 Yes, how are you feeling today? And where do you want to get sick? U.S. or Canada? In order to find out, we're going to talk to a Canadian, our favorite Canadian, Ken Rogers, in the British Columbia. Hi, Ken. Hello, Jay. Now, I'm looking at the Inflation Reduction Act. There's some health provisions in there. But the inflation reduction I had passed by Kamala Harris to break the tie because Republicans voted against it, all of them. And so the politicization of health, health benefits of pharma hasn't really changed in this country. It's almost as if half the country doesn't want the other half to have medical care. And as a result, our outcomes aren't so good, our health costs are really astronomical. And Americans are dying sooner than they have to. Is life better in Canada? It is lots better in that regard. In particular, our health care is universal in a sense that if you have any medically necessary procedure, that's covered, period. So if you have a heart attack, you don't pay anything. If you have, that is the individual. And ours is based on the need rather than on your ability to pay. So that, you know, something like a hip replacement in Canada, because that's a medically necessary procedure, but it's not as urgent a need as a heart attack or certain cancer things or, you know, a traffic accident, you know, you, you would continue to get bumped down the line. And so you'd have a waiting list for something like a hip replacement. But when you have universal coverage, by universal, I mean, absolutely everybody is covered and the priority is on the need, how medically necessary is that procedure. You're going to have a lot healthier society, but you're also going to have an awful lot more medical procedures. That is, if you think of in the US, when does the poor person going to get their knee replacement or hip replacement? You know, well, if they don't have insurance that covers it, they're just going to delay it or not get it. You know, and so the economy suffers because that person is less healthy. I was most surprised in Canada when they, you know, I'm old enough that I went through the many years that it took for the Canadian system to come into place. And by the way, the Canadian system is nowhere as all inclusive as some of the European countries, you know, the Scandinavian countries, Germany, Holland, they all have Britain and France. They have a more inclusive universal system in Canada, like our system does not include dentistry. Now it does include, you know, if you were in a car accident or you got thugged on the street and you had your chin bashed in, you know, and you're in a hospital, that procedure to fix your mouth and your teeth and everything is included in the medical, in an assess the universal coverage as a medically necessary procedure. But, you know, otherwise, you know, dentistry is not included. But I grew up as the laws changed and what was or was not included in the Canadian system. And ours is far from perfect. But it's sure better than the American in the sense that we do not have people go bankrupt because of a needed procedure for themselves or for a loved one. You know, the thing that surprised me most as the many years went by and the Canadian system got developed was the attitude of medical doctors. Initially, the doctors were the most opposed to the whole idea that they kind of had the idea that if you had some general national Medicare system, they were just going to be civil servants and going to have be stomped down and whatever. But actually, it's been a fantastic bonanza for the doctors. It's been a, you know, economically the best thing that ever happened to them. They have less expenses. They don't have to, you know, have any collection problems. And yet, you know, the doctors like the doctor's services are all covered as if they were medically necessary. So a hypochondriac can go into your corner medical professional, you know, every two weeks for forever and ever. And each time he goes to visit, it clicks through the meter and the doctor gets paid. You know, it's really up to the doctor to tell them to stop coming in for unnecessary things because the legislation treats it all as necessary. So, you know, they, you know, they have, you know, some efforts by the provincial governments to try to prevent, you know, somebody that's churning customers through, you know, when not they're not really necessary visits. But those are pretty rare. But the, you know, the doctors, you know, they don't have the same expenses that a doctor in the US has. The first side is they don't have any bad debts. Anybody comes in. There's a fee schedule. The fee schedule is really negotiated between the, let's call it the medical union. I call the union, even though in theory it's a professional organization. But it's each province negotiates for the fees for each service that somebody provides. And so they get paid in full for, you know, somebody coming through for each item. The, you know, the litigation is something that in Canada there's almost none of for malpractice that there's a federal entity that handles all of the malpractice claims. And for example, I looked at a study the other day that had over the last five years, about 215,000 people estimated to have died because of medical acts, let's call it medical errors, you know, rather than a soft pedal of malpractice. But enough of an error that somebody died and that in the United States would have instantly brought on mega