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  • US Infrastructure Will Be Broken Forever

    Posted by Carl from Chicago on March 11th, 2017 (All posts by )

    Recently I visited Cathedral Park in Portland, which lies beneath the St. Johns Bridge.  The St. Johns Bridge is a magnificent structure, built in 1931, during the height of the depression.

    Portland is a city of bridges.  These bridges were mostly built long ago, when construction projects were feasible in terms of costs and delivery time frames were measured in years, not decades (when approvals, funding, environmental contingencies, etc… are factored in).

    Today the Portland metropolitan area, which includes large Washington communities north of the city, faces severe constraints on traffic and there is widespread local agreement that commute times are growing longer and in some instances intolerable.  I know individuals in Chicago, LA or NYC that would laugh at commute times that aren’t 2+ hours but that is little consolation to the locals who previously had been able to drive around the metro area with relative ease.

    Many of these bridges need to be replaced for multiple reasons – the Pacific Northwest is an earthquake zone and most of these bridges are not built to survive a quake, traffic on the bridges is soaring and causing delays throughout the system because they function as bottlenecks, and frankly bridges cannot last forever without collapsing.

    And yet… it will never happen.  I am confident that we won’t be able to raise the billions that it will take to build these bridges and lawsuits and environmentalists would create innumerable roadblocks (with accompanying cost increases and delays) so that even difficult projects will become impossible. There is an utter breakdown in funding, public will, solid execution, and all the fundamental components that make infrastructure possible.  While China has built giant, soaring cities, we can’t even replace bridges and roads built 100 years ago.

    I would be willing to bet large sums of money that none of these bridges will be replaced over the next decade with actual drivers using the roads and seeing the benefits of the billions that would need to be invested.  There will be a lot of talk and likely hundreds of millions spent on studies and much political posturing and probably some desperate repairs on some of the bridges that will soon be in dire condition.  But it is easy money to bet that nothing new and substantially better will rise through this cacophony and come to fruition.

    America would be much better off if we faced the facts that what we could do in 1931 we simply cannot do today.  Then we could ask deeper questions about what happened and how we can truly solve these sorts of difficult questions.  We would need reform in contracting, new productivity enhancements, certainty in our regulations, local industry that was capable and cutting edge, and goodwill with the public to put up with disruptions and compromises that inevitably accompany this sort of work.

    Like the failed nuclear power renaissance, which I’ve chronicled many times, the fact that I know that these efforts will fail doesn’t make me a naysayer, just a realist.  Avoiding facts and having beliefs unsupported by tangible evidence and relying on recent events for predictive power is foolish.  We can’t tackle our problems unless we address them out loud and accept that we are failing and our processes and systems are completely broken.  Else we are living in a dream world.

    Cross posted at LITGM

     

    54 Responses to “US Infrastructure Will Be Broken Forever”

    1. Anonymous Says:

      I’ve said in other contexts, but it fits here: why my people voted to destroy themselves isn’t known to me, but they did.

      They choose to make social utopia, wasted billions on social programs that wouldn’t, couldn’t, and didn’t work, then trillions, putting their descendants into debt to… well, what exactly? Have lots of safe drinking water? (Nope: we oppose damns.) Lots of cheap, available power? (Nope, we hate power plants: dams, nukes, coal….) Roads? (Not near enough.) Trains? (Only wasteful ones; never newer, faster, wider.) Communications? (Yes, actually. We spent money on making Internet.) Rockets? (Nope.) Sewers. (Nope.)

      All that money was handed out to people to waste in petty ways or spent on lawyers (to sue each other) and administrators, and justified by politicians and intellectuals as the moral thing to do. (Why anyone believe politicians, intellectuals, and morality could intersect fruitfully is opaque to me as well.)

      Who in their right mind could think funding lawyers and administrators would bring about Utopia? (I think someone really did poison drinking water will hallucinogens in the 1960s.)

    2. David Foster Says:

      See my related post Like swimming in glue

    3. dearieme Says:

      “frankly bridges cannot last forever without collapsing”: Roman aqueducts are having a good shot at it, bestriding earthquake country for a couple of millennia.

