Reason Magazine - Topics > Canada

The Old, Weird Niagara

info@reason.com (Damon W. Root) — Tue, 13 May 2008 17:35:00 EDT

From last Thursday's Wall Street Journal, here's the great reactionary radical (and reason contributor) Bill Kauffman on Ginger Strand's intriguing new book Inventing Niagara:

Ms. Strand's populist defense of the glorious disorder of the private Niagara Falls Museum is of a piece with her appreciation of the falls as God and nature intended them to be. But just as the five-story museum was leveled by the New York State parks authority and replaced by a parking lot, so have the falls, in Ms. Strand's words, been "manicured, repaired, landscaped and artificially lit, dangerous overhangs dynamited off and water flow managed to suit the tourist schedule." One can't help noticing that the "improvements" Ms. Strand deplores were almost entirely the work of government. Those overhangs were blown off by the Army Corps of Engineers, which has trimmed, blasted, dammed and fortified this natural wonder and its river. State, not commerce, was unable to leave well enough alone.

As an American patriot, I've long been ashamed of the fact that Niagara's greatest attraction, the uncanny Criminals Hall of Fame Wax Museum, rests on the Canadian side of the falls. And as Kauffman notes, we can thank the bulldozers of the vile Robert Moses, among other government villains, for the destruction of "the carnival-barker spirit that once gave the city brass, if not class."

Whole thing here.

Too Fast for Sarnia

info@reason.com (Damon W. Root) — Thu, 01 May 2008 12:27:00 EDT

Thank the gods, today's London Free Press brings word that the effort to keep glam metal dinosaurs Mötley Crüe from rocking Sarnia, Ontario's Rogers Bayfest have failed. Despite efforts by Sarnia city council member Dave Boushy, who opposed the band's appearance and accurately described their offstage antics as "pornographic," the full council refused to heed his warnings.

But as the paper reports, local grandfather Gord Park, the man who first alerted city officials to the Crüe's lewd legacy, remains defiant:

"There's been an enormous reaction and I'd say 99 per cent is in favour of my opinion," Park said. "People are saying this world is on a downward spiral. I'm not just talking about Motley Crue, I'm talking about any kind of trash."

Park is disappointed council didn't support Boushy's attempt to have input on Bayfest's lineup.

"I just hope groups like the Women's Interval Home and other protection agencies that combat drugs and sex abuse can handle the repercussions of what's being promoted."

Mandatory Niceness

jsullum@reason.com (Jacob Sullum) — Fri, 11 Apr 2008 12:00:00 EDT

In January an officer of the Alberta Human Rights and Citizenship Commission interrogated the Canadian journalist Ezra Levant about his decision to reprint the notorious Muhammad cartoons that originally appeared in the Danish newspaper Jyllands-Posten. Levant, the former publisher of the Western Standard, did not try to ingratiate himself. He called the commission “a sick joke” and dared the “thug” across the table to recommend that he face a hearing for offending Muslims.

Levant wanted to be convicted, since that would give him a chance to challenge the censorship that Canadian human rights commissions practice in the guise of fighting discrimination. “I do not want to be excused from this complaint because I was reasonable,” he told the officer. “It is not the government’s authority to tell me whether or not I’m reasonable.” That position has attracted broad support in Canada, where editorialists, columnists, activists, and legislators from across the political spectrum have criticized the commissions for threatening freedom of speech.

The national and regional commissions were established in the 1970s to vet complaints about illegal discrimination in employment, housing, and the provision of goods and services. But many of them have broad, ambiguous legal mandates that can be used to target controversial speech. Alberta’s Human Rights, Citizenship, and Multiculturalism Act, for example, prohibits publishing anything that “is likely to expose a person or class of persons to hatred or contempt.”

Syed Soharwardy, president of the Islamic Supreme Council of Canada, claimed Levant did that by running the Muhammad cartoons. “Publishing of cartoons in the Western Standards [sic] is in fact spreading hate against me,” Soharwardy scrawled on a complaint form he submitted to the commission in February 2006. He also complained that “Mr. Ezra Levant insulted me” when the two debated the cartoon controversy on CBC Radio. Until mid-February, when he announced that he planned to withdraw his complaint, Soharwardy was demanding an apology. Human rights commissions can impose fines and gag orders as well.

Meanwhile, the Canadian, Ontario, and British Columbia human rights commissions are considering similar complaints against Maclean’s magazine and the journalist Mark Steyn over an October 2006 article adapted from Steyn’s book America Alone. The Canadian Islamic Congress claims Steyn “subjects Canadian Muslims to hatred and contempt” and harms their “sense of dignity and self-worth” by worrying about high Muslim birth rates. Levant notes that even if a complaint is dismissed, responding to it requires “thousands of dollars in lawyer’s fees” and “an enormous amount of time,” which encourages journalists to steer clear of touchy subjects.

The Prince of Pot Makes a Pitch to Conservatives

jsullum@reason.com (Jacob Sullum) — Fri, 22 Feb 2008 15:51:00 EST

Libertarian activist Marc Emery, who faces extradition to the United States for selling marijuana seeds to Americans, makes his case to Canadian conservatives in a three-part video posted on the Western Standard's blog. Emery explains how, inspired by Ayn Rand and Ludwig von Mises, he embarked on campaigns of civil disobedience against unjust laws, including bans on Sunday retailing, "obscene" recordings such as 2 Live Crew's As Nasty As They Wanna Be, and drug-oriented publications. His most conspicuous effort was his marijuana seed business, aimed at "overgrowing the government" and raising money for the worldwide marijuana legalization movement. It proved a little too conspicuous.

Emery's operation, which shipped seeds to the U.S. and other countries, was one of hundreds such vendors in Canada, and he operated openly for more than a decade with little trouble from the government, which happily accepted the taxes generated by his business. But his financial support for drug policy reform groups, his political activism as founder of the B.C. Marijuana Party, and his advocacy of legalization in forums such as his Pot TV website and his magazine Cannabis Culture irritated both Vancouver police and American drug warriors, who conspired to arrest him and ship him to the U.S. for trial on drug trafficking, conspiracy, and money laundering charges that could send him to prison for the rest of his life. In Canada, by contrast, the worst penalty he was apt to face for selling marijuana seeds to growers was a fine, and in practice the government not only turned a blind eye but referred medical marijuana patients to him.

By Emery's account, the effort to arrest and extradite him began after he heckled John Walters during the U.S. drug czar's visit to Vancouver in November 2002. "That's really what this is all about," he says. "Three days later, his friends at the Vancouver Police Department opened an investigation of me." This is not as far-fetched as it might sound, since the day of Emery's arrest in July 2005 DEA head Karen Tandy admitted it was politically motivated, implying that Emery was being punished for his activism and philanthropy:

Today's arrest of Mark [sic] Scott Emery, publisher of Cannabis Culture magazine and the founder of a marijuana legalization group, is a significant blow not only to the marijuana trafficking trade in the U.S. and Canada, but also to the marijuana legalization movement. Hundreds of thousands of dollars of Emery's illicit profits are known to have been channeled to marijuana legalization groups active in the United States and Canada. Drug legalization lobbyists now have one less pot of money to rely on.

As I noted last month, Emery has tentatively accepted a Justice Department deal under which he would serve five years and his two co-defendants (one of whom uses marijuana to relieve the symptoms of Crohn's disease) would be released. Emery, who wants to serve all or at least most of his sentence in Canada, says he is still negotiating the details of that arrangement. He proposes another way out: If the Canadian authorities charged him with illegally selling marijuana seeds, he says, there would be no reason to extradite him; he could instead be tried in a Canadian court under Canadian laws and face the penalties Canadians consider appropriate.

Part of Emery's pitch to conservatives is that the U.S. government's prosecution of him impinges on Canadian sovereignty. He likens his situation to that of a Canadian charged with sending Falun Gong literature to China, selling alcohol to Saudis, or running a gambling website used by Americans, and asks whether the Canadian government would agree to extradition in those cases. "I've always defended peaceful, honest lifestyle choices," he concludes. "I paid all my taxes, never hurt anybody, only violated unjust laws transparently and openly, and that is something every conservative and libertarian should be able to get behind."

What's All This I Hear About Freedom of Speech?

jsullum@reason.com (Jacob Sullum) — Wed, 13 Feb 2008 11:53:00 EST

As a couple of commenters have noted in response to my column today, the National Post reports that Muslim activist Syed Soharwardy plans to drop his "human rights" complaint against Ezra Levant over the latter's decision, as publisher of the Western Standard, to reprint the Jyllands-Posten Muhammad cartoons. This is how Soharwardy explained his decision:

Over the two years that we have gone through the process, I understand that most Canadians see this as an issue of freedom of speech, that that principle is sacred and holy in our society. I believe Canadian society is mature enough not to absorb the messages that the cartoons sent. Only a very small fraction of Canadian media decided to publish those cartoons.

By his account, then, Soharwardy had not heard of this whole freedom-of-speech thing until after he filed his complaint with the Alberta Human Rights and Citizenship Commission, and it took him two years to fully absorb how important it is to Canadians. During that time, he also took the measure of Canadians and judged them "mature enough" to look at cartoons depicting Muhammad without going on an anti-Muslim rampage. I think it may take a few more years for Soharwardy to get the concept at stake in his tiff with Levant.

Levant, for his part, says he plans to sue Soharwardy for wasting his time and money. I understand the sentiment, but I'm not sure it's a smart P.R. move.

The Western Standard comments on Soharwardy's announcement here.

