Is Ideology-Free Health Reform Possible?
posted by Frank Pasquale
Apparently the message of Tom Daschle’s confirmation hearing today was standard anti-partisan fare: “‘We will be guided by evidence and effectiveness, not by ideology,’ Mr. Daschle told the Senate Committee on Health, Education, Labor and Pensions.” I have no doubt that this is the correct rhetorical posture to adopt. But after listening to podcasts from an excellent Princeton/Woodrow Wilson School conference on health care reform, I think anti-ideologism has its limits.
At the conference, Len Nichols, Director of the Health Policy Program of the New America Foundation, gave the paradigmatically postpartisan perspective on health care. According to Nichols’ vision, both Democrats and Republican need to be far more open to ideas from one another’s best thinkers. He held out the Massachusetts plan for universal coverage as a model for melding Democratic emphasis on universal coverage with Republican commitments to personal responsibility, private insurers, and markets.
Yet I found the most compelling talks to be Uwe Reinhardt’s and Maggie Mahar’s. Far from preaching “middle of the road”-ism, both found fault with the incrementalism it usually results in. Mahar noted that the Massachusetts plan does not have a compelling model of controlling costs–and that without cost control it is virtually impossible to accomplish sustainable reform. Reinhardt underscored the degree to which policy elites in other countries consider the risk of bankruptcy due to medical bills in the US “obscene”–a value commitment hard to square with much rhetoric of personal responsibility.
I think it’s time for us to follow Jack Balkin’s groundbreaking work on ideology, and to realize that the goal is not to be ideology-free, but to recognize and correct for the inevitable biases that ideology can generate. As Balkin says of the cognate concept “cultural software,” ideology is “simultaneously empowering, useful, and adaptive on the one hand, and disempowering, distorting, and maladaptive on the other.” But it is inevitable, and the faster we can get clear on its role in health debates, the more substantive health care reform is likely to be.
Anyone familiar with my health law archives on this blog probably knows my convictions here: The US health care system wastes huge amounts of money, inflicts financial and physical distress on many vulnerable people, and has been excessively commercialized. Profits are too often put ahead of patients. We can learn from other countries that spend less, and have as good or better health care outcomes.
An ideological framework like that (or its mirror image on the right) is proabably necessary to motivate real action on the health reform front.
As Geertz says in his great essay Ideology as a Cultural System:
The differentiae of science and ideology as cultural systems are to be sought in the sorts of symbolic strategy for encompassing situations that they respectively represent. Science names the structure of situations in such a way that the attitude contained toward them is one of disinterestedness. Its style is restrained, spare, resolutely analytic: by shunning the semantic devices that most effectively formulate moral sentiment, it seeks to maximize intellectual clarity. But ideology names the structure of situations in such a way that the attitude contained toward them IS one of commitment. Its style is ornate, vivid, deliberately suggestive: by objectifying moral sentiment through the same devices that science shuns, it seeks to motivate action. Both are concerned with the definition of a problematic situation and are responses to a felt lack of needed information.
Ideologies do make empirical claims about the condition and direction of society, which it is the business of science (and, where scientific knowledge is lacking, common sense) to assess. The social function of science vis-a-vis ideologies is first to understand them–what they are, how they work, what gives rise to them–and second to criticize them, to force them to come to terms with (but not necessarily to surrender to) reality. . . .
Before we aspire to do away with the “ornate, vivid, deliberately suggestive” methods of ideology, we should remember commitment’s place in the world of health care reform. For me, that means universality–a strong commitment to a robust baseline of care for all–should be at the top of reformers’ agenda. Cost-containment is important, too, but its achievement needs to hinge as much on values of compassion and equality as on the number-crunching of technocrats. If bipartisanship becomes too technocratic, partisanship may not be such a dirty word after all.
January 8, 2009 at 2:28 pm
Posted in: Health Law
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Responses (17)
A.W. - January 8, 2009 at 4:50 pm
I don’t know, is it ideology to say that we don’t want socialized medicine because everything else anyone has ever socialized has made it worse?
Or is that just talking about what works and what doesn’t? As in, socialism never works.
