By Melvin J. Howard
Canada has a don’t ask don’t tell policy when it comes to private health care. Other words don’t ask the Government of Canada do you have a private health care industry and they won’t have to tell you no lies. The latest court case in British Columbia between the private clinics and the Province is just one more example of hypocrisy I witnessed for years when it came to private health care in Canada. Excuse me while I let out a big yawn but please! Canada are you just starting to realize you have a private health care industry? Both the Federal and Provincial governments have been turning a blind eye to it for years even to the point of contracting out medical services to the private health industry. So what’s the big deal in June 2005, the Supreme Court of Canada struck down Quebec laws that outlawed private insurance. The case became known as the Chaoulli decision. When Justice Marie Deschamps wrote in the Chaoulli judgment “I find that the prohibition (on private insurance) infringes the right to personal inviolability and that it is not justified by a proper regard for democratic values, public order and the general well-being of the citizens of Quebec”,
Chief Justice Beverley McLachlin wrote, “Patients die as a result of waiting for public health care” and “Access to a waiting list is not access to health care”, surely the message implied an expression of concern for all patients in Canada? Quebec seems to be the only Province to allow freedom of choice when it comes to their health care needs.
What’s even nuttier is Kevin Falcon, British Columbia's new Health Minister, believes patients should be able to use their own money to buy expedited health care in the private sector" I do not have any objection to people using their own money just as they do for dental care or sending their kids to private school," Mr. Falcon said. "I think choice is a good thing and reducing it is not a good thing. This is in contrast to George Abbott the previous health minister before Falcon who informed Dr. Brian Day that the government would vigorously defend the lawsuit Day initiated against the government who wanted to look at his books. But Day said screw that and launched legal challenge claiming the laws against "extra billing" and charging patients for "medically necessary" services like surgery were unconstitutional. "The waiting periods for medical care in the province are unreasonable and result in patients receiving inadequate care in the public health-care system," the suit says. "The unacceptable delays in patient care result in extended suffering and, in some cases, death. "The rights to liberty, life and security of the person are a constitutional guarantee of access to medical care, and include both a right to access to medical care of one's choice, whether public or private.
The Province on the other hand claims with a statement of defence, saying the laws against private billing are consistent with the charter of rights and are meant to protect a public health-care system "based on need and not an individual's ability to pay."
Then the government counter-sued against Day for refusing to let the auditors examine his financial records can you blame Day. Even a former Liberal member of the provincial legislature, Barry Penner, used a private surgery centre in 2004 when he needed a back operation during a hospital employees union strike, Mr. Falcon said: "I have no problem with what he did, particularly because it was during the strike. Mr. Penner was among 7,000 British Columbians who had surgery cancelled or delayed during the strike.
The government ended up contracting out many of the procedures to private clinics as a way to catch up. Can you see boys and girls the hypocrisy here for 12 years this is what I put up with. I am so proud health care is at the forefront of US debate and sure people are passionate about it. Why wouldn’t we be it has been simmering for sometime and now we are on the verge of reform. That reform is a work in progress never the less the US had the guts to confront a major issue that every American will have to deal with in their life time I want to be clear Universal or Private Care are just labels I’m for the best care possible period. I have often written in the past about countries like Switzerland, http://centurionhealthcorp.blogspot.com/2006/04/switzerland-health-care-system-that.html Belgium, Germany, Austria and France that have a system where government and the private health industry co-exist together to serve patients needs.
The problem I have with all of this is I had to jump through made up roadblocks and politicians who could not stand up to their own convictions when it came to private health care and allowing my hospital to be built. Now some are saying if the private clinics win this case this will allow the big bad Americans in! I am going to let you in on a little secret I would have filed my NAFTA claim regardless of the recent Supreme Court cases both in Quebec and British Columbia. So lets get that fear off the table now and get back into reality. If Canada wants to close their borders to this particular trade issue let me know I will be happy to pass that message on to other trading partners!
By Kim Murphy
September 27, 2009
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."
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
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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.
