The horizon is not so far as we can see, but as far as we can imagine

Visiting the Hospital in Canada

So, last night, after a few days of illness, getting worse, I took some codeine and a sleeping pill, lay myself down to sleep, and couldn’t.

Right then, it was obviously serious enough that I needed to go the hospital.

I arrived at one of Toronto’s largest hospitals (Toronto is Canada’s largest city). There was no one else in the waiting room. I was processed and given a bed in a corridor within 20 minutes There were other people, but it wasn’t terribly crowded (I’ve seen terribly crowded). I had my initial evaluation by another nurse about 20 minutes after that. Then I waited two hours, and no one came by, so I flagged a nurse. Oops.

A doctor saw me about, yes, 20 minutes later, got me some pain relief (Thank God) and about ten minutes after that did a manual exam to try and find out what was wrong. Half an hour later I had a referral to a specialist (it not being possible to get said specialist to look on the weekend unless the situation is deemed life threatening), three prescriptions, and detailed instructions on what to do if things improved (not much) and if they didn’t.

I did have to pay for the prescription medicine, which put me back about $40. Fortunately, I was downtown and there was a nearby 24 hour drug store, which also filled the pain prescription (not always a given).

Overall, the experience wasn’t perfect, but it was a sight better than what I rarely hear about from American friends, and not as good as the better European system stories I tend to hear.

I hate going to hospitals, as I spent a lot of time in hospital in my 20s. I think most people who have spent a lot of time in hospitals as a patient hate them. But the nurses and doctors were kind, and other than being briefly misplaced, the experience was fine. I left in better shape than I went in.

This seems to me to the be the basic minimum any prosperous society should expect.

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  1. Willy

    One night I woke up to an increasingly piercing pain near my shoulder, worst I’d ever felt. Called my local big city clinic/hospital. They said I had to get in there now.

    I was admitted into a beautiful new ER suite inside a huge new building with a huge new atrium. Various nurses/techs drove in and out with various huge new motorized-computer-desk testing device thingies. The doctor finally arrived after all that to tell me I needed an MRI. I’d heard the cost for those things at that place was exorbitant, and declined, since the opioids they’d shot into me were easing the pain. They insisted I needed to come back.

    I left after 2 hours with zero diagnosis and a $2000 bill. I later self-diagnosed that it was a bicep tear, and let it heal itself although today it’s a bit weaker than it had been, and I have a little nerve damage. I complained to my older/wiser neighbor about this, and he topped my story about that place.

    His wife had sudden severe chest pains. The ambulance driver had refused to take her anywhere else. After 5 hours in a luxury ER suite, with many wheely-thingy tests and several opioid shots, she came away with zero diagnosis and a $13,000 bill. Six months later his wife experienced the very same symptoms while visiting their daughter in a distant small city. Daughter took her into her own local typical clinic that used typical tools and typical doctors. In one hour mom had a full diagnosis and full treatment plan for $900.

    Recently the CEO of that big city clinic was fired for a publicly reported price gouging scheme involving unscrupulous surgeries. Apparently this is the current state of medical practice in America, a service situation which is difficult to ‘caveat emptor’ with all the smoke and mirrors going on. I’d think that when the healing system of any given society has been allowed to go corrupt (and full retard), that society is fucked.

    It’s happened fast. I never imagined I’d be writing this a few short decades ago.

  2. Webstir

    In a nation whose constraints daily bind us ever tighter, we continue to worship at the feet of “freedom.” Like we all live in some banal western movie. Doesn’t it feel good to be free to take positions that regularly kill others — so long as we in control of our individual liberty?

    Hope you feel better soon, Ian.

  3. Webstir


    It’s called the bezzle. Just look at Elizabeth Holmes of Theranos fame. In our country getting rich by defrauding others is to be admired.

    The Baffler had a great article on this a few years back:

  4. peonista

    I just looked up the price for Alphagan eyedrop as my daughter has medicaide and needs it for her glaucoma and her medicaide insurer will not cover it. We thought we might just buy it ourselves.
    Well 5 milliliters retails for about $470. You can find coupons and get it for $170. This is a 1 month supply.
    Price on all glaucoma drops has doubled every year for sometime.
    Someone is making lots of money on people’s misery.