litigation. Well, of those, only 2% of them actually ended up in any litigation. Of those, a little over two thirds of those, that teeny percentage were kicked out by the courts, like just dismissed fairly quickly, or the applicant abandoned it. Well, in the end, you really only had 2.5% of the claims that proceeded. You know, there was the small percentage that even got to a lawsuit. And then you had only 2.5% of those that ended up in damages. And the average damages for over a whole five year period, including, you know, if there were any big numbers in comes in the average, was a little over $100,000. So that you really had, you know, you know, five years for the whole country, you know, which has a population about the same as California, you know, you only had about $2 million of of money paid out. Now, they really don't have any that I could see where there's punitive damage. You know, the the and part of it is really you get a correlation of interest between the government and the medical profession. If the government has to tax to get the money to pay for the medical, they don't want to pay more because of a bunch of legal action. And they're the ones that create the legislation. So you really have, you know, a medical doctor, for example, will pay a fee for it's a pretty small fee compared to American insurance cost, you know, for medical malpractice or whatever, just so you keep it on the plate. Well, you know, in Canada's biggest province, Ontario, I think that Ontario pays 85% of the fee, even, you know, it's like essentially nothing. So that the the cost of all of the medical in Canada is about two thirds of what it is per capita or as a percentage of GDP compared to the U.S. And yet, we got a bigger a better bang total. I mean, your economy is better if you have the, you know, bottom, you know, one third of the people getting much, much better health care, or you know, whoever the people are that portion of the people that can't afford care if it was on a pay, pay it to yourself basis. Well, you think outcomes are better if you're going to get sick. I mean, forgetting about the economics for a moment, where would you rather be sick? Well, if I was very wealthy, and I could afford to go to the Mayo Clinic, I would rather get sick in the United States. But if I were any ordinary citizen, I would sure prefer it in Canada. The, you know, the quality of the average, you know, physician is essentially the same. The technology being used is the same. It's just in Canada, the priority is need in the U.S., the priority for who gets served first is who puts the money on the table first, or the most money. What about drugs? You know, pharma is huge global industry, and sometimes the price bears virtually no relationship to the cost of manufacture, or even the cost of R&D. How it has the cost of drugs, the availability of drugs, pharmaceuticals in Canada? Well, it's, let me split it down. If you go into a hospital and you have some, you know, medically necessary procedure, that's the terminology. And you've got some weird disease like Guillambari, I don't know if you've ever heard of it. Yeah. You know, but it's one that if it's not caught, the result is, it starts to look like a polio. Anyhow, the medical method to solve that is really to take thousands of blood donations and you create a plasma that's a mixture of a large number of blood donations, and you have a cocktail of that and a bunch of pharmaceuticals, and that that cures it. Now, I have a very close relative that had that disease, which is why I at least have heard of it. And it was all in the hospital and 100% of it was paid for. It cost nothing whatsoever. You know, the drugs included. Or my wife, who died of cancer about five years ago, but went through a fair amount of chemotherapy and chemo is essentially a whole bunch of drugs that was 100% paid for by the Canadian system. You know, she and I didn't have to pay anything for those drugs. Now, if I go to my normal GP or general practitioner, and he suggests I should take Tylenol threes for something, he may give me a prescription and I go to the corner drugstore and I have to pay the drugstore something for that. However, that drugstore has bought it under the Canadian pharmacare type of system. And so that the drugstore didn't pay Pfizer or Merck or Rabbit or any of the big pharma companies the full price for that that the US pays. You know, they've negotiated a price and then usually each provincial government even subsidizes those. And so you really don't have much like drugs that like there are few things not included in the Canadian system. You know, I mentioned dentistry. You know, I care, you know, if you go and have your eyes tested to see whether you need new glasses or not, that is not covered in the Canadian system and there's a few other items. But drugs is one of the items. Well, everybody can also get in Canada supplementary insurance. And because the costs of the drugs at the drugstore have been subsidized by the governments, firstly by negotiating prices for everybody. You know, buying in bulk, that then this insurance for somebody is a very nominal cost compared to US prices. Yeah, it reminds me of the movie SICKO, which was a kind of a story of the firefighters and first line defense people who helped after 9-11. And one of the elements of the movie was these people were taking very expensive drugs to deal with the medical issues that arose out of their work at the site of 9-11. And