By Melvin J. Howard
By Melvin J. HowardSpeaking of doubt lets leave none Canada in the past has shown a wide systematic institutionalize discriminatory practice of shutting out American health care companies in any form. I want even get into the other discriminatory practice I encountered don't worry if you don't get it now you soon will. So when I read Americans are not being very good trading neighbours right now. I just say interesting for over 12 years of my life starting in 1998 Canada was an awful trading neighbour. Just to be sure you understand how long I have been continually given the run around and spent countless and countless dollars you have no further then to look at your own Federal Corporation Data link http://strategis.ic.gc.ca/cgi-bin/sc_mrksv/corpdir/dataOnline/corpns_re?company_select=3797945 People are just starting to realize what a one-sided trade deal this has been for Canada for so long. On the other hand Canadian health care companies take full advantage of the free enterprise system that America is so famous for. This arbitration will be one of the most transparent one’s yet the public should be able to peer behind the curtain and see what I saw for many of those years. It is time to shed some light in those dark places and like any good trial lawyer I have been prepping for this for a long time and my closing argument will be strong. So what is 12 years of a man’s life worth let’s start with $160,000,000.00 dollars the rest we can negotiate.
Why aren’t you expanding your claim to the Province of Quebec
By Melvin J. Howard
Because Quebec has seen the free trade light they are not waiting around for the rest of Canada to come out of the dark ages. Through a little know piece of legislation called Bill 33 the Province of Quebec has allowed private surgical clinics to bill patients and the government at the same time. Under Bill 33, adopted by the National Assembly, clinics can charge patients ''accessory fees'' for the use of a private operating room, equipment and even some personnel. Two-tiered systems end up costing less and operate more efficiently, said Démocratique du Québec Leader Mario Dumont, "They do much better than we do" with mixed health-care systems, he said. The working group on health financing for Quebec was led by Claude Castonguay, a former Liberal cabinet minister who has been an advocate of greater privatization, user fees and private insurance in the system. Quebec's Liberal minority government appointed Castonguay in 2007 to oversee the closed-door committee on health-care financing. Update on September 30th, the role of private surgical clinics will be greatly expanded. In addition to hip and knee replacements and cataracts, private clinics will be able to do a wide range of procedures, including mastectomies, hysterectomies and bariatric surgery. The new regulations will also assign these surgical procedures away from hospitals to the private surgical clinics. Hip replacements, for example, will be done exclusively in clinics. The Quebec government has gone even further they will now allow physicians and surgeons to practise simultaneously in both participating and non-participating hospitals and clinics. You gotta love Quebecois are you sure Quebec is apart of Canada. From an outsiders point of view it looks murky at best but that’s another story. I am now declaring Canada’s healthcare system from trade treaty obligations is now null and officially void.
If this is not a NAFTA and GATS challenge I don’t know what is. The Government of Canada’s argument has been public financing was the principal exemption of healthcare from trade treaties. Let’s just say Canada needs to press the refresh button private health care in Canada is there to stay the rabbit is out. The Supreme Court’s decision in Chaoulli v. Quebec has made that very clear. Canada failed to anticipate the possible conflicts of domestic, international and constitutional law when it made commitments in the area of private health insurance at the WTO. Come on Canada now is the time to admit and acknowledge the oversight between your health care system and trade policies. The expansion of private health insurance and clinics, changes the scope of your public system why do you have to be in denial? Your system is no longer shielded from national treatment, MFN or NAFTA obligations.
Now that the Chaoulli decision has been made Canada’s arguments that “health insurance services” are clearly restricted to supplemental health insurance services provided by private insurers should also be challenged. There should be competition the assumption that medically necessary services are “public” and that supplemental insurance is “private” is up for debate what is medically necessary? Canada’s public health insurance plans should be forced into competition with private suppliers. Canada’s Medicare’s monopoly or single-payer insurance is no longer protected. I know some insurance executives maybe I should give them a call. Can you say national treatment rights to U.S. companies that compete for health services! I salute Quebec and to their honour I am learning how to speak French. Voici à votre santé !
By Melvin J. Howard
Centurion has completed its selection process for Arbitrators and we have selected our party-appointed arbitrator for our NAFTA proceedings against the Government of Canada. In summary after interning at the American Civil Liberties Union and clerking for a US Federal Judge where they drafted judicial decisions on a range of diverse issues of law, including contract disputes, federal habeas corpus review of death penalty cases and employment discrimination claims. After leaving a large law firm where the selected party practiced International Trade law. The party entered the world of academia as a Law Professor and has worked in the Office of the U.S. Trade Representative as Assistant General Counsel and the Department of Commerce. In addition the selected party litigated disputes before the World Trade Organization and negotiated bilateral and multilateral trade agreements. Authored a series of WTO articles for U.S.-based Initiative for Policy Dialogue, a U.S. think tank. In addition to authoring and CO-authoring numerous reviews, articles and essays.
