34 thoughts on “Why is America is the greatest country on Earth?

  1. 1..Canada DOES NOT give away health insurance, they pay thru the nose for it!!! Just as they do in England and many of the english I talked with in 1970’s say they wish they had our system because over there no one cares about health..get sick — free medical.
    2..In the US you watch your health or get a big bill or no real help. If you watch your health no need for expensive insurance.
    Yes it is a simplification but the main point is ..IT AINT FREE!!!
    OH ya …I’ve been to a number of other places & we are the greatest country! But I do like his comedy!

  2. What the **** are you burbling about? A tiny proportion of altmed loonies believe they can completely control their risk of disease (with the corollary that illness is a moral failing), but the vastest majority of the UK population are very, very pleased to know they can access healthcare without upfront costs. In fact, the instances where there are patient charges (dental work and prescriptions spring to mind) are very unpopular. Yes, we all grumble about taxes (and about inefficient spending practices within the healthcare system), but we’d take an extra 10p on income tax before we’d actually consider doing away with the NHS.

  3. LLong you have no idea what you are talking about. Combined US Federal and State spending per citizen (to pay for the health care of a small portion of your population) is greater than the cost per citizen to cover ALL Canadians. Yes, the cost is embedded in our income taxes or deductions, but everybody gets it whether they are unemployed or rich, and whether or not they have ‘pre-existing conditions’.

    I happen to be a pretty wealthy guy and I pay a lot of taxes. You see, in the civilized world, we don’t mind paying taxes for the greater good. Thats a strange concept for most Americans, I know, but thats why you are #1 and we just live better, are more healthy, etc..

    Nobody in Canada goes broke for medical reasons. Most people in the US who go bankrupt go bankrupt due to medical bills. I guess they deserve it for letting a sick baby live or getting cancer.

    Your statement “If you watch your health no need for expensive insurance” shows you are a complete idiot. What about accidents? What about infection? What about congenital problems? What about shit that just happens? Or are you into prayer and homeopathy?

    I have also been through two potentially serious health crises in the past year: potential lymphoma and a broken leg. In both cases my government looked after me and the doctors treated me with amazing professionalism. Every test, every consultation, every surgery was timely and well done and the total cost was next to nothing.

    Man – I am proud to be Canadian!

    Your plutocrats really have you guys wrapped around their fingers, don’t they?

  4. Mingr: “Most people in the US who go bankrupt go bankrupt due to medical bills” Is that true? Do you have a source? It’s not that I don’t believe you (or agree with the rest of your post) but I’d love to have a source on that.

    I imagine it may be less true in the US over the last five years as a lot of people went bankrupt in connection with the mortgages on their modest working class homes, but that’s a spike in the longer term data.

  5. I thought this was common knowledge. There are dozens of articles like this, most or all predating the mortgage crisis by a number of years.

    If you open Stephanie Z’s post, you will note it refers to stats from 2007, prior to the collapse, when everybody was still flush.

    The mortgage crisis may or may not make a significant impact on bankruptcy causes, depending on whether foreclosure causes bankruptcy, which it may or may not, though it isn’t going to help your credit score.

    Don’t get me wrong: people go bankrupt here as well, but its not because they got sick, slipped and fell, or their kid got cancer.

  6. Stephanie

    I was not implying that common knowledge was a substitute for facts. I’m just a dumb Canuck and I’ve read it so many times, etc., I thought pretty much everybody in the US knew this.

    Fortunately, if you Google US medical “major cause of personal bankruptcy” you get a profligacy (over 14,000) hits, so sources are not hard to come by!

  7. I don’t have a source, unless I dig through a lot of PBS, but

    a) The US spends twice as much, per capita, as Canada on health care. (I’m sure that number is in wikipedia, but I’m in a hurry). Going to emergency is expensive.

    b) the US is #12 in ‘health care preventable’ deaths. We’re great for cutting edge fancy shit, but we lose a lot for lack of basic health care. (I’m pretty sure that was on Moyers)

    c) roughly half of all personal bankruptcies are related to medical costs.

    I’ll dig around when I get back and see if I can find the clips.

