Close The Border To Canadian Health Care

 Next week, the U.S. Senate will return to work in Washington. Several key committees will welcome new leaders, including the Health, Education, Labor, and Pensions Committee, which will be led by Vermont socialist Sen. Bernie Sanders.

Sen. Sanders has promised to make "universal health care" a focus of his tenure atop the HELP Committee. He's long been a fan of Canada's single-payer system, wherein the government has a monopoly on paying for medically necessary care.

But that system is crumbling. Canadian patients face record waits for both routine and emergency care. And they pay dearly for the privilege.

Canada's healthcare system, called Medicare, was once the country's pride and joy. But as the program enters its seventh decade, public opinion is starting to turn. Just over half of Canadians said they were satisfied with their healthcare system in 2022, down from nearly 70% in 2020.

It's easy to see why. Waits are interminable. In 2022, Canadian patients waited a median 27.4 weeks between referral from a general practitioner and receipt of treatment from a specialist, according to the Fraser Institute, a Vancouver think tank. That's nearly two weeks longer than the median wait time in 2021—and almost triple the 9.3 weeks Canadians waited on average in 1993.

And since private health insurance is illegal for care the government deems medically necessary, patients can't pay a premium to escape the queue.

Nor, for that matter, can doctors. They have one customer—the government. And that customer is committed to keeping a lid on costs. Canada spends 12.2% of GDP on health care; health care accounts for 18.3% of U.S. GDP, by comparison.

So Canadian doctors have to do more with less. And that's pushing many to the brink. More than half of Canadian doctors reported burnout in 2021, up from just 30% in 2017, according to a recent Canadian Medical Association survey.

Another survey found that over 75% of Canadian nurses "qualified as burnt-out in 2021." And while doctors work an average of 52 hours a week, they spend just 36 hours treating patients, devoting a total of 16 hours to paperwork and other bureaucratic tasks.

Facing these onerous conditions, Canadian doctors are quitting the business. Nearly 20% of family doctors in Toronto are planning to shut their doors in the next five years, according to a study published in the journal Canadian Family Physician. Many are citing burnout as their reason for doing so.

The Canadian Medical Association estimates some 5 million Canadians did not have a primary care provider in 2021. The Children's Hospital of Recent Ontario was so short-staffed this winter that the Canadian Red Cross needed to send reinforcement doctors.

To add insult to injury, this shoddy "free" care actually costs Canadians a pretty penny. A typical family of four paid a whopping $15,847 in taxes just to cover the cost of public health insurance, according to research from the Fraser Institute.

The Canadian health tax burden has surged in recent years. A childless couple who paid $8,225 in taxes for public coverage in 1997 pays around $15,229 today — an 85% increase.

Not even these hefty taxes can keep Medicare running smoothly. Provincial leaders are asking the Canadian government to cover 35% of healthcare costs, up from the 22% they currently cover. But 57% of Canadians say the current spending rate is already unsustainable, and experts agree. As Steven Staples, national director of policy and advocacy for the Canadian Health Coalition, put it, increasing funding to Medicare at this point is like "pouring hot water into a leaky bathtub."

Rather than doubling down on failed and expensive socialized medicine, Canadian leaders need to consider lifting the ban on private health coverage and allowing market forces to repair some of the nation's broken healthcare system.

Single-payer may be Bernie's dream, but it's rapidly becoming every Canadian’s nightmare. Perhaps some of his colleagues on the HELP Committee can invite some of the Canadians waiting for care to offer a firsthand perspective on the crisis plaguing their healthcare system.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All, (Encounter 2020). 

https://www.forbes.com/sites/sallypipes/2023/01/17/close-the-border-to-canadian-health-care/

Can We Please Stop Asking if Crossword Puzzles Prevent Dementia?

 In the pantheon of lay press health articles that are sure to make me crazy are ones about the supposed benefits of vitamin D, the risks (or benefits depending on the month) of coffee, and the most effective ways to exercise. Lording over this pantheon, however, are articles about how brain exercise can ward off dementia. These articles are guaranteed churnalism and reliable for proving Betteridge's law of headlines.

