A Usenet persona calling itself BCITORGB wrote:

Scotty, sounding positively obtuse by now:
===================
But, each hospital is required to abide by the prioritization
guidelines set
by the government, are they not?
=================

FOR THE LAST F#CKING TIME: NO! NO! NO!

Sheeesch!

Um, you're wrong.

You're trying to tell us that there are no national standards for treatment
and care in Canada, and that the federal government just accepts whatever
some doctor decides is the proper priority? Sorry, I don't believe it.

Here's some proof showing why I don't believe it, and neither should anybody
else:

(I've posted the extracts as quotes to visually separate them from my
comments. They are extracts, not the complete documents, but the source of
each is provided for those who want to look further into the issue.)

Here we go!

From the Canada Health Act website:

The Canada Health Act defines for the provinces and territories the criteria
and conditions that they must satisfy in order to qualify for their full share
of the federal transfers under the Canada Health Transfer (CHT) cash
contribution."

The five criteria of the Canada Health Act a

1. public administration: the administration of the health care
insurance plan of a province or territory must be carried out on a non-profit
basis by a public authority;

The health care insurance plan is a government operation that MUST be
carried out by the government. Private insurance is not allowed for
"medically necessary" care. As we will see, it's a federally-imposed system
that the provinces are *required* to participate in. They CANNOT "opt out"
of the system, because the Act specifies that ALL Canadians are ENTITLED to
government-funded health care, no matter where they live, and the provinces
are obligated to provide it to them.

2. comprehensiveness: all medically necessary services provided by
hospitals and doctors must be insured;

And IF a "medically necessary service" is insured, then access to that
service is directly controlled by the government. It is rationed and
priority lists are created and people are not allowed to "jump the queue" to
get better or faster care.

3. universality: all insured persons in the province or territory must
be entitled to public health insurance coverage on uniform terms and
conditions;

Everybody's covered...except a few excluded categories like the RCMP, the
military and, interestingly, prison convicts. The latter category is
interesting because of all Canadians, THEY are the ONLY civilians who CAN
seek better, faster private treatment at their own expense. Of course,
getting out of prison to obtain that care is another matter entirely...

4. portability: coverage for insured services must be maintained when
an insured person moves or travels within Canada or travels outside the
country; and

Good thing the US doesn't recognize extraterritoriality, otherwise Canada
would be demanding that US hospitals provide Canadian tourists care under
Canadian rules. As it is, it's ambiguous how the Canada Health system pays
for care in the US.

5. accessibility: reasonable access by insured persons to medically
necessary hospital and physician services must be unimpeded by financial or
other barriers.

Number 5 is a trap, as we will see below, that pretty much prohibits private
enterprise from getting around the system, even by opting out entirely. It's
not just that people cannot be "impeded" by financial barriers, they cannot
get *better service* because they are rich, either.

Source: http://www.hc-sc.gc.ca/medicare/home.htm

Epp Letter. (NOTE: This is not the full text, I've extracted pertinent
quotes.)

[The following is the text of the letter sent on June 18, 1985 to all
provincial and territorial Ministers of Health by the Honourable Jake Epp,
Federal Minister of Health and Welfare. (Note: Minister Epp sent the French
equivalent of this letter to Quebec on July 15, 1985.)]

Public Administration

This criterion is generally accepted. The intent is that the provincial health
care insurance plans be administered by a public authority, accountable to the
provincial government for decision-making on benefit levels and services, and
whose records and accounts are publicly audited.

Government-operated health care, no doubt about it at all.

Comprehensiveness

Within these broad parameters, provinces, along with medical professionals,
have the prerogative and responsibility for interpreting what physician
services are medically necessary. As well, provinces determine which hospitals
and hospital services are required to provide acute, rehabilitative or chronic
care.

Note who has *primary* authority to "interpret" what services are "medically
necessary." The Provinces. Not the Doctor, the Provinces. And you can bet
your ass that in a dispute between government bureaucrats and doctors, the
bureaucrats will always win.

Government control without any doubt.

Reasonable Accessibility

I want to emphasize my intention to respect provincial prerogatives regarding
the organization, licensing, supply, distribution of health manpower, as well
as the resource allocation and priorities for health services.

Provinces have pretty much plenary authority in the areas listed above, BUT,
if they don't provide it to the satisfaction of the federal government, the
federal government will WITHOLD federal payments. And, there is a provision
for additional PENALTIES against the province too.

That's the leash of the federal government. "Do it our way or you don't get
paid." Moreover, as we will see later, opting out is not an option for the
provinces, because the Act itself MANDATES universal health insurance and
imposes the mandate on the provinces, subject to enforcement by the federal
government.


