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In an ambitious effort to slow the growth of health care costs, the Affordable Care Act created the Center for Medicare and Medicaid Innovation CMMI and armed it with broad authority to test new approaches to reimbursement for health care payment models and delivery system reforms. CMMI was meant to be the government’s innovation laboratory for health care: an entity with the independence to break with past practices and the power to experiment with bold new approaches. Over the past year, however, the Department of Health and Human Services HHS has quietly hobbled CMMI, imperiling its ability to generate meaningful . Insurance policy design and regulation continually grapples with moral hazard concerns. Yet these concerns rest largely on theory based assumptions about how rational economic actors will respond to financial incentives. Advances in behavioral economics call these assumptions into question.

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It is not totally socialized medicine but a mix of private and public services. The hospitals are owned and funded by the provinces and in the case of British Columbia that was accomplished originally by a sales tax. It is a one payer system and the doctors as a group must negotiate their rates for services with the provinces. In other words, they can't charge whatever they want for any given procedure. Each province is a little different, but is required to provide basic health services under federal law. In BC, we only pay 25% of nearly all prescriptions up to an annual maximum of $400 and up depending on income.