning themselves to the fact they have risen as far as they are likely to.

This is bound to lead to trouble ahead for the Prime Minister. MPs and the party’s Western base are likely to start grumbling about geography, gender and ethnicity being the determining factors when it comes to promotion and policy decisions. A number of MPs are already whispering that they thought Mr. Harper would have felt more free to focus more on merit and contribution to the team, having won a majority. “I don’t see a revolt but more a sustained disenchantment,” said one MP.

Recall that winning triple majorities didn’t make Chretien any more popular with some factions of his caucus.

Look for Harper to continue trying to make the Conservative base believe that they are still “in opposition” to large segments of Canadian society (leading with the media).

Here’s a chart showing some of the cost-increasing effects of privatizing payment for healthcare.

Under the Ryan proposal, Medicare beneficiaries would be given a voucher to purchase private health insurance or services rather than having access to Medicare’s single-payer plan. As a result, government spending goes down but total healthcare spending goes up because the private insurance companies lack Medicare’s purchasing power and cost controls.

(via Yglesias » Medicare Privatization Will Increase Health Care Spending)

From Misurata

The most memorable — and hardest — moment was on Sunday, when casualties were streaming in at a rate of almost 10 an hour. A 5-year-old girl was brought into the triage tent with a bullet or shrapnel wound to the right side of her head. Bits of her brain were protruding from her skull, and her pupils seem to be fixed. Libyan doctors, including one who happened to be her uncle, and an Italian team tried to save her desperately. Doctors seemed to linger over her longer than others.

After 10 minutes, one of the Libyan doctors dropped his instruments and bent over the table she was on and broke down next to her motionless legs and feet, which looked so small next to him.

(via Bryan Denton Has Distinguished Himself in Libya, C. J. Chivers Reports. And Denton Shares His Story With Lens. - NYTimes.com)

(via Worthwhile Canadian Initiative: Population aging has begun in earnest)

The question is, though: could non-working seniors pay for healthcare out of their own pockets any more easily than they can through a universal medicare system?

(Also relevant: Seniors not a threat to Canada’s healthcare system, by Noralou Roos & Nicholas Hirst.)

I cannot emphasize enough how good this piece is, and what a necessary antidote it is to — you guessed it — Gwyn Morgan:

The anti-medicare approach goes like this: Given the impact of aging, we cannot continue to spend billions of taxpayer dollars on health care. It is time to be grown-up about this, and to make Canadians assume greater individual responsibility for health care by delisting services and imposing user fees and co-payments. This way, we can release the pressure on public budgets by funding more health care privately. Moreover, since health care is a provincial responsibility, the federal government should reduce, or eliminate, federal transfers to the provinces, and allow them to experiment with private funding — even if this means getting rid of the Canada Health Act. In effect, this approach to health-care reform assumes that the problem is on the funding side, and thus advocates replacing a tax-based pooling with private financing as the fix. Far from being a visionary, future-oriented approach, this is in fact a trip back to the past, to the era before the existence of universal medicare.

… the sounder choice for reform is to provide more innovative, responsive and integrated care, but to do so in ways that preserve the advantages of universal access under medicare. There are many ways to encourage this innovation, and none are really impeded by tax-based funding.

Single-payer administration of hospital and physician services has been “our ace in the hole” in terms of keeping administrative costs down. Private insurance is far more costly and administratively burdensome for both patients and providers. The two most costly health systems in the world — in the United States and Switzerland — have been built on private health insurance.

Expanding on the arguments about funding: fundamentally, the question is not, “how much can governments afford to pay for healthcare?” It’s “how do we as a society afford to pay for the healthcare we want?”

If anything, single-payer administration and restrictions on payment mean that both demand for and the price of healthcare services are being artificially reduced. Moving to a private-payment system would imply allowing greater demand. It would also imply higher prices, both because of the increased demand and because it would be less efficient at keeping prices down.

Copayments might reduce demand somewhat further, but they would probably do so by encouraging people without money to avoid necessary, preventive care, while wealthier people would continue to consume the same services. Furthermore, the vast proportion of healthcare spending is on things that you can’t exactly just skip: hospital costs near the end of life, emergency surgeries, etc. The studies on this are very, very clear.

You can make an honest argument for allowing private payment by saying that it would encourage greater innovation, which might in turn reduce costs. But that’s not exactly working out in the US. In fact, the argument there is that they need to spend so much more than we do on healthcare because those excess profits pay for innovation! (I’d also argue that Canada’s public healthcare system produces plenty of innovation — our academic hospitals, for example, are truly world-class.)

It’s true that rising healthcare spending is a strain on government budgets. But that doesn’t necessarily reflect an impending crisis or that anything is going particularly wrong. It arguably just shows that rising healthcare spending is something we want and appreciate: we spend less and less of our incomes on food and shelter and household goods, and more of it on innovations that let us lead longer, healthier lives.

Any argument about healthcare financing needs to acknowledge that the costs of the healthcare services we enjoy can’t just be wished away, and nor would we want them to be: somebody is going to end up paying. If you don’t acknowledge that, then you’re probably more interested in who’s paying for whom.

I tend to read and cite a lot of stuff from the US, simply because there is a much more vibrant political blogging and commentary scene down there. But obviously that means trying to keep some perspective on what’s different about their situation than ours.

This piece is a good structural analysis of one key difference:

The British system is both more majoritarian and much less laden with veto points. This makes certain kinds of tactical extremism a much less viable political strategy. If you make promises to your base, your base expects you to deliver. And the median voter fears you’ll deliver. That lends itself to a different kind of political strategy. It also lends itself to a different kind of governing strategy, specifically to that kind of bipartisanship by alternation.

This is part of why I’m very unconvinced that Harper’s victory is some kind of lasting realignment. Despite the Liberal Party’s impressive record, government in Canada has alternated between the parties on a fairly regular basis. The character of government has shifted much less significantly, and power has always shifted back. This is not an argument for complacency, or a sense of entitlement: I just don’t think it does any good to start hyperventilating or seeing “epochal change” around every corner.

Still, I wasn’t going to post this until it occurred to me that this institutional structure could also be partly responsible for our less-vibrant political blogging scene. Our smaller population may be the dominant factor — after all, even the US only has one each of Ezra Klein, Matt Yglesias and Tyler Cowen. But I think it’s also true that the rewards of political blogging are diminished in a system where the government (even a minority government) unilaterally sets the agenda; competing voices carry very little weight; and there are few if any avenues for independent actors (even within the governing party!) to bring forward policy issues and turn them into legislation.

This dynamic makes me more inclined toward an elected Senate. Before I had thought of it as a potentially paralyzing source of competing democratic legitimacy. Now I think of it as fodder for something to read.

Obviously our political system and our deficit problems are different. As Stephen Gordon wrote today, getting rid of the US deficit will be much harder than getting rid of ours was in the 1990s (though it is by no means impossible! For example, Congress could simply go home.)

Nevertheless, I think the basic dynamic of deficit-posturing is recognizable, particularly when it comes to healthcare:

But the explanation I find most convincing is also the most depressing: The deficit can be useful to everything else on your agenda in a way no other issue can match. Think about what Republicans are pushing under the guise of deficit reduction: Privatizing Medicare. Lowering tax rates. Block-granting Medicaid. Repealing the Affordable Care Act and most of financial regulation. Capping spending as a percentage of GDP. …

Which is not to say that there aren’t real deficit hawks, real consequences to unending deficits, and real policy proposals that specifically address deficits. It’s just to say that a lot of the focus on deficits is actually a focus on, say, stopping the policies of an incumbent president, or pushing to entrench an equilibrium in which spending is low and taxes are lower.