Regulations

As you know, the Act provides that there must be consultation and agreement of
each and every province with respect to such regulations.

Note the "every province" part. This makes the national plan mandatory. The
feds have to "consult and agree" with the provinces, but push comes to
shove, the feds can shove the plan down the province's throat by withholding
required funds and imposing penalties. I imagine even more force would be
used if a recalcitrant province still refused.

...[T]he Act provides for regulations concerning hospital services exclusions
and regulations defining extended health care services.

Thus, the FEDERAL government (in the person of the Governor in Council) can
define what is covered and what is not and who gets it.

Source: http://www.hc-sc.gc.ca/medicare/Epp.htm

Marleau Letter

[The following is the text of the letter sent on January 6, 1995 to all
provincial and territorial Ministers of Health by the Federal Minister of
Health, the Honourable Diane Marleau.]

For reasons I will set out below, I am convinced that the growth of a second
tier of health care facilities providing medically necessary services that
operate, totally or in large part, outside the publicly funded and publicly
administered system, presents a serious threat to Canada's health care system.

This is the primary policy statement that makes private enterprise pretty
much illegal and "queue jumping" impossible, even when private enterprise
chooses to provide the service outside the system entirely by billing
willing patients directly. In Canada, there IS NO "outside the system."
Participation is MANDATORY, and that is enforced by the provinces under the
thumb of the federal government which will withhold money if unauthorized
"extra payments" are made. That's what happened in BC, and BC then wrote a
law restricting private clinics and how much they could charge, as you will
see below.

Private clinics raise several concerns for the federal government, concerns
which provinces share. These relate to:

€ weakened public support for the tax funded and publicly administered
system;

Governments don't like competition because it makes them look bad, because
they are universally wasteful and inefficient. This statement absolutely
proves this. Even the possibility of free-market competition scares the ****
out of the bureaucrats. They know if they allow private competition, people
will bail out of the public system by the millions, and then they will
demand that the taxes they pay for the wasteful, inefficient, bureaucratic
nightmare of a health care system they are being forced to pay for be
returned to them. The bureaucrats in charge would like to keep their jobs,
so they make private competition essentially illegal. It's really pretty
typical for government-controlled monopolies. We had lots of them down here,
but we got rid of most of them because they didn't work well, and private
free-market enterprise worked quite well.

€ the diminished ability of governments to control costs once they have
shifted from the public to the private sector;

The government gets to set the price, and thus the level of expertise and
care a person receives, no matter what. So, if you want a *really* good
heart surgeon, you can't get one that isn't willing to work for what the
PROVINCE has set as "reasonable compensation" for the surgeon's work.

That's why the best Canadian (and British, as it happens) surgeons come to
the US.

€ the possibility, supported by the experience of other jurisdictions,
that private facilities will concentrate on easy procedures, leaving public
facilities to handle more complicated, costly cases; and

Once again, free-market competition is deliberately quashed BECAUSE it's
more efficient and economical. If the government were really interested in
people, they would be happy to take on the more complicated, costly cases
that private enterprise doesn't want to deal with. So long as they can
collect taxes to cover the costs, which they can, all this does is benefit
the taxpayers, who DON'T have to pay for the "easy stuff." This concern is
particularly illogical and typical of the bureaucratic mindset.

€ the ability of private facilities to offer financial incentives to
health care providers that could draw them away from the public system -
resources may also be devoted to features which attract consumers, without in
any way contributing to the quality of care.

The federal government knows what's best for you, and doesn't want sick
people to be privy to information that might be of use to them in getting
the very best care. God forbid that a hospital might advertise more
comfortable beds, semi-private rooms and free TV...what a disaster for
socialistic egalitarianism that would be!

Even worse, the government cannot allow private enterprise to woo hospitals
away from the government teat, because if that happens, there won't be any
government-funded hospitals at all. Of course, they have to stick some
asinine excuse like "without in any way contribution to the quality of care"
into the paragraph to scare people and expound on their socialist ideology.
Who says a private room, private full-time nurses, good food and cable TV
don't contribute to the quality of care and enhance healing? Socialist
swine, that's who.

The only way to deal effectively with these concerns is to regulate the
operation of private clinics.

And there it is, the death-blow to quality health care in Canada in favor of
egalitarian, socialistic, "share the pain" and "die-if-you-get-too-sick"
health care.

Source: http://www.hc-sc.gc.ca/medicare/Marleau.htm

From the Act itself:

Purpose of this Act

4. The purpose of this Act is to establish criteria and conditions in respect
of insured health services and extended health care services provided under
provincial law that must be met before a full cash contribution may be made.