    4. Joe Triscari Says:

      “America would be much better off if we faced the facts that what we could do in 1931 we simply cannot do today.”

      should be

      “America would be much better off if we faced the facts that what we could do in 1970 we simply cannot do today.”

      Imagine if an alien species came to earth and told us, “We have planted a flag on the moon. You must execute a government program using rules and regulations you have in place today to fly to the moon get the flag and return it here on earth with 5 years. If you fail, we will turn the planet into a cinder.” We would all die.

      The sticking point would be getting the line spacing right on the vendor proposals for picture frames to hang in the offices where the mission patch would be designed.

    5. Anonymous Says:

      “We can’t tackle our problems unless we address them out loud and accept that we are failing and our processes and systems are completely broken.”

      This is true. We need someone in the executive branch who will change the processes and systems that can be changed by regulation, and who will push congress to change the processes and systems that can only be changed by legislation. The last few Presidents had no awareness of the problem or interest in changing it. The current guy at least worked in a world where he saw these problems personally, and who has spoken about them, and claims he wants to change them. Will he? Can he?

      Stay tuned.

    6. Mike K Says:

      Portland, like Chicago and New York is a “blue city” and the reason why, after 60 years, I left California.

      Tucson is also “blue” with a leftist city council elected by university faculty and students but the rest of the city is low tech and flat.

      The houses where we live are on large lots, many of an acre or more. South Tucson has lots of Hispanics but they are far closer to us in culture than the Muslims being recruited to places like Minneapolis.

      My middle daughter, who is very bright and talented, is being recruited by Apple for their design team. It has been a very lengthy courtship but she is now at the stage of staring to look for somewhere to live. I sent her a Guardian article about the reality of life in Silicon Valley.

      One Apple employee was recently living in a Santa Cruz garage, using a compost bucket as a toilet. Another tech worker, enrolled in a coding bootcamp, described how he lived with 12 other engineers in a two-bedroom apartment rented via Airbnb. “It was $1,100 for a fucking bunk bed and five people in the same room. One guy was living in a closet, paying $1,400 for a ‘private room’.

      She is thinking if they actually hire her, she will buy a small motorhome to live in. She is now researching a place to park it during the week. Weekends she could drive away from the campus.

      I wonder why companies like Apple don’t just build employee housing like universities and the military did ?

    7. Phil Ossiferz Stone Says:

      At least they have rainbow crosswalks and sensible gun control.

    8. Grurray Says:

      I don’t know what the answer is, but this is a good opportunity to watch the Tacoma Narrows Bridge collapse

      https://www.youtube.com/shared?ci=qLKQNDcUcLo

      All infrastructure is going to shake and vibrate. In the case of the Tacoma Narrows Bridge the vibrations just happened to occur at the bridge’s natural frequency, which caused catastrophic positive feedback. This indirectly proved the efficacy of Nicolas Tesla’s so-called earthquake machine.

      Something similar also happened with the London Millenium Bridge

      https://www.youtube.com/shared?ci=VrniUIgxb-E

      This was by the way an excellent example of synchrony

      Anyway, nerd break over, carry on with policy recomendations.

    9. orthodoc Says:

      Well, here in Seattle, we apparently have the will to build things.

      Of course, they’re stupid and useless things, like a $56 billion light rail system that will take all of 3-5% of commuters off the roads, and remove lanes from the I-90 bridge which is already choked with traffic. Nothing like a 19th century solution…

      Or replacing the 520 bridge across Lake Washington. Naturally, it had to have a bike lane, and use locally sourced organically grown concrete, and be built by a firm owned by a black lesbian with one leg shorter than the other. 2 years late, and $400 million over budget….

      Or the Alaskan Way viaduct, which will open 4 years late….

    10. David Foster Says:

      Victor Davis Hanson observes that those politicians who have grandiose Utopian plans are generally those same ones who can’t manage to deal with snow removal and bridge maintenance:

      https://townhall.com/columnists/victordavishanson/2017/03/09/dont-sweat-the-big-stuff-n2295880

    11. Mike K Says:

      I used to own 10 acres on Vashon Island. My plan was to retire there some day.

