In Canada, a move toward a private healthcare option
In British Columbia, private clinics and surgical centers are capitalizing on patients who might otherwise pay for faster treatment in the U.S. The courts will consider their legality next month.


By Kim Murphy

Reporting from Vancouver, Canada - When the pain in Christina Woodkey's legs became so severe that she could no long hike or cross-country ski, she went to her local health clinic. The Calgary, Canada, resident was told she'd need to see a hip specialist. Because the problem was not life-threatening, however, she'd have to wait about a year.

So wait she did.

In January, the hip doctor told her that a narrowing of the spine was compressing her nerves and causing the pain. She needed a back specialist. The appointment was set for Sept. 30. "When I was given that date, I asked when could I expect to have surgery," said Woodkey, 72. "They said it would be a year and a half after I had seen this doctor."

So this month, she drove across the border into Montana and got the $50,000 surgery done in two days.

"I don't have insurance. We're not allowed to have private health insurance in Canada," Woodkey said. "It's not going to be easy to come up with the money. But I'm happy to say the pain is almost all gone."

Whereas U.S. healthcare is predominantly a private system paid for by private insurers, things in Canada tend toward the other end of the spectrum: A universal, government-funded health system is only beginning to flirt with private-sector medicine.

Hoping to capitalize on patients who might otherwise go to the U.S. for speedier care, a network of technically illegal private clinics and surgical centers has sprung up in British Columbia, echoing a trend in Quebec. In October, the courts will be asked to decide whether the budding system should be sanctioned.

More than 70 private health providers in British Columbia now schedule simple surgeries and tests such as MRIs with waits as short as a week or two, compared with the months it takes for a public surgical suite to become available for nonessential operations.

"What we have in Canada is access to a government, state-mandated wait list," said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. "You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list."

Yet the move into privatized care threatens to make the delays -- already long from the perennial shortage of doctors and rationing of facilities -- even longer, public healthcare advocates say. There will be fewer skilled healthcare workers in government hospitals as doctors and nurses are lured into better-paying private jobs, they say.

"What it means is that people who have no money, who are chronically ill, disabled, who require medical attention frequently, are going to suffer dramatically," said Leslie Dickout of the B.C. Health Coalition, which is involved in the lawsuit to determine whether the Canadian Constitution guarantees citizens the right to choose their own care.

"There's so much money to be made by the insurance industry," she said. "If this [legal] case succeeds, what we would have is a system of U.S.-style healthcare -- along with a public system that is decimated."

Indeed, an investment group backed by Arizona businessman Melvin J. Howard this year filed a $160-million challenge under the North American Free Trade Agreement, demanding that U.S. healthcare companies gain access into Canada. The consortium hopes to build Canada's largest private health center in Vancouver, offering orthopedics, plastic surgery, general surgery and other services.

In many ways, the prospect of private investment is alluring in British Columbia, where the provincial government, like those all across Canada, funds the healthcare system. Provincial officials recently announced a $360-million shortfall in the $15.7-billion healthcare budget for the fiscal year that ends in March.

The shortage will mean fewer surgeries and longer waits.

The Vancouver Island Health Authority has said it would reduce the number of nonemergency MRIs by 20%; nonemergency patients now are being booked for scans in March.

Vancouver Coastal Health, which serves a quarter of the province's population, said it would eliminate 450 elective surgeries, about 30% of the schedule, during the four weeks of the 2010 Winter Olympics.

And in the rapidly growing suburbs east of Vancouver, the Fraser Health Authority plans to close its spending gap by, among other things, holding the number of MRIs to last year's total, ending $550,000 in service programs for senior citizens and reducing elective surgeries by about 14%.

The authorities also are making administrative cost cuts and looking to pool resources for things like computers and laboratories.

"We need to be crystal-clear. . . . I'm not denying anybody access here to urgent or acute or immediate care," Nigel Murray, the Fraser authority's chief executive, said in an interview. "If our surgeons feel people need access to urgent care, they get it."

