The Depressing Future of American Health Care

[Chris]

Canadian healthcare is often held up as the epitome of socialized single payer systems. That's changing, as we head toward what they had.


In 1997, Jacques Chaouilli, MD, a family physician in Montreal, Quebec, decided he could no longer tolerate seeing his patients suffer—sometimes die—lingering on waiting lists for treatment and/or specialty care. He started a private emergency housecall service that got shut down by the government because of its prohibition of private health care. He then decided to challenge Canada’s law prohibiting patients from seeking—and doctors from providing—private health care outside of the government run single-payer monopoly health care system.

Ultimately, after many years, his efforts bore fruit. A lower-level court had ruled that Dr. Chaouilli was correct in contending that the prohibition of private health care violated ones rights to “life, liberty, and security,” as guaranteed by the Charter of Rights and Freedom, but that the development of a two-tiered medical system was unacceptable to the Canadian vision of “equality.”

In 2005, the Supreme Court of Canada heard Dr. Chaouilli’s appeal, and ruled that the Canadian single-payer system led to situations whereby patients suffer and die on government waiting lists, in violation of their rights guaranteed by both the Canadian and the Quebec Charters of Rights and Freedoms. The Supreme Court ruled as unconstitutional the prohibition of a parallel private medical system in addition to the government mandated single-payer system.

...The Court’s decision has since led to the growth of numerous private clinics, throughout the provinces, where patients can obtain private medical care for cash, in a consumer-driven market, and avoid having to travel south of the border to get off the queue.

A May 2011 article in the Canadian Medical Association Journal (CMAJ) stated: “What once was privatization trickle may soon become a wave.” Dr. Zoltan Nagy, President of the Canadian Independent Medical Clinics Association, estimated that in 2011 there were over 300 private clinics in Quebec alone, including clinics emphasizing executive health and cosmetic services. A spokesperson for the Quebec Department of Public Health Services said that the clinics are not only increasing in number, but also in size, becoming “mini-hospitals.” He noted that one-day cataract, knee, and hip surgeries are increasingly being performed in private clinics.

The colleges of physicians and surgeons for British Columbia and Alberta publish lists of independent clinics providing surgeries outside of hospitals. As of 2011, they listed 66 clinics in British Columbia and 60 in Alberta, providing multiple types of surgeries and dozens of services. Their lists don’t include the many private imaging and executive health centers in those provinces.

The former President of the Canadian Medical Association, Dr. Brian Day, owns the private Cambie Surgery Centre in Vancouver, BC. In an interview in the CMAJ article, he says the proliferation of private clinics is a function of the inability of the public system to meet demand.

In an interview in 2009 by the Los Angeles Times, Dr. Day said, in justifying the proliferation of private clinics, "What we have in Canada is access to a government, state-mandated wait list… You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list."

The Canadian experience provides an opportunity to anticipate the future of health care delivery in the United States.

I'll let you read what it portends for the US...

@ The Depressing Future of American Health Care (http://reason.com/archives/2013/05/06/the-depressing-future-of-american-health)

[roadmaster]

The rich will always get better health care than the middle class or poor unless it's bringing in a person from a different country and giving them something free to make the news. We also have people on waiting list for heart, kidney ect transplants that many die before receiving. At least they have a chance and on a list because Americans in-between jobs that don't have insurance won't even try in fear of the debt they will put on the family. No perfect system but at least they don't have to worry about the courts taking everything away from their family if they should die.

[Chris]

The rich pay today for the innovations we all enjoy tomorrow.

[Cigar]

The rich pay today for the innovations we all enjoy tomorrow.


"Enjoy" trying to pay for it. :)

It's not much of an "innovation" if the access to it is limited to the wealthy.

There been plenty "innovations" in the technology for Yachts and Lear Jets, but no ones life is dependent on these "innovations".

[Chris]

"Enjoy" trying to pay for it. :)

It's not much of an "innovation" if the access to it is limited to the wealthy.

There been plenty "innovations" in the technology for Yachts and Lear Jets, but no ones life is dependent on these "innovations".

I think you missed my point that the rich pay for the innovations that the rest of us enjoy at reduced cost. Who do you think is going to pay for it initially, the cost of R&D, the cost of FDA testing?

[nic34]

http://theincidentaleconomist.com/wordpress/wp-content/uploads/2010/10/Phantoms-500x387.jpg (http://theincidentaleconomist.com/wordpress/phantoms-in-the-snow/phantoms/)http://theincidentaleconomist.com/wordpress/in-defense-of-canada/

[Chris]

nic, relevance to topic? This is On the Serious Side.

[nic34]

nic, relevance to topic? This is On the Serious Side.

From your link:

In an interview in 2009 by the Los Angeles Times, Dr. Day said, in justifying the proliferation of private clinics, "What we have in Canada is access to a government, state-mandated wait list… You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list."

My post and link that you obviously ignored simply shows that despite your OP, Canadians are not flocking to the US because of "waiting lines" or any other reasons because frankly they are pretty much happy with their care. Which is never perfect anywhere. ..........serious enough?

[Chris]

From your link:

In an interview in 2009 by the Los Angeles Times, Dr. Day said, in justifying the proliferation of private clinics, "What we have in Canada is access to a government, state-mandated wait list… You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list."

My post and link that you obviously ignored simply shows that despite your OP, Canadians are not flocking to the US because of "waiting lines" or any other reasons because frankly they are pretty much happy with their care. Which is never perfect anywhere. ..........serious enough?

Uh, nic, the OP does not discuss Canadians going to the US for healthcare at all. The OP is about Canada internally changing from a public single payer system back to a private multi-payer one.

[nic34]

Uh, nic, the OP does not discuss Canadians going to the US for healthcare at all. The OP is about Canada internally changing from a public single payer system back to a private multi-payer one.

But it is not. And it shows that you still did not follow my link.....

[Chris]

But it is not. And it shows that you still did not follow my link.....

Apparently you haven't read the OP for Canada is doing that. Why would I read an unrelated link?

The OP is a comparison of two systems within Canada.

Your link is a comparison between CA and US. Not relevant here.

[nic34]

Why would I read an unrelated link?



Stubbornness....

[jillian]

Apparently you haven't read the OP for Canada is doing that. Why would I read an unrelated link?

The OP is a comparison of two systems within Canada.

Your link is a comparison between CA and US. Not relevant here.

not relevant because you can't respond to it.

cool.

