Denticare - Good Politics & Policy, & Obama = Opportunity

The movement towards universal dental care started with Mackenzie King's Liberals in 1919, and has been carried by all political parties, Conservatives as well as the CCF-NDP & Liberals. Now is the time to make this vote-winner a reality, by leveraging Canadian pro-Obama sentiments and Canadians' awareness & approval of the Democrats' desired "public health care option" to propose a similar "public dental care option", to cover the 40% of Canadians without dental insurance, and help the even greater number who struggle with the costs of profiteering insurance companies and "gourmand" dentists.

King's Liberals proposed comprehensive national health insurance in 1919. The 1933 Regina Manifesto, strikingly relevant, called for "a properly organized system of public health services including medical and dental care". R.B. Bennett, the Tory PM, promised health insurance in the 1930s and Conservatives proposed it again in opposition during WWII. The Canadian Dental Association, representing dentists, proposed compulsory dental insurance in 1943. In 1944, the Tommy Douglas CCF campaigned & won election on a platform that included public health and dental care. Under King, Liberal PM in 1945, the Liberals favoured such comprehensive health insurance on a national basis, just as the CCF was implementing its health care plan in Saskatchewan, including dental care. But it was the Conservative government of Diefenbaker that, as Ross notes, "decided to make good on the idea of 50 per cent cost sharing for those provinces wanting to set up and administer a public health care program. While the idea of private insurance plans was already well underway in many parts of Canada, more than 30 per cent of Canadians had no health insurance at all" [EFL bold - consider that today, 40% of Canadians have no dental insurance].

It was Diefenbaker's Tory Govt which created the Royal Commission on Health Services, chaired by Justice Hall, whose 1965 report, called for, along with other health services, "dental treament costs paid from the public purse." Pearson & the Liberals, having replaced Diefenbaker, had the following response: "First, the scope of benefits should be, broadly speaking, all the services provided by physicians, both general practitioners and specialists. A complete health plan would include dental treatment, prescribed drugs, and other important services, and there is nothing in the approach we propose to prevent these being included, from the start or later, if this were the general wish. We regard comprehensive physicians' services as the initial minimum." [EFL bolding] Pearson was not able to do all he wanted, but he persisted, and national medicare was born in 1968, though fragile, until Trudeau scotched any further prevaricating.

But despite public dental care being part of the plan for public health care from the beginning, under Liberals, the CCF-NDP & Conservatives, it has yet to be achieved. During the Chrétien-Martin years, the Federal, Provincial and Territorial Dental Working Group, or FPTDWG was founded, and published the first ever Canadian Oral Health Strategy in 2005. It notes that at best, only 58% of Canadians have some form of dental insurance, however limited. As a result: "There are 30-40% of people who pay for dental services out-of-pocket. In addition, there are a percentage of insured people for whom the co-pay portion of the costs creates a financial burden. This leads to a significant number of people, measuring in the millions, for whom there is a financial barrier to access to oral health services. While 80% of high-income Canadians have dental insurance, only 11% of low-income elderly have dental insurance."

This is very serious, as dental care IS health care. Under the heading The Oral Health, General Health Connection, the FPTDWG makes this obvious point: "There is a growing body of evidence that indicates that oral health is directly linked to general health. As was stated in the first Surgeon General’s Report on Oral Health in the United States “… oral health and general health should not be interpreted as separate entities.” In order to recognize and enhance the integration of oral health to general health, it is necessary to integrate health promotion activities, health services and the measurement of health outcomes."

The subsequent heading, What governments can do to improve access to care and reduce barriers to oral health care, lists a number of measures whose obvious logic, taken together, is to make dental care affordable and accessible for all Canadians, through increased funding by all levels of government, free services for all who need it, subsidies for others, etc.. The Democrats' desired health care plan, with a public option, in effect. And this was recommendation of group representing all governments, federal, provincial & territorial, of all political stripes.

The Canadian Association for Public Health Dentistry (CAPHD) has a page that links to the mishmash of public dental programs across the country. Crazy.

It would be best, most rational and useful, to extend our current single-payer health insurance system to dental care, as was the intent from the beginning, by all parties, in all parts of the country, at all levels of government. But considering how entrenched the interests of those who are opposed, the cowardice of politicians, and perceived fiscal constraints, that would be difficult. Of course, just as public health care is far more efficient than private, so it would be with the integration of dental care into the system, as is already the case in most every developed country with public health care. And of course, all these fiscal arguments are fundamentally false, as they are parlour tricks in which one is supposed to look at health costs from the perspective of government accountants and not from a national economic perspective. It is the difference between accounting and economics. The inefficiency, high transaction costs and negative externalities (ex: increased oral hygiene problems that have to be more expensively dealt with in hospitals when they reach crisis point than if prevented earlier) of a tiered dental health care system mean that dental care, as currently structured, may be costing Canadian governments little as part of their obvious budget calculation, but it is costing Canadian society as a whole an enormous amount.

A public dental insurance option, modelled on the Obama plan, free for the poor, working- & lower-middle classes, subsidised on a sliding scale for all others, would save Canada a lot of money, reducing extreme costs of hospital emergency demands, and forcing dentists & insurers to be less "gourmand", and more efficient. It would also make Canadians healthier, happier and more productive. Just as Democrats and Republicans predict, the former quietly, the latter madly, such a system, given public administrative efficiency and bargaining power, would probably ease out all but the most niche-targetted private insurance over time. Given our existing public health system, which the USA lacks, in Canada this logic would result in an eventual complete integration of dental services into the public health system, within a generation.

Given Canadian awareness of the American health-care debate, our commitment to our own health care system, Canadians' support for Obama, the logic of the proposed reform, the popular support for accessible & affordable dental care for all, and the wide resentment for insurance companies' & dentists' profiteering among those who pay for insurance or dentistry out-of-pocket, and those who cannot afford to, now is the time to propose a national dental care plan that would mimic Obama's initial health care plan.

Dental insurance would become obligatory, so that should please the insurers and dentists. Those with dental insurance through their employer or other source (worker's comp, welfare, etc.) would keep it. Private insurance rates would be capped. But any citizen without dental insurance would have to get it, available free through the public insurer for those who can't afford it, and subsidised for those who need the help. There would be a transition period of, say, three years, during which time those with private insurance would not be able to switch to the public plan, so as to give time to the private insurers to become more efficient as they prepare to compete with the public insurer, who will also need the time to work out the kinks. But after the three years, game on: companies and people are free to switch to the public insurer. If the private insurers can compete with the not-for-profit public insurer, then good for them. But given the public insurer will command an initial market share of some 40% of the population, one imagines their administrative efficiency will allow them to gain ever more market share, which in turn will allow them to control costs (economies of scale and bargaining power), allowing them to further lower rates, etc..

There is not a lot of sympathy out there for dentists and insurers, to put it mildly. If you offer a chance for Canadians to get the dental care they need, that will be enormously popular. The fact that the private sector will be allowed to compete removes any credibility from claims of illiberal "socialistic" behaviour. Given public views of insurers and dentists, any squawking from them about competing with a public option would only make the plan more popular. Especially given our own culture.

