Senator Rand Paul comes to Canada for Surgery.

[Canadian Visitor]

Senator Rand Paul is coming to Canada for his surgery.

This amuses me no end.

Its slavery he said! Its socialism! Let me have it! LOL

https://www.usatoday.com/story/news/...QBwldppcULdJH4

[oladub]

Senator Rand Paul is coming to Canada for his surgery.

This amuses me no end.

Its slavery he said! Its socialism! Let me have it! LOL

https://www.usatoday.com/story/news/...QBwldppcULdJH4

Your article said that Paul went to a "private hospital" said to be a leader in meshless hernia repairs. He is paying his own bill. How is that "socialist"?

[Canadian Visitor]

Your article said that Paul went to a "private hospital" said to be a leader in meshless hernia repairs. He is paying his own bill. How is that "socialist"?

Every hospital in Canada is private.

The vast majority are non-profit, which this clinic, Shouldice is nominally not.

I say nominally, because they are a part of the public care system and get the exact same payment for their work as any other provider, from the government.

In Mr. Paul's case, he is not a resident, which means he has to pay, as would be the case for any other non-resident.

In other words Shouldice is part and parcel of the system Mr. Paul claims to despise.

Except that one can choose to go there or not [[as can any Ontario resident), or choose a different provider [[as can any Ontario resident), and that provider is autonomous except for the fact it must accept public insurance, it may not allow an Ontario resident to queue-jump, and its facilities and doctors must be accredited by government or its designate.

Its not slavery, its not socialism, its universal, public, insurance coverage.

Mr. Paul is both a liar and a hypocrite in showing that the system he denigrates is the world leader in care quality in this particular area.

[oladub]

Every hospital in Canada is private.

The vast majority are non-profit, which this clinic, Shouldice is nominally not.

I say nominally, because they are a part of the public care system and get the exact same payment for their work as any other provider, from the government.

In Mr. Paul's case, he is not a resident, which means he has to pay, as would be the case for any other non-resident.

In other words Shouldice is part and parcel of the system Mr. Paul claims to despise.

Except that one can choose to go there or not [[as can any Ontario resident), or choose a different provider [[as can any Ontario resident), and that provider is autonomous except for the fact it must accept public insurance, it may not allow an Ontario resident to queue-jump, and its facilities and doctors must be accredited by government or its designate.

Its not slavery, its not socialism, its universal, public, insurance coverage.

Mr. Paul is both a liar and a hypocrite in showing that the system he denigrates is the world leader in care quality in this particular area.

I did not know that every hospital in Canada was private. However, I did not suggest that Canadian health care was in any way "slavery" or "socialism" or otherwise denigrate it. Rand Paul, as you point out, is paying for his own surgery rather than helping himself to whatever you claim he is denigrating. He is purchasing a $4-8,000 operation much like he might buy a $30,000 car from another country.

I don't expect you to know or care about the Constitution but states can adopt a Canadian single payer plan. Instituting a Canadian type single payer plan would not be either something states are forbidden from doing or a power delegated to the federal government. I wonder why none of the 14 states with Democratic control of the governorship and both houses haven't done so. I suspect, to some extent, its because its a carrot that can be held out in front of voters. Only California and Vermont have tried. California's plan would have raised state income taxes 280% because all the lawyers, bureaucrats and corporate profit were kept in it. Vermont's affordable Canadian type single payer plan was only acceptable to [[un)ACA bureaucrats if it kept lawyers, bureaucrats, and corporate profits found in the [[un)ACA in Vermont's proposed single payer plan. I'm open to a state plan. The federal government could amend the Constitution to delegate the power to Congress to have a national single payer plan. Of course, Democrats would argue in favor of an imaginary "living" Constitution which can mean whatever they want it to mean.

[Canadian Visitor]

I did not know that every hospital in Canada was private. However, I did not suggest that Canadian health care was in any way "slavery" or "socialism" or otherwise denigrate it. Rand Paul, as you point out, is paying for his own surgery rather than helping himself to whatever you claim he is denigrating. He is purchasing a $4-8,000 operation much like he might buy a $30,000 car from another country.