    My favorite is the talk about waiting lists for health care in Canada. Sure. If they had our health care budget, they wouldn’t have any lines either. And maybe if we didn’t make up 43% of the world military spending, we’d have a little something left over for schools, health care, high speed rail, planned parenthood, Americorps AND some tax cuts.

  8. I have only limited experience with wait lists in the US but I can speak towards my personal experience in Southern Ontario.

    You can wait a long time if you walk into Emerg (‘ER’) with miscellaneous non-life threatening symptoms like a cough or a sore leg, a fever, or a (in one experience I had) shooting a nail through your finger with a nail gun. (It was just a flesh wound). This sort of experience is probably a direct consequence of ‘free’ care: people who would otherwise take an aspirin go to Emerg. My father in law went in because he thought he had a flu and had a stroke and heart attack while waiting in Emerg. He would not have survived if he had not been in the hospital when it happened.

    However, if you are pregnant and your water breaks (as per my wife) or, if you present with a broken leg (my recent experience) stuff happens real fast.

    With my lymphoma scare (I’m still not sure I got it), after a physical, my GP spotted a high lymphocyte count on 2 successive tests. It was high, but not sick high. I saw a hematologist within 4 weeks. She gave me specialized blood test. They sent me for a CAT scan about 2 weeks after my visit. Within a few months I had also seen a GI specialist, a respirologist, and a sleep doctor and had several tests associated with each of those specialties and one or two follow ups. I now see the hematologist every 6 months or so.

    To be frank, I don’t know if it could have been any faster and I don’t think any delay made difference to my odds of survival if I had been really sick.

    So, its not ideal, but its pretty good.

  9. It should be noted that getting to see a specialist in the US takes weeks. Some of that wait is hidden from the average patient. If you go to the clinic of a regular checkup with a problem that really is best dealt with by a specialist, there is not talk of seening a specialist. If you bring up a specialist, you are told that this is not the time to see a specialist. The non specialist mucks round with you for a month or two if possible, and eventually you get a referal. It might take four weeks to get that appointment.

    If you really really need the specialist and the Dr is on board with that, this can happen much more quickly. Also, the very old and the very young get to see specialists sooner. There are two separate specialists my daughter should really see. One has been denied for a year, the other is probably going to happen but it has been 6 weeks and will take another five or six weeks. Meanwhile Infant Huxley needed to see a specialist for something (not too important) and that took only 6 weeks.

    The only time I’ve ever seen a specialist in my entire life is when the specialist was a surgeon and it was emergency surgery. Of course, I probably haven’t had much need. My point is, Americans believe the stories about the multi-week waits in Canada, but don’t realize that it is very similar here.

  10. #3-I was commenting on the comedy. Canada does NOT give it away for free.
    #2 & #3-Many health problems are self generated and I bought insurance for my kids at $200/year, but it did not cover colds and other silly stuff they had to take care of their overall health.
    #2-I was stating what others told me not what the overall population thought.
    And I did state it was a simplified statement. And none was false i.e. the english guy has been to a doctor only 5 times in 60+ years so why should he pay high taxes for something he never uses and others need because they don’t care for their own overall health, and yes maybe eventually he may need it but then again he may not.

    #12-Around here (New Hampshire), I’ve been able to see specialists within 3days of the referral. But my experience is limited to only 7 incidents.

    But all in all there is only ONE way not to have problems with any health care system…Be filthy rich and buy it!

    #3-And yes the taxes pay for good health care for a small part of the population….Nobles and kings (federal workers) have always gotten the best health care available in their times and for everyone else IT SUCKS!

    But the main problem with this country is the tax system and monumental Twits who think any kind of socialism is Satan worship. If they would set up the taxes such that the social security was in its own account and medical was in its own account, etc then various taxes and expenses could not be hidden and could be tracked and congressional crooks would find it harder to steal it….But this will never be allowed.

  11. I have no sources and this is purely heresay, but in Canada, it’s up to 2 years to see a proctologist,or a few months to see a surgical consultant who if he recommends an elective surgery, might happen in a year from then. Seriously, months for an MRI.

  12. I have no source for this, but I heard that the wait time issue in Canada was a bigger problem in the past but things have steadily improved, while at the same time wait time and other issues have become worse and worse in the United States, so they are nearly the same now between the two countries.

