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Monday, March 22, 2010

The Sad-but-True Cost of the New Health Care Bill

I really had hoped for something more. But, as the saying goes, a camel is a horse made by committee.

The New York Times believes it "...would raise, not lower, federal deficits, by $562 billion."

What a nightmare.

23 comments:

Ed said...

Anytime you create an entity that doesn't need to make a profit and has access to unlimited financial resources (i.e. taxpayers) it is bound to be a nightmare sooner or later. This is true in our national government with this bill, Iowa's state government with huge budget shortfalls on the horizon and our local government with a $1 million shortfall on the horizon. I'm thinking I need to swap my stocks and cash into hard currency and disappear from society.

Scott said...

I have been watching all of this develop from over here in Canada and have found the 'debate' on health care to be facinating.

I read the article that you posted, and I think that it is one man's opinion. One man who happens to be a George W. economist so I think that there is probably a bit of an agenda there. The true cost will probably not be known for many many years.

The fact remains that the US health system had/has allowed Insurance companies who are in health care for profit to make decisions on who does and does not get care. That is simply unacceptable and the government needed to rectify that. There is that, and the fact that most American supported health care reform. Democracy in action.

What is the cost of not reforming the system? That is an equally important question to be asking here.

Gary Baker said...

Scott,

"The fact remains that the US health system had/has allowed Insurance companies who are in health care for profit to make decisions on who does and does not get care."

Why? There seems to be an implicit assumption that the government will make a better decision. History has not born that out. An excellent example is the public school system. The government is responsible for service and quality. The result is a patchwork. Some public schools are excellent. Most are mediocre. Some, however, are pig awful and despite the rhetoric the government takes no effective action to fix them (largely because of the political impact of unions).

There is no evidence that the government will do a better job at health care. Quite the opposite actually. Canada, Mexico, and Britain are all in close proximity to the US and all have government run health care. And in the balance sheet, more of you are coming here for care than Americans going to any or all of those places. Your systems are plagued by long waits, rationed care, and/or poor service, and once the US adopts a similar model where we are no longer able to handle your overflow it will get even worse.

Condemn for profit decision making all you like, but it is the reason why an impoverished person in the US has a home with more square footage than a middle class person in Tokyo, and more modern conveniences than were available to all but the wealthy thirty years ago. The profit motive allows a person to enrich himself by improving the lives of others. That's the reason that private schools are generally better than public schools, private stores are better than government stores, and private services are better than government services. People tend to be no better than they have to, and government service bureaucrats and union members can be pig awful and still hang on until retirement.

Scott said...

Gary,

I would not argue for a second that the health care systems in Canada and Great Britain do not have their issues. (I don't know about Mexico) But what I will say is that treatment is fair, it doesn't matter how much you are worth, who your Father is, or that you don't have two nickels in your pocket, you will still get the same health care. Sure there are wait times, but in Canada (where I am from) this is not an overwhelming issue and most Canadians are very proud of our health care system and would not want to switch. There are some who go the US for treatment and that is fine, but you can't jump the line in the Country because you can pay more. That is equality.

Many many poor Americans used to come to Canada all the time for their health care. I lived in two border cities and my mother is a nurse and she knew of many US families who came back in the days when you didn't really have to show any proof of government coverage. Even Ms Pailin admitted to doing so.

Yes there are issues with public systems, they are not perfect, but in the case of health care I would rather the government be making the decision than an actuary.

Gary Baker said...

Scott,

"Even Ms Pailin admitted to doing so."

Actually, she admitted that her parents took her and her brother there about forty years ago when both health care systems were a lot different. That's not an endorsement of either system as they are.

Getting a few extraneous issues out of the way: I'm glad that most Canadians like their system, but that is irrelevant to the discussion. If 90% of people in a system get adequate care, but the most ill 10% die for lack of care or rationing, the 90% might say everything was fine. I wouldn't think so. And those wait times that you say are not an overwhelming issue might be thought of differently by the 20% more people in Canada that die of cancer on average than those in the US, in no small part due to the time it takes to see a cancer specialist.

You say the system is "fair" and that people have "equality." I am skeptical that that is always the case, but let's assume that you are correct? Does that make your system morally superior?

