Friday, July 30, 2004

Klein's Gong Show...

So, Ralph - which is it, more money will fix Health Care, or "innovative restructuring" will fix it???

In the news yesterday, our illustrious premier was ranting that he wants more money from Ottawa

This guy can't even get his story straight. One day, his tirade is that we can only fix our Health Care system by doing it the American Way(tm); the next day, he's saying that it's all a matter of dollars from Ottawa.

On top of that, the musings over his "proposals" due to come out this fall continue to focus on user fees, privatization, deductibles etc. So, even if Klein gets his vaunted 25% funding from Ottawa, he's still going to push forward with some noxious restructuring.

He continues to talk about what "Mr and Mrs. Grundy want". If Mr. and Mrs. Grundy are the "average Albertan", then he's not hearing them. This "average Albertan" wants a Health Care system that works. In the past few years, I've had the opportunity to see the current system "jump to" when needed - it works admirably well as it is. (It can still be improved, but let's recognize what works and what doesn't work before we go diving off the deep end with radical restructuring and simply breaking things for no good reason).

Personally, I don't think Ralph knows, nor cares, what the "average Albertan" wants. He's behind the political 8-ball. He has to know that the sun is setting on his political career, and he no doubt has some significant political debts to pay off. (I can only speculate on this, but I imagine the political donations books for the PC's in this province would make very interesting reading, especially when held up against the light of the various policy decisions this government has made...)

I don't think the average Albertan wanted their health care premiums to double or triple over the last few years; I don't believe the average Albertan wanted deregulation of the electricity and natural gas industries - particularly not with the costs that have accompanied that effort. I don't believe that people wanted the government to gut the public education system, and put in place a shadow "private school" system in the form of charter schools. The list goes on and on. The last decade or so of Klein Tory rule in this province are not a promising track record.

Monday, July 26, 2004

Please tell me these guys are wrong!

I've speculated for some time that the current American Government has its eyes on either Syria or Iran next.

In the past few days, others have started to voice similar thoughts. This column by Eric Margolis appeared in the Sun newspapers this past week, more or less echoing thoughts I've had for quite some time. Then on CBC's 'Sunday Morning' program this past Sunday, one of the discussions was on the same topic, although more from the perspective of the current White House policy groups. Apparently, many of the same people that advocated attacking Iraq are now pushing to go after Iran.

Sure enough, we see early signs of the axes being sharpened. Bush opening his trap and making sinister comments about "wanting the facts" about Iran's "support" of Al-Qaeda. The "facts", such as they were about Iraq turned out to be thinly veiled fiction at best. I can only imagine how reliable the US facts on Iran will be.

Given the sudden concern over Iran's nuclear programs, and its highly porous border with Afghanistan, I'm going to guess that the logic put forth (publicly) will be along the following lines:

Iran doesn't want to control is borders, therefore it is supporting the great bogeyman "terrorism".

Iran has an active nuclear research program. They must be trying to develop nuclear weapons to drop on "American Interests"

Because they can't control their border, terrorists are making off with nuclear materials to make 'dirty bombs' from.

Therefore, to protect the safety of the "free world", Iran must be quashed.

The real reasons for invading Iran? I'd have to guess it's a few things:

1. Iran has significant oil reserves - more than Iraq does actually.
2. There's no love lost between the hard-line Islamic government in Tehran and Washington - ever since the infamous hostage taking in the US Embassy in Tehran, factions in Washington have no doubt been assuaging their bruised pride.

Does it have anything much to do with "terrorism" - only in as much as terrorism is that lovely ephemeral bogey-man that they can wave around and the populus gets all scared. I'd guess that the lifespan of that threat will be just long enough for significant numbers of US troops to come home in body bags. Unlike Iraq, Iran hasn't been labouring for the last decade under economic sanctions. They have a fairly affluent economy, and no doubt a reasonably equipped military.

If, as Jeffrey Simpson speculated in the Globe and Mail, that US intentions lean towards some form of global dominion, I think the world as a whole should be deeply worried. As the Romans proved, military occupation of the known world doesn't work terribly well. For all that the US has great military power, they do not have the might (nor does any other country) to effectively occupy even a relatively small geographic region like the Middle East.

Wednesday, July 21, 2004

I don't know if I should laugh or cry...

In Iowa yesterday, Bush proclaimed that he has made 'America Safer'(tm).  Further, he went on to say that he would make America 'even safer' if he received a second mandate from the public.

After reading that the US is 'investigating Iran's connections with 9/11', I can't help but wonder if Iran is the next thing on Bush's little 'list of slights against his honour'.  After all, Iranians rose up and deposed the US-backed Shah in 1980, and then proceeded to hold American embassy staff hostage for close to two years.