I don't expect you to know or care about the Constitution but states can adopt a Canadian single payer plan. Instituting a Canadian type single payer plan would not be either something states are forbidden from doing or a power delegated to the federal government. I wonder why none of the 14 states with Democratic control of the governorship and both houses haven't done so. I suspect, to some extent, its because its a carrot that can be held out in front of voters. Only California and Vermont have tried. California's plan would have raised state income taxes 280% because all the lawyers, bureaucrats and corporate profit were kept in it. Vermont's affordable Canadian type single payer plan was only acceptable to [[un)ACA bureaucrats if it kept lawyers, bureaucrats, and corporate profits found in the [[un)ACA in Vermont's proposed single payer plan. I'm open to a state plan. The federal government could amend the Constitution to delegate the power to Congress to have a national single payer plan. Of course, Democrats would argue in favor of an imaginary "living" Constitution which can mean whatever they want it to mean.

I'm not contending that Americans must have this model of insurance or any other.

My distaste is hypocrisy by Mr. Rand and lies by same.

He has incorrectly described the system.

You can like/dislike, take it/leave it, propose a variation on it, all or none of the above.

Just don't lie about it. Also don't suggest [[as Mr. Rand has) that it produces a lower standard of care than the US system as is; then go take advantage of that same care you said wasn't good enough for your constituents.

That's obnoxious.

The faults above belong to Mr. Rand, not you.

My critique here is squarely aimed at him.

****

As for the organization of hospitals, I won't attempt to describe hundreds of different arrangements.

But I will afford a couple of examples.

Toronto has a nominally Catholic research hospital which was founded by an order of nuns. St. Michael's.

It has/had an independent board [[it just merged w/two other nominally Catholic facilities).

It is a non-profit/charity, which provides services to the public at no cost, if they are covered by Ontario's Hospital Insurance Plan [[OHIP)

They must and do take patients of all faiths.

They must refer patients to doctors willing to provide abortions if they are sought, but the hospital itself would not perform an elective abortion, nor does it participate in assisted dying.

They may and do add supplementary Catholic elements [[they have a chaplain and chapel and various religious offerings, including last rites.)

They may not impose any of these.

The hospital itself does not directly employ its doctors, except those in management positions with the hospital.

Doctors are independent contractors in our system.

Most doctors operate a 'private practice' as well, and they choose their own office space, make their own hires, set their own hours etc.

That practice, like the hospital, is publicly funded through insurance on a fee-for-service basis in most cases [[some doctors work on alternate funding models such as capitation or a salary if part of a group practice).

Like the hospital they charge patients who do not have public insurance [[every Canadian does, as do most permanent residents, and refugee claimants)

Foreign students are required to buy insurance to study here.

Foreigners are charged, so are citizens for non-insured services. [[doctor's notes, reports to third-parties, certain cosmetic procedures are examples of non-insured services).

In addition to the Catholic hospital downtown Toronto also has a 'Jewish' hospital that operates in a similar way.

The rest of the downtown hospitals are part of UHN [[the University Health Network) and affiliated to the University of Toronto.

***

It would be wrong to suggest the government doesn't have influence, even though it does not directly manage the facilities or the care.

The government chooses what to insure.

The government also has sway though what are called 'Block Grants' and some capital spending dollars.

The hospitals get a base budget to cover what the government assumes are certain core costs, prior to fee for service kicking in; these are based on estimates provided by the hospital but which are negotiated with government in terms of affordability.

That said, the government does not direct an exact quota of procedures, nor do they have any say who gets what procedure that is entirely a medical decision of the doctor/hospital as may be the case.

The government does have 'emergency powers' that allow for it to suspend a hospital board if things appear to be going awry. But this power is rarely used, and things have to be bad for the government to temporarily upend local control.

Doctors are not told where to work. Private practices may take patients as they see fit [[or may choose not to take new referrals).

