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This morning my breakfast was ruined, ruined by an anti-health care reform ad on TV.

Now I've seen innumerable slimy, disingenuous attacks ads in my days, but for some reason this one in particular struck a nerve. Perhaps it was just that the flat-out lies and misrepresentations were stacked so high on top of each other that they reached some critical mass and triggered my gag reflex. Or perhaps all of the right-wing lies I've had to hear over the last decade or so have just reached a certain degree of toxicity in my blood, so that my kidneys can't filter it anymore, leaving the lies to meander through my bloodstream to my brain, rather than being flushed out properly like the human waste they represent.

Or perhaps I'm just sick and tired of living in a country where health care is viewed as a privilege, and not a fundamental human right.

Regardless of the reason, the newest ad by the insurance lobby front group "Patients United Now" pissed me off.

First, let me share the misery that is this ad (but beware, you may die exactly seven days after watching this video, without health coverage):

Now I really shouldn't have to wade through this garbage to deconstruct exactly how many different ways this is wrong (most of these should be obvious to anyone with a basic functional literacy of the health care debate), but I believe that the cosmic order of balance in the universe compels me to say something. So let's go slumming:

Lie #1: This whole story smells fake.
Yes, this has next to nothing to do with the actual health care debate (then again, neither does this ad), and I can't prove this one way or another, but I get the feeling that this story is fabricated, the woman an actress. I just hate these ads that build up some ridiculous straw man argument using a G-list actor who is more likely than not an economic victim of the same policies they are now selling their souls for. If you have any doubt, just recall the hilarious leaked audition videos for the infamous "the gay storm is coming" anti-marriage equality fear-mongering ads (here and here).

Given that trying to get private insurance in America (which she would have had to do coming from Canada) with such a dangerous and costly preexisting condition would be next to impossible, even for an American citizen, I find it incredibly hard to believe that any of this is true. And given that she is shilling for the health insurance lobby, I doubt that she has ever had to suffer the nightmare or indignity of battling with your faceless health insurance company to get medical attention. Instead, this sounds like an all too convenient, and all too far-fetched fictional tale, one specifically tailored to scare Americans into siding with corporate America over their own health. In other words, business as usual for right-wing lobbies.

Lie #2: The entire ad presupposes a single-payer system.
Really, the entire basis of this fallacious attack ad is built upon the lie that "Washington wants to bring Canadian-style health care to the U.S." Canada has a single-payer health care system (which incidentally provides much better health care than our broken for-profit system), and regardless of the merits of single-payer (which I won't go into here), this is 100% not at all what Congress is going to be debating and eventually (hopefully) pass. So right from the beginning, know that this ad is flat out lying to you. Yes, they think you are stupid, that you won't know any better. Doesn't that piss you off?

Lie #3: The ad promotes lies about the Canadian health care system.
This ad pushes the #1 right-wing attack against public health care -- that it leads to long lines and rationed care, and that you'll die cold, alone and miserable while waiting in some gray dystopian barred waiting room while mustachioed "bureaucrats" laugh at your misery. Of course none of this is true. As my colleague Sara Robinson has noted in her must-read "Mythbusting Canadian Health Care" articles (Part I and Part II), no health care system is perfect, but Canada's does in fact manage to maintain wait times equal to, and often less than, the broken American system--this while providing universal, and less-costly, medical care.

Rhonda Hackett, another knowledgeable citizen (and clinical psychologist) with personal experience with health care systems on both sides of the border, wrote earlier this month for the Denver Post to debunk similar myths about the Canadian health care system. About waiting, she writes:

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society.

Simply put, they are distorting the reality of the Canadian health care system to scare you, which is confusing given that President Obama's health care reform plan only seeks to give Americans yet another option, a public one, on top of all of the private plans out there, and in no way mirrors the Canadian model. Obama has made it absolutely clear, that if you are happy with your current coverage, you can keep it. The only thing you have to lose is a percentage of your health care bill, after increased competition (and new regulations) force the insurance companies to increase efficiency, expand coverage, and push down costs. So why anti-reform groups talking about Canadian health care when that isn't what is on the table? Because they think you are stupid, and they've got nothing else.

