Thoughts On The “Tanning Tax”

A few days ago a 10 percent federal “tanning tax” took effect.  The tax is one of the revenue-generating provisions of the “health care reform” bill.  It applies only to tanning beds and other devices that use ultraviolet rays to give customers tans and is expected to generate some $2.7 billion in annual revenue.  The stated purpose of the tax is to fill federal coffers while at the same time discouraging people from engaging in risky behavior.  Is indoor tanning really more risky than sitting out in the summer sun without using any sunblock?  Both approaches expose the skin to ultraviolet rays, but a recent study (criticized by some industry groups) concludes that indoor tanning is a special risk factor for melanoma.  Interestingly, the “tanning tax” replaced a different tax — dubbed the “Botax” — that would have put a 5 percent tax on Botox injections, breast implants, and other forms of elective cosmetic surgery.  The “Botax” was rejected after heavy lobbying by doctors and the medical industry.

I don’t use indoor tanning salons and can’t imagine doing so — but I question the underlying concept of the “tanning tax.”  Do we really want to get into the habit of taxing what the federal government considers to be risky behavior?   Should sports cars and motorcycles be taxed at higher rates than sedans?  Should mountain climbers, skydivers, and participants in extreme sports should be taxed more heavily than couch potatoes?  We are moving beyond “sin taxes” on alcohol, tobacco, and gambling to a new realm of governmental efforts to modify human behavior — and I am not comfortable that the government is well-situated to make those kinds of judgments.

The “tanning tax” is a good example of what can happen when the government makes these kinds of decisions.  The “Botax” would have produced more revenue than the “tanning tax,” but it had powerful opponents who were able to derail that initiative.  Most tanning salons, in contrast, are locally owned small businesses without significant political clout.  In the test of political muscle, the tanning salon owners lost.  Political clout doesn’t seem like the most scientific way to determine behavioral modification goals, however.

One other point about the “tanning tax” is worth mentioning.  Tanning salons are sources of jobs and shopping center leases in virtually every community.  The local owners of those businesses are concerned that the tax will cause customers to cut back on their visits and thereby force some tanning salons out of business.  It is too soon to tell, of course, whether those dire predictions will come to pass — but in these difficult economic times why are we taking steps that might put small businesses into bankruptcy and cost scarce jobs?

Be Careful What You Ask For

One of the first rules learned by trial lawyers is this:  when cross-examining an adverse witness at trial, you never ask a question if you don’t know how the witness must answer that question.  You don’t want surprises, and asking one question too many and getting an unexpected answer that is a spear to the chest of your case is the worst surprise of all.

Congress apparently doesn’t know this rule — or at least the House Energy and Commerce Committee didn’t.  As readers of this blog will recall, after the “health care reform” legislation was enacted a number of large American companies changed their financial statements to reflect increased liabilities.  Congress responded by asking the companies to produce all of their confidential internal documents related to the impact of the new law on health care costs.  That was the question that should not have been asked.

As Fortune recently reported, the documents produced by the companies show that the companies are considering getting rid of their employee and retiree health care plans entirely — which is exactly what opponents of the “health care reform” legislation predicted.  It turns out that, for many companies, paying the penalty to the government for not offering health care plans is far less costly than the expense of continuing to offer the plans.  Part of the reason for that imbalance is that the “health care reform” legislation is going to add considerably to the cost of the plans, by requiring coverage for people who are currently uninsured, through operation of the “Cadillac tax” on certain plans, and as a result of the pass-though of new taxes on drug manufacturers, medical device makers, and health insurers.  According to the documents the Committee received, AT&T alone would save nearly $2 billion a year by junking its plan and paying the penalty.  In this highly competitive global economy, where corporations are trying to squeeze every penny, does anyone doubt that at least some American companies will lock in those savings by getting rid of their employee plans?

If corporations do jettison their plans, what will it mean?  For one, it will mean a lot more Americans will need to be covered by plans that are subsidized by the government, which in turn will cause the projected cost of the whole “health care reform” apparatus to skyrocket.  For another, it will mean a lot of people who have Human Resources jobs at American companies will need to dust off their resumes.  If companies don’t need to administer health care plans they won’t need as many HR people as they have now.  And finally, it means there will be a lot of unhappy Americans.  For all of the focus on the “problem of the uninsured” during the debate on the “health care reform” legislation, the fact is that the vast majority of Americans have insurance and are happy with that insurance.  Most of those people are insured through their employers.  If their company plans go poof, and they have to try to find some kind of alternative coverage, they aren’t going to grateful to Congress for that opportunity.

