SENATE DISTRICT 42
REPUBLICANS
REPRESENTING EDEN PRAIRIE AND SOUTHERN MINNETONKA

Who Is Kidding Whom?
By: Carolyn Rebholz, Eden Prairie

Rep. Maria Ruud and Rep. John Benson of Minnetonka are proposing “Universal Health Care for all Minnesotans by 2011.” This is not the answer, and it is mediocrity at best.

In the past 18 months my husband has been hospitalized several times in two different facilities for surgical procedures for a life-threatening condition. His private health insurance was excellent. Upon his final exit interview after the last procedure on his way to better health, we visited various caregivers in that facility who had provided superb assistance. We wanted to thank them for everything. One response to my husband was “At your age [65] the lines to receive specialized care under Universal Health Care would have been so long, you’d likely be dead.” Thank goodness we have an opportunity for private health insurance.

The notion that Universal Health Care will provide “high quality affordable health care” is just another “sounds good” governmental ploy to control individual choice.

Here's why we must resist SCHIP expansion
By: Rep. Michele Bachmann (R-MN)

Congress is engaged in a debate about the future of health care in America and about what should have been a proposal to extend affordable coverage for low-income children.

The State Children's Health Insurance Program, or SCHIP, is set to expire soon. This decade-old program offers states federal funding to provide health insurance for children in households that do not qualify for Medicaid but cannot afford private coverage.

Unfortunately, the program has become politicized, and Congress recently passed legislation to expand SCHIP coverage beyond children, beyond U.S. citizens and beyond those who are truly in need, and, contrary to the Star Tribune's editorial (Oct. 5), that is where the problem lies.

According to the U.S. Census Bureau, several million SCHIP-eligible children are uninsured. Surely, children in need should have the health insurance promised to them before SCHIP is expanded further up the income ladder or before more of the program's limited resources are used for adults.

Here's my idea: Let's cover the kids first. Let's focus on children in need who don't have access to health insurance and fund SCHIP as it was meant to be. I've publicly supported legislation that would accomplish these goals and keep SCHIP moving forward to help those it was intended to help.

But some want to move SCHIP in the wrong direction. Under the bill passed by Congress and vetoed by the president, SCHIP dollars could be used to cover childless adults and more-affluent families -- in some cases, households earning up to $83,000 per year. It also changes current law to make it easier for illegal immigrants to get SCHIP funds.

A Congressional Budget Office study shows that more than 77 percent of children affected by this expansion already have personal, private health insurance. So why create an incentive that pushes kids out of private insurance into a government-run program, rather than focusing on low-income, uninsured children?

Worse, this legislation makes SCHIP financially unstable. In order to appear fiscally sound, it gives children health insurance for five years, then cuts SCHIP funding by nearly 80 percent -- a classic bait and switch that will cause millions of American children to lose their health coverage.

And what are the taxpayers getting in return? According to the CBO, the bill will lead to only 800,000 eligible-but-unenrolled children being enrolled in SCHIP by 2012. The sad fact is that it would be cheaper to give each of these kids $72,000 than it would be to enact this bill, and it would probably show healthier results.

Rather than playing politics with children's health or scoring points with radio and TV ads, Congress can show the American people that we are here to solve problems. I hope that House leaders will do the right thing and bring up a bill we can all support.
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Michele Bachmann, R-Minn., serves in the U.S. House of Representatives.

Governor Pawlenty's a conservative? Since when?
By Katherine Kersten, Star Tribune

If you think Gov. Tim Pawlenty has a conservative bone left in his body, read the news reports about his statements Tuesday at a Minneapolis health care conference.

Pawlenty announced that he would use the machinery of government -- and a "surplus" of taxpayer money -- to "start moving toward universal health coverage." How? First, by "covering the state's 70,000 to 90,000 uninsured children." He proposes either to expand MinnesotaCare, the state's publicly subsidized health coverage program, or create a brand new state program.