Frank - January 8, 2009 at 4:58 pm
AW, if you listen to the Reinhardt clip, he addresses exactly that point. He says that we have socialized medicine for only one group in this nation: the military and veterans. Is this a measure of our mistreatment of them–or our high regard for them?
This article (now book) suggests the latter:
http://www.washingtonmonthly.com/features/2005/0501.longman.html
“[W]hen it comes to health care, it’s a government bureaucracy that’s setting the standard for maintaining best practices while reducing costs, and it’s the private sector that’s lagging in quality. That unexpected reality needs examining if we’re to have any hope of understanding what’s wrong with America’s health-care system and how to fix it. It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well–incentives that are lacking in for-profit medicine.”
Patrick S. O'Donnell - January 8, 2009 at 5:12 pm
I also think there’s some virtue in approaching these issues from the vantage point(s) provided by philosophical reflection on, say, justice and inequality with regard to health (not just health care), however difficult it may be to tease out the precise legal and policy consequences and implications from such ruminations (we need ‘middle terms’ or conceptions that modulate and mediate between this necessarily abstract discourse and the rhetoric of public policy). And of course we need not wait on anything like the consensus or agreement of philosophers before acting, but they can help us see things a bit more deeply and clearly, indeed, perhaps discern facets and features of the current situation and its possible resolution that we may have missed. Cf., for example, http://plato.stanford.edu/entries/justice-inequality-health/
[One should refrain from using words like 'socialism' and 'socialized medicine' unless one is well-versed in the literature on same. It's painfully transparent that A.W. has no inkling whatsoever about what she's talking about.]
Frank - January 8, 2009 at 5:18 pm
Patrick, you’ll be glad to hear that one speaker at the conference (I think it was Zeke Emmanuel or Reinhardt) said that Israeli policymakers are increasingly attuned to health outcome differences between rich and poor, and are trying to figure out ways to address them. The promise of comparative policy analysis!
Patrick S. O'Donnell - January 8, 2009 at 5:42 pm
I trust “the poor” include Palestinians in the West Bank and Gaza, as well as Palestinian Arabs in the state of Israel.
Perhaps they’ve been studying health care in Cuba:
In 2006, BBC flagship news programme Newsnight featured Cuba’s Healthcare system as part of a series identifying “the world’s best public services”. The report noted that “Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority” The report stated that life expectancy and infant mortality rates are pretty much the same as the USA’s. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK’s. The report concluded that the population’s admirable health is one of the key reasons why Castro is still in power. In fact, a recent poll carried out by the Gallup Organization’s Costa Rican affiliate — Consultoría Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of Cuban citizens are positive about their country’s education and healthcare systems.
In 2000, Secretary General of the United Nations Kofi Annan stated that “Cuba should be the envy of many other nations” adding that achievements in social development are impressive given the size of its gross domestic product per capita. “Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities – health, education, and literacy.” The Kaiser Family Foundation, a non-governmental organization that evaluated Cuba’s healthcare system in 2000-1 described Cuba as “a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources” President of the World Bank James Wolfensohn also praised Cuba’s healthcare system in 2001, saying that “Cuba has done a great job on education and health”, at the annual meeting of the Bank and the International Monetary Fund. Wayne Smith, former head of the US Interests Section in Havana identified “the incredible dedication” of Cubans to healthcare, adding that “Doctors in Cuba can make more driving cabs and working in hotels, but they don’t. They’re just very dedicated”. Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it. Furthermore, London’s The Guardian newspaper lauded Cuba’s public healthcare system for what it viewed as its high quality in a Sept. 12, 2007 article. [references omitted]
In 2001, members of the UK House of Commons Health Select Committee travelled to Cuba and issued a report that paid tribute to “the success of the Cuban healthcare system”, based on its “strong emphasis on disease prevention” and “commitment to the practice of medicine in a community”.
The Parliament of the United Kingdom also drew up an analysis of the key features of Cuba’s healthcare system, drawing comparisons with the state funded National Health Service (NHS). The overall conclusion was that many of the features identified would not have occurred had there not been an obvious commitment to health provision demonstrated by the protection and proportion of the budget given the health care. The study concluded the following.
There appeared to be little evidence of a divide between the prevention/proactive response and the disease management/reactive response within Cuban healthcare.