Given present realities, it would be difficult to suddenly nationalise dentistry: the time to do it was at the beginning of medicare. In fact, it was largely achieved in Saskatchewan, until the worst government in Canadian history, the Devine Conservatives, "dismantled the dental plan, turning dental care over to private clinics", while also managing historic feats of indebtedness, corruption & incompetence.

From Mackenzie King in 1911, to Pearson to Trudeau (and Bégin's Canada Health Act) to Chrétien and Martin, Liberals have always been the ones to expand and improve medicare, nationally. They have also been at the forefront provincially, thinking back to the introduction of youth denticare under Peterson in Ontario, and McGuinty's expansion of dental services. In 2004, George Smitherman, then Ontario Minister of Health & Long-Term Care, quoted Tommy Douglas approvingly. I conclude with Smitherman's speech (he forgot a couple of Douglas' words, which I have inserted in italics). Smitherman:

Defending medicare is not the same thing as defending the status quo.

Medicare is very much a 'work-in-progress.' That was always the intent.

Tommy Douglas made the very same point. And he made it much better.

"Let's not forget," he said, "that the ultimate goal of medicare must be to keep people well rather than just patching them up when they get sick. That means clinics. That means making the hospitals available for active treatment cases only, getting chronic patients into nursing homes, carrying on home nursing programs that are much more effective, making annual check-ups and immunization available to everyone. It means expanding and improving Medicare by providing pharmacare and denticare programs. It means promoting physical fitness through sports and other activities. All these programs should be designed to keep people well--because in the long run it's cheaper than the current practice of only treating them after they've become sick."

Tommy Douglas and champions of medicare who have followed, like Bégin and Romanow paint a similar picture of a mature system where the different parts all work together ... and all work for the patient.

That's what our government's plan to transform health care is all about : taking medicare to its necessary next step – creating a comprehensive and integrated system of care that is shaped with the active leadership of communities and driven by the needs of the patient.

[EFL: Original Tommy Douglas here.]

More Health Care Is Better: OG Wisdom, Straight Outta 1999

Charles R. Morris's famous 1999 article, via Levant: "Given that healthcare is in fact a productive industrial sector, the “drain on the economy” issue really translates into the issue of competing priorities. If we don’t spend the money on healthcare what will we spend it on? Larger homes, bigger SUVS, better electronic games, faster food, or a missile defense system? However, a discussion of choosing to divert healthcare dollars to other sectors is a mere academic exercise. For as Morris (1999, p. 96) points out “policy wonks still treasure the delusion that we as a nation will somehow decide what share of resources should be claimed by health care, when the demographic facts have already decided it for us.”"

Morris via NCPA:

Within the next 25 years or so, according to recent estimates, health care could account for as much as 25 percent of spending in the United States (ed. note: Obamacare = less?). Spending trends in almost all other developed countries are headed in the same direction, although with a time lag. Author Charles R. Morris asks, what is so bad about that?

Morris argues that health care is becoming a high-productivity, high-technology industry where each dollar buys more. Thus, although health spending is increasing, most health care costs are going down. And as the personal computer industry shows, falling costs and improved performance usually induces more spending, not less.

The share of national income devoted to food and health care combined hasn't changed in 50 years, says Columbia University economist Sherry Glied. We just spend a lot less on food, and a lot more on health care.

There is lots of literature out there on this basic point, I recommend U.S. Health Care Spending In An International Context, notably the section Health Care In The Macro Economy, which everyone should read. I'll just quote this:

the fact that in most industrialized countries health care has absorbed an ever-increasing fraction of GDP while other types of output—for example, agricultural products — have claimed a decreasing share does not by itself imply an excessive allocation of resources to health care.

The alleged economic burden of health spending.
How serious a problem, if it is one at all, is the inexorable growth of health care as a component of GDP? On this question the responses of policymakers can vary, depending on their political purview. At the local level, policymakers usually give much weight to the employment opportunities offered by a growing health sector, which leads them to resist reductions in or closing of local health care facilities. On the other hand, at the macroeconomic level, policymakers often view growing health spending with alarm, although added consumer spending on other goods and services—on SUVs or entertainment— invariably is viewed as a sign of economic health by both policymakers and the media. What explains these seemingly inconsistent views toward consumer spending?

And some crucial Cancon as a follow-up, from our own Finance Department, those well-known irrational spendthrifts, Health-care Spending: Prospect and Retrospect, with these vital points:

What conclusion can be drawn then about the sustainability of health spending? Again, it depends on how sustainability is defined. Some suggest that any category of spending that grows faster than GDP is problematic, since it could require reductions in the share of GDP devoted to other areas of spending. However, the structure of public spending has always evolved over time, and these changes have been affordable. For example, total health spending as a share of GDP increased from 7% to 9.4% between 1975 and 2001. At the same time, federal public debt charges came down from 6.6% of GDP in 1990-91 to 3.2% of GDP in 2002-03 (Figure 18). Future reductions in debt charges may be expected to create additional fiscal room.
(...)
The spending increases projected under 1990s enrichment ratios thus appear to be within the limits of sustainability from both fiscal and political perspectives. However, this could change with a swing in public opinion. Given the wide range of spending options that are fiscal feasible, discussions of sustainability ultimately become a question of public choice. Even very large increases in health spending as a share of GDP are technically feasible, provided citizens choose to devote an ever increasing portion of GDP to the health-care system and are willing to pay for its cost.
(...)
Our projections show sizeable increases in total (public/private) health-care spending as a share of GDP. However, total provincial-territorial government spending on health remains under 10% of GDP by 2040 under the scenario we consider to be a reasonable baseline. While it is impossible to predict the level of health spending increase that can be successfully absorbed, the increases projected under this baseline scenario may be considered likely to be sustainable on a couple of bases:
• historical perspective – the projected increase is well within the range of historical increases over the last 20 years;
• inter-provincial comparisons – figure 10 showed that the projected increase is within the range of existing provincial variation in spending.
It should be emphasized, however, that these projections alone provide only one measure of the sustainability of health spending i.e. the health spending-to-GDP ratio.
A more complete analysis could place the projections shown in this note in a broader fiscal framework that includes all government revenue and spending. Such a framework could be used to evaluate the long-term impact of increases in health spending on government budget balances and debt-to-GDP ratios by taking into account potential offsetting changes in other components of spending.

PS. Denticare & Federalism

In my previous post on denticare, I forgot to explain the relationship between denticare & Canadian federalism, probably because it seemed obvious. But here it is, just in case. Nothing prevents any province from listing denticare or any other service, like pharmacare, as medically necessary, and receiving funding for it under the established legislation, criteria (Cda Health Act) and transfer agreements. That has been part of the architecture of medicare from the beginning, from Hall to Pearson to Trudeau and on, and oft-praised by Tommy Douglas. To date, no province has agreed to recognise general dental care as medically necessary, which would trigger its integration within the current health care system. So a Federal Government intent on following the Obama example of offering a public option for dental insurance would present provinces with three options:

1) Continue to refuse to recognise dental care as medically necessary, offer no universal dental insurance, and their citizens will be covered by the Federal Plan.

2) Continue to refuse to recognise dental care as medically necessary, but propose to offer their own universal dental insurance that respects Federal criteria, so they can run it themselves, but get Federal funding.

