Welcome to the American Revolution II

Welcome to the American Revolution II
But when a long train of abuses and usurpations, pursuing invariably the same object evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such government, and to provide new guards for their future security.
"We face a hostile ideology global in scope, atheistic in character, ruthless in purpose and insidious in method..." and warned about what he saw as unjustified government spending proposals and continued with a warning that "we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex... The potential for the disastrous rise of misplaced power exists and will persist... Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together."Dwight D. Eisenhower

Tuesday, February 23, 2010

Obama's Great Canadian health care system

'My heart, my choice,' Williams says, defending decision for U.S. heart surgery

Newfoundland and Labrador Premier Danny Williams

An unapologetic Danny Williams says he was aware his trip to the United States for heart surgery earlier this month would spark outcry, but he concluded his personal health trumped any public fallout over the controversial decision.

In an interview with The Canadian Press, Williams said he went to Miami to have a "minimally invasive" surgery for an ailment first detected nearly a year ago, based on the advice of his doctors.

"This was my heart, my choice and my health," Williams said late Monday from his condominium in Sarasota, Fla.

"I did not sign away my right to get the best possible health care for myself when I entered politics."

The 60-year-old Williams said doctors detected a heart murmur last spring and told him that one of his heart valves wasn't closing properly, creating a leakage.

He said he was told at the time that the problem was "moderate" and that he should come back for a checkup in six months.

Eight months later, in December, his doctors told him the problem had become severe and urged him to get his valve repaired immediately or risk heart failure, he said.

His doctors in Canada presented him with two options - a full or partial sternotomy, both of which would've required breaking bones, he said.

He said he spoke with and provided his medical information to a leading cardiac surgeon in New Jersey who is also from Newfoundland and Labrador. He advised him to seek treatment at the Mount Sinai Medical Center in Miami.

That's where he was treated by Dr. Joseph Lamelas, a cardiac surgeon who has performed more than 8,000 open-heart surgeries.

Williams said Lamelas made an incision under his arm that didn't require any bone breakage.

"I wanted to get in, get out fast, get back to work in a short period of time," the premier said.

Williams said he didn't announce his departure south of the border because he didn't want to create "a media gong show," but added that criticism would've followed him had he chose to have surgery in Canada.

"I would've been criticized if I had stayed in Canada and had been perceived as jumping a line or a wait list. ... I accept that. That's public life," he said.

"(But) this is not a unique phenomenon to me. This is something that happens with lots of families throughout this country, so I make no apologies for that."

Williams said his decision to go to the U.S. did not reflect any lack of faith in his own province's health care system.

"I have the utmost confidence in our own health care system in Newfoundland and Labrador, but we are just over half a million people," he said.

"We do whatever we can to provide the best possible health care that we can in Newfoundland and Labrador. The Canadian health care system has a great reputation, but this is a very specialized piece of surgery that had to be done and I went to somebody who's doing this three or four times a day, five, six days a week."

He quipped that he had "a heart of a 40-year-old, so that gives me 20 years new life," and said he intends to run in the next provincial election in 2011.

"I'm probably going to be around for a long time, hopefully, if God willing," he said.

"God forbid for the Canadian public I won't be around longer than ever."

Williams also said he paid for the treatment, but added he would seek any refunds he would be eligible for in Canada.

"If I'm entitled to any reimbursement from any Canadian health care system or any provincial health care system, then obviously I will apply for that as anybody else would," he said.

"But I wrote out the cheque myself and paid for it myself and to this point, I haven't even looked into the possibility of any reimbursement. I don't know what I'm entitled to, if anything, and if it's nothing, then so be it."

He is expected back at work in early March.


anadian health care survives Danny Williams’ surgery

by John Geddes on Tuesday, February 23, 2010 10:24am - 81 Comments


I haven’t heard anybody say that Danny Williams shouldn’t have been allowed to travel to the U.S. for heart surgery. As the Newfoundland premier has declared in interviews published yesterday and today, it’s his heart, his health.

But accepting the personal nature of the choice hardly ends the conversation. Williams’ decision to check into Mount Sinai Medical Center in Miami to be operated on by a veteran surgeon has been seized upon by critics of public health insurance as proof of the Canadian system’s inherent weakness.