How will Pawlenty's proposed new health care entitlement avoid the pitfalls of other government-driven health care arrangements, which tend to cost more than expected, result in rationing, and be hobbled by assembly-line care?

"Pawlenty didn't outline specifics for expanded children's coverage," according to the Star Tribune. How much will this new entitlement cost? Spokesman Brian McClung says there's "no cost estimate yet."

Pawlenty is vague about what he means by his new goal of "universal health coverage." But his remarks on Tuesday suggest that he envisions an expansion of government control over the financing and delivery of health care -- hardly a prescription for what ails us.

It's clear that health care policy needs reform in this country. The problem isn't quality of care. We've got the best in the world. The challenge is paying for that care and ensuring that coverage is as broad as possible.

The source of our current difficulty, in part, is that market forces, which produce the best product for the best price in other aspects of our lives, have largely been suspended when it comes to health care. Government piles requirements and regulations on the plans that can be offered, while a third-party-payer system insulates consumers from the real economic impact of their health care decisions.

If we want to substantially enhance consumer choice and competition, we'll probably have to rethink the entire health insurance industry.

The matter is extraordinarily complex, and anyone who claims to have the whole answer needs to visit a doctor. But an expansive new benefit, on the taxpayers' tab, will only make matters worse.

Pawlenty himself recognized this in July 2005 when he was resisting DFL legislators' attempts to relax controls on MinnesotaCare spending. Back then, he told me that Minnesota's state-subsidized health care programs, already among the most generous in the nation, faced projected cost increases that could break the bank in coming years. Left unchecked, he said, health care spending could require a doubling of state income-tax revenue every eight years to pay the bill.

Does Pawlenty now want to go down that road? We need details, Governor, and fast.

In another troubling sign, Pawlenty engaged on Tuesday in pseudo-populist bashing of private companies that are trying to wade through the current health care swamp. According to the Star Tribune, "The governor saved some sharp words for health maintenance organizations":

"'What is the health value of what they do?' he said. 'How have the outcomes improved? Are we less obese? Are we less diabetic? Do we have less heart disease? Do we have less cancer? Are our children more engaged and active? Do we have less mental health challenge?'"

While the answer to some of these questions is no, Americans are in fact living longer than ever. And you've got to have a utopian vision to believe that, without HMOs, we'd be "less obese" or that our children would be "more active and engaged."

I remember a Pawlenty who once would have talked for hours about parental responsibility for childhood obesity before mentioning a word about government. Now he seems a distant memory. (Disclosure: I served on Pawlenty's transition team in 2002.)

There's a lot of talk these days about him as a possible presidential running mate in 2008. I suggest that Rudy Giuliani or John McCain hurry up and make him an offer. Otherwise, Hillary Clinton may beat them to it.

CCHC Responds to Today's Speech by Governor Tim Pawlenty

St. Paul, Minnesota -- Twila Brase, president of Citizens' Council on Health Care, provides the following comments-pro and con-to points made by Governor Tim Pawlenty in his speech at the Midwest States Health Reform Summit in Minneapolis. The forum focused on bringing the 2006 Massachusetts universal coverage law and in particular, its controversial health insurance mandate, to Minnesota.

Governor: We must chart a path toward universal coverage.

CCHC: Universal coverage is a government-directed initiative, not a consumer-driven initiative. The discussion should not be about coverage. Coverage is not care. Many people with insurance coverage, including the privately and publicly insured in the U.S. and the entitled in other countries, fight to receive care every day. Health plans and governments use restrictions, bureaucracy, and control of dollars to ration patient access to care.

Governor: I think we should move to universal coverage. We need to move in steps. We've been studying diligently the Massachusetts model. We need to start with covering all kids. That's the logical next step to universal coverage in Minnesota.

CCHC: A health insurance mandate is a boon for insurers, a a bad idea for citizens, and a big step to government-run health care. A mandate is also unconstitutional. Government forces citizens to transfer their hard-earned incomes to the pockets of health plans. In addition, a mandate will not create universal coverage. As the Governor himself said, Minnesota requires car insurance, yet 17% of the public has not complied with the law.