Mandatory Niceness

jsullum@reason.com (Jacob Sullum) — Wed, 13 Feb 2008 07:23:00 EST

Last month, when an officer of the Alberta Human Rights and Citizenship Commission interrogated him about his decision to reprint the notorious Muhammad cartoons that originally appeared in the Danish newspaper Jyllands-Posten, Ezra Levant did not try to ingratiate himself. Levant, former publisher of the news magazine the Western Standard, called the commission "a sick joke," compared it unfavorably with Judge Judy, and dared the "thug" across the table to recommend that he face a hearing for publishing material that offended Muslims.

That way, Levant explained, he could be convicted, which would give him a chance to challenge the censorship that Canadian human rights commissions practice in the name of fighting discrimination. "I do not want to be excused from this complaint because I was reasonable," he said. "It is not the government's authority to tell me whether or not I'm reasonable."

Legally, that remains to be seen. Canada's national and provincial human rights commissions were established in the 1970s to vet complaints about discrimination in employment, housing, and the provision of goods and services. But many of them have broad legal mandates that can be used to attack freedom of speech. Alberta's Human Rights, Citizenship, and Multiculturalism Act, for example, prohibits publishing anything that "is likely to expose a person or class of persons to hatred or contempt."

Syed Soharwardy, president of the Islamic Supreme Council of Canada, claims Levant did that by running the Muhammad cartoons. "Publishing of cartoons in the Western Standards [sic] is in fact spreading hate against me," Soharwady scrawled on a complaint form he submitted to the commission in February 2006. He also complained that "Mr. Ezra Levant insulted me" when the two debated the cartoon controversy on CBC Radio. Soharwardy is demanding an apology. The commission can impose fines and gag orders as well.

Meanwhile, the Canadian, Ontario, and British Columbia human rights commissions are considering similar complaints against Maclean's magazine and the journalist Mark Steyn over an October 2006 article adapted from his book America Alone. The Canadian Islamic Congress claims Steyn "subjects Canadian Muslims to hatred and contempt" and harms their "sense of dignity and self-worth" by worrying about high Muslim birth rates.

Even if a complaint is dismissed, Levant notes, responding to it requires "thousands of dollars in lawyer's fees" and "an enormous amount of time," which encourages journalists to steer clear of touchy subjects. "A warning shot has gone out to every other media [outlet] in the country," he said during the 90-minute commission interview. "‘Don't mess around with the Muslim radicals, because they'll call in the censors.'"

In Levant's case the censors were represented by a bland bureaucrat named Shirlene McGovern, paid to enforce the commandment that Jonathan Rauch dissected in his 1993 book Kindly Inquisitors: "Thou shalt not hurt others with words." As Rauch cogently argued, "This moral principle is deadly...to intellectual freedom and to the productive and peaceful pursuit of knowledge."

But in a sense, Levant and Steyn are lucky. An Afghan journalism student recently was condemned to death for downloading and distributing a report that criticizes the way Islamic fundamentalists interpret the Koran to justify oppression of women. The student's Afghan defenders argued that distributing the report did not amount to blasphemy, that the prosecution was politically motivated, that the trial was unfair, and that the sentence was excessively harsh.

The one thing they did not say was what Levant said when confronted by Canada's kindly inquisitors: that even if the controversial speech is contrary to Islam and offensive to Muslims, the government has no business punishing him for it. "I reserve maximum freedom to be maximally offensive, to hurt feelings as I like," Levant told McGovern. While he has publicly explained the journalistic reasons for running the Muhammad cartoons many times, he said, "The only thing I have to say to the government about why I published [them] is because it's my bloody right to do so."

John Walters' Drug Message: Buy Canadian

jsullum@reason.com (Jacob Sullum) — Mon, 21 Jan 2008 13:07:00 EST

A few weeks ago, when U.S. drug czar John P. Walters warned that Canadian drug traffickers were flooding our country with methamphetamine-laced "Extreme Ecstasy," it came as news to drug warriors in Canada. Paul Nadeau, head of the Royal Canadian Mounted Police's national drug branch, recently told the Canadian Press he did not understand why Walters would say such a thing:

"I shook my head when I read the release that they put out," said Nadeau, adding he's never heard of extreme ecstasy.
"That term is unknown to us, certainly in Canada, and I can tell you that I've spoken to law enforcement people in the U.S. and they've never heard of it either so it would appear that it's a term that somebody came up with in a boardroom in Washington, D.C."...
Nadeau said there's nothing new about ecstasy—the so-called love drug that gained popularity during the 1990s rave scene—being laced with methamphetamine or other stimulants and that it's been happening for the last decade.
"According to our stats the presence of methamphetamines in ecstasy is dropping," he said, adding tests by the RCMP indicate that currently, about 35 per cent of ecstasy pills contain meth, down from 75 per cent several years ago.
"Why now do they feel the need to announce this to the world?" Nadeau said of the Office of National Drug Control Policy.

I don't know. Maybe to justify their budget by keeping the public in a constant state of alarm about drugs? Walters' press release made it sound as if putting meth in MDMA tablets was a new, growing, scary yet exciting phenomenon linked specifically to Canada:

Alarmingly, more than 55 percent of the Ecstasy samples seized in the United States last year contained methamphetamine. Cutting their product with less-expensive methamphetamine boosts profits for Canadian Ecstasy producers, likely increases the addictive potential of their product, and effectively gives a dangerous "face lift" to a designer drug that had fallen out of fashion with young American drug users.

Confusingly, Walters claimed Ecstasy dealers were ripping off their customers by substituting a cheaper drug for MDMA yet also somehow providing extra value by fortifying the pills with meth. As I noted at the time, the ONDCP's warnings about "Extreme Ecstasy" could be mistaken for advertising, which is often the case with government's anti-drug propaganda. "If I was a meth dealer in Canada," a former ONDCP economist tells the Canadian Press, "I would certainly rebrand mine to 'extreme ecstasy.' " Likewise, I'm sure Canadian pot growers were grateful for Walters' warnings about their "crack of marijuana."

[Thanks to Caleb O. Brown for the tip.]

Later She Was Seen Perusing the 'Sorry About the Torture' Section of the Hallmark Store

jsullum@reason.com (Jacob Sullum) — Thu, 25 Oct 2007 14:28:00 EDT

Secretary of State Condoleezza Rice has acknowledged that the U.S. government made a mistake in 2002 when it deported Canadian software engineer Maher Arar to Syria, the country of his birth, where he was imprisoned as a suspected terrorist for a year and tortured. Arar was arrested during a stopover in New York based on what turned out to be erroneous information from the Canadian government, which has since exonerated him, apologized, and paid him $11 million in compensation and legal fees. Rice, for her part, did not exactly apologize, telling the House Foreign Affairs Committee:

We do not think that this case was handled as it should have been. We do absolutely not wish to transfer anyone to any place in which they might be tortured....We have told the Canadian government that we did not think this was handled particularly well in terms of our own relationship and that we will try to do better in the future.

But Rice also indicated that the U.S. government is not prepared to meet the Canadian government's request that Arar be removed from a list that bars him from entering the United States. "I think we and the Canadians do not have exactly the same understanding of what is possible in the future with Mr. Arar in terms of travel and the like," she said.

My 2006 column about the Canadian report that exonerated Arar is here.

Imaginary Nanotech of the North Spooks U.S. Defense Officials

bdoherty@reason.com (Brian Doherty) — Tue, 08 May 2007 15:14:00 EDT

While it isn't a Mooninite level of phony panic, it is pretty amusing: The Associated Press reports on how the U.S. Defense Security Service (a division of the Defense Department) spread false rumors that a common Canadian coin was in fact a nanotech-embedded tracking device meant to spy on U.S. contractors for nefarious purposes.

[Hat tip to reader Jay Weiser.]

No Trips for Trippers

jsullum@reason.com (Jacob Sullum) — Wed, 25 Apr 2007 14:34:00 EDT

A couple months ago, Brian Doherty noted that Canada has begun turning away American visitors with records of minor offenses such as marijuana possession. Now it looks like the U.S. is retaliating and, as usual, taking the anti-drug idiocy up another notch. Over at Alternet, Linda Solomon describes the predicament of Andrew Feldmar, a Canadian psychotherapist who has been prevented from visiting his children, friends, and colleagues in the U.S. because a border agent's Web search turned up a journal article in which Feldmar discussed his experiences with LSD and other psychedelics. In the '60s. In Canada and England.

A Department of Homeland Security official explains that Feldmar was barred from entry not because of what he wrote but because of what he did: "Anyone who is determined to be a drug abuser or user is inadmissible. A crime involving moral turpitude is inadmissible, and one of those areas is a violation of controlled substances." Even if it occurred four decades ago in other countries and never resulted in a criminal charge. Feldmar can seek a waiver, but the process costs several thousand dollars and has to be repeated every year.

I was only kidding when I said blocking Feldmar's visit was the U.S. response to Canada's border policy. But maybe both countries can agree to stop barring harmless people for ridiculous reasons. If Canada adopted the standard applied to Feldmar, turning back anyone who has ever used illegal drugs, half the U.S. population would be prohibited from crossing the border.

[Thanks to Amy Alkon for the tip.]

Pot Smokers From Decades Ago, Your Kind is Not Welcome in Canada

bdoherty@reason.com (Brian Doherty) — Fri, 23 Feb 2007 13:34:00 EST

Interesting piece from the San Francisco Chronicle website on one of the elements of the new information age that disturbs a lot of us: it is now harder to get away with things we traditionally have gotten away with because it was too hard for authorities to keep track of all our transgressions.

