I got a good chuckle out of this story. Here are several links:
I guess one reason I found it amusing is that Rand Paul has been such a vociferous opponent of universal health care and “socialized medicine”, once declaring that universal health care was “slavery” because it would “conscript” doctors and their staff members to provide care. So it’s good to know that he’s traveling to Canada for the express purpose of getting health care from “slaves”.
Another aspect of this that’s downright hilarious is the extreme lengths that his spokespeople are going to in order to spin and downplay it, including lying about it:
[Paul spokeswoman Kelsey Cooper] was furious about media coverage of the surgery, blasting it as “fake news.”
“This is more fake news on a story that has been terribly reported from day one,” she wrote in an email to the Courier-Journal. “This is a private, world renowned hospital separate from any system, and people come from around the world to pay cash for their services.”
Paul has called universal health care “slavery” because it would “conscript” doctors and their staff members to provide care.
She also noted that this was “the opposite of socialized medicine”, apparently completely failing to understand the significance and the fundamental universality of the Canada Health Act under which this hospital is legally required to operate.
It’s also funny because opponents of UHC like to cite incidents of Canadians traveling to the US for specialized medical care, but as I’ve often pointed out, medical travel happens in both directions and in most cases is driven, not by a shortage of timely or quality care in Canada, but by the quest for world-class specialty facilities when such are needed. Being much larger and the base of much leading-edge medical research, the US tends to have more such specialty centers, like the Mayo Clinic and the Sloan-Kettering cancer institute, but otherwise the health care provider systems are pretty much equivalent.
And the statements from Paul’s spokespeople are truly wondrous spin. Yes, the Shouldice Hospital in Toronto where he’s going is indeed a world-class hernia repair center. But no, it is not “separate from any system” any more than any other hospital, all of which operate independently. It’s true that the Shouldice is for-profit, but it is very much part of the UHC system since it’s required by law to accept Canadian health insurance payments as payment in full. It is, IOW, free to Canadian residents. Sure, Rand Paul and “people from around the world … pay cash for their services”, but that’s only because they don’t have Canadian UHC coverage.
Preach it, Rand, old boy, and when you’re back in Kentucky you can tell everyone what it was like to be operated on by oppressed conscripted slaves!
Normally I can overlook a little hypocrisy. I can accept that a conservative opposed to public assistance might accept Social Security or that a liberal opposed to the Second Amendment might own a gun. These people can argue “Yes, I would like to abolish this system. But it currently exists and I have to live in the real world. I would suffer a great burden if I was paying for this system and then not using it while everyone else around me was. So I will use this system while it exists while also working on eliminating it.”
But that’s not the case here. Rand Paul got what he wanted. The United States has a private health care system. And Rand Paul has said that’s the best health care system and it’s what America deserves. But Rand Paul apparently feels that he personally deserves something better than the health care system he helped impose upon everyone else.
I get that people are amused by this, but as the CBC article points out, he’s going to a private hospital separate from the public system in Ontario. So he’s not going to Canada for socialized medicine.
So he paid for the services that he got, but the doctors he used are also required to accept the Canadian UHC payments from Canadians as payment in full. By Paul’s definition that makes them at least partially slaves.
Back in the days of US slavery, there was occasionally a slave who had some unique, marketable skill, say wood-turning or something, where his owner would allow him to accept paid assignments in his own time. He was still a slave but he could make extra money that way. So Paul’s situation, according to his own standards, is on the same moral level as an abolitionist traveling to the south to contract with a slave and pay cash for a beautiful wooden bowl.
I addressed this in the OP, but maybe I wasn’t clear enough. The fundamental error in your claim – and in Paul’s – is that, unlike most countries, Canada does NOT have a two-tier public/private health care system. In fact, this is explicitly forbidden by the Canada Health Act. There is therefore no such thing as any hospital, public or private, that is “separate from the public system” when it comes to universal access.
Quite simply, the Shouldice Hospital is accessible at no charge to all residents of Ontario and indeed to all residents of Canada. The fact that hypocritical lying dipshits like Rand Paul have to pay cash upfront for access is of absolutely no relevance to the rest of us. Nor, indeed, is there any practical distinction between a “private” or for-profit hospital and a non-profit one like most of them are. Any medical institution that provides medically necessary services has to serve ALL Canadians, and has to provide those services free at the point of delivery, accepting public insurance as full payment. This is a very important and basic fact about health care in Canada.
