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Lisa Pauli, 47, who says she wants to apply for medical assistance in dying (MAiD) when she is eligible because of her severe anorexia, looks on, in Toronto, Ontario, Canada June 9, 2023.
Canada: A great place to die?
Canada’s medical assistance in dying (MAiD) regime is garnering criticism, as its rapid growth threatens to make the country the world capital of assisted suicide - if it’s not already. Health Canada has just released the statistics for 2023 that show Canada sat just behind the Netherlands in terms of the number of assisted deaths. In both countries, one in 20 deaths are due to medical assistance - a total of 15,343 Canadians in the 2023 calendar year. However, it took the Netherlands 22 years to reach that proportion; it has taken Canada just seven.
The original intent of the legislation was to offer a painless death with dignity to those with a terminal disease. Since then, court challenges have opened medical assistance in dying to people who do not have a “grievous and irremediable” condition. The most worrying statistic for opponents of expanding the regime was the revelation that 622 people with non-terminal illnesses received assisted dying. Nearly half of them cited “isolation or loneliness” as one of the causes of their suffering. Rejections of MAiD remain much higher for non-terminal applicants, but yet more liberalization of the regime is coming, unless a future government steps in to block it.
As of March 2027, people with mental illness as their underlying condition will be eligible for MAiD, a development that has many experts worried. The change was due to come in last March but was punted down the road by parliamentarians spooked by expert testimony that indicated the difficulties of predicting mental illness outcomes. One witness told members of Parliament that the long-term prognosis of a person with mental illness is wrong one half of the time.
The voices of concern will grow louder if the 2024 numbers confirm that Canada is now medically assisting the deaths of more of its own citizens than any other country on earth.
Luigi Mangione, 26, a suspect in the New York City killing of UnitedHealth executive Brian Thompson, arrives for an extradition hearing at Blair County Court House in Hollidaysburg, Pennsylvania, U.S. December 10, 2024.
Accused killer hailed a folk hero
Luigi Mangione, the 26-year-old alleged assassin of UnitedHealthcare CEO Brian Thompson, was captured while eating hashbrowns in a Pennsylvania McDonald’s on Monday after a customer recognized him, ending a six-day manhunt.
Mangione, the scion of a prosperous Maryland family who had an Ivy League education, appeared motivated to murder Thompson by frustration with the American medical system. Posts on social media show that he suffered from chronic back pain, and he had withdrawn from friends and family over the past year.
Mangione faces five felony counts in what one expert described as a “super strong” case against him.
Despite the cold-blooded nature of the murder — Thompson is survived by a widow and two children — Mangione has been hailed a folk hero by many on social media, reflecting and crystalizing widespread anger with health insurers who profit while denying care to the ill.
It remains to be seen whether this moment of anger will lead to political calls for reforms to protect patients, but it has led to increased security for CEOs.
A doctor checks the progress of a patient with tuberculosis at the Beijing Chest Hospital March 31, 2009. Health officials gathered in Beijing on Wednesday warned against deadly drug-resistant strains of tuberculosis, which are spreading fastest in developing countries that lack the infrastructure to tackle the disease.
Please cough for the AI
What if an artificial intelligence stored on your phone could listen and hear how sick you are? Google is training a bioacoustic AI model called Health Acoustic Representations with 300 million snippets of audio collected from around the world — of people sneezing, coughing, and breathing. The goal? To spot tuberculosis early and treat it.
A whopping 1.3 million people died of tuberculosis in 2022 alone, according to the World Health Organization, and 10.6 million fell ill with the disease. “TB is a treatable disease, but every year millions of cases go undiagnosed — often because people don’t have convenient access to healthcare services,” Google’s Shravya Shettywrote in a blog post. “Improving diagnosis is critical to eradicating TB, and AI can play an important role in improving detection and helping make care more accessible and affordable for people around the world.”
Google is focused first on preventing tuberculosis in India and is partnering with an Indian company called Salcit Technologies, whose own AI app Swaasa is being used by healthcare providers on the subcontinent. Swaasa will integrate Google’s model to improve its own detection of the disease.
Health care: A tale of two electoral timebombs
With Americans heading to the polls in November and Canadians set to join them by October 2025, political parties on both sides of the border are busy defining the stakes of their campaigns. Key themes include the economy, immigration, and, in the US, democracy itself, with health care emerging as a particularly contentious issue affecting nearly every voter.
Pew Research Center in May found that health care affordability ranked among the top issues for Americans, with 57% saying it’s “a very big problem” and 32% citing it as “a moderately big problem” – a concern that held across party lines, but not equally. While 65% of Democrats cited it as “very big problem,” just 48% of Republicans did.
Canadians are just as concerned, with health care ranking third among the top issues facing Canada at 42% and only housing affordability/accessibility (46%) and the rising cost of living (71%) outranking it.