Last I heard, there are something like two MRI machines in Ontario. Or is that all of Canada? Your government gets prescription drugs to the people cheaper, but more of them are developed in America. Same with new medical technology. And a lot of the reason is that by allowing people with more resources to spend do so, more resources are available for R&D. The other part is that the people who develop new technologies know that they will be rewarded, so they are inclined to spend money on the risk.

On the subject of "fair": There are a lot of interpretations of what that means. Charging one person who makes a great deal $100,000 per year in taxes but giving them no more service than the one who pays no taxes hardly seems fair to me. And what is the result of that type of "fairness" to others? If two people come in with the same illness at the same time. Only one bed is available. One can pay a great deal, so much in fact that treating him will allow for much needed upkeep and extra equipment. The other can't pay squat. You take him. How many other patients will suffer because of your "fairness"?

"but in the case of health care I would rather the government be making the decision than an actuary."

You assume there is a difference. There is not. In any case where supply exceeds demand, rationing is implemented. Right now in the US health care is rationed by cost. In England, it is rationed by the government. I read a story recently of a woman in England who came in and gave birth prematurely. The baby was born alive, but was delivered several days before the minimum time specified for care by the National Health Service. The child lived for something like three hours. It was screaming it's lungs out, the mother crying, and no one of the hospital staff would lift a finger to help it because the rules said no.

One of the basic differences in philosophy between modern liberals and conservatives I've noted is in the area of worst possible outcomes. Liberals seem to think the worst possible thing is if someone has a way to buy a service that someone else can't. Conservatives have a different view. We think that it's worse that the service is unavailable at any price. You can have your government health care and welcome to it. For my part, the government is the last entity I want in control of making the decision whether I, my wife, or my children live or die.

Scott said...

Where to begin....

First, I would love to see the story that you heard about the situation in England and this baby. There is ZERO chance that happened. None.

Second, your assertion that 20% more people die of cancer in Canada than Americans, again, I would love to see that statistic.

I don't know where you get this idea about rationing and about our lack of medical equipment. Ontario is a huge province, probably about the size of Texas. Much of it very rural or completely empty, so yes, getting an MRI if you live way up North is very difficult and you will have to travel a great distance to get the care, but it is there.
What we do know about the US system is that 30 million Americans don't have health care coverage.
You said that the government is the last entity you would want to control your health care. Well say, god forbid, that you had a catastrophic illness that effected your family and you did not have insurance and did not have the money to pay for it is that okay for you? Are you comfortable accepting that?

Three Score and Ten or more said...

I have long favored some kind of health service reform, but I am extremely pessimistic about the results of our weekend action. At seventy five plus, with a wife only three years younger, I suspect that any major surgeries that are recommended for us, we had better get them done this year, or we will, as the President said during his campaign will received the medication that allows us to die in less pain. I do hope I am wrong.

Ed said...

Scott - Again I am going to say this and will sound like a broken record but universal healthcare or any government run healthcare in the United States is unconstitutional. It is not one of the rights protected in the constitution and thus should be left to the states to decide.

I've also mentioned this before here. My wife was a practicing doctor in England and about ready to quit when she married me and moved to America. She agrees that our system has its flaws but would MUCH rather practice here than in a country like England that has socialized medicine? Her reason? Here is she wants to run a test to diagnose something, she does it. There, she can't run the test until the government says it is okay and as a result, she ended up guessing and yes even misdiagnosing patients because of it. She also talks about people waiting all day in the lobby for their clinic appointment and then admitting them overnight, without reason other than to put them at the head of the line for the next day.

Give me America's current healthcare system with its flaws any day.

Saur♥Kraut said...

Everyone, My best friend Esme has an insurance license (I have a couple best friends, and you rarely hear about some of them - Esme almost never gets mentioned).

In Esme's insurance classes, the one fact they repeatedly drilled into her head is that the definition of insurance is, among other things, equal risk on both sides.

There currently is no equal risk. Insurance companies have access to all your medical records from the time you started seeing doctors.

There truly is no need for you to fill out an application for insurance. So why do you do so? So that if YOU make a mistake, or don't tell the truth about a medical condition, they can approve you and take your money, but deny you coverage when you need it.

Also, if insurance companies can deny people with pre-existing conditions, they certainly have the advantage.

Gary Baker said...

Scott,

Someone once told me that liberals know right from wrong. Conservatives require proof. Can you please tell me what it is that makes liberals so intellectually lazy and dishonest?