Wait - I thought the rest of the world was a barren wasteland of medical knowledge, because they have no profit motive? How can a Canadian facility – to say nothing of a solitary doctor – have any appreciable skills and not be instantly drawn to the extreme riches to be had in the U.S.?
I’m beginning to think our health care system in the U.S. might NOT be the best. America First!!! Build a wall around our clincs!!
And some people might wonder, so what? Nothing in this episode means that Paul lied or was a hypocrite. Clearly you’re gleefully hoping to reach such conclusions, but it isn’t justified.
He believes, for better or for worse, that people should be allowed to shop for private health care and insurance. In either the USA or Canada, that’s not fully possible, as the government strictly regulates and provides a part of the funding for all hospitals. If a person believes that a certain service should be available from a fully private source, but the government has removed that option, then getting the service from a partially public source is not lying or hypocrisy.
Hypocrisy is when someone demands that other people do something, but personally chooses not to do that same thing. To give a hypothetical example, if a politician were to demand that the country as a whole must cut energy usage, but himself had a super-luxurious house that used ten times more energy than average, that would be hypocrisy.
I think the hypocrisy charge comes into play due to the “slavery” accusation (that doctors under UHC are virtually slaves). It seems that either he doesn’t really believe that, or that he has no problem having financial transactions with people who are otherwise in slave conditions.
Rand Paul is himself a doctor (an ophthalmologist) and he must have known he would get criticism for this move. So why did he do it? As I understand it, hernias are fairly straightforward to correct. So why didn’t he just go to someplace in the US, perhaps the hospital associated with the state university in Kentucky?
Hernias are so common that you can usually get powerful statistics showing how good various hospitals/surgeons are, complication rates etc. It may be that his insurance does not give him in-network access to anywhere with good numbers.
The being so, he’s probably encountering the fact that paying for anything yourself in the U.S. system is virtually impossible. Nobody canquote you a price even for a routine commodity like a hernia operation. They usually only have the ridiculously inflated fictitious list prices that are 5-10X the contracted rates that they charge insurance companies; and it won’t be an all-in price, you’ll have to figure out the dozens of different things you’ll be billed for. It’s completely dysfunctional - the idea that the U.S. is the only healthcare system where the free market operates is a ridiculous fiction. For an individual going out-of-network, the market in the U.S. does not operate at all.
So, if he wants to just pay for the operation himself, it may well be the case that going to Canada is the only way he can find a hospital/surgeon with good statistics that will actually quote him a sensible up-front price for the service.
Additionally, the Canada Health Act does not ban a separate private system. What the Canada Health Act bans is any private healthcare provider participating in both the public and private markets for services covered by the public system. So, a private MRI clinic may not accept both OHIP patients and private patients, for example. On the other hand, a surgeon may perform surgeries under OHIP, and also provide private cosmetic surgeries not covered by OHIP.
In practice, the private market for many healthcare services is too small, and so there are no private providers. But they aren’t out-and-out banned.
I have been to the Shouldice Hospital. It is… nice. When I was there, it resembled an old mansion in parklike grounds. It predates OHIP, the Ontario Health Insurance Plan, but going there was as hassle-free as going to any other hospital in Ontario: just show your (OHIP) Health Card.
You’ve covered a number of bases here but I don’t think any of them is relevant to the subject of Rand Paul’s hypocrisy or the incorrectness of his claims.
I’m quite familiar with the Shouldice and its history and its grandfathered status under OHIP. This does not change the fact that the Shouldice is accessible at no charge to all residents of Ontario and the rest of Canada, and thus is every bit as much a part of our UHC system as any other hospital. This is distinctly different from private hospitals in most countries, such as in Germany or the UK, which are accessible only to those paying cash and/or via private insurance. If that were the case, Paul would have a point in claiming that the Shouldice is some kind of shining icon of private enterprise that is not part of the UHC system. But this is manifestly not the case. They not only have to take OHIP patients, they have to accept OHIP payments directly and as payment in full. Conversely, any hospital in Ontario will take cash payments or private insurance from foreign visitors, and those charges are usually much higher than OHIP payments. So really, the only difference between Shouldice and any other hospital in that respect is that the Shouldice makes money for its owners. For that matter, so does any ordinary small lab or clinic that does blood tests or diagnostic imaging – they are generally for-profit, but OHIP pays for their services. Nothing unusual in that.