      I eventually sold the land and that was probably a mistake, but my wife could not live in that climate.

      I loved the island but there was no way I could work and live there so I eventually gave up. I would not dream of living anywhere else in Seattle.

    12. Brian Says:

      “America would be much better off if we faced the facts that what we could do in 1931 we simply cannot do today.”
      Of course we can. We just choose not to. We view things like new bridges, dams, freeways, etc., as unnecessary, because it sure seems like the ones we have are good enough.

      Even in looney tunes California, when such things are actually needed, all the bureaucratic nonsense, which is nothing but luxury drivel, gets pitched out the window, and Americans get stuff done:
      http://articles.latimes.com/1994-04-06/news/mn-42778_1_santa-monica-freeway
      Santa Monica Freeway to Reopen on Tuesday : Recovery: The contractor will get a $14.5-million bonus for finishing earthquake repairs 74 days early.

      http://www.sfgate.com/bayarea/article/A-MAZE-ING-His-reputation-on-the-line-2592154.php
      A-MAZE-ING / His reputation on the line, contractor finishes repair early, and I-580 opens

      It will be very interesting to see if/when Trump decides to make a push for non-white working class voters. California is a total disaster for anyone except for the super-rich and the pure believer dead-enders. Hispanics and blacks want to be able to buy a house too. There’s no reason they should be loyal to the Democrats, given how they’ve destroyed the state. With the right strategy by the GOP, the Dems could find themselves reduced to the equivalent of today’s Labor Party in the UK–nothing but the lefty crazies, with the workers long since gone, and ideological purity all that matters, even as the ship goes down.

    13. Mike K Says:

      The 1994 freeway repairs were done under Pete Wilson, last GOP governor.

      Jerry Brown is Mr “Small is Beautiful.”

    14. Tacitus Says:

      To be fair the Romans:

      Did not give a damnatio for environmental impact statements (moved entire mountains in Hispania getting at the gold), labor relations issues (see Spartacus), or much else.

      Also most of the structures you see well preserved from Roman times had an intermediate stage of being medievil fortresses (pretty much any amphitheater) or an early modern use (Pont du Gard rehabbed as a military road).

      And finally the things they build in really earthquake prone areas did become stately ruins rather quickly….North Africa especially saw this. Septimus Severus spent a ton on infrastructure for the folks back home….and it tumbled down with dispatch.

      Tacitus

    15. Carl from Chicago Says:

      Thanks for all the comments! Yes I thought of that bridge response in LA but it was a long time ago (23 years!) and I haven’t seen similar positive events since then.

      Here in Portland they did complete a mass transit and pedestrian bridge which is quite cool but does little or nothing to address the actual traffic capacity issues we face.

      I wasn’t aware of all the Seattle items but I’ve been to Seattle by car (from Portland) and the traffic there is horrendous. My iPhone told me to get off the highway and I saved over an hour by snaking through side streets adjacent to the interstate.

    16. DirtyJobsGuy Says:

      A few years back after Hurricane Sandy a major local highway in Vermont had numerous washouts and bridge failures due to extreme flooding (Rt 100). This highway is the main access to many towns and resort areas in the Green Mountains. The lefty Democratic Governor declared an emergency waiver of most of the environmental and contracting rules to speed repairs. He was honestly astonished how fast and inexpensively the repairs were completed. This was not enough to prompt him to alter the current rules or repeal Vermont’s restrictive new work permit process. In reality most projects could continue to follow reasonable environmental precautions but the legal environment cannot handle “reasonableness”. The old de minimus understanding has been warped out of any usefulness.

      But remember that Big projects took a long time in the past as well. The Brooklyn Bridge took 14 years to complete due to political infighting and technical issues. We have to recognize that big stuff has a time scale extending past typical politician terms of office so we need stability in both regulation, funding and commitment.

    17. Mike K Says:

      “I saved over an hour by snaking through side streets adjacent to the interstate.”

      The lakes in Seattle can make this an exercise in frustration unless you are familiar with the geography. Very few bridges going north and south.