Governor: Television advertising for pharmaceuticals creates consumer-driven appetites and should be limited if not temporarily suspended.

CCHC: Government should not limit citizen access to information on medical treatments. This is a patient protection issue. Health plans and government agencies are building data monitoring systems to direct and control the practice of medicine. If drug and medical device companies are not allowed to advertise, how will citizens and patients ever learn about treatments governments and health plans do not want doctors to tell them about?

Governor: We need to get to the point where we don't need to be a Ph.D to figure out your medical bills.

CCHC: Agreed!

Governor: We need to incentivize or require everybody to go to e-prescriptions.

CCHC: Computerization is not problem-free. Several studies report that electronic prescribing increases medical errors. A study in the Journal of the American Medical Association found Computerized Physician Order Entry (CPOE) added twenty-two new medical errors.

Governor: We need to pay doctors according to how well they meet recognized standards of care. We won't use a stick approach. We'll use a carrot approach. We'll reward doctors who meet the standards. This system is only going to get more robust.

CCHC: We disagree. This is a big government stick approach. Anyone who is not "rewarded" is penalized. They get a stick. There are no carrots, and increasing robust means increasingly punitive. This approach also permits government to intrude in private medical records and interfere with private medical decisions.

Governor: The role of the HMOs is called into question. Are they just banks? Are they just underwriters of risk? Or are they true partners. What is the health value of what they do? If they are just glorified aggregators of risk that don't meaningfully improve health, we need to chart a different future.

CCHC: We concur. We have long said that HMOs are banks that don't have to give the money back. In fact, they are allowed to write their own definitions of "medical necessity" and deny care based on those definitions. It's time for citizens to "bank" their own dollars, protect their assets, and keep the dollars they need to get the health care they want.

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Citizens' Council on Health Care is a non-profit, independent health care policy organization that supports free-market ideas in health care.

Gordon Cook with    his superglue

Dentist shortage leads man to superglue own tooth

A man fixed his front tooth with superglue after failing to find an NHS dentist.

Gordon Cook, 55, has used the bizarre "DIY dentistry" technique on a loose crown for the last three years - with each fresh application of glue lasting around two months.

The father of seven, who was erased from his original dentist's register after moving to a new home in Tranmere, Merseyside, said he turned to glue after losing hope of finding a dentist. He said: "I tried to find a new dentist but they had all gone private.

"A lot of them said they would take me on as an NHS patient, but only if I agreed to have the loose crown fixed as a private patient, which would cost around £100.

"In the end, I just decided to take matters into my own hands. I had read somewhere that super glue was invented for medical use, to bond skin, so I gave it a go.

"I tried a few different brands but the one I use now, which is just called Industrial Super Glue, is the best.

"You can't really taste it but you do have to be careful not to use too much, in case you glue your mouth shut."

Mr Cook, a security manager, has now found an NHS dentist and hopes to have the crown fixed professionally.

Councillor Chris Blakeley, chairman of Wirral Council's social care and health overview and scrutiny committee, said: "Mr Cook's solution was rather extreme but he is not alone when it comes to dentistry horror stories.

Supports Cullen
By Tim Goodyear, Minnetonka

It was disappointing to learn that Rep. Maria Ruud has joined those who endorse a universal health care system.

I am afraid to even imagine how this type of system would dramatically increase the costs of all of our health care, as well as decrease quality due to government bureaucracy. While the government certainly should play a role in helping those who need assistance, the vast majority of consumers want more choice and control over their own health care.

The competition between Target, WalMart, Costco, and Kmart benefit us all with lower prices and more choices in consumer goods, and this high level of competition in the Minnesota health care market would help keep down costs as well. Profit and nonprofit companies alike should be allowed to compete in our state so that we, the consumers, have the most competitive choices available.