The American Government has also been rattling sabres at Iraq's other neighbor - Syria for quite some months.  (e.g.  shortly after Saddam Hussein's government had obviously collapsed)

With Iraq slowly turning into a tarpit that threatens to suck down US military and aid resources for the forseeable future, it seems like rather poor election strategy to turn people's attention abroad.  Of course, Bush's record on domestic issues hasn't been terribly promising.  His tenure in office has seen the country's economy struggle along, burgeoning deficit spending, stagnation in the jobs market, and the re-emergence of inflation.  (They don't admit it yet, but then again, the so-called 'consumer price index' that they measure inflation against in the States doesn't include things like gasoline, heating fuel etc.) 

Rattling at Syria and Iran can only serve some cynical purpose in the Bush re-election strategy.  One possible read on it is this - if it starts to look like Bush is going to lose the election, it would work to the Republican's favour if they committed the US to an ongoing conflict in the Middle East - one that the next president couldn't extricate themselves from if they tried.  That would be one possible reason for going after Iran - a country which is likely to be orders of magnitude harder to invade and occupy than Iraq.  (for starters, Iran hasn't spent the last decade suffering under UN embargo)  Of course, one could also argue that Iraq already serves that purpose - as the country seems to be teetering on the edge of its own civil war.

After the last few years of pugilism coming from the US, it would be nice to see a government that's actually interested in governing the nation rather than starting wars. 

Monday, July 19, 2004

Politispeak - a layman's guide

Our politicians are throwing around more catch-phrases, half-statements and implied meanings that I thought it was time to start creating a lexicon of how to interpret the real meaning behind the words:

"Pandering to special interest groups" - What this means usually is the speaker is trying to denigrate their opposition by claiming that special interest groups shouldn't be able to stand in the way of the will of the majority. Usually, it means that the speaker doesn't like the direction that some legislators are going.

"Judicial Activisim" - Lately this has been used with respect to the judiciary over their interpretations of law, constitutional and case, vis a vis Gay Marriage. Often the speaker will cry for Judges to 'interpret the law not write it'. Usually it means 'I can't legislate this and get away with it, so I'll sit here and whine, blaming it all on the nasty judiciary'.

"Paid in Full" - Recently, Alberta Premier Klein made this claim about Alberta's debt. The reality behind such claims is cheap electioneering. Alberta's fiscal year is not yet closed, nor will the final revenues be realized for some months. What Ralph basically did was make an election promise to use the budget surplus to pay off the balance of the provincial debt.

Sunday, July 18, 2004

Signs of an Impending Fall Election

Well, the provincial Conservatives are making all of the obvious signals for a fall election:

1. During the Federal Campaign, Ralph starts musing aloud about going to the polls in November.
2. Ralph proclaims that our debt is 'Paid in Full' at the beginning of this year's Calgary Stampede.
3. Mysteriously, provincial coffers suddenly have monies for hiring hundreds of new teachers.
4. Supposedly, public discussions over Medicare are due this fall.
5. The RHAs get enough money to wipe out their budget shortfalls for the year.

Typical tactics for the Klein Tories - basically they spend most of their term in office acting as petty dictators, debating little in the Legislature, and doing much of the governing by 'Order-In-Council' while the legislature isn't sitting.

Things to watch for, and keep track of:

1. Ralph's increasingly thin-skinned. Anyone who challenges him is met with an emotional tirade that would do a two year-old proud. Remember, Mr. Klein is a political leader, and as such should be able to deal with public questions.

2. In the last ten years, how much of the current Medicare crisis did Ralph's team manufacture? They are the ones who blindly chopped social spending when they came to power in the early 1990's, and hurt many more people than just the ill. Ralph has mused out loud about his disdain for the Canada Health Act, and he continues to make moves towards increasing the use of 'for profit' delivery of health care.

3. On Ralph's watch, electricity and natural gas services have been privatized. So far, all that this consumer has seen is skyrocketing costs, shady billing practices, and contracts with exit clauses that guarantee the gas company a huge profit - for no better reason than I am moving from a house into a condo.

4. The provincial Conservatives have acted more like American-style Neo-Conservatives than Canadians. Theirs is a particularly mean-spirited view of the world. One in which the most vulnerable members of society fall victim to a form of Social Darwinism. If you aren't wealthy, too bad - you suffer.

This will likely be an election driven by discussion over health care, and its future form in Alberta. There is much more to this than just a matter of policy. As citizens, we have to ask if the constant pleas of poverty on the part of the Klein government, followed by enormous, multi-billion dollar surpluses reflects prudent budget practice, or sloppy forecasting? We need to ask if Ralph and his merry bandits have a vision for 'post-debt' Alberta?