Oh, and as a fun experiment, go ask a few real Canadians (not paid actors) if they would like to give up their public health care system and take their chances with a private for-profit system built on the American model. What you'll find is that almost all Canadians, even conservatives, would tell you to take a hike. If you have some free time, watch Sicko and pay special attention to the reactions of citizens of other Western nations when they try to conceptualize our health care system. They think we are crazy--And if it weren't for the fact that 3/4 of Americans favor a public option, they'd be absolutely right.

Lie #4: The ad promotes lies about the American health care system.
Beyond the myths about the Canadian health care system promoted in this ad, the shockingly delusional view of our own health care system was what really floored me. Do you really want to talk about rationing care? What do you call the 52+ million Americans who can't afford insurance and thus can't even get in line in the first place? What about the tens of millions of other Americans who have some form of private insurance but don't have enough insurance to actually cover their medical needs? Back-door rationing. Sara Robinson laid it out nicely:

Don't look now: but America does ration care. And it does it in the most capricious, draconian, and often dishonest way possible.

Mostly, the U.S. system rations care by simply eliminating large numbers of people from the system due to an inability to pay. Last year, one-quarter of all Americans didn't go to a doctor when they needed one because they couldn't afford it. Nearly that many skipped getting a test, treatment, prescription, or follow-up appointment recommended by a doctor. In Canada, those same numbers are in the 4-5% range; in the UK, 2-3%. Also: nearly 20% of all Americans had a hard time paying a medical bill last year [Other data suggest this number is closer to 2/3 of adults, or 116 million people]; and these stresses now trigger over half of all personal bankruptcies in the country.

Furthermore, nominally having health insurance is no guarantee against financial ruin, as Sicko amply illustrated. Being cut off or denied by your insurance company is rationing, too. And there are vast numbers of fairly well-off Americans -- many of them middle-aged, and too young for Medicare -- who have pre-existing conditions that render them uninsurable at any price. They're one heart attack, one diabetic event, or one bad turn away from financial disaster. Please don't insult these people by telling them that the American system doesn't ration care.

And that really gets at the heart of what pissed me off about this's flat out insulting. It is insulting that the health insurance lobby thinks it can scare me into backing their corporate greed, screwing myself in the process, all because of some pathetic, lie-ridden bait-and-switch fear-mongering campaign that would have me believe that a Canadian with a documented preexisting brain tumor can come to America, enroll in a first class private health insurance plan, despite that high-risk (and incredibly costly) preexisting condition, and get "world class" treatment for her condition resulting in a full "happily ever after" recovery, all in the time it would take to get the same life-saving treatment in Canada, where the evil government apparently tells you that your life isn't "worth it".

Talk about a fantasy. In fact, to highlight how much of a fantasy this all is, here is a real story of Blue Cross trying to yank a cancer patient's coverage based on even the slight possibility that there may have been a pre-existing condition (there wasn't). That is reality in the United States, not this ad.

Oh, and for the record, we do have government-run health care in this country already, which is enjoyed by everyone over 65, veterans, and even members of Congress. Yes, it's true! I bet you didn't even realize that the elderly, veterans and even our very own members of Congress are in fact living socialist nightmares and dropping like flies in a DEET factory. That must be why so many members of Congress, Republicans included, are so anxious to tell the government "thank, but no thanks" for the health care.

How stupid do they think we are?

Well, in closing, since I made you suffer through that sorry excuse for an issue ad, here is a better video, which comically exposes the thought processes behind health care lobbyist sponsored campaigns like "Patients United Now":

And a little homework assignment:

1) If you haven't already, sign Dr. Howard Dean's petition demanding that Congress gives you the OPTION to have a public health care plan, if you so choose.