Here is the story that you would like to see that has a zero percent chance of happening in England:

http://www.dailymail.co.uk/news/article-1211950/Premature-baby-left-die-doctors-mother-gives-birth-just-days-22-week-care-limit.html

And just for good measure, here is the same story in a different British newspaper:

http://www.telegraph.co.uk/health/healthnews/6156118/Premature-baby-dies-as-guidelines-say-he-was-born-too-early-to-save.html

Now, here are some statistics cited in a UN World Health Organization survey as recounted in the Investor's business daily:

very interesting statistics from a survey by the United Nations International Health Organization.
March 14, 2010 — budsimmons

This article was pulled from the “Investor’s Business Daily.” It provides some very interesting statistics from a survey by the United Nations International Health Organization.
Percentage of men and women who survived a cancer five years after diagnosis:
U..S. 65%
England 46%
Canada 42%
Percentage of patients diagnosed with diabetes who received treatment within six months:
U.S. 93%
England 15%
Canada 43%
Percentage of seniors needing hip replacement who received it within six months:
U.S. 90%
England 15%
Canada 43%
Percentage referred to a medical specialist who see one within one month:
U.S. 77%
England 40%
Canada 43%
Number of MRI scanners (a prime diagnostic tool) per million people:
U.S. 71
England 14
Canada 18
Percentage of seniors (65+), with low income, who say they are in “excellent health”:
U.S. 12%
England 2%
Canada 6%


Here's a link showing how elderly patients in Liverpool are being left to die in the hospital by the staff:

http://www.infowars.com/elderly-woman-left-to-die-under-britains-death-care-system/

"you will have to travel a great distance to get the care, but it is there."

Likewise true in the US. Contrary to the horror stories that the President and his liberal familiars spread, people are not tossed out on the street without health care. In fact, if you look up a lot of the sob stories that Obama has been parading in front of the cameras, you'll find that they are getting health care. They are simply willing props.

"What we do know about the US system is that 30 million Americans don't have health care coverage."

Then you don't really know anything. The majority of those listed as uninsured to have access to health coverage through one or more government programs. Others, while technically uninsured, could afford insurance and choose not to.

"Well say, god forbid, that you had a catastrophic illness that effected your family and you did not have insurance and did not have the money to pay for it is that okay for you? Are you comfortable accepting that?"

Back to the emotional arguments, eh? FYI - That's the situation that we all live under. I've accepted it every day of my life.

You seem very content with claim the fruits that other people earn and have no trouble justifying it. And if everyone agrees, that's fine. If they don't, it's theft. It's the majority saying "You're working for me."

That's slavery any way you slice it.

Scott said...

You are going to start a reaction by saying that liberals are intellectually lazy and dishonest? After the insanity that I see from the Republican party and my own Conservative party here in Canada that statement is laughable. Citing Alex Jones is like me citing Michael Moore as a source.

I read the articles that you provided regarding the premature baby in England. They talk about bioethics, the survival rate of a baby born at the time that this particular child was born and they mention the fact that a midwife was with the mother. In this article there is no reaction from the hospital and no talk about the development of said child. It is an emotionally charged article that speaks to medical ethics more than anything else.

Again you cite statistics from the UN with varrying numbers. That is great. What stats always fail to capture is the number of people that were never in the pool to begin with. What about all of the people that die without ever being diagnosed? What about the ones who never get to see a specialist because there insurance would not cover it because there condition was deemed to be pre-existing. The number of MRI machines doesn't really matter if you can't afford to get an MRI taken does it?

Look, I can't debate with you the ins and outs of your current health are system. What I do know and I don't think that it can be argued is that the cost of health care is something that is very difficult for many of your citizens to bare. That gest even worse if they lack employment or skills to get a good job. The impact for many has been personal bankruptcy, lack of preventative medicine and a system that is not equal. The majority of Americans believe in some kind of health care reform. You live in a democracy that voted in the Democratic party who ran with health care reform as a major part of their platform. How does their decision become 'slavery?'

Scott said...

Ed,

Yes it is a broken record about the constitution but I understand your position. I just wonder why it is that so much spending by both parties over the years would be considered unconstitutional with your interpretation?
Maybe it is time that the constitution have another amendment to reflect the 21st Century. let's face it, the 'founding fathers' were certainly not right about everything and one of the great things about your constitution is that it can change.
Does your wife practice medicine in the US? If so, how does she feel about insurance companies saying that someone can't receive a test or a treatment because they can't afford it?