Free, open markets are the best way of providing health care services, especially when they aren't overly burdened with government mandates and red tape. Newer innovations like HSA accounts are great choices that encourage consumers to become cost conscious, compared to the outdated third party co-pay plans that have led to our current high costs.

More competition, freedom, and limited government will make Minnesota an even better place to live. This is another reason I heartily support Bill Cullen for the Minnesota House of Representatives and encourage you to join me.

Questions Ruud
By Bonnie Gasper, Eden Prairie

Rep. Maria Ruud champions her work related to "children's mental health." She boasted about an award she received from a lobbyist organization called the National Alliance on Mental Illness (NAMI-MN) which supports Minnesota initiatives to screen "early and continuously" children birth to age 5 for mental illness.

Does Rep. Ruud know or care that NAMI has a serious conflict of interest? A large portion of its budget comes from drug companies. According to internal documents obtained by Mother Jones magazine; from 1996 to mid-1999, 18 large pharmaceutical firms gave NAMI a total of $12 million. NAMI's largest donor was Eli Lilly who delivered over $1 million in 1999 alone.

NAMI supports mental health screening of children (for the children, of course) and drug companies support NAMI because they stand to make billions of dollars pushing drug therapy on your children as a result of these screenings.

When the overall positive predictive value of a common screening tool is a mere 27 percent, you can be certain millions of children will be falsely diagnosed and recommended for treatment.

In 2005, Rep. Ron Paul of Texas introduced the "Parental Consent Act" - a bill forbidding federal funds being used for any mental-health screening of students without the express, written, voluntary and informed consent of their parents. The bill was supported by Minnesota Reps. Kennedy, Gutknecht and Kline.

NAMI, the organization that Ms. Ruud supports, worked to defeat this bill. They said that the bill would harm their "efforts" to screen schoolchildren for mental illness. As a result, the bill remains stalled in committee and has not been allowed to come to a vote.

Universal mental health screening simply has no place in a free or decent society. The notion of federal bureaucrats screening then ordering potentially millions of youngsters to take psychotropic drugs strikes an emotional chord with American parents, who are sick of relinquishing more and more parental control to government.

The government does not own our kids, and it has no constitutional authority to interfere in our family's intimate health matters. Psychiatric diagnoses are inherently subjective, and the drugs regularly prescribed can produce serious side effects; especially in developing children. The bottom line is that the government is out of its jurisdiction here.

Questions Ruud's health-care plan
By Allen Bode, Eden Prairie

I'd like to thank the Eden Prairie News for clarifying Maria Ruud's position on health care. As the paper explained in a correction on Aug. 31, 2006,

"Ruud supports universal health care."

If government forces employers to pay for universal health care, it will negatively impact wages and take-home pay. Consumers will feel the pinch as the price of goods and services rise to cover these new costs. Small businesses will be hit especially hard.

If the government were to simply take over health care, we only need to look at the medical systems in Canada, Europe and the former Soviet Union. They're outdated, inefficient and costly, with many procedures frequently rationed.

As a recent survivor of major spinal surgery, I was most fortunate to have been able to select the neurologist, surgeon and hospital of my choice such that I can again walk and care for my new granddaughters.

Universal healthcare is not just another costly, feel good, big government program that doesn't work; it won't cure what ails our health care system and will ultimately lead us to join our Canadian friends who frequently need to leave their country to find quality physicians and timely treatment for their serious ailments.

When Hillary Clinton tried to impose universal healthcare on America, the only good that came out of it was the public rebuke. Americans knew then, this plan wasn't good for them, for patients or their doctors ... and the citizens of Eden Prairie and Minnetonka know that it isn't good for them now.
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(Editor's note: Bode is vice chair of the Senate District 42 Republican Party.)

Ruud supports universal healthcare.

The 21st Century Healthcare System

There has been a lot of discussion about the health-care crisis on these pages. This crisis is really a crisis of cost as the care we receive is outstanding and the vast majority of Minnesotans have coverage. Today health-care costs consume 16.2 percent of our gross domestic product, which is twice the rate of any other country. Health-care costs continue to grow at almost three times the rate of inflation. In other words, the problem is huge and getting worse. Our solution must contain costs without losing (preferably improving) quality.