We should, ask ourselves if having an overwhelming, single-party majority in the provincial legislature is good for Alberta. In the hands of a man like Peter Lougheed, a landslide government worked out for Alberta's benefit. Since Lougheed stepped aside, we have had a series of less men taking the reigns of government. Don Getty didn't do Alberta any favours, and I'm not at all sure that Ralph's much better than Getty was.

Also, Albertans should be looking carefully at the responsiveness of the Klein government over the last ten years. They've taken stands, and basically leaned with the prevailing winds of opinion when the howling starts. The only things that they have 'stayed the course' on have been matters of political dogma, such as privatizing the utility industries.

Wednesday, July 14, 2004

The Intelligence Was Flawed?!

That's one of the biggest understatements to come out of the political realm in the last 100 years! In the last couple of weeks, reviews of the "intelligence" gathered on Saddam Hussein's Iraq have been published in both the United States and Great Britain.

In the United States, the CIA and its related agencies bore the brunt of the heat for the intelligence used to justify the war in Iraq.

Today, the 'Butler Report' is hardly any more complementary towards the parallel efforts in the UK.

As the Mother Jones website indicates, there were serious problems identified in the public media with the "intelligence" being used to justify invading Iraq. This article from Mother Jones it pretty blunt about it.

So, the intelligence was "flawed", the conclusions "exaggerated". I hear both Mr. Blair and Mr. Bush protesting that "they believe they did the right thing". Last time I looked, if you made the decision, you bear the responsibility for its consequences. As the respective leaders, both Mr. Blair and Mr. Bush hold ultimate responsibility for the decision to engage in war. That means bearing moral, fiscal and political responsibility. The constant refrain 'It was justified' from Mr. Blair, and similar protestations from President Bush just don't hold water. If your advisors lied to you gentlemen, it's time to do a serious house cleaning. Failure to engage in a very public, obvious clean-up is tantamount to backing the actions of these people.

The argument has been made, several times, that 'The world is a safer place without Saddam Hussein' by both Bush and Blair. This is the worst kind of 'the ends justify the means' logic that can ever be made. It is time for this kind of disgusting rhetoric to be put aside, and the culprits that perpetrated the web of lies that led this world into an unnecessary, largely unjustifiable, war be held to account for their actions.

Mr. Bush faces accountability before his electorate this fall - but that isn't the kind of accountability I refer to. The electorate is not judicially trained, and certainly not in a position to treat the complex legal issues properly. This is something to be held before the courts. Yes, those non-elected, "activist" populated bodies that are tasked with the complex job of interpreting people's actions against the laws of the land.

The Best Laid Plans of Mice and Idiots

What is it about the Social Conservatives in this part of the world. Not only do they insist that there is some magical validity to their particular interpretation of scripture that others don't possess, but they seem to feel entirely justified in trying to write objectionable legislation based on that.

Case in point, the Republican party in the US Senate puts forth a bill proposing an amendment to the US Constitution to explicitly ban gay marriage. Personally, I can't think of a more pointless reason to amend the constitution of any country.

Perhaps I'm being a bit smug, but in the news this morning, it appears that such an amendment makes a lot of Republican Senators uneasy, and the proposed amendment likely won't even get as far as a debate, much less a vote. That's a very telling sign - like the Conservative Party in Canada, the Social Conservatives may have a lot of political clout, but they are definitely NOT the majority. I'm glad to see enough of the party's Senators are uneasy about such a mean-spirited approach to the issue that they are backing away from it. It's mildly reassurring that the narrow-minded, neanderthal view that spawned this legislative mistake is not held universally within the Republican party.

The topic aside, the debate over same-sex marriage is important. We do ourselves few favors if we ignore these discussions because they make us uncomfortable. These discussions need to take place in order for society to evolve. There will always be those who want to 'leap ahead', and those who want very badly to stay where they are. The debate is important in determining when society is ready to make a change. If the civil rights debate of the 1950's had taken place in the 1890's, the outcome would have been quite different.

Monday, July 12, 2004

Talk about confusing the issues!

I don't ordinarily do two postings in one day, but then again, I don't often run into articles as patently farcicle as this entry in the Sun newspapers by Michael Coren, entitled "Rewriting War History"

Talking about the American Civil War, and trying to compare it to the situation in Iraq doesn't even constitute laughable. Ostensibly, the war on Iraq was about an alleged, growing military threat to world peace. So, instead of addressing the cause, Coren attempts to self-justify invading Iraq by claiming that deposing Saddam Hussein is analogous to emancipation of black slaves. There are huge differences between a civil war within a nation's borders, and invasion of another nation - no matter how onerous its leadership may appear.