3) Recognise general dental care as medically necessary (rather than just emergency dental care, as now). In this case, they would be obliged to fold it within their current health care system. But they would be able to assert that it was provincial jurisdiction.

Unless provinces are willing to stipulate that denticare is medically necessary, hence part of the Canadian & provincial health system architectures, they cannot claim it is provincial jurisdiction. A Federal Government that proposed a public dental insurance option, modelled on Obamacare, would no doubt be overjoyed if provinces stepped up and recognised denticare was medically necessary, and we could save 20 years by integrating it within the public health care system immediately. But unless a province was willing to do so, it would have no grounds for objecting to a Federal plan that clearly did not touch provincial jurisdiction, since by its own admission, denticare was not health care. The Federal Government already offers unemployment insurance - it can also offer dental insurance.

I don't doubt that there might be a province or two that might maintain the incoherent position that denticare is medicare, hence provincial jurisdiction, even though they refuse to accept it as such themselves. That being the case, the Federal Government could attempt to satisfy them by proposing to transfer equivalent funding to a recalcitrant province to run its own equivalent dental insurance plan. Where partial public plans exist, for youth, welfare recipients, etc., the Federal plan would cover all the other uninsured, unless the provinces expanded their own coverage to all citizens, whether through an equivalent plan, or through the simple, logical expansion of public health care.

In effect, the political dynamic would be such that provinces would be obliged to sign on now or sign on later. The quicker denticare was folded into medicare, the better - we could save the 20-year transition. But they would be free to continue to insist that denticare was not health care, and as long as they did, the Federal Government would be free to offer its own universal dental insurance plan.

Iggy, Don't Piss Us Off - Your Health Care Line Is BS

I read the Iggy speech very carefully and checked the media reports. He is trying to thread a needle that isn't there (relevant passages & analysis at bottom). He needs to stand up for ACCESSIBILITY REGARDLESS OF INCOME, not this BS "universality" escape clause. Parse his remarks and they could be interpreted either for or against user fees & regressive taxation. He's chicken to criticise Charest (or he agrees) and he's chicken to stand against Medicare (or he believes in it, but chicken to say so). But there's no way around this, there's no Mac Kingian obfuscation possible. You're either with the counterproductive user-fee & regressive taxation idiots, or you're with the forces of productive truly accessible universal health care. You're with us or against us. I should note, for the ignorant, that the reason the UK has always made their health care "freely" available for all, recently landed immigrants & refugees as well as anyone else (no three month waits!) is because of the danger of communicable diseases, and costs: what happens if someone has some Ebola or something, but didn't get it checked out as early as possible because they were poor and wanted to avoid the user fee? Think, people, think!!!

GPs win care fight for asylum seekers

The government is ready to scrap controversial plans to clamp down on so-called 'health tourism' among asylum seekers, following a revolt by doctors.

Ministers had threatened to withdraw the right to free GP treatment from asylum seekers whose claims were rejected, forcing them to pay for care privately or go without in all cases except emergencies. However, doctors have argued the move would be unethical and potentially illegal, with some saying they would treat patients regardless of any new rules.
(...)
Ministers first proposed denying free primary care from GPs four years ago, driven by concerns about the cost of health tourism. But a decision has been repeatedly delayed, amid objections from doctors and refugee organisations, who argued that it would be inhumane, could encourage the spread of infectious diseases and would put A&E wards under strain as overseas patients whose conditions had gone untreated developed life-threatening complications.

Iggy Speech - Relevant Section

La semaine dernière, quand on m’a demandé ce que je pensais du budget du premier ministre Charest, j’ai rapidement reconnu qu’il agissait pour essayer de résoudre un très gros problème : celui du financement du système de santé dans un contexte de vieillissement de la population.

Il faut être ouvert à ce que les provinces puissent expérimenter, dans le cadre des grands principes de la loi canadienne sur la santé. Il faut protéger l’accès au système de santé.

Le gouvernement du Québec le sait et a indiqué qu’il allait situer sa réforme à l’intérieur des paramètres de la loi canadienne. Je salue le fait qu’il lance le débat. C’est de là que vient le progrès.

Lancer un débat, oui, mais un débat qui respecte le grand principe de notre système : de garantir l’accès universel aux soins de santé. Ce principe est l’épine dorsale de la citoyenneté canadienne.

Est-ce que M. Harper entend respecter ce principe? Son silence est révélateur.

You see, the problem is he says "access must be protected", "QC is saying it'll reform system within parameters of Canada Health ACt (untrue), "must respect universal access as basic principle' and opposes his support for "universal access" with Harper's silence. BUT ANYONE WHO FOLLOWS THESE THINGS KNOWS IT'S POSSIBLE TO CLAIM UNIVERSAL ACCESS WHILE CHARGING USER FEES. We all have universal access to McDonald's, theoretically, it's just that we need to pay for food and drink...so if you don't have the money, you can't. There is a huge difference between the principle of universality and accessibility, and Iggy, you're not fooling anyone. Speak up for accessibility, as defined by the Canada Health Act, or suffer the consequences.

CHA
Accessibility
12. (1) In order to satisfy the criterion respecting accessibility, the health care insurance plan of a province
(a) must provide for insured health services on uniform terms and conditions and on a basis that does not impede or preclude, either directly or indirectly whether by charges made to insured persons or otherwise, reasonable access to those services by insured persons;
(b) must provide for payment for insured health services in accordance with a tariff or system of payment authorized by the law of the province;
(c) must provide for reasonable compensation for all insured health services rendered by medical practitioners or dentists; and
(d) must provide for the payment of amounts to hospitals, including hospitals owned or operated by Canada, in respect of the cost of insured health services.

And this is translated into law the following way:

EXTRA-BILLING AND USER CHARGES

Extra-billing

18. In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, no payments may be permitted by the province for that fiscal year under the health care insurance plan of the province in respect of insured health services that have been subject to extra-billing by medical practitioners or dentists.
1984, c. 6, s. 18.
User charges

19. (1) In order that a province may qualify for a full cash contribution referred to in section 5 for a fiscal year, user charges must not be permitted by the province for that fiscal year under the health care insurance plan of the province.

Deduction for extra-billing

20. (1) Where a province fails to comply with the condition set out in section 18, there shall be deducted from the cash contribution to the province for a fiscal year an amount that the Minister, on the basis of information provided in accordance with the regulations, determines to have been charged through extra-billing by medical practitioners or dentists in the province in that fiscal year or, where information is not provided in accordance with the regulations, an amount that the Minister estimates to have been so charged.
Deduction for user charges

(2) Where a province fails to comply with the condition set out in section 19, there shall be deducted from the cash contribution to the province for a fiscal year an amount that the Minister, on the basis of information provided in accordance with the regulations, determines to have been charged in the province in respect of user charges to which section 19 applies in that fiscal year or, where information is not provided in accordance with the regulations, an amount that the Minister estimates to have been so charged.