It’s demographics, stupid
Both populations are aging, and seniors require more medical resources. The US is expected to see its 65-plus population rise from 58 million in 2022 to roughly 82 million by 2050.
In Canada, meanwhile, the senior population is expected to jump by 68% between 2017 and 2037, with the 75-plus cohort set to double.
Outcomes are less than ideal
Health-related costs and outcomes in both countries are far from optimal. While some see the Canadian health system as a blessed alternative to the American one, Canada’s outcomes are mixed. Its universal, single-payer health insurance is covered by provincial governments and funded by shared money between the provinces and the federal government, but it’s far from perfect.
Canada spends about CA$344 billion on health care, or 12% of its GDP. And yet a recent study found that in the country’s most populous province, Ontario, wait times varied wildly across hospitals, with some patients waiting for up to a year for hip replacements and knee replacements. For some patients, the waits can be deadly: A report last year revealed that at least 17,000 Canadians died while waiting for surgery or diagnostic scans in 2022-2023, and hundreds of emergency rooms closed nationwide owing to a lack of staff. Meanwhile, more than 6 million Canadians – roughly 15% – do not have a family doctor.
But the Canadian system does have a leg up in some ways on its US counterpart, where the country spends more on health care than any other rich country. American health care spending hit $4.8 trillion in 2023 between private and public sources – roughly 17% of GDP. And it’s rising, with spending expected to reach nearly 20% of GDP by 2032. A huge chunk of that comes from individual Americans, with the average yearly employer health premium running now over $8,400 and family plans just under $24,000. For individual plans without an employer option, premiums averaged nearly $1,200 a month.
The US is the only rich country without universal health care. And while the number of uninsured Americans has fallen in recent years, approximately 27 million lack coverage – and that number may rise as millions more are struggling to afford health insurance.
According to data from the office of Sen. Bernie Sanders, 68,000 Americans die annually because they lack access to health care. Also, a third of Americans do not have a family doctor – a failure that leads to increased chronic conditions and a rise in deaths. The American system is so troubled that it has contributed to a decline in average life expectancy in recent years, from 79 in 2019 to 76.4 today.
Who’s going to fix health care?
In the US, Donald Trumpsays he’s open to cutting Medicare and opposes universal coverage despite supporting it in the past – some have warned that the former president would even “destroy” Medicare. Meanwhile, Trump has warned that if Kamala Harris wins in November, the US would be “thrown into a communist system,” one where “everybody gets health care.”
Harris, who previously backed a universal, single-payer system, has abandoned Medicare for All. Instead, she says she’d build on Biden-era policy planks including Medicare price negotiations aimed at lowering drug costs for all patients, including those on Medicare and other plans.
The Canadian election is still more than a year out, and the main parties haven’t yet released platforms. But the governing Liberals face pressure to fix the health care system. That is primarily the responsibility of the provinces, but the feds pour billions of dollars into it each year.
In May, Prime Minister Justin Trudeau’s budget included an annual 5% health care funding increase to the provinces through 2028 – over CA$200 billion in total. His government also committed to student loan forgiveness for doctors and other health professionals who work in rural and remote communities and to improve the process of getting foreign credentials accepted for immigrants in the field in a bid to boost medical professional numbers, alongside other measures.
The feds are also pursuing dental care and prescription drug programs aimed at covering expenses for millions of Canadians. That sounds like a lot, but the bulk of the work remains up to the provinces, who are primarily responsible for health care policy.
The Liberals claim Conservative Party leader Pierre Poilievre would axe pharmacare and other social programs, but he hasn’t committed one way or another. His party hasn’t released a full plan but has said the solution to fixing problems associated with the doctor and nurse shortage would be a national testing standard for licensing that would speed up the credential recognition of foreign-trained workers.
Poilievre has also committed to maintaining the Liberal’s 10-year funding plan and says he’ll make cutting wait times a priority.
What does all of it mean for the ballot box?
Health care is already shaping electoral strategies in both Canada and the US. At the DNC Convention this week, Sen. Bernie Sanders hammered on lowering health care costs, a goal that’s dominating much of the gathering, and New Mexico Gov. Michelle Lujan Grishamwarned that Trump and JD Vance would “dismantle” affordable care.
Graeme Thompson, a senior analyst with Eurasia Group’s global macro‑geopolitics practice, says Harris is “running away from promises for Medicare for All as part of a broader strategy to tack towards the political center.” He thinks this is a bid to present herself as a “generic Democrat” who’s not going to scare anybody, a move that may be critical to her chances of winning in November.
Up north, however, the governing Liberals can’t do the same. Thompson says it will be tougher for Trudeau to try to pull off such a maneuver since he’s been in power for nearly a decade. Instead, Trudeau will have to make the case that the money transfers and reforms his party has introduced federally will help enable provinces to reduce wait times, keep ERs open, and ensure Canadians can find a family doctor.