By far the biggest difference was the ratio of doctors per person. In Cuba it was one doctor per 175 people, in the UK the figure was one doctor per 600 people.
There is a commitment in Cuba to the triple diagnosis (physical/psychological/social) at all levels.
Extensive involvement of “patient” and the public in decision making at all levels.
Integration of hospital/community/primary care via polyclinics.
Team-work that works is much more evident both in the community and the hospital sector and the mental-health and care of the elderly sites visited were very well staffed and supported.
The study also pointed to problems within the system, these included,
Low pay of doctors
Poor facilities—buildings in poor state of repair and mostly outdated.
Poor provision of equipment.
Frequent absence of essential drugs.
Concern regarding freedom of choice both for patient and doctor. [references omitted]
See too the 2002 report from Oxfam, “Cuba: Social Policy at the Crossroads.” Available: http://www.oxfamamerica.org/newsandpublications/publications/research_reports/art3670.html
Daniel S. Goldberg - January 9, 2009 at 1:56 am
Again, the pervasiveness of the idea that we should aspire to any value-free social enterprise is mind-boggling to me, and not just for its total incoherence, but also because I agree that such a state is normatively undesirable.
Some value judgments are better than others, but striving to eliminate value from thinking about health, let alone delivering and financing health care, is just an enormous social and cultural problem. It is hard to counter the notion that in many industrialized notions which enjoy better health, values are intentionally incorporated into policy at a deep level.
A.W. - January 9, 2009 at 12:48 pm
Frank
Well, why don’t you ask anyone in the military how good military medicine is?
I know my mom doesn’t have fond memories of being pregnant with my sister and being treated by marine corps obstetricians. Of course it is necessary for the government to run some of military health care (battlefield medics, etc.), but where they have the option to go to the private sector.
So in answer to your question, like it is with pay and so on, it is another way we undervalue public servants just as we do cops, firefighters and teachers. Indeed, I would suggest that those who advocate socializing our medicine first show how to make our socialized education function, first.
And government is making healthcare better? Give me a break. I work in healthcare. My company is so sick of the needless strings attached to Medicaid and Medicare that we are considering dropping them entirely and treating self-pay patients only. Are those patients going to be better off or worse off, pray tell?
Patrick
> One should refrain from using words like ’socialism’ and ’socialized medicine’ unless one is well-versed in the literature on same. It’s painfully transparent that A.W. has no inkling whatsoever about what she’s talking about.
Give me a break, Patrick. You are just trying to rebrand your socialism as something else. Its an old trick and it disrespects your audience when you engage in it.
> Healthcare, however, is a top national priority [in Cuba.]” The report stated that life expectancy and infant mortality rates are pretty much the same as the USA’s. Its doctor-to-patient ratios stand comparison to any country in Western Europe.
According to whom? Typically it is not easy to get any sense of how good medicine is in a particular country. In Chinese history class we watched a “documentary” on their wonderful “barefoot doctors” and chortled at how these gullible Americans socialists believed the line the government sold them. Later we saw a documentary made without government permission and it told a slightly different story.
Certainly the Cuban I went to law school with, who couldn’t get even basic orthodontic care in the island paradise, would tend to disagree with that sunny outlook of Cuban medicine. And for that matter, when Fidel fell ill, he made sure no Cuban doctor laid a hand on him, but instead had doctors flown in from Spain. It seems he didn’t get the memo, either.
But I find your argument interesting. On one hand you say this is not socialized medicine. Then you say, “but socialized medicine works. Look at Cuba!” Mmm-hmm.
A.W. - January 9, 2009 at 1:26 pm
Sorry, left out an important adjective in one sentence:
> Typically it is not easy to get any sense of how good medicine is in a particular COMMUNIST country.
Seriously, you sound like one of those people who thought that the soviet union would be around today. These countries lie, pathologically.
Patrick S. O'Donnell - January 9, 2009 at 2:07 pm
On SOME of the varied meanings of “socialism” see the selected bibliography available here: http://ratiojuris.blogspot.com/2008/12/marx-marxism-very-select-bibliography.html
“Typically it is not easy to get any sense of how good medicine is in a particular country.”
