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I've made my first novel, Ventus, available as a free download, as well as excerpts from two of the Virga books.  I am looking forward to putting up a number of short stories in the near future.

Complete novel:  Ventus

 

To celebrate the August, 2007 publication of Queen of Candesce, I decided to re-release my first novel as an eBook. You can download it from this page. Ventus was first published by Tor Books in 2000, and and you can still buy it; to everyone who would just like to sample my work, I hope you enjoy this version.

I've released this book under a Creative Commons license, which means you can read it and distribute it freely, but not make derivative works or sell it.

Book Excerpts:  Sun of Suns and Pirate Sun

I've made large tracts of these two Virga books available.  If you want to find out what the Virga universe is all about, you can check it out here:

Major Foresight Project:  Crisis in Zefra

In spring 2005, the Directorate of Land Strategic Concepts of National Defense Canada (that is to say, the army) hired me to write a dramatized future military scenario.  The book-length work, Crisis in Zefra, was set in a mythical African city-state, about 20 years in the future, and concerned a group of Canadian peacekeepers who are trying to ready the city for its first democratic vote while fighting an insurgency.  The project ran to 27,000 words and was published by the army as a bound paperback book.

If you'd like to read Crisis in Zefra, you can download it in PDF form.

Personal tools

What Canadian health care is really like: 1. My Health Card

Filed Under:

First in a series to counter the lies and confusion spread last summer about Canadian health care

I carry my Ontario health card (OHIP card) in a plastic sheath in my wallet because it's falling apart.  I've had it for twenty-five years, ever since I moved from Manitoba to Ontario.  Previously, I had never bothered to sign up with the health plan in whatever province I was living in; heck, I was young, and I would get treated anywhere anyway on the basis of my Manitoban origin.

Since I suspected  I was settling in Ontario for a long time, I put in the extra effort to stand in line for a few minutes and get the card.  Modern cards have a photo and stuff, but this one, which is still good, just has my name and number.  It's all I've ever had to show in a hospital or clinic.

About ten years ago, I started having palpitations. (Incidentally, they followed a particularly nasty bout of the flu--which, however, bad, still wasn't as bad as the Swine flu is reputed to be; so get your vaccinations, please.)  I was working downtown, nowhere near my doctor of the time; so, like any Canadian in trouble, when I had an episode, I went to the nearest emergency ward.  I walked in, flashed my card, and was put through triage.

The reason this is significant is that my heart kept popping back into normal mode before they could get the leads on me to find out what was happening. So I kept going in; somebody suggested I wear a halter monitor, but we caught up to the problem before I had to.  In any case, I never had any financial hesitation about visiting the ER because, as a Canadian, the very idea of any financial calculation being involved in such a decision is foreign to me, and repugnant.  Nor did I ever have to do anything but flash my card at the door as I came in.  No papers to sign.  No waiver to pay.  (If there are cashiers at Canadian hospitals I've never seen one, and I don't know where they're located.)

So, here's the essence of the great Orwellian big-brother health care system we live under:  my card is ancient, cracked and falling apart, and doesn't even have my picture on it.  Every now and then, I wave it at somebody in a pro forma sort of way.  Something bureaucratic happens when I do this, but I don't know what it is and don't care; and if I didn't have a card something else bureaucratic would happen that I similarly don't need to care about.  No agency of the government has ever interceded in my life regarding my health care; I've never been told nor asked by any government entity to take any test or have any treatment.  My health is a matter entirely between me and my doctors and no one else has any say in it.

Health care, in Canada, is you and your doctor.  It's nobody else's business; and that little card has no sinister government apparatus behind it.  All it does, as far as I know, is keep things between you and your doctor.

Which is what the government should do about your health.

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I enjoy your fiction, but I must demur here.