2) Write you members of Congress to demand a public health care option.

3) If you are in or around DC on Thursday, June 25th, attend the Health Care '09 rally to demand real health care reform.

4) And of course, fight back against lies, distortions and any other assorted misinformation coming from opponents of real health care reform. We've tried it their way, its failures are all around us, now it is our turn to try some sensible (and hardly controversial) reforms to hold insurance companies accountable and improve our health care system.


It turns out that this woman, Shoha Holmes, is indeed a genuine Canadian, and not an actress after all. So much for that hunch (although as I said, it would have been par for the course), but that of course wasn't the main issue in "Lie #1".

My problem was with this story in general which smelled like BS, and very important parts of it turned out to be BS. It isn't necessary what was included in the story, but rather what was conveniently left out. Ms. Holmes did in fact come to the US for treatment after her "local doctor" told her it would take "months" to get her an appointment for a neurologist or endocrinologist (why she would want to see an endocrinologist is beyond me, an oncologist would have been the first place to go).

This is what lead her to abandon the entire Canadian health care model...a local doctor told her there was a long wait to see a specialist. I'm of course not saying that this isn't a regrettable thing, because it clearly is, and something that ought to be fixed, but two things ought to be kept in mind, that I noted in my original post:

1) The waiting time for a specialist in a particular field doesn't prove a structural defect in the Canadian health care model; rather, it is a symptom of a separate problem--Canada, a country of about 1/10th the US population, has a relative shortage of specialists in a particular field (or at least a relative shortage in her part of the country).

2) There are of course also people who face prohibitive wait times in the United States. In fact, as I mentioned previously, there are tens of millions of Americans who would be happy just to be in line, but can't even get that far because our health care system already tagged them "too poor to save".

Also, her story seems to indicate that her local Canadian doctor hadn't even diagnosed her with a brain tumor (judging by the endocrinologist appointment and the fact she didn't get pushed to the front of the line yet--in other words a lack of urgency since her symptoms were vision-related). And don't insult us by pretending that serious conditions don't go undiagnosed until it is too late in the United States all of the time (see Lie #4). Preventative care and early detection are two areas the Canadian health care system usually excels in, while the United States has been failing miserably.

Anyway, as I said, what was left out of the story in the ad is the telling part. Ms. Holmes came to the United States, without health insurance, and couldn't get any. I don't know if she even bothered trying. If she did try she would have quickly found that she would have had a better chance of removing the tumor herself with a q-tip than of getting a private health insurance provider to cover her with her preexisting condition.

Here, Ms. Holmes got an important lesson in what it is like to live under the American for-profit health care system. In Canada the only barrier to her getting diagnosed and treated was her position on a list, which could probably have changed dramatically depending on where she went, who she talked to, and if she could convince a doctor that it was more than a problem with her eyesight. But throughout the entire process, she didn't have to worry about the costs in Canada, whether or not she could afford the first doctors visit, or the second, or the treatment, or the hospital room, or the post-op care, or anything. It was covered. No hassle.

But here in America she quickly experienced what millions of Americans experience every year: you have a pre-existing condition, you are on your own. Luckily for her she somehow managed to get her treatment in the United States, without health insurance, and she made her recovery. The other part conveniently left out of the attack ad? She is now saddled with huge amounts of debt, debt she can't pay, because she didn't have insurance. In Canada she would have been completely covered, including generous benefits while she was unable to work. But since she gave up on the Canadian system and went to the US, she went from one epic battle to another.

For many people this is the hard part of recovering from a serious medical condition. There are millions of Americans who have been driven to bankruptcy, their families and loved ones along with them, by their illnesses, through no fault of their own. The bill collectors are said to take a terrible emotional and physical toll on some recovering patients, leading some so far into despair that they say they wish they would have just refused treatment so they could have just died, sparing their families the financial hardship that their illness brought upon them.

That is the reality of the American system.