Mr. Coren should be ashamed of his rather sad attempt at a straw man argument. I've seen better done by first year college students who don't know any better. The US _INVASION_ of Iraq was an invasion of a sovereign nation by another nation. No more, no less. Since purported reasons for invasion have been substantially disproven, one can only speculate as to the real intentions of the US government.

If deposing an onerous dictator was the only reason, then why did the US spend most of the 1970's and 1980's supporting some absolutely horrific regimes in Central and South America? Why did the United States stand by while the Taliban in Afghanistan robbed people of their civil rights and destroyed that country's historical monuments? Why does the United States leave Robert Mugabe in power in Zimbabwe? How come they haven't intervened in the horrific civil war taking place in Sudan? How come the United States has left Kim Jong-Il in power in North Korea?

The pattern is obvious - the United States didn't invade Iraq for any reasons so noble as liberating its people. That wasn't the intention in the first place. Deposing Saddam Hussein was a goal, I'm sure - but to claim it was about 'liberating Iraqis' is the weakest form of 'the ends justify the means' reasoning that I have ever seen.

How Will Bush Hold On To Power?

The picture is beginning to unfold, with the United States moving into a Presidential election, the Republicans are doing everything they can to stay in power, and the range of activities is astonishing:

Delay the Election

Ostensibly, this is being looked at as a measure to be invoked in the event of some catastrophic event. Of course, 9/11 would be the image they want to evoke, but just what would be catastrophic enough to delay a presidential election? I believe one went off just fine in the thick of WWII, so it would have to be pretty bad before it could justifiably delay voting day.

Cynically, it could be used as a means to defer the vote long enough for unfavorable shock waves to settle down. (or for the President to take steps to 'appear' as a decisive man of action - whatever is expedient at the moment) Particularly worrisome is the similarity that this has to the extension of Consular mandates in the Rome of Gaius Marius (late Republic), an action which ultimately led to rising Imperial Rome replacing the system of elected authorities with an Emperor. (Rome tried very hard to avoid that term, but a spade is a spade...)

Gay Marriage Amendment

This is nothing more than an attempt to split the Democratic vote around John Kerry/John Edwards. The vote on this comes up just before the Democratic Convention in August. Given the polarizing effect of the Gay Marriage debate, will upset a lot of voters, no matter how Kerry/Edwards vote in the senate.

Israel Playing its Usual Hard-line

One would think that events in the Middle East are a long ways removed from the US Presidential election. But are they really? Every time that Israel does something reprehensible, the US imposes its veto in the Security Council to clobber any sanctions. The Bush administration can use the ongoing mess in Israel as a tie back to the so-called "war on terror". (We won't go into the fact that there is much more to the Israeli-Palestinian conflict than simple acts of terrorism)

Iraq Continues to Bubble

Like a pot left on the stove, Iraq continues to be just on the edge of boiling over into something far uglier than the current 'armed peace'. I have to wonder if this isn't semi-deliberate - by leaving Iraq slightly unstable, it's relatively easy to 'stir the pot' enough to cause a major problem, and thus allow Bush to continue to play the 'hero president' by giving the impression of being a man of action.

I'm not saying that all of these things are deliberate, or necessarily within the control of Bush and his handlers, but there does seem to be lots there that can be used by an incumbent President to manipulate the picture with - either by trying to make his rivals look bad, or to bolster his own apparent strengths. (At least, those attributes that the voters will see as "strengths") Bush is apparently capable of deriving some kind of populist support, not entirely unlike Premier Ralph Klein in Alberta. That doesn't mean that he's any good at governing, just that he creates an impression that people will vote for.

Saturday, July 10, 2004

Bush Launches His Next Assault on Civil Rights

In his weekly address, President Bush initiated the anti-gay marriage part of his campaign. According to President Bush, a constitutional amendment is required to prohibit gay marriage in the United States.

Perhaps critical to Bush's argument is the following statement:

The union of a man and woman in marriage is the most enduring and important human institution, and the law can teach respect or disrespect for that institution. If our laws teach that marriage is the sacred commitment of a man and a woman, the basis of an orderly society, and the defining promise of a life, that strengthens the institution of marriage.

Unfortunately, the good president has failed to understand a few things that have changed in the last 50-100 years. First of all, neither Canada nor the US can claim to be predominantly "Christian" nations - we aren't, and there have been far too many immigrants from other lands to allow such a claim to be valid. The laws that currently surround marriage in both countries are predicated on a particular judeo-christian notion of the idea of a family unit. The notion of separating church and state - which I believe is written into the US constitution at some level - means that applying religiously derived constructs to civil law is likely to encounter problems.