Posted by Tom Tobin at Sep 17, 2009 04:34 PM
I haven't read much of your work yet; I've only just completed _Sun of Suns_, and thoroughly enjoyed it. That said, I must demur regarding your views on health care; while I'll happily agree that the current system here in the US is a mess, I don't believe the solution is even more government involvement. Health care has not followed the ever-better/ever-cheaper trajectory of other industries because it is quite distorted by the bewildering array of regulations in place. Not taxing employer-provided health benefits leaves an unequal playing field with other options, and Americans have gotten quite used to "someone else" paying the bill when they go to a doctor. It's telling to compare the case of completely elective procedures like laser eye surgery with the medical system at large, here; laser eye surgery is not covered by insurance, yet it has rapidly become both better and cheaper over time. With most medical care, though, there is little incentive to provide cheaper service when many customers aren't cost-adverse because they don't know and don't care where the money is coming from.

There was a recent Atlantic article that lays this all out, and more, better than I can:

http://www.theatlantic.com/doc/200909/health-care

I don't agree with everything the author says there, but I feel it's a much more accurate picture of the problems of both the current situation and the proposed "solutions" currently being touted than what most people come across.

Demur? Against what?

Posted by Karl Schroeder at Sep 19, 2009 01:20 AM
Not sure what you're demurring about; I didn't present any opinions or "views" of health care in the above post; I merely presented the facts of my experience. I only made one assertion, so I guess what you disagree with is my strong feeling that the only thing the government should do is make sure that health care is a matter strictly between the patient and his doctor.

Also, I'd like to know how you think my battered, cracked old health care card, which is my one and only (and rare) contact with the government presence in our health care system, constitutes "more government involvement." The single-payer system is quite streamlined; we pay less than half the administrative costs that you do, which is a pretty clear sign that under our system there is *less* government involvement, not more. This goes for both the large-scale macroeconomics of the situation, and for individual experience--my whole point in the above post was that waving the card on my way into a hospital is and always has been the only government involvement in my care that I have seen!

"No one else has any say" just isn't so / the larger issue

Posted by Tom Tobin at Sep 21, 2009 03:18 AM
I do disagree with an assertion you made: "My health is a matter entirely between me and my doctors and no one else has any say in it." The government is acting as your insurer, and just like here in the US, your insurer does indeed have a say in your health, whether or not it is visible to you; no insurer will pay for every possible treatment regardless of cost. When there is only one insurer, it may reduce your options in a manner that is never obvious.

(I am curious, though: did you read the article I mentioned?)

As for costs, my larger problem with the Canadian system is the very manner in which it is funded: through taxation. Whether or not the Canadian system costs more is ultimately besides the point (although comparisons with the current US system are not comparisons with a "free market" system, since the US government does have much involvement here) — I do not believe that government's proper place is in providing "positive" rights (such as a right "to" health care), period. Governments should be limited to providing courts of law, and a system for protection against violent aggression (which should overlap with, rather than replace, a citizen's own means of self-defense); everything else should be left to individual people to decide and provide for themselves, amongst themselves. I'm quite certain we disagree here, and since this is a difference in values, it's not something we can argue factually about.

Well, regardless, I hope I enjoy _Queen of Candesce_ and _Pirate Sun_ when I get my hands on them; thankfully, I don't need to agree with an author's politics to enjoy his works. ;-)

Politics in science fiction

Posted by Karl Schroeder at Sep 21, 2009 07:34 PM
Hmm... my Virga books are light entertainments, of course--but maybe you should read my 2005 novel Lady of Mazes. That book describes a "post-government" future while of course not being a libertarian screed either (although many libertarians seem to think that it is).

Lady of Mazes

Posted by Tom Tobin at Sep 23, 2009 01:23 AM
I plan on reading _Lady of Mazes_, although I should probably read _Ventus_ first, I imagine, since Lady of Mazes is described as a prequel to that. (All your longer-format fiction is in my reading queue ... so much to read, so little time.)

Thanks

Posted by Jason M. Robertson at Sep 17, 2009 05:41 PM
As one of your readers who lives in the States, thank you for offering up this post. The degree to which our present conversation here is dominated by lunatic fantasies is deeply depressing. Much like maintaining the capacity to defend against invasion, health care is a core part of the state's foundational obligation to provide for the common defense.