Honors include:
Fulbright Scholar to France
International Law Fellow, merit tuition scholarship for academic achievement in international law
Staff Editor, Journal of International Law and Politics
Marden Moot Court, second in division for best brief and oral
Centurion will expand its claim to include all Provinces except Quebec. I want to personally thank the various lawyers and institutions that helped with this process. For further information http://www.state.gov/s/l/c29884.htm#
Surely you jest how can that be by
Melvin J. Howard
As the US tackles its health care issues Canada has yet to admit that they have one. Deniability seems to be the word of the day for Canada’s health care system I hear the word sacred a lot being referred by Canadians to their health care system. As though their health care system they have was somehow ordained by God. It is this illusion that will be the eventual downfall of the system. Canada often attacks the US on a number of issues but health care should not be one of them. Canadians often say we don’t want a two-tier health care system wake up and smell the rubbing alcohol. For those who think that Canada doesn’t have a two-tier healthcare system let me open your eyes. Their second tier is called “The GOOD OL USA”, which is where all the Canadians go when they need urgent healthcare.
You see while America’s politicians have seen the light of health reform. They have now come to understand the health care system, as it is now is unsustainable and dangerous to the economic viability of the country and that change needs to happen now or else. I have yet to stumble upon a Canadian politician that has the guts to say to the Canadian people we have a problem and if we don’t fix it now we are jeopardizing our economic viability. Sure they will say it in private as they have done to me many times but never in public. The only Province that had the nerve to change the status quo was Quebec now you might asks yourself out of all the other Provinces what makes Quebec so unique? It’s simple really separation Quebec can and does use the separation card with Ottawa, and it has been very effective in getting the needs of Quebec met. I just want to point out how different Quebec is from the rest of Canada I am not sure if Quebec is still even apart of Canada I think if it is its only on paper, I jest of course. But in reality as Quebec gets more and more sovereignty just like the one the Supreme Court handed down that Quebec can have private healthcare their independence will grow its inevitable. It seems the Judges in Canada have more of a political will to change the health care system in Canada then the politicians do now fancy that. Where is the backbone are the politicians only concern is to maintain power without rocking the boat. Well congrats job well done nothing accomplished on the health care front as usual. It is shame that the Supreme Court of Canada had to step in for all of the major political parties in Canada and rule in favour for the rights of patient’s and their freedoms in Quebec.
The other provinces have yet to make the same challenge for their patient’s rights and freedoms and I doubt they will. I don’t see any dynamic political leader that has the chutzpah to do it. There was the province of Alberta that was contemplating such a move and was going to violate the Health Act until it got its way. Well that went nowhere I was not surprised if you been doing this as long as I have you tend dismiss political posturing in Canadian politics.
Now lets get to the protectionism issue, for number of months Canada has been crying constantly that the US is using protectionism in its buy America clauses in its stimulus bill that was passed by congress. As a free-trade advocate, I just want to say straight up have you checked your own back yard lately Canada? It is because of your policies that healthcare was outsourced to the US in the first place because political interference destroyed all Canadian competition in the health care field. Let me remind you singling out America is way off base at this time in regards to domestic policy when it comes to trade. I think if you really check you will see from all countries some form of domestic policies that can be misconstrued as protectionist. You have no further to look then to Britain and the Netherlands. For instance, they are forcing banks receiving taxpayer bailouts to start lending at home at the expense of overseas clients. The French are insisting that his nation's automakers move manufacturing jobs home in exchange for a government bailout I am not sure where that went but regardless. The point is this there has never been a time that such financial upheaval has occurred globally all at the same time as this. I think any head of state is going to take care of home base first. To think otherwise is foolish and naïve. The thing is to get all of the trading partners healthy financially and economically at home so they can continue to trade freely abroad, the faster the better.