Scottt

Saur♥Kraut said...

Re: Leaving Baby to Die

This becomes a real slippery slope because you have to ask yourself what a life is worth. Is it really OK to spend an exorbitant amount of money on a baby that would never have survived even 20 years ago? Yes, modern medicine has allowed us to progress and there are many marvelous procedures, but ultimately we still need to allow cost to be a factor.

I say that as a mom who dearly loves her kids, and am immensely fortunate that they are physically healthy. I have seen the horrific agony parents go through when their child is dying or has died, and I hope I will never go through it myself.

BUT, we must be objective about this, regardless. If a parent is capable of paying out tons of money to save a child that could normally not be saved, then more power to them! But can we really burden the taxpayers with exceptional cases that can sometimes even run into the millions?

The same is true for saving elderly people. Sad, but true.

And for that matter, let's talk about brain dead people on life support. Would we have to continue to keep them on life support? Why? They aren't even present any more, and never will be again. And goodness knows that it's not natural to keep their bodies artificially alive - left to themselves or their families, they would die because they cannot feed themselves or drink. What obligation do we have to turn them into living zombies? And for how long?

These are serious things we need to consider.

I don't pretend to have all the answers, incidentally. But they'll need to be tackled.

Gary Baker said...

Scott,

"You are going to start a reaction by saying that liberals are intellectually lazy and dishonest?"

You wrote that something absolutely did not happen. ZERO chance. You didn't even check. And when you were shown you were wrong, you sidestepped and tried to justify yourself instead of just saying "I was wrong." So yes, I think that very much qualifies as lazy and dishonest.

And as is typical, you immediately throw up an emotional smoke screen, all of which is to provide ethical cover for the fact that you feel entitled to take whatever you feel is needed to match your ethics without regard to the impact on them.

"The number of MRI machines doesn't really matter if you can't afford to get an MRI taken does it?"

Actually it does, and if you understood squat about real world economics you would know why. The machines are very expensive, and the only way that they can pay for themselves is if they are used. So there is an incentive to keep them going, which means the more there are in any particular region, the more competition there is to drive the price of service down to attract more patients. However, if you only have a very few, they are going to be busy at every available appointment anyway and there is no encouragement to do anything to reduce cost to the customer.

"How does their decision become 'slavery?'"

Let's see: The democrats have decided that any and all of what I earn is fair game to finance their plans without my consent, which means I have no rights to my labor or profits thereof. Sounds a lot like slavery to me.

And the greatest protection that our Constitution (supposedly) provides is that no matter how large the majority, they cannot override the rights given under the Constitution without going through a strict procedure involving consent of two thirds of the states and both houses of Congress. They aren't even close. As to your note about the country electing the congress to do this, that's a pretty ridiculous thing to say considering that over 50% of the electorate have spoken that this is not what they want in every poll taken. The health care reform that the Dems ran on bears very little resemblance to the monstrosity that has been delivered with the probably exception that under the 10th amendment that one would have been unconstitutional as well.

Gary Baker said...

Saur,

I think you hit the nail on the head. In order to save one of my children, I would sign my life away and work until I dropped to pay for it. I would tap every friend, sell every asset, as long as I thought there was any kind of chance. Now, I completely agree with Scott or anyone else who says that's a lousy decision to have to make, but I want to be the one making it. As soon as healthcare becomes a national expense, someone else makes that decision, and someone is always going to end up on the wrong side.

Another thing which has hardly been touched upon in the news frenzy is the unequal allocation of assets in the bill as is. Extra funding has been targeted for minority groups and in areas where legislators have particular interests. That's not going to go away. How do you think it's going to be when congressmen and senators have the power to reduce funding for health care in areas that vote against them?

Scott said...

Gary,

The cost of health care in the US is more expensive than most anywhere in the world. How have all those MRI machines caused costs to go down in your system?

The UK baby story that you spoke about is not a story that I feel has sufficient backing to be taken quite as literally as you have. it does not say if the Doctor did any kind of assessment on the child, it says that they did not initiate life saving treatment. The only person who is quoted in the article is the grieving mother of a very premature child. You can't take an article like that and use it to say that they did nothing. They most likely did a medical assessment and followed established guideliens to make their decision. So the question that story really brings up is not about the quality of the health care system but rather the ethics and definition of life saving. The article does not prove your point which would be that the UK's Health Care system is not as effective as the current US system.