As to the first commenter, every piece of data I've ever seen about attempting to create market pressure by passing cost onto the consumer indicates that we humans are _terrible_ risk assessors and make profoundly bad choices when asked to do those cost-benefit trade-offs ourselves. Witness how many people immediately go flying off into nutty alternative therapies when presented with life-threatening scenarios, rather than staying with the data.

This isn't something people can learn, or be educated about effectively. It is in the wiring to discount future considerations. Furthermore, the basic logic of insurance works best for those being insured when the pool is as wide as administratively possible. A single actor demanding cost controls also performs much better. You may cite elective procedures for your price control argument, but those procedures are structurally very different from critical-to-life ones, and not even primarily because of the insurance/lack of insurance associated with those cases. Peer nations do much better than we do on medical cost control while having mechanisms that obscure costs to the consumer much more than those of employer-provided health insurance.

Anyways, Mr Schroeder, why can't I find The Sunless Countries in any brick and mortar stores in all of Chicagoland? I'm going to get around to ordering it online, but I really hope the book is getting distribution!

Bad decisions / Chicago-SF?

Posted by Tom Tobin at Sep 17, 2009 08:50 PM
I've seen the "humans make bad decisions" argument raised before in various cases (not just health care), and I don't dismiss it out of hand — I'm very much aware of research in cognitive science and neuropsychology, and I wish I could get all our lawmakers to read _The Blank Slate_ by Steven Pinker. Thing is, if humans *are* such bad decision makers, putting these decisions in the hands of government just amplifies bad decisions by many orders of magnitude with no strong corrective force in play. The market provides that corrective force against any number of bad decisions that might be made; failures in the market are every bit as important as successes, as they help eliminate what doesn't work in favor of what does. I don't believe health care is somehow inherently different in this respect. Even in the not-quite-so-free medical market we have, the United States ranks first in life expectancy when you control for deaths from violence (which you certainly can't blame on the quality of health care).

And BTW: you're in Chicago-SF, right? I was the originally-from-NY new guy who brought his wife to the last pizza outing. :p

Bad decisions / chicago-sf.org

Posted by Jason M. Robertson at Sep 18, 2009 10:56 PM
Your claim regarding the characteristics of government decision making are rather glib, and not particularly well-supported in reality. Again, there are numerous governments containing huge populations which make health delivery systems with substantial government intervention work at least comparably to our own outcomes.

Humans are bad decision-makers, _especially_ with regard to assessing risk for themselves. We're programmed optimists and are terribly bad at balancing that. You look to the market for correction in this matter, but where the 'teachable unit' is the individual, the consequences catch up too late to be useful.

Libertarian-leaners should find healthcare co-equal to the common defense on the list of functions the government might legitimately take on. After all, common defense provides for the freedom to pursue a broadly freely chosen life, defends the circumstances of commerce and provides for securing material wealth. The defense of life and the instantiated capacity for its enjoyment is the same thing with a less martial flare for drama. The medical market also sees substantial consumer benefit from collective negotiations, and the percentage of the population capable of betting better than established medical wisdom with regard to procedure availability is vanishing low. Most who believe they can are kidding themselves. Clinical success is found in following the numbers where they lead, and bureaucracies can actually do that pretty well.

I see no reason why I cannot blame deaths from violence on the quality of health care. I blame the poor and over-cautious American mental health care system for a perpetual class of low-functioning individuals who are not helped. I blame a lack of access to mental health diagnosis and therapy. I even think a half-century of lagging behind the modern health-security state is a part of the inequality which inevitably brings criminal violence to our lives. Certainly there are other factors, but it isn't clear to me that the variables are not at least weakly linked.

A free marketeer who values the informational power of markets as championed by Nozick should understand that betting on the future of your health is a gamble where we all get the best odds if we all go in together. If we're all expected to hide away cash in health-savings accounts then when we land on a losing square in the health game we gain none of the benefits of being part of a larger risk-pool. If that HSA is to give us the market information you want it to, we must allow grave consequences to accrue to those (i.e. most who encounter a serious problem ahead of schedule) who were unable to stash away enough money to handle such an outcome.