Then I hear the Provinces are cheering the lets retaliate US procurement for municipal and city contracts song. If that don’t beat all and that’s my polite way of putting it. Let’s take a trip down memory lane Provinces come on don’t be afraid I just want to show you the err of your ways. Few Canadians realize, that provincial governments have for many years opposed any reciprocal trade deal with Washington DC that would prevent them from excluding not only U.S. firms, but also companies from elsewhere in Canada, from bidding on provincial or municipal contracts. In the original free trade negotiations with the US the provinces were adamant that they were not willing to have their procurement, or that of their municipalities, governed by the agreement. So an unusual procurement chapter was put together that applied only to the federal level and even then with some limitation. Then in the WTO negotiations because of the protectionist views of the provinces, Canada was not willing to put sub-national procurement into the agreement. I have to say that move caused a great pain in the ass, especially among some state governments. So the US said screw it lets move on to other free trade agreements, with countries in which sub-national procurement was included.
So what was the end result well companies from those countries can now bid on U.S. procurement projects from which Canada is now excluded that right excluded. You can’t have you cake and eat it to so stop crying. You even had numerous chances to re-negotiate but you passed. I have now come to understand the problem when dealing with Canada. From an international point of view it is really not a country per-say. They do have a central government but it doesn’t have authority over the provinces over matters that are considered part of international trade. Hence my NAFTA proceeding with the Federal Government of Canada and not the Provinces of which the breaches occurred. Under GATS, the federal government is obligated to take reasonable measures as may be available to it to ensure that regional and local governments and authorities observe Canada’s GATS commitments. Under NAFTA, Canada must ensure that all necessary measures are taken to give effect to the provisions of NAFTA, including their observance by provincial and local governments. As I discussed in earlier posts, in the event of any alleged breach of Canada’s obligations under GATS or NAFTA, the federal government is responsible for responding to the allegations and when necessary, for providing compensation in the manner required under Canada’s treaty obligations. So Canada who’s fault is it that you find yourselves in this position? Look in the mirror it is something you brought upon yourselves. Provinces are not even guaranteed access to procurement markets in their own country. It’s all fragmented just like the health care sector there its crazy. Canada’s Medicare system is completely in left field when it comes to the principles of free trade. By establishing a public sector health insurance monopoly, and by regulating who can provide health care services and on what terms, the Canada Health Act and the Medicare system go against the intentions of free trade. So when I hear Canada calling unfair trade practises against the US I just have to chuckle and say really that’s interesting. That is very smug when foreign banks are not allowed to set up shop in Canada or you have a crown corporation that is the only choice for any number of services. Most Americans could not comprehend one telephone company, one gas company, one insurance company, only 5 banks to chose from, depending what part of Canada your in one cable company. I am not even finished but lets just say if you had a problem with either one of those services I just mentioned. Well I am afraid you don’t have much choice that’s it your up the creek and you can only get your paddles from one place.
Americans are brought up on free markets from the moment you’re born on US soil. You get choices that is why the US is called the land of opportunity. The reason for that is if you don’t like a particular service you can go down the street and get a better deal from someone else. Competition breeds the best in the market place monopolies whether they are government or private breeds contempt. All throughout history monopolies were bad for society bottom-line no choices is bad for all societies period. So Canada I am glad to be your escape goat in helping change your protectionism ways in your health care system. It seems you need a bogeyman to do it since your politicians want stand up and state the obvious, which they have stated to me over and over. Of course I will be charging a hefty fee for my services on top of the money you already owe me! So what have we learned boys and girls that people who live in a glass house shouldn’t be throwing stones!
Democrats Weigh Health Mandate as Obama Urges Taxing Wealthy
By Laura Litvan and Ryan Donmoyer
June 7 (Bloomberg) -- President Barack Obama wants Congress to consider taxing the wealthy instead of workers to pay for a health-care overhaul, as House Democrats discuss a plan to require health insurance for most Americans.
The Obama administration stepped up efforts to influence health-care legislation today as advisers David Axelrod and Austan Goolsbee appeared on television talk shows to discuss the issue.
The president is trying to avoid broad-based levies such as a Senate proposal to tax some employer-provided health benefits Axelrod said. Instead he is urging lawmakers to reconsider limiting all tax deductions for Americans in the highest tax brackets.
“He made a very strong case for the proposal that he put on the table, which was to cap deductions for high-income Americans, and he urged them to go back and look at that,” Axelrod said on the CNN’s “State of the Union.” Goolsbee, appearing on “Fox News Sunday,” said Obama is “mindful” about how “ordinary Americans are able to foot the bills” and never proposed taxing employee benefits.