  13. Or, we could just look it up in Wikipedia:

    Health Canada, a federal department, publishes a series of surveys of the health care system in Canada based on Canadians first-hand experience of the health care system.[52]

    Although life-threatening cases are dealt with immediately, some services needed are non-urgent and patients are seen at the next-available appointment in their local chosen facility.

    The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 90 days.[52]

    The median wait time for diagnostic services such as MRI and CAT scans [53] is two weeks with 86.4% waiting less than 90 days.[52]

    The median wait time for surgery is four weeks with 82.2% waiting less than 90 days.[52]

    Another study by the Commonwealth Fund found that 57% of Canadians reported waiting 30 days (4 weeks) or more to see a specialist, broadly in line with the current official statistics. A quarter (24%) of all Canadians waited 4 hours or more in the emergency room.[54][55]

    Dr. Brian Day was once quoted as saying “This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.”[56] Day gave no source for his two to three years claim. The Canadian Health Coalition has responded succinctly to Day’s claims, pointing out that “access to veterinary care for animals is based on ability to pay. Dogs are put down if their owners canâ??t pay. Access to care should not be based on ability to pay.” [57] Regional administrations of Medicare across Canada publish their own wait time data on the internet. For instance in British Columbia the wait time for a hip replacement is currently a little under ten weeks.[58] The CHC is one of many groups across Canada calling for increased provincial and federal funding for medicare and an end to provincial funding cuts as solutions to unacceptable wait times.[59] In a 2007 episode of ABC News’s 20/20 titled “Sick in America,” host John Stossel cited numerous examples of Canadians who did not get the health care that they needed.[60] The Fraser Institute, a conservative think tank, claims to do its own research and found that treatment time from initial referral by a GP through consultation with a specialist to final treatment, across all specialties and all procedures (emergency, non-urgent, and elective), averaged 17.7 weeks in 2005.[61][62] However, the report of the Fraser Institute, an organization advocating a “prosperous world through..markets”[63] is greatly at odds with the Canadian government’s own 2007 report.[64] Canadian psychiatrist Dr David Gratzer, who is also employed by the libertarian Cato Institute, was once asked by U.S. congressman Dennis Kucinich if he knew what the wait time for diagnostic imaging procedures such as CT scans and MRIs was across Canada. Gratzer began his reply “I can tell you what the Ontario government said it was for cancer and…” when Kucinich cut him short and gave him the true figure of 3 weeks, just as Gratzer was uttering the answer of “six months” to his preferred question.[65]

    Criticisms have been laid during the administration of H1N1 shots in 2009, in parts of Canada, including Hamilton and Toronto. “Wait times for flu shots continued to be hours long yesterday [October 29] as Hamiltonians lined up for the only protection from H1N1 that public health can offer. Waits were about five hours at the clinic on the West Mountain, with 1,000 people in line. The Dundas clinic wasn’t much better, with 700 waiting for a shot.”[66] “Hundreds of people who lined up in Toronto today were given slips of paper with a time on it so they could return for their vaccination without standing around for hours on end.” [67]

    Since 2002, the Canadian government has invested $5.5 billion to decrease wait times.[68] In April 2007, Canadian Prime Minister Stephen Harper announced that all ten provinces and three territories would establish patient wait times guarantees by 2010. Canadians will be guaranteed timely access to health care in at least one of the following priority areas, prioritized by each province: cancer care, hip and knee replacement, cardiac care, diagnostic imaging, cataract surgeries or primary care.[69]
    [edit] Counter-criticism: some longer wait times can benefit patients

    It has been observed and found in data that the complete elimination of all waiting times is not ideal. When waiting lists arise through a prioritization process based on physician-determined medical urgency and the procedure’s risk, (in contrast to patient’s ability to pay or profitability for the physician), waiting lists can possibly help patients. It’s been postulated that a system of immediate care can be detrimental for optimal patient outcomes due to avoidance of unnecessary or unproven surgery. An example is the Canadian province of British Columbia, where, according to surgeon Dr. Lawrence Burr, 15 heart patients died in 1990 while on a waiting list for heart surgery. According to Robin Hutchinson, senior medical consultant to the Health Ministry’s heart program, had the waiting list not existed and all patients given instant access to the surgery, the expected number of fatalities would have been 22 due to the operation mortality rate at that time. Hutchison noted that the BC Medical Association’s media campaign did not make reference to these comparative statistics and only focused on deaths during waiting for surgery.[70]

