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Soaring Costs Force Canada to Reassess Health Model

Von: Leroy N. Soetoro (leroysoetoro@usurper.org) [Profil]
Datum: 06.06.2010 20:37
Message-ID: <Xns9D8F7651CAD2C6F089P2473@>
Newsgroup: alt.gossip.celebritiesfree.impeach.obama alt.politics.bush alt.health alt.politics.obama

Pressured by an aging population and the need to rein in budget
deficits, Canada's provinces are taking tough measures to curb health
care costs, a trend that could erode the principles of the popular
state-funded system.

Ontario, Canada's most populous province, kicked off a fierce battle
with drug companies and pharmacies when it said earlier this year it
would halve generic drug prices and eliminate "incentive fees" to
generic drug manufacturers.

British Columbia is replacing block grants to hospitals with
fee-for-procedure payments and Quebec has a new flat health tax and a
proposal for payments on each medical visit -- an idea that critics say
is an illegal user fee.

And a few provinces are also experimenting with private funding for
procedures such as hip, knee and cataract surgery. It's likely just a
start as the provinces, responsible for delivering healthcare, cope with
the demands of a retiring baby-boom generation.

Official figures show that senior citizens will make up 25 percent of
the population by 2036.

"There's got to be some change to the status quo whether it happens in
three years or 10 years," said Derek Burleton, senior economist at
Toronto-Dominion Bank.

"We can't continually see health spending growing above and beyond the
growth rate in the economy because, at some point, it means crowding out
of all the other government services. At some stage we're going to hit a
breaking point," Burleton said.

Mirror Image Debate?

In some ways the Canadian debate is the mirror image of discussions
going on in the United States.

Canada, fretting over budget strains, wants to prune its system, while
the United States, worrying about an army of uninsured, aims to create a
state-backed safety net.

Healthcare in Canada is delivered through a publicly funded system,
which covers all "medically necessary" hospital and physician care and
curbs the role of private medicine.

It ate up about 40 percent of provincial budgets, or some C$183 billion
($174 billion) last year. Spending has been rising 6 percent a year
under a deal that added C$41.3 billion of federal funding over 10 years.

But that deal ends in 2013, and the federal government is unlikely to be
as generous in future, especially for one-off projects.

"As Ottawa looks to repair its budget balance ... one could see these
one-time allocations to specific health projects might be curtailed,"
said Mary Webb, senior economist at Scotia Capital.

Brian Golden, a professor at University of Toronto's Rotman School of
Business, said provinces are weighing new sources of funding, including
"means-testing" and moving toward evidence-based and pay-for-performance

"Why are we paying more or the same for cataract surgery when it costs
substantially less today than it did 10 years ago? There's going to be a
finer look at what we're paying for and, more importantly, what we're
getting for it," he said.

Other problems include trying to control independently set salaries for
top hospital executives and doctors and rein in spiraling costs for new
medical technologies and drugs.

Ontario says healthcare could eat up 70 percent of its budget in 12
years, if all these costs are left unchecked.

"Our objective is to preserve the quality healthcare system we have and
indeed to enhance it.

But there are difficult decisions ahead and we will continue to make
them," Ontario Finance Minister Dwight Duncan told Reuters.

The province has introduced legislation that ties hospital chief
executive pay with the quality of patient care and says it wants to put
more physicians on salary to save money.

In a report released last week, TD Bank said Ontario should consider
other proposals to help cut costs, including scaling back drug coverage
for affluent seniors and paying doctors according to quality and
efficiency of care.

Winners and Losers

The losers could be drug companies and pharmacies, both of which are
getting increasingly nervous.

"Many of the advances in healthcare and life expectancy are due to the
pharmaceutical industry so we should never demonize them," said U of T's

"We need to ensure that they maintain a profitable business but our
ability to make it very very profitable is constrained right now."
Scotia Capital's Webb said one cost-saving idea may be to make patients
aware of how much it costs each time they visit a healthcare

"(The public) will use the services more wisely if they know how much
it's costing," she said.

"If it's absolutely free with no information on the cost and the
information of an alternative that would be have been more practical,
then how can we expect the public to wisely use the service?" But change
may come slowly.

Universal healthcare is central to Canada's national identity, and
decisions are made as much on politics as economics.

"It's an area that Canadians don't want to see touched," said TD's

"Essentially it boils down the wishes of the population. But I think,
from an economist's standpoint, we point to the fact that sometimes
Canadians in the short term may not realize the cost."

Nancy Pelosi, Democrat criminal, accessory before and after the fact, to
House Ways and Means Committee Chairman Charles B. Rangel of New York's
million dollar tax evasion.  On February 25, 2010, the House ethics
committee has concluded that Ways and Means Committee Chairman Charles B.
Rangel knowingly accepted Caribbean trips in violation of House rules that
forbid hidden financing by corporations.  Democrat criminal Nancy Pelosi
is deliberately ignoring the million dollar tax evasion of Democrat
Charles Rangel.

House Speaker Nancy Pelosi had to be forced to remove Charles B. Rangel
from the House Ways and Means Committee.

Felony President.

Obama violated the law by trying to buy Joe Sestak off with a political
appointment in exchange for not pursuing an election bid to replace Arlen
Specter.  Obama violated the law by trying to buy former Colorado House
Speaker Andrew Romanoff off last fall to see if he'd be interested in an
administration job -- instead of running against Sen. Michael Bennet.

18 USC, Sec. 600. Promise of employment or other benefit for political

Whoever, directly or indirectly, promises any employment, position,
compensation, contract, appointment, or other benefit, provided for or
made possible in whole or in part by any Act of Congress, or any special
consideration in obtaining any such benefit, to any person as
consideration, favor, or reward for any political activity or for the
support of or opposition to any candidate or any political party in
connection with any general or special election to any political office,
or in connection with any primary election or political convention or
caucus held to select candidates for any political office, shall be fined
under this title or imprisoned not more than one year, or both.

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