The Canadian government has invested a large amount of money nationwide in a successful effort to reduce wait times, especially for life-threatening conditions such as cardiac disease and tumors, and for procedures such as knee replacements and cataract surgery.

Under Canada's system, most doctors run private practices but are paid uniform rates by a government-funded network. (Many Canadians have private or employer-paid insurance that covers things such as dental and eye care, which are not part of the larger plan.)

Murray, a proponent of the system, acknowledged that the growing number of private clinics and public-private partnership hospitals could strengthen government healthcare.

"You can lose staff to the private systems. . . . But the other side of the coin is that you may be keeping nurses in your communities by providing other employment options for them, so that you're adding to the pool of overall healthcare professionals," Murray said. "Additionally, the private system can take some of the strain off the public system."

The heart of the legal case is the 1984 Canada Health Act, which established the framework for the national insurance system known as Medicare. It outlawed most private insurance for essential healthcare and provided the vast majority of Canadians with free medical services.

Canada spends about $172 billion a year on healthcare, which is one reason the nation's taxes are higher than those in the U.S. (Canadians pay about 33% of the gross domestic product in taxes, compared with 28% in the U.S.) British Columbia is the only province that still charges residents an extra health premium of $54 a month, subsidized for those who can't afford it.

The first foot in the door for private medicine came in 2005, when the Supreme Court of Canada struck down the laws in Quebec that banned private insurance. The court found that having people die while on wait lists violated the province's Charter of Human Rights and Freedoms. The ruling does not apply outside the province, because only a minority on the court found that the laws also violated Canada's basic human rights charter.

The case to throw out the law in British Columbia was launched when authorities attempted to audit some clinics that were collecting government payments for surgeries in addition to fees they charged patients for the use of their private operating rooms and nursing staff.

Day's Cambie Surgery Center refused to open its books and filed suit along with other private clinic operators, saying citizens deserved a choice.

"In Canada, the rights of the individual patient are trumped by the welfare of the system," said Richard Baker, who runs a Vancouver-based consulting group that helps patients find quick access to care in private clinics or in the U.S.

"We have patients come from all over Canada, because B.C. has the most liberal rules on private surgical centers, other than Quebec," he said. "They complain, 'They're all jumping the queue!' Well, it's not jumping the queue at all. It's leaving the queue."

In fact, the British Columbian government has been slow to crack down on private clinics. Health Minister Kevin Falcon told the Vancouver Sun newspaper in June: "I don't have an objection to people using their own money to buy private services, just as they do with dentists, just as they do with . . . sending their kids to private school or what have you. I think choice is a good thing, actually."

The outcome of the legal case, most analysts say, probably will determine the future of private healthcare in Canada.

Not all Canadian doctors have flocked to the defense of private clinics; many see the public health system, for all its strains, as a gem that ought to be protected from the out-of-control expenditures and huge inequities that are part of the U.S. healthcare system.

"We can and need to improve [healthcare]. . . . But it's always going to be more effective, and it's certainly going to be more equitable, if it's done within the public system," said Robert Woollard, a longtime family practitioner and member of Canadian Doctors for Medicare, which has applied to join the lawsuit in British Columbia. Woollard said the public system has the nimbleness to provide speedy, quality care to those who truly need it.

"Just six or eight weeks ago, I had a patient come in who needed urgent attention to her knee. She was in severe pain," he said. "She was seen by a [reviewing] team within a week, and she was slated for surgery that will probably happen in the next two to three months."

I would love to see the opinion of those Universal Healthcare lovers in DR and see what they think of this. Maybe they would start to appreciate the price of those small clinics and how fast they are to act when the money is there and they even do in-house financing. I know this by first hand , i would never support anything like Canada has done in DR. Just imagen what "universal" healthcare in DR would be with lot less resources than Canada.