Before diving into the genre, let’s look at one recent example from the Washington Post, “Can a daily crossword puzzle slow cognitive decline?”[i] Now I have to say, this isn’t a bad article about a study that, although essentially meaningless, is better than most. The study in question was actually a randomized trial. Patients with mild cognitive impairment, generally referred to as an intermediate clinical state between normal cognition and dementia, were randomized to 12 weeks of intensive, home-based, computerized training with cognitive games or to computerized crossword puzzles. The primary outcome in the study was a change from baseline on the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) score.

The results of the study were underwhelming. On the 70-point ADAS-Cog (on which higher scores are associated with worse cognition), scores worsened for people assigned to the games (9.53 to 9.93) and improved for those assigned to crosswords (9.59 to 8.61[ii]). The WaPo article does not overstate the results article but it does commit many of churnalistic sins:

“While the study didn’t investigate whether crosswords benefit younger adults who are not dealing with cognitive decline, it suggests that keeping your mind active as you age may benefit your brain. And the research offers hope to those diagnosed with mild cognitive impairment that they may be able to stave off further declines in the memory, language problems and decision-making that are the hallmark of the condition.”

We can certainly accuse this paragraph of Sin #2 Extrapolation and generalization, Sin #4 Neglecting plausibility, and Sin #5 The Disclaim and Pivot maneuver, as well as mistaking statistical significance for clinical significance. But, as I said, this is one of the good articles covering one of the better studies on the topic. Most articles published in the lay press cover observational trials which show that people who are keeping their minds active – reading, playing cards, doing puzzles – have less dementia than those who don’t. Let’s enumerate a few of the reasons we should be suspicious of these articles.

1.       Little bio-plausibility. As we learn more and more about dementia in general, and Alzheimer's in particular, we realize the complexity of the disease. In Alzheimer’s there is an overproduction and/or decreased clearance of amyloid beta peptides. The pathogenesis also involves the hyperphosphorylation and aggregation of the tau protein. The more we learn, the less likely it seems plausible that puzzle-doing would prevent disease.

2.       Confounding. Doing puzzles or other challenging mental activities is unpleasant for people with cognitive impairment. A person with “premorbid” symptoms of dementia, even extremely mild ones, will shy away from these activities. In an observational study this will cause confounding. People with dementia will not have been puzzlers, not because puzzling prevents dementia but because premorbid dementia prevents puzzling.

3.       Terrible endpoints. If we are attempting to prevent dementia, we would like to know that we actually are. This means showing that an intervention actually preserves people’s independence. Showing that they can do better on a test, one that the intervention group is essentially practicing for, is not an adequate endpoint.

4.       Publication bias. Remember that the entire medical literature is probably biased toward positive findings. This is especially true for small studies. Large studies that have looked at this topic have been negative or profoundly unimpressive (1, 2 and 3).

5.       Sin #6  Keep testing; report just once. I have no proof that this sin applies to this literature but I would be surprised if it did not. In a literature filled with observational studies of clinically insignificant and barely statistically significant results, there is a high likelihood that multiple testing or p-hacking is happening.

Dementia frightens us all. Many of us have experienced a friend or loved one fading away (sometimes quietly and sometimes excruciatingly. The prevalence of the disease is frighteningly high and increasing. We also still have little to offer patients in the way of medical treatment. We all wish there was something simple we could do to prevent dementia[iii]: a crossword puzzle a day; a couple of sudoku, a word finding game. Unfortunately, all signs point to this not being the case and another lazy piece of churnalism reporting on a small, confounded, observational study won’t change that.

Although I would not recommend wasting money on this study, if we wanted to design a good study we could. Randomize people in their 50’s to a number of different cognitively stimulating activities or a non-intervention control. Enrich the population with people with a first degree relative with dementia. Follow the patients for two decades with endpoints being a clinical diagnosis of dementia or institutionalization. I’m pretty sure we would find no benefit.

I hope only hope we good therapy by the time the study ends.

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[i] You’ll never guess the answer to that question.

[ii] I actually had to review the article a few times to convince myself that the benefit was, if fact, as small as it seemed.

[iii] We do know that somethings prevent dementia. Mostly, over the course of a lifetime, things that help the heart help the brain. This is because a a sizable minority of people with dementia have vascular dementia. Don’t smoke, eat well, exercise regularly.