they wound up making fun of that by going into Cuba. And the very same firemen were in Cuba buying the very same drug that cost a fortune in the United States. And it cost pennies, literally pennies in Cuba. Same drug, same manufacturer. And you really wonder how that disparity could exist. And by the way, the Inflation Reduction Act that just passed in the Senate in a way it's action in the House, I think. This is hot news. It passed only because Kamala Harris broke the tie. The pharmaceutical industry was kicking and screaming about the provision that would allow negotiation of drug prices like in Canada, like Canada has had for years. But in the United States drugs are so much more expensive because there hasn't been any such ability for the government or any of the government agencies involved in health to negotiate the cost of the drugs. And now there's going to be some negotiation possible. But there are caps. There are various caps. And it's an imperfect solution. And it's not nearly as good as what you describe in Canada. And I find it remarkable even now when we recognize that people are dying for the lack of insulin, for example. Still, the pharmaceutical industry fights like hell to stop any kind of relief for them. And these caps are really a thorn in the side of anyone who cannot afford to buy the drug, doesn't have insurance and the like. Well, you mentioned Cuba. And as a Canadian, we don't consider Cuba to be so bad compared to the attitude of the United States. And Cuba, interestingly, has much better healthcare system than the United States in regards to if you got sick in Cuba, their coverage is actually better than the Canadian coverage and the quality of their medical people is right up to world top world standard. Even though, you know, it's a really, really a poor country because of the American sanctions, just squeeze them to death. I enjoyed your your Cuba comment in that regard. I was very impressed with the medical coverage and quality of care in Cuba. Yeah, Cuba sends doctors, medical professionals to other places in Latin America to help them. It actually exports its expertise. So you got to give them credit. Anyway, diabetes, big problem. And you know, there's so much in the media about people who cannot afford the insulin and don't have insurance and they wind up dying. They wind up dying in this country for the lack of insulin. Well, Bernie Sanders has been beating the insulin drum in particular, because it's such a blatant one. Yeah. And you know, he's dead on. I mean, he lives just, you know, you know, I don't know whether it's 50 miles or 100 miles from the Canadian border and all kinds of people in Vermont to cross the border and get their insulin. I was going to ask you about that. So if I'm an American and I want to get cheaper, much cheaper insulin, I can just go across the border. I can, I guess I can buy at any number of places in Canada and come back with it, right? Yes. Well, now I'm not sure what American customs have, you know, what, you know, what they would call an illegal importer or anything, but I don't think so because I mean, my knowledge of that cross border stuff in a lot of ways was, you know, listening to Bernie Sanders when he's on national TV saying his neighbors are crossing the border with the insulin. I don't think he would be saying that if it was an illegal activity. Well, you know, you've been talking about how this is free and that's free. But what I just want to confirm is that when you pay your bills as a Canadian citizen or resident, when you pay your bills on the first of the month, you have to send a check to the National Health Service or is it zero pay, zero bills, no cost whatsoever to get the basic, you know, health care that people have in Canada? And Canada has 10 provinces and each province administers the health care in their province. The federal government provides a huge portion of the financing. It's much like the US, the federal authority has all the taxing power. The cities have the most responsibility in the lease taxing power and the provinces or the states in the US case are in the middle as they don't, you know, they have lots of responsibility, but they don't have enough money to pay for it. They need to get on bended knee to get the feds to help. So, you know, that's really where we sit. So, do you have to pay anything? In some provinces, they have had a monthly amount you'd pay for your health care. I used to live in, you know, two different provinces which had a monthly amount. That amount, if your income was below a certain level, you paid less and if your income was below another level, you didn't pay anything. But the amount was pretty small. It was like a hundred bucks a month. Now, that has generally been eliminated, you know, that I don't know of any province now that charges a monthly fee. Of any kind. You're right. Right. The other thing you mentioned that I think we had to spend a moment dwelling on is the economics. You're a student of business and economics, so you can certainly appreciate that a person who is sick or worse bankrupt because he's sick or she or somebody in the family is bankrupt is not going to be as productive as if he or she were well. And so when you take that on a macro level, these things we've been talking about have a huge effect. Am I right on the national economy of the country involved? Can you talk about it? Yeah, I would even say it's a little more than the way you described it