In the UK you can have private treatment - in fact it is a major business when foreigners etc. come to Harley Street. There is also private medical insurance that will ensure rapid treatment and a private room in a private hospital. But there have been scandals that the the private treatments do not measure up - in case of poblems emergency teams not at hand etc. But everyone is entitled to the National Health Service and taxes are collected accordingly - no exemption for someone insuring privately.

I think this about right - the NHS uses budget against other priorities of government schools, social services, pensions etc. It is not possible to provide an infinite amount of health care - some form of rationing is needed. Priority is given to those interventions that extend meaningful life. Also prevention is important - education on eating habits anti smoking campaigns etc.
S.

The Supreme Court already rulled years ago that if you have a serous need (the test case was prostate cancer) and you are told to wait in Canada, you can go to the USA or UK and the gov. has to pay and they do.

The former PM, a Liberal Socialist was against private clinics - but got all his health care at a private clinic in Quebec.

Willi stop apologizing for that system America can do better but first euthanasia for ABC in the DR or at least he should be neutered

That's sensible...universal health care with an option for private care for those that can afford it.

And the tax in CAnada is 42%, not 33%.




If you earn $100,000 and the gov. takes $40,000, you will still pay 13% sales tax on every dollar you spend of the balance, and more of gas etc. - whch makes it over 50%

Tax Freedom Day is the first day of the year in which a nation as a whole has theoretically earned enough income to fund its annual tax burden. It is annually calculated in the United States by the Tax Foundation—a Washington, D.C.-based tax research organization. Every dollar that is officially considered income by the government is counted, and every payment to the government that is officially considered a tax is counted. Taxes at all levels of government—local, state and federal—are included.

The concept of Tax Freedom Day was developed in 1948 by Florida businessman Dallas Hostetler, who trademarked the phrase "Tax Freedom Day" and calculated it each year for the next two decades. In 1971, Hostetler retired and transferred the trademark to the Tax Foundation[1]. The Tax Foundation has calculated Tax Freedom Day for the United States ever since, using it as a tool for illustrating the proportion of national income diverted to fund the annual cost of government programs. In 1990, the Tax Foundation began calculating the specific Tax Freedom Day for each individual state.

In the United States, Tax Freedom Day for 2009 is April 13, for a total average effective tax rate of 28.2 percent of the nation's income. The latest that Tax Freedom Day has occurred was May 3 in 2000. In 1900, Tax Freedom Day arrived January 22, for an effective average total tax rate of 5.9 percent of the nation's income. According to the Tax Foundation, the most important factor driving changes in Tax Freedom Day from year to year is growth in incomes, as the progressive structure of the U.S. federal tax system causes taxes as a percentage of income to rise along with inflation.

Canada 157 42.6% 6 June 2009

The Fraser Institute: Switzerland and Netherlands Provide Models for Reforming Unsustainable Canadian Health Care

TORONTO, ONTARIO--(Marketwire - Sept. 21, 2009) - The cost of the Canadian health care system is spiraling out of control and Canadians will continue to face lengthy wait times and limited access to new medicines and medical technology unless governments liberalize the health care system and adopt reforms similar to those in Switzerland and the Netherlands, concludes a new book released today by the Fraser Institute, Canada's leading economic think tank.

"The Canadian health care system is a textbook case of government failure in medical insurance and medical services. All available evidence indicates that Canadians are paying more but getting less from our government-run health insurance system," said Dr. Brett Skinner, Fraser Institute director of bio-pharma and health policy and author of Canadian Health Policy Failures: What's wrong? Who gets hurt? Why nothing changes.

The peer-reviewed book paints a troubling picture of a country whose public health expenditures have persistently grown at unsustainable rates, while the health insurance system has failed to provide the access to and quality of medical services available elsewhere in the world.

"No other developed country in the world has adopted the Canadian approach to health care where governments effectively ban private-sector funding of hospital and physician services and prohibit competitive provision of publicly funded services," Skinner said.

"Most other developed nations have chosen a pluralistic health care system that involves a mix of public- and private-sector involvement in medical insurance and delivery of medical goods and services."

