Both are good examples of how billing (or IT) systems can structure program delivery. Sometimes this is by design but often it’s at the expense of program goals.

“The OMA says the billing system has not kept pace with surgical innovation and often doesn’t account for newer or more complex surgeries. This has led to some doctors no longer offering procedures to patients over fear of not getting paid, while others choose to leave the province.”

As one does.

It's such a nice example of how the structure of law and government structures political disputes.

Finally, what I find so fascinating about this is that when economic crises occurred in both countries the subsequent constitutional questions reflect the mechanisms deployed to check federal power: in the US separation of powers between the branches and in Canada between the levels of govt.

Since Canada has a parliamentary system of government with a comparatively weak federal government, the question was not a separation of powers question. A Prime Minister with a majority government can always pass legislation in Canada. Instead it was a federalism question.

The Supreme Court found that it was and in the process gave us our modern leading case on the national emergency power under POGG. The case is here, if you're interested: canlii.ca/t/1mzjg

To over-simplify: the key question was whether this double-digit inflation was an emergency for the purposes of the national emergency branch of the Peace, order, and good government provision (POGG) of the 1867 Constitution Act.

By the mid-1970s, Canada was in an inflationary crisis. The Federal Government responded with the Anti-Inflation Act in 1975. The constitutionality of this legislation was immediately questioned, so in 1976, the feds referred a series of questions to the Supreme Court.

Third, the discussion of the constitutional issues around separation of powers and the limits of delegation was a great reminder of the differences between the two countries.

Second, while I knew a little about the monetary crises of the early 1970s, I didn't know anything about the legal history of the American response. I found that discussion fascinating, leading to an interesting if somewhat obvious interpretation exercise.

First, I didn't know that this court existed although I do remember a reference to its former incarnation as the Customs Court. A new (to me) court with specialized jurisdiction is always interesting. The decision is here: www.cit.uscourts.gov/sites/cit/fi...