Grand French Bargain For Health Care? 3rd Best, But Better Than Destruction

I know France very well, having lived there, East to West, North to South. There are a lot of good things about their health care system. There are also an awful lot of bad things. I know that the peverse effects of the very French Republican approach to public policy, health care specifically, is that when people pay for insurance, they maximise, as one would expect, according to economic theory. "I've paid for it - I might as well get as much as possible out of it". So France has most hypochondriacs, most over-prescription of drugs, most over-use. Similarly, allowing medicine to be a free liberal profession like any other mean there are far too may doctors in high revenue areas, and not enough in less glamourous ones, and just too many doctors, all in all. Misallocation of resources, waste. And all this means its specific health-fund, la SECU, is deeply in debt, as is country, as a whole, far more than Canada. And also, that introducing a modest user fee for seeing doctor has only discouraged low-income folk from visits, who probably need visits more, and had no effect on middle classes and upper classes. And were they to raise it high enough to discourage many, they would end up with worse health treatment, and later, too late, when conditions worse, and more complicated and costs more to fix. And I've already mentioned how some 5% don't have private "complementary" insurance to cover their 1/3 of costs, and they are of course the working poor, don't qualify under welfare etc., but too poor to buy insurance, and so try to save. Just as in USA. And then the number of insurance plans is so complicated that although fine for educated folk, ie. middle classes and up, generally, confusing for less-educated, generally working class, who buy "wrong" insurance for their situation. Etc..

But it is true that 2/3 - 1/3 funding system, State paying for 2/3 of expenses, you/your insurance paying other 1/3, COVERS EVERYTHING, TEETH, EYES, DRUGS, as well as doctor care. So while I consider French system less efficient than Cdn, more wasteful overhead and transaction costs, it does at least cover everything, as we promised we would, all parties, over the last century. I prefer Tom Kent's tax recovery of social benefits plan which would extend benefits to include everything, as we should, starting with children first, as most politically powerful opening move, being obvious moral imperative. This way, we retain the administrative efficiency of our system, while building it further.

But should that prove a hard sell, another option, 2nd or 3rd best in my view (best is increasing general taxation, corporate and individual - most efficient, most equitable - while extending benefits to cover everything) would be to propose a grand bargain: We will go to French System, ie. you, the citizen will have to pay for 1/3 of your non-hospital care (hospital still 100% State covered, as in France) but Govt will pay 2/3 of everything, in return.

I don't particularly see how this makes things cheaper, given the French example, more the opposite it seems to me, but since everyone is all het-up about co-payments and dedicated health taxes and the like, and there is some mystical delusion taking control that leads people to think private involvement will everything better, despite all evidence to the contrary, but "the problem is selling it to public", then one way would be to offer public this grand bargain, which would be great for middle and upper classes, and suck for working and lower classes and poor. But at least Govt could say it wasn't a simple case of making people pay out of their own pockets, but rather a way of extending needed additional services (eyes, teeth, drugs, etc.) to everyone, while finding a way to pay. That would probably fly.

But best is to keep our excellent system, expand it to cover everything, do best practices and encourage healthier lifestyles, and pay for it, most wisely, by increasing taxes on corporations and individuals. Figure out what you need, and then tax to need. That's smartest, and best. But if we ever get to the point that we absolutely are going to change things because elite opinion is in lockstep, despite public's rightful pushback, then the French Grand Bargain is better than simply going two-tier, or user fee, or cutting services.

Mais quant à moi, je dis : Vive le Canada! Vive son excellent système de santé! Vive les impôts!

"Taxes are the price we pay for civilised society." - Some Republican

PS. Subsequent to a couple of comments, I include the following in the main post:
I suggest all read the following CMA report on health systems, their strengths and weaknesses, to get some perspective, particularly the tables right at the end, re. $ vs. outcomes, and cost/debt and efficiency:
Background report on 5 European health systems (April 2009)

Also, shamelessly, I recommend my previous post re. point about geo-historical specificities and limits/opportunties to and for change:
Bless The Obama USA

My Denticare proposal, referenced above, also offers a good quick review of our health care history and future challenges and opportunities, with this proposal:

Now is the time to make this vote-winner a reality, by leveraging Canadian pro-Obama sentiments and Canadians' awareness & approval of the Democrats' desired "public health care option" to propose a similar "public dental care option", to cover the 40% of Canadians without dental insurance, and help the even greater number who struggle with the costs of profiteering insurance companies and "gourmand" dentists. (...) A public dental insurance option, modelled on the Obama plan, free for the poor, working- & lower-middle classes, subsidised on a sliding scale for all others, would save Canada a lot of money, reducing extreme costs of hospital emergency demands, and forcing dentists & insurers to be less "gourmand", and more efficient. It would also make Canadians healthier, happier and more productive.

Blogging Ethics: Am I Allowed To Reprint Rob Silver In Toto?

Come and get me coppers! Essential Silver here and below:

Jedi mind-tricking the Canada Health Act away
John Ivison and Jeffrey Simpson jump into the Canada Health Act fray with their respective columns today.

Let me tackle Ivison first and his column headlined "When is a User Fee Not a User Fee." He addresses Parliament finally discussing the issue this week:

"In Question Period on Wednesday, the issue was raised by NDP leader Jack Layton, who asked the Prime Minister whether his government is committed to enforcing the CHA "or is preparing to amend it?"

Stephen Harper's answer was inscrutable enough to suggest a number of interpretations are possible.

"The NDP ... should be sure that violations have actually occurred. The reality is very clear. The Canada Health Act is the law of the land. The government has indicated that it expects provinces to follow the law of the land," he said.

Since the CHA is pretty clear that "for a province to qualify for a full cash contribution [from the federal government], user charges must not be permitted," the uninitiated might think the Prime Minister was threatening to crack the whip.

But I don't think that's what Mr. Harper was suggesting at all. Nor does Brian Lee Crowley, the economist and author of Fearful Symmetry: The Fall and Rise of Canada's Founding Values."

Pause.

The law is clear, the law must be followed but both Ivison and Brian Lee Crowley (as I have written here previously, Crowley's Fearful Symmetry was the Canadian political book of the year last year) don't think Harper is actually threatening anything here.

Big assertion, time for some analysis boys:

"For one thing, contravention of the CHA is in the eye of the beholder. The government has a high degree of discretion when it comes to contravention -- and even more latitude when it comes to penalties."

This is of course true. There are three important points about the CHA and user fees:

1. They are explicitly prohibited (as per my post earlier this week);

2. The explicit penalty under the CHA for user fees is a loss of federal transfers; and

3. The Federal Health Minister is judge, jury and executioner for enforcing this section.

In other words if the Federal Minister decides not to enforce the Act, nothing is going to happen. Life will go on. That doesn't mean Quebec isn't in violation of the Act, just that the Feds have decided to turn a blind eye to its transgression. And other provinces can also do whatever they want in healthcare - CHA be damned. In other words, the result of Harper deciding to ignore Quebec's violation is the CHA becomes a meaningless piece of legislation - in complete contradiction of what Harper actually said in the House this week.

Back to Crowley:

"Mr. Crowley said Quebec's plan may not even constitute a user fee. "It depends on what you think a user fee is -- it's a very important question .... If you have an addition at the end of the year to your tax bill, then no one is being prevented from access to health care."