  5. Hugh

    The problems with American medicine are vastly over-rated. The system for most of us is actually surprisingly simple and efficient. There’s a ditch over there. Go die in it.

  6. marku52

    Sorry to hear it Ian. Hope your feel better soon. At least you aren’t in the US. A friend took his son to the ER, and they described his insurance as inadequate and refused to treat him unless he coughed up $3000.

    American Exceptionalism indeed.

  7. someofparts

    If Stephen Hawking had been born in my corner of America he would have just died at an early age.

    Sorry you’ve been sick. Hope you feel better soon.

  8. DonnaCurtis

    Sorry to hear you had to seek out an ER, Ian. I hope you’re feeling better real soon.

    I recently had a $5000.00 day in an ER but I’m disabled so I was covered by USA Medicare. All I had to pay out of pocket was $154.00 which was billed a couple of weeks later. I wish we could get a Medicare For All here. Yes, it would be expensive but Congress needs to allow Medicare to negotiate drug prices. That would certainly help and it would be better than throwing money away in never ending wars. (Some of us do still dream here in the US.)

  9. Herman

    I hope you get better soon, Ian.

    As for the United States, the answer is that you have to prove that you deserve heath care and the way to do that, like so much else in America, is tied to proving economic worth. Americans hate the idea of the “undeserving poor” getting anything for free or close to free. Besides, they probably did something to deserve getting sick just like they did something to deserve their poverty.

    Even poor Americans hold these attitudes because they are so indoctrinated into believing that the rich are superior and that the poor are trash. They would rather die or go bankrupt from medical bills than give up their “freedom” or see an “undeserving” person get something for free or low cost. American culture is pathological.

  10. Webstir

    DonnaCurtis said:
    “Yes, it would be expensive but … .”

    I think you’re falling into their trap DonnaCurtis.
    Can you explain exactly why medicare for all would be expensive?
    Or, for example, why debt matters to a sovereign nation?

  11. Watt4Bob

    My son attends grad-school in Canada.

    His school admittance hand book listed two important points regarding health coverage.

    1. Health insurance is mandatory.

    2. Health insurance is free.

  12. bob mcmanus

    Oh hell, here why not. Hoping for ya, Ian

    Been bleeding, not spotting but flowing and clotting for a year. Tried for six months to find a urologist, but all I got is Texas Medicare and Medicaid the worst, and with the heavy equipment profitable investments urologists make and diagnosis requires, was rejected by doctors at least a dozen times. The stories Willy tells at the start terrify me, and I am not going to cause the loss of my partner’s house, all she has to retire with, which is the law in Texas.

    So me and Townes, waiting around to die, hoping to not be a burden, having a plan if it gets too heavy.

  13. bob mcmanus

    I should be clearer.

    Yes, if the tests are performed in the hospital Medicare will pay, but urologists don’t like to share, and usually form groups of 5-10 to build their own offsite testing facilities. My Texas Medicare and Medicaid, being evil, will not pay for out-of-hospital testing. So urologists tell me: Suffer and Die.

    If I could get into a hospital with serious enough symptoms then I could get a urologist, but see Willy above. I have also been sent home twice by emergency clinics.

    Lost my primary, but she was a worthless Medicaid exploiter. What’s your name again? Why are you here? Oh, I made an appointment. So how are you. OK. Medicare gets charged 500.

  14. NR

    Hope you get better soon, Ian. Take care.

  15. StewartM


    Can you explain exactly why medicare for all would be expensive?

    It wouldn’t. Even dismissing the insurance bit, if you had to pay out of pocket for healthcare, you can stay in a Dutch holiday for *a week* for the same cost it costs a US hospital for a *day*. For-profit healthcare gives all the wrong incentives; if you have a person who can’t pay you send them home with aspirin and those who can pay you order a gaggle of the most expensive tests and procedures you can think of. Doing both those things up your profit margin.