I understand your argument a tad more clearly about 'slavery,' and thanks to yourself and Ed I get the Constitutional conundrum it presents. I guess the issue is that I just have a completely different philosophical perspective. I live in Canada and since I have been alive health care has been treated as a basic human right and that all people should have equal access to treatment. It is something that we accept and constantly work to improve upon. My inocome tax is no doubt much higher than yours but it is something that most Canadians feel is right and just so there is little debate here about it.

How do you feel about the money the Republicans have taken from you to wage war in both Iraq and Afghanistan? Does partisan politics come in to this anywhere?

Gary Baker said...

Scott,

"How have all those MRI machines caused costs to go down in your system?"

Know anything about industrial type production? If you were to gear up to make one MRI, it would cost billions. But since people who make them count on places like the US buying more, the price for everyone drops because they can spread the capital cost out over many units. In short, if the US didn't have so many, Canada would be able to afford far few.

There is no way that I am going to argue that our system is cheap. It isn't. There is also a lot of evidence that the amount of insurance and subsidies already provided increases the price to everyone by artificially inflating demand.

"They most likely did a medical assessment and followed established guideliens to make their decision."

It says the doctor never showed because he was not allowed to treat. Period. The baby lived for over two hours. You want to imagine a child of yours screaming and dying for two hours?

"The article does not prove your point which would be that the UK's Health Care system is not as effective as the current US system."

You would be correct if that were my point. It is not. My point is that at present there are no official guidelines that a doctor is required to follow that require him to withhold treatment. The doctor and the patient (or in this case the parent) makes the decision. It is based on the medical situation at the time.

You have failed to prove your point that rationing is not a fact of life in government run systems, which is understandable because it is.

"How do you feel about the money the Republicans have taken from you to wage war in both Iraq and Afghanistan? Does partisan politics come in to this anywhere?"

Partisan politics always comes into play. The answer to your question is two fold. On the first level, there have been no recurrences of serious attacks of the same scale by mid-Eastern terrorists on US soil since we engaged in the middle east. From that standpoint, I feel the money was well spent. As Saur pointed out, it remains to be seen what the long term effect is.

From a legal and moral side, national defense is a recognized, Constitutional concern of the federal government in the US and always has been. While there are specific legal questions that will be addressed for some time to come, the congress and the President are on firm Constitutional footing in pursuing military action, especially when a good deal of Europe was getting paid off at the UN while Iraq constantly violated sanctions and the cease fire with impunity.

Does it ever occur to you that if you and the rest of the liberal countries actually got up and took a stand against dictators that the US wouldn't be so prominent? (Though in all fairness, I'll be the first to admit that given its population Canada is a lot better than most.)

Scott said...

Gary,

YOu talk a lot about the rationing of health care. Here is the thing. I have lived here and had grandparents, parents and family friends all need care. There were heart patients, cancer treatments and my Father who is diabetic. In all that time, aside from crowded emergency rooms I have never seen health care rationed out. If by rationing you mean that those who are more ill receive priority I have seen that, but nobody was denied service and nobody went bankrupt when they were discharged from the hospital.

Is there a longer wait time to be seen for most things, probably, does that mean that we are less healthy and the outcomes are dramatically different when taken as a whole, not at all.

You say that Doctors don't have guidelines? Sure they do, if a poor person without insurance walks into Cedar Saini or the Mayo Clinic and asks for treatment for their rare cancer and they do not have insurance or the money to pay for it, they are turned away. I would say that is a pretty much a treatment guideline. No money, no service.

You asked: Does it ever occur to you that if you and the rest of the liberal countries actually got up and took a stand against dictators that the US wouldn't be so prominent?
Yeah I have thought about that, and then I wondered what if nations tried to understand one another and perhaps not try to impose our cultures on one another then there would be less extremism, less war and less poverty in the world. If you look at the amount of money that has been spent on just these two recent wars you could fun health care many times over.
I know that is 'unconstitutional' but man, why wouldn't you want everyone to be looked after?

I am quite sure that there is nothing that I can say that would in any way change your mind. I am glad that I am in Canada where we don't have to have this debate.

Ed said...