Right. And if I go to a restaurant, put my steak on my credit card and don't pay the bill for another month then it's like I got my steak for free - I mean, they let me walk out of the restaurant without giving them a penny! The proposed user fee in Quebec is being collected through the income tax system for administrative efficiency reasons. As we understand it to date, the "fee" at the end of each year will be based on the number of "uses" you made of the health care system. The clause under the CHA prohibiting user fees makes no reference to accessability, it prohibits user fees per se. I'm not sure how when you have to pay it is relevant to whether it qualifies as a "user fee".

Ivison goes on to propose the same jurisdictional swaperoo that Andrew Coyne laid out in his column this week for the federal government to get out of funding healthcare, transfer tax points to the provinces in exchange for economic union (minus Andrew's senate reform two-step).

Jeffrey Simpson makes an even more blunt argument in his column:

"It doesn't much matter what federal Liberals, or any of the federal parties, say or think. It is the provinces, not Ottawa, that deliver health care and provide most of the money for it. Frankly, what Mr. Ignatieff or other federal politicians think or say doesn't count for much."

I think there are two very different, though related questions that are being confused in both columns:

1. Does the Quebec proposal violate the Canada Health Act that is currently the law of the land?;

2. Should the Canada Health Act be amended on a going forward basis?

The answer to the first question is clearly yes - the Quebec proposal violates the current Act.

In terms of where we go from here, that is a much bigger question. Should the federal government have anything to do with health care in the futrure? I have my thoughts, others have theirs. This debate is not off to a good start though when we can't even agree what the law is today as it gets underway.

If we are, as a country, going to ignore the CHA - if we have decided that it is outdated and outmoded or impractical to enforce it - then let's call it what it is and change the law.

But let's avoid the mental gymnastics and jedi mind tricks that are currently being played to try to claim that a policy proposal that is in clear violation of the law is something else entirely.

Marissal Says What I've Been Thinking Since Budget

As soon as the QC budget came out, I thought it was a set-up, since the regressive health tax was so obviously inequitable, and the proposed regressive user fees so stupid, and the political consequences so obvious. I like Charest, as a person, and I'm a federalist, so I didn't want to cramp his style, in case I was right. But I saw Marissal say part of what I've been thinking out loud, so here goes. There seem to be four ways to explain the Charest Govt approach:
1) They're serious, and stupid-foolhardy-suicidal, and either didn't foresee the reaction such regressive taxes would have, or didn't/don't care, and are willing to lose power over it. Since the taxes could easily have been designed better, and been progressive, as in Ontario, it's hard to see why they would want to introduce measures that will lead to their certain defeat and the measures' repeal, assuming they were serious. The mere statement they make, about needed cultural shift, was important enough to bring them in, knowing that at best they would be amended and made progressive by the following PQ Govt? Hard to believe, given politicians' ingrained survival-success instincts.

2) As mentioned by Marissal, the most obvious reason is they wanted to advance a "culture-changing" agenda, and so purposefully included these measures, fully expecting they would have to be amended, but in so doing, they would get credit for their response, while having still introduced a separate health tax, and who knows, maybe user fees as well. They'd have a go, see if they could get them through as is, in their current regressive form, and if not, they would amend them, and get credit for flexibility, while drawing attention away from all the other explosive measures in the budget. They know how Catholic Quebeckers are, psychologically, and that there's nothing we like better than an Easter story, the death & resurrection, or sin-atonement-forgiveness narrative. And also (implicit), a good drama/melodrama. So play the meme, sin with budget, say you won't change a word, have everyone use up their protesting energies on those two specific egregious regressive measures, say you recognise you were wrong, atone by making the measures progressive, and be even better appreciated for your act of atonement, receive forgiveness. Everything else in budget is ignored and goes through no problem, and even amended measures are more than Finance could have hoped to get through previously. A complete set-up.

Makes sense, but if so, one wouldn't have expected Bachand & Charest to be so firm in their rejection of amendments proposed by the Govt's closest friends, Castonguay, Pratte, etc.. I understand that in bargaining, the stronger one 's apparent position, the less one has to give up, eventually. But in this case, their language is so firm that they would be seen as having completely crumbled if they changed position. This is not a normal negotiation, this is politics, with serious consequences on innumerable levels, short-, medium-, and long-term. Given their language, I don't think they could survive, or will suffer even worse, if they seemingly crumble, forgiveness meme be damned. It may be a set-up, and they may be just be staking out as extreme a position as possible, for eventual changes to be as weak as possible. But when you think of all the work that goes into a budget, their language, and how these two measures, whose revenue is rather small in overall scheme, and yet which are tainting the entire budget, and the entire idea of "culture-shift", and the entire Govt, it seems hard to believe, or is tribute to the miscalculation, stupidity and insensitivity of Govt.

3) Incompetence. Incompetence is usually the explanation for public policy and political mistakes rather than machiavellian calculation. It's always hard to believe, because one thinks: but they're the Govt?! Surely, given all their resources, and knowledge, and skills?! Whatever. Most such mistakes are pure incompetence. Maybe they're out of touch - been in power a while, and it's been an exhausting environment. Knowing the world, I usually put my money on plain incompetence.

4) If it's not mulish dogmatism, nor a negotiation-PR-political tactic, nor incompetence, then it's an even more machiavellian plan than Marissal supposed, a desire to safeguard the Canadian & QC models of progressive fiscal & social policy, notably health care, for good. It may not even be Bachand or Charest, but some advisor or bureaucrat who got their ear and convinced them it was a good idea to bring in regressive, access-limiting health taxes. Maybe Bachand & Charest don't even know they're being played. But the idea all along was to bring in measures so obviously disgusting and unacceptable that they would cause a revolt, an uprising of Canadians & Quebeckers determined to defend progressive taxation, social policy and health care, the Canadian-Quebec model. Where better than QC? I mean, if you were to pick one province where this kind of thing would be sure to cause a revolt, where the protestors' networks are sufficiently deep and strong to respond overnight, you would pick QC. Isn't that the strangest thing in the story, that the Finance Minister & Premier who would be trying this on, without forewarning or preparing the terrain, would be in QC OF ALL PLACES?! So you bring this stuff in, the response is so strong the Govt has to retreat, their numbers in the toilet, and all other governments say to themselves: "well, that settles it - not touching that, ever. We will rely on progressive taxes to finance these things, for good, and not even dream of user fees, or privatisation of health care, etc.". I mean, I find it hard to see, however this ends, how this doesn't end very badly for PLQ Govt, and that is the moral of the story, reiterated once again: don't mess with health care! Stick to progressive measures to pay for services!

Whichever it is, I am fairly sure of one thing: This will probably prove, in the end, one of the greatest victories for progressive forces in Canadian history, settling the question and setting the agenda for the foreseeable future, maybe for a generation, even.

Thank you Bachand & Charest!

PS. I like the idea that B&C are bringing all this down on themselves on purpose, in order to set in motion a process that will safeguard the Cdn-QC model for good - self-sacrificing deep moles if you will. That's my favourite - B&C playing dumb and sacrificing their political careers to ensure that the progressive model endures. Inspiring improbability.