How did the House Energy and Commerce Committee react to these documents?  Predictably, they canceled the hearings and meekly concluded that the companies’ accounting treatment of the increased health care costs was just fine.  That kind of “hear no evil” approach won’t work quite as well when companies start to cancel their employee health care plans, however.

It’s About Time

Last night President Obama directed the Department of Health and Human Services to require all hospitals that receive Medicare and Medicaid funding — which means virtually every hospital in the United States — to afford visitation rights to the partners of gay men and lesbians who are hospitalized.  It is hard for me to believe that, in the year 2010 in America, there are hospitals that bar same-sex partners from visiting patients, but apparently there are still some such benighted institutions in the land.  It is to President Obama’s great credit that he took action to end that practice.

If a hospital’s mission is to help sick people get better, how can they reconcile that purpose with a a policy that excludes a loved one who could provide emotional support and comfort to the patient?  Common sense says that the visit of a loved one will make the hospital patient feel happier and less isolated and therefore quicker to feel better.  Studies have supported that conclusion.  Given that fact, hospitals should be welcoming any visitor who will facilitate the healing process, regardless of the nature of the visitor’s relationship with the patient or the hospital’s unrequested and unnecessary moral judgment on the propriety of that relationship.

It is too bad that the President of the United States had to issue instructions that will cause hospitals to simply focus on their mission of healing, because it says something unfortunate about some American hospitals.  But, if a presidential edict was needed to implement basic fairness, I am glad President Obama supplied it.

A Chilling Thought About The “Health Care Reform” Law

The New York Times is reporting that the “health care reform” legislation includes a provision which bars members of Congress and their staffs from continuing to participate in the Federal Employees Health Benefit Program.  A Congressional Research Service study of the new law reaches that conclusion — which is unfortunate for Members of Congress and their staffers, because the FEHB program provides rich benefits at low cost.  So now, our Senators and Representatives may have to fend for themselves and find their own insurance, just like the rest of us.

The most interesting part of the Times article, though, is this chilling passage:  “The confusion raises the inevitable question: If they did not know exactly what they were doing to themselves, did lawmakers who wrote and passed the bill fully grasp the details of how it would influence the lives of other Americans?”

Given what we are learning about the “health care reform” bill in the weeks since its enactment, does anyone actually believe that Members of Congress who voted for the bill, or the President who signed it, “fully grasp[ed] the details of how it would influence the lives of other Americans?”  Whether Republicans or Democrats are in charge, Congress has always proven to be very proficient at advancing the interests of Members of Congress and proving great perks for themselves.  At times, that seems to be Congress’ highest priority.  If the House and the Senate weren’t even paying enough attention to determine that the bill was going to cost them a great benefit, what else did they miss — and how badly is it going to hurt the rest of us?

A Primer On The Impact Of Regulations On Health Insurance Costs

Here’s a thought-provoking article from Fortune comparing health insurance costs in New York and Arizona, and analyzing how the regulatory regimes in those states have affected those costs.  The article notes that health insurance costs in New York are far higher, and the available options are far fewer, than in Arizona.  It attributes the cost difference, at least in part, to two regulatory requirements that exist in New York but not Arizona.

One of the regulatory requirements is “guaranteed issue,” which means plans operating in New York must accept all applicants regardless of their medical condition.  Health insurers therefore cannot exclude applicants because of “pre-existing conditions” — an approach which, as I have noted previously, encourages people to wait to apply for health insurance until they are immediately facing significant health care costs.  The second regulatory requirement is called “community rating,” which means that all applicants must pay the same amount regardless of their health condition.  So, young healthy people who have low health care costs pay the same amount as older people who make much greater use of health care.  As a result, the younger and healthier participants in the insurance pool are directly subsidizing the health care of older and less healthy participants.

New York imposes the “guaranteed issue” and “community rating” requirements, and as a result the health insurance costs for young healthy people are much higher than they are in Arizona, which does not impose those requirements.

What does that mean for the rest of us?  It is relevant because the “health care reform” legislation recently enacted by Congress and signed into law by President Obama imposes both the “guaranteed issue” and “community rating” concepts, although the “community rating” requirement is not as stringent as that which exists in New York.  The question is whether those two requirements will operate to push up health insurance premium costs.  The experience in New York — and common sense — suggest that that is exactly what will happen.  And the increased burden will fall most significantly on the shoulders of young, healthy individuals who use health care the least.