Nonsense that bespeaks ignorance. See, for example, some of the titles found in the bibliography here (many of which contain discussions of and references to cross-national studies, etc.; there’s actually quite a substantial and reliable literature on this subject; see WHO, for instance, for some reports and documents): http://ratiojuris.blogspot.com/2008/11/health-law-ethics-social-justice-basic.html
Your (testimonial) anecdotal report is just that, and thus rather impoverished and feeble by way of an evidential counterexample to the aforementioned summary of studies readily available.
In light of your correction: Communist nation-states are hardly exemplars of socialism, but in any case we actually do know a fair amount about the health, say, of individuals in China, which is in stark contrast to that of (as far as can be determined) individuals in North Korea. I also recall reading somewhere (I’ll have to look it up anon) about the worsening health situation in the former Soviet Union: it seems here at any rate that capitalism has not been, at least on this front, a force for the good.
Given the economic squeeze put on Cuba by the U.S. it is rather astonishing and inspiring how well the Cubans have been able to (comparatively) fare with regard to health care.
Countries that are not “communist” or “socialist” often have what some would deem “socialized” institutions, methods, and means of health care. And they put our nation’s health care system to shame, pure and simple.
A.W. - January 9, 2009 at 2:44 pm
Patrick
Right. Socialized medicine works. Like the maternity ward in canada with the ten month waiting period. don’t you wish you had such good care?
And sorry, no, you cannot get good data on communist dictatorships. That’s lesson number one on how not to fall for communist propoganda.
You are the heir to the American fools who thought Mao was going to make a “great leap forward.” Its a perfect example of how self-deception in a communist country can lead to disaster. China had long been barely able to feed itself as a country, but after Mao announced they would “leap forward” officials began to report massive new yeilds in agriculture, field producing many times more than they were capable of doing. Soon anyone reporting they had reasonable expectations had their loyalty questioned and they soon learned to either lie, or they would be jailed. Further when inspectors came by, the local officials would steer them toward a “typical field” which was in fact four or five fields’ worth of crops translanted into one place. The inspector would leave believing the inflated numbers while all the crops on that “typical field” died. meanwhile, food consumption shot through the roof, encouraged by Mao. It didn’t help that Mao also sold much of the food to other countries. Pretty soon reality crashed in and people literally started starving to death. fearing a restless city population the communists stole the food from the farmers to feed the city folk. all in all between 16 and 40 million people died, mostly among the very people who grew the food.
And that’s only self-deception. The deception presented to the world is even deeper. Bill Clinton agrees to appear in Tiananmen Square. He was told that this was a traditional place for foreign dignitaries to visit. That was a lie: they wanted him there merely to signal that America didn’t care about the massacre there. They also told him that he would get the chance to speak to the Chinese people directly about freedom and all that good stuff. A Chinese friend in law school told me about how that deal worked out; all across her country, there was suddenly a TV outage that night. What a coincidence!
But it gets worse than that. The protests themselves weren’t really about freedom as so many americans believed. mind you, they literally held up signs that said freedom and liberty but to them the terms meant “the freedom of Mao-style dictatorship.” They were really protesting Deng Xiaoping’s privatizing of the economy. And communist papers like the People’s Daily encouraged that misunderstanding.
Anyone who trusts the numbers or “facts” coming out of a communist country, or any totalitarian dictatorship for that matter, is willfully blind to history.
Again, if the healthcare is so great there, then how come their leader would have none of it? Actions speak louder than words and all the questionable data in the world can’t change the fact that when the chips were down and their leader’s life depended on it, they didn’t trust their own supposedly great health care system.
Seriously, what is wrong with otherwise intelligent people like you who buy into totalitarian propoganda? Do you not understand how stupid you sound to anyone with common sense? do you even understand that you can’t trust them? or are you so blinded by ideology you don’t even see the problem?
Patrick S. O'Donnell - January 9, 2009 at 5:27 pm
I know all about the follies of Mao’s policies and the great famine in China, having commented about it several times at several blogs. A nice comparative assessment of China’s success on the health care front as well as other indices of human development is found in Amartya Sen’s Development as Freedom (1999). Otherwise my comment stands and I find the remainder of your rant, when not off topic, unintelligible.