QC Budget: Excellent Unintended Pedagogical Effect, Allows Destruction of Right-Wing Myths

One good thing about this QC budget is it offers an excellent opportunity to destroy common myths about public finances, economics & health care which are propagated by numbskulls, sellouts & the self-interested. Case in point, on Thursday, le Téléjournal had an excellent report titled Health Care: the Unforeseen Consequences of Private Sector Involvement which "discovered", again, that, private health care costs more and is more inefficient, and distorts and worsens the system in the aggregate when introduced or provided in a parallel system, by all measures, care, efficiency & economics.

Previously, on Wednesday, during 24 heures en 60 minutes, Louis Gill won a debate between economists, pointing out that the budget would terrible for a great majority of the population and wondering why other measures weren't considered, like a tax on capital gains and negative speculative behaviour (ed.note: denounced by Keynes et.al., leading to Tobin et.al.): "In the case of the general distribution of income, those who benefit from a non-exempt or mildly exempt capital gains, and who can in one day cash in on stock options which profit them massively, are still, even today, not taxed on these sources of income."

Now even a business columnist for a right-leaning paper like La Presse is following up, in The Legal Tax Evasion of CEOs, with Michel Girard drawing a parallel between the regressive taxation proposed by Bachand & Charest and the already regressive treatment afforded CEOs when they cash in their stock options, paying the same Fed-Prov 29% combined taxation rate as those earning $20 000, thanks to Bachand-Flaherty. He cites the real-world example among many, five Montreal CEOs who since 2007 have pocketed a fabulous 160 Million Dollars by cashing in their stock options. At the Federal level they qualified for an 80 Million Dollar tax deduction, a 40 Million Dollar tax deduction provincially, with the result that on the income from this stock options, they saved 19 Million Dollars in Federal Taxes and 10 Million Dollars in provincial taxes. He concludes by asking Bachand, Flaherty & all those business types lecturing us on how everyone has to pay their part, how it is they haven't yet proposed eliminating this privileged treatment of stock options? Hmm, I wonder, eh?

Like any social liberal & social-democrat, I am more than happy for a free and open debate on these questions, as the regressive taxation types are always advocating. We'll debate it openly, as Gill did, and see who the public believes and trusts. No cheating, eh, since you regressive taxation types are so convinced of the rightness of your position. And since you're true believers in rational actor theory and the wisdom of markets, political as well as any other, to be coherent, you will be more than happy to abide by the decision of the rational decision-making Canadian public, won't you? You are all democrats, aren't you. right?

PS. QC Budget: Good educational graphs here

PPS. Reality vs Corporate Taxes (Spoiler Alert, Reality Wins):

First, “taxes typically represent up to 14 percent of location-sensitive costs.” Since corporate income tax (CIT) is only one of the taxes paid by business, it alone accounts for an even smaller percentage of costs. Therefore, changes in the CIT rate have very little effect on total business costs.

Second, Canada’s effective CIT rate is about 4 percentage points below the next lowest country (Holland) and about 10 percentage points below the other countries examined (see exhibit 5.10 on page 60 of volume I). So, Canada could raise its CIT appreciably and still have a lower CIT than our main competitors.

Third, Canada had the second-lowest costs overall. The current round of federal CIT cuts was introduced in the 2007 Economic Statement. Looking back before that, Canada had also ranked second in the 2006 Competitive Alternatives report (PDF). Apparently, the latest CIT cuts have not affected our overall ranking.

 (h/t Accidental Deliberations)

At Risk Of Becoming Carolyn Bennett's Publicist

Having once mentioned her Chicago speech, I feel I should follow up with her Chicago Powerpoint, when she was "Honoured to defend Canada's cherished universal public health care system in Chicago today" (April 13, 2010). More interesting to me is her blog post "This is what the British achieved between 1997 and 2010...BBC: NHS record praised on speed and access to care." The point being, of course, taken in combination with her speech, that we have made progress, things are getting better here and in UK, single-payer is cheapest, most efficient & fairest, given our particular evolutions (Cda & UK), but that as NHS example shows, we can do even better, and cheaper, if we press ahead with needed reforms within public framework. But make no doubt, health care costs will rise, as all costs do, but that being the case, and since we have loads of fiscal capacity, the only question is the administration and delivery methods, public or private? And as all those in the field keep trying to hammer into everyone's thick skulls, not only is public fairest, it is also cheapest & most efficient, viewed from macro perspective.

Finally, as regards societal specificity, I have previously commented on Obamacare & its consequences for us (higher USA taxes allows higher Cdn taxes) and I'd also like to remind people of Obama's line about how if they were starting from scratch they'd go single-payer, but they're not, because their system evolved in its own particular way. Similarly, we are not Sweden or Holland, our system evolved in its own way, with its own context, as theirs did, and we can't suddenly import theirs without importing much of their own internal web of taxes and services that ensure the public welfare. And even if that's what we wanted to do, adopt their tax rates, and social spending practices, etc., and thus be coherent in allowing a larger private role, it might still be a bad idea, given where we are and who's our neighbour and trading partner, as compared to them. Not to mention the time and money lost in such a massive transformation. We have an excellent system, born out of our own history and context, which is pretty cheap & efficient and can be made more so. The arguments for maintaining, improving and building our system vastly outweigh those for radical deconstruction and reinvention. Every developed country is in same situation, and our situation is golden compared to the rest. The progressive taxation-single payer model is best, supplemented by clever & equitable implementation of sales & green taxes. To claim otherwise is either ignorance or sophism.

Bogus ‘dentists’ prey on immigrants: Denticare Needed = Obama Inspired Public Option

Bogus ‘dentists’ prey on immigrants - Front Page Story. My solution, from a while ago - Denticare - Good Politics & Policy, & Obama = Opportunity:

Now is the time to make this vote-winner a reality, by leveraging Canadian pro-Obama sentiments and Canadians' awareness & approval of the Democrats' desired "public health care option" to propose a similar "public dental care option", to cover the 40% of Canadians without dental insurance, and help the even greater number who struggle with the costs of profiteering insurance companies and "gourmand" dentists. (...) A public dental insurance option, modelled on the Obama plan, free for the poor, working- & lower-middle classes, subsidised on a sliding scale for all others, would save Canada a lot of money, reducing extreme costs of hospital emergency demands, and forcing dentists & insurers to be less "gourmand", and more efficient. It would also make Canadians healthier, happier and more productive.

PS. Denticare & Federalism
PPS. Initial Denticare Rates
Bonus: Canadian Political Economy & Health Care In Context (one of many, but I mention Denticare in passing)

The Provocative Mr. Silver

Silver missed his calling, he would have been a great headline writer for the Toronto Sun. Always smart, always fun, and often provocative. Today, The Canada Health Act is dead. Knowing Silver, the intent of the headline and apparent conclusion may not be what it seems. Maybe yes, but I wouldn't have been surprised to see the whole thing end with a ";)". Perhaps Silver hasn't been able to find a paper copy of Macleans and is only aware of Coyne's piece. Were that the case, I would strongly suggest that he and others find themselves a paper copy and read Geddes vital piece. I'll link to both Coyne's and Geddes' when they are both up (nb. generally, if you're not reading Geddes, you're snoozing & losing). Sufficeth to say, the game is afoot. Silver perhaps does not know that the hypothetical user-fee would only come into effect, supposedly, in 2012-2013 at the earliest, and probably not until 2013-2014. Supposedly. I am sure that he and others remain innocently unaware of any reminders of hard facts and considered reflections: "Quant au ticket modérateur, il faudra voir si les avantages potentiels d'un tel système valent les coûts, la complexité et les risques de sa mise en place."