The story tells of a new wave of denials-of-entry of American tourists to Canada because of picayune legal troubles from the past. An excerpt about why:

While Canada officially has barred travelers convicted of criminal offenses for years, attorneys saypost-9/11 information-gathering, combined with a sweeping agreement between Canada and the United States to share data, has resulted in a spike in phone calls from concerned travelers.
They are shocked to hear that the sins of their youth might keep them out of Canada. But what they don't know is that this is just the beginning. Soon other nations will be able to look into your past when you want to travel there.
"It's completely ridiculous,'' said Chris Cannon, an attorney representing the East Bay couple, who asked that their names not be used because they don't want their kids to know about the pot rap. "It's a disaster. I mean, who didn't smoke pot in the '70s?''
We're about to find out. And don't think you are in the clear if you never inhaled. Ever get nabbed for a DUI? How about shoplifting? Turn around. You aren't getting in.
"From the time that you turn 18, everything is in the system,'' says Lucy Perillo, whose Canada Border Crossing Service in Winnipeg, Manitoba, helps Americans get into the country.

Reason has looked at the perils--as well as the oft-neglected advantages--of the new hyperefficient information and surveillance age in this June 2004 feature (the famous one with subscribers' homes pictured on the cover individually) by Declan McCullagh and this one by me from 2003 focusing on John Gilmore's (now pretty much lost) fight to not have his papers checked every time he travels, and most recently in Julian Sanchez's January cover story .

[Hat tip: my pal and world traveler Barbara Fried]

Is Privacy Protection in the U.K. No Better Than in China?

jsullum@reason.com (Jacob Sullum) — Fri, 03 Nov 2006 12:14:00 EST

A new Privacy International survey of 36 countries ranks the U.K. with China, Russia, Malaysia, and Singapore as an "endemic surveillance society." British Information Commissioner Richard Thomas is worried. “Two years ago," he says, "I warned that we were in danger of sleepwalking into a surveillance society. Today I fear that we are in fact waking up to a surveillance society that is already all around us."

The U.S., an "extensive surveillance society," fares only slightly better than the U.K. The survey deals only with privacy-related issues, of course, not with civil liberties generally. In that sense it's too narrow to accurately reflect the state of individual freedom in the countries surveyed. The U.K. may have more surveillance cameras per capita than China does, but when it comes to what governments do with the information they collect, the Chinese have a lot more cause for worry than the British do.

In another sense, the criteria for Privacy International's ranking are too broad. Citizens of the U.K. and the U.S., for example, have good reason to feel more secure against arbitrary government search and seizure than citizens of China and Russia do. And they are apt to be more concerned about that risk than, say, the chance that magazines to which they subscribe will sell their names and addresses to direct-mail merchants. Yet Privacy International's "statutory protection" and "privacy enforcement" categories include restrictions on the use of information people voluntarily divulge to private companies; it also has a category for "workplace monitoring" (a.k.a. keeping an eye on your employees). The inclusion of business regulations is one reason Canada and Germany (identified as countries with "significant protections and safeguards") do so much better in the ranking than the U.S.

I've long argued that it's a mistake to treat private use of voluntarily revealed information as a violation of privacy rights in the absence of an agreement restricting use of the data (which would include a company's official privacy policy) or special circumstances in which confidentiality is assumed (as with medical records or psychological counseling). The voluntary sharing of information as part of a commercial transaction is qualitatively different from the nonconsensual collection of information by the government. I have a choice about whether I want to let my grocery store track my purchases in exchange for discounts; I don't have a choice about whether the government searches my house or eavesdrops on my phone calls.

At the same time, the collection of information by private entities is undeniably worrisome when that information can be demanded by the government on a whim through devices such as administrative subpoenas. Because the Supreme Court has ruled that information you give to a private business is no longer yours as far as the Fourth Amendment is concerned, the government's access to that information is governed by a hodgepodge of statutes and regulations. As the NSA's phone call database shows, these rules have loopholes that allow the government to collect information that most Americans would consider private without any sort of court order. In the case of the phone call information (which included numbers dialed and call duration), any statutory violation was committed by the phone companies that surrendered the information, not the government agency that "requested" it.

That's an example of a business regulation aimed at preventing unjustified government surveillance. So while it's important to distinguish between the threats posed by the government and the threats posed by private entities, regulation of data sharing may be an important backstop when the courts and the legislature fail to restrict government directly.

Canadianizing the Golden State

rbailey@reason.com (Ronald Bailey) — Fri, 03 Mar 2006 10:31:00 EST

A plan to outlaw private health insurance in California has been proposed by state Sen. Sheila Kuehl (D-Los Angeles). Senator Kuehl's bill, SB840, proposes to create the California Health Insurance Agency, a state government run single payer system for financing the health care of all Californians. Her bill, if enacted, would abolish all private health insurance in the Golden State. Her legislation essentially aims to replicate the system of socialized medicine in Canada which, until a recent court ruling in Quebec, made all private health care illegal. Her health care proposal is more authoritarian than the health care systems in the United Kingdom or Germany in which citizens can buy private insurance if they so choose.

Remarkably, Kuehl's proposal to socialize California's health care is being made just at the time when the Canadian system it resembles is falling apart at the seams. For instance, Canada's single payer system is projected to absorb more than half the budgets of most Canadian provinces. In addition, the amount of time a Canadian patient must wait before receiving medical care is notorious. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years," said Dr. Brian Day in a recent New York Times article on Canada's health care crisis.

Kuehl flatly denies that her plan is "government-run health care." She prefers to style it as "a publicly administered finance system." Of course, as the old saying goes: "He who pays the piper, calls the tune." In this case, the new California Health Insurance Agency (CHIA) will be paying, and thus every health care provider and patient in the state would have to dance to its tune.

Kuehl maintains that her government single payer health insurance system will cover all Californians including the one-fifth who are uninsured now and be cheaper at the same time. How? In order to control rising health care costs, Kuehl's plan pegs annual growth in health spending to growth in California's economy. But is that the right amount of spending? In fact, we know that as people earn more, they generally choose to spend higher percentages of their incomes on health care. For instance, economic studies show that for every one percent increase income, families generally prefer to increase their spending on health care by 1.6 percent.

Let's consider a simplified example of how Kuehl's plan would lead to less spending on health care than most Californians would like. Take the California median household income of $50,000 and assume that each household spends an average of 20 percent, or $10,000, on health insurance and out-of-pocket medical expenses each year. Then let's assume that California's economy continues to grow and that median family income climbs to $80,000.

If economists are right, this means that California families on average would prefer to spend $19,600 annually on health care. In other words, people would rather buy health care than the biggest houses or fastest cars that they could afford with a higher income. However, under Kuehl's proposal to fix health care spending at the growth rate of the economy, California health insurance bureaucrats would allocate only an average of $16,000 per year to each family. And since it would be illegal for California families to buy supplemental private insurance, they would be getting much less access to doctors and modern treatments than they would prefer.

Like all politicians Kuehl promises voters all good things. For example, she vows that under CHIA, "You will choose your own doctor and you and your provider, not insurance agents, will decide your care. All needed services, drugs, hospital stays, therapies, and medical equipment will be covered."

Looking at the fine print, you find that Kuehl's government-run single payer system will be cheaper because it will actually ration health care. In other words, decisions about what treatments will be available to Californians and when they will become available will be in the hands of government health care bureaucrats. Just like the Canadian socialized health care system, the new California Health Insurance Agency will determine how much it will pay pharmaceutical companies for new more effective medicines. This means that Californians, like Canadians today, will wait a long time, possibly forever, to get access to modern therapies. In 2002, Sally Pipes, head of the Pacific Research Institute, a free-market think tank in San Francisco noted,, "One hundred new drugs were launched in the United States from 1997 through 1999. Only 43 made it to market in Canada in that same period. Canadians are still waiting for many of them."

California health bureaucrats will also set doctors' fees. Kuehl likens her plan to the Federal government's Medicare system for seniors. She overlooks the fact that physicians are fleeing Medicare in droves because the program doesn't adequately reimburse them. Doctors are like anybody else; they work less when they get paid less. If Kuehl's system is adopted, you will eventually see waiting lines lengthening and doctors treating fewer and fewer patients. California doctors and other health care workers will leave for other states where they are better compensated, and few new doctors, nurses and other personnel will be attracted to California. Another side effect will be that many of California's innovative biotech companies will relocate to friendlier business environments.

Kuehl plans to finance the California Health Insurance Agency through a dedicated payroll tax in which employers would pay 8.2 percent and workers would pay 3.8 percent. And when the system runs short of money, as it inevitably will, the new health bureaucracy will impose cost control measures that include the "postponement of introduction of new benefits or benefit improvements; a temporary decrease in benefits; a postponement of planned capital expenditures, and limitations on aggregate reimbursements to manufacturers of pharmaceutical and durable and nondurable medical equipment." Translation: California health care bureaucrats, not doctors or patients, will be deciding what new treatments will be offered; what new hospitals and laboratories will be built; and what new drugs and new biomedical technologies will be permitted in the state.

Today, as the Canadian health care system implodes, more and more Canadians are seeking private medical care across the border in the United States. Within a decade after Kuehl's single payer system has been adopted, I predict that many Californians will similarly be fleeing across the border into Arizona and Nevada looking for modern private medical care in state-of-the-art hospitals and clinics.

The Crimes of Pot Justice

bdoherty@reason.com (Brian Doherty) — Mon, 06 Feb 2006 00:00:00 EST

Last week a man was shivering and vomiting in a cold cell in Auburn, California, at the foot of the Sierra Nevadas in Placer County, his urine bloody, the medicine he needs denied him.