[Cigar]

I think you missed my point that the rich pay for the innovations that the rest of us enjoy at reduced cost. Who do you think is going to pay for it initially, the cost of R&D, the cost of FDA testing?



Anyone who bets on a return on a Dollar ... check mutual funds.

Are you expecting someone who is laid-off, homeless, unemployed and sick to pay their fare share?

[Mister D]

not relevant because you can't respond to it.

cool.

No, it's not relevant because it's not relevant. That has been explained above. Do yourself a favor and get serious.

[Chris]

Stubbornness....

nic, your link compares CA and US. That is not related to the OP. Obviously you cannot show any relation, but just hem and haw.

[Chris]

not relevant because you can't respond to it.

cool.

I remind you that this topic is under On the Serious Side. Posting here requires a contribution.

[Chris]

Anyone who bets on a return on a Dollar ... check mutual funds.

Are you expecting someone who is laid-off, homeless, unemployed and sick to pay their fare share?


Again, wholly unrelated to the topic.

[pjohns]

The rich will always get better health care than the middle class or poor unless it's bringing in a person from a different country and giving them something free to make the news. We also have people on waiting list for heart, kidney ect transplants that many die before receiving. At least they have a chance and on a list because Americans in-between jobs that don't have insurance won't even try in fear of the debt they will put on the family. No perfect system but at least they don't have to worry about the courts taking everything away from their family if they should die.

We are certainly far from "rich"; and our Blue Cross/Blue Shield healthcare insurance is not supplied by an employer. (In fact, we are both retired.)

[zelmo1234]

But it is not. And it shows that you still did not follow my link.....

Yes it is private clinics and hospitals are starting to be big business in Canada. the people go sick of waiting!

[Dr. Who]

I think you missed my point that the rich pay for the innovations that the rest of us enjoy at reduced cost. Who do you think is going to pay for it initially, the cost of R&D, the cost of FDA testing?And the cost in human life in between? The rich get treatment, the poor die? What happened to the idea behind the DoI: "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

[Chris]

And the cost in human life in between? The rich get treatment, the poor die? What happened to the idea behind the DoI: "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

What do you mean the cost of life between? The innovation has to be created, marketed, transported before it comes into existence and I s available. That's the point, without some to pay for the initial high cist of innovation nithing innovated will be.

The Declaration speaks to equality before the kaw.

[Dr. Who]

What do you mean the cost of life between? The innovation has to be created, marketed, transported before it comes into existence and I s available. That's the point, without some to pay for the initial high cist of innovation nithing innovated will be.

The Declaration speaks to equality before the kaw.You may be in dangerous territory there. There have been scientists jailed for the ends justify the means philosophy.

[Chris]

Yes it is private clinics and hospitals are starting to be big business in Canada. the people go sick of waiting!

Yes, that is what the OP is about.

(nic, your topic is another interesting one and I for one would love to discuss it in a separate thread if you don't mind.)

[Chris]

You may be in dangerous territory there. There have been scientists jailed for the ends justify the means philosophy.

Fact remains the innovations cost lots of time and effort and capital. I worked for a biomedical company that developed genetic tests and it cost tons just to do the research, which we did with AI, and then millions to test. All knowing that within years generics would be developed to under price us.

So to bring this back to topic, private healthcare is a must.

[pjohns]

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

And which co-authors of the Declaration of Independence, to the best of your knowledge, ever expressed a desire to institute Universal Healthcare?

Or is it just possible that their words were not intended as an endorsement of this concept?

[jillian]

The rich pay today for the innovations we all enjoy tomorrow.

so let's get this straight... what is purportedly the greatest of countries can't do what every other civilized country on earth does?

really?

[zelmo1234]

so let's get this straight... what is purportedly the greatest of countries can't do what every other civilized country on earth does?

really?

do you beleive that the ACA will insure more people?

And if so why?

[pjohns]

so let's get this straight... what is purportedly the greatest of countries can't do what every other civilized country on earth does?


The verb, "can't," is highly (perhaps intentionally?) misleading.

The point is this: Why would the US wish to resemble, more closely, the democratic-socialitst states (a.k.a. the "social democracies") of Europe and Canada?

[Chris]

so let's get this straight... what is purportedly the greatest of countries can't do what every other civilized country on earth does?

really?

And what is that?

[Dr. Who]

Uh, nic, the OP does not discuss Canadians going to the US for healthcare at all. The OP is about Canada internally changing from a public single payer system back to a private multi-payer one.