Quidpro - January 10, 2009 at 11:55 am
No. Idealogy-free health reform is not possible. We live in a time where all issues, institutions, and ideas are increasingly politicized. Science, the academy and law are increasingly politicized. So why should we expect anything different for health care?
What are the the goals sought by reform? The American model stresses inovation and quality. The Cuban model stresses equal access and quantity.
As Patrick states, it is not difficult to learn of the quality of medicine in any particular country. So let’s consider the international market for health care. When people want quality services they come to the US, not Cuba. Or Canada. Or the UK. I would hope that any reform to health care would not threaten this recognized expertise.
Aaron - January 10, 2009 at 9:18 pm
To answer the question posed by your post:
No.
A.W. - January 12, 2009 at 9:03 am
Patrick
You know all about China and its incompetancies? Well, maybe so, but you seem to have failed to grasp that it is not a bug in the communist system, but a feature.
And now you are claiming China has good health care too?
Is there a communist country you don’t claim has great health care?
And notice you can’t even address the fact that Fidel won’t take his own country’s health care. I suppose because there is nothing really to say about it. it is as searing an indictment as you can get.
Maggie Mahar - January 15, 2009 at 3:12 pm
Frank–
Thank you for mentioning the podcast.
“Ideologue” and “Ideology” became dirty words during the Cold War. Ideologues (communnists and socialists) believed in
social policies such as “from each according to his ability and to each according to his need.”
True-blue Americans, by contrast, argued that policies (or social values) such as these undermined the “freedom of the individual” so prized in the U.S. The individual who is fortunate enough to be born healthy and talented (and white) should be free to make as much money as possible and pay as little taxes as possible.
Why should he have to share with those who have less ability– and greater need?
(In school, the children of the 1950s were taught that Capitalisn not an “ideology”–it was not a belief-set–it was a god-given truth.
The social values of socialism/communism stress a collective vision of the public good ,while in the 50s and early 60s (the height of the Red Scare) the U.S. stressed the importance of the individual.
In the 1960s, this changes with the civil rights movement and the war on poverty. We seemed to be moving toward a collective vision. But then came the backlash– the Me Decade (the 1970s) and the
Greed Decade (he 1980s).
By the 1990s, anyone who talked about social values was considerd overly “earnest.” (I rememmber one day in the 1990s, when I was reading the New Yorker, and realzied that, when I wasn’t looking, “earnest” had become a pejorative term.
Going back to the 1950s –Of course the old Soviet Union was far from pure.. It violated the values of communism: there were classes, there were wealthy beaurocrasts, there were peasants. . . .But there was equality in some areas: In the 1950s intelligent Soviet women could receive as good an education as intelligent men; everyone who was not in prison had access to heatlh care. This was not true in the U.S. (Before Medicare, the elderly often received very little care. And it was rare to meet a woman with a Ph.D. or M.D. By contrast, here were many Soviet woman scientists and dctors.
But on the whole, the Soviet Union did a poor job of living up to its philophsy. Nevertheless, values such as “from each according to his ability . . .” could be found, in much purer from, in socialist countries like Sweden and Denmark.
To this day, these countires have healthcare systems that are better than ours: not only are they more equitable, outcomes are better.
France also has an excellent healthcare system–better outcomes, much greater equality, and all at a much lower cost. I always like to say that the French have such a good system because the French believe that nothing is too good for another Frenchmen. Unfortunately, we do not feel that way about each other. Our “Individalism”
leaves many of us unable to see beyond the speck of self.
Not long ago I heard someone who is supposedly a heathcare reformer (Belinda Lake) tell a large audience: Don’t ask an American family to give anything up for another American family. They won’t do it. That’s not our culture.”
Without question, ideologiy–i.e. a commitment to certain social values should be a part of politics and a part of healthcare reform. Without that “ornate, vivid, deliberately suggestive” language that objectifies”moral sentiment” we would have only a technocracy–and technocrats.
(Thank you Frank for that wonderful quote)
A.W. –I’m afraid you know very little about healthcare in other countires. Try reading some U.S. medical journals. Research shows that we rank very poorly –even when you only look at Caucasian Americans– in terms of life expectancy and coutcomes for many disaess.