In the book, Skinner details how Canada tends to be in the lowest ranks among all 30 Organisation for Economic Co-operation and Development (OECD) countries for availability of medical resources including physicians, diagnostic technologies, and new medicines per population, despite having one of the most expensive health care systems.

He shows the significant hidden costs buried within the Canadian system, including:

- Significant unfunded liabilities and a financial sustainability crisis facing governments because of the uncontrolled growth of public health care spending;

- Significant numbers of people who lack actual effective access to publicly insured and medically necessary health care;

- Shortages of medical resources, especially for high technology and the most advanced medical treatments;

- Significantly delayed access to the relatively fewer medically necessary goods and services that are available;

- Government-imposed restrictions on the incomes and supply of health professionals; and

- Serious disincentives for medical innovation.

Despite these alarming trends, Canadian policy-makers have resisted economically liberal policy solutions that are commonly used by the health systems of other countries with similar social goals to Canada.

"Other countries that share Canada's core social goals for health care have better health care systems," Skinner said. "In terms of delivering actual access to medical goods and services, the Canadian system is not doing a better job at universalizing effective health insurance coverage than the American system. Access to a wait list is not the same thing as access to medical care."

Skinner lays the blame for a refusal to consider real reform on a lack of political will, incentives within the system that encourage special interest groups to oppose reform, and a lack of objective information about health care options in use elsewhere, especially outside North America.

"Policy-makers face fewer political risks from raising taxes to fund health care than from introducing price mechanisms that are paid by everyone, and special interests in the health policy community benefit economically from the state's involvement in health care. As a result, they favour interventionist public policies and oppose liberalization," Skinner said.

He concludes that governments should implement a universal requirement for Canadians to buy private-sector health insurance, but also offer publicly funded subsidies to guarantee that low-income people can afford to buy such coverage.

"A private, competitive market for health insurance and medical services, combined with a regulatory-subsidization role for the state, could ensure that everyone has access to medically necessary services, while still allowing Canadians the advantages of consumer empowerment and competition among insurers and providers," Skinner said.

"This approach is similar in principle to the health insurance models in Switzerland and the Netherlands and would maximize consumer choice and introduce the economic benefits of price and competition."

Canadian Health Policy Failures: What's wrong? Who gets hurt? Why nothing changes can be downloaded as a free PDF or purchased in print at www.fraserinstitute.org


The Fraser Institute is an independent research and educational organization with locations across North America and partnerships in more than 70 countries. Its mission is to measure, study, and communicate the impact of competitive markets and government intervention on the welfare of individuals. To protect the Institute's independence, it does not accept grants from governments or contracts for research. Visit www.fraserinstitute.org.

I guess Fred will hijack a Federal Gold shipment ( being the proceeds of unfair taxes ) kill the guards gloat for an hour or two tlll the Feds catch up - then the electric chair.
S.

Abc read this you squeeler /Fink... ..............America's health care is not doing badly. Indeed a National Center for Policy Analysis study from last March shows how much better we are doing than countries like Canada, Britain, and other European nations that have government health care control:

* Breast-cancer mortality is 52% higher in Germany and 88% higher in Britain than in the U.S.
* Prostate-cancer mortality is 457% higher in Norway and 604% higher in Britain than in the U.S.
* Eighty-nine percent of middle-aged women in the U.S. have had a mammogram, compared with 72% in Canada.
* Fifty-four percent of men in the U.S. have had a prostate-specific antigen test, compared with 16% of Canadian men.

As for the availability of health care, another study shows that 74% of those in the U.S. meet for scheduled doctors appointments within four weeks, while only 42% of British and 40% of Canadians do. Only 10% of Americans wait longer than two months, while 33% of Brits and 42% of Canadians wait that long.

On average, doctors in a survey say neurosurgery should be performed within 5.8 weeks, but in Canada it takes about 31 weeks. And orthopedic surgery should be within 11 weeks, but in Canada it takes 37 weeks. So it is pretty clear that government health-insurance monopoly is dangerously inefficient.