His name is Steve Kubby. He was the Libertarian Party's 1998 gubernatorial candidate, and a major player in the crafting and passing of California's Proposition 215, the 1996 initiative that legalized medical marijuana in the state.

Kubby did not enjoy the protection of the law he helped pass. Prompted by an anonymous tip, police in California's Placer County began surveilling Kubby's home near Lake Tahoe in 1998, including digging through his garbage. Eventually on January 19, 1999, 12 armed officers raided his home and arrested him and his wife, claiming to have found 265 pot plants. (More than half, Kubby insists, were unsexed seedlings, and California law does not have a specific numerical limit on personal use marijuana growth for medical marijuana patients.) The warrant was obtained partially on the basis of claims that a journalist who had been seen visiting the Kubbys' home was in fact a known Jamaican drug smuggler, according to a DEA report later found not to exist; Kubby is certain his prominence in the pro-marijuana movement made him a target.

Kubby is struggling with a rare and usually fatal form of adrenal cancer, pheochromocytoma, which he has suffered from since the late 1960s. A doctor who helped treat him for the condition in the 1970s, Vincent DeQuattro of the University of Southern California, was amazed, upon seeing Kubby's name in California's voter guide during his gubernatorial race, to discover that his old patient was still alive. As High Times reported:

"In some amazing fashion," DeQuattro subsequently advised the judge in Kubby's case, "this medication has not only controlled the symptoms of pheochromocytoma, but in my view, has arrested growth" of the cancer. "Every other patient than Steve, with Steve's condition, has died in the interval of time [that Kubby has had the disease.] Steve was the only survivor."

Kubby insists the only treatment he's taken in a long while for the cancer—whose effects include sudden rushes of adrenalin and noradrenaline, resulting in high blood pressure spikes, headaches, and panic attacks—is marijuana; that it, and only it, had kept him alive this long; and that without it, as he now is in Placer County lockdown, he'll likely die.

Is he right? Even with the grim reports of his vomiting, chills, and bloody urine this past week in jail, it's hard to be sure. He's merely one anecdote, and concerted research into such questions of marijuana's medical efficacy are hamstrung by restrictive federal regulations and supply constraints. But right now his Placer County jailers are conducting a very dangerous experiment to test Kubby's theory. A Canadian doctor, Dr. Joseph M. Connors, chair of the Lymphoma Tumor Group at the British Columbia Cancer Agency, has testified that without his pot, Kubby is at high risk of suffering potentially fatal heart attacks, seizures, or strokes from his cancer's effects.

Kubby was acquitted of the pot charges arising from the raid, but convicted in 2001 for some peyote buttons and a psychedelic mushroom the cops also found. Before serving his term, he and his family left for Canada, where they've spent the past five years. He, his wife Michele, and his two daughters were finally deported back to the U.S. last week. They were met at the San Francisco airport by a gang of officers, Kubby was handcuffed and taken away, avoiding the press and well-wishers awaiting him in the airport, and ended up in Placer County jail.

Kubby has become something of a cause célèbre because of his intimate connections with the libertarian and medical marijuana communities. But he's not the only one suffering in prison because of lack of marijuana. In a similar situation—ill, in prison, denied marijuana that helps them cope or survive their illness—are Joe Fortt (in jail in Fresno, his T-cell count plummeting, he'd been using pot to cope with AIDS while free), Robert Schmidt (currently in Leavenworth, a prison under full "lockdown," denied both medicine and visitors), and many others. Prisons in California may, at their discretion, but are not required under the law, provide inmates with their medical marijuana-and generally don't.

As of this writing, Kubby is being permitted the use of marinol, a pharmaceutical synthetic THC, though not the whole marijuana plant. His blood pressure has stabilized and the blood has left his urine. (When he refused to take standard blood pressure medicine, inappropriate for the spiked variety of high blood pressure his adrenal problems caused, they made him sign a waiver absolving his jailers of all responsibility for what might happen to him.) His pre-trial hearing on a charge of failure to appear for probation is scheduled for February 15.

The Kubby case presents many unresolved controversies; is it really the marijuana that has kept his adrenal cancer from killing him? Did his status as a felony fugitive arise from judicial misconduct? (His conviction was originally for a misdemeanor, raised to a felony level by a judge during his appeals process, which is what made his lack of appearance at a hearing because he was in Canada a crime. Kubby has filed a complaint with California's Commission on Judicial Performance, alleging the judge, who had been earlier recused from his case, was acting illegally.)

Whatever the final resolution of those questions, in Auburn, California, a man is in jail ultimately for growing a plant he believes helps him, suffering from cancer, his vitals erratic, deprived of medication that makes his life bearable. He has harmed no one, and is being harmed for it.

Beware the Climate Lilliputians

rbailey@reason.com (Ronald Bailey) — Mon, 12 Dec 2005 00:00:00 EST

In Gulliver's Travels, the diminutive Lilliputians tie down the "giant" Gulliver with hundreds of tiny cords. The other nations of the world are hoping to try the same trick on the "giant" United States, binding it with strings of small international agreements that will ultimately restrict its emissions of greenhouse gases.

The United Nations Climate Change Conference in Montreal ended this past weekend with two such accords. In the first deal, the parties to the Kyoto Protocol reached an agreement to launch negotiations about imposing further restrictions on their emissions of greenhouse gases after that treaty expires in 2012. Since the United States is not a party to the Kyoto Protocol it had no say in this agreement.

Currently, the industrialized nations who are parties to Kyoto Protocol have agreed to reduce their emissions by an average of 5 percent below the levels they emitted in 1990. Significantly, developing nations like China, India, and Brazil that signed the Kyoto Protocol do not have to cut their emissions. In the next round of climate talks, it's very unlikely that they will agree to any binding limits on their emissions unless the United States agrees to go along too. This means the European Union, Japan, and Canada will be negotiating to impose stricter limits on their emissions, which will result in higher energy prices than those enjoyed by their developing country competitors like China and India—as well as by the Kyoto-refusenik United States. Obviously, the industrialized countries that are Kyoto signatories are anxious to find some way to impose the same economic pain on countries that do not have limits on their emissions.

That brings us to the second track of last week's climate negotiations. The Montreal conference featured a parallel set of negotiations among the 189 signatories to the broader climate treaty, the United Nations Framework Convention on Climate Change (UNFCCC). At the last minute the United States reluctantly agreed to engage in a global dialogue in "the form of an open and non-binding exchange of views" that "will not open any negotiations leading to new commitments." This agreement would seem to amount to little more than a promise by the United States to show up at future United Nations climate meetings, but it was nevertheless hailed as a "triumph." The environmental activist group Greenpeace called the agreements "historic," and British Prime Minister Tony Blair declared them "a vital next step in tackling climate change."

All decisions under the Framework Convention must be reached by consensus, so the Bush Administration could have stopped the second set of negotiations dead in Montreal simply by walking away. The activists and Kyoto signatories are convinced that as climate negotiations grind on that they will have a chance to tie more strings to the recalcitrant giant that is the United States. They are also confident that when the Bush Administration ends in January 2009, the United Nations' climate negotiations will have built up a momentum that the new American administration will find difficult to resist. I once wrote that the Kyoto Protocol was dead, but this decision by the Bush Administration has resurrected it. Unless the United States drops out of the climate negotiations altogether, it's a pretty good bet that the climate Lilliputians will eventually succeed in binding the country they consider the global warming giant.

Ronald Bailey is Reason's science correspondent. His book Liberation Biology: The Moral and Scientific Case for the Biotech Revolution is now available from Prometheus Books.

The Perpetual Health Care Crisis

bdoherty@reason.com (Brian Doherty) — Fri, 01 Jul 2005 00:00:00 EDT

2005 Medical Care Forever

rbailey@reason.com (Ronald Bailey) — Wed, 15 Jun 2005 00:00:00 EDT

"The United States is the only industrialized nation that does not have some kind of universal health care," is the oft-heard mantra of progressive activists and politicians. It is, of course, understood that that means a socially backwards U.S. should adopt a system of government-financed health care immediately. In support of their campaign for universal health care, progressives cite the fact that more than 40 million Americans do not have health insurance. They also point out that 15 percent of the country's GDP is spent on health care while countries with nationalized health care spend only around 10 percent of theirs. And they note that American life expectancy and infant mortality rates are worse than in most countries that furnish government health care. Finally, polls show that more than 60 percent of Americans favor some kind of universal government health care. Nationalized health care sometimes seems all but inevitable in the United States.

Undeniably, the United States has seen the steepest rise in health care expenditures over the past half century or so, growing from 1.3 percent of gross domestic product (GDP) in 1960 to 4.2 percent in 1980; they now stand at 15 percent of GDP. But even in nationalized systems, health care costs are rapidly escalating as a proportion of GDP. For example, Canada spent 2.4 percent of its GDP on health care in 1960 and 5.6 in 1981; health care spending now stands at 9.9 percent of Canada's GDP. Britain's health expenditures were 3.4 percent in 1960, rising to 5.4 percent by 1981 and are now 7.7 percent.

Health expenditures in nationalized systems are kept lower chiefly by price controls and the frank rationing of services. In Canada waiting lines for many medical procedures are legendary. Last year, lawyers in Quebec filed a class action suit on behalf of 10,000 breast cancer patients who contend they had to wait too long for radiotherapy. The story is the much the same for Britain's National Health Service where more than 800,000 patients are waiting for NHS operations.

US life expectancy does lag Britain's (77.7 versus 78.4 years), but Britons are four times more likely to die than Americans while undergoing major surgery. Furthermore, the most seriously ill NHS patients were seven times more likely to die than their American counterparts.

