Do they refund your taxes if you decline to use government services? If not, it's the best kind of monopoly since they still get paid even if they don't provide the products or services...

Also, in 6 out of 10 Canadian provinces, it is illegal to enter into a contract for health services that are publicly funded. (http://www.cmaj.ca/cgi/reprint/164/6/825) Still not a monopoly?