THE CANADAHEALTH ACT
· The preamble (http://en.wikipedia.org/wiki/Preamble) of the act states that the objective of Canadian Health Carepolicy (http://en.wikipedia.org/wiki/Health_care_in_Canada) is "that continued access to quality health care withoutfinancial or other barriers will be critical to maintaining and improving thehealth and well-being of Canadians. The primary objective of the Act is"to protect, promote and restore the physical and mental well-being ofresidents of Canada and to facilitate reasonable access to health serviceswithout financial or other barriers." (Section 3).
· To do so, the act lists a setof criteria and conditions that the provinces must follow in receive theirfederal transfer payments: Public administration, Comprehensiveness,Universality, Portability, and Accessibility. There is also a requirement thatthe provinces ensure recognition of the federal payments and provideinformation to the federal government.[14] (http://en.wikipedia.org/wiki/Canada_Health_Act#cite_note-14) An overview published by the federalgovernment clarifies the conditions as follows:
· Public administration
· The health insurance plansmust be "administered and operated on a non-profit basis by a publicauthority, responsible to the provincial/territorial governments and subject toaudits of their accounts and financial transactions." (Section 8). This condition is the most frequentlymisunderstood; it does not deal with delivery, but with insurance. However, itdoes reduce the scope for private insurers to cover insured services (althoughthey are still able to cover non-insured services, and/or non-insured persons).
· Comprehensiveness
· The health care insuranceplans must cover "all insured health services provided by hospitals,medical practitioners or dentists" (Section 9). The Act lists, in theDefinitions (Section 2), what is meant by insured services - in general, thisretains the restriction to hospital and physician services arising from theearlier legislation. The provinces are allowed, but not required, to insureadditional services. Note that the CHA refers to "surgical dentalservices" but only if these must be provided within a hospital. Inpractice, this almost never occurs, and the annual health expenditure datapublished by the CanadianInstitute for Health Information (http://en.wikipedia.org/wiki/Canadian_Institute_for_Health_Information) (CIHI) confirm that Canadian dentalservices are almost entirely financed privately. Lobbying by other providers,including nurses, led the act to speak of 'practitioners' rather thanphysicians; physician services had to be covered, but provinces were allowed,but not required, to define other health professions as qualifying under theAct. To date, this provision has been used only occasionally; for example, someprovinces have added Midwifery (http://en.wikipedia.org/wiki/Midwifery), which means thattheir services are also fully publicly paid for.
· Universality
· All insured persons must becovered for insured health services "provided for by the plan on uniformterms and conditions" (Section 10). This definition of insured personsexcludes those who may be covered by other federal or provincial legislation,such as serving members of the Canadian Forces or Royal Canadian MountedPolice, inmates of federal penitentiaries, and persons covered by provincialworkers' compensation. Some categories of resident, such as landed immigrantsand Canadians returning to live in Canada from other countries, may be subjectto a waiting period by a province or territory, not to exceed three months,before they are classified as insured persons; this waiting period arises fromthe portability provisions.[15] (http://en.wikipedia.org/wiki/Canada_Health_Act#cite_note-chal10-15)
· Portability
· Because plans are organized ona provincial basis, provisions are required for covering individuals who are inanother province. The conditions attempt to separate temporary from morepermanent absences by using three months as the maximum cut-off. As theabove-mentioned summary clarifies, "Residents moving from one province orterritory to another must continue to be covered for insured health careservices by the "home" province during any minimum waiting period,not to exceed three months, imposed by the new province of residence. After thewaiting period, the new province or territory of residence assumes health carecoverage." The portability provisions are subject to inter-provincialagreements; there is variation in what is considered emergency (since theportability requirement does not extend to elective services), in howout-of-country care is covered (since there is no 'receiving' province), in howlonger absences are dealt with (e.g., students studying in another province),whether the care will be paid for at home province or host province rates, andso on.
· Accessibility
· Finally, the insurance planmust provide for "reasonable access" to insured services by insuredpersons, "on uniform terms and conditions, unprecluded, unimpeded, eitherdirectly or indirectly, by charges (user charges or extra-billing) or othermeans (age, health status or financial circumstances);" (Section 12.a).This section also provides for "reasonable compensation for...servicesrendered by medical practitioners or dentists" and payments to hospitalsthat cover the cost of the health services provided. Note that neitherreasonable access nor reasonable compensation are defined by the CHA, althoughthere is a presupposition that certain processes (e.g., negotiations betweenthe provincial governments and organizations representing the providers) satisfythe condition. The CHA allows fordollar-for-dollar withholding of contributions from any provinces allowing usercharges or extra-billing to insured persons for insured services. As notedbelow, this provision was effective in 'solving' the extra-billing issue.
· Additional conditions
· Section 13 lists twoadditional conditions which must be met by the province in order to receive itsfull share of the federal transfers. The first condition is that the federalMinister of Health is entitled to specific information relating to a province'sinsured & extended health care services. This information is used in draftingannual reports, presented to parliament, on how the province administered itshealth care services over the previous year. Again, there was - and continuesto be - controversy as to how detailed this information should be.
· The second condition is thatthe province must "give recognition" to the federal government"in any public documents, or in any advertising or promotional material,relating to insured health services and extended health care services in theprovince" (Section 13.b). Again, this is controversial.
· http://en.wikipedia.org/wiki/Canada_Health_Act

[Chris]

The problem is you can't just make laws and grand pronouncements and just expect them to work.

[Dr. Who]

The problem is you can't just make laws and grand pronouncements and just expect them to work.Whether private clinics are tolerated in Canada, at least there are no people who must do without health care simply because they can't afford it. If you have additional insurance or the money, you can buy up or jump the queue, but no Canadian will ever be in the position of having to liquidate all of their assets to obtain treatment.

[Chris]

Whether private clinics are tolerated in Canada, at least there are no people who must do without health care simply because they can't afford it. If you have additional insurance or the money, you can buy up or jump the queue, but no Canadian will ever be in the position of having to liquidate all of their assets to obtain treatment.

But that public wish is failing. It results in higher prices and lower quality care.

[Dr. Who]

But that public wish is failing. It results in higher prices and lower quality care. The lowest quality of care is none at all and unfortunately in America too many must do without or an HMO decides that the treatment that will work is too expensive, so you must go to the next best or third best option. How is that better than the Canadian option? At least Canadians can seek out the appropriate treatment, wherever it is available, and the Provincial Health Care provider will pay most if not all of the cost. Perhaps private insurance may have to contribute to some of the cost. About 27.6% of Canadians' health care is paid for through the private sector. This mostly goes towards services not covered or only partially covered by Medicare, such as prescription drugs (http://en.wikipedia.org/wiki/Prescription_drug), dentistry (http://en.wikipedia.org/wiki/Dentistry) and optometry (http://en.wikipedia.org/wiki/Optometry). Some 75% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.
http://en.wikipedia.org/wiki/Health_care_in_Canada

[zelmo1234]

Whether private clinics are tolerated in Canada, at least there are no people who must do without health care simply because they can't afford it. If you have additional insurance or the money, you can buy up or jump the queue, but no Canadian will ever be in the position of having to liquidate all of their assets to obtain treatment.

It was against the lae in this country to deny healthcare base on the ability to pay? but now that the poor will have helath insurance, the hospitals can and will deny care except for life threating emergencies!

[pjohns]

The lowest quality of care is none at all and unfortunately in America too many must do without or an HMO decides that the treatment that will work is too expensive, so you must go to the next best or third best option.

(1) Many who "do without" healthcare insurance have made a (rather careless) decision: to allocate their existing funds in a manner that covers more of their wants, and not necessarily all of their needs. (An example would be someone who has, say, a cell-phone, but no healthcare insurance.)

(2) Our own healthcare-insurance plan is a PPO; but, like an HMO, it is a type of managed-care healthcare insurance. And it emphatically does not dictate to the consumer that he (or she) must opt for the less expensive option. (I should know, since my wife and I have both used it extensively. Moreover, I scour the Benefit Plan handbook each January for any changes in policy.)

[jillian]

do you beleive that the ACA will insure more people?