It is sad that President Bush seems to feel it is necessary to blame the issue on "judicial activism", when it has little to do with that, and much to do with the laws being questioned with respect to their foundations in Constitutional Law. The legal definition of marriage has nothing to do with its sanctification within a church. It defines the relationship that two individuals have with other legal entities (a bank for example, when a house is mortgaged; the government with respect to taxes)

When I look around the community I live in, I ask myself if two men (or women) getting married devalues the other marriages around them? I fail to see how it can. Some people will find it morally offensive, but the government isn't in the business of legislating morality (nor should it ever be). I'm not saying that society should be amoral, but rather, we need to ask if harm is being done. So far, outside of vague theological ramblings, I've never heard someone make a clear, coherent argument as to what harm a homosexual union causes.

Frankly, if two adults are in love with each other, and they choose to share their lives in a marriage, so be it. The notion of family has changed much in my lifetime alone:

- Single parent families are commonplace
- Divided families, where two divorced parents are sharing custody are not unusual
- Gay people have children, and rear them just fine.
- Mixed race marriages are not unusual (or shocking, as they once were)

All of these are forms of family, and as far as I can see, the outcome for the children involved has more to do with the parents providing a safe, loving environment than the structure of the family unit itself. So what's the big deal about legalizing that which already is taking place?

Considering the content, and application of the so-called Patriot Act, and its sibling dubbed Patriot II, I would be inclined to be very suspicious of Bush's motives in advocating an amendment to the constitution over something as trivial as two people of the same gender sharing their lives both legally and socially with each other.

Friday, July 09, 2004

And so the FUD'ing begins...

My, my, my. I thought they'd at least leave the FUD thing alone until sometime in late August.

On the news this morning, I see the US Dept. of Homeland Security is claiming that Bin Laden is plotting to disrupt the coming presidential elections. I wouldn't be at all surprised if Bin Laden - or any one of a number of other nut cases in the world - was plotting something. A US Presidential election is a nice big target in terms of timeline - pretty much anywhere from August through to November - that's a pretty big window of opportunity.

On the other hand, the track record for "plausible threats" hasn't exactly been awe-inspiring. For the last three years, every time the 'threat level' gets increased, the silence is deafening. It's also notable that the 'threat level' has increased around holidays and other 'leisure' times - obvious target periods that a schoolchild could recognize.

Cynically, I have to wonder if this warning isn't an effort to get people all worried about "security", and therefore run to the 'hero-war-president' Bush during the election. Let's face it, past "alerts" haven't exactly amounted to anything.

Like the so-called "evidence" that Saddam Hussein had all kinds of nasty weapons, and intentions of using them that was put forth during the run-up to invading Iraq, I have to wonder just what "evidence" is driving the current paranoia-inducing announcements.

In my mind, this all fits into other factors in the US election race:

1. The GOP attempting to trash John Edwards as VP candidate.

2. The Bush campaign is trying to play up GWB's "successes"

3. Iraq is a two-edged sword. In Bush's favor, the US "handed power" over to an Iraqi government at the end of June. On the other side of the coin, the country is hardly stable, and American troops continue to come home in body bags.

As the election heats up, I expect several major issues to become more prominent:

1. Did the Bush administration lie to the public about Iraq?
2. Has the Presidency overstepped its authority where prisoners from Iraq and Afghanistan are concerned?
3. Is the Patriot act excessive (not to mention "Patriot II")?
4. Gay Marriage (read - civil rights in general)
5. Is separation of Church and State being maintained?
6. Was there ever any real relationship between Iraq and Al-Qaeda?

Thursday, July 08, 2004

The Summer Doldrums

After the debates of the recent Canadian Federal election, things seem to have gone a bit quiet in the news. Or perhaps, there isn't anything that seems to be grabbing the attention right now.

In Canada, the health care debate appears to be starting up, but that won't get overly active until this fall. There's a First Ministers meeting coming soon (I'm not sure if it's in July or August). Whatever the outcome of that meeting, the real debate is quite some ways off. I'm somewhat worried about the proposals that Ralph Klein has put forth, but they are still sufficiently vague that I'm going to fish for more details before I draw any solid conclusions. Personally, I don't trust this government at all. They seem to be driven by a particularly nasty kind of ideology lately, and I don't think that makes for good governance.

The US Presidential campaign is beginning to warm up, with John Kerry finally announcing his running-mate, John Edwards. As expected, Bush is dismissive of both candidates. I know that I shouldn't judge a book by its cover - but John Kerry bears a frightening resemblance to Brian Mulroney - I can only hope he is of more noble stock than our former Prime Minister.