The DFL, and my opponent, [Rep.] Maria Ruud, want tax-supported, single-payer healthcare. This only makes sense if you believe our government is a low-cost, high-quality provider capable of providing personalized care. Other single payer systems have resulted in the government hiding escalating costs in tax rolls and rationing services. Do you believe that more government bloat and control is the prescription for health care?

I believe government should reform our health-care market to be consumer driven. All HMO providers should be allowed to sell in Minnesota so we have more competition. Health savings accounts should be more readily available. The fees and quality of our providers must be transparent to the consumer. When consumers are in control of their own health care, they will make financially wise choices with regard to procedures, insurance and behaviors.

Ruud sponsored health-care measures
By Maria Ruud,

I would like to thank Angela Erhard for her letter to the editor in the July 20 Eden Prairie News regarding affordable health care in Minnesota. I appreciate her concern about this issue, and agree with her that this is a worthwhile goal to work toward.

Ms. Erhard specifically inquired about measures I sponsored to control health care costs in Minnesota. I was pleased to co-author House File 1635, legislation that would have allowed individuals and small employers to purchase affordable health care coverage by joining existing groups of purchasers. This approach, if enacted, would have saved small businesses as much as 31 percent on the cost of health care coverage. No state subsidies would be involved because the businesses and individuals would pay full cost, yet still be able to access lower premiums as part of a larger pool. In addition, I supported House File 588, a new law that permits health insurers to sell lower cost policies that are not subject to burdensome state health insurance mandates which increase premiums. I look forward to continuing work on health-care cost containment efforts next session.

In addition, during my first term in the Minnesota House I was honored to co-author many health-related pieces of legislation. Some of the topics these bills dealt with included children's mental health, breast and cervical cancer treatment, organ donation, lead poisoning screening, mental health parity in insurance coverage, prescription drug bulk purchasing, a statewide smoking ban, MinnesotaCare coverage, and the nursing shortage. Also, I am proud to be a founding member of the Mental Health Legislative Caucus which was named Legislator of the Year for 2005 by the Minnesota Chapter of the National Alliance of Mental Illness in Minnesota (NAMI-MN).

“My 20 years in health care have shown me that health care should be a right, not a privilege.”

“(We support) Nationally funded, community-based comprehensive and affordable health care for all.”

“The League favors a national health insurance plan financed through general taxes in place of individual insurance premiums [and] is opposed to a strictly private market-based model of financing the health care system. ”Source: League of Women Voters MN Capitol Letter, May 12, 2006

“I supported the Minnesota Children's Health Security Act.”

“Affordable, high quality health care will keep our families healthy, our businesses competitive and our communities strong.”

Alberta 's Liberal leader is calling on the head of the Calgary Health Region to resign because of what he calls continuing problems in emergency departments, including a recent miscarriage in a hospital waiting room.

CEO Jack Davis should resign because emergency rooms are still overcrowded and not providing the level of care they should, Kevin Taft said Friday. 

"These issues are not getting solved. This is not getting better," Taft said.

The opposition leader also wants a public inquiry to be held into hospital operations.

Rose Lundy went to the emergency room at the Peter Lougheed Centre with abdominal pain last week. Three months pregnant, she suffered a miscarriage in the waiting room after staff told her there was a shortage of beds and she would have to wait.

The Calgary Health Region said it is investigating Lundy's case, but will not comment on Taft's call for changes.

"Remember this is not a single incident. This is a pattern that's repeated time and again," Taft said. "If things aren't corrected, if steps aren't taken, if new management isn't put in place, it's going happen again."

Board chair David Tuer should also consider resigning, Taft said.

Health Minister Iris Evans was not available for comment Friday.