And if so why?

it will insure more people because more people are required to be covered.

does that mean it will be the best way of covering them?

i don't know.

but the heritage foundation sure thought so... until this president used their plan....

and mitt sure thought so...

until he ran against this president who used his plan.which came from the heritage foundation


just to directly answer your question, though... it already covers more people... if you have a college student under 26 years old, your kid is now covered under your policy.

and, frankly, if the issue on the right was that not enough people were being covered or were going to be covered, they'd be working on making it better....

but that isn't what they want... which is why the protestations aren't particularly credible.

[Chris]

The lowest quality of care is none at all and unfortunately in America too many must do without or an HMO decides that the treatment that will work is too expensive, so you must go to the next best or third best option. How is that better than the Canadian option? At least Canadians can seek out the appropriate treatment, wherever it is available, and the Provincial Health Care provider will pay most if not all of the cost. Perhaps private insurance may have to contribute to some of the cost. About 27.6% of Canadians' health care is paid for through the private sector. This mostly goes towards services not covered or only partially covered by Medicare, such as prescription drugs (http://en.wikipedia.org/wiki/Prescription_drug), dentistry (http://en.wikipedia.org/wiki/Dentistry) and optometry (http://en.wikipedia.org/wiki/Optometry). Some 75% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers.
http://en.wikipedia.org/wiki/Health_care_in_Canada

But we're not talking abstractions, we're talking specific changes in Canadian healthcare toward privatization because, despite your wanting public care, people want private. The problem with abstractions, like "The lowest quality of care is none at all", is they tend to result in idealized solutions that serve no one when no one receives no care at all.

[lynn]

Here is some shocking news of what Medicare's average reimbursement annually per: Inpatient Hospital stay $2,680.46 Hospice $15,252, Durable Medical Equipment $191.45 Home Health $277.22 Managed Care $1399.01. Average cost for high risk diagnosis codes is $9,004.65 annually.

[truthmatters]

single payer is where we will end up.


the right just keeps torturing the American people for the sake of the weathy

[Chris]

single payer is where we will end up.


the right just keeps torturing the American people for the sake of the weathy



That's what the OP says, that we are headed in that direction while Canada has found it has failed them. As such, that direction makes little sense.

[pjohns]

it will insure more people because more people are required to be covered.

does that mean it will be the best way of covering them?

i don't know.

but the heritage foundation sure thought so... until this president used their plan

Would you care to post the pertinent link, in support of this assertion?

[pjohns]

single payer is where we will end up.


the right just keeps torturing the American people for the sake of the weathy

I have said it before, but since it evidently did not take, I will reiterate it here: My wife and I are very far from "wealthy"; but we have excellent healthcare insurance.

So it would probably be best if the left would refrain from its (quite erroneous) mantra that only the "wealthy" can afford healthcare insurance.

That is, of course, assuming that they are at all interested in honesty...

[zelmo1234]

it will insure more people because more people are required to be covered.

does that mean it will be the best way of covering them?

i don't know.

but the heritage foundation sure thought so... until this president used their plan....

and mitt sure thought so...

until he ran against this president who used his plan.which came from the heritage foundation


just to directly answer your question, though... it already covers more people... if you have a college student under 26 years old, your kid is now covered under your policy.

and, frankly, if the issue on the right was that not enough people were being covered or were going to be covered, they'd be working on making it better....

but that isn't what they want... which is why the protestations aren't particularly credible.

That is a wonder ful thought, however?

The CBO has detirmined that there will be fewer people insurnce under this system!

http://blog.heritage.org/2012/03/14/obamacare-higher-taxes-more-uninsured-says-cbo/

And here is the fun part the new un insured will be middle class and have assets that the hospitals can take as a form of payment! Is that not wonderful!

Not to mention the companies that will lay off workers at the end of the year to get below 50 full time employee's!

And we have already witnessed the hiring of part time instead of full time employee's this is also a drain on the economy!

Here is what I beleive ! Obama wanted to be the President to make the major healthcare reform! He knew that the republicans would not go along with any form of socialization of the ehalthcare system! When the republicans took Kenedy's seat in Mass, he time had run out, so they rushed the bill that was in progress through!

[zelmo1234]

Sorry I hit enter to soon!

The ACA is written on the run, and now it is turing out to be a disaster?

Like most Liberal plans, It was desigened to be conpasionate they really wanted to help people! However this plan is gong to hurt a lot more people thatn it will help! And there really is no fix, it needs to be scraped! The taxation is opressive, the regulations are opressive, and the demoanded coverage is foolish in amny cases!

Not to mention that the bill shreads the medicare program by 700 billion, and will restrict care for some!

Had he had another year to work on this they might have come up with some good ideas, but this bill is a disaster in the making!

[lynn]

Did you know that many of the states that accepted the Medicaid expansion now have waivers that allow them to reduce benefits due to costs. While the rest of us have to buy coverage that the mandate stimulates what benefits must be covered. Did you know that many hospitals are buying up private practices so the doctors work for the hospital? By doing this they can charge hospital rates when you see your doctor for an office visit and since most health insurance comes with a high deductible for outpatient care, your office visit will be applied to the deductible.

Until costs becomes the number one complaint with consumers and we insist our government do something about it, this will continue into the next decade. Consumers that are enrolled in a group health coverage should demand a copy of the fee schedule that provides the allowable amount for each service code that is billed so we know exactly what everything is going to cost before services are performed. Everyone is soon going to realize that those hospital bills that can be in the thousands how much of a markup in price gouging when you compare it to fee schedules.

[jillian]

Did you know that many of the states that accepted the Medicaid expansion now have waivers that allow them to reduce benefits due to costs. While the rest of us have to buy coverage that the mandate stimulates what benefits must be covered. Did you know that many hospitals are buying up private practices so the doctors work for the hospital? By doing this they can charge hospital rates when you see your doctor for an office visit and since most health insurance comes with a high deductible for outpatient care, your office visit will be applied to the deductible.

Until costs becomes the number one complaint with consumers and we insist our government do something about it, this will continue into the next decade. Consumers that are enrolled in a group health coverage should demand a copy of the fee schedule that provides the allowable amount for each service code that is billed so we know exactly what everything is going to cost before services are performed. Everyone is soon going to realize that those hospital bills that can be in the thousands how much of a markup in price gouging when you compare it to fee schedules.

which states?

what were the costs (pre-implementation) that required them to cut benefits?

i think you'd better rethink that.

[Chris]

i think you'd better rethink that.

What and why?

