I get to vote!

… at least in this federal election.

After Elections Canada’s letter requesting my intended date of return, I responded by postal mail declaring a future date that should accommodate my intended career development in the United States. Needless to say, that intended date was pretty far into the future. At the close of my letter, I stressed that the Canada Elections Act has no statutory time limit on the intention to return:

I also write to emphasize that I became a nonresident of Canada upon acquiring residence in the United States on ****** **, 2014. Therefore, I am within the five-year limit on actual time abroad recently reinstated by the Court of Appeal for Ontario, even if my intended return would be beyond five years, since the applicable statute imposes no temporal restriction on the intended date of return for an eligible elector “who… (c) intends to return to Canada to resume residence in the future.” Canada Elections Act, S.C. 2000, c. 9, § 222(1).

I look forward to receiving a special ballot from your office at the upcoming election.

This week, I received the special ballot voting kit, which includes a guide pamphlet, ballot paper, an inner envelope, an outer envelope, and a preaddressed envelope.

Voting kit for special ballot
Voting kit for special ballot

* As far as I am aware (and yes, I’ve checked), it is not illegal in Canada or Ontario to photograph this kit, provided that no vote has been marked. I haven’t yet decided for whom I will vote, so this photography serves simply as an illustration of what to expect for Canadian expats, rather than as evidence of my vote.

Hopefully this won’t be the last time I get to vote in Canada from abroad.

Are you a Canadian temporarily abroad?
Register to vote with Elections Canada!

The silent threat

On September 11, 2001, some 3000 Americans were killed by terrorists... every year since... some 20000 Americans died because they couldn't get health care.

Terrorism is salient and graphic. Wars abroad are visible — at least imaginable. Justifying trillions in spending on fighting threats that can be exaggerated is easy when triggering fear in the population is as easy as reporting a claim without evidence; even more so when all Americans feel like it’s a threat they face.

But death from lack of access to medicine isn’t the kind of problem that privileged lawmakers and the people with power and influence tend to encounter, except, perhaps, the doctors and health economists who see it most vividly.

Quotation above from The Healing of America, by T.R. Reid. Required reading for HCMG 850.

I am Un-American

Yes, it’s no secret that I find myself refusing to accept unregulated gun ownership. But I’m not going to use this short post to advance that view specifically.

Without speaking to the many rational arguments both supporting and opposing gun rights, specifically in the context of the United States, I wanted to point out the illogicality1 of the modes of argument adopted by some in this debate.

1 Look it up in the Oxford English Dictionary.

un-American

Generally, the label of “un-American” is applied to people and policies that are perceived to be contrary to “American values”—whatever they may be for the speaker who uses this label.

There is no shortage of recent news articles highlighting someone’s usage of this label:

As these examples illustrate, the users of this label are not limited to one party or view. They are often the worst self-evident cases of ad hominem attacks on the person who holds a view rather than the merits of the view.

In another more subtle form, this argument is stated like “gun rights are a part of American identity; refusal to accept that is incompatible with being American”. This comment on a CNN article exemplifies this point of view:

CNN comment: "Feel free to MOVE to another country then... STOP trying to change OUR Country STOP trying to take OUR Constitutional rights away! GO AWAY....PLEASE"
An expression of the un-American attack

The problems with this are in its implications:

  1. Gun rights are unquestionably integral to American values.
    I’ll address this below under the constitutionality argument. Nevertheless, the fact that there is any domestic debate on the issue naturally refutes this.
  2. It’s wrong not to embrace American values.
    There’s two ways to address this. First, there should be no obligation for a non-American (by birth, citizenship, etc) like myself to accept American values, whether I live in the US or not. Second, even American citizens are members of a pluralistic society that should respect differences even if they do not conform to norms.
  3. Dissent is invalid unless it conforms to American values.
    Isn’t dissent and discussion a part of liberty and democracy—actual values that most Americans embrace and share? Why should moral views on specific issues be uniform?

Nothing to learn

Furthermore, the comment above espouses the view that America has nothing to learn from other nations and cultures, a supremely arrogant and unacceptable view for any member of any nation.

If another nation is better at ensuring widespread access, low costs, and high quality of health care, or then there is something for America to learn, even if that system is socialist.

If another nation achieves a lower crime rate without granting unrestricted gun ownership, there is something to learn.

Or I could accept her argument that anyone seeking to make America better in any way by modelling changes on other nations should just leave. In that case, see ya, suckers. Feel free to let your beloved country suffer from all of its problems.

Constitutional ≠ righteous

I don’t care how you interpret the Second Amendment, but either way, a legal document does not, by itself, provide a moral basis. Laws are formed from morals and to uphold morality, but are not themselves sources of morality.

Just to remind you of that, the University of Pennsylvania’s motto:

Leges sine moribus vanae
Laws without morals are in vain

Not the most eloquent motto in English, but 1) I’m sure it loses something in translation, and 2) the actual importance of this statement is deep.