On the world stage, the US has "officially" handed over political power to an interim government in Iraq. Given the state of Iraq these past few months, I can't quite decide if that's a good thing, or merely hastening the arrival of civil war in that country. Somehow, the handover feels to me like a bit of political staging - an attempt by Bush and his handlers to remove a key part of his critics' arguments. I don't particularly see how this pseudo victory mitigates the fact that Bush and his cronies appear to have lied to the world to justify their own political objectives; nor does it mitigate the awful events in Abu-Ghraib.

Okay, you toppled a government and instituted an appointed regime - so what? That regime now has to bring a country armed to the teeth to heel long enough to hold "democratic elections". Even with US troops to fill in for the Iraqi police/military, that's going to be a tall order. Many will argue, justifiably, that this interim government is little more than a puppet to Washington's whims, and they will continue to fight - violently - for a government that isn't propped up by US interests.

I suspect that the handover has more to do with creating some appearance on the home front of Bush as a 'liberator'. If the Republicans can successfully cast GWB as a 'Conquering War President', that makes him easier to sell than if they try to proceed on policy and economic record. The handover may also have a second purpose in the re-election. If it starts to look like a serious probability that Kerry will win, I expect some stirring of the pot with respect to either Iran or Syria - inflammatory rhetoric, likely along the lines of 'supporting terror' or whatever. The US can't really afford another invasion right now, but a desperate Bush-Cheney campaign might just try to manufacture a crisis so that they can play the 'hero' card a bit further.

Over the next few months, the scene unfolding in the Middle East will no doubt be influenced by the fortunes of the Bush-Cheney campaign.

Sunday, July 04, 2004

Health Care - The Crisis is Funding? - Not Really

It occurs to me that the Government's focus on Health Care _FUNDING_ is completely missing some critical points.

First, the assertion is made that costs are escalating out of control, or certainly, at a rate that exceeds both inflation and the growth in governmental revenues.

Second is that a 'means test' is an appropriate way to determine who "can" pay, and who "cannot" pay. The assertion being that "low income" Canadians should not have to pay at all, but the rest of us should be sanctioned for going to the doctor, even on a preventative basis. I perceive a significant problem with this, for it ensures that a lot of people in the low-end of the earning spectrum are going to have to think twice about a trip to the doctor - by the time they pay the premiums (head tax), and then the proposed deductible, they are pretty much guaranteed to pay 100% of the costs that they are incurring. Basically, short of major illness, AHC becomes a pure cost sink with no identifiable benefit.

The last assumption being made is that the healthcare market should run free - just as it does for groceries. We can look around the world and identify obvious problems with an unfettered health care market - look at the United States, where they spend considerably more per capita for health care than we do in Canada; in Russia where a "partial" two-tier system provoked a serious decline in the public health system after the collapse of the Soviet Union, there are other examples to be sure.

What are the cost drivers that are involved? According to the 'Graydon Report':

a) Salaries for Health Care Workers
b) New Technology - such as MRI machines
c) Growing population

Not unlike the high-technology industries, Medicine is knowledge-driven. Therefore, you wind up paying people a lot of money - for the knowledge that is trapped in their heads. I don't think the salaries paid to nurses and doctors have been unreasonable these past few years - remember that the Klein government froze or reduced those salaries considerably in the 1990s.

New technology costs - this is a fascinating assertion. On one hand, we have a government talking about the costs in terms of day-to-day costs, then they turn around and add the cost of capital equipment into the fray, as if the cost of an MRI machine is written off the day it arrives. This is a serious accounting error. Capital costs, such as buildings and specialized equipment have a lifespan, and are accounted for using well-defined rules of depreciation. Let's clarify the picture a bit by separating operating costs (salaries and consumable materials) from capital costs (buildings and durable equipment). The government shows us that there is an accounting distinction by using a recent $700 million dollar cash infusion in the following manner - $500 million towards capital investment, $200 million to pay off operating deficits in the RHAs.

Let's make some intelligent analysis here - if the issue is increasing costs in the operations side of the picture, there are ways to deal with that; similarly, if the issue is primarily capital cost related, then let's take a look at how we should handle those expenses.

I recognize that we live in a world where public and private enterprise co-exist in many different fronts. We should be cautious about reducing Health Care related transactions to the same level as a common commercial transaction. Simply put, they are not the same thing. When I get a new roof put on my house, that's a very commercial transaction - money is exchanged for a combination of product and service. When I go to my doctor for a checkup, the transaction is far more subtle - the exchange of money (figurative or literal) takes place for the doctor's expertise and knowledge that exceeds my own. Hopefully he will detect anomalies that are early signs of a problem before I will, and thereby forestall more expensive treatment with preventative treatment. In essence, I am ultimately saving the system money by being somewhat proactive.

So - if the problem are escalating costs, and the complaint of the Government is that they can't afford to continue paying they way they have, how do we begin addressing it.