[Dr. Who]

But we're not talking abstractions, we're talking specific changes in Canadian healthcare toward privatization because, despite your wanting public care, people want private. The problem with abstractions, like "The lowest quality of care is none at all", is they tend to result in idealized solutions that serve no one when no one receives no care at all. Don't mistaken the disgruntled grumblings of a few doctors who don't like the Canadian fee schedules for an overall failure. http://www.diemer.ca/Docs/Diemer-TenHealthCareMyths.htm

[Chris]

Don't mistaken the disgruntled grumblings of a few doctors who don't like the Canadian fee schedules for an overall failure. http://www.diemer.ca/Docs/Diemer-TenHealthCareMyths.htm

A doctor has led the charge but many are changing to give Canadians what they want. That link tends to assume a few elites know better what everyone wants when they can possibly know that.

Your link is also about "An overview of the Canadian health care system compared with the United States." Not the point here.

[Dr. Who]

A doctor has led the charge but many are changing to give Canadians what they want. That link tends to assume a few elites know better what everyone wants when they can possibly know that.

Your link is also about "An overview of the Canadian health care system compared with the United States." Not the point here. Actually it does not compare Canada to the US alone, but to OEDC countries in general. Needless to say, the proximity of Canada to the US leads to comparisons. It does nevertheless compare the relative cost of healthcare administration, which is the point. It also compare healthcare outcomes, which is also the point."The U.S. pays $911 per person per year in administrative costs. Canada by contrast pays $270 per person.
The disproportion in insurance overhead costs is even more marked: insurance overhead per capita comes to $212 in the U.S., $34 in Canada. Blue Cross/Blue Shield of Massachusetts, a typical major insurer, employs 6680 people to administer insurance for 2 1/2 million customers, more than are employed to administer public health insurance for all 28 million Canadians."
"When Germany recently shifted dental services from the public system to private insurance, administrative costs tripled from 5% to 15%." "Studies show that on average, Canadians are more likely to receive needed care quickly than Americans. Canadians get more physicians visits per capita than Americans, more immunizations, more hospital admissions, and more surgical procedures. A survey of 10 OECD countries showed that Canadians were the most satisfied with the care they received, while Americans were the least satisfied. In fact, Canadians are more than five times as likely to be satisfied with the health care they receive than Americans. "
"Infant mortality, maternal mortality, and life expectancy were worse in Canada than in the U.S. before the introduction of Medicare. Canada's infant mortality rate is now only 70% of that in the U.S., while American women are almost twice as likely to die during childbirth as their Canadian counterparts. The average Canadian now lives two years longer than the average American." That doesn't sound like failure to me.

[Chris]

Here's the problem with those comparisons. Two problems. One, they compare features that are easy to predict will result in findings favoring theorized better socialised healthcare, ignoring finding that counter that. Two, the theory is failing in practice as evidenced by the facts presented in the OP.

[Dr. Who]

[QUOTE]Here's the problem with those comparisons. Two problems. One, they compare features that are easy to predict will result in findings favoring theorized better socialised healthcare, ignoring finding that counter that. How so?
Two, the theory is failing in practice as evidenced by the facts presented in the OP. Most of the quotes in your article are not from disinterested parties.

[zelmo1234]

Don't mistaken the disgruntled grumblings of a few doctors who don't like the Canadian fee schedules for an overall failure. http://www.diemer.ca/Docs/Diemer-TenHealthCareMyths.htm

What I can tell you is that My Doc was here in the USA because he could not make enough money in Canada to pay his education bills and cover expenses. Once they started allowing the private Practices and private Health organizations? He returned!

There are already people in this country that are starting to try and organize these types of private health organizations. I know that is how I will be going!

But we will see I hope that I am totally wrong and This new system works!

[Chris]

[QUOTE=Chris;287996]How so?

They fail to include those aspects failing as reported in the OP.


Most of the quotes in your article are not from disinterested parties.

Doctors living up to their Hippocratic oath.

[Dr. Who]

[QUOTE=Dr. Who;287997]

They fail to include those aspects failing as reported in the OP.



Doctors living up to their Hippocratic oath.How about the US system failures: An economic overview of America's system is: 42 million people are not covered, the various health care plans place rigid limitations on which doctors and hospitals people can use, cost-saving measures are forcing patients out of hospital beds prematurely, administrative costs are approaching 25% of the health care dollar, managed care is generally structured such that physicians have incentives to cut costs and gain revenue by withholding care, and many Americans live in fear of losing whatever care they have. http://bcn.boulder.co.us/health/healthwatch/canada.html Canadians may have wait times on non-urgent care, but none are without healthcare insurance, nor are they forced by HMOs into hospitals where their doctor does not practice. I don't know, but I think I would rather wait an extra couple of weeks to have my knee surgery performed by the surgeon of my choice.

[pjohns]

How about the US system failures: An economic overview of America's system is: 42 million people are not covered, the various health care plans place rigid limitations on which doctors and hospitals people can use, cost-saving measures are forcing patients out of hospital beds prematurely, administrative costs are approaching 25% of the health care dollar, managed care is generally structured such that physicians have incentives to cut costs and gain revenue by withholding care, and many Americans live in fear of losing whatever care they have. http://bcn.boulder.co.us/health/healthwatch/canada.html Canadians may have wait times on non-urgent care, but none are without healthcare insurance, nor are they forced by HMOs into hospitals where their doctor does not practice. I don't know, but I think I would rather wait an extra couple of weeks to have my knee surgery performed by the surgeon of my choice.

(1) This implies (quite falsely) that a lack of healthcare insurance and inaccessability to healthcare services are synonymous.

(2) Anyone who has a healthcare-insurance plan that is focused upon cutting costs at the expense of the patient has a very poor healthcare plan, in my opinion. Which is just one more argument in favor of the government's offering tax incentives to those employers who will offer a menu of healthcare-plan options--perhaps 20 or 30 such options--rather than a one-size-fits-all, take-it-or-leave-it plan.

[Dr. Who]

(1) This implies (quite falsely) that a lack of healthcare insurance and inaccessability to healthcare services are synonymous.

(2) Anyone who has a healthcare-insurance plan that is focused upon cutting costs at the expense of the patient has a very poor healthcare plan, in my opinion. Which is just one more argument in favor of the government's offering tax incentives to those employers who will offer a menu of healthcare-plan options--perhaps 20 or 30 such options--rather than a one-size-fits-all, take-it-or-leave-it plan.
(1) Indeed, if you have no healthcare insurance you may be better off than having poor healthcare insurance. The latter may be subject to collection agency harassment and lawsuits after a protracted illness.
(2) Many people have limited choices when it comes to healthcare insurance - generally only the one their employer provides. Tax incentives may help, but a broad-based plan would likely be the option of choice for those with families and older employees.