    18. jaed Says:

      There actually was a new bridge built recently in Portland. Construction “only” took four years, too.

      However, it is not an automobile-capable bridge. It is designed and designated exclusively for pedestrians, bikes, and “transit”, meaning buses and light choo-choos.

      (Unable to decide which of “Tillikum Crossing” and “Bridge of the People” was more twee, the planners saddled the construction with both, and so it was officially named “Tillikum Crossing, Bridge of the People”. The implication that drivers aren’t people is something I found interesting. As I did the fact that they can actually build something, if it’s PC enough.)

    19. Jonathan Says:

      Doesn’t Portland have a master plan for land use and transportation, that mandates light rail at the expense of roads and removes large areas from consideration for residential development?

    20. Stan Witherspoon Says:

      And we used to be able to do this:
      Nothing Like It In the World: The Men Who Built the Transcontinental Railroad 1863-1869

      https://www.amazon.com/Nothing-Like-World-Transcontinental-1863-1869/dp/0743203178/ref=sr_1_1?s=books&ie=UTF8&qid=1483504012&sr=1-1&keywords=ambrose+railroads

    21. Stan Witherspoon Says:

      This is part of the same route today.
      “Rotary Snowplow Returns to Donner Pass”: https://youtu.be/RjBQ3MaBYiU

    22. PenGun Says:

      Choices. You made em’. You have elected to make a few people insanely rich and your system is designed around that. Freedom.

      Of course your medical system is a joke and your crap is all collapsing.

      Choices!

    23. Joe Wooten Says:

      Yeah, and the Canuck system is such a paragon of efficiency and fairness…….

    24. Mike K Says:

      Pennie, did I ever tell you how I used to go to an annual medical meeting in Sasakatoon?

      It was on the latest info on laparoscopy and other medical advances.

      Then one year it wasn’t held. All the faculty had emigrated. Never held a again.

      What you don’t know can hurt you sometimes.

    25. PenGun Says:

      “Yeah, and the Canuck system is such a paragon of efficiency and fairness…….”

      But of course ….. not. It’s still a moderately socialist country though, although that’s under attack. As such we will not part with the medical system we enjoy, and really egregious breaks for big money, are quite hard to engineer.

    26. PenGun Says:

      Mike K. You have gone on at length about your Canadian experiences, several times.

      Our comprehensive universal medical care system is funded by the federal government and administered by the Provinces. Different Provinces have somewhat different rules and payment schedules.

      As you have a for profit medical system, it’s fairly obvious the best of Canadian medical professionals, can make more in the US. Those would be the people at UofS, holding the events you attended. That they chose to, is up to them.

    27. Mike K Says:

      “Mike K. You have gone on at length about your Canadian experiences, several times.”

      Not really. I have known quite a few immigrant Canadian doctors and have watched the hollowing out of the Canadian medical profession.

      I attended a course on quality improvement in health care a few years ago and sitting next to me was the architect who had received an assignment to build the first new hospital in Canada in several decades. Canada made the decision to limit positions in medical schools for Canadian citizens and rely on foreign medical graduates. Nursing schools were closed.

      It is your choice as Canadians to do what you wish with your medical system. It is typical for those who do not use the system to boast about its quality.

      My preference for a national system is France as I have repeatedly pointed out here and on my own blog.

      The US system has been badly distorted by employer based insurance, by insurance company contracting, which hides real prices, and by Medicare which has maintained the fiction of artificial prices with severe discounts and declining acceptance by many physicians.

      I had some concerns if we would find physicians in Arizona as we are Medicare members and I was prepared to go to a cash medical practice if necessary for routine care. So far, it seems that we have been fortunate. My wife was referred by her allergist to a friend of his in Tucson and I plan to see the internist who admitted me as an emergency in 2011.

      I would never want to be a patient in the NHS in Britain and my opinion seems to be shared by the expatriate Britons in France where they seek admittance to the French system that they have never paid into rather than go home to Britain for care in an NHS facility.

    28. PenGun Says:

      One can comment anecdotally about anything. It is apparently a fact though that having cystic fibrosis in the US will kill you 10 years earlier.

      http://www.cbc.ca/news/health/cystic-fibrosis-survival-rates-1.4022970

      This not because of anything other than our medical system. People with good insurance, in America, have similar results. It’s the average of everyone that produces that number.