Adam Cifu, MD is an internist, professor, patient Author: Ending Medical Reversal, Symptom to Diagnosis Host: S2D Podcast, The Clinical Excellence Podcast 

https://sensiblemed.substack.com/p/can-we-please-stop-asking-if-crossword

Woke medical schools are a threat to your health

 Doctors are supposed to examine their patients as individuals, analyzing their symptoms and behavior without regard to race or economic status. For hundreds of years, that’s what medical schools taught doctors to do.

Not anymore.

In the wake of the 2020 riots, the Association of American Medical Colleges is trying to change fundamentally how medicine is practiced. This will be hazardous to your health .

The association started initiatives to “promote social justice in a comprehensive manner,” including by pushing medical schools to undergo an inventory to assess their so-called Diversity, Equity, and Inclusion policies. Do No Harm, a conservative medical watchdog group, has obtained documents from medical schools across the country from this inventory, and the results are alarming.

This week, the Washington Examiner will be publishing stories about documents obtained from four medical schools that show an alarming embrace of the social justice ideology behind these DEI initiatives. In the name of “health equity,” AAMC is pushing medical students to rethink how they practice medicine.

“Inequities cannot be understood or adequately addressed if we focus only on individuals, their behavior, or their biology,” reads an AAMC DEI document. Instead, “health equity work requires” the identification and disruption of “dominant narratives” that “limit our understanding of the root causes of health inequities.”

The tendentious ideological mumbo-jumbo continues: “Narratives grounded in white supremacy and sustaining structural racism, for example, perpetuate cumulative disadvantage for some populations and cumulative advantage for white people, especially white men,” the guide explains in a passage filled with enough buzzwords and jargon to choke a camel. “Narratives that uncritically center meritocracy and individualism render invisible the genuine constraints generated and reinforced by poverty, discrimination, and ultimately exclusion.”

In other words, instead of thinking, “How can my patients protect themselves against health problems?” the AAMC asks medical students to think, “What kind of public collective action is necessary to confront health inequity across identifiable populations?”

When doctors are at work, they should focus exclusively on the well-being of each patient, whom they should treat as an individual deserving of an individual's human dignity. They should not be treated as a marker of some social ill identified less by genuine observation than by the doctor's ideological prejudices. These are ills, in any case, for politicians to resolve, not for doctors to freelance. It's one thing if medical students want to become social activists in their free time outside the classroom, but this sort of ideological claptrap has no place taking valuable time and effort in the detailed medical training that doctors undergo.

Seeing patients as members of a racial group instead of as individuals with scientifically explainable health problems is precisely the opposite of good medicine. The state governments that control many of these medical schools should take a hard look at how DEI programs are undermining their public health missions and should reject them.

https://www.washingtonexaminer.com/restoring-america/equality-not-elitism/woke-medical-schools-are-a-threat-to-your-health

Why Have the Biden Papers Surfaced, and to What End?

 On the first business day after Republicans got their House in order, word came that the president they were planning to probe was being probed by the Deep State they too were planning to probe.

In fact, as House Republicans were readying a Church-style committee to investigate the weaponization of the FBI and DOJ, illustrated by acts such as the unprecedented raid of the personal residence of former president Donald Trump over his removal and retention of classified documents, these agencies were pursuing the current president, Joe Biden, on similar grounds.

Now, amid revelations the Biden Papers turned up not just at the Penn Biden Center, but in President Biden’s Delaware garage, and amid public outrage over a seeming double standard in the Justice Department’s relentless pursuit of Trump, and deferential treatment towards Biden regarding classified document handling, Attorney General Merrick Garland has appointed a special counsel to Biden’s case.

With dueling special prosecutors probing the former and current presidents over their removal and retention of files upon their exits from office—Trump from the presidency, which gave him a right to declassify that he maintains he exercised, and Biden from a vice presidency that gave him no such authority—Americans will be fixated on how the DOJ disposes of these cases, and the impact on the 2024 presidential election.

As significant as these matters are, one question looms over them: Why have the Biden Papers surfaced, and to what end?