[pjohns]

Many people have limited choices when it comes to healthcare insurance - generally only the one their employer provides. Tax incentives may help, but a broad-based plan would likely be the option of choice for those with families and older employees.

I have suggested, on other political forums, tax incentives for employers who will offer a menu of healthcare-insurance options; here, I have merely alluded to it.

And why should I be opposed to "those with families and older employees" (or anyone else, for that matter) choosing a "broad-based [insurance] plan" from this menu of plans?

Actually, I think that would make very good sense--even for younger people, who might suddenly become ill or injured at anytime...

[Dr. Who]

I have suggested, on other political forums, tax incentives for employers who will offer a menu of healthcare-insurance options; here, I have merely alluded to it.

And why should I be opposed to "those with families and older employees" (or anyone else, for that matter) choosing a "broad-based [insurance] plan" from this menu of plans?

Actually, I think that would make very good sense--even for younger people, who might suddenly become ill or injured at anytime...

I got the impression when you used the term menu that you supported people opting out of certain types of medical care.

[pjohns]

I got the impression when you used the term menu that you supported people opting out of certain types of medical care.

Perhaps I was not as precise as I might have been.

My wife receives a menu of options each year (FEHB healthcare insurance, through OMB).

This is actually what I had in mind.

[lynn]

If people only had a clue in what actual reimbursement is by health insurance companies, they would come to the conclusion that who needs healthcare coverage, we only need their fee schedules to pay for our own healthcare. When HMO's were popular when the consumer only had to worry about was a co-pay or a $50 coinsurance if they went to the E.R. their reimbursement didn't matter to us of what was paid to the provider of care.

Today, it does matter because 78% of people that have health coverage now have a high deductible to meet before they pay their 20%. Sure they will re-imburse the physician visits charges but everything else will be applied to their deductible. People need to start demanding that they have the right to a copy of the fee schedule of who insures them so they know ahead of time what their out of pocket costs is going to be.

Most people will be surprised when they realize that their deductible is paying for most of the allowable fees per the fee schedule and they will also wonder what their premiums are actually paying because it sure isn't healthcare expenses.

[simpsonofpg]

As I read all of this it confirms my problem. I am not rich and only have medicare so if I get really sick the best case is that is bad, progress very fast and I die. If not my family will incurr a debt they will never be able to pay it off. When someone tell you that they have a deal for you and then exempt themselves from that good deal watch out. Congress does not participate in Obama care. It should be unconstitutional for them to pass a law that they don't follow. If it is not unconstitutional it is still wrong bt congress reall doesn't care and that is not a R or D issue. Both sides are doing it.

[jillian]

As I read all of this it confirms my problem. I am not rich and only have medicare so if I get really sick the best case is that is bad, progress very fast and I die. If not my family will incurr a debt they will never be able to pay it off. When someone tell you that they have a deal for you and then exempt themselves from that good deal watch out. Congress does not participate in Obama care. It should be unconstitutional for them to pass a law that they don't follow. If it is not unconstitutional it is still wrong bt congress reall doesn't care and that is not a R or D issue. Both sides are doing it.

i'm more interested in how you can oppose something that provides coverage to more people.

you get medicare. shouldn't someone who isn't entitled to medicare be able to get affordable care?

[zelmo1234]

i'm more interested in how you can oppose something that provides coverage to more people.

you get medicare. shouldn't someone who isn't entitled to medicare be able to get affordable care?

Acording to the CBO it is neither affordable, and it will not cover more people!

[jillian]

Acording to the CBO it is neither affordable, and it will not cover more people!

actually, based on the new CBO Report, it seems the ACA is significantly responsible for the rapid drop in the deficit.

[zelmo1234]

actually, based on the new CBO Report, it seems the ACA is significantly responsible for the rapid drop in the deficit.

And you might be right! So many people will be loosing their insurance and paying the additional taxes?

That very well could be!

[jillian]

And you might be right! So many people will be loosing their insurance and paying the additional taxes?

That very well could be!

i disagree with you.

but i understand that you have an industry to protect and beileve what the big boys in the industry have told you.

or at least agree with them.

[Chris]

Instead of ad hom like that, jillian, why don't you stick to opinions and ideas and demonstrate what you claimed: "actually, based on the new CBO Report, it seems the ACA is significantly responsible for the rapid drop in the deficit." All you need do is cite the specific part of the report, not so hard to do.

[pjohns]

If people only had a clue in what actual reimbursement is by health insurance companies, they would come to the conclusion that who needs healthcare coverage, we only need their fee schedules to pay for our own healthcare.

Well, that is not exactly accurate. Especially for those of us who are older (my wife and I are both in our sixties) and no longer entirely healthy.

For instance, just about two years ago, my wife was hospitalized for 12 days. The hospital bill came to almost $52,000 (well, $51,941.45, to be exact). Medicare Part A (which is the only portion either of us has) paid $3,328.26. Blue Cross/Blue Shield paid another $1,132.00. The remaining $47,481.19 was written off as an insurance adjustment. We owed nothing out-of-pocket. (Note: Doctors' charges--whether they are hospitalists--i.e. employees of the hospital in question--or merely independent doctors with hospital privileges--are billed separately. With these, BC/BS paid 85 percent of the Plan Allowance. We wound up owing just a few hundred dollars, out-of-pocket, for these charges.)

Also, we like the annual out-of-pocket cap of just $5,000 among in-network providers. (The plan is a PPO; so it also accepts charges from out-of-network providers also--but the coinsurance is 30 percent, rather than a mere 15 percent, and it also requires that the patient pay the difference between the Submitted Charges and the Plan Allowance.)


Today, it does matter because 78% of people that have health coverage now have a high deductible to meet before they pay their 20%. Sure they will re-imburse the physician visits charges but everything else will be applied to their deductible.

Our own deductible (which applies to only certain covered charges, such as tests) is $350 per person per year, with an annual maximum, for the entire family, of $700 per year. (Since there are only two of us anyway, that works out the same as it would if there were, oh, say, eight of us in the household.)

A mere $700 per year does not strike me as being financially ruinous...


Most people will be surprised when they realize that their deductible is paying for most of the allowable fees per the fee schedule and they will also wonder what their premiums are actually paying because it sure isn't healthcare expenses.