    29. Mike K Says:

      Speaking of anecdotes.

      people in Canada had a 77 per cent lower risk of death compared with people in the U.S. with no insurance,”

      USC has a very active lung transplant program and the chief of surgery, Vaughn Starnes, is one of the pioneers in lung transplant for Cystic Fibrosis.

      As is typical of all countries comparing their health and or violent crime rates with the US, the US inner city blacks are not excluded as an outlier in almost all studies.

    30. Jonathan Says:

      From Pengun’s cited article:

      “People who had private insurance in the U.S. had a similar risk of death compared to Canadians … whereas people in Canada had a 77 per cent lower risk of death compared with people in the U.S. with no insurance,” Stephenson said.
       
      People in the U.S. relying on Medicaid and Medicare also had a higher risk of death than Canadians.

      Americans without insurance, and Americans relying on govt insurance and govt medicine, had a higher risk of death than Canadians. Also, American death rates have been decreasing since American medicine started recommending a certain type of diet for CF patients, years after Canadian medicine did. I think we need more information about the ages, races, sexes, ethnicities and other demographics of the specific groups of American and Canadian patients who are being compared here, before we can draw conclusions. In any case it’s conceivable that the Canadian medical system is better than the American system in selected areas while being worse overall. Do Americans visit Canada for CF treatment? It’s obvious that large numbers of Canadians visit the USA to be treated for cancer or heart disease, get joint replacements, etc.

    31. Jonathan Says:

      As is typical of all countries comparing their health and or violent crime rates with the US, the US inner city blacks are not excluded as an outlier in almost all studies.

      Some countries appear to have better infant mortality stats than we do, because we successfully treat many high-risk infants who would have been aborted elsewhere.

      Many of the international statistical comparisons that appear in popular media are agenda-driven garbage.

    32. Mike K Says:

      A very interesting article appeared a few years ago comparing birth weight and neonatal complications among army dependents and female members.

      All had the same care. All were “covered” meaning access to prenatal care, for example.

      Black birth weights were lower and neonatal trouble was higher than white and Hispanic.

      Hispanics had better birth weights and lower neonatal complications than either whites or blacks.

    33. Xennady Says:

      I drove through Portland once, on a cross-country driving vacation about a decade ago. The traffic was by far the worst I recall. The brief time I spent off the highway in Portland reminded me of failing Detroit suburbs, except I couldn’t pump my own gas to get away.

      But I wouldn’t assume this sort of stupidity will last forever. I remain amazed at the astonishing incapacity of the supposed opposition to the left- that is, the GOP- to offer genuine opposition.

      California is a better example, having gone farther down the path to oblivion- but it seems like someone in Oregon should object to the idiotic policies the left has bestowed upon that state.

      But someone never does, as far as I have ever heard. Instead, the Oregon gop- like the gop in California- appears to remain nothing more than a me-too assortment of bootlickers who promise to do the same as the left, only better.

      This hasn’t worked, duh. I’d like to know what the supposed opposition is thinking- or supposedly thinking, because they don’t seem to be thinking at all- because both Oregon and California have ugly problems that never actually seem to be addressed by their respective prog governments, or the other party.

      Again, this won’t last forever.

    34. Larry Says:

      I’m a Portlander. We spent 400 million dollars on a study for the replacement of the I-5 bridge aka The Columbia River Crossing (CRC). Chiefly, because light rail was not included in the plan it was tossed. The 400 million was thrown away.

      It is worth mentioning that both the US Coast Guard and the commercial interests on the river provided a minimum height requirement for the bridge. That height would accommodate the lucrative commercial traffic that uses the river.

      The 400 million dollar plan ignored this height requirement and came in at a much lower elevation.

      With the heavy rains and run off this season the bridge will be raised much of the time because shipping that would normally slip under the bridge will require the bridge to be raised. Traffic backups will be nightmarish.