Representative Bart Stupak, a Democrat who represents the Upper Peninsula of Michigan, has announced that he will not seek reelection.  Stupak was at the vortex of the “health care reform” legislation end game in the House of Representatives.  He originally voted against a “health care reform” bill — not because he opposed the “reform,” but because he opposed certain provisions of the bill that addressed federal funding for abortions.  He changed his vote at the end of the process because President Obama promised to issue an executive order addressing the abortion funding issue.  Some are skeptical of that stated rationale, because if the final legislation passed by both Houses and signed into law in fact has abortion-funding language, the legal force of a unilateral executive order attempting to override that language is extremely doubtful.  They think Stupak either caved in to intense political pressure from the White House and fellow Democrats or peddled his vote for some pet program or other emolument.

Stupak says he is quitting to spend more time with his family.  His district is remote, and traveling to and from Washington is time-consuming.  I have no reason to doubt his stated reasons, of course, but I think the timing of his decision is interesting.  Members of Congress have been back home for the Easter recess, and I expect that they have been getting an earful from their constituents — not just about the unpopular “health care reform” legislation and the corrupt process that produced it, but also about our struggling economy, the ballooning federal deficit, the failure of the “stimulus” bill, and a number of other issues.

Stupak has served in Congress since 1992 and has never had a problem getting re-elected.  I wonder whether the reaction he received from voters in this district during this recess influenced his decision.  We’ll get a better sense of that as the weeks pass.  If more Democrats decide not to stand for re-election, it may be because their political judgments are telling them that, in this political climate, it is wiser to go out on their own terms.

Doubts About The In-And-Outers

Massachusetts has its own version of “health care reform” legislation, which is similar in some ways to the federal “health care reform” legislation.  For that reason, the current Massachusetts experience may be a precursor of what we could soon be facing on a national scale.

Yesterday that Boston Globe ran an interesting article that should cause concern among all responsible citizens.  The article addresses the phenomenon of what might be called “in-and-outers.”  “In-and-outers” are people who come in to the health “insurance” system only when they already need immediate health care, rack up health care costs that far outstrip the amounts they pay in premium, and then go out of the system when their need for health care ends.  The rest of the time, they pay a monthly penalty that is less than the monthly cost of the premium would be.  During the few months they are in the system, their average health care costs are far greater than the average health care costs of the long-term participants in the health insurance system. This phenomenon — which has created an imbalance in Massachusetts totaling in the millions of dollars — also could occur under the federal “health care reform” legislation.

Polls show that one of the most popular concepts in the federal “health care reform” legislation is the provision banning insurance companies from denying coverage to people who have pre-existing conditions.  As I’ve written before, I think this may only be because people don’t fully understand the point of exclusion of pre-existing conditions, which addresses one of the fundamental underlying concepts of insurance.  In reality, pre-existing condition exclusions hold down costs for responsible people who buy insurance to protect against future risk by preventing people from “gaming the system” by buying insurance only when, for example, they learn that they need knee surgery or have some other condition that requires expensive short-term treatment.  “In-and-outers” aren’t buying “insurance” against future risk because the risk is already realized.  Instead, they are buying a subsidy for their health care, and sticking the people who stay in the insurance pool long term with most of the tab.

This phenomenon isn’t fair, but it is predictable.  There always will be people who will try to maximize their economic benefit and take advantage of other people, without regard to fairness.  If the federal “health care reform” statutes don’t recognize and account for that reality of the human condition, it will be a significant problem for the rest of us.

The Law Of Unintended Consequences

A number of U.S. companies have modified their accounting statements to reflect increased liabilities that will be imposed on them as a result of the “health care reform” legislation.  The latest (and largest) is AT&T, which is taking a $1 billion non-cash charge to its accounting statements for the first quarter of 2010.  AT&T says the charge reflects additional taxes it will have to pay.  The increased tax burden in this particular instance could cause AT&T and other companies to change — and perhaps eliminate entirely — benefits offered to retirees.