    Since, ideally, waiting lists prioritize higher-risk patients to receive surgery ahead of those with lower risks, this helps reduce overall patient mortality. Consequently, a wealthy or highly-insured patient in a system based on profit or ability to pay (as in the U.S.) may be pushed into surgery or other procedures more quickly, with a result in higher morbidity or mortality risk. This is in addition to the better-understood phenomenon in which lower-income, uninsured, or under-insured patients have their care denied or delayed, also resulting in worse health care.

  14. Wow, those are not my experience with the Canadian system. If only the wait times were that short. Prioritization makes it really good for the person with an emergency, and for sure they have made some wait times shorter. My sister is waiting to have her hip re-done, that will be more than a year wait when it’s done in May (barring a rescheduling). My close friend has an appointment to see a procto so far in the future it’s ridiculous. Personally, I can’t find a family doctor, I have to use clinics since my family doctor just dropped his practice and became a clinic doctor.

  15. This doesn’t address one of my original claims, but keep in mind that in the US even if you have a job, and insurance, a medically related event can ruin you financially:


    “About 3/4 of the families who ended up in bankruptcy in the aftermath of a serious medical problem had health insurance at the onset of the illness or accident that ultimately bankrupted them.”

    Still looking for the others

  16. Greg

    Thank you for your lengthy and detailed post. I was worried I was going to stand alone on this.

    I’ll set aside for a moment Larry L’s confusing comments and speak a little bit about wait times.

    I think if car repairs were free, a lot more people would go to the garage to get their cars repaired. However, car repairs are not free, so some people bring their cars to the repair shop when there is a small problem, and some people drive around with faulty brakes and/or safety systems because they figure they canâ??t afford such a repair. To compare wait times in a hypothetical situation where repairs are free vs. where they cost money is misleading, and, in any event moot, especially when human lives are involved. If medical expense can bankrupt you, people who are unemployed or among the working (uninsured) poor are going to avoid going to see a doctors unless they have a serious acute condition. People who have no fear of penury are more likely to see a doctor, even for minor complaints. Perhaps this is an â??abuseâ?? of the system. Iâ??m sure it goes on here and there.

    It boils down to this: do I, as a citizen, prefer to see my fellow citizens looked after, or am I willing to sacrifice a small amount of my income to make it less likely that people will die because they canâ??t afford medical care? I make a lot of money and pay a lot of tax. My tax bill alone is several times what the gross income of the average Canadian family is â?? so Iâ??m the guy who pays for this and I am happy to do so. Most high income Canadians grumble about taxes, but I suspect most of us high earners would prefer the government not piss money away on corporate welfare or new, useless, F22s than cut back on health spending. Itâ??s just a different way of looking at the world.

    Those who think the US system is the best in the world seem to think the rest of the civilized world idiots for supporting universal health care. Yet, the rest of us have actually lived it, whereas most of you are told about it. We know it works. The people who tell you it doesnâ??t work have a huge financial incentive to mislead you.

    I donâ??t get in to these discussions about universal health care because I want to say â??Canada is #1â? (very un-Canadian, in any event), but because I know and work with a lot of Americans. It distresses me to see that you spend more than the entire rest of the world combined on defense (a figure which continues to grow) and yet you are content to see people bankrupt or die because they canâ??t afford a medical procedure. As noted a profit system means you spend an enormous amount per capita for medical care and yet achieve inferior results, on average, than we do. And yet you persist in this delusion that you have a superior system. And this isnâ??t the only thing: donâ??t get me started on education â?¦

    With respect to Larry Lipitorâ??s comments â?? ignoring the self-contradiction â?? my friend went to the doctor complaining of bad headaches and had an MRI within 4 days. Not ideal if he had had a cerebral haemorrhage, but Iâ??m sure the doctor made a judgement call. They didnâ??t find anything. My wife has had a sore shoulder for about 10 years now and figured she go see if there was anything they could do about it. A chronic sore shoulder is not exactly a life or death thing, usually. She waited 6 weeks for an MRI. With respect to a proctologist, I think you just pulled a number out of your butt. I know a couple guys with prostate cancer and they never once complained that they had excessive waits to see specialists or to get treatment. And these are guys who could afford to write a personal cheque to the Harvard Medical Centre if they wanted to.