So far, a lot of 'increase the user cost' proposals have been floated. To say that such proposals are troubling is an understatement indeed. Blindly turning the system over to private, profit-driven interests is simply guaranteeing that the Public Health System will very quickly become the "Poor Health System", both because it will be under-funded, and only utilized by those who cannot afford anything else. The reason we are having this debate today is because _everyone_, rich and poor alike is in the same system, and therefore all are lobbying to improve it.

Let's start discussing the regulatory environment in which these services and products are sold as well - obviously, even the constrained market that's out there is creating problems - simply throwing money at things is pointless unless we take steps that are non-punitive to the user of the system - to bring the commercial interests under control.

Saturday, July 03, 2004

How to Fund Medicare?

After getting completely annoyed with our Provincial Government the other day in regards to King Ralph's latest decrees on what he'd like to do to our health care system, finally calmed down enough to start looking at what is being proposed in a semi-rational fashion.

The Graydon Report seems to form a key part of the positioning that the Klein government is taking with regards to health care. It is relatively short, only about 25 pages of material. The second report comes from the Conference Board of Canada, and is entitled "Challenging Health System Sustainability: understanding Health System Performance of Leading Countries". This is a much longer document - some 126 pages in length. This news release gives a brief synopsis of what the Alberta Government thinks are the key findings of these two reports.

The short synopsis is this:

Conference Board:

# Money alone is not the answer.
# Canada must do more to control escalating pharmaceutical costs.
# Creating and maintaining a satisfied and productive workforce is vital.
# Canada needs to focus more on health promotion, prevention and determinants of health.
# An aging population does not have to result in a more expensive health system.
# Investing in information technologies and training creates a more productive workforce.
# User fees/cost-sharing control costs under certain circumstances, but have consequences.
# A public system with no or low user fees needs surgical capacity to avoid long wait times.

Graydon Report:

# Wages and salaries, new technology, prescription drugs and a growing and aging population are the main cost drivers in Alberta's health care system.
# Costs are expected to continue to outpace provincial revenue growth, creating a growing gap between resources and costs.

I find it intriguing that missing from the discussion (apparently) are both the Mazankowski Report, and the Romanow Report on health care in this country. Both are large, and substantial documents - which I do not doubt I will be referring to much in the next few months. The Graydon report makes brief allusion to the Mazankowski Report, but quietly ignores the Romanow Report. (No doubt because the Romanow Report is a Federal Government document, and therefore quite inapplicable to Alberta - at least if you listen to the Alberta Government politicians.)

Two things have been brought forth that seem to have raised the most active discussions in Alberta. The first is a proposal to escalate the amount of money paid in Health Care Premiums by individual citizens; the second is a proposal to introduce a "deductible" to health care access.

Both of these options are described in the Graydon Report, along with offhandedly dismissing the idea of increasing income taxes in Alberta to fund Health Care more effectively.

Since the monies gathered as "Health Care Premiums" go into the Government "General Revenues", and not specifically into accounts set aside for Health Care, I would assert that a Health Care Premium is simply a form of poll (or head) tax - everyone pays it - regardless of their income. Worse, we pay it, ostensibly for health care, but we have no guarantee that those dollars actually go there. For all I know, my health care premium dollars from the past year could be sitting in some meat packing company's bank account. Unless you are demonstrably destitute, you are paying those premiums.

Actually, I'd rather see our income taxes go up in this province, and scrap the fiction that we pay "lower taxes". Let's deal with the reality of looking after our citizens - decently - if it costs a few dollars, so be it. The Graydon report poo-poos the idea of increasing taxes because "Albertans are not very supportive of income tax increases", and "it may affect Alberta's Tax Competitiveness". At best those are spurious arguments; at worst we should view them as insulting to the intelligence of the citizens. Income taxes actually do a far better job of managing the 'ability to pay' than do the arbitrary means tests applied to get exemptions from the Health Care Premiums this province levies.

The notion of a 'deductible' makes me shudder. Basically what the proposal in the Graydon report does is jack up the premiums we all pay, and then further punishes us if we go to the doctor by demanding that we pay up to 1.5% of our taxable income as a deductible for whatever procedures we need. Talk about kicking someone when they are down! My goodness - the year that someone needs serious health care, their income is already likely to take a significant hit due to lost work time; and those under long-term medical supervision will find themselves with an additional bill that they can ill afford. Again, a means test of sorts is suggested in the Graydon report, but it seems to be rather arbitrary - 1.5% of taxable income as a ceiling.