Congress’ response to this news is interesting and entertaining.  The Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce has asked the CEOs of the affected companies to appear for a hearing and to produce clearly confidential corporate documents, like analyses of the impact of “health care reform” legislation on the companies and other documents, including e-mails, prepared or reviewed by senior company officials concerning health care reform.  Copies of the letters to the company CEOs are available on the Energy and Commerce Committee website.  The tone of the letters is quasi-intimidating and humorous at the same time.  The letters earnestly state that “[t]he new law was designed to expand coverage and bring down costs, so your assertions are a matter of concern” and notes that the companies’ decisions “appear to conflict with independent analyses” like the Congressional Budget Office and the Business Roundtable.

The implication of these letters is that the Committee expects to find a giant cabal, in which large American companies have gotten together to take phony accounting charges to undercut the “health care reform” legislation and make the President and the Congress look bad.  Is Congress really so clueless?  Do they honestly think that large companies manipulate their accounting statements and take $1 billion charges for political purposes?  In this post-Enron era, the accounting statements of publicly traded companies are carefully considered and vetted by independent accounting firms and independent audit committees of the company’s Board of Directors; political views don’t enter into the equation.  And in this economy, do Members of Congress really believe that companies would take huge unnecessary charges that would make their earnings look worse than they already are?

Even more hysterical is the letters’ pitting of the decisions of company management against “independent analyses” from the Congressional Budget Office and the Business Roundtable.  Does Congress actually think that the generic findings of the CBO about decreased premium costs by 2016, or the comments made by the Business Roundtable months ago about some earlier version of the “health care reform” legislation, have more substance than the determinations of company executives who must grapple with how accounting and auditing standards require them to evaluate and report the liabilities of their companies based on the specific of their particular health care plans?

The congressional investigation will leave the company CEOs being summoned in a quandary.  They probably can’t refuse to attend.  In this era of big government, no American company wants to be in the cross-hairs of anti-business congressional committees.  But the alternative is not attractive.  If the companies produce sensitive corporate documents to a notoriously leaky Congress, those documents may end in the hands of keenly interested competitors.  And if the CEOs appear to testify, they will likely be browbeaten by a gang of know-nothings who couldn’t distinguish generally accepted accounting principles from a cracked pumpkin and who will attempt to shirk their own responsibility for foisting increased taxes and increased costs on American businesses.  The hearings won’t be pretty.

Don’t be surprised if other companies announce similar accounting decisions as a result of the changes made by the “health care reform” legislation and if, ultimately, benefit plans get changed materially as a result.  Congress is about to get a serious lesson in the law of unintended consequences and the repercussions of making poorly considered, wholesale changes in the law applicable to a huge chunk of the American economy.

A Test Of Representative Democracy

I haven’t posted anything about the actual passage, and now the signature into law, of the “health care reform” legislation.  We are now learning about heretofore undiscussed provisions of the massive legislation — like the provision that requires disclosures of calories on the menus of restaurants, the provisions that exempt certain congressional staffers from certain aspects of the new law, and the special projects and funding agreements that secured some votes in the House of Representatives — and I have no doubt that we will learn more along those lines in the days to come. 

In any case, the “health care reform” bill is now a law, and Americans need to decide how to deal with it.  This country is a representative democracy.  The underlying concept of that form of government is that we are too big to have national plebiscites on every issue.  Instead, individual citizens elect representatives who then cast the determinative votes on legislation. Once they are in office, we must trust our elected representatives to exercise their best judgment, based on their knowledge of the issues and the interests of their constituents, in deciding how to vote.

In our system, therefore, the Members of Congress who voted in favor of the “health care reform” legislation had every right to do so.  They are not obligated to follow the currents of popular opinion or the findings of the latest poll.  Similarly, though, voters have every right to vote against a Member of Congress on the basis of their voting record.

The question now is how Americans will react come November, and whether they will vote out those Congressmen and Senators who voted for the “health care reform” legislation.  I know that many people are infuriated at what Congress has done.  Tonight, for example, as Kish and I were walking to the library we were stopped by a neighbor who vented for a good five minutes about the bill and the process by which it was enacted.  Will that neighbor have the same passion after months have passed?  Will she contribute to campaigns and canvas for candidates who vow to work to repeal the new law?  Only time will tell — but I expect we’ll be hearing a lot more about the “health care reform” legislation in the coming months, from the media and our friends and neighbors.