      We threw away 400 million dollars on a failed Obamacare website and implementation program, too. And, I do mean completely thrown away. Nothing exists from that spending output

    35. Larry Says:

      And another thing. Because the St Johns Bridge didn’t budget for a bike lane two of the four lanes on the bridge are required to permit biking.

      Consequently, trucking from our port terminals which offload merchandise and equipment from Asia and etc. must accommodate bike traffic on the bridge. The bridge in the most direct route from the port terminals to the city and points south.

      Never mind that the broadened walkways on both sides of the bridge can easily carry bicyclists. It is a biker’s riders civil right to use the auto lanes every bit as much as it is for the Freightliner hauling goods from Shanghai.

      The commutes over the bridge are as you would imagine.

    36. Xennady Says:

      Larry,

      Those are fascinating anecdotes.

      My guess is that the left wasn’t really so stupid to fail to remember that shipping would need to use the river, or that they wanted bikes lanes. I think they just don’t want the public to have private vehicles at all, so they take care to throw as many obstacles in the way as possible.

      First, having bike lanes on what I take to be a major highway is plainly idiotic. Someone should be saying so, loudly and publicly, especially during a political campaign. Second, failing to plan for riverine traffic is astonishingly incompetent, even if you did it accidentally on purpose. Someone should be fired, or perhaps imprisoned. Perhaps many someones.

      I think a serious opposition party would have had enough to say about those issues that you’d have reason to mention it. But no, the gop is irrelevant, as usual.

      Now you’re there, and I’m not. It is entirely possible that I’m completely wrong, and the local GOP was strenuously objecting to this all along. Yet long experience has inspired me to climb out on a limb and hazard a guess that the people in charge of the gop are doing their usual best and completely ignoring such real world concerns as traffic and bridge-building, because it’s just much more important for them to spend their time and effort making sure that no one ends their control of the party, no matter how incompetent they are or how often they fail.

      I’m not a fan of the gop establishment, in case that wasn’t clear.

    37. tomw Says:

      Larry:Because the St Johns Bridge didn’t budget for a bike lane two of the four lanes on the bridge are required to permit biking.

      Ummh, in most other parts of the world, a normal traffic lane, one, could accomodate two bike lanes.
      If the bike riders have a ‘right’ to cross the bridge, there’s nothing that says they could not walk their bicycles across the bridge and get where they are going without taking lanes paid for by fuel taxes they do not suffer. If they want bike lanes, they can pay for them, just as the motorists pay for their traffic lanes.
      Of course, that will never happen because the politicians see a huge pile of money they can re-direct to gain votes from the bike riders who want a free ride… The same as the electric car drivers who are irate that they are being charged taxes for use of public roadways here in GA.

    38. PenGun Says:

      “In any case it’s conceivable that the Canadian medical system is better than the American system in selected areas while being worse overall.”

      Does this endless need for preeminence ever end, or is a part of the American character?

    39. Joe Wooten Says:

      Does this endless need for preeminence ever end, or is a part of the American character?

      Better that than continual mediocrity in all areas.

    40. PenGun Says:

      “Better that than continual mediocrity in all areas.”

      I have no argument with that. It’s just that if you can’t get over yourselves, you face a heap of pain. You are not the greatest, a stupid idea, in any real sense.

    41. Mike K Says:

      ” You are not the greatest, a stupid idea, in any real sense.”

      Speaking of not being able to get over something.

      I remember years ago, a couple from Australia came to LA while the husband did a fellowship at USC. The wife regaled us with constant stories about how everything in Australia was better than the USA.

      Two years later, it was time for him to return to OZ. She left heel marks all across the Pacific being dragged home. That was 30 years ago and she still comes to the US for shopping trips once a year.

    42. Jonathan Says:

      You are not the greatest

      OK, we are not the greatest. Now tell me how many people come from the USA to Canada for medical care vs. the other way around. Then explain again why anyone should think that your medical system is better than ours.

    43. Mike K Says:

      When my daughter was at Gonzaga law school in Spokane, we would visit and stay at a nice B&B in Spokane. The other guests were always Canadians in Spokane for medical care. Spokane has huge medical centers, sort of like Mayo Clinic but less well known. If you notice, the population of the states around them would not support such big medical facilities.

