Canada, they hardly know ye
Topic: economy
As soon as I saw Dr. Peter Mott's April 12 D&C op-ed on single-payer health insurance, I knew some MD out there would lob a grenade, live or otherwise.

And sure enough, just five days later, a dud from a Brighton MD landed on the D&C letters page. The doc warned against a Canadian-style single-payer plan, which he claimed "lacks the capacity to provide needed care in a timely manner." He played a slight variation on the orthodox tune: Canadians flock to US hospitals to get care they're denied at home because of long queues and sparse equipment - a situation Americans would never tolerate.

But then the doc tipped his hand.

Shockingly, he suggested that "the solutions to our problems lie in reaching agreement [about] whether we value committing scarce resources to extending the lives of our extreme elderly and those with chronic diseases."

Whoa. And ouch. I thought we had a durable agreement to give care as needed to prolong life and ease suffering. Or at least we held up something like this as an ideal. But was this doctor actually arguing for a form of human sacrifice? Did he mean to endorse a regime of cost-driven triage that would throw the oldest people (age cutoff presumably to be determined by accountants) in the dumpster, and push the chronically ill to the margins?

I hope the argument was nothing more than a D&C editing error, or someone letting his words get away from him. But let's get real: The sort of triage the letter implicitly supported is already common practice. And this might explain in part why the US has such dismal health stats - much worse than Canada's, no matter what the orthodox professionals here would have you believe.

Compare some figures drawn from World Health Organization data bases:

Infant mortality ratio: Canada, 5.1 per 1,000 live births; US, 7.2

Maternal mortality ratio: Canada, 5 per 100,000 live births; US, 14

HIV prevalence, 15-to-49 year olds: Canada, 0.3 percent; US, 0.6 percent

Life expectancy at birth, total pop.: Canada, 80 years; US, 77 years
--- males: Canada, 78 years; US, 75 years
--- females: Canada, 82 years; US, 80 years

Healthy life expectancy at birth. total pop.: Canada, 72 years; US, 69.3 years

Per capita Gross National Income (US dollars): Canada, $23,930; US, $37,600

Per capita health spending (US dollars): Canada, $2,222; US, $5,274

Looking at any or all of these figures, you can't help but conclude the Canadians, who on average aren't as rich as Americans, are doing it better and smarter.

Our neighbors across the lake aren't blind to their
system's shortcomings, either. Recently, the Council of Canadians published an update on health care that acknowledges some problems with their national single-payer system but also - contrary to the practice of stateside critics - shows where the true remedies are to be found. On the matter of queues (wait-times), the Council laid major blame on "a serious shortage of health care providers," and in turn, on health-care funding shortfalls that will require tens of billions in new spending.

In short, the Canadian single-payer system is flawed only to the extent it has been starved of money. As you can see from the WHO figures above, Canada spends half of what the US spends on health per person. If its annual expenditure per capita went up significantly, Canada could easily fix the problems dogging its health system - problems which in any case don't prevent superior national health outcomes.

The bottom line for the US is this: If we went single-payer, we could spend much less per capita and get a lot more health for our buck. And we wouldn't have to set the old folks out on the ice floe.

Paris in the spring (2)
Late-breaking footnote to my previous post: Read what the wonderful Barbara Ehrenreich has to say on the French demos and the "Anglo-Saxon Model" (go to http://progressive.org/mag_ehrenreich0506)... And now (April 7), an afterthought to the footnote: Read a lively piece by labor writer Dave Lindorff at http://www.counterpunch.org/lindorff04062006.html - he urges us all to get into the streets; to think about important things in life, like decent work, pay, and leisure; and to ask where the US labor movement is when it's needed.

We're all Parisians now
Topic: economy
During the run-up to the Iraq invasion, the French took a beating from chickenhawk conservatives and big-business liberals alike.

The rants took this basic form: How dare those foreigners contradict our great and wise leaders (here I refer not to George Bush or Dick Cheney – that would be stretching the joke past the breaking point – but to Colin Powell and others who supposedly had “credibility” and basic moral instincts)? Why can’t they be team players? They’re so mysterious; it must be some cultural quirk, an ingrained stubbornness, a pious exceptionalism. Surely there can’t be actual reasons for such contrary behavior.

Now the chick-cons and bb-libs are at it again. But this time the object of their cluelessness is the inspiringly unending series of French rank-and-file protests against the “CPE,” the odious measure that would take away basic job protections from younger workers.

Again, our clueless classes blame it all on French idiosyncrasy. But as even some of the domestic business press is saying, it’s clear the French are struggling against something all too real and threatening – the imposition of American-style labor rules, like the “work at will” regime that condemns working people of all ages to the kind of social insecurity that many Europeans rejected decades ago.

The protesters deserve our support. They understand that their government, carrying water for capital, has its eyes on a further prize: the incremental “casualization” of labor, to be sold over the coming years as one after another adjustment to achieve “competitiveness.” Which, of course, is better known as “the race to the bottom.”