Paying Attention And Participating

Richard’s post below reminded me of a point that I wanted to make before the whole health care debate effectively ends, supposedly with a vote on Sunday in the House of Representatives.  Whether you support or oppose the “health care reform” legislation — and even a casual reader of the blog knows that Richard, UJ and I are on opposite sides of the fence on that point — I think we can all be proud of how politically engaged many Americans have been on the issues.  Although the media approach may be superficial, I think people are paying close attention to both the substance of the bill and to the process.  During the torturous path of the “health care reform” legislation, people have become knowledgeable about issues related to “the public option,” about certain insurance industry practices, about the role the CBO plays in estimating the budget and deficit impact of bills, about deals that have been cut to secure votes, about the Senate filibuster rules, the reconciliation procedure, and the role of the House Rules Committee, and about a number of other topics.

All of this is a good thing — a kind of civics refresher course that should make our body politic more attentive to important political issues and to the need for people to participate in the process.  We are already seeing this, through the various protests and the estimated 100,000 calls per hour that currently are overloading the congressional phone system capabilities.  I would guess that many of the people who are calling and advocating, pro and con, for the “health care reform” legislation didn’t vote in recent elections, or perhaps voted without a sufficient understanding of their candidate’s positions on issues like “health care reform.”

I expect that all of that will now change.  Although some pundits are predicting that the public interest in politics will wane, because some voters supposedly are disillusioned with President Obama, I think the opposite will be true.  If the “health care reform” legislation is enacted, the resulting law will have real consequences for people’s lives, their health care options, and their pocketbooks.  The impact of those real consequences will cause people to realize that, if they just sit on the sidelines, they have only themselves to blame if the consequences are not to their liking. 

American voters obviously disagree on “health care reform,” but I think we can all agree on one point — it is better to have our citizens  paying careful attention to what our elected representatives are doing and giving them an earful on what their constituents are thinking about the important issues of the day.  Democracy works best when voters are actively engaged in the process.

A Craven and Cowardly Congress

The Democrats in the House of Representatives apparently are carefully considering using various procedural machinations that would allow them to avoid casting a direct vote on the Senate version of the “health care reform” legislation.  Instead, the approach under exploration would allow the Senate bill to be “deemed passed” if the House adopts a rule on the consideration of the reconciliation bill or passes some other procedural proposal.  Speaker Nancy Pelosi and her leadership team reportedly are looking at other, similarly spineless options, like approving the bill through a voice vote rather than a recorded roll call vote.

With this kind of gutlessness, is it any wonder that people are fed up with Congress and despair at its ability to make tough decisions on issues like deficit reduction?  Our elected representatives are happy to get personal attention when it comes to campaign contributions, or congressional junkets, or being treated like a big deal at the Labor Day parade or the Jefferson-Jackson Day Dinner.  But when it comes to actually casting a vote on one of the most important pieces of legislation Congress has considered in years — legislation that has been the focus of more than a year of debate, speeches, and foul political maneuvering — Members of the House shrink into the woodwork and want to be let off easy.

I strongly disagree with Ohio Senator Sherrod Brown on the merits of the Senate bill, but I appreciate his willingness to publicly state his position and be held accountable for it.  My advice to the Representatives in the House is this:  if you are unwilling to publicly vote for the Senate bill, then you should not attempt to obtain the bill’s passage through some subterfuge that you believe will give you “plausible deniability” come Election Day. You may, deep down, hold your constituents in contempt and believe that they can be misled about anything by some slick TV ads, but in this case you are wrong.  People are paying attention, they will remember, and they will vote.

Arm Twisting, Deal Making, And Story Telling

We’ve been assured before that the legislative process of “health care reform” had reached its “end game.”  This week, that description might finally be accurate.  The focus has shifted to the House of Representatives, which must pass the Senate version of the “health care reform” legislation — complete with its corrupt deals, accounting gimmicks, and other indicia of crass horse trading — and then join with the Senate to try to modify the Senate form of the legislation through a process called “reconciliation.”

Every night the news shows purport to give counts of the yes and no votes in the House, with the current story being that, as of now, the “yes” votes are falling short.  In such a scenario, the rank scent of deal making and arm twisting must be heavy in the air — leading to a political process that likely is even more crude and corrupt that was found in the Senate as the hours counted down to a final Senate vote.  If health care reform passes, we should not be surprised to learn of promises made for funding of new initiatives in a wavering Congressman’s district or a quick path to a floor vote on his pet legislation, of deals cut for political patronage, or of threats of blocked initiatives or other forms of legislative punishment for potential naysayers.