Solutions Needed for “Healthcare Crisis”
Angela Erhard

In the July 20 edition [letters] of the Eden Prairie News, Claire O'Connor spoke of the healthcare crisis and how Rep. [Maria] Ruud is working for high quality and affordable healthcare for all Minnesotans. However, I am confused. I have not seen one piece of legislation that Rep. Ruud has authored that will reduce the cost of healthcare. Though she proclaims a "healthcare crisis," Rep. Ruud, a registered nurse and healthcare professional, has no answer or vision to solve this problem.

Indeed, the DFL party, to which Rep. Ruud belongs, has voted for restricting commerce and for-profit insurance companies from doing business in this state. Competition is what is going to bring healthcare costs down. How does restricting the commercial environment (and these nonprofits paying outrageous executive compensation) reduce healthcare costs?

O'Connor seems to imply that the solution is for the government to provide our healthcare. Since when has the government been a low-cost and efficient provider of anything? Isn't it better to select our own health care from a competitive market with a wide array of options?

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Angela Erhard is an Eden Prairie resident

Amy Klobuchar's U.S. Senate campaign has just launched a new TV ad. In it, she laments that when her daughter was born, her health care provider had the nerve to make her leave the hospital after 24 hours, although the baby was sick and had to stay longer.

That was about 10 years ago. The ad shows that Klobuchar's daughter is just fine now, and, taking after her mom, is becoming a bright and spirited young woman.

Klobuchar didn't just sit and fret over her short hospital stay, according to the ad. She testified before the Minnesota Legislature and "got one of the first laws in the country passed guaranteeing new moms and their babies a 48-hour hospital stay."

Her story hit home with me. I, too, benefited from a 48-hour hospital stay after one of my children was born. I won't deny that I was pleased that my health insurance covered it.

Over the years, our Legislature has heard hundreds of moving stories like Klobuchar's. As a result, Minnesota now has more health insurance mandates than almost any other state -- over 60 and counting. An insurer selling health coverage to an employer or individual in Minnesota must now include everything from hearing aids to chiropractic care to hairpieces.

But there's a catch. While candidate Klobuchar trumpets her success in creating a health care mandate, she also frequently decries the high cost of health care in Minnesota. Could success on the mandate front compound the cost problem?

The fact is, the cost of all these mandates adds up. In recent decades we've created a standardized roster of benefits -- some quite expensive -- that everyone covered by the mandates must buy, regardless of whether they need them or want to pay for them. A sizable number of people are being priced out of the health care market.

Many factors affect the cost of health insurance, but mandates are one cost-driver.

Merrill Mathews, director of the Council for Affordable Health Insurance, describes the problem this way: "Coverage with lots of mandates is like a Cadillac with options," he says. "It's great if you want it and can afford it. But if you can't, you have to walk."

State Sen. Brian LeClair, a member of the Senate Health and Human Services Budget Committee, builds on the automobile analogy. "We should mandate seat belts. But should we mandate leather upholstery and four-wheel drive? When it comes to health care, many people would find that a standard Buick works for them. What we need in this state is health insurance flexibility and choice."

Take the case of a healthy young single man, just out of school. He may not want maternity coverage, mental health benefits or a hearing aid. But in Minnesota, if he wants health insurance, he has to pay for all these and more. As a result, he may decide not to buy health insurance at all.

Small businesses, which employ a significant part of our state's workforce, are especially hard hit by Minnesota's mandates.

"Mandates -- especially mental health, chemical dependency and maternity coverage -- may add close to 20 percent to the cost of health insurance here," says Mike Hickey, state director of the National Federation of Independent Business. "Small employers won't offer health insurance if it threatens their financial stability."

Hickey thinks reform is long past due. "We need to stop three decades of costly mandates," he says. "Our goal now should be to make health insurance more affordable."

Looking For My Candidate
Claire O'Connor

I am an active, healthy, maturing adult. I've worked all my life, paid my share of taxes (of course), contributed to the economy and to society. Though recently retired, my contributions continue through taxes and through volunteer work in my community. Now, it seems, I have to worry about health care for me, my children and grandchildren. Will it be there when we need it and will we be able to afford it?