These people should read their annual healthcare-plan brochures to see how these deductibles work.

Also, they should scrutinize their EOBs when they arrive in the mail, rather than just tossing them in the trash...

[lynn]

Well, that is not exactly accurate. Especially for those of us who are older (my wife and I are both in our sixties) and no longer entirely healthy.

For instance, just about two years ago, my wife was hospitalized for 12 days. The hospital bill came to almost $52,000 (well, $51,941.45, to be exact). Medicare Part A (which is the only portion either of us has) paid $3,328.26. Blue Cross/Blue Shield paid another $1,132.00. The remaining $47,481.19 was written off as an insurance adjustment. We owed nothing out-of-pocket. (Note: Doctors' charges--whether they are hospitalists--i.e. employees of the hospital in question--or merely independent doctors with hospital privileges--are billed separately. With these, BC/BS paid 85 percent of the Plan Allowance. We wound up owing just a few hundred dollars, out-of-pocket, for these charges.)

Also, we like the annual out-of-pocket cap of just $5,000 among in-network providers. (The plan is a PPO; so it also accepts charges from out-of-network providers also--but the coinsurance is 30 percent, rather than a mere 15 percent, and it also requires that the patient pay the difference between the Submitted Charges and the Plan Allowance.)



Our own deductible (which applies to only certain covered charges, such as tests) is $350 per person per year, with an annual maximum, for the entire family, of $700 per year. (Since there are only two of us anyway, that works out the same as it would if there were, oh, say, eight of us in the household.)

A mere $700 per year does not strike me as being financially ruinous...



These people should read their annual healthcare-plan brochures to see how these deductibles work.

Also, they should scrutinize their EOBs when they arrive in the mail, rather than just tossing them in the trash...


So in other words your hospital bill for $52,000 actual cost was $4,460.26 (per their fee schedule allowances). Like I said we only need their fee schedules.

[lynn]

Its nice to know that Medicare part A and BC/BS are still making it affordable for seniors. I was mainly talking about the people under 65 and have group coverage through their employer.

[lynn]

It is important to realize that all health insurance companies do NOT pay much more then Medicare's reimbursement levels. According to Pjohn's wife hospital bill for 12 days for 52,000 dollars was only reimbursed at from Medicare was only 3,328.26. There is only a small percentage of the population that falls in this amount of hospital expenses so you have to wonder why insurance premiums are so high compared to what is actually reimbursed to providers.

[Chris]

It is important to realize that all health insurance companies do NOT pay much more then Medicare's reimbursement levels. According to Pjohn's wife hospital bill for 12 days for 52,000 dollars was only reimbursed at from Medicare was only 3,328.26. There is only a small percentage of the population that falls in this amount of hospital expenses so you have to wonder why insurance premiums are so high compared to what is actually reimbursed to providers.

Because insurance companies pay out over a population, their premiums have to cover all incidents in a population they cover and make some profit. Your premium covers everyone covered. This may not be so clear you get home or auto and it seems you're just paying for personal insurance, but it's clearer in a situation like where I work where we co-owners purchase our own group coverage that every employee shares in, depending on level of insurance you opt for.

[lynn]

Because insurance companies pay out over a population, their premiums have to cover all incidents in a population they cover and make some profit. Your premium covers everyone covered. This may not be so clear you get home or auto and it seems you're just paying for personal insurance, but it's clearer in a situation like where I work where we co-owners purchase our own group coverage that every employee shares in, depending on level of insurance you opt for.

I have coverage through my husband's employment and his company is self insured where United Healthcare just administers it. Our portion of the premiums cost $3500 annually while his employer puts in their own healthcare account almost $11,000 annually. We also have a 3,000 deductible. Physician visits are $25 co-pay but if I have to go to the E.R. or have any diagnostic testing its applied to the deductible.

If I had been in the hospital for 12 days for $52,000 in hospital charges, my insurance would have allowed approx $3500 which is a small increase over Medicare's fee schedule. I would have to pay $3000 due to my deductible and the insurance would only have paid $500. All other charges associated with that bill would be adjusted to the fee schedule and I would pay the 20% on those charges since I reached my deductible.

I paid out of my own pocket so far was the $3500 in premium share and $3,000 in deductible which so far totals 6500 that I would have been so far if I had those medical expenses. This does not include the other 20% of other services performed if I had been in the hospital. This situation is the exception in medical expenses and is not the norm for a population that is covered by insurance. The actual cost to the self insured company most likely would not exceed 2,000 for this expense. This is paid out of my share of premiums and the company pays nothing but actually earns a profit at the end of the year.

[Chris]

I don't think it works that way. For example about a year ago my truck was stolen and my insurance paid out a hefty sum way more than any premiums I've paid. Where did that come from but the entire pot of premiums paid by all its customers?

[lynn]

I don't think it works that way. For example about a year ago my truck was stolen and my insurance paid out a hefty sum way more than any premiums I've paid. Where did that come from but the entire pot of premiums paid by all its customers?

Health and auto are different beasts.

[jillian]

Health and auto are different beasts.

they work the same way. the fund of money collected is based on a risk assessment, with high risk drivers paying more than low risk drivers... what constitutes risk has a lot of different considerations. (like the fact that a good student gets better auto insurance rates than a bad one).

the fact that the low risk people pay into the system and don't, presumably, need to make as many claims as high risk people, is why the insurance companies can pay off claims and still be hugely profitable.

[pjohns]

So in other words your hospital bill for $52,000 actual cost was $4,460.26 (per their fee schedule allowances). Like I said we only need their fee schedules.

The (greatly diminished) amount, $4,460.26, is what the hospital accepted as payment in full, according to their contractual agreements.

We owed nothing out-of-pocket for hospital charges.

(Note: With this particular BC/BS plan, there is ordinarily a $250 Admission Fee for hospitalization; followed by a payment of 100 percent of the Plan Allowance, if the hospital in question is in-network--which our local hospital is. However, whenever Medicare Part A is primary, even this rather modest fee of $250 is waived.)

[Chris]

Health and auto are different beasts.

OK, not the way I understand it but I'm at the limit of my knowledge and have read you enough to accept what you say.

[Chris]

This echoes the OP which we've gotten away from...