House Democrats are weighing a new proposal in response to Obama’s call for legislation to be enacted by August. An outline of the plan obtained by Bloomberg News would require Americans to have insurance with some exceptions.
It would probably exempt those who can prove they can’t find an affordable policy. There could be a tax penalty for those with adequate financial resources who don’t elect to get insurance, according to the outline.
Group Rates
The outline suggests consumers who have individual health insurance policies that they like could keep them. Still, it says that “by and large” the nation’s market for individually purchased health insurance policies would move to a new federally operated exchange. It would permit both individuals and employees of small firms to buy policies at less expensive group rates.
“States will have the option to run a state exchange but the default will be a national exchange,” according to the outline.
Karen Lightfoot, a spokeswoman for House Energy and Commerce Committee Chairman Henry Waxman, a California Democrat whose panel is working on a proposal, said the document that is circulating is not the official work of the committee.
All House Democrats will be briefed June 9 on the details of a single piece of legislation that three House committees will work on, with the House slated to act by the end of July. The proposal is part of a broader push by Democrats in Congress to complete a revamp of the U.S. health-care system by an early fall timetable set by Obama.
Kennedy’s Approach
In the Senate, health committee chairman Edward Kennedy has an early draft of legislation that also includes a so-called “individual mandate,” and would require all employers to supply health insurance for workers or contribute to the cost of a plan.
Kennedy, a Massachusetts Democrat, would also create a public health plan to compete with private insurers, a priority of Obama’s that is opposed by Republicans, and would bar insurers from limiting coverage.
The effort to overhaul health-care would affect a sector that makes up 17 percent of the U.S. economy. The goal of Democratic supporters is to provide insurance to most of the nation’s 46 million uninsured, and lower the soaring cost of care. A key challenge is the potential impact of legislation on an already rising U.S. budget deficit that may reach $1.8 trillion this year.
Axelrod, speaking on CNN today, said the ultimate goal of legislation is to reduce costs.
“We have to bring down the cost of health care,” he said. “If we do that and make it affordable, people are going to buy it, mandate or no mandate.”
Burdens on Business
Google Inc. Chief Executive Eric Schmidt, speaking on Fox, said reducing costs would also ease burdens on business.
“The only way to really address this is to address the combination of coverage and cost,” Schmidt said. “So anything that the Congress and the president does has to do that. And from my perspective, the sooner the better.”
“You won’t fundamentally solve the problems in business until you solve the problem of spiraling health-care costs, which is driving everybody crazy,” he added.
Lawmakers have a plethora of proposals to raise the hundreds of billions estimated to be needed for an overhaul, including new taxes on soda, beer, and wine, and a partial tax on employer-provided health insurance for the first time. The tax-free nature of employer-provided insurance is the biggest tax expenditure in the federal budget.
Taxing Cap Deductions
Obama’s own proposal would set a 28 percent cap on tax deductions for items such as mortgage interest, investment expenses and charitable gifts for Americans in the two highest tax brackets, which would be 36 percent and 39.6 percent under his proposals. Without the cap, they would be able to deduct 36 cents and 39.6 cents on the dollar for those expenses, respectively.
Obama also proposes new taxes on securities dealers and life insurers, and to raise revenue by prohibiting certain estate-planning techniques.
House Democrats intend, like Kennedy, to include a new government program to provide health-care to a portion of the uninsured who don’t already qualify for Medicare or Medicaid, according to the outline.
While the lawmakers continue working out the details, they intend the new program to operate through the exchange and for both the public program and private insurance policies to have the same basic benefits.
Helping the Poor
House Democrats want to improve the Medicaid health-care system for the poor, including a uniform benefits package and “improved” provider payments. They are weighing whether to add people who are near the poverty level to Medicaid or to provide subsidies to allow them to purchase their own policies.
The plan would place new restrictions on private insurers, including a bar on excluding coverage for those with “pre- existing conditions.”
The legislation would seek to get some cost savings from Medicare and Medicaid, including incentives for doctors to coordinate their care and get bonuses for improving quality, according to the outline.
Check back here for my commentary on trade wars and protectionist attitude in Canadian health care.