It is a myth that people from Canada come streaming into the U.S. for healthcare–propaganda put out by the for-profit healthcare companies. Reserachers writing in a peer-reviewed medical journal (Health Affairs) looked
into the myth, interviewed hundreds of American
doctors living near the border and looked at
admissions information at hundreds of hospitals near the border. They then wrote an article titled “Phantoms in the Snow.” All of those
Canadians who supposedly come here for haltlhcare simply don’t exist.
And A.W. –As for “countries (and governments) lying, pathologically,” have you spent much time in the U.S. in the past 8 years?
pathologically
Maggie Mahar - January 15, 2009 at 3:15 pm
Frank–
Thank you for mentioning the podcast.
“Ideologue” and “Ideology” became dirty words during the Cold War. Ideologues (communnists and socialists) believed in
social policies such as “from each according to his ability and to each according to his need.”
True-blue Americans, by contrast, argued that policies (or social values) such as these undermined the “freedom of the individual” so prized in the U.S. The individual who is fortunate enough to be born healthy and talented (and white) should be free to make as much money as possible and pay as little taxes as possible.
Why should he have to share with those who have less ability– and greater need?
(In school, the children of the 1950s were taught that Capitalisn is not an “ideology”–it is not a belief-set–it is a god-given truth.
The social values of socialism/communism stress a collective vision of the public good ,while in the 50s and early 60s (the height of the Red Scare) the U.S. stressed the importance of the individual.
In the 1960s, this changed with the civil rights movement and the war on poverty. We seemed to be moving toward a collective vision. But then came the backlash– the Me Decade (the 1970s) and the
Greed Decade (he 1980s).
By the 1990s, anyone who talked about social values was considerd overly “earnest.” (I rememmber one day in the 1990s, when I was reading the New Yorker, and realzied that, when I wasn’t looking, “earnest” had become a pejorative term. )
Going back to the 1950s –Of course the old Soviet Union was far from pure.. It violated the values of communism: there were classes, there were wealthy beaurocrasts, there were peasants. . . .But there was equality in some areas: In the 1950s intelligent Soviet women could receive as good an education as intelligent men; everyone who was not in prison had access to heatlh care. This was not true in the U.S. (Before Medicare, the elderly often received very little care. And it was rare to meet a woman with a Ph.D. or M.D. By contrast, here were many Soviet woman scientists and dctors.
But on the whole, the Soviet Union did a poor job of living up to its philophsy. Nevertheless, values such as “from each according to his ability . . .” could be found, in much purer from, in socialist countries like Sweden and Denmark.
To this day, these countires have healthcare systems that are better than ours: not only are they more equitable, outcomes are better.
France also has an excellent healthcare system–better outcomes, much greater equality, and all at a much lower cost. I always like to say that the French have such a good system because the French believe that nothing is too good for another Frenchmen. Unfortunately, we do not feel that way about each other. Our “Individalism”
leaves many of us unable to see beyond the speck of self.
Not long ago I heard someone who is supposedly a heathcare reformer (Belinda Lake) tell a large audience: Don’t ask an American family to give anything up for another American family. They won’t do it. That’s not our culture.”
Without question, ideologiy–i.e. a commitment to certain social values should be a part of politics and a part of healthcare reform. Without that “ornate, vivid, deliberately suggestive” language that objectifies”moral sentiment” we would have only a technocracy–and technocrats.
(Thank you Frank for that wonderful quote)
A.W. –I’m afraid you know very little about healthcare in other countires. Try reading some U.S. medical journals. Research shows that we rank very poorly –even when you only look at Caucasian Americans– in terms of life expectancy and coutcomes for many disaess.
It is a myth that people from Canada come streaming into the U.S. for healthcare–propaganda put out by the for-profit healthcare companies. Reserachers writing in a peer-reviewed medical journal (Health Affairs) looked
into the myth, interviewed hundreds of American
doctors living near the border and looked at
admissions information at hundreds of hospitals near the border. They then wrote an article titled “Phantoms in the Snow.” All of those
Canadians who supposedly come here for haltlhcare simply don’t exist.
And A.W. –As for “countries (and governments) lying, pathologically,” have you spent much time in the U.S. in the past 8 years?
pathologically
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