They simply can't discriminate arbitrarily.

[JBMcB]

Mr. Paul is both a liar and a hypocrite in showing that the system he denigrates is the world leader in care quality in this particular area.

From what I've read, he doesn't like the government run insurance program. I don't see where he disparaged the hospitals themselves.

In any event, when I worked with a dozen or so Canadians in Detroit a decade ago, most of them had chosen to have medical procedures done in the US, mainly because it was faster and more convenient. Maybe that has changed since then, but when I was in high school in the 90's one of my teachers, a Windsor native as well, had her thyroid surgery done at U of M, so it seems to be an ongoing thing.

[oladub]

I'm not contending that Americans must have this model of insurance or any other.

My distaste is hypocrisy by Mr. Rand and lies by same.

He has incorrectly described the system.

You can like/dislike, take it/leave it, propose a variation on it, all or none of the above.

Just don't lie about it. Also don't suggest [[as Mr. Rand has) that it produces a lower standard of care than the US system as is; then go take advantage of that same care you said wasn't good enough for your constituents.

That's obnoxious.

The faults above belong to Mr. Rand, not you.

My critique here is squarely aimed at him.

****

As for the organization of hospitals, I won't attempt to describe hundreds of different arrangements.

But I will afford a couple of examples.

Toronto has a nominally Catholic research hospital which was founded by an order of nuns. St. Michael's.

It has/had an independent board [[it just merged w/two other nominally Catholic facilities).

It is a non-profit/charity, which provides services to the public at no cost, if they are covered by Ontario's Hospital Insurance Plan [[OHIP)

They must and do take patients of all faiths.

They must refer patients to doctors willing to provide abortions if they are sought, but the hospital itself would not perform an elective abortion, nor does it participate in assisted dying.

They may and do add supplementary Catholic elements [[they have a chaplain and chapel and various religious offerings, including last rites.)

They may not impose any of these.

The hospital itself does not directly employ its doctors, except those in management positions with the hospital.

Doctors are independent contractors in our system.

Most doctors operate a 'private practice' as well, and they choose their own office space, make their own hires, set their own hours etc.

That practice, like the hospital, is publicly funded through insurance on a fee-for-service basis in most cases [[some doctors work on alternate funding models such as capitation or a salary if part of a group practice).

Like the hospital they charge patients who do not have public insurance [[every Canadian does, as do most permanent residents, and refugee claimants)

Foreign students are required to buy insurance to study here.

Foreigners are charged, so are citizens for non-insured services. [[doctor's notes, reports to third-parties, certain cosmetic procedures are examples of non-insured services).

In addition to the Catholic hospital downtown Toronto also has a 'Jewish' hospital that operates in a similar way.

The rest of the downtown hospitals are part of UHN [[the University Health Network) and affiliated to the University of Toronto.

***

It would be wrong to suggest the government doesn't have influence, even though it does not directly manage the facilities or the care.

The government chooses what to insure.

The government also has sway though what are called 'Block Grants' and some capital spending dollars.

The hospitals get a base budget to cover what the government assumes are certain core costs, prior to fee for service kicking in; these are based on estimates provided by the hospital but which are negotiated with government in terms of affordability.

That said, the government does not direct an exact quota of procedures, nor do they have any say who gets what procedure that is entirely a medical decision of the doctor/hospital as may be the case.

The government does have 'emergency powers' that allow for it to suspend a hospital board if things appear to be going awry. But this power is rarely used, and things have to be bad for the government to temporarily upend local control.

Doctors are not told where to work. Private practices may take patients as they see fit [[or may choose not to take new referrals).

They simply can't discriminate arbitrarily.

Did I lie about something? What might that be? I still don't see how Rand Paul paying for an operation out of his own pocket somehow proves he is a hypocrite or liar.

"Also don't suggest [[as Mr. Rand has) that it produces a lower standard of care than the US system as is; then go take advantage of that same care you said wasn't good enough for your constituents."

I didn't but would have done so if I chose to. Thank you though for explaining some aspects of the Canadian health care system.