It’s no exaggeration to say the protesters in Paris and elsewhere across France are acting on American workers’ behalf. If Chirac and de Villepin carry the day – at the moment they’re flogging a softer version of the CPE, but the people in the streets aren’t taking the bait – the American labor movement will suffer a real setback. We’ve got enough on our hands already, not only with the massive loss of jobs (cf. GM/Delphi and many others) but with the relentless attacks on labor organizing, again even by those posing as “liberals.”

Maybe justice will prevail and the CPE and the government that floated it will fall. Then we can hope – and work actively – for a westward domino effect.

QUERY: What about Genesee Hospital?
Dear all: It's been announced that, after lengthy behind-closed-doors negotiations and wheeling-dealing, Genesee Hospital on Alexander Street will be semi-demolished by a new owner, the ubiquitous Buckingham Properties. As outlined in the Democrat and Chronicle, BP plans to level most of the north half of the parcel and convert it eventually to residential. This will mean the loss of the oldest (ca. 100 years) of the buildings. More seriously, it means there will be even less chance we'll get Genesee back as an urban hospital serving the most vulnerable. I know there are many factors involved, though, so I'm putting the question to you. Should we get the Save Genesee campaign back on track, or what? (Click on the "post a comment" link directly below.) Thanks for your ideas. -Jack

Crossing guardedly
Topic: urban issues
Excuse me for being obsessed with transportation issues. But I think this vital piece of the human rights agenda doesn’t get enough ink.

Anyway, the bad news keeps on coming. I just read in the D&C about a fatal accident – two teenagers, brothers – at what I know to be a lethal intersection just outside of Marion, Wayne County. At this busy spot, east-west traffic must cross a high-speed stretch of Route 21. Sitting there at the stop sign, you realize how easily you could be blindsided.

You ask yourself, why is there no traffic signal here? Well, replies your Inner Realist, the funding that could provide such things usually gets channeled to higher-profit ventures. Like Rochester’s Renaissance Square, which just got a $36 million boost to its sorry career. It all goes to prove the counter-adage: Necessity is the child of invention.

Meanwhile, in my own back yard, and along the bicycle path to my teaching gig at RIT, there’s another intersection crying out for change.

The following message, which I sent a couple months ago to an RIT online response service, tells the story:

”[Dear Pres. Simone:] Are there plans to improve conditions for pedestrians and bicyclists at the intersection of Jefferson and Brighton-Henrietta Town Line roads and John St.? The busy intersection now is equipped with some upgraded pedestrian signals, which are fine, but there's only one demarcated pedestrian crossing [i.e. on the west side of the intersection] where there arguably should be four.

“Crossing such an intersection, particularly after dark, can be intimidating and dangerous, as you can imagine, and the conditions surely don't encourage non-motorized commuting to campus. Can we expect improvements at this intersection, as well as on the now-substandard walkway on the south side of Jefferson Road, east and west of John St.? Thanks for responding.” (Note that the existing pedestrian signals were installed to accommodate people using the recently-opened Lehigh Valley Trail, North Branch, which roughly connects the University of Rochester to the RIT campus and points south. The signals look like state-of-the-art, and they’re highly visible, but they seduce walkers and bikers onto pavement occupied by cars and trucks stopped at the red light.)

Quite properly, RIT staff forwarded my email to the New York State Department of Transportation. Here’s the DOT’s response, delivered to me via rit.edu:

“The segment of the Jefferson Road project which includes the John Street/BHTL Road intersection is the fourth and final stage. It involves improvements to facilitate traffic flow as well as improvements to pedestrian and bicycle facilities. Specifically, new sidewalks would be constructed on both sides of Jefferson Road and bike space would be provided adjacent to the curb on both sides. Unfortunately due to funding limitations, construction is not scheduled until 2013.

”Regarding the current pedestrian facilities, we realize that a crosswalk for Jefferson Road on the west side of the intersection was omitted when the road was repaved. We had already planned on correcting this as part of our annual pavement striping contract for the 2006 season. The stop bar will be moved back to provide room for a crosswalk to line up with the existing multi-use path. It is our opinion that striping crosswalks for the east and north legs of the intersection is not warranted since there is no sidewalk system to connect to on the north side of Jefferson Road. These will be provided when we construct our project in the future...”

I can’t help noticing a few things. First, the much-needed sidewalks serving the Jeff-Town Line-John St. intersection won’t materialize for another seven years, assuming the funding comes through. By that time, Renaissance Square, now hardly more than a gleam in the blinkered eye of the bourgeoisie, will be showing its first signs of age and the business types will be tut-tutting about “under-utilization.” And over at the outskirts of Marion, a bunch more “accidents” will have occurred.

Second, for years to come, the lack of marked crosswalks on the north and east flanks of the intersection will remain an obstacle - and may tempt some people to take risks.

Looking over the scene the other day, I realized that pedestrians going from, say, the RIT campus to MacGregor’s Grill, which sits on the north side of Jefferson a couple hundred yards east of the intersection, will have to hoof it a long distance east or west of their destination to find an actual legal crossing.

The "great circle route" may work great for transcontinental air travel, but for pedestrians this sort of thing generally means "you can't get there from here."