With elections coming up, I wondered which of the candidates for state representative share my concerns about health care. Minnesota Republicans' solution (as I understand it) is to reduce government's role in protecting health care for me and my family. I don't know about you, but it seems strange to ask me to vote for someone who wants not to do the job. Does that also mean they will take a smaller salary?

[Rep.] Maria Ruud, current representative for my district, knocked on my door recently. So I asked her how hard she works to protect health care.

I found out that she is a registered nurse and nurse practitioner who is very aware of many of the problems with our health care system. She told me that her experience has taught her that Minnesotans of all ages must be able to get the highest quality affordable health care when they need it. As an elected government representative she works to rein in costs, improve care for those with mental illness, help small employers provide health benefits, ensure protection for children and reduce the nursing shortage. Maria Ruud gets my vote.

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Claire O'Connor is an Eden Prairie resident

REVIEW & OUTLOOK
Unsocialized Medicine
A landmark ruling exposes Canada's health-care inequity

Let's hope Hillary Clinton and Ted Kennedy were sitting down when they heard the news of the latest bombshell Supreme Court ruling. From the Supreme Court of Canada, that is. That high court issued an opinion last Thursday saying, in effect, that Canada's vaunted public health-care system produces intolerable inequality.

Call it the hip that changed health-care history. When George Zeliotis of Quebec was told in 1997 that he would have to wait a year for a replacement for his painful, arthritic hip, he did what every Canadian who's been put on a waiting list does: He got mad. He got even madder when he learned it was against the law to pay for a replacement privately. But instead of heading south to a hospital in Boston or Cleveland, as many Canadians already do, he teamed up to file a lawsuit with Jacques Chaoulli, a Montreal doctor. The duo lost in two provincial courts before their win last week.

The court's decision strikes down a Quebec law banning private medical insurance and is bound to upend similar laws in other provinces. Canada is the only nation other than Cuba and North Korea that bans private health insurance, according to Sally Pipes, head of the Pacific Research Institute in San Francisco and author of a recent book on Canada's health-care system.

"Access to a waiting list is not access to health care," wrote Chief Justice Beverly McLachlin for the 4-3 Court last week. Canadians wait an average of 17.9 weeks for surgery and other therapeutic treatments, according the Vancouver-based Fraser Institute. The waits would be even longer if Canadians didn't have access to the U.S. as a medical-care safety valve. Or, in the case of fortunate elites such as Prime Minister Paul Martin, if they didn't have access to a small private market in some non-core medical services. Mr. Martin's use of a private clinic for his annual checkup set off a political firestorm last year.

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The ruling stops short of declaring the national health-care system unconstitutional; only three of the seven judges wanted to go all the way.

But it does say in effect: Deliver better care or permit the development of a private system. "The prohibition on obtaining private health insurance might be constitutional in circumstances where health-care services are reasonable as to both quality and timeliness," the ruling reads, but it "is not constitutional where the public system fails to deliver reasonable services." The Justices who sit on Canada's Supreme Court, by the way, aren't a bunch of Scalias of the North. This is the same court that last year unanimously declared gay marriage constitutional.

The Canadian ruling ought to be an eye-opener for the U.S., where "single-payer," government-run health care is still a holy grail on the political left and even for some in business (such as the automakers). This month the California Senate passed a bill that would create a state-run system of single-payer universal health care. The Assembly is expected to follow suit. Someone should make sure the Canadian Supreme Court's ruling is on Governor Arnold Schwarzenegger's reading list before he makes a veto decision.

The larger lesson here is that health care isn't immune from the laws of economics. Politicians can't wave a wand and provide equal coverage for all merely by declaring medical care to be a "right," in the word that is currently popular on the American left.