    My proposal would be Medicare-for-all and VA-for-all, with the VA (which actually gives the country’s best-rated healthcare) setting the reimbursements (no negotiation, private providers have to live under the VA’s non-profit cost structure, which hopefully drives the profiteers out of health care.
    Rather than radical change, this would largely return private providers to the same non-profit model that was in vogue before the 1970s.

    The only problem I’d see with government-provided health care–and this is not unique to it, we have it with private-provided health care– is how much flexibility the system allows. It seems that doctors now are often directed by insurance companies to order certain tests and procedures and treatment first that they don’t think are needed or useful to ‘check the list’ before they can prescribe what they think will work, which drives up cost. Substituting government-mandated checklists for those imposed by private insurance companies isn’t much better.

  16. Webstir

    It was a rhetorical question.
    I try to advocate Modern Monetary Theory whenever I see people buying into the neoliberals “we can’t have quality public services because they’re too expensive” trope. It’s bullshit. Just like bill of goods the deficit hawks always try to sell the people when it suits them. A sovereign state does not need to balance its check book like a household.

    Why? Well, this is one of the better discussions of MMT I’ve seen:

  17. Hugh

    US healthcare is 1/6 of the country’s 18 trillion dollar economy, so $3 trillion. Most industrialized countries have some kind of single payer or hybrid system which costs about 2/3 per capita the US, is universal, and has better health outcomes. We could save a trillion dollars and give real healthcare to everyone. We don’t because our powers that be would rather loot us, kill us, and ruin our lives. Shorter version, our powers that be are monsters.

  18. Ché Pasa

    Wishing Ian restored vigor and freedom from pain.

    Sorry to hear that he had to go to the ER and that he was lost for a time while there. Even in Canada. It seems that shouldn’t happen under a universal health care coverage scheme, but it apparently does.

    I’ve spent plenty of time in US ERs and hospitals on my own account and on behalf of others, and it’s always been a crap shoot. Sometimes there isn’t enough praise for the caregivers and treatment received. Sometimes it’s horrible and potentially or literally deadly. You never know going in what you’ll encounter.

    The testimonies of ER, clinic, and hospital woe documented here are daunting. The problems with US health care access and delivery are well known, or should be, and their astronomical cost is scandalous. Poor diagnoses, poor outcomes, reduced life expectancies, and so on are some of the consequences of the current US health care system, and it seems that those consequences and others are features, not bugs, of that system. They appear to be spreading, infecting other health care systems including Canada’s.

    It seems to be something that grows out of bloated and top heavy administration and deeply embedded corruption. It’s a system which intentionally feeds itself. We see it in many other public and private operations from the military, government in general, to corporations, education, the prison industrial complex and so on.

    Correcting it may not be possible. Abolition and replacement may be the only answer. That requires revolution, and that’s not on the horizon in the Anglo-European cultural sphere; not soon, perhaps not ever. And should revolution ever come, it might well lead to more of the reversion/repression we’re already witnessing.

    Staying healthy to the extent you can, staying out of the self-feeding systems to the extent you can, developing as much self-reliance and community as you can… these are the alternatives. Every one of them is fragile and ultimately interdependent with the very systems they try to counter or escape.

    Nevertheless, we do what we can.

  19. StewartM


    It was a rhetorical question

    I knew it was, I should have directed my reply to DonnaCurtis.

    I’m not completely sold on MMT, though not dismissive of it either. To me, it’s just as valid to point out that we overspend on health care to cover fewer people (often with inadequate coverage), that we maintain near-WWII spending in constant dollars, that we spend trillions on bailouts of corrupt banksters, that we spend billions on mass surveillance and for-profit prisons, that we allow capitalist predators to ‘enclose’ things that once were, and should be again, free or open for profit (Apple, Google, Microsoft, Facebook, etc).

    My reply is thus that it doesn’t matter if MMT is correct or not. Even allowing if it were not, we could still have oodles to spend on improving materially the lives of Americans plus everyone else in the world if we didn’t allow ourselves to be gouged so on just about every front.

  20. Tom

    Scroll down to where it discusses the havoc caused by patenting pharmaceuticals.