[Canadian Visitor]

From what I've read, he doesn't like the government run insurance program. I don't see where he disparaged the hospitals themselves.

In any event, when I worked with a dozen or so Canadians in Detroit a decade ago, most of them had chosen to have medical procedures done in the US, mainly because it was faster and more convenient. Maybe that has changed since then, but when I was in high school in the 90's one of my teachers, a Windsor native as well, had her thyroid surgery done at U of M, so it seems to be an ongoing thing.

U of M and Ford are contracted to the gov't of Ontario to provide certain services.

That was done because it didn't make sense to duplicate certain services in the Windsor/Detroit area, and the alternative was sending patients to London, ON or Toronto, depending on the procedure/specialty.

Much of that will change when Windsor gets its new mega-hospital, though I imagine some services may still be contracted out.

Specialty procedures, in both countries, are often [[not always) done in large teaching hospitals.

Windsor doesn't have one of those.

Windsor, in isolation is a comparatively small city.

Specialty services in Ontario are concentrated in Toronto and Ottawa to the largest degree, followed by the other cities with full medical schools, Hamilton, London and Kingston to a lesser degree Thunder Bay and Sudbury in the north.

Cheaper and more efficient to pay a Detroit hospital instead of sending the patient 100-250 miles away.

[Canadian Visitor]

Did I lie about something? What might that be? I still don't see how Rand Paul paying for an operation out of his own pocket somehow proves he is a hypocrite or liar.

"Also don't suggest [[as Mr. Rand has) that it produces a lower standard of care than the US system as is; then go take advantage of that same care you said wasn't good enough for your constituents."

I didn't but would have done so if I chose to. Thank you though for explaining some aspects of the Canadian health care system.

I went to great pains to be clear my allegations are against the Senator, not you.

And you're welcome.

[Richard]

Of course there is always the elephant in the room of the wait time.

Canada has spent billions of dollars to try to bring down wait times for more than 10 years, and the outcome has been mediocre at best compared to other similar Western industrialized countries.”

Wait times [[in weeks) by procedure in 2016:
Plastic surgery: 25.9
Gynecology: 18.8
Ophthalmology: 28.5
Otolaryngology: 22.7
General surgery: 12.1
Neurosurgery: 46.9
Orthopedic surgery: 38.0
Cardiovascular: 8.4
Urology: 16.2
Internal Medicine: 12.9
Radiation Oncology: 4.1
Medical Oncology: 3.7
The average wait time across the board sat at 20 weeks in 2016.

https://globalnews.ca/news/3084366/q...and-procedure/

[Canadian Visitor]

Of course there is always the elephant in the room of the wait time.

Canada has spent billions of dollars to try to bring down wait times for more than 10 years, and the outcome has been mediocre at best compared to other similar Western industrialized countries.”

Wait times [[in weeks) by procedure in 2016:
Plastic surgery: 25.9
Gynecology: 18.8
Ophthalmology: 28.5
Otolaryngology: 22.7
General surgery: 12.1
Neurosurgery: 46.9
Orthopedic surgery: 38.0
Cardiovascular: 8.4
Urology: 16.2
Internal Medicine: 12.9
Radiation Oncology: 4.1
Medical Oncology: 3.7
The average wait time across the board sat at 20 weeks in 2016.

https://globalnews.ca/news/3084366/q...and-procedure/

I know you live to Canada bash.

Stop being a bigot.

This is a thread about the hypocrisy of one man, not Canadian Healthcare per se, except in so far as that is the matter about which he has been a hypocrite.

Now that said, if you're going to bash, could you possible get more current information?

Here's the wait times site for all procedures in Ontario.

https://www.hqontario.ca/System-Perf...=WT%20Referral

Its current to last month.

I won't list waits for each procedure.

However, you can look those up, for the province as a whole and by hospital or City.

Here's cataract surgery.

https://www.hqontario.ca/System-Perf...ng-Eye-Surgery

You'll note the wait time is 13 weeks, on average, not 28.