So what is a Canadian to do? Now that she is back in Canada, and wholly unable to pay her large American medical bills, she expects that evil Canadian public health care plan to pay the costs so she doesn't have to worry about it. Wow, it must be nice being a Canadian have that sense of entitlement to health care that doesn't bankrupt you, as if health care was a right and not just a privilege for those who can pay top dollar.

And who knows? Maybe she'll get the Canadian system to pay for it, even though she broke the rules by getting treated in another country. If she can get them to, good for her, I wish her all the best. But next time she wants to shill for the American private health insurance lobby, I would hope that she would at least consider that if she were an American citizen, she would have been ruined by her treatment, even if she had survived, and there would have been no safety net for her to fall back on for help.

The final verdict on all of this is that Lies 2-4 stand as written. Despite the fact that the person in question is real, the story, as it was presented in the insurance lobby attack ad, was obviously not. She didn't actually live happily ever after. She came to the US seeking health care, she was denied health insurance (or would have been denied if she had been naive enough to apply for it) by the very people she is now cutting ads for (what is the exchange rate for irony nowadays?). As a result she is now drowning in health care bills, thanks to the American for-profit health care system. In Canada, she wouldn't have had to worry--she just had bad luck navigating deficiencies that had nothing to do with their health care model, deficiencies shared by the American system, deficiencies that Americans here at home die from every day we don't get serious about health care reform.

And of course don't forget Lie #2--this story has absolutely nothing to do with the health care reform being debated in Congress, because it will be nothing like the Canadian system (which is actually unfortunate). Shoha Holmes is nothing more than a straw woman, being used by people who wouldn't have blinked an eye if she had died because they refused to give her health insurance. That, perhaps, is the most tragic part of this story.


More details about the tale of Shona Holmes. Apparently, her for-profit American health care costs ran her $100,000. Note that this would have cost her nothing in Canada. Also interesting is the fact that her "life-threatening brain cancer" was actually not quite...that. According to the Ottawa Citizen (h/t Crooks and Liars):

Holmes has become the darling of conservatives and the stop-public-health-care movement in the United States. She's testified before Congress, been on Fox TV as well as CNN, and her story is retold on hundreds of right wing blogs. She's now doing a nasty TV ad for Patients United Now, a Republican-led group opposed to Obama's reforms. You can see the ad at The group is spending almost $2 million on it to target politicians in Washington.

For a person living with cancer, the idea that someone's care could be unreasonably delayed is truly scary. It also doesn't reflect the experience I've had or the experiences that have been shared with me by so many other patients. Even CNN interviewed Doug Wright, a more typical patient in Toronto who is receiving very speedy treatment for his cancer.

Still, I found Holmes tale both compelling and troubling. So I decided to check a little further. On the Mayo Clinic's website, Shona Holmes is a success story. But it's somewhat different story than all the headlines might have implied. Holmes' "brain tumour" was actually a Rathke's Cleft Cyst on her pituitary gland. To quote an American source, the John Wayne Cancer Center, "Rathke's Cleft Cysts are not true tumors or neoplasms; instead they are benign cysts."

There's no doubt Holmes had a problem that needed treatment, and she was given appointments with the appropriate specialists in Ontario. She chose not to wait the few months to see them. But it's a far cry from the life-or-death picture portrayed by Holmes on the TV ads or by McConnell in his attacks.

Just more examples of disingenuous attacks from the right on health care reform.

Maybe if the right-wingers actually cared about Shona Holmes they would at least drop $100,000 on paying off her medical bills, out of the millions they are spending daily on attack ads and lie campaigns against reform efforts. Of course these people aren't in the business of making health care affordable, even for their pet straw women. In the end the right-wingers and the for-profit insurance industry they represent will just use Miss Holmes and spit her out, just like they do for American citizens. At least they are equal opportunity exploiters. That much is heartening.

Also read: "33.7 million Canadians are not Shona Holmes"

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