Super short version: clinical methodology gives better data on health services than market speculation while mandatory universal risk pools may leave some slightly worse off than had they been allowed to speculate on their own, the costs of a health service failure are categorically greater than the freedom lost by not being allowed to make that gamble. Root agency vs. supplemental economic agency.

And yes, I am the chicago-sf.org user known as 'Redag'. I was pleased to meet you at the pizza event, and trust we'll see you at our subsequent events. :)

Just one point for now, then bedtime

Posted by Tom Tobin at Sep 21, 2009 03:50 AM
I'll just make one point here, besides my reply to Karl (since it's getting late and I really should be getting to bed):

The lack of foresight that gives rise to much violent crime is due to low intelligence, and mental health care can't do much for that. Or, put more bluntly, *dumb people can't be fixed*, and perhaps one of the only ways we can keep such people from trying to mug, murder, and rape us is to make the costs of doing so both overwhelming, immediate, and obvious — such as having an armed populace that swiftly dispatches anyone foolish enough to attempt mugging, murdering or raping us. This also raises one of my odd non-libertarian stances — I'm not so sure that people should be free to create new sentient lives with their own rights and responsibilities regardless of the capabilities of the parents (whether nature or nurture), and I believe this is a hole in most political theories (libertarian, progressive, conservative, or what-have-you) ... but now I'm rambling.

But yes, I was happy to meet you (and all of you!) at the pizza meeting, and I hope to see all of you at the D&B meeting next month. I'm always worried, being a quirky geek, what other people who share my interests will end up thinking of me should they realize my political leanings, since almost everyone who shares my interests is politically liberal. I always feel like the odd one out, on either "side" — at the local board game and RPG shop, I'm probably the only person there who is an NRA member ... and at the gun store, I'm probably the only male who knows how to apply makeup (back from years ago, when I dressed up as a goth girl on a regular basis).

And seriously, *all four of you* who were on that side of the table are librarians? I'm not sure if you overheard the part where I nearly became a librarian myself, before dropping out of grad school ... but yes, too weird. ^_^

Which decisions are you putting in the hands of the government?

Posted by Karl Schroeder at Sep 19, 2009 01:54 AM
I'm unclear about what health care decisions you think Canadians have put in the hands of our government? Our government does not make health care decisions, our medical professionals do in consultation with their patients (that was the whole point of my post above). How many times does this have to be said? --Anyway, in a democracy government does not amplify bad decisions unchecked because it has a very strong corrective force in play: elections. At least, our government works that way--and yes, largely, our government works.

Sorry you can't find The Sunless Countries, Redag. It's all over up here; but then maybe Tor is doing a Potemkin Village on me to convince me that it's widely available...

Cashiers

Posted by Chuk Goodin at Sep 17, 2009 10:20 PM
At least here in BC we have cashiers in the hospital. It's where you go to get your punch card for long-term parking. There's only one though and they're not open all day.

My Health Care in the Boonies!

Posted by W. Michael Cook at Sep 18, 2009 05:00 AM
Hi Karl. As you know, I had the mother of all heart attacks 4-5 years ago. No worries outside of just getting better. They took one look at me in triage, whisked me into the ER and gave the full monty! I even got hooked up to the machine that goes PING! The only thing I had to worry about was surviving it. Tammy only had to worry about me getting better. 6 days in ICU and another 5 days on the ward and I was home. I recieve one of the largest coronary Stents placed in Manitoba when the did my angiogram. The cardiologist thought it prudent to go this route because I was so young (under 50). That leaves the option for 2 sets of bypass surgery open for the future if need be. 2 weeks after my heart attack, the physio people had me walking as much as I could, but in short spurts several times a day. The nutritionist had reviewed my diet with me and the hospital pharmacist had reviewd my medications, explained how each works, gave the heads up on side effects and possible negative outcomes etc and the social worker had done a review of my stress levels, work situation and home life. A month after the heart attack I started to attend a series of clinics designed to reinforce my lifestyle changes and to educate me with all of the above information. It served as a second reinforcement of the stuff that was done in the hospital and when I just got out. I have access to these professionals if I have questions, feel the need to further my lifestyle changes or if my health situation changes. I regularily attend a heart rehab class designed for heart patients. I also walk/jog on my own. Last spring was my 4 year aniversery. My doctor thought it would be prudent to do a stress test, med review and a possible angiogram. and muga scan. I had all but the angiogram tests. The cardiologist felt there was not enough change to do an angiogram at this point, the other tests went well.

