October 14, 2009

When It Comes To Private Health Care In Canada Don't Ask Don't Tell Is The Policy

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!

October 08, 2009

In Canada, a move toward a private healthcare option


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

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."

"The Canadian health care system is a textbook case of government failure in medical insurance and medical services.

Sep 21, 2009 06:30 ET

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

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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.