Senator Rand Paul comes to Canada for Surgery.

[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.

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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.

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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.