The point is, that I have cadillac health care and it cost me nothing but the taxes I pay. All I have to worry about is getting better and staying healthy. Positive lifestyle changes are a hell of a lot easier when one does not have to worry about access to health care... I should mention that I did almost go bankrupt because of all the time off-I was off work for 18 weeks. The lost income was devastating enough, but I could not have afforded any care if I had to pay for it myself. Then what? I die looking at the damned hospital down my street knowing I can not have access to it?

Canadian health care can be a pain in the ass some times-no denying that. However, we take it for granted more often than not. Like Joni Mitchel said, "you don't know what you've got till its gone". Oh, by the way. All this care was in a town of 39,000 people and the standard used for cardiac care was developed in the best American hospitals and is used there. The only thing sinister about our health care system is those individuals who are hell bent on getting rid of it for some dream ideology that has no real basis in reality.

Ah, the boonies!

Posted by Karl Schroeder at Sep 19, 2009 02:02 AM
Thanks for your contribution, Mike. The best counter to a theoretical argument is the facts, and you've provided some good ones in your post above.
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About Me

I'm a member of the Association of Professional Futurists with my own consultancy, and am also currently Chair of the Canadian node of the Millennium Project, a private/public foresight consultancy active in 50 nations. As well, I am an award-winning author with ten published novels translated into as many languages. I write, give talks, and conduct workshops on numerous topics related to the future, including:

  • Future of government
  • Bitcoin and digital currencies
  • The workplace in 2030
  • The Internet of Things
  • Augmented cognition

For a complete bio, go here. To contact me, email karl at kschroeder dot com

Example: The Future of Governance

I use Science Fiction to communicate the results of actual futures studies. Some of my recent research relates to how we'll govern ourselves in the future. I've worked with a few clients on this and published some results.

Here are two examples--and you can read the first for free:

The Canadian army commissioned me to write Crisis in Urlia, a fictionalized study of the future of military command-and-control. You can download a PDF of the book here:


Crisis in Urlia

For the "optimistic Science Fiction" anthology Hieroglyph, I wrote "Degrees of Freedom," set in Haida Gwaii. "Degrees of Freedom" is about an attempt to develop new governing systems by Canadian First Nations people.


I'm continuing to research this exciting area and would be happy to share my findings.

 
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    A Young Adult Scifi Saga

    "Lean and hugely engaging ... and highly recommended."

    --Open Letters Monthly, an Arts and Literature Review

    Sheer Fun: The Virga Series

    (Sun of Suns and Queen of Candesce are combined in Cities of the Air)


     “An adventure-filled tale of sword fights and naval battles... the real fun of this coming-of-age tale includes a pirate treasure hunt and grand scale naval invasions set in the cold, far reaches of space. ”
    Kirkus Reviews (listed in top 10 SF novels for 2006)

    "With Queen of Candesce, [Schroeder] has achieved a clockwork balance of deftly paced adventure and humour, set against an intriguing and unique vision of humanity's far future.
    --The Globe and Mail

    "[Pirate Sun] is fun in the same league as the best SF ever has had to offer, fully as exciting and full of cool science as work from the golden age of SF, but with characterization and plot layering equal to the scrutiny of critical appraisers."
    --SFRevu.com


    "...A rollicking good read... fun, bookish, and full of insane air battles"
    --io9.com


    "A grand flying-pirate-ship-chases-and-escapes-and-meetings-with-monsters adventure, and it ends not with a debate or a seminar but with a gigantic zero-gee battle around Candesce, a climactic unmasking and showdown, just desserts, and other satisfying stuff."
    --Locus