There are no coincidences in politics. Beyond the conspicuous timing of the Biden Paper leaks, and the Justice Department’s action, are we to believe that six years after Joe Biden left the vice presidency, his lawyers just happened to stumble upon classified documents he took with him, implicating Biden in the same conduct used to pursue his predecessor and opponent for the Oval Office in 2024? Looking further into the timing, actors involved, and how they might benefit from the Biden Papers leads us to several plausible explanations for what’s going on.

Theory 1: Joe Biden is no longer useful to Democrats and/or the Deep State, and the Biden Papers can be used to purge or minimally control him. There’s no shortage of motives for the Democratic Party and/or Deep State to hoist Biden on his own “mishandling of classified materials” petard, leveraging the Biden Papers to induce him to step down, or, at a minimum, stand down for the 2024 election.

For Democrats, the rationale for discarding Biden is straightforward: The president has advanced the radical progressive agenda demanded of him, but that agenda may advance no further with the House lost, Biden is past his “sell by” date, and the Party wants to reset with a fresh figurehead.

Under this theory, the timing of the fishy finding of the Biden Papers in November 2022 was perfect—landing squarely in the period when the DOJ would claim it was prohibited from disclosing politically sensitive investigations. By keeping a lid on the story until January 2023, the politically damaging revelations couldn’t impact the midterm elections, nor derail the Democrat agenda while the Party still controlled Congress.

The post-midterm timing could also prove relevant for another reason. While a president may only be elected for two terms, under the Constitution’s 22nd Amendment, one could serve as president for up to ten years by replacing a president for the last two years of his term, and then winning two presidential elections. Once the clock begins ticking on Biden’s third year in just a few short days, were he to step down or be removed, Vice President Kamala Harris could assume the office and reign for a decade.

However improbable the prospect of VP Harris getting elected twice might be, it isn’t impossible. Remember, Democrat power brokers, presumably led by Barack Obama, thought well enough of Harris to install her as Biden’s VP knowing she might well replace the declining now-octogenarian. And it’s worth noting that in recent weeks, some in the media have seemingly been straining to rehabilitate Harris, while the president’s most visible presence came at a Southern border that stands as a symbol of his administration’s failures—and for which Harris was supposed to bear responsibility. Who a potential President Harris might nominate as a vice president, and how that process might play out alone, could create further political opportunities for Democrats to exploit.

At a minimum, with the Biden Papers hanging over Joe’s head, the Democratic Party could use the probe to pressure him out of running in 2024, particularly with more political carnage perhaps to ensue under oversight onslaught from House Republicans. Down the road, Democrats could argue no person facing federal investigation for his handling of classified documents should run for the president, using it to torpedo Joe and try to claim a “moral high ground” to undermine Trump, knowing he would never bow out.

As for the Deep State, it’s harder to pinpoint specifically why it might wish to see Biden out of power. It is telling, however, that the national security apparatus and Biden White House mouthpieces have repeatedly walked back the president’s proclamations on a whole slew of critical matters of national security and foreign policy. If nothing else, as for the Democrats, this probe provides the Deep State leverage over Biden.

Now, why threaten the president with political and legal liability over his handling of classified documents of all things? Set aside for a moment the significant relevance given the ongoing Trump probe. Recall that as Senate Majority Leader Chuck Schumer told Trump, the intelligence community can get you “six ways from Sunday.” This is to say, the feds could unleash a barrage of far more damaging information on Biden and his relatives to the public—rooted in the contents of Hunter Biden’s laptop alone—not only humiliating the family but putting its members in far graver potential legal peril.

Put yourself in Biden’s shoes. Would you rather cry uncle over relatively less serious charges of having mishandled classified documents, or risk getting hit with bigger bombshells, leading to potential impeachment—impeachment Democrats might wish to goad Republicans into, thinking it will backfire on them going into 2024—possible removal, charges once out of office, and trouble for your family?

On that note, let’s not forget, as the New York Times reminded readers just as the Biden Papers saga was starting to unfold, that Hunter Biden himself is still under investigation and potentially facing charges. Could it be that there’s a quid pro Joe—that if the president walks away now, authorities will spare his son?