    American doesn’t just need healthcare for all, Patents need to go, they hinder innovation and cause stagnation.

  21. Webstir

    Spot on. As to the patent issue, Larry Lessig has been hammering on this point for years. Predictably, it’s fallen on deaf ears. This is one example of my comment above about economists being the high priests of greed rationalization. If I had my way, they’d be the first to get tarred and feathered.

  22. I hope you feel better soon, Ian. Feel free to keep us posted, if you like.

  23. Herman


    Sadly it is not just the elites who want this system. Many ordinary Americans don’t want universal heath care because that might mean more taxes and having to pay for “losers” and “undeserving” people. I have come to believe that we cannot only blame our elites for our predicament. We have to be honest and look at the attitudes that many Americans hold and many Americans would rather live under a crap system than have to pay more taxes or do anything to help other Americans especially if they feel those other Americans are inferior and brought their problems on themselves.

    We live in a society where cruelty and meanness are considered praiseworthy. Beating up on the poor and weak, “punching down” is considered a sign of being “alpha” and might as well be our national sport. I don’t think anything will change until American culture changes and this probably won’t happen unless we have a major catastrophe like the Great Depression. The only reason we got the New Deal was because the Great Depression convinced enough Americans that you could become poor through bad luck and that poverty was not just a sign of stupidity or bad morals. Since the New Deal generation died off we are back to the old belief that the unfortunate deserve their misfortune so to hell with them.

  24. highrpm

    liberal blah blah. i live on the edge of the ‘hood. my apt fronts on the street connecting the hud towers to the nearest parasite liquor store. lots of walk thru traffic. and soon to be more with the opening of the new neighborhood clinic across the street from the liquor store. made possible with public funds granted to short circuit the 911 calls from the towers for freebie transports to the nearest private hospital to treat aches and pains and sores with tylenol and bandaids. i’d welcome you as a buyer in our co-op. lets talk. i’ll give you a good stock price. a great place & neighborhood so you can live the liberal mantra, “diversity is our strength.” and likely suffer assaults & vandalisms at the hands of young teen underclassers who are very good at preying on the oldster vulnerables. which happens repeatedly and infrequently to our tenants.

  25. Herman


    Thanks that is a good example of what I mean. If you think this country could do better and that universal health care would be better than what we have now you must be a dumb, fuzzy-headed liberal who thinks all poor people are wonderful and perfect but has not been “mugged by reality” yet.

    I hope the Lefties on this blog can see why things will never improve in this country. Americans would rather screw themselves over than let any “thug” or “parasite” get a “freebie.” Because we all know that every poor person is a thug or a parasite especially if they look a certain way.

    I am getting to the point where I don’t even care anymore because I am convinced most Americans enjoy living in a hellhole where everyone hates each other.

  26. Willy

    Maybe highrpm hasn’t been mugged by liberal reality yet? Today its all this kind of talk… but then tomorrow WHAM! Then we’ll all have to suffer through endless commiserating with hood liberals all angsty about The Man.

    I’m lucky (in this context), in that I’ve been mugged by both realities. Be nice if people could try to see all sides regardless of how reality has mugged them.

  27. Hugh

    The share of income of the lower 80% peaked in 1968, fifty years ago. Unions have been decimated, pensions and benefits too. Millions of jobs have been shipped to China and elsewhere abroad. 18% of the US labor force is foreign born. The Fed views any wage increase, even theoretical and potential ones, as inflationary and to be crushed. This has created a massive transfer of wealth to the rich. So no jobs, certainly no good jobs. Public education is underfunded and under attack by those trying to privatize it. University is out of reach. Healthcare is too expensive for many to use. The country has been flooded by tens of millions of guns. Big Pharma flooded it with opioids making the traditional cartels look like chumps.

    These things have effects on people’s lives. They destroy, twist, and ruin them. The lower 80% is 260 million of us, and we are all fair game for the powers that be. For those who look at their ‘hoods, maybe they should think a little about who made them that way and never, never had the stones to own what they did.