because there's a difference of the worry. You know, if you're just worrying about it as opposed to actually having dispersed, you know, you're not as productive. And I'm a great believer that society gets their leaders and their great producing or productive people from a wide swath of the population. If you you just cannot rely on the sons and daughters of the really, really wealthy, you know, most second generation wealthy people are spoiled kids and no good for anything. You know, the kid that came from the wrong side of the tracks and the ghetto that scraped and finally made it to a college is probably going to be an awful lot more productive. Well, if you look after the health of the bottom rung of people, you know, their kids are going to help you a lot more than then if they were just left to in smaller, you know, our Canadian system has an unusual population with as it comes with natural health problems almost. And we have, you know, about 5% of the Canadian population are the indigenous people. And a lot of them live in very remote places. I mean, where there's no roads and no airports and know this and know that. And even though they're they're totally covered by the federal system, the feds let them down a lot. You know, but when we have a few of those indigenous people living, let's say in the area that I live in Canada, there's a called the Okanagan Valley in British Columbia. And there's a couple of native tribes there where those kids have or those natives have gone through a couple of generations of full health care. And boy, are they productive. I mean, they had this society where in places where they're so remote, or you know, even the the Eskimos are Inuit that in the far north that don't have a couple generations of decent health care that these natives from the Okanagan are just fantastically productive and add to society in great ways. You know, they have wineries. They have, you know, all kinds of neat businesses that they are in and do really, really well at. Yeah, well, you know, it's so interesting to compare that to the way our federal United States federal government is working these days. You know, there's a reluctance to provide social safety net. There's a reluctance to, you know, provide anything to help poor people be less poor. This thing about Roe v. Wade is very troubling because it means there will be children born who the community doesn't care about to people who don't have the money to go to another state or country for an abortion. And they're going to, you know, wind up being poorer still. And if they're sick and they need drugs and they don't have insurance, I mean, there was a tweet this morning about how the price of insulin in Canada is $12 for, I guess, for a month's supply or there thereabouts in the U.S. It's hundreds and hundreds of dollars. If you don't have insurance, you have to pull money out of your wallet. So the bottom line is that these people, A, will be poorer, you know, because of the failure of the safety net, because the failure of a universal health system, because of the failure of drugs at reasonable prices. And as a result, they will not be productive, not as much as the Inuits or the other indigenous people in your neck of the woods. And also be, you know, they will, they will be a drag on everyone else. It costs much more. You have to get your health care at an emergency room every time, which is what happens in this country. It's always the emergency room. And so what you have is a completely dis-economic experience. It's almost as if the people in Congress wanted to hurt the poor people. It's almost as if the people in the Supreme Court wanted to have unwanted babies in this country who will make it even more difficult for the poor people. And the net effect for the lack of universal health care, universal drug coverages is absolutely a damaging, if not a profoundly damaging blow to the economy of this country. We may not see it yet, but it is coming. Don't you agree? Well, I agree. And while you were giving that thought, made me think of perhaps the best example in the world of treating your entire population as being the key to your economy is Singapore. Singapore is a small place. One city might have six million people stuffed in it, or it's the size of Boston or San Francisco or Philadelphia or Dallas kind of thing. But nevertheless, they had no natural resources. They had nothing going for them. The political decision was the only thing we have is people. So why don't we educate them, create a healthy environment? And they stood on their head to move everybody along. Part of the reason they now have six million is everybody that lived with several hundred miles away would try to get to go to Singapore and see if they can join in. But it's really the second generation and third generation people that have made it to a standard of living that's far better than the US right now. Yeah. Oh, all true. They're so smart. But it's not rocket science. This country could do those kinds of things. It's just that the people who are running the country just can't seem to find their way. And one thing you and I have talked about this is if I'm really dissatisfied with the United States, if Trump is ever or is acolytes are ever elected, presidents occupy the Oval Office and do the kinds of things they were teasing us with, teasing themselves with in his first term, you know, it's going to be much worse for the average citizen, not just the people who are