    So, my advice: spend a lot less money funding your military industrial complex to kill other peoplesâ?? citizens and a bit more money looking after your own citizens. Youâ??ll balance your budget and feel better. Trust me on this.

  17. Dr. Brian Day is owner of Canada’s largest privatized for-profit health care centre, and is well known for attempting to push the public discourse toward adopting the for-profit model that’s obviously serving America so well lo these past decades.

    Err, sorry, I mean serving America’s health care leeches, the insurance industry and for-profit hospitals who do not serve the public good.

    Larry Lipitor’s experience is relatively unique in Canada, and hardly unique at all in the States. Wikipedia has the facts straight on this one.

  18. @Mingr Minor nit, since this is also one of my battle cries

    It distresses me to see that you spend more than the entire rest of the world combined on defense

    We actually only out-spend the next 13 countries combined (12-13, depends on exactly how you count it). But hey, there’s room for improvement. My own congressperson (Tom McClintock R-CA) thinks we need more. Or at least thinks it needs to be ‘improved’.

  19. “they pay thru the nose for it!!!”

    If you really want to compare what we pay for, take your health insurance premiums, add them to your taxes, and then compare.

    Here are tables of 2010 federal tax brackets and rates for comparison:
    Canada: http://www.cra-arc.gc.ca/tx/ndvdls/fq/2010_rt-eng.html
    US: http://taxes.about.com/od/Federal-Income-Taxes/qt/Tax-Rates-For-The-2010-Tax-Year.htm

    I’ve worked out some tables to make the comparison easier:


    Poorer Canadians pay a little more than their American counter parts, but wealthier Canadians pay less. There’s not a very large difference over all, except of course that Canadians don’t have to buy health insurance on top of this. We do buy supplemental insurance to cover costs like prescriptions, ambulance rides, and the like, but you can get individual coverage for under $1000/yr.

    We basically end up paying less individually and manage to have universal coverage. If you want to call that paying through the nose, then I’m not sure what you’d call what Americans do.

  20. Rich

    Lets say those figures are correct: if you do spend as much as the next 13 countries, most of whom are allies, that’s pretty screwed up. I believe there are various definitions of what constitutes military spending: low figures take the DoD number, whereas higher figures include a sizable part of NASA, National Guard, Coast Guard, the vast security establishment, pension and health spending for past service, etc., etc.. The objective reality is that the US economy is highly dependent on defense spending, wars, ‘toys for the boys’ and so on, and it continues to grow, year on year.

    It makes sense for a super power to spend more than anybody else, I grant you that. I don’t think you disagree, but at what point does insane become batshit crazy?

  21. Mingr, Dan Carlin addressed your very question one a recent “Common Sense” podcast. He cited the Royal Navy of Imperial Britain which spent as much as its next competitors combined. It’s an arbitrary value, but at any rate, it’s hard to argue the US is not long past the point of diminishing returns.

  22. Consigned to the spam bucket due to blatant self-pimping. Sigh. I was posting something relevant, too. (For once.) 🙂

    For the record, til Greg unlocks my post, you’d do well to research Brian Day and his efforts to bring America-style health care to Canada. He’s got a vested interest, being the owner of the largest for-profit hospital in the nation.

  23. @Mingr my self correction didn’t make it past the spam-filter, it’s actually the next 17 countries, according to wikipedia (the link to which probably triggered the spam bit, so I’ll let you find it if you want).

    Given that, I think we passed batshit crazy without collecting $200 a long time ago.

  24. All that work in excel, then waiting for moderation, and the google spreadsheet link fails me. NNNYYYYYUUUURRRRRBBBBB!

  25. It makes sense for a super power to spend more than anybody else, I grant you that. I don’t think you disagree, but at what point does insane become batshit crazy?

    I would say roughly 1965.

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