And I don’t believe your second paragraph is correct. The key consideration of what is governed by the Canada Health Act is “medically necessary procedures”, not whether an institution is public or private or makes a profit or not. There are gray areas that have sometimes caused controversy and differences of interpretation, like boutique clinics (sometimes called things like “executive health centres”), but these have legal legitimacy only in respect to extra services or amenities not covered by OHIP. They are technically illegal as soon as they cross over to providing medically necessary services that would normally be OHIP insured. Remember that Canada has explicitly chosen to reject a two-tier public/private insurance system for medically necessary procedures, and this is enshrined in two of the five foundational principles of the CHA, the principle of comprehensiveness – all medically necessary procedures normally performed by medical providers must be covered, and the principle of universality – every citizen and legal resident must be covered. You’re quite correct about cosmetic surgery, where it’s very common for dermatologists and plastic surgeons to perform both insured medical procedures and cosmetic procedures, but the latter is not considered medically necessary, so they can require cash and charge whatever they want.
Another point is that the question of whether something is “banned” or not has to be considered in light of the interplay of federal and provincial laws. Is “extra-billing” banned (the practice of charging an additional fee above what OHIP pays in Ontario)? Federally, it would violate a provision of the CHA, but a province could go ahead and do it anyway, just like they could reject the CHA altogether, but those decisions have consequences in terms of loss of the corresponding health transfer payments. Thus, extra-billing is disallowed by Ontario provincial law, because if it was allowed, Ontario would lose an imputed corresponding portion of federal health transfer payments. Again, being part of the same system, the Shouldice Hospital cannot require any extra payments from OHIP patients, as much as I’m sure they would dearly love to. They are free to gouge foreigners like Rand Paul as much as they can, and I’m sure they do.
A final point I’ll make in passing is that there are many good reasons that Ontario didn’t want to see new private for-profit hospitals and only allowed those that were grandfathered in. Among those reasons is the fact that private hospitals can be selective and exclusionary in who they admit for treatment, looking to maximize patient turnover and profits while building a success record they can grow their business around. This is practically the opposite of being dedicated to serving the best interests of the community.
And this can be seen at the Shouldice. Their reputation for excellence is partly based on having developed innovative solutions for hernia repair and, as the American surgeon Atul Gawande writes in one of his books about achieving high performance in medicine, by becoming highly specialized in just this one specific area. But there’s a darker and more insidious side. They also do it by accepting only low-risk patients whose conditions exactly fit the techniques they’ve developed. A normal hospital, especially a research and teaching hospital, would strive to extend their innovations to help as many people as possible, especially those with risky or complex conditions. The Shouldice instead looks to admit healthy patients with routine conditions, and churns them through rapidly, assembly-line style, with a virtually guaranteed success rate that they can boast about. Those with an inguinal hernia, for example, who have even a moderate amount of belly fat will be asked to lose a specified amount of weight before the surgery, and if the required condition is not met, the surgery will be canceled and the patient, in effect, cast into the outer darkness. Kind of like some US hospitals refusing to accept Medicare or Medicaid, or poor patients, or very sick patients, or engaging in patient dumping.
Here’s another observation about how misinformed and/or dishonest Rand Paul is on this matter. So he’s desperately trying to backpedal from the embarrassment of a hardcore libertarian and relentless critic of “socialized medicine” like himself having to come to the land of socialized medicine for his hernia surgery. One recalls that he claimed that the Shouldice Hospital is a private hospital that is not part of Canada’s universal health care, that it is “separate from any system” and “the opposite of socialized medicine”.
I pointed out that this is false because all Canadian residents have full access to the Shouldice and all of its services, free of charge, as a fundamental part of how UHC operates in Ontario and in Canada. But there’s another element to this that make Paul’s pronouncements even more ridiculous, and even further exposed as the babbling of an uninformed buffoon. Not only is the Shouldice a de facto part of the public UHC system, but it has formally for many years operated under the authority of the Toronto Central Local Health Integration Network (LHIN). The LHINs are a network of regional agencies of the Ontario Ministry of Health intended to coordinate, fund, and improve the efficiency of health services delivered in the province. So, far from being “separate from any system”, the Shouldice is party to a Hospital Service Accountability Agreement with the Central LHIN (i.e.- with the Government of Ontario), which includes service level commitments and provides them with a nominal level of base funding from the provincial government above and beyond the fees they collect from OHIP public insurance – although that latter point is really what makes them part of the public health care system.
“Not part of any system”, eh, Rand? I think the moral of the story here is that anything that a Republican ever says about how health care works in Canada can be safely assumed to be a lie.
I’ve been hearing the US has the best health care in the world for over 20 years. No one could get away with lying for that long, could they? :dubious:
