« mea culpa | Main | Wait! Was Blink right after all? »



glad that gladwell is blogging, too.

just curious, what accounted for the change, to go from championing a "masculine" (heroic) to "feminine" (maintenance) health care system? (maybe i just missed that part of the debate.) did this go from a "blink" analysis to a "double blink" or "triple blink"?

just asking.

Mark Crane

I have my students read your stuff all the time in our writing class. Hope the blogging doesn't suck up too much time.

Jon Swift

I think the best solution to the health care crisis is "a la carte insurance," an idea inspired by Steven Landsburg:

Mongo Nikol

Graham says it best:
The Canadian system is all about preventative care, which enlists the agency of the individual, thereby semi-deflecting the moral hazard problem. If they want to stay healthy, they have to go to the doctor.

When the US went to war on Iraq, I left the US and renounced my citizenship at the US consulate in Vancouver. As a result, I got a first-hand, up close and personal introduction to Canada's medical system. As such I learned through experience the difference between what I knew and what I had to learn.

What I learned was this. Prevention means seeing a doctor as soon as a treatable malady overwhelms one's personal resources and abilities to heal and recover effectively. From there on out, for the vast majority of treatable ailments, help became available.

Is there long waits? Yes. Too long? No.

One of the most basic and simple ailments which hinders approximately 15 million US citizens (http://www.emedicine.com/emerg/topic496.htm)is hemorrhoids. Considering the statistic of more than 45 million people in the US are without ANY kind of health insurance (http://www.census.gov/Press-Release/www/releases/archives/income_wealth/002484.html) which is one-sixth the US population, this means approximately 2.5 million people have a condition which is usually easily treated but inversely is aggonizing left untreated. (I have heard of severe cases but common cases left untreated being equated with the pain of rectal cancer.)

Imagine! People living with pain which is simply treated and repositing that pain into mental dis-ease and anguish which spreads outwardly exponentially into communities US-wide.

And this is one single condition!

The biggest toll on any US economy is the mental dis-ease and anguish which is spread as a result of people being without resources to take care of basic needs. Comparitavely, the so-called expense of national health care is a drop in the bucket.

In the Nineteen-Fifties, 'Sixties, and 'Seventies, people argued for and won education reform which reposited themselves in enormous increases in nationwide and (subsequently) worldwide quality of life and living. In the Nineteen-Eighties, these reforms were undone, and to make matters worse, mental health facilities lost funding as well, re-dedicated by three Republican US presidents to military and personal interests. The consequence of this on the United States is the world of 2006.

In order to make a turnaround, a twenty-year investment in healthcare reform, education, and mental health will have to devised, implemented, and committed to. Where will that money come from? It will come from where the money comes from when it is decided to declare war. Up until war is declared, there is no money for such a thing. After war is declared, the money appears. So to is it to be for a US-led "offensive" on ignorance and dis-ease. The money will appear because it must be spent for self-preservation.

Delicious Pundit

Maybe Gopnik will be happy as "the voice of bourgeois sense" if he thinks of it in a French way.


Oh, good. Phew. That's a relief. I shuddered reading what you said. I can go back to loving you.

Peter Holden

It does not necessarily follow that just because one sees flaws in the U.S. health care system, that the Canadian system is preferable. Perhaps they have equivalent but different flaws.

One of the previous posters asserts "Is (sic) there long waits? Yes Too long? No."

Surely such a value judgment depends on the preferences of the person in the queue. It is both regrettable and embarrassing that so many Canadians feel that Canada's great contribution to the world is a system of compulsory medical insurance.


I'm a bit surprised your view has changed. You seem(ed) to be somewhat of a non-governmental type.

In general, I think people should be responsible for their health. I think it makes sense for employers to have an interested since a sick employee is less productive.

As expected, the US's market system is best equipped to treat ailments. But it may not be the greatest at preventing ailments.

Trapier K. Michael

Evian has a lot to say about this over on "Free Canada," a blog devoted purely to Canadian health reform...



Trapier K. Michael

Evian has a lot to say about this over on "Free Canada," a blog devoted purely to Canadian health reform...



Sylvain P. Poitras

As a canadian citizen, I would like to comment on our health system.

Yes, there are waiting periods, sometimes very long. Yes it is not perfect.

However, in case you have not experienced it, it is extremely reassuring that the doctor's first question is about our pain rather than your method of paying. And I know I will never have to choose between selling my house if i break an arm (ok, it's a small house, but still, you get the point).

Again, it is not perfect, but believe me, i would never change those imperfections for the ones you guys have to deal with...

anthony baxter

Given the original piece is attracting attention, maybe you could get the WM to put a link to these articles on your blog from the piece in question? The wonderful thing about the web is that you can do this.


A fascinating debate, but it all comes down to one question: Who pays?

Malcom Gladwell offered a brilliant insight when he divided the health care system into Male and Female systems. I'm a middle-aged guy whose job requires that I take a physical every six months. I visit the doctor, he tells me I'm fine, I write a check for a hundred bucks and go back to work. My last hospitalization was over thirty years ago when I separted my shoulder in a bike crash. In fact, my very few forays into the world of medicine all seem to involve broken bones. I a user of the acute system and I view the entire system through the prism of my own experience. As I result I am strong on the Moral Hazard argument.

MG's remarks opened my eyes to the demands placed upon female/child demans on the health care system. I have to admit that it argues persuasively for the Social Insurance case. So what's the answer?

Britain's NHS is a disaster, Canada is really not a model for the rest of the world, European governments and old line American industries are groaning under the weight of their social programs.

Reading the anecdote of the people with bad teeth, or the guy with the bones sticking out of his hand the question comes to mind, "Isn't cleaning your teeth or getting surgery on you hand at least as worthy a use for your own money as buying a new car or a widescreen TV?" I mean this only in the sense if financing the purchase of a new car or some other consumer good is a good idea, isn't financing a visit to the dentist or the surgeon also a good idea? Does health care have to be a government service and, if so, how do you address the economic conundrum of "public goods and free-riders?"

As much as I enjoyed the debate between MG and AG, as many times as I've looked at Newt Gingrich's Web-site, I have yet to see a workable solution that adequately adresses the question, Who Pays?


It takes a big man to admit he was wrong. So glad to find you're blogging, too. Yay.

I'm lately with Molly Ivins when she says, the opposition must take up three points and avoid distraction:

1. Iraq is more dangerous because of our presence.

2. Publicly funded elections, everywhere.

3. Single payer health care for all.


Viktor Vresnik

There is the other thing no one of you mentions in your freaconomics-crime debate. If your theory works for NYC(and I think it does), why should not we consider that life in other parts of the country became just enough better to lower the crime rate?
Too simple?
May be, but a crime - except sexual and other psycho-related butcherings - was always tightly connected with poverty.


hello friends


hello friendsk

The comments to this entry are closed.

My Photo


  • I'm a writer for the New Yorker magazine, and the author of four books, "The Tipping Point: How Little Things Make a Big Difference", "Blink: The Power of Thinking Without Thinking" and "Outliers: The Story of Success." My latest book, "What the Dog Saw" is a compilation of stories published in The New Yorker. I was born in England, and raised in southwestern Ontario in Canada. Now I live in New York City.

    My great claim to fame is that I'm from the town where they invented the BlackBerry. My family also believes (with some justification) that we are distantly related to Colin Powell. I invite you to look closely at the photograph above and draw your own conclusions.

My Website


  • What the Dog Saw

    buy from amazon


    buy from amazon

    buy from amazon UK


    buy from amazon

    buy from amazon UK

    Tipping Point

    buy from amazon

Recent Articles

Blog powered by Typepad