      Where do you think the patients have come from the past 25 years ?

    44. Mike K Says:

      A Spokane story. A friend of mine finished his cardiac surgery training in Oregon and was looking for a job. There is a big cardiac surgery group in one of the medical centers in Spokane and he went up for the interview. The first question he got was, “Do you like to hunt and fish ?”

      His answer was, “I love to hunt and fish!”

      Their response was, “We all love to hunt and fish. We are looking for someone who doesn’t hunt and fish !”

      He replied, “Why would anyone come here to practice who doesn’t hunt and fish ?”

      He settled in Tacoma.

      Guess who goes to Spokane for heart surgery ?

    45. Bill Brandt Says:

      I am always amazed to know things like the Bay Bridge, Golden Gate were built in 4-5 years. It would take 20 years just to go though all the red tape these days.

      Hoover dam? Too lazy to look it up but I am sure it was way less than 10 years.

    46. PenGun Says:

      “OK, we are not the greatest. Now tell me how many people come from the USA to Canada for medical care vs. the other way around. Then explain again why anyone should think that your medical system is better than ours.”

      In a word. It’s universal.

      What I am finding is that all that matters, to many of you, is that America is the greatest ever. This is very childish for starters, and unsustainable in any real world. It also dumbs down any discussion, if what matters, is that America wins every time. This is part of your present malaise, which you are not enjoying.

    47. Jonathan Says:

      It’s called universal. That doesn’t mean it is. For example, it isn’t universal if you have to wait a long time to get treatment because your system’s incentives don’t adequately compensate doctors or investments in medical equipment. The US system isn’t called universal, but in practice it is since nonpaying patients aren’t turned away from emergency rooms where they usually receive high-quality care. Don’t confuse rhetoric with reality.

    48. Ginny Says:

      Thanks Jonathan for a dose of reality. I still remember Perry answering the question of how many in TX are covered by arguing that access, access, access is the answer. And it is. How many doctors are retiring because of Obamacare?

    49. PenGun Says:

      “Don’t confuse rhetoric with reality.” That’s exactly what you are doing.

      The emergency room is hardly universal care, in anything other than a very narrow sense.

      Ongoing care throughout ones life is why Canadians as a group do much better than Americans in many areas. It’s true you have more expensive hi tech stuff, but that has little to do with general regular health care.

      It’s true you spend about twice as much as most first world countries with considerably worse results across the general population.

    50. Jonathan Says:

      -Our population is relatively heterogeneous as compared to Canada’s. This comes back to the points about cystic fibrosis and infant mortality, which you ignored. Looking at health and medical stats for US vs. Canadian groups with similar demographics, how does Canada compare?

      -“It’s true you have more expensive hi tech stuff, but that has little to do with general regular health care.” Three questions: 1) Why is “general regular health care” the standard of comparison (surely a high-quality medical system should be effective at delivering many different types of health care)? 2) Is “general regular health care” better in Canada than in the USA for members of similar demographic groups? and 3) Is it better to have cancer, heart disease or other serious conditions that benefit from the availability of “expensive hi tech stuff” in Canada or in the USA?

    51. Mike K Says:

      why Canadians as a group do much better than Americans in many areas.

      “In many areas” Does that include ski resorts ?

      Natasha Richardson could not be reached for comment.

      Look, I know that Canada chose to reward primary care and starve specialist care. It was a political decision because people like you are not aware of what is not available unless you are in a severe car accident or other serious illness. The vast majority of primary care patients are not aware of what they don’t get unless the primary care doctor recommends it. If he/she knows it is not available, it is not mentioned.

      It has gotten so severe in the UK that people are starting to notice.

      According to Nursing Times, Dr Bill Kirkup claimed that almost a year after the inquiry into failures in maternity care at Furness general hospital that contributed to the deaths of at least 11 babies and one mother, there has been progress on only 10 of the 26 national recommendations the report made. Kirkup was particularly concerned that his calls for the introduction of investigations by professional regulators, national reviews into isolated rural services and a review of the NHS complaints system have yet to be fully implemented.