You can also see the wait times by priority grouping.

High Urgency patients are priority one, lowest urgency [[elective) are priority 4. The average is across all 4 levels.

Priority level 2 patients [[who should receive surgery within six weeks for this, are averaging 30 days.

***

Wait times vary by province and are higher outside Ontario, typically, particularly for low-urgency patients.

For rural provinces that's a function of attracting specialists, as well as funding and a need for centralized wait lists.

Regardless, entirely off-topic, and put up just to embarrass you again for being lazy and bigoted rather than helpful, and on-topic.

[Meddle]

Did I lie about something? What might that be? I still don't see how Rand Paul paying for an operation out of his own pocket somehow proves he is a hypocrite or liar.

He's an idiot. He's always been an idiot. He talks out both sides of his face at the same time, which may be why his neighbor jumped him.

And see, no need to quote or requote a mile long post.

[Meddle]

Oh and if you want to bellow about wait times and below standard care ... try the VA Hospitals.

[Richard]

Oh and if you want to bellow about wait times and below standard care ... try the VA Hospitals.

I have been the last 36 years.

[Richard]

I know you live to Canada bash.

Stop being a bigot.

This is a thread about the hypocrisy of one man, not Canadian Healthcare per se, except in so far as that is the matter about which he has been a hypocrite.

Now that said, if you're going to bash, could you possible get more current information?

Here's the wait times site for all procedures in Ontario.

https://www.hqontario.ca/System-Perf...=WT%20Referral

Its current to last month.

I won't list waits for each procedure.

However, you can look those up, for the province as a whole and by hospital or City.

Here's cataract surgery.

https://www.hqontario.ca/System-Perf...ng-Eye-Surgery

You'll note the wait time is 13 weeks, on average, not 28.

You can also see the wait times by priority grouping.

High Urgency patients are priority one, lowest urgency [[elective) are priority 4. The average is across all 4 levels.

Priority level 2 patients [[who should receive surgery within six weeks for this, are averaging 30 days.

***

Wait times vary by province and are higher outside Ontario, typically, particularly for low-urgency patients.

For rural provinces that's a function of attracting specialists, as well as funding and a need for centralized wait lists.

Regardless, entirely off-topic, and put up just to embarrass you again for being lazy and bigoted rather than helpful, and on-topic.

Bashing somebody for being hypocritical while being hypocritical,

I do not have a problem with Canada,just when somebody tries to portray things as the best alternative,showing and only believing the positives without looking at the negatives or refusing to look at the negatives does not make things practical in the real world.

[JBMcB]

That was done because it didn't make sense to duplicate certain services in the Windsor/Detroit area, and the alternative was sending patients to London, ON or Toronto, depending on the procedure/specialty.

That, kind of, doesn't make any sense. If you need a medical procedure done in Windsor, you go to another country for it? Traverse City has a population 1/10th of Windsor and manages to support a fairly comprehensive regional hospital, in addition to a smaller hospital in Petosky. I know because my father in law had a heart attack up there and they sent him to Traverse City to have a stent put in. It just seems bizarre that a city with a quarter of a million people doesn't have a comprehensive medical center.

[Canadian Visitor]

That, kind of, doesn't make any sense. If you need a medical procedure done in Windsor, you go to another country for it? Traverse City has a population 1/10th of Windsor and manages to support a fairly comprehensive regional hospital, in addition to a smaller hospital in Petosky. I know because my father in law had a heart attack up there and they sent him to Traverse City to have a stent put in. It just seems bizarre that a city with a quarter of a million people doesn't have a comprehensive medical center.

It makes perfect sense. The hospital is just 2 miles from the tunnel!

Why would you duplicate all those services and facilities creating unnecessary capacity?

Passports are waved, the tunnel closes for the ambulance, its all seamlessly coordinated.

In the case of one man receiving a stent Ford normally bills $40,000 USD for the operation to an American.

The contract Ontario has with them stipulates a 35% discount, so they billed Ontario $26,000USD and change.

