NYC. UK. Canada. February 15, 2019 There’s much to admire about AOC’s energy, much to share in her goals for a better world. But boy did she ever screw up by costing New York its Amazon headquarters — and by giving Republicans yet another way to mischaracterize the Democratic Party in the next election. A big unforced error. Could we have a do-over? Speaking of unforced errors, how about Brexit? Could they have a do-over? Paul Abrams made the case for this 30 months ago and it’s no less compelling today. Some of my friends tell me the outcome of a second referendum would be no different — and that may be true. But as the March 29 deadline looms, don’t the Brits owe it to themselves to find out? CORRECTION Last month I noted that Libertarian Republican Senator Rand Paul was going to Canada for hernia surgery. “Better care than he can get here. If he were Canadian, it would even be free.” Steve: “The clinic Rand Paul is going to for surgery is world renowned but is NOT part of Canadian single-payer plan. If I went there I would have to pay their rate but would get reimbursed for the scale rate under Canadian system which might be a fourth or a tenth the actual charges. Sorry to correct your column.” –> Oops. “On balance,” I asked Steve, “which system do you think is delivering a better result? The most bang for the buck?” Steve: “No question the Canadian System does . . . with one notable exception: cancer. While you get world class treatment for it here, a fast- or even moderate-growing cancer might not be treated in a timely manner (depending upon where you live, as wait time can vary dramatically by province or city where you are located). Here is the big difference between the two systems: Americans have health care rationed by price. Canadians have it rationed by time. Everyone gets it but you may have to wait. “In 2010 I had a mild heart attack. I needed four stents put in. Total out-of-pocket cost to me, including doctors (diagnostic cardiologist with four appointments for stress tests and nuclear stress tests; surgery including hospitalization; and four Boston Scientific Drug coated stents inserted by a surgeon who had trained at Mayo Clinic): zero. “A friend of mine whose son at a very young age was diagnosed with non-Hodgkin lymphoma had chemotherapy and radiation treatment over six months which cured it (or so they thought) same cost zero. When it recurred he has just undergone stem cell treatment including four weeks in hospital. His parents do very well, but even with their upper middle class lifestyle they would have been looking at selling their house and a major financial setback had they lived in the US. Instead, their only cost was for housing in a city they didn’t live in because treatment is at a major city. Better yet, the son (patient) had disability coverage at work, which paid his salary; Canada Pension Plan (think US Social Security) also has a disability portion so he got that as well.” And Canada does this at a dramatically lower percentage of GDP than we do (roughly 11% versus 18%). It’s impossible to go overnight to the same kind of single-payer system every other advanced nation on the planet employs so much more cost-effectively that what we had to. The Affordable Care Act was a first step toward a fairer more efficient system. Adding a public option to it would be another. Lowering the Medicare age by one year per year would be a third. Have a great weekend.