But innocent as Silver is, and as unlike him as it would be, on the off-chance that he was implying that Iggy & the LPC don't need to denounce the airy hypothesis and alienate Charest & the PLQ right away, losing their material support during the Federal election that will precede by quite a bit the introduction of any hypothetical user-fee, that "there's many a slip 'twixt cup and lip", and one can wait until the QC politics work themselves out and the final proposals are brought forward, whenever that is, however far away, before finally taking a hard position, I would respond, should Silver be taking such an position, despite his innocent, unworldly nature, that there is of course the simple matter of right & wrong, not just on health care & Liberal principles re. society, but as regards coherent federalism vs. asymmetrical chaos (a question about which I know he is ignorant and apathetic, carefree even), in addition to the probability of someone else waking up and eating our lunch. But as I know Silver is an innocent idealist with no idea of the machinations of politics nor the workings of the media and public opinion, and never tries to influence these in any clever way, I shan't bother, of course.

;)

PS. In unrelated news - McGuinty on health care user fees: no evidence that they work

We Are Undertaxed! Check Out OECD & Carolyn Bennett

19 OECD countries tax more than us, all those with decent services, and until recently, only 10 taxed slightly less - Mexico, Turkey, Korea, USA, Japan, Switzerland, Slovakia, Ireland, Australia and Greece. However, given their troubles, some of those ten will be taxing more, like Ireland, Greece and the USA (plus Obamacare tax effects). Which extremes should we be comparing ourselves to, Mexico & Turkey, or Denmark & Sweden? Look, our tax burden is 16% lower than the EU 15 average (ie. Western Europe - we're still 14% than EU 19 average including less comparable Eastern European countries). Keep in mind that these numbers are based on 2007 numbers and provisional 2008 information, so given how much better placed we are compared to others, esp. post-recession, the margins are probably even wider, and growing. We can easily raise taxes a bit to pay for cost growth, as Finance has noted: "Even very large increases in health spending as a share of GDP are technically feasible, provided citizens choose to devote an ever increasing portion of GDP to the health-care system and are willing to pay for its cost."

As Carolyn Bennett recently reminded us, "There's no question that Canadians sometimes expect to be able to pay American level taxes and have European level services". But forced to choose, they pick the services and commensurate taxes. Actually, Bennett has been full of good sense on health care recently, on QC budget & user fees. She's giving a speech in Chicago tomorrow Healthcare: Understanding the Future. Could be interesting. She provides a useful backgrounder in the form of a brief and easily understandable Powerpoint presentation by Monique Bégin & Judy Erola.

Centre Defined: Between Prentice & Comartin

What is this mythical Centre that Coyne, Manley, CTV, & Canwest (start to see a pattern?) want us to "regain"? A simple test is to take the right-most MP of the left, say, Joe Comartin, & the left-most MP of the right, say, Jim Prentice, & imagine those as the outer limits of the Centre. Seems to me if anything the LPC remains a centre-right party. We offered by far the largest tax cuts of all parties in the last election, $50 Billionish! How much further right would we have to go to occupy this mythical Centre? Privatise health care? Adopt an "Empire Lite"-supporting foreign policy? Cut services, devolve all possible powers to the provinces, decentralise all responsiblities, etc. - only then will we reach this mythical Centre? Do they take us for fools? That's the Right, not the Centre.

Every public opinion survey always shows a large majority of the population adhere to supposedly "leftish" or commonsensical views: investments far preferred to tax cuts, public services (eg. health care), multilateralism, an end to foreign military adventures, civil liberties protected but balanced with collective identity & self-protection(anti-hatemongering laws, Canadian nationhood). Even if we just take the last election, an anomalous Con win in historical context which should point to a more right-wing country, 62% of people voted for then NDP, Greens, Bloc & a supposedly red-Liberal platform & leader,although how a platform that advocated the biggest tax cuts of all is left-wing is beyond me.

The NDP & Bloc, & Greens too, at least in popular perception, are all to the left of us. So if we try to find the median voter at 50%, we can start at let's say, Jim Prentice, the last .01 in the 37.65% the Cons received. From there it's 12.35% to reach 50%. That's slightly less than half of our 26.26% support. So the Centre leans ever so slightly left, to the palest of pale pink Liberals. If say, at least in perception, Dryden & Dosanjh are two poles on the left & Brison & Ignatieff are two poles on the right, which Liberal, policy-wise, best represents Mr. & Mrs. Median Voter? Policy-wise, it's someone like Stéphane Dion. I realise that's not the perception but I'm assuming readers have followed policy debates over the years. One of the forgotten reasons Dion won in 2006 is most Liberals were comfortable with his policy positions. It helps to have been in the caucus since 1996 of course.

I hope all Liberals act according to their convictions. But if we were to consider how we should position ourselves, a couple of questions arise: who best represents the median voter? What policies does that entail? Given the Cons fantastic party machinery and rock solid base (particularly in rural Saskatchewan, Alberta & BC), amounting to at least 33% support, how is it easiest to take support, from the less wealthy, less organised Greens & NDP, both who achieved historic highs in the last election (ie. can only go down?) or from the Cons?

Others may have different answers but to me, "poser la question, c'est y répondre": to ask the question is to answer it.

Conference Board vs. Pessimism, esp. re. Health Care

It's funny, the headline CBOC spin is pretty negative, yet as Picher points out, the report is very positive, in its details. And on health care, Canada performs better than our 16 peers on six indicators, worse on three, and average on two. Gee, that's TERRIBLE...actually, no it's not, it's really strong. And the whole report doesn't account for Canada's unique challenges of size, heterogeneity and having the American elephant next door, our overwhelming partner, with its crazy system, hideously undertaxed and underserviced, and the pressure this puts on us. In the absolute we're doing excellent, and if one was grading on a curve, we'd be tops, far and away. I mean Canada's challenges and Finland's are not exactly equivalent, eh? The only true weak spot, as always, is with our useless capitalists, with innovation as the best indicator. Take away? Great public servants and public services, weak capitalists. "Capitalists - Must Do Better".

Bless The Obama USA

Listening to Springsteen & sipping JD in celebration. There are still a lot of problems, but tonight was a good night for USA, a long-term realignment of their politics, and hence a good night for the world. A race between USA getting rational and global environmental, economic & security disaster. Solutions depend on functional USA politics, which means convincing Americans that Govt is the solution, not the problem, to a lot of basic problems, proving the system CAN work, and thus inspiring higher voter turnout, which always works to advantage of forces of democracy and progress. And that's why Obama went all-in on health care. The Republicans of tomorrow will look a lot more like Cons elsewhere. The curve is bent, hard, for good, now (assuming even Dems can't screw up Senate reconciliation).