A 2001 poll of Britons found that 40 percent would consider opting for private health care. In a 2004 poll, 51 percent of Canadians said that they would support the creation of a private health care system parallel to the government health care system. The first crack in the Canadian provincial monopolies that banned almost all private health care opened last week when the Supreme Court of Canada ruled that private health care was a constitutional right of Canadian citizens. And in Britain the NHS is increasingly contracting out to private providers for surgeries, MRI scans, and radiology treatments in order to cut its monumental waiting lists. Wouldn't it be ironic, if America embraced nationalized health care, just as such systems crumbled abroad?

Harvard University economist Kenneth Rogoff sees health care expenditures rising to perhaps 30 percent of a country's GDP over the next 50 years. If the US adopts a nationalized health care system, taxes will have to double for pay for it. Rogoff also observes, "[I]f all countries squeezed profits in the health sector the way Europe and Canada do, there would be much less global innovation in medical technology. Today, the whole world benefits freely from advances in health technology that are driven largely by the allure of the profitable U.S. market. If the United States joins other nations in having more socialized medicine, the current pace of technology improvements might well grind to a halt."

Which suggests the following thought experiment—what if the United States had nationalized its health care system in 1960? That would be the moral equivalent of freezing (or at least drastically slowing) medical innovation at 1960 levels. The private sector and governments would not now be spending so much more money on health care. There might well have been no organ transplants, no MRIs, no laparoscopic surgery, no cholesterol lowering drugs, hepatitis C vaccine, no in vitro fertilization, no HIV treatments and so forth. Even Canadians and Britons would not be satisfied with receiving the same quality of medical care that they got 45 years ago.

Everybody pays more to obtain improved pharmaceuticals, imaging technologies, cancer therapies, and surgical techniques. The happy result is that average life expectancy has increased by about eight years since 1960.

As Rogoff suggests, the nationalized health care systems extolled by progressives have been living off the innovations developed by the "only country without a universal health care system." I wonder how Americans would vote if they were asked if they would be happy freezing medical care at 2005 levels forever?

Adapting to Climate Change

rbailey@reason.com (Ronald Bailey) — Tue, 14 Dec 2004 00:00:00 EST

Buenos Aires—Delegates from the European Union and activist groups are celebrating the advent of the Kyoto Protocol, but both are beginning to realize that strategies aimed at mitigating projected global warming have just about run their course. The United States will not agree to binding limitations on greenhouse gas (GHG) emissions and neither will rapidly industrializing developing countries like China and India. The costs are just way too high in lost jobs and stalled economic growth. If these countries refuse to limit their use of fossil fuels, then there is no point in going forward with new treaties establishing limits on GHG emissions. So those worried about possible catastrophic global warming will have to resign themselves to figuring out how best to live with projected higher temperatures. And in fact this process is already happening.

"We are beginning to see more research on adaptation strategies in response to climate change," said Jonathan Pershing, a climate impacts analyst with the World Resources Institute. Pershing was speaking during a side event sponsored by the Pew Center on Global Climate Change at the United Nation's Framework Convention on Climate Change's (UNFCCC) 10th Conference of the Parties (COP-10). Pershing noted that up until now most climate policy research focused on ways to mitigate climate change impacts—that is, devising schemes aimed at lowering projected increases in the Earth's average temperature, usually by cutting back the use of fossil fuels. Pershing suggested that politicians have promoted research on mitigation strategies as a way to avoid admitting to the public that climate change impacts are or will soon be occurring.

Setting aside for the time being whether or not catastrophic global warming really lies in our future, floods, droughts, oceanic storm surges and wind storms will continue to afflict humanity. Consider two recent examples: a cyclone struck the Indian state of Orissa in 1999 destroying 2 million houses and killing 10,000 people and in 2004 three hurricanes hit Florida killing 116 people. The people of Orissa and Florida both suffered disasters, but there was big difference in their aftermaths. What makes people more or less vulnerable to weather disasters? Pershing cited the admittedly imperfect attempt by University of East Anglia risk researcher Neil Adger who has concocted a set of indicators of vulnerability and adaptive capacity.

Among other things, Adger uses data collected by the EM-DAT disaster database which is run by the WHO Collaborating Centre for Research on the Epidemiology of Disasters. EM-DAT collects data on calamities and their human and economic impact from around the world. Adger combines natural cataclysms like floods, droughts, hurricanes and the like with various measures of a country's capacity to adapt to the disasters. These measures include things sanitation, literacy, infant mortality, caloric intake, and life expectancy. Adger then calculates "vulnerability scores" ranging from 50 as most vulnerable to 10 as least vulnerable.

Some of the most vulnerable countries are Ethiopia (score 41), Burkina Faso (40), Pakistan (37), Haiti (37), Nepal (35) and Bangladesh (32). Not too surprisingly the least vulnerable countries are the United States (10), Australia (10), UK (11), Germany (11), and Canada (11). While Adiger's vulnerability scores surely correlate with things like life expectancy, sanitation, and literacy, there is also something else that vulnerability correlates strongly with—poverty. As measured in purchasing power parity in dollars, the countries with high vulnerability scores have very low gross domestic products per capita: Ethiopia ($700), Burkina Faso ($1,100), Pakistan ($2,100), Haiti ($1,600), Nepal ($1,400), and Bangladesh ($1,900). If something goes wrong the people living in the world's poorest countries have fewer material and social resources with which to respond and recover.

The United Nations Intergovernmental Panel on Climate Change predicts: "The effects of climate change are expected to be greatest in the developing countries in terms of loss of life and relative effects on investment and the economy." The Christian Tearfund charity issued a report for COP-10 noting that "98 percent of those killed and affected by natural disasters come from developing countries, underlining the link between poverty and vulnerability to disaster." The Tearfund report added that in 2001 some 170 million people were affected by disasters. The three billion people living on less than $2 per day don't have much to fall back on in an emergency.

Consider the difference in the death tolls caused by a cyclone in Orissa and hurricanes in Florida. The United States has better early warning systems, more hospitals and paved roads, sturdier houses and better emergency response than does India (vulnerability score 30, average income, $2,900). All these things are made possible because Americans are wealthier than Indians: U.S. per capita annual GDP is $37,800.

In climate-speak some mitigation strategies aimed at cutting GHG emissions by limiting energy use are called "no regrets" proposals, that is, actions that a company or agency would take anyway that also results in GHG reductions, e.g., switching a power plant from coal to natural gas. It is past time to seriously consider "no regrets" strategies for adapting to climate change. No country would regret having better roads, hospitals, sanitation, sea walls, houses, access to electricity, communications and so forth. All of these things would make its citizens less vulnerable to whatever weather disasters a changing climate might bring. So how to implement a no regrets climate change adaptation strategy? The best way to do it is the old-fashioned way by encouraging economic growth and free trade to alleviate poverty, illiteracy, maternal and infant mortality, and so forth. For example, people living in the developing countries that have participated in the current wave of globalization by being more open to free markets and trade have been becoming richer. World Bank economist David Dollar has pointed out, "Between 1993 and 1998, the number of absolute poor in the globalizing developing countries declined by an estimated 120 million, while poverty increased in the rest of the developing world by 20 million." Indeed, Dollar adds, "China has seen the most dramatic poverty reduction in history."

It turns out that by liberalizing their economies, China and India are well on the way to reducing their vulnerability to any climate shocks. And now it's finally beginning to dawn on some of the delegates at COP-10 that becoming wealthier means becoming less vulnerable to climate change. That will turn out to be a no regrets policy to confront climate change that every country can support.

Losing Patients

info@reason.com (John Graham) — Mon, 01 Nov 2004 00:00:00 EST

The Barbarian Invasions, recently released on DVD by Buena Vista Home Video, offers a disturbing vision of state-run medicine. The Canadian film won two awards at the 2003 Cannes Film Festival (best screenplay and best actress) and took home this year's Oscar for best foreign-language film. It is the story of a man with a terminal disease who renews his relationships with his friends and family, especially his adult son. Much of the action takes place in a hospital in Montreal, Quebec, where director and screenwriter Denys Arcand dissects the Canadian health care system.

The film opens with a nun struggling down the corridor of a crowded ward to administer Holy Communion. Patients, health professionals, even electricians, are tripping over each other, packed into an environment of general confusion. And yet there is another floor of the hospital that is completely closed, thanks to a government directive.

The dying man's son is a successful investment banker in London. He's the kind of guy who can wriggle around anything. First he wrangles his way into the hospital's management offices without a pass and corners the manager, who is completely isolated from the chaos outside. He offers her a bribe to get his father moved out of the zoo and into a private space on the empty floor. She quietly takes the bribe but points out that she can do nothing without the hospital employees' union. The son pays off the union boss to prepare a private room on the empty floor. Painters, carpenters, and other workers quickly make it up.

Then, because there is virtually no access to PET (positron emission tomography) scans in Canada, the banker takes his father to Vermont to get one. One of the son's friends in Baltimore -- one of many Canadian doctors who have emigrated to the U.S. -- examines the scan and informs him his father will have a much better chance in Baltimore than in Montreal. Remarkably, the father will have none of it: "I voted for socialized health care," he proclaims, "and I'm prepared to suffer the consequences!"

With this line, the father speaks for too many Canadians, who often wrap their national identity in nationalized health care. This is why Canadian politicians have not had the courage to give Canadians more health freedom. But the pain and inhumanity caused by the Canadian system are starting to make even the most nationalistic of us reconsider the amount of control over health services that we've ceded to our government.

The Barbarian Invasions tells us a lot about the consequences of government monopoly health care. The hospitals are poorly managed, the doctors and nurses confused, the unions who really run the show thuggish, the patients all but ignored.