      Canada is about 25 years behind UK in the ongoing disaster. You have a younger and healthier population.

    52. PenGun Says:

      “Look, I know that Canada chose to reward primary care and starve specialist care.”

      A very good decision indeed. Although specialist care is hardly starved, the emphasis on _universal_ care is the right way to do this.

    53. Jonathan Says:

      the emphasis on _universal_ care is the right way to do this

      Why? Why should govt emphasize one medical sector over others?

      The answer is that if you have a govt monopoly whose policies are driven by cost considerations rather than customer preferences, cheaper types of care will usually be given priority over those that are more expensive; the arbitrary preferences of the political elite will be imposed on everyone else. This will be true even if doing so kills people, and even if many of the patients who are going to die under your govt’s cost-driven rationing of care would have been happy to make their own arrangements for payment by cash or private insurance for the kinds of expensive high-tech care that could save their lives.

      “The right way to do this” isn’t the way that you in your arrogant ignorance believe right. It’s the way that lets individuals decide for themselves the level and types of care they wish to purchase. If they are too poor to pay, give them subsidies so that they can buy coverage as good as the Trudeau family gets.

      Your current system privileges the rich who can travel overseas, clever middle-class people who know how to game the system, and politicians and other members of the political elite who control the system’s policies and purse strings. For many ordinary Canadians the quality of medical treatment they get is based on chance depending on where they live. And some lifesaving services that are routinely available almost anywhere in the USA (e.g., emergency brain scans near ski resorts) are unavailable in much of Canada. Is that what you want?

    54. Subotai Bahadur Says:

      Going back and forth between Canada and the US for citizens of the two countries is a lot more complex than it used to be. It used to be that passports and visas were not even part of the equation.

      Now, while technically, Canada does not require a US citizen to have a US passport to enter Canada, you cannot enter unless you can go home. And the US requires a US passport to come home. So functionally, you need a passport to enter Canada.

      For Canadians to enter the US, they fall under this classification:

      A foreign national or alien entering the U.S. is generally required to present a passport and valid visa issued by a U.S. Consular Official, unless they are a citizen of a country eligible for the Visa Waiver Program, or are a lawful permanent resident of the U.S. or a citizen of Canada.

      The foreign national must arrive on an approved carrier (if coming by air or sea), staying no more than 90 days, for pleasure/medical purposes/business, and be able to prove they are not inadmissible.

      The Canadian government says this about Canadians re-entering Canada from outside the country:

      You must carry proper identification for yourself, your children and any dependents travelling with you.

      Proper identification includes a Canadian passport, a Canadian birth certificate, a citizenship card or a Certificate of Indian Status. The Government of Canada recommends that Canadian citizens and dual citizens travel internationally with a valid Canadian passport. This is the only reliable and universally accepted identification document available to Canadians for the purpose of international travel.

      This would imply that you may need a Canadian passport to come back to Canada, which would place them in an identical situation as our citizens. However, not being Canadian I don’t know how strict they are on that.

      Both governments assert their sovereignty and right to control, place conditions on, limit, or block foreign nationals from entering or remaining in their country.

      Under Obamacare, and even more so under the Ryan-Care which makes Obamacare even more dictatorial and expensive while reducing available care even more; the delivery of medical care inside the borders of the US becomes a Federally controlled rationing of a limited resource. It is the Federal government that sets the limits on who gets what medical care and sets the cost.

      Note above that the conditions on the entry of foreign nationals includes “for pleasure/medical purposes/business,”.

      What if, because we have created a local self-inflicted shortage of available medical care here [mandated government insurance is not the same thing as having the medical treatments actually available for citizens], we conduct a Gedankenexperiment? Or maybe a real experiment.

      If we, by regulation or statute, removed the “medical purposes” from the quoted restriction, barring all legally entering foreign nationals [including politicians] from our medical care system in order to preserve the resources for our own citizens and the illegal invaders from the South that the Left values more than our own people . . .

      1) what effect would there be on the economics of the Canadian healthcare system?

      and

      2) what effect would there be on say a 5 year span on Canadian mortality and morbidity?