One note: only ignorant fools miscontextualise mixed public-private health insurance systems. Go live in Europe, fools. For example, right-wing Canadians like to cite straw-man French system without noting 5+% have no health insurance, quite a few more have sub-optimal insurance, as confused by details of multiplicity of plans, the system is worse managed than ours, more in debt, more overspending, misallocation of resources (too many docs, and in wrong fields), paying for insurance = more hypochondria, highest drug use, costs, etc.etc.. And then they also forget how these systems, as in Sweden, are part of interconnected web of services. So if they want to be coherent, they have to also advocate that all other social services are offered on Swedish/French/Dutch level: MUCH HIGHER welfare, EI, virtually free education, daycare, etc. etc.. So before repeating these infuriatingly ignorant tropes, do some frigging research. And then be coherent: want French/Swedish systems, despite failings? Then also have to favour vastly increase expenditures on EI, welfare, etc., so people can buy their care. Etc.. God I hate decontextualisation. Every society has its own path, determined by history, geography, econ & politics - the right solution in one place is not the same elsewhere. You would think commentators in a federation as heterogeneous as Canada would understand this, by now. Apparently not. Crikey.

I'm glad the USA is on track to joining the rest of the civilised world. This will also increase USA tax levels down the line, and give Canada more freedom to pursue better services, as we will have consequently greater margin for manoeuvre. So bless the Obama USA. But God keep Canada glorious and free.

Health Tax In QC, But Regressive, Not Progressive

Not a bad idea, or precedent on which to build, tax-wise, but should be progressive, like Kent's superior model.

So while principle is OK, I agree with Marois' & Khadir's criticism: «Les Québécois vont payer 200 $ de plus par année, pour avoir exactement les mêmes services» de soutenir Pauline Marois. «C'est une taxe régressive. Tout le monde paiera la même chose sans égard aux revenus» déplore Amir Khadir, de Québec solidaire.

Trans. But Parti Québécois leader Pauline Marois said the government did nothing to improve management of the health system. The new fee won’t improve health care because it will simply cover the expected growth in spending, she said. “Users will pay more but they’ll get exactly the same services,” Marois said.

Khadir: It's a regressive tax. Everyone will pay the same amount without taking their income into account.

Harper, Defender of Medicare = CPC Majority?

If I was Iggy, I'd backtrack very quickly. Spector's describing this one correctly, it's not just poll numbers of 75+% strongly opposed, it's over THREE TIMES the "Gui  Effect". When Latendresse was traded, there was uproar, and TVA got 1500 emails in protest, which was huge, and unheard of. But within 24 hours of this budget, they've received over 5000 emails! The Gui emails were over a couple of days, the budget emails, re. health care, were triple, and within 24 hours. That's to give outsiders of an idea of the tumult, in easily understandable pan-Canadian terms.


Harper's goal has always been to replace the LPC as the Natural Governing Party, and to do so he has, judo-like, stolen and reworked the iconography & mythology of Canadian identity and nationalism to his advantage, and been shameless in his tactics, from the 2006 campaign and "Stand Up For Canada", to knowingly engaging in stupid policy like the GST cuts, and the whole Tim Horton's agenda, to Blue-ing everything, to using the military as props, Canada's Action Plan, etc.. If I were him, I'd do what Dief did to Pearson in 1958 and Chrétien did to Day in 2000, leap on Iggy's comments in favour of the regressive health taxes, and come out strongly in favour of medicare, declare he needs a majority to defend it from Liberals who want to destroy it, and also to defend the troops, and declare an election today.


It is the one issue, along with defending the troops from the evil coalition, that could put the CPC over the top. Completely cynical, as we all know if he had a majority he'd actually kill medicare, but Iggy's given him an opening. And given Iggy's position, anti-Harperites will go to the other Opposition parties. Perfect fragmentation of the vote for a CPC majority.


Harper & the CPC can drape themselves in the flag, and replace the LPC as the party of nationalism and patriotism, and judo-like, use medicare to their advantage, the one icon they hadn't yet been able to make into a winning CPC position as yet.


As I say, Iggy & the LPC better "correct" their words pronto. Given how unpopular Charest is, and how is understood to be a Liberal in the rest of Canada, and how he's treated Harper, you don't think Harper woudl relish running against him in QC and Iggy outside, fighting for medicare and our troops against the un-Canadian Liberals? He'd pick up seats in QC, PLQ machinery or no (ADQ would join in), and sweep Ontario, BC, hell, he'd pick up seats everywhere.


By messing around with medicare, Iggy & the LPC may just have created the unique conditions for a Harper majority, and once he's done, you won't recognise this country, and no traditionally identifiable progressive Canadian party will win again, for a generation.


"Correct" your position, pronto, Iggy. Charest & the PLQ's affection is not worth handing the issue to Harper on a platter.

Does Picard Ever Talk To Simpson?

Picard: "Despite popular mythology to this effect, health-care spending in Canada is not out of control: After adjusting for inflation and population growth, spending increased 2.5 per cent last year"

PS. That Walkom is a bright fellow - of course one always says that when one is in agreement, as I am with pretty much everything he's written recently. I would ask though, in the interests of accuracy and fairness, that when people mention NDP & Afghanistan in same sentence, they also mention NDP's sickening self-indulgent support of Cons in 2007, extending the mission beyond 2009, effectively. Every party has blood on their hands, in this folly.

Shocking Anti-Journalism, But Also: Questions décevantes des médias francophones

Why Harper wasn’t asked about census
Harper Takes Questions After Cabinet Shuffle C'est assez triste comme histoire, mais c'est quoi ça, osti : "Two French-language questions followed: on John Baird's appointment as Government House leader and Ottawa’s plans for future health care spending." On ne s'intéresse pas au recensement, au G20, nous autres? La nomination de Baird plus importante que le recensement? C'est quoi l'affaire?

Trudeau le héros et Mulroney le nul - Trudeau the Best & Mulroney the Worst (Angus Reid)

Trudeau the best prime minister; Mulroney the worst, Canadians say
"Trudeau is the top choice across every region in the country and
almost all demographics."

Parlons "fibre moral" : et les 300 000$ de Schreiber, M. le Menteur corrompu?
And that's without Lyin' Brian explaining the $300K from Schreiber -
moral fibre anyone?

June 28, 2007 – Nearly 40 years after he first came to power, Pierre
Trudeau's tenure as prime minister continues to stand out for
Canadians, a new Angus Reid Strategies poll has found.

In the online survey of a representative national sample, 42 per cent
of Canadians rate Trudeau as Canada's best prime minister since 1968.
Trudeau is the top choice across every region in the country and
almost all demographics.

Trudeau also emerges as the leader with the best record on four of
eight national issues, more than any other prime minister. Canadians
believe Trudeau did better than any other leader on international
relations (31%), health care (21%), federal/provincial relations
(18%), and national unity (31%).

The poll also finds that Brian Mulroney is considered Canada's worst
prime minister, with 21 per cent selecting him as the worst leader
since 1968. Mulroney, who was prime minister from 1984 to 1993, was
widely unpopular during his leadership because of patronage scandals
and the introduction of the GST, among other things.

http://www.angusreidstrategies.com/index.cfm?fuseaction=news&newsid=79&page=3