The film has sparked a debate in Canada about the role of the state in health care. Any American who thinks health care in the United States would be improved by implementing a single-payer system would learn much from it too.

Mandatory Health Insurance Now!

rbailey@reason.com (Ronald Bailey) — Mon, 01 Nov 2004 00:00:00 EST

In an ABC News/Washington Post poll last fall, 62 percent of the respondents favored a universal, government-run medical insurance program. Such surveys reflect a widespread frustration with a health care system that is too expensive, too uncertain, and too complicated.

The answer proposed by John Kerry and John Edwards is to continue the creeping socialization of medicine that Americans have been experiencing since the 1960s. That course would mean the end of private health care in the U.S., and with it the unparalleled medical progress that has benefited patients in this country and throughout the world. It would have a disastrous impact on medical innovation and the quality of care.

The Bush administration, for its part, has failed to offer a coherent alternative to piecemeal nationalization of health care. But the increasingly successful campaigns to privatize Social Security and expand school vouchers suggest a way out: mandatory private health insurance. Under this system, in effect, purchasing health insurance would be not much different from buying car or homeowner's insurance today. As a result, we could preserve and extend the advantages of a free market with a minimal amount of coercion.

Why Worry

The current system poses three main problems. First, it's expensive. In 2003 total spending on health care was $1.7 trillion, some $5,800 for every man, woman, and child in the nation, accounting for more than 15 percent of the U.S. gross domestic product (and up from 14.1 percent of GDP in 2002).

Second, despite all the spending, many Americans don't have health insurance. A May 2003 Congressional Budget Office study estimated that 59 million Americans are uninsured at some point in the course of a year, while 21 million to 31 million are uninsured for the whole year. According to a June 2003 report from the Institute of Medicine, the U.S. loses between $65 billion and $130 billion annually as a result of poor health and early death due to lack of insurance. The uninsured impose costs on the rest of us, too: A 2003 Kaiser Commission report to the Urban Institute estimated that uninsured Americans each year receive about $34.5 billion in uncompensated health care while paying $26.4 billion out of their own pockets.

Third, health care is a paperwork nightmare for patients, doctors, insurers, and employers. In 1999 The New England Journal of Medicine published a study that found it cost $300 billion annually to administer various health insurance plans. It takes some 3 million clerks and managers to run our health care system; that's nearly four times the number of doctors practicing medicine in the United States. It costs between $8 and $18 to file each insurance claim, and a third of them have to be refiled. In a survey published last year by the American Hospital Association's Trendwatch, 64 percent of doctors said they were either extremely or very concerned about the level of paperwork and administration they have to deal with.

Fed up with the whole mess, 82 percent of Americans rank health care as one of the most important issues in the 2004 presidential election, according to a Gallup poll conducted in February. A Pew Research Center for the People & the Press survey conducted in the summer of 2003 found that 67 percent of Americans favored "the U.S. government guaranteeing health insurance for all citizens, even if it means raising taxes." In last fall's ABC News/Washington Post poll, 79 percent of respondents said it was more important for the government to provide health care coverage for all Americans than it was to hold down taxes.

Politicians pay attention to the polls. The compassionate conservatives in the Bush administration tried to neutralize a traditionally Democratic issue by ramming a new $530 billion Medicare drug benefit program through Congress last fall. They have also offered various half-hearted market-oriented baby steps that do not add up to a plan that can compete with the Democrats' vision of "affordable, quality, and reliable health care coverage" for all.

John Kerry vowed at the Democratic National Convention, "When I am president, we will stop being the only advanced nation in the world which fails to understand that health care is not a privilege for the wealthy and the connected and the elected -- it is a right for all Americans." His running mate has declared, "I want to make health care a birthright for every single child born in this country, period. I want to make sure all of us vulnerable adults are covered." The main thrust of the Kerry-Edwards reforms is to extend the coverage offered by various government health insurance programs to more and more Americans. The candidates want to enroll nearly everyone under age 18 in the State Children's Health Insurance Programs (S-CHIPs) and allow Americans to join Medicare at 55.

These Democratic health care proposals are a continuation of the socialization trend that began with the adoption of Medicare and Medicaid in the 1960s. Despite the breakdown of the ambitious Clinton health care plan in 1994, we have seen gradual adoption of elements of that proposal, including the S-CHIP program in 1997 and the new Medicare drug benefit. What remains of private medicine is being slowly strangled by the mandates and regulations that come with growing government health care spending. In fact, we're already nearly halfway to a completely centralized, government-funded medical system. Since Medicare was enacted in 1965, the federal and state portion of medical expenditures has risen from 24 percent to 45 percent.

ClintonCare Lives

A decade after Bill Clinton almost forced through his all-embracing health care plan, government-run medicine is once again becoming a respectable public policy idea. Last year a coalition called Physicians for a National Health Program launched a new campaign for universal single-payer health insurance. In the August 13, 2003, issue of The Journal of the American Medical Association, the coalition proposed what "in essence would be an expanded and improved version of traditional Medicare," covering "every American for all necessary medical care," funded through a new tax on income. The proposal, which has been endorsed by 8,000 physicians, has been introduced in Congress as a bill that aims to establish "a new American national health insurance program by creating a single payer health care system."

Advocates of a single-payer system often cite the lower medical costs of the completely nationalized health care systems in Canada and Britain, which spend less than 9.6 percent and 7.7 percent of their GDPs on health care, respectively. Despite the lower spending, the average life expectancy at birth is 79.8 years in Canada and 78.2 years in Britain, higher than America's 77.1. What explains the differential? As University of Iowa health economist Robert Ohsfeldt notes in the fall 2003 issue of The Independent Review, if higher U.S. accident and homicide rates are taken into account, our life expectancy numbers match those of Britain. The difference is also partly due to a slightly higher infant mortality rate in the U.S.: 6.8 per 1,000 live births, compared to Canada's 4.9 and Britain's 5.3 rate per 1,000. (That seems largely related to racial disparities -- the white U.S. infant mortality rate in 2000 was 5.7 and the black infant mortality was 14.4.

Another factor is improvements in fetal medicine that have allowed infants who would otherwise have died before delivery to survive into the early newborn period. Canada too has racial disparities; the infant mortality rate for aboriginals is 8 per 1,000 live births -- nearly double that of the white population.)

The U.S. looks much better than countries with nationalized health care when you consider waiting times for tests and treatments. Ohsfeldt reports, for example, that in 1997 the mean waiting time for magnetic resonance imaging (MRI) of the head was 150 days in Canada, compared to three days in the U.S. In 1998 the U.S. had 16 MRI machines per million citizens, compared to 3.4 in the U.K. and 1.7 in Canada. Such delays have a serious impact on quality of care: A patient has to wait longer for a good diagnosis, increasing the probability that his treatment will not prevent a lasting disability.

Even more important, America's mainly private system has made the U.S. a font of medical innovation. The U.S. pharmaceutical and biotechnology industries have developed more cancer drugs than their European, Canadian, and Japanese competitors combined, according to Robert Goldberg at the Manhattan Institute's Center for Medical Progress. Due to other countries' price controls, pharmaceutical research and development is increasingly centered in the United States. Consequently, Goldberg notes, that is where 75 percent of all new drugs are discovered and first used. It was U.S. companies, for example, that developed coated stents for treating narrowing heart arteries and invented LASIK surgery for correcting vision problems.

And even when a new therapy is not invented in the U.S., the country's markets can rapidly deploy it. Although the first test tube baby was born in Britain, the U.S. is now the world's leader in human reproductive medicine, pioneering treatments like pre-implantation genetic diagnosis of embryos and sorting sperm by sex chromosomes.

Insuring Cost Inflation

The payoff for less innovation under a single-payer system is supposed to be lower spending. Yet such proposals do not address the origins of the health care system's ever-escalating costs, which go back to World War II. During the war, employers competing for workers found a way around the government's wage controls by offering health insurance in lieu of higher pay. On October 26, 1943, the Internal Revenue Service further encouraged this practice by ruling that employees did not have to pay taxes on such benefits. In 1954 Congress codified the tax-exempt status of employer-provided health insurance.

Nowadays most insured Americans (61 percent) get their health insurance through their employers. The rest buy their own insurance (9.6 percent) and/or receive some sort of government coverage, including Medicaid (11.6 percent) and Medicare (13.4 percent). However well this system may have worked in the immediate postwar years, it is not meeting the needs of Americans today. Fewer and fewer Americans are following the career path of their grandparents and parents: graduate from high school, go to work for a big corporation that provides health insurance for the family, and retire at 65 with a company pension.

"This arrangement might have made some sense back in the days when most families consisted of a man working at a single company over the course of his life supporting a wife and kids at home," says Grace-Marie Turner, president of the Galen Institute, a health policy research organization in Alexandria, Virginia. "The problem is that politicians are still trying to impose a 20th-century health insurance system on a 21st-century work force." Workers today change jobs more frequently, more people are working for smaller companies that offer fewer benefits, and 8 percent of Americans (a share half as big as the percentage of Americans who are uninsured) start their own businesses.

Health insurance is also much more expensive than it was in the 1940s and '50s, partly because modern medicine can do so much more to heal our ills. As William B. Schwartz, a professor of medicine at the University of Southern California, notes in his 1998 book Life Without Disease: The Pursuit of Medical Utopia, "In 1950 costs of health care were remarkably low, because, for a large percentage of patients, doctors really couldn't do much. People spent relatively little on health care (only 4.4 percent of gross domestic product) and got what they paid for -- very few useful diagnostic tests or effective treatments." In 1950 there were no polio, measles, or hepatitis vaccines; no open heart surgeries or pacemakers; no organ transplants; few cancer chemotherapy agents; no MRI or CAT scans; and no drugs for ulcers, high blood pressure, or arthritis.