This is the Big Stick. If provinces don't comply, both by kowtowing to the
feds, and by quashing private enterprise to prop up the government monopoly
and control of health care, the feds not only don't pay, they can actually
impose financial SANCTIONS on the provincial governments.

The Governor in Council may issue regulations:

(b) prescribing the services excluded from hospital services;

There's one of those "government bureaucrats" I was referring to.

I imagine he/she has a name, but I couldn't find it right off the bat, not
that it really matters which bureaucrat occupies the seat.

From the Canada Health Act website:

With respect to private payment for insured health services, Health Canada is
concerned that any trend toward privatization that results in a two-tiered
system, where individuals can pay for quicker access to medically necessary
hospital or physician services represents a threat to the fundamental
principles of the CHA, and therefore to the overall health care system. Access
to insured services must be based on need, not the ability to pay.

This cuts both ways. While the implication is that those who cannot pay
ought to have access to adequate "medically necessary" care, it ALSO says
that those who CAN pay CANNOT be allowed to get better health care than
those who have less money. That's the "queue jumping" referred to.

The threat of private enterprise is so scary that the provinces have been
bullied into regulating private clinics so that they can't even opt out of
the system and provide service strictly to those who are willing and able to
pay.

Some jurisdictions have recently questioned the definition of the term
³medically necessary² in the Act. As noted by former federal Health Minister
Jake Epp in his 1985 interpretation letter to all provincial and territorial
health ministers, provinces and territories, along with their medical
professionals, have the prerogative and responsibility for interpreting what
physician services are medically necessary.

Again we see that it is the government bureaucrats who are controlling what
care people can get. Thus, the government SETS THE PRIORITY LIST by
dictating what is covered and what is not, and who may provide the service,
and at what price.

In July 2003, former federal health minister Anne McLellan wrote to the four
provincial health ministers concerned to communicate her objection to the
queue jumping that results in provinces that allow private clinics to sell
quicker access to medically necessary diagnostic services.

That's why you can't get an MRI, even from a private provider, without
waiting your turn. That's why you can't get a hospital room or surgeon
without waiting your turn, even if you can afford the very best private
care. That's why rich Canadians come to the US for medical care.

Patient charges by specialty referral centres and for self-referrals to
physician specialists

Since 2002, two specialist referral clinics in Vancouver have been offering
expedited consultations with physician specialists for a fee for individuals
who choose to bypass their family physicians to seek specialized treatment.

Charges to insured persons for insured services contravene the CHA.

Please read this again, it's important!

Charges to insured persons for insured services contravene the CHA.

And that means ANY CHARGES, by ANY medical practitioner, ANYWHERE in Canada,
even if the patient himself wants to pay, can pay and indeed DOES pay for
the service. It's ILLEGAL to CHARGE an "insured person," which means EVERY
CITIZEN OF CANADA (with a few exceptions) for an "insured service," which
means EVERY MEDICALLY NECESSARY SERVICE that Canada has so defined,
irrespective of where the service is performed, by whom, or who pays for it.

If you're Canadian, you're insured, and you CANNOT pay for private care for
anything the government already provides under the Act, which is every kind
of "medically necessary" treatment.

This
practice is also a concern from a CHA perspective because it encourages queue
jumping for insured health services.

That's why the girl with the bad knee has to wait three years for treatment,
because she's forbidden from seeking out a private clinic and paying more
for faster service. That's undeniably government priority setting and list
making.

During a meeting between British Columbia
Ministry of Health Services and Health Canada officials in 2003, the province
indicated that Medical Services Plan (MSP) policy allows specialists to bill
self-referred patients for the difference between the fee paid by MSP and the
fee charged to self- referred patients. Health Canada officials informed the
province that this practice constitutes extra-billing under the CHA and
further bilateral consultations are required on this issue.

See the extract of the BC code below where they made private clinics
financially infeasible by limiting the amount they can charge a patient to
the amount the government would pay under the insurance plan. The government
has ruled that even the act of charging a willing and able patient more for
quicker, better service is illegal, even though adequate service is
*required* for all persons, regardless of their ability to pay. This simply
penalizes those who can afford better medical care while not providing any
better service to those getting care on the cuff.

Swinish, socialistic "we don't give a damn about the individual" dogma.

Patient charges for bone density scans

In April 2002, the press reported that a Saskatchewan physician was providing
preferred access to bone density scans to patients in return for a donation of
$95 to a research foundation incorporated by the physician in 1995. Charges to
insured persons for insured services contravene the CHA. This practice is a
concern from a CHA perspective because it encourages queue-jumping for insured
health services

Which means ALL "medically necessary" services. If it's "medically
necessary," it's "insured," and if it's insured, it comes under the Health
Act, and if it comes under the Health Act, you, the patient, CANNOT opt out,
CANNOT seek better, faster private service at a clinic by paying more,
CANNOT pay more for a better surgeon, even if you can afford it, and CANNOT
get the very best care available...in Canada.

