Thread by @kempthead

@WilderFleming & @bob_oakes of Boston's @NPR station @WBUR take a deep dive into Nova Scotia's health care system and produce a damning report--you might say a takedown. They clearly did a lot of work, but I find it flawed in two ways 1/x

wbur.fm/2LfCEVw

First, and most obviously, many of the problems they report have nothing to do with the single payer system, and everything to do with the difficulty of providing emergency care in tiny communities with plummeting populations. (2/x)

They lead with Annopolis Royal, bemoaning the fact its emergency dept. is closed 2 days a week because it lacks the 7 ER docs needed for full-time operation. Some distressed patients must travel 97k to Kentville.

They fail to mention Annapolis Royal has 371 people. (3/x)

The same problems afflict delivery of public education, day care, policing, and many other public services in rural Nova Scotia counties. They're not caused by public financing, but by a lack of sufficient population. (4x)

@WilderFleming & @bob_oakes don't say how adding a parallel system of privately paid health care for those who could afford it, diverting millions into administrative costs and insurance company profits, would help Annapolis Royal, because of course it wouldn't. (5x)

The examples they cite are all from small rural centres, Kentville (pop. 6271) being the smallest. Halifax, with half the provinces population, is never mentioned. (6/x)

My second beef with the @WBUR piece is that it's framed as a refutation of @SenWarren's & @SenSanders's support for a single payer system. I could be wrong about this, but it made the whole exercise sound like an attempt to debunk single-payer systems. (7/x)

Many of the most negative comments @WBUR collected come from doctors who were in the midst of tough contract negotiations at the time of their reporting. It's never hard to find a few docs who hate single payer b/c they could make much more under a US-style system 8/x

Only is passing do @bob_oakes & @WilderFleming mention the enormous popular support among Canadians for publicly funded health care. None of their informants blames the problems they cite on public funding, or suggests a parallel private system would improve things. (9/x)

There are unquestionably lots of problems providing health care in declining rural parts of a large, sparsely populated province. No one would suggest NS is at the top of its game in 2019. Still, it felt to me as if @WBUR was indulging in some axe-grinding here. (10/10)

Oops!

CORRECTION: That should say Kentville is the LARGEST center they discuss.

@threadreaderapp unroll please