Employer-provided medical coverage is itself another major reason for the high cost of heath care. Rather than pay workers wages that will be taxed, companies use pre-tax dollars to purchase health insurance as a benefit. Instead of paying an employee $1,000 more in wages, of which $400 will be taxed away, companies purchase $1,000 in additional health insurance tax-free. In this way companies funnel more than $140 billion a year in federal tax breaks to their workers. The tax-free status of employer-provided health insurance encourages generous coverage that allows employees to ignore the prices of medical services, which in turn encourages providers to charge more and more. Employees, seeking to take advantage of their coverage, tend to overutilize the system, which also puts pressure on prices.

Thus we have a system skewed toward overuse by the haves and underuse by the have-nots, in which the healthiest people (highly paid employees) get the most generous health insurance. The Kaiser Commission reported that per capita spending on health care is $2,484 for fully insured Americans, compared to $1,253 for Americans who are uninsured for a full year.

No Such Thing as a Free Physical

"Everybody thinks they're spending somebody's else's money," explains Robert Helms, a health care scholar at the American Enterprise Institute. Yet "payments for health insurance come out of wages. Everything ultimately comes out of wages; it's just accounting that obscures that fact." For decades American patients have had little reason to worry about how much they spend on medical care, because they erroneously believe someone else is paying for it. Consequently, doctors and hospitals have little reason to control their expenses. Spiraling costs are the predictable result. The federal government has added to the problem with its own third-party payments through programs such as Medicaid and Medicare.

Nowadays patients are accustomed to low out-of-pocket medical expenses, and big companies are expected to give their employees gold-plated health insurance policies. "Insurance should cover low-probability, high-cost events," says Helms. When it comes to medical care, the whole idea of insurance -- of protecting against unexpected losses -- has been obscured. Think how expensive your car insurance would be if the cost of routine maintenance such as oil changes and tire purchases were included in your premiums. This is the problem with most health insurance policies today. Instead of insuring against large, unpredictable costs such as chemotherapy or a heart bypass, many policies cover what is essentially routine maintenance: flu shots, annual physicals, and so on.

Despite such generous coverage, employer-based insurance makes Americans anxious. "It's just a stupid system that causes you to lose your health insurance when you lose your job," says Grace-Marie Turner. "If you lose your job, you don't lose your car insurance or your homeowner's insurance. Why should you lose your health insurance?" Last fall's ABC News/Washington Post poll found that 53 percent of insured Americans were worried about losing their health insurance as a result of losing their jobs. This fear helps explain why most Americans tell pollsters they favor universal government-financed health care.

Unable to unravel this dysfunctional system of third-party payments, American companies have turned to health maintenance organizations, which constrain both doctors and patients to keep costs low. But HMOs ultimately were unable to control costs because they couldn't enforce limits on use and because the gains from preventive care were less than they hoped. Single-payer advocates argue that it's time for the government to step in.

"National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run," says the proposal from Physicians for a National Health Program. In his 1998 book False Hopes, Hastings Center bioethicist Daniel Callahan is a bit blunter. "A steady-state, equitable medicine will have to limit, not expand, patient choice," he writes. "It will require frank rationing. It will work to resist patient demands, particularly demands stimulated by market pressure and incentives."

Unfortunately, there is no prominent political or intellectual figure on the national scene offering a comprehensive free-market alternative to socialized medicine. You certainly won't find one in the Republican Party. Frank Luntz, the Republican pollster and spinmeister, told an audience of libertarian and conservative activists last year that Republican politicians had simply failed to come up with any way, much less a persuasive way, to discuss health care with the public.

When it comes to health care policy, Republicans are Democrats Lite. "The Republicans always say, 'We're going to give you the same program, only less than that proposed by the Democrats,'" says Tom Miller, former director of health policy studies at the Cato Institute. "Republicans just offer cheaper, more apologetic programs." Witness the new Medicare drug benefit, which John Kerry immediately denounced as "a raw deal for America's seniors and a big windfall for the big drug companies." No matter how much they give away, Republicans can never give away enough to satisfy the demands of the nationalized health care advocates.

Piles of Bodies?

Why not just tell Americans they are responsible for buying their own health insurance from now on? If people couldn't pay for medical care, either through insurance or out of pocket, they wouldn't get it. "After people begin to notice the growing pile of bodies by emergency room entrances," Tom Miller wryly suggests, "they will quickly get the message and go get medical coverage."

But that's not going to happen, says Mark Pauly, a health care economist at the University of Pennsylvania's Wharton business school. "Americans don't want to see their neighbor dying bleeding in the street," he says. "Therefore we already make sure that everyone gets some medical care when they need it. The alternative would be a world in which voluntarily uninsured people wore a bracelet that read: 'In case of an accident, do not take me to the nearest hospital. I've made my choice.'"

Since it's unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance.

The New America Foundation, a liberal policy shop in Washington, D.C., has outlined some elements of how such a system would work. The slogan for its proposal is, "Universal coverage in exchange for universal responsibility." The devil is in the details, of course, but the plan offers some interesting possibilities. For example, mandatory health insurance coverage might be combined with medical savings accounts that would encourage people to save and invest for future medical emergencies.

The New America Foundation proposal preserves private insurance and allows consumers to choose among competing insurance plans and coverage options. Most intriguingly, the plan offers a way out of the dysfunctional employer-financed third-party-payer model that is so grievously distorting our health care system. Employers eventually would devolve responsibility for health insurance to their employees by giving them the money the companies currently pay to insurance companies. Employees would then have a strong incentive to shop around for the best health care deals, putting pressure on insurers to keep costs low.

Even some Republicans are suggesting that mandatory health insurance be required for at least some Americans. Senate Majority Leader Bill Frist (R-Tenn.) recently argued that it is unfair to expect taxpayers to pick up the health care tab for the third of Americans without health insurance who make incomes over $50,000. "I believe higher-income Americans today do have a societal and personal responsibility to cover in some way themselves and their children," the senator said in a speech at the National Press Club in July.

Privatizing Medicaid and Medicare

Uninsured Americans currently receive health care for which they don't have to pay. Their bills are paid by tax dollars spent on Medicaid or the state Children's Health Insurance Programs, or through higher insurance premiums and medical charges to make up for the losses doctors and hospitals incur when they treat the uninsured. Why shouldn't we require people who now get health care at the expense of the rest of us to pay for their coverage themselves?

There's a big bonus. "Mandated coverage would replace Medicaid and state Children's Health Insurance Programs because lower-income and unemployed people would receive a voucher to purchase private health insurance," says Wharton's Mark Pauly. "This would mean full privatization for people under age 65." He holds out an even brighter prospect: "Actually, in principle, mandated coverage could replace Medicare too." The entire medical system could be privatized. The slowly expanding Medicare, Medicaid, and S-CHIP behemoths that are inexorably absorbing more and more of the U.S. health care system could be eliminated.

Mandatory health insurance would be not unlike the laws that require drivers to purchase auto insurance or pay into state-run risk pools. They also resemble the libertarian Cato Institute's proposals for reforming Social Security, which do not eliminate mandatory payments; they privatize them. Similarly, school voucher plans generally mandate that children receive an education. As the Rose and Milton Friedman Foundation notes, universal school vouchers would allow "all parents to direct funds set aside for education by the government to send their children to a school of choice, whether that school is public, private or religious." This system separates "the government financing of education from the government operation of schools."

Once government and health insurers have defined a standard basic package of health care benefits, the current dynamic of constant government meddling in health insurance and health care markets that leads to higher and higher costs should change. Consumers, transformed from passive recipients into direct purchasers, can be expected to be vigilant about government interference that would increase their rates or reduce their services.

As Rep. Bill Thomas (R-Calif.) noted at a recent National Center for Policy Analysis conference, if everyone had to buy his or her own coverage the way people buy car or homeowner's insurance, and if the size of the tax breaks didn't hinge on employment status, you would have the beginnings of a real market. Thomas said he wanted to make basic, low-cost catastrophic health care coverage widely accessible through tax subsidies and credits. More-extensive coverage would be available to individuals who wanted it, but they would have to pay for it with after-tax dollars.

Under a mandatory insurance scheme, all Americans would be required to purchase a basic high-deductible catastrophic health insurance policy from a private insurance company. "Let's say you cap the deductible at $4,000 and set a limit that out-of-pocket health care costs can't exceed 10 percent of an individual's or family's income," suggests Pauly. "That would mean that a family earning $30,000 per year would receive $1,000 in a health voucher." In other words, the family would pay the first $3,000 of medical expenses out of pocket and receive a $1,000 voucher to cover expenses up to the $4,000 deductible.

A high deductible would encourage people to be more careful about the services they purchase. They would shop around for good deals on drugs and scrutinize the costs of various treatment options more closely. Of course, some people inevitably would try to save a penny or two by delaying a visit to the doctor for their stomachache, only to find out later that it's cancer, but no system can make people perfectly prudent.

Health insurance policies covering catastrophic expenses today typically cost under $300 per month for a family of four. So that's $3,600 per year for insurance. Assuming employers pay between $6,000 and $9,000 to cover an employee and his family, that means workers would be getting an extra $2,400 to $5,400 in their paychecks. Even a $3,600 policy would be expensive for a family living on $18,000 a year, so perhaps they would be required to pay 10 percent of their income, $1,800, for insurance and receive a voucher for $1,800 to cover the rest of their premiums.