“To the extent that [Trudeau] brings up health care as leverage against the Conservatives to try to paint a picture for voters of a Conservative Party that is out of step with the mainstream,” he says, “that may backfire by highlighting the problems in the system already.”
The problems that have mounted over decades won’t be solved in a few months or years, but voters still expect results and both nations face a common challenge in the run-up to Election Day: to fix a healthcare system that neither side can afford to ignore, yet neither seems able to cure.
Patient has an eye test at Venice Family Clinic in Venice, California, June 25, 2009.
Your new insurance advocate is AI
Health insurers are routinely using artificial intelligence and algorithms to evaluate insurance claims, but now the tables have turned. Doctors are increasingly turning to generative AI to write appeals for prior authorizations and to fight insurance denials.
A survey from the American Medical Association found doctors and their staff spend an average of 12 hours a week dealing with such denials, which insurance companies routinely issue, even in serious cases including cancer and HIV/AIDS care. Now, with the help of HIPAA-compliant apps like Doximity GPT, physicians can use the power of AI to generate persuasive reply letters, citing all the relevant medical research they need, in minutes.
One physician even told the New York Times that he tells the bot to make his letters four times longer: “If you’re going to put all kinds of barriers up for my patients, then when I fire back, I’m going to make it very time-consuming.”
So the next time you find yourself annoyed by a glitchy AI chatbot customer service, just remember, AI might help you get lifesaving drugs one day.
Graphic Truth: Motherhood can wait
Women in wealthy countries are increasingly waiting to have children. What gives? Well, a complex array of factors are fueling this trend, but financial concerns appear to be a central cause.
A recent poll in Canada, for example, found that 55% of Canadians between the ages of 18 to 34 pointed to the housing crisis as affecting their decision and timing about when to start a family.
In the US, child care costs are a growing concern across the country. Meanwhile, the US remains on a short list of countries that do not guarantee paid parental leave. Have economic conditions made it more difficult to have children? We’d love to hear your thoughts. Write to us here.
Graphic Truth: Hospital bed decline
They made their bed – and were forced to lie in it.
At the start of the pandemic, G7 countries were plagued by a huge uptick in hospital admissions – and the shocking reality that hospital beds had been on a 50-year decline. Four years later, these countries have still not reversed the downward spiral.
In the US, over the last five decades, care has shifted away from inpatient hospital settings and to outpatient services to cut costs. The decrease has also been intentional. In 1974, the government began an initiative to directly cut the number of hospital beds, believing in a rule calledRoemer's Law, which said that “a hospital bed built would be a hospital bed filled,” thus driving up costs.
However, the US’s free-market healthcare system still provides more hospital beds per capita than the government-dominated system in Canada. According to the Canadian Institute for Health Information, Ontario has just one intensive-care bed for every 800 residents, giving it no surge capacity. Michael Decter, the former chair of the Health Council of Canada told theCBC that because Canada’s system is public, “we tend to ration everything.”
Across the G7, governments have reduced hospital capacity to cut costs and because advances in medical care have decreased the amount of time patients spend in hospitals. However, older people – who are more likely to spend time in hospital – are also taking up an increasing share of G7 populations. The result is higher wait times, lower surge capacity, and worsening patient care.
An adult female Anopheles mosquito bites a human body to begin its blood meal at Tehatta, West Bengal; India on 24/02/2023.
Djibouti goes high-tech to take a bite out of malaria
The coastal country of Djibouti, one of the smallest by population in Africa, has a big problem in a tiny package: An invasive species of mosquito from the Indian subcontinent has driven malaria rates through the roof, so the government on Thursday released thousands of genetically modified bugs in a bid to save thousands of lives.
How deadly is the disease? Malaria has probably killed more human beings over the sweep of history than any other single infectious disease, and African governments have been fighting for decades to eliminate it. Djibouti darn near made it: In 2012, the country recorded just 27 cases.
But since then, an invasive species has arrived. Unlike the mosquitoes indigenous to most of Africa, the new bugs thrive in urban environments and bite during the day, making them impossible to avoid. In 2020, over 70,000 people contracted malaria — one in every 15 Djiboutians — of whom 190 died. The invasive bugs are spreading to important cities in Ethiopia and Kenya, and have been found as far away as Lagos, Nigeria, a metropolis of over 15 million.
Fight bugs with bugs: Working with scientists at US firm Oxitec, Djibouti released thousands of genetically modified versions of the invasive mosquitos whose female offspring die quickly. Since only females of the species bite humans, the hope is reducing their number will reduce human exposure.
Similar programs in Brazil met with astonishing success, driving down the population of dengue-carrying mosquitoes by 96%, a model later copied by Panama and the Cayman Islands. We’re watching Djibouti’s plan with great hope.