The second assumption that is made in the Graydon Report - and it is an attitude assumption - is that those who use the Health Care system do not "value" it appropriately. "Unlike the current system where people tend to think of health care services as "free"..." speaks strongly to a desire for a "user-pay" model. Basically, they want to punish people for going to the doctor. I think for the majority of Albertans, the assumption is completely bogus in the first place. Most of us go to the doctor once a year for a checkup, and periodically if we are under long-term supervised care - whether that is following the effects of a prescription, or just to make sure that something that could be bad doesn't change suddenly. I hardly think that constitutes abuse of the system in any way, shape or form. The idea of putting out "invoices" that tell you how much you consumed last year is somewhere between pointless and silly. First of all, most people don't understand what it costs for a mechanic to fix their car; much less what the health care providers have to deal with trying to heal people.

When a study appeared in the Canadian Medical Association Journal that reviewed 'for profit versus not-for-profit' health care delivery in the US, I think we had our first, clear, non-politically motivated review of the differences between for-profit and not-for-profit health care delivery. From 10,000 feet (e.g. scanning the study), this appears to confirm something I have long asserted - the profit motive is in direct conflict with the needs and interests of the patient. In the coming debate, especially in Alberta, we need to be cautious about this balance.

There is an underlying assumption in Canada that not-for-profit means public sector; and for-profit is immediately 'private sector'. This is not necessarily true - if there are efficiencies to be gained by creating private sector, non-profit delivery mechanisms, let's evaluate them - carefully. In any case, the biggest issue is that of transparency. Private corporations don't like opening their books up to anyone - including shareholders. Therefore, I have to suspect that any move away from public sector delivery will require a strong regulatory environment that guarantees that the activities of the provider organizations are completely transparent and reviewable at all times. (With some appropriate legislative teeth in place to ensure that things can be reined in should they start to get out of hand.)

There's a lot of material in this one - I'll probably clearer ideas once I have read through some of the verbage I've referenced in more detail.

Friday, July 02, 2004

Of Elections and Other Mass Hallucinations

On CBC yesterday (or was it Wednesday?), they had someone doing one of an interminable number of post-mortems of this week's election results. However, they got into the conversation over different schemes of representation, and they proposed one that actually made a lot of sense to me:

Take the current 'Representation by Population' model, which allows individual regions to explicitly select their representatives, and split it into a two part vote:

Vote #1 - Elects the local representative.

Vote #2 - Is a "party vote", intended to reflect political leanings rather than individual candidates. This becomes the input into a 'Proportional' representation vote.

The winners of the local representative races are, of course, elected to the House of Commons. Based on the outcome of Vote #2, each party then is permitted to add a certain number of seats 'by appointment'. This would make up approximately 1/3 of the seats in the house - enough to sway the balance somewhat as long as an Alberta-style landslide didn't occur in the regional representation.

It's an intriguing hybrid that might serve to break the regional deadlock that seems to routinely polarize the voting in this country. (Thus relegating the Conservative party to the status of 'regional protest' party, and making the Liberals the 'natural ruling party' simply because they have made themselves appeal to Central Canada)

The other aspect of this model that I like is the idea that the local representative selection can be treated somewhat less along 'party-lines'. This would make it much easier to get rid of particularly noxious MPs that people are electing not because they are good MPs, but simply based on the party they belong to. By coincidence, it would also remedy the rather frustrating 'headless party' syndrome that happens every time a party changes leaders, and the new leader isn't a sitting MP - the party could elect to change one of its 'appointed' seats around.

Whether such a scheme would do anything to revive the interest of the electorate so that more people actually get out and make informed voting choices (aside from political junkies like me) is a whole different kettle of fish. The numbers that came out yesterday suggested that only 60% of registered voters actually cast a ballot this time around. The most hotly contested election in some 25 years, and only 60% of the voters exercised their rights??? (* sigh *) Of course, it is difficult sometimes to see how what Ottawa decides affects us day to day. (Most of the time, I can't tell how City Council's decisions affect my day to day life!)

I've been deliberately staying away from looking at articles about what King Ralph thinks we should do with Medicare. I don't need my blood pressure to skyrocket right now - I have enough stresses in my life without adding that one to the list. Optimistically, we can hope that what Ralph wants to do is posturing for another pissing match with Ottawa - but I'm not feeling overly optimistic today. I suspect that Ralph owes a few people some serious political debts, and it's payback time.

The good news is that we are due for a provincial election - soon. Let's get the whole smelly bag of issues out on the table, and hopefully Alberta's voters will wake up enough to send back a minority government. The PC's in this province have been in power so long that I think they believe themselves to be anointed royalty, governing by some perverse divine right. It's time for Alberta voters to remind them that they govern AT OUR COMMAND.

The Cass Review and the WPATH SOC

The Cass Review draws some astonishing conclusions about the WPATH Standards of Care (SOC) . More or less, the basic upshot of the Cass Rev...