Just because the Constitution can be interpreted to protect the “right to keep and bear arms” doesn’t mean that the amendment should exist. That would be begging the question (that is, asking whether it’s morally right to have firearms by relying to a document which itself relies on a judgement of whether it’s correct to have the right). The very fact that laws are changed over time reflects the fact that laws come from the values of the populace, which can and do change.

Crossing the border

It’s ridiculously easy to get back into Canada from the United States, it seems, especially for a Canadian citizen.

“Where do you live?
“What were you doing in the States?
“What are you bringing with you?
“Any alcohol, tobacco, or controlled substances?
“Any weapons or firearms?”

Meanwhile, the guy is processing my passport in a reader. The whole interaction was under 20 seconds. Efficient enough, it seems.

When I entered the US on F-1 status, on the other hand, baggage had to go through an X-ray machine, questions were asked about fresh produce (why does that even matter), officers grilled other people for a long time, and the overall trip time gained about two hours from the border.

I don’t think there’s any difference in effective border safety/security on the two sides of this bridge.

My experience with American health care

Right now*, I stand among several dozen patients at Health Center #3, operated by the Philadelphia city government to provide clinical care to residents in a way that is available even to those without insurance or wealth. I’ve nearly been waiting for two hours for a quick skin test.

My alternative is Student Health Service, on another edge of campus, where there is a comfortable environment, shorter waiting times, and probably better trained personnel.

Instead of taking advantage of the benefits afforded to me by my student health insurance plan, a consequence of my attendance at the University of Pennsylvania, I chose this clinic because I could get the test done on an earlier date. I imagined it wouldn’t be as great of a place as SHS, or the expansive, top-tier hospitals of Penn Medicine, but what I am experiencing has convinced me, even more so than I thought before, of the epic failures of the American health care system.

* This post has since been revised and reformatted, although it was initiated during my time in the clinic.

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A comparison

Those who are fortunate enough to have employer- or school-sponsored health insurance may have access to HMO hospitals, clinics, and doctors.

Those who attend a comprehensive university like mine may have access to the combined resources of a student health clinic and a set of university hospitals merely a block away.

Those who are in the lower strata of income and status, or whose recent unemployment leaves them uninsured, are relegated to public institutions such as these health centers, left to understaffed clinics, long wait times, and expensive, unaffordable medications. Some of these people are also caught outside the eligibility criteria of governmental programs like Medicare and Medicaid.

I’m from Canada

If timing weren’t an issue, I would just do this skin test back at home in Ontario, Canada. Sure, the skin test itself might not be covered by the provincial OHIP program, but at least every resident (after a certain number of months of residence) has access to physicians and walk in clinics at no basic charge beyond their taxes; those who are below the low-income cutoff might even pay $0 in federal and/or provincial taxes.

There is no such thing as a general practitioner who will turn you away because you “belong” to another unaffiliated insurance company. Low income citizens do not have to go to a crowded government “health center” for basic medical care; any privately-operated walk-in clinic, or a family doctor who is accepting new patients, will do. The UK also demonstrates how access to prescription medicine can be broadened.

Even those who are insured in the US are shocked when they find the cost of health care to be much higher than budgeted.

  • Students on our private university-organized insurance plan still must pay a $100 co-pay to go to the emergency room, although the co-pay is waived under restrictive conditions
  • There’s a co-pay of $35 for an X-ray diagnostic test. I had a chest X-ray done as a matter of an annual physical examination over the summer in Canada, and it was covered by OHIP.
  • Flu vaccinations are $24 (at least) in the vicinity of this university. While private health insurance may cover the cost, it’s surprising that this basic tool of public health isn’t free; municipal governments in Ontario almost universally administer them at no charge, and they are available through doctors’ offices, public health clinics, walk-in clinics, and even some pharmacies.

Even if we forget entirely about how much this sucks compared to medical care in Canada—which admittedly has its own issues—the disparities in access to, and quality of, health care between classes here in the United States should be appalling.

Dr. David Himmelstein of The Cambridge Hospital and Harvard Medical School, and his colleagues, authored a paper in the International Journal of Health Services in 2004 on the inefficiencies in the American health care system. One of the most potent conclusions is summarized in the abstract:

The United States wastes more on health care bureaucracy than it would cost to provide health care to all its uninsured … Only a single-payer national health insurance system could garner these massive administrative savings, allowing universal coverage without any increase in total health spending.

He also concludes that, in the US in 1999, “administrative spending consumed at least 31.0 percent of health spending… [i]n contrast, administrative costs in Canada… are about 16.7 percent of health spending.” I imagine some people are profiting from this spending.

Closing

I am a student, who, as a matter of circumstance (i.e. parents’ hard work) and fortune, have access to one of the top hospital systems in America. Not everyone is as fortunate. And it takes a bit of altruism to be able to stand up in a position like this and advocate on behalf of those who can’t.

Experience has shown that a weak populace is easier to rule over. One wonders if the goal of weakening the populace, especially the poor, is the reason that America continues to fail at reforming health care.