Money in the Bank

This plan differs from the mandatory health care schemes in Germany and France, which are financed by payroll deductions set at a percentage of wages up to a certain income level. In the United States today, an employer generally pays the same health insurance premium for each employee. So if the premium at a company is $5,000 a year per employee, under this plan each employee would get $5,000, tax-free, to purchase insurance. That money would make a lot more of a difference to an employee earning $20,000 than to one earning $80,000.

A second component of the new private insurance scheme might encourage (or even mandate) that families and individuals make annual contributions to health savings accounts (HSAs) similar to those included in the otherwise very flawed Medicare prescription drug law. As currently formulated, HSAs allow employees to set aside pretax money to cover routine checkups, co-payments, prescription drugs, vaccinations, and so forth, while costly medical procedures are covered by high-deductible insurance policies. HSAs permit employees to keep their own money, rolling over any unspent funds in their HSAs at the end of the year and investing the money for future medical expenses or saving it for retirement; the money can be passed on to heirs. Since it's a real asset, people have an incentive to manage it frugally.

HSAs have several attractive features. Employers as well as employees make contributions, so instead of paying insurers for low-deductible policies, companies can give the money directly to their workers. Best of all, for those worried about the instability of linking health insurance with steady employment, people who lose their jobs can withdraw funds from their HSAs to continue their families' health insurance coverage. Employers will be attracted to HSAs because they will be able to lower their health care expenses by offering their employees higher-deductible insurance plans. Such plans generally cost 20 percent to 60 percent less than conventional low-deductible health insurance policies.

There's no reason to put off the campaign for a mandatory private system until we've worked out all the details. To keep the great American health innovation machine running, it is vital to keep medicine private and consumer-driven, and that means going on the offensive now.

Maintaining our private medical system is vital because American health care and medical science are the most advanced and innovative in the world. If a national single-payer health care system is adopted, most medical progress will be stopped in its tracks. The proposal for mandatory health insurance offers a way to maintain our private system, expand consumer choice, lower costs, and allow medical progress to continue.

Targeting the Bay

cpf@reason.com (Charles Paul Freund) — Tue, 17 Aug 2004 00:00:00 EDT

Toronto—Canada's distinguished and formerly rather low-key newspaper, The Globe and Mail, seemed pretty excitable late last week: On Thursday, its page-one headline screamed in classic tabloid accents that "Boatpeople ate human flesh." (Turns out that some Dominicans had recently spent two hellish weeks adrift.) The very next day, the front page managed to strike an even more dramatic note: The paper ran a full banner headline across all six columns alerting Canadians that a "U.S. giant seeks to buy the Bay."

Non-Canadians will be forgiven for reading into that wording an effort by U.S. interests to pay cash for the Canadian landscape. Doubtless many Canadians expect to read just such a story someday, but in this case, "the Bay" refers to a store. Well, maybe "store" doesn't quite capture it. We're talking about Hudson's Bay Company (HBC), a 334-year-old institution that runs a "family" of retail chains (including the Bay), and that has shouldered aspects of a battered and wary Canadian identity. The "U.S. giant" that is reportedly in talks to buy part or all of HBC is Target.

"The sale of HBC," sighed The Globe and Mail in the first of a great many stories on the subject, "would leave Canada's oldest company in foreign hands, relegating to the history books a firm that opened up the country after receiving a monopoly to trade on all the rivers flowing into Hudson Bay, dating back to 1670."

You caught that bit about "foreign hands"? That's an uncharacteristically weak euphemism. No doubt Canadians would be sorry to see HBC controlled by the Dutch or Chinese, too, but the real point of this story is that these particular foreign hands are from the States. Picture those hands as relentlessly grasping, as reaching mindlessly from a vulgar commercial hell south of the border, and probably as featuring ragged and dirty fingernails, and you've got a Canadian view of the matter.

"I would much rather see Hudson's Bay Co. fold its charter and close its doors forever," wrote one Canadian reader to the newspapers, "than see it owned by the Americans." "I think Canada selling anything to the States is a step backwards," a Bay customer told a reporter. Such a sale "would be awful. Terrible," said a shopper who was described as "anguished" by the news. "Would I reconsider shopping here if it was bought by a U.S. company?" asked a loyal Bay customer. "Definitely," she answered. Yet another insisted that the Bay "should be left in Canada. Americans are going to take over everything. We don't want that." TV coverage consisted largely of Bay customers saying these kinds of things.

That last quoted customer is in fact articulating the real uber-story here: that a voracious and imperial U.S. continues to gobble up the culture, economy, and identity of a nearly defenseless Canada. The portrayal of the U.S. as the corrupt, grasping, and stupid giant next door seems to be in 24-hour rotation in the Canadian media, in whatever news guise happens to be available.

Canadian TV coverage of the opening of the Olympics, for example, seemed always to find its way back to the doping troubles of the U.S. track team (at least until a pair of Greek runners missed their drug test). The U.S. track-team story might have been told as a tale of a national program trying to police itself; instead it came across as a story about a corrupt culture. Similarly, the reports last week about San Francisco's invalidated gay marriages provided another chance to bash the U.S. A gay Toronto couple appeared on TV to dismiss the benighted U.S. as "farther away" from enlightened Canada than is the planet Mars. Apparently, a majority of Canada's own provinces have yet to recognize gay marriage, but never mind. In such a context, the prospect of HBC falling into the clutches of Target is a story that just about tells itself.

Or to put it another way, the HBC story offers an opportunity to assert the familiar and perhaps comforting news myth of a Canada embattled by its morally inferior neighbor. News "myths" like these are not necessarily falsehoods; rather, they are grand, overarching themes that, rightly or not, can be imposed on limited events to give the latter both meaning and context. They are like an instant moral to any given story. (The U.S. press obviously deals in such myths as well; its controlling themes about Canada are that the great northern neighbor is politically unstable, emotionally oversensitive, and that it has constructed a modern identity out of political correctness. Moreover, its Anglophone majority owes its sovereignty to historical accident and its exaggerated sense of difference to delusion. This mythic Canada merits as much "foreign" coverage as does North Dakota or Maine.)

While news myths shouldn't be confused with lies, they nevertheless can do notable harm. One source of harm is to limit coverage: Editors are more likely to run stories that appear to reinforce such themes than they are to run stories that seem to contravene them. Another source of harm is to distort the shape of those stories that do run. The HBC story, for example, is full of complexities that are submerged by focusing on supposedly grasping U.S. corporate interests.

HBC itself, for example, may be guilty of failing to respond effectively to a changing retail environment, especially the entry into the Canadian market by Wal-Mart and its lower prices. If that phenomenon were at the center of coverage, this would be a very different story. Furthermore, there's some ambiguity about the ultimately Canadian identity of HBC itself. There's an argument, for example, that for its first 300 years or so, the controlling interest in HBC was actually British. However, the theme of "Canada under U.S. threat" wouldn't work so well if HBC were portrayed as less than a purely Canadian institution. Finally, HBC's own business practices in the course of its long history may not always have been admirable. One of its "competitive" responses to the challenge of other chartered fur trappers in regions adjacent to its own, for example, is said to have been the extermination of all the beavers in the area, so as to starve non-HBC trappers of valuable furs. However, an HBC with a mottled business history makes for a less appealing business victim.

Yet while Canadian journalism naturally reflects national concerns, it doesn't actually pander to national prejudice. TV coverage may have tended toward the simplistic, but the tidal wave of print coverage of the HBC story included many of its angles. For example, the issue of HBC's anemic response to retail changes was quickly addressed, albeit as a sidebar in the business section. Indeed, in its massive second-day coverage of the issue, The Globe and Mail ran a front-page paean to Target by a journalist who had lived in Los Angeles. "We're not losing a cultural icon," read the print headline on that story, "we're gaining the cult of Target." The story attempted to explain Target's niche in the U.S. market as both a discount house and a source of stylishly designed household goods. It even tried to train Canadian readers to say "Tar-zhay."

Nevertheless, the central thrust of the story remained true to national mythologies on both sides of the border. In Canada, you could measure the myth by the introductory banner headlines about a "U.S. giant," and especially by the "anguished" reception of the story by readers and viewers. As for the U.S., you could measure the countervailing myth by the fact that the story received hardly any attention at all.

Judicial Choice

jwalker@reason.com (Jesse Walker) — Sun, 01 Aug 2004 00:00:00 EDT

Starting this year, Muslims in Ontario can settle their disputes in religious Shariah courts. This development shocked pundits on both sides of the border: Andrew Sullivan wrote that it's "horrifying," the Muslim-bashing blog Little Green Footballs called it "dangerous and utterly wrong-headed," and various writers wondered whether this meant Canadian women could be stoned to death for adultery. But there's an important difference between Canada's Shariah courts and those of, say, Afghanistan: In Ontario, no one will be forced to follow Islamic law.

Indeed, Muslims there are simply setting up the same sort of voluntary institutions that Ontarian Jews have enjoyed for centuries. As Rabbi Reuven Tradburks told The Washington Post, traditional Jewish courts, known as batei din, "have been operating in Toronto for as long as Jews have been here." A less formalized Koranic arbitration system already exists in Ontario; the new Islamic Court of Civil Justice will merely make the process official, under the framework set by the Ontario Arbitration Act of 1991. Corporal punishment will be barred, and decisions that violate individual rights can be struck down by the public courts, so adulterers won't have to fear any stonings.

In the United States, citizens unhappy with the government's expensive and time-consuming courts enjoy a range of other options, from the American Arbitration Association to our own batei din to Judge Judy, The People's Court, and other products of the latest religion to take America by storm: reality television. They can even approach their local imam.