There are only two ways to allocate any good or service: through prices, as is done in a market economy, or lines dictated by government, as in Canada's system. The socialist claim is that a single-payer system is more equal than one based on prices, but last week's court decision reveals that as an illusion. Or, to put it another way, Canadian health care is equal only in its shared scarcity.

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When asked whether he was worried about being known as the man who helped bring down his country's universal health-care system, Mr. Zeliotis told the Toronto Star, "No way. I'm the guy saving it." If the Canadian ruling can open American eyes to the limitations of government-run health care, Mr. Zeliotis's hip just might end up saving the U.S. system too.

As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging
By: Clifford Krauss

VANCOUVER , British Columbia: The Cambie Surgery Center, Canada's most prominent private hospital, may be considered a rogue enterprise.

Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years in discomfort before receiving treatment.

But no one is about to arrest Dr. Brian Day, who is president and medical director of the center, or any of the 120 doctors who work there. Public hospitals are sending him growing numbers of patients they are too busy to treat, and his center is advertising that patients do not have to wait to replace their aching knees.

The country's publicly financed health insurance system frequently described as the third rail of its political system and a core value of its national identity is gradually breaking down. Private clinics are opening around the country by an estimated one a week, and private insurance companies are about to find a gold mine.

Dr. Day, for instance, is planning to open more private hospitals, first in Toronto and Ottawa, then in Montreal, Calgary and Edmonton. Ontario provincial officials are already threatening stiff fines. Dr. Day says he is eager to see them in court.

"We've taken the position that the law is illegal," Dr. Day, 59, says. "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Dr. Day may be a rebel (he keeps a photograph of himself with Fidel Castro behind his desk), but he appears to be on top of a new wave in Canada's health care future. He is poised to become the president of the Canadian Medical Association next year, and his profitable Vancouver hospital is serving as a model for medical entrepreneurs in several provinces.

Canada remains the only industrialized country that outlaws privately financed purchases of core medical services. Prime Minister Stephen Harper and other politicians remain reluctant to openly propose sweeping changes even though costs for the national and provincial governments are exploding and some cancer patients are waiting months for diagnostic tests and treatment.

But a Supreme Court ruling last June it found that a Quebec provincial ban on private health insurance was unconstitutional when patients were suffering and even dying on waiting lists appears to have become a turning point for the entire country.

"The prohibition on obtaining private health insurance is not constitutional where the public system fails to deliver reasonable services," the court ruled.

In response, the Quebec premier, Jean Charest, proposed this month to allow private hospitals to subcontract hip, knee and cataract surgery to private clinics when patients are unable to be treated quickly enough under the public system. The premiers of British Columbia and Alberta have suggested they will go much further to encourage private health services and insurance in legislation they plan to propose in the next few months.

Private doctors across the country are not waiting for changes in the law, figuring provincial governments will not try to stop them only to face more test cases in the Supreme Court.

One Vancouver-based company launched a large for-profit family medical clinic specializing in screening and preventive medicine here last November. It is planning to set up three similar clinics in Toronto, Ottawa and London, Ontario next summer and nine more in several other cities by the end of 2007. Private diagnostic clinics offering MRI tests are opening around the country.

Canadian leaders continue to reject the largely market-driven American system, with its powerful private insurance companies and 40 million people left uninsured, as they look to European mixed public-private health insurance and delivery systems.

"Why are we so afraid to look at mixed health care delivery models when other states in Europe and around the world have used them to produce better results for patients at a lower cost to taxpayers?" the premier of British Columbia, Gordon Campbell, asked in a speech two weeks ago.

While proponents of private clinics say they will shorten waiting lists and quicken service at public institutions, critics warn that they will drain the public system of doctors and nurses. Canada has a national doctor shortage already, with 1.4 million people in the province of Ontario alone without the services of a family doctor.

"If anesthetists go to work in a private clinic," Manitoba's health minister, Tim Sale, argued recently, "the work that they were doing in the public sector is spread among fewer and fewer people."

But most Canadians agree that current wait times are not acceptable.

The median