Private clinics have taken over services formerly provided on a non-profit basis in public hospitals, they have bolstered their owners’ incomes and profits by charging extra user-fees to patients amounting to hundreds or even thousands of dollars for medical care. For patients, costs have risen and user fees have proliferated. And as clinics have gained an expanding foothold, they have grown more aggressive. In some cases they are flagrantly charging patients for services for which they have already paid in their taxes, in violation of public medicare laws. In some cases they are double- dipping -- billing individual patients and public health plans for the same procedures. Dangerously, private clinics have institutionalized the practice of co-mingling medically needed services with medically unnecessary tests and procedures to sidestep Canadian laws that prohibit extra user fees for patients.