In the meantime, President Obama stumps the country.  Lately, he has been focused on the story of one ill Ohio woman as exemplifying the need for “health care reform.”  As I’ve mentioned previously, I despise efforts to reduce extraordinarily complex issues to one person’s story.  The tale of Natoma Canfield is no more instructive or broadly meaningful than the weird story, told by one Representative at the recent Blair House “health care summit,” about a woman who supposedly was forced to wear her dead sister’s dentures due to lack of health care coverage.

It is absurd to argue that we should fundamentally change our approach to a multi-billion industry that provides excellent health care to millions and millions of Americans on the basis of one woman’s experience.  If Americans fall for such blatant manipulative efforts to pull on our heart strings and overwhelm our reason, we have only ourselves to blame, and our elected representatives to hold accountable come November.

Dealing With The Annoying Door-To-Door Salesman

They call the presidency the bully pulpit because the President’s visibility and stature allows him, to a significant extent, to set the nation’s agenda.  I wonder, however, whether President Obama hasn’t abused the bully pulpit with his constant drum-beating on health care.  Every poll shows that a large majority of the American people don’t want the overreaching, budget-busting, “health care reform” bill that was passed by the Senate, but the President just doesn’t seem to get the message.

Today, President Obama left Washington D.C. to make yet another speech on health care reform.  It is hard to believe he has anything new to say — and he hasn’t.  Sure, he’s set another arbitrary, unilateral deadline for Congress to act on the bill, but he’s done that countless times before.

It is as if President Obama is trying to wear people down, like a persistent vacuum cleaner salesman who has stuck his foot in the door and just won’t leave until he has tried every possible trick to get you to buy an expensive contraption that you have said, repeatedly, that you don’t really want and can’t really afford.  Sometimes polite efforts to get rid of the annoying salesman just don’t work.  Perhaps it is finally time for voters to tell their elected representatives to slam the door.

Motivated Consumers And Health Care Cost Containment

Virtually every American, at some point in their lives, has had to cut back and adjust their spending habits.  It may have been when they were saving for a honeymoon or a special gift for a loved one, or it may have been when they scrimped to put a child through college.  Sometimes the decision is forced on us, such when we are laid off or find ourselves dealing with unexpected expenses, like an unanticipated home repair.  For many people who have lost their jobs in the current recession, the time for careful personal budgeting is right now.

In my experience, consumers who are personally focused on cost containment can, and do, contain costs.  They eat out less or buy the “un-brand” alternative at the grocery store; they decide to drop a magazine subscription or two, drive instead of fly on a trip, or forgo a vacation altogether.  As the sacrifices mount, so do the savings.

That is why this article by Indiana Governor Mitch Daniels seemed sensible to me.  He reports on the Health Savings Account option offered to Indiana state employees and the significant cost savings it has achieved.  Under that system, the state deposits a set amount in an account for each employee for their health care costs for the year, and whatever the employee does not spend becomes their personal property.  The employee has an incentive to be a careful consumer — to think about what they really need, to hunt for a cheaper provider, to choose the generic alternative rather than the name brand, and so forth — and that is precisely what has happened.  The employees want to keep as much of the money in the accounts as they can manage, and as a result the State is realizing substantial savings in its health care expenditures.

I think one significant step toward bringing our health care costs under control would be to introduce the concept of naked financial self-interest to the health care choice equation.  Currently, individuals whose care is paid for by third parties, whether a government-sponsored plan or an employer-sponsored plan, have no incentive to engage in penny-pinching.  They don’t look for the cheapest alternative or consider whether they can reasonably forgo the service because someone else is footing the bill.  I think if they saw an impact on their pocketbook they would make those kinds of careful judgments, and the federal and state governments — and ultimately taxpayers — would benefit as a result.

Actions Speak Louder Than Words

The Premier of the Canadian provinces of Newfoundland and Labrador came to the U.S. for a special form of heart surgery.  In Canada, his only choices given his condition were procedures that would have required breaking his ribs.  In America, he underwent an advanced procedure that allowed his heart condition to be surgically fixed through an incision that did not require breaking bones and allowed him to return to work more quickly.

This decision is not an indictment of the Canadian national health system, but rather a positive reflection of the tremendous American system.  The Premier’s statement about his decision also has the sound of a rallying cry.  “This was my heart, my choice, and my health,” he said.  We should all be happy that the United States offers such health care choices, and leery of proposals that might eliminate those choices.