Theory 2: The Justice Department and FBI are using the Biden Papers to protect themselves and grow their power. It’s always a safe assumption that government bureaucracies act first and foremost in their own perceived self-interest. For the Justice Department and FBI in particular, the Biden Papers can be manipulated for ends unrelated to sidelining Joe Biden. In fact, if we have learned one thing in recent years, it’s that the national security and law enforcement agencies operate as if they’re superior to commanders-in-chief.

That said, there’s no Deep State without public funding for it, and that funding in part requires political support. It’s perhaps unlikely the Republican House will attempt to use the power of the purse as leverage to rein in the Deep State, but at minimum, the public image of the likes of the FBI and DOJ is under threat with the just-established House Judiciary subcommittee on the Weaponization of the Federal Government. So, from the perspective of the Deep State, what better way to blunt the force of a committee claiming weaponization against conservatives than to, two days after that subcommittee comes into being, announce a special counsel probe of the current president over similar conduct to that which a special counsel was already probing the prior Republican president?

AG Garland made the intended optics quite clear in announcing that the appointment of a special counsel to probe the Biden Papers “underscores for the public the Department’s commitment to both independence and accountability in particularly sensitive matters, and to making decisions indisputably guided only by the facts and the law.”

However many times AG Garland returns to this refrain, of course, it doesn’t make it true. The entirety of his DOJ’s record in targeting Wrongthinkers on everything from Jan. 6 and election integrity, to draconian public school lockdowns and abortion, gives lie to the narrative. The disingenuousness is even reflected in AG Garland’s selection of a special counsel who, though presented as a Republican, a la Robert Mueller, has longtime ties to senior leaders in the DOJ/FBI who have led its politicization and weaponization—conduct he allegedly supported in at least one notable instance.

The appointment of a special counsel in a bid to shield the Justice Department from the House Weaponization subcommittee, and perhaps divert attention from the subcommittee’s findings of Deep State depredations, itself can be seen as political. But the political nature of the Biden Papers probe goes deeper than that.

By selecting a special counsel now for Trump and Biden, the FBI and DOJ likely believe they have now hived off these two cases from the prying eyes of House Republicans and any other inquiring minds. They will stonewall requests for documents and testimony remotely touching on either of the two probes. Just how reckless was Joe Biden with classified documents, what did those documents really consist of, and what else might the FBI and DOJ unearth as they lock down every location tied to him? We may never know.

The special counsel also gives the DOJ optionality. For the sake of argument, assume that the Justice Department recognizes its case against Trump on the mishandling of classified materials, given precedent, and on the merits, is weak. Assume that its case against Biden is relatively stronger, particularly given his lack of declassification authority. How best to “save face?” Punt the pretextual charges against Trump, find no wrongdoing in Biden’s case too as a matter of “fairness,” but ultimately indict Trump on other matters such as obstruction, or those pertaining to the 2020 election. In this way, the Justice Department will claim it acted fairly and independently while still achieving its goal of charging and perhaps convicting Trump.

Creating these dueling special counsels also provides the Deep State optionality of a kind we have seen before—now having leverage over two leading candidates for the presidency in 2024. Remember that in 2016, while authorities were relentlessly pursuing Trump over purported Russian collusion, at the same time it was engaged in a sham probe of Hillary Clinton over her emails. After exonerating Clinton, in the waning days of the election, the FBI Director James Comey, in effect, hedged his—and the agencies’—bets by re-raising the matter of Hillary’s emails based on the bureau’s review of those found on former Congressman Anthony Weiner’s laptop. As with their kid gloves treatment of Clinton, the FBI and DOJ have served as a sword and shield for Biden to this point, but by appointing a special counsel to him, they are, in effect, hedging once again in investigating Trump and Biden.

Theory 3: The Biden Papers aim to distract us from a bigger scandal. This supposition speaks for itself. If Americans are focusing on the Biden Papers, what other scandals or disasters of the Biden administration, the Democrats, or the Deep State are we the people not focusing on?

That it isn’t only reasonable but prudent, based on what we’ve witnessed in recent years, to consider the theories presented herein is a beyond sad commentary about the state of our republic and the power and politicization of our Deep State.

We’re left with one question: If Joe Biden is in effect deep-sixed by that Deep State, will he get behind the House Republicans’ New Church Committee?