A cost Ontario could not have done better on.

****

Be that as it may, angioplasty is now done in Windsor.

A program has been set up in the last few years and more than one doctor hired to staff it.

But you simply aren't going to duplicate every service, everywhere.

Windsor has MRI, CT, PET Scan, birth, neo-natal ICU, a plethora of surgery types, chemo, and radiation therapy etc etc.

But it does have limitations in terms of certain types of organ transplants, neuro surgery and some other specialties.

The decision is then a rational one about whether to send the patient 15 minutes away, or 2 or more hours away.

Typically, non-urgent goes to London/Hamilton/Toronto

Urgent goes to Detroit.

[Canadian Visitor]

Let me add here, that emergencies of different kinds are assisted cross-border all the time.

That means not just medical.

California wildfires had Canadian crews helping fight the fires, and Canadian hydro crews helping to clean-up and restore electrical service.

Forest Fires and hydro damage due to storms etc. are common instances of this type of cooperation which goes both ways.

Why wouldn't that apply to medical situations?

In fact it does.

[Richard]

The bringing up of how the VA operates in this country is a good example of how socialized government run healthcare works in this country,it takes funding.

The way it operates with the VA here,Canada’s healthcare and the UKs healthcare are all the same in the issues that they have and mimic each other.

Yes it is expensive in the US but we are not really dealing with the issues that the other three are,because of the wait times people conditions deteriorated and ended up being more expensive then if dealt with immediately.

Rand was correct,soclized medical,as proven with the VA and elsewhere is not the ultimate solution that it is presented as,how is that making him hypocritical when it does not work here and he is paying cash to have surgery done in another country and not actually useing the government provided system.

It is cheaper because the doctors are paid less so the ones that do not leave for higher salaries in other countries are used to working for less.

If the hospitals are privately run and recieve reimbursement from the government for the ones on social medicine how is he taking advantage of socialized medical?

[oladub]

"This is a thread about the hypocrisy of one man, not Canadian Healthcare per se, except in so far as that is the matter about which he has been a hypocrite." post#11

I don't think that you have made the case that Rand Paul is a hypocrite. Rand Paul isn't a fan of expansive government and does heed the 10th. Amendment. Your original article said this Canadian hospital was in the forefront of mesh-less hernia repairs. That could have been something he wanted and it is difficult to spin this as an endorsement of national single payer plans. He is paying cash which isn't an endorsement of single payer plans.

You previously pointed out that all Canadian hospitals are privately owned. However, "Washington correspondent for the Toronto Star Daniel Dale tweeted the hospital"is one of a very small number of private, for-profit clinics that were grandfathered into Ontario's socialized health system.""According to Shouldice Hernia Hospital, U.S. and other international patients "with private insurance coverage may be eligible for reimbursement on submission of paperwork provided to you. We do not bill insurance companies on your behalf.""All charges are payable on admission by credit card, bank draft or cash," the hospital notes."

You both agree that this is a private hospital. Mr. Dale adds that this clinic was somehow grandfathered in as a for profit clinic. Whether or not that detail conflicts with your explanation or Canadians can apply their single payer benefits there, Sen. Paul is paying cash.

Sen. Paul wouldn't even be there if it wasn't for his violent Democratic neighbor who received only a 30 day sentence four mauling a U.S. Senator. Sen. Paul was also at a baseball practice at which another violent Democrat started shooting at Republicans. That has nothing to do with you calling Paul a hypocrite but somehow I thought those were bigger stories than spinning that Sen. Paul was somehow a hypocrite paying for an operation in Canada.

[Canadian Visitor]

You both agree that this is a private hospital. Mr. Dale adds that this clinic was somehow grandfathered in as a for profit clinic. Whether or not that detail conflicts with your explanation or Canadians can apply their single payer benefits there, Sen. Paul is paying cash.
.

There is no conflict. As I noted this clinic derives the vast majority of its revenues from OHIP [[public insurance). They get paid the same rates as any other Ontario hospital for the same procedures. Any profit derived is solely from servicing those without public insurance [[foreigners).