  28. “I am getting to the point where I don’t even care anymore because I am convinced most Americans enjoy living in a hellhole where everyone hates each other.”

    Me too. Sigh….

  29. Ed

    I get the same treatment in ER’s regularly that you got, Ian. But… I have insurance through an HMO and my employer that is considered a “Cadillac plan” for US tax purposes. That means I pay extra income tax for having it (on top of high premiums of course).

    It’s literally considered a luxury instead of a basic service…

  30. Sid Finster

    Ever since I was a small kitten I have said that healthcare is not an economic good and therefore market mechanisms are not particularly helpful in pricing.

    The entire theoretical underpinning of market economics assumes, among other things, that you have an infinite number of willing buyers and willing sellers, and that everyone has perfect information.

    Now, most of us do not have the type of specialist education and knowledge to determine whether a particular medical procedure is “not necessary, but nice to have” versus “supported by a credible minority of medical opinion” versus “outright quackery” versus “you need this like yesterday or would have died already!” Nor do most of us know the difference between a good doctor, but overpriced versus a relative bargain in treatment, for instance.

    This is especially true when you are lying stretched out on your back in a Stutsman County, North Dakota ER. You are then entirely at the mercy of your doctor, and will have to accept whatever price the good doc charges, unless you wish to secondguess his diagnosis and course of treatment or his pricing *and* you can drive for an hour to get to the next hospital.

  31. edwin

    In spite of what the University said, health insurance costs money, though for most students in Ontario it would be free.

    Ontario health care insurance is billed when you file your income tax. For people earning under 20k the premium is 0. The maximum premium is $900/year. I don’t know what percentage this covers and how much is hidden in general revenue. The premium is included in income tax owing, so there is not really any medical penalty for not paying. Revenue Canada will be after you though for unpaid taxes.

    While medications are not covered, there are special plans to assist with extremely high prescription costs. My wife ended up with a prescription for about 15K a few years back. We were required to pay the first about 1.5k based on income. All prescriptions for the rest of the year were free for the family.

    The WHO data for healthy life expectancy paints a slightly different picture than Ian’s perceptions. The US sucks, but Canada is perhaps a bit better than most of Europe at #7. Of course there are factors other than quality of medical care that affect how long one can expect to live. The real eye opener is that Cuba has a better life expectancy than the US.

    Life expectancy: (2016)

    Japan 84.2 #1
    Switzerland 83.3 #2
    Spain 83.1 #3
    Australia 82.9 #4
    France 82.9 #5
    Singapore 82.9 #6
    Canada 82.8 #7
    Italy 82.8 #8
    Republic of Korea 82.7 #9
    Norway 82.5 #10
    Iceland 82.4 #11
    Luxembourg 82.4 #12
    Sweden 82.4 #13
    Israel 82.3 #14
    New Zealand 82.2 #15
    Austria 81.9 #16
    Netherlands 81.6 #17
    Ireland 81.5 #18
    Malta 81.5 #19
    Portugal 81.5 #20
    Finland 81.4 #21
    United Kingdom of Great Britain and Northern Ireland 81.4 #22
    Belgium 81.2 #23
    Denmark 81.2 #24
    Greece 81.2 #25
    Germany 81 #26
    Slovenia 80.9 #27
    Cyprus 80.7 #28
    Costa Rica 79.6 #29
    Chile 79.5 #30
    Czechia 79.2 #31
    Bahrain 79.1 #32
    Cuba 79 #33
    United States of America 78.5 #34

  32. Altandmain

    Each of the provinces in Canada needs to invest more in their healthcare system.

    There are gaps like dental care, eye care, etc. There also need to be more doctors and nurses vs patients to minimize wait times.

    Many of these could bring about cost savings, such as universal drug care:

    Even though the system is not perfect, as you note, it is still better than the US system. Poor and often even middle class people cannot afford to see doctors or go deeply in debt. Premiums are skyrocketing in many states. Deductibles and co-payments are also going up as well.

    Let us face the brutal reality: Corporations and lobbyists will seek economic rent for themselves, not for the people.

    The neoliberal direction that the world has taken has made things worse, not better.

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