disadvantaged economically or health care wise. Everybody is going to suffer in one way or another. And so, you know, the question is, suppose I cross the border, you know, in the state of Washington over to British Columbia, and I say I present myself and I want to have the benefit of the Canadian health care system. I'll be there. I'll bring my backpack and I'll sign any papers you want. Can I do that? Not the first day you arrive, but it's a fairly short period of time that you need to be a citizen. I, you know, I'm not sure of the immigration status, but for Americans, you know, much like somebody who's from Australia or United Kingdom or New Zealand, you know, they come to Canada often and work here and have all the coverage. Some, you know, are here, you know, intentionally on a temporary basis, but to work, you know, and they're not limited in their working like US visas, but also, you know, they can get citizenship while the minute you've got to work permit and things the health care system applies. No, that's really good. And so, gee, that's very appealing to be able to do that. And as you mentioned earlier, I can always get kind of a supplemental policy to cover me for the gaps while I'm waiting, am I right? Oh, you'd always get service. That is, you know, if you're in the US and you, you know, pay for the service there, if you cross the border, the cost to pay for the same service will be less, you know, like, you know, but, you know, you have difficulty paying. Like some of the provinces are really careful to not allow physicians to do extra billing, you know, so extra billing kind of highlights, you know, one of the problems with universal health care is that the rich guy gets annoyed that he wants a hip replacement and he wants to go to the front of the line, you know, and he can lay down a lot of money. And so, you know, why can't he just go to, you know, the orthopedic surgeon and say, put me to the front of the line and I'll pay more, you know, and if the surgeon had the legal authority to do so, he probably would. Well, in Canada, that's not legal. You can't jump the queue. You know, the universal coverage, it's kind of like for a medically necessary procedure or service based on need, not ability to pay. So the guy with the most need goes first. That's fair. That's totally equitable. It's fair and reasonable, but you want to jump the line anyway. But then you have the idea of let's get down to constitutional rights and say, pretend I'm the rich guy, which unfortunately I'm not, but anyhow that I want to have my hip replacement and it's really annoying me and I'm hobbling and so that I could give a constitutional argument that my right to life, liberty and the pursuit of happiness or whatever the phrases are in the constitution, you know, that's suffering badly and that, you know, this healthcare system is preventing me from paying money to get it fixed and that's unconstitutional. You're depriving me of a right. Well, those cases, they've actually had some of those cases in Canada and they've booted them out. You know, that is, they've kind of said, you know, yes, you know, Mr. Rich Guy, you're suffering. That is unreasonable, but it does not go, it doesn't pass the public goods or what's in the public good test. That is, if you do that, it damages the system and the system doesn't work. And so goodbye. That's a wonderful result, Ken. That's so reasonable and rational and equitable. In any event, you know, we're out of time and I just want to thank you for this discussion. It's helpful and it's helpful to understand where the U.S. is and where it isn't and we have to knock our heads now wondering why it isn't and why this country can't seem to take care of its citizens and doesn't want to. It doesn't want to give them options. Even the Obama Affordable Care Act is so constrained and limited that we have to work so hard against so many lobbyists to achieve public health in this country. It's not a good sign and if I don't go to Canada, I'll take a look at the U.K. Maybe you can look with me. Check out Europe. Anyway, thank you, Ken. It's great to talk to you, Will. One last bit is politically. It seems really stupid to be against health care because if you take people in Canada, there is nothing as sacred politically as the health care system. The push is to have more, better coverage, not less. And there is nobody like medical doctors. Like there are really rare, rare occasions where you've got people that would politically vote for any reduction in anything to do with the health care. So I can't see why people don't really push it for American political gain. Yeah, absolutely. It's a great platform point for anybody running for office as it has been, but it doesn't seem to get over the Rubicon that well. Anyway, we'll see what happens with the implementation of the changes in the Inflation Reduction Act. It remains to be seen how effective that will be and remains to be seen what we're going to talk about two weeks from now. Maybe we should talk about retirement systems in the U.S. versus Canada. There's a lot there too. Ken Rogers? Well, you keep picking on where the U.S. has no safety net and we got lots. Okay, that's the subject two weeks from now. It's the comparative retirement systems between Canada and the U.S. With Dr. Ken Rogers. Thank you so much, Ken. Bye for now. Aloha. You can also follow us on Facebook, Instagram, Twitter, and LinkedIn, and donate to us at think.kawaii.com. Mahalo.