Since I support the single-payer model, I admit I was worried about how details of Williams’ condition and treatment, when he finally talked about them, might reflect on Canadian cardiac care. If it turned out he had needed some esoteric procedure not available in Canada, I figured the critics would have a field day.

But the reality appears to be the opposite of what I feared. Williams needed an operation on his mitral valve. His office admits the procedure was, in fact, available in Canada. It’s more than that, though: Canadian cardiac surgeons happen to be renowned for their expertise in valve repair.

It was two Canadian physicians who wrote the how-to paper on valve surgery published only late last year in the New England Journal of Medicine. There are famous surgeons like Toronto’s Dr. Tirone David, who’s been called a “virtuoso” valve man. Minimally invasive procedures, the style of surgery Williams chose, are offered in Canada in places like the University of Ottawa Heart Institute.

None of this is to suggest that Williams might not have had good reason to go to Miami. He might have heard impressive things about the surgeon who worked on him there. He might have preferred to be close to his Florida condo for recuperation. He might have liked the sound of the amenities and privacy offered by a pricey U.S. hospital.

But those sorts of factors don’t tell us anything about the capacity of the Canadian health care system to provide high-quality care. I’ve heard no credible claim that Williams would have faced a long wait, if any wait at all, for surgery in Canada. And now we know that his category of heart problem, far from being one Canadian surgeons can’t handle, is one of their fortes.

I’m reminded of another politician’s medical history and how it briefly made news decades ago.

When Paul Tsongas, the former Massachusetts senator, was running for president in 1992, he lashed out at the Canadian health model. Tsongas had suffered from lymphoma, and he said, rather dramatically, that the bone marrow transplant that saved his life was an example of how the American system spurred innovation that would never happen under creativity-stifling Canadian-style health care.

It was a gripping personalized take on the issue. The only problem was that the key research breakthroughs that led to bone marrow transplants were made in Toronto, and Canadians, at the time Tsongas was speaking, were receiving the procedure more often than Americans.

Case studies that initially cloud the broader issues can ultimately be quite illuminating.


Getting into the details of why Danny Williams made the choice to go to Miami is delicate. Health is a personal matter, and anyway, the real issues here are about policy, not the particulars.

Still, Williams told Canadian Press that doctors in Canada suggested conventional surgery, while his U.S. surgeon did the operation through a incision under his arm that didn’t require opening up the bones in his chest.

This might create the impression that minimally invasive surgery wasn’t offered in Canada because of some limitation in the techniques available here. I put the question to the University of Ottawa Heart Institute. Quite properly, the institute stresses that its doctors can’t comment on Williams’ case.

But Dr. Thierry Mesana, chief of the institute’s cardiac surgery division, and a leading international authority on mitral valves, responded by email on the general question of how minimally invasive surgery is viewed by the experts.

“Minimally invasive mitral valve repair consists of doing an MV repair surgically through a 5 cm small side chest incision instead of a 10 cm incision in the middle of the chest. A recent survey published at the Society of Thoracic Surgeons meeting (Jan 2010) expressed some word of caution and showed it is not recommended for complex mitral valve repair and also that the rate of complication (strokes in particular) is higher.

“There are a few advantages in terms of length of hospital stay or transfusion or post-operative arrythmias. The only real benefit is cosmetic. Many world renowned experts do not advocate it, in fact. It is done in Canada, but again, with caution. I propose it only for cosmetic reasons in a young woman who dislikes the idea of having a scar visible in summer. This procedure is well publicized in the U.S. in some centres.”


I mention above the well-known Toronto heart surgeon Dr. Tirone David. From India, where David is teaching just now, he responded by email to questions I asked through his office. Here’s what he said:

“I don’t know the reasons Mr. Williams opted to have his operation in Florida. It is certainly not because minimally invasive mitral valve repair is not available in Canada. Canadian heart surgeons routinely do minimally invasive mitral valve repair including techniques involvng endoscopic and robotic approaches.

“There is absolutely no evidence that robotic mitral valve repair is superior to other minimally invasive approaches, such as a limited sternotomy or lateral thoracomy, with or without the aid of endoscopes. Moreover, when it comes to heart valve surgery, there are very few places in the world that can match the outomes we have provided at Toronto General Hospital.

“Having said all that, Mr. Williams certainly had the right to go anywhere he wanted for surgery.”

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