All of Ontario's non-profit hospitals also accept foreign patients and charge a for-profit rate unless they take a case on a charitable basis. [[The Hospital for Sick Children has a charitable fund for this purpose to extend care to those in the developing world that would otherwise not have access).

Shouldice is as much a part of Ontario's system of care as any other hospital.

Rand's hypocrisy is that he derided the quality of care offered by such a system, and yet he is happy to avail himself of it.

His lie concerned describing the system as slavery when it is clear that patients choose their doctors and hospitals and the government does not micro manage care at the patient level.

[JBMcB]

It makes perfect sense. The hospital is just 2 miles from the tunnel!

Why would you duplicate all those services and facilities creating unnecessary capacity?

Because there is demand for it in Windsor. I understand cross-border cooperation for emergencies - Detroit Receiving has one of the best trauma units in the US - but I don't understand why Windsor residents are sent to US hospitals for non-emergency and elective procedures. I'm sure, if given the choice, most Windsor residents would prefer to not travel to another country for health care, no matter how close it is.

I'm assuming this will change when the new hospital opens up?

[Meddle]

What it says is that he doesn't trust or respect the industry he is personally a part of. Aside from his other sideline, his main industry is that of medicine. He is a doctor. He's saying American doctors aren't worthy of his business.

[Canadian Visitor]

I'm sure, if given the choice, most Windsor residents would prefer to not travel to another country for health care, no matter how close it is.

I don't know why you would think this.

Canadians writ-large do not see it as a big deal to visit another country. Even most moderate income Canadians have visited the US a great deal, and often many other countries.

I myself have been in.....several countries. The U.S. and much of Europe.

But people I know who earn less are every bit as well traveled.

The vast majority of Canadians hold passports.

Your seeming distaste for crossing the border would be viewed as weird here. Its a line on a map.

If there were some reason for tangible concern that would be different. But would any Canadian have a tangible concern about either an ambulance trip to Detroit, or choosing to drive over and go straight to a hospital and park in their garage/lot?

I'm assuming this will change when the new hospital opens up?

As noted, many elective procedures previously contracted out to Detroit are now in-house in Windsor.

Yes, I expect the new hospital will move even more procedures in house.

But I imagine there will still be some that a hospital in a City of 400,000 won't provide, where the choice will be Detroit or a drive/train trip to London, Hamilton or Toronto 90m to 4 hours away.

One trip is a day trip [[depending on the procedure), the other is an overnight. Or one hell of a lot of driving in one day.

[oladub]

There is no conflict. As I noted this clinic derives the vast majority of its revenues from OHIP [[public insurance). They get paid the same rates as any other Ontario hospital for the same procedures. Any profit derived is solely from servicing those without public insurance [[foreigners).

All of Ontario's non-profit hospitals also accept foreign patients and charge a for-profit rate unless they take a case on a charitable basis. [[The Hospital for Sick Children has a charitable fund for this purpose to extend care to those in the developing world that would otherwise not have access).

Shouldice is as much a part of Ontario's system of care as any other hospital.

Rand's hypocrisy is that he derided the quality of care offered by such a system, and yet he is happy to avail himself of it.

His lie concerned describing the system as slavery when it is clear that patients choose their doctors and hospitals and the government does not micro manage care at the patient level.

My take was that he was paying his way and so was not endorsing the government payment system. I was not aware that he derided the care offered by this clinic.

Besides being physically attacked by extra crazy Democrats, neocon Republicans and whatever you call their hawkish Democratic counterparts were blaming Rand Paul for persuading President Trump to pull troops out of Syria. I wouldn't doubt but cannot prove that the hyped up story about Paul paying for his own medical treatment in Canada is payback.

Had Rand Paul or his father become president, neither came close, there wouldn't have so many refugees in Canada and elsewhere. That's an aside but maybe Rand's purchase of a mesh-less hernia operation in Canada is a bigger deal than Bush and Obama creating millions of refugees. To each his own.