You can, however, come to the US, where your dollars will get you the very
best treatment you can afford as quickly as you can afford it.

The Canada Health Act, which came into force April 1, 1984, reaffirmed the
national commitment to the original principles of the Canadian health care
system, as embodied in the previous legislation, the Medical Care Act and the
Hospital Insurance and Diagnostic Services Act. By putting into place
mandatory dollar-for-dollar penalties for extra-billing and user charges, the
federal government took steps to eliminate the proliferation of direct charges
for hospital and physician services, judged to be restricting the access of
many Canadians to health care services due to financial considerations.

This is mostly bull****. It didn't just eliminate over-billing, which would
have been fine, what it actually did was utterly eliminate the ability of a
patient to pay for BETTER care if they can afford it, while still providing
ADEQUATE care for everyone.


As a result of a dispute between the British Columbia Medical Association and
the British Columbia government over compensation, several doctors opted out
of the provincial health insurance plan and began billing their patients
directly. Some of these doctors billed their patients at a rate greater than
the amount the patients could recover from the provincial health insurance
plan. This higher amount constituted extra-billing under the CHA. Including
deduction adjustments for prior years, dating back to fiscal year 1992-1993,
deductions began in May 1994 until extra-billing by physicians was banned when
changes to British Columbia¹s Medicare Protection Act came into effect in
September 1995.

The federal government withheld money from the province because private
physicians had the temerity to opt out of the system and serve people who
could afford to pay for better care until the province passed legislation
restricting the amount ANY physician could charge to that amount the
government would pay.

YOU CANNOT GET BETTER, FASTER MEDICAL CARE IN CANADA FOR "MEDICALLY
NECESSARY" TREATMENTS NO MATTER WHAT, NO MATTER HOW MUCH MONEY YOU HAVE, NO
MATTER WHETHER OR NOT A PRIVATE PHYSICIAN IS WILLING TO GO THE EXTRA MILE
FOR YOU!

That's the fact, Jack.

Because of those restrictions, doctors have become de facto government
employees. Their compensation is strictly limited to what the government
feels is "reasonable," and they can't set up a private practice to make
more, not even on the side, from willing patients. So, as a result, there is
little impetus for highly qualified doctors to stay in practice in Canada,
and there's less reason for people to spend a decade of their lives in med
school just so they can work for government wages.

Source: http://www.hc-sc.gc.ca/medicare/CHAadmin.htm

From: British Columbia Medicare Protection Act

18 (1) If a medical practitioner who is not enrolled renders a service to a
beneficiary and the service would be a benefit if rendered by an enrolled
medical practitioner, a person must not charge the beneficiary for, or in
relation to, the service an amount that, in total, is greater than

Since every Canadian is a "beneficiary" of a nationalized health care plan,
the only people who can get better care by paying for it are tourists, the
RCMP and the military...oh, and prison convicts.


(a) the amount that would be payable under this Act, by the commission, for
the service if rendered by an enrolled medical practitioner, or

(b) if a payment schedule or regulation permits or requires an additional
charge by an enrolled medical practitioner, the total of the amount referred
to in paragraph (a) and the additional charge.

(2) Subsection (1) applies only to a service rendered in

(a) a hospital as defined in section 1 of the Hospital Act, or

(b) a community care facility as defined in section 1 of the Community Care
Facility Act.

(3) If a medical practitioner described in section*17*(2)*(c) renders a
benefit to a beneficiary, a person must not charge the beneficiary for, or in
relation to, the service an amount that, in total, is greater than

(a) the amount that would be payable under this Act, by the commission, for
the service, or

(b) if a payment schedule or regulation permits or requires an additional
charge, the total of the amount referred to in paragraph (a) and the
additional charge.

Resistance is futile, you will be assimilated.

http://www.qp.gov.bc.ca/statreg/stat....htm#section18

There it is, folks, the proof positive that Canada centrally controls and
rations health care. It's even worse than I thought, too. Because the
bureaucrats don't like competition, they have crushed private enterprise
entirely in their socialistic, egalitarian zeal.

Boy, am I glad I live in the US, where I can get the very best medical care
I can afford.

--
Regards,
Scott Weiser

"I love the Internet, I no longer have to depend on
friends, family and co-workers, I can annoy people WORLDWIDE!" TM

© 2005 Scott Weiser