Ben Weingarten is deputy editor for RealClearInvestigations. He is a senior contributor to The Federalist, columnist at Newsweek, and a contributor to the New York Post and Epoch Times, among other publications. Subscribe to his newsletter at weingarten.substack.com , and follow him on Twitter: @bhweingarten.

https://www.theepochtimes.com/why-have-the-biden-papers-surfaced-and-to-what-end_4983955.html

How the wokeness it pushes could destroy higher education

 “Get woke, go broke.” It’s a phrase people coined to describe the failure of Hollywood’s recent politics-drenched efforts at blockbuster films, from which viewers stayed away in droves. But now it applies to another field: higher education.

College and graduate degrees were comparatively rare before about 1970. People could be quite successful without them, and there was little stigma attached to their absence.

That changed as the baby boomers and the GI Bill hit colleges. By the 1970s, college became an essential ticket to entry in the managerial and professional classes (and even to military promotions). Where higher ed had once been a luxury, it became a necessity to membership in the middle, and especially the upper-middle, class.

Parents struggled to live in districts with “top” public schools so they could get their kids into good colleges. Once admitted, the students often borrowed huge sums (most of which went into the colleges’ pockets) to attend. The goal was a degree from a “prestige” school, which would guarantee a good job out of college or admission to a top law, medical or other professional school and thus a secure position among the haute bourgeoisie.

That system is falling apart. Higher education’s enormous costs, which have grown at a rate exceeding that of most other items in today’s budgets, have become such that even a good job as a doctor or lawyer often isn’t enough to justify them, and hardly any other professional jobs even come close. 

As a result, college enrollments are plummeting — nationwide undergraduate enrollment fell by 650,000 in a single year, spring 2021 to 2022. It’s down 14% in the past decade, even as the US population grows.

But there’s a new wrinkle. It’s not just colleges that are “woke,” it’s also employers. And woke employers are pursuing a new strategy that may make colleges go broke faster, as notions of “equity” and “privilege” popular on campus spread to the corporate world.

As The Post reported recently, some employers are asking applicants to leave the colleges they attended off their applications. Instead of the school, they are simply to list the degree. Whether it came from Harvard or Slippery Rock won’t matter anymore because the employer doesn’t want to know. Prestige degrees confer “privilege,” you know, and that’s bad for equity.

Well, of course people know prestige degrees confer privilege. That’s why they pursue them. But now all that studying, all those contrived extracurricular activities, all those anguished nights spent writing a heartrending “personal essay” are for naught. You might as well have gone to a school whose admissions requirement was the ability to exhale warm air. The degree counts the same.

But wait, there’s more. The Gartner consulting firm recently recommended its 15,000 clients, in the name of equity, consider hiring people without degrees at all. The focus on degrees is bad for “underrepresented candidates” because they’re less likely to have attended, or finished, college. Gartner suggests employers instead focus on “assessing candidates solely on their ability to perform in the role,” rather than on their “formal education and experience.”

Far be it from me to criticize hiring people based on their ability to do the job instead of the polish of their résumés, but this is a huge departure from the past, and it spells bad news for the people who’ve been selling the polish. If employees are no longer hired based on credentials, the market for credentials is going to head south.

And there are problems on the other end, too. Why should parents struggle to get their kids into “top” public schools if they don’t need to get them into prestige colleges?

This goes double since some top public schools are embracing “equity,” too. At least seven high schools in tony Fairfax County, Va., turn out not to have told their students they’d won National Merit Scholarship awards. That sort of merit-based recognition is bad for “equity,” they felt, and the announcement might make the students who didn’t win feel bad.

So if working hard in a top high school won’t get you a scholarship to attend a prestige school that won’t get you a fancy job afterward, why bother? Why not start work sooner and develop skills and a track record employers will want?

Why not indeed? I don’t think there’s a happy ending for prestige colleges in this. Maybe pushing “equity” so hard was a mistake.

Glenn Harlan Reynolds is a professor of law at the University of Tennessee and founder of the InstaPundit.com blog.

https://nypost.com/2023/01/16/how-the-wokeness-it-pushes-could-destroy-higher-ed/