Scott - Sorry I took so long to get back to your question. My wife is practicing medicine here in the U.S., specifically in Iowa. If a patient is insured, she can order whatever test she wants and it is paid for according to the rules of the health insurance plan. The insurance companies don't limit tests prescribed by doctors to diagnose an illness. (They mostly limit procedures like breast enhancement, tummy tucks, plastic surgery, etc.) If the patient comes in through the ER and is uninsured, she also orders whatever tests are required. (We the taxpayers already pay for this.) The only time in which she limits tests are for those that come in via appointment or post ER visit and who are uninsured. Of those, perhaps 50% of those people are people who simply don't want insurance (even our government subsidized version) and would rather spend their money on cigarettes, fancy vehicles, bigger houses, etc. They gambled with their health and lost. The other half are people who are generally unemployed and have essentially given up on life. They could apply for medicare, food stamps, etc but don't. Now, everyone will be mandated to have health insurance yet I haven't seen any provision to enforce this. I'm guessing when the smoke clears, we will have 28 million uninsured instead of 30 million and for that gain of 2 million newly insured, we taxpayers have the pleasure of coughing up 1 trillion dollars. The real people this unconstitutional legislation is targeting are small employers who can't afford to provide health insurance to their workers. Now that they will be mandated to provide that, we will pay for it with decreased competition for services because they go out of business or through higher prices.

Gary Baker said...

Scott,

"If by rationing you mean that those who are more ill receive priority I have seen that, but nobody was denied service and nobody went bankrupt when they were discharged from the hospital.

Is there a longer wait time to be seen for most things, probably, does that mean that we are less healthy and the outcomes are dramatically different when taken as a whole, not at all."

In case you didn't notice, if someone has to wait 6 weeks to see a doctor or three months to see a specialist because the doctors are booked up, you have rationing.

I'm sure that all of the people who die of cancer in Canada who would have lived in the states are glad they are not affecting things in a dramatic way.

"I know that is 'unconstitutional' but man, why wouldn't you want everyone to be looked after?"

How about this: It's impossible. You could have everyone working and all of their extra money go to fund health care and someone would still miss out on something. And in truth, you don't want "everyone" looked after either. If you really did, you would be sending every spare dollar you had to some fund that supplies health care to people overseas or in some part of the world where they don't have it. The line that you draw around Canada is just as artificial as any other. You like for people to have coverage, and you are willing to pay a certain level, and not beyond.


BTW - Can you walk into any restaurant in Canada and order anything you would like and have the government subsidize that also? People need food more than they need health care, so by your logic they shouldn't have to worry about that either.

Scott said...

Gary,

Just thought I would show you a study that shows the results of both health care systems compared head to head.

http://www.openmedicine.ca/article/view/8/1
This study looks at the health outcomes of people with various illnesses in both Canada and the US. It shows that for most things te outcomes for Canadians and Americans who go to the Doctor are about the same.

No, there are no food subsidies that I know about. We don't even have food stamps, though we do have food banks and such and people who need to eat get the help they need.

You are right that it is impossible to make sure that everyone gets the help that they need but is it not a good goal for a nation? I am fairly rational and know that it is impossible to fix everyone in the world (that would be an ideal though) but why not, with all of the wealth in our respective countries should we not strive to look after people when they are at their most vulnerable?
It's a values thing. You don't value that, I do. You think I am wrong, I think that you are wrong.

Scott

Gary Baker said...

"but is it not a good goal for a nation? I am fairly rational and know that it is impossible to fix everyone in the world (that would be an ideal though) but why not, with all of the wealth in our respective countries should we not strive to look after people when they are at their most vulnerable? "

First off, that's not really what you are talking about. Looking after people is kindness and charity. Forcing it is tyranny. If you gave people the option of refusing the government system, that would be one thing, but you don't. So essentially it's a manner of control.

Second thing, it breeds an attitude of complacency and dependence. You are exhibit A, totally horrified at the idea that a person my actually have to take care of himself and mystified (as demonstrated by your repeating the same question) why some people actually prefer it that way.

You made a comment down below about not forcing cultures on each other, but apparently that only refers to certain aspects as anyone who immigrates to Canada will have to abandon their own ideas of liberty and self reliance (and free speech, though that's another issue).

Yes, I value freedom, and I have seen the kind of attitudes that entitlement and dependency breeds. You can have it.

Kathleen said...

Fascinating. Thanks, Saur.