I believe we are moving toward two different health systems. In one, patients will be able to see doctors promptly. They will talk to physicians by phone and email. They will have no difficulty scheduling needed surgery. If they have to go into a hospital, a “hospitalist” (who reports to them and not to the hospital administration) will be there to make sure their interests are looked after. They may even have an independent agency that reviews their medical records, goes with them when they meet with specialists, and gives them advice on every aspect of their care.

In the other system, waiting times will grow for almost everything ― to get appointments with physicians, to get tests, to obtain elective surgery, etc. Patients may find that they don’t have access to the best doctors or the best hospitals. They may find that the facility where they are treated does not have the latest technology. In terms of waiting times and bureaucratic hassles, health care for these patients may come to resemble the Canadian system. It may become even worse than the Canadian system....

@ Coming Soon To America: A Two-Tiered, Canadian-Style Health Care System (http://www.forbes.com/sites/johngoodman/2013/05/23/coming-soon-to-america-a-two-tiered-canadian-style-health-care-system/)

[Peter1469]

This echoes the OP which we've gotten away from...



@ Coming Soon To America: A Two-Tiered, Canadian-Style Health Care System (http://www.forbes.com/sites/johngoodman/2013/05/23/coming-soon-to-america-a-two-tiered-canadian-style-health-care-system/)

If the US must move to single payer, I will be satisfied with the two tier system. I will pay for quality care.

[lynn]

Once upon a time the health insurance companies during the 90's when HMO's were popular were great insurance plans. Now that we moved to mostly PPO plans with high deductibles, we are essentially paying for our care out of pocket with a contract that has negotiated our fees that are usually under our deductible limit. This is what angers me the most with health insurance companies these days because it becomes very clear how much money they are making off of every single person that has group health insurance.

So yes, it is time for a single payer system though I am not fond of the idea that it must be government run, what other choice to we have? We should all be put under Medicare into one giant pool where everyone is contributing to it. The cost control is already built into the Medicare's fee schedule and the many different levels that profit from it would be eliminated.

[Peter1469]

Once upon a time the health insurance companies during the 90's when HMO's were popular were great insurance plans. Now that we moved to mostly PPO plans with high deductibles, we are essentially paying for our care out of pocket with a contract that has negotiated our fees that are usually under our deductible limit. This is what angers me the most with health insurance companies these days because it becomes very clear how much money they are making off of every single person that has group health insurance.

So yes, it is time for a single payer system though I am not fond of the idea that it must be government run, what other choice to we have? We should all be put under Medicare into one giant pool where everyone is contributing to it. The cost control is already built into the Medicare's fee schedule and the many different levels that profit from it would be eliminated.


Let those of us who can pay for it have private insurance. The rest can suffer their single payer system.

[Chris]

Problem is socialized health care won't work unless everyone is forced to pay for it. You'll end up laying for both public and private.

[lynn]

What other choice is there going to be if pricing continues to go up in healthcare and those that provide coverage?

[Chris]

What other choice is there going to be if pricing continues to go up in healthcare and those that provide coverage?

Only private healthcare provides choices. Public does not.

[Dr. Who]

Only private healthcare provides choices. Public does not.Not everyone has choices or private healthcare.

[Chris]

Not everyone has choices or private healthcare.

Why not?

[Dr. Who]

Why not?

Some people don't have money, not always as a result of their own making. What are these people supposed to do? What is the man or woman working two or three part-time jobs just to provide food and shelter for their family supposed to do about health insurance? Is good health insurance only for those who have money? Are people with money more valuable than those who have little, more deserving of good health care?

[jillian]

Why not?

because most people can't afford the $2,100 a month i paid for health coverage for my family when i worked for myself...

and then cover the $1,000 deductible... per person

and then only get 80% of "reasonable and customary" as set in someplace where health coverage costs some pretend low price.... when you live in NY and pay a fortune for health care.

that's why.

[Dr. Who]

because most people can't afford the $2,100 a month i paid for health coverage for my family when i worked for myself...

and then cover the $1,000 deductible... per person

and then only get 80% of "reasonable and customary" as set in someplace where health coverage costs some pretend low price.... when you live in NY and pay a fortune for health care.

that's why.That 25K per year. More than some people make in a year. Outrageous.

[Chris]

Some people don't have money, not always as a result of their own making. What are these people supposed to do? What is the man or woman working two or three part-time jobs just to provide food and shelter for their family supposed to do about health insurance? Is good health insurance only for those who have money? Are people with money more valuable than those who have little, more deserving of good health care?

Use emergency rooms. Law says they cannot be denied.

[jillian]

That 25K per year. More than some people make in a year. Outrageous.

and that was in 2003

[jillian]

Use emergency rooms. Law says they cannot be denied.

but they DO get billed.

you've been told this.

[Dr. Who]

Use emergency rooms. Law says they cannot be denied.The ER addresses emergencies only. What about congenital deformities, hip replacement, knee replacement, cerebral palsy, prenatal care, chronic pain, annual exams, diabetes care, renal issues, arthritis treatment, diseases of the eye, anemia, crones disease, irritable bowel syndrome....

[jillian]

The ER addresses emergencies only. What about congenital deformities, hip replacement, knee replacement, cerebral palsy, prenatal care, chronic pain, annual exams, diabetes care, renal issues, arthritis treatment, diseases of the eye, anemia, crones disease, irritable bowel syndrome....

not to mention oncological and neurological issues which require chronic care as well

of course, we can just let those people die if they can't pay or don't have insurance... right?

[Dr. Who]

not to mention oncological and neurological issues which require chronic care as well

of course, we can just let those people die if they can't pay or don't have insurance... right?If they don't qualify for Medicare it would seem so.

[jillian]

If they don't qualify for Medicare it would seem so.

now that is obscene

[Chris]

but they DO get billed.

you've been told this.

But have no money to pay. The costs are pushed off on those who can pay. You've been told. Again, see Lipstein on Hospitals (http://www.econtalk.org/archives/2008/12/lipstein_on_hos.html), sort of bored with explaining it.

[Chris]

The ER addresses emergencies only. What about congenital deformities, hip replacement, knee replacement, cerebral palsy, prenatal care, chronic pain, annual exams, diabetes care, renal issues, arthritis treatment, diseases of the eye, anemia, crones disease, irritable bowel syndrome....

They have access to healthcare through ERs. Look up the law.

[Chris]

not to mention oncological and neurological issues which require chronic care as well

of course, we can just let those people die if they can't pay or don't have insurance... right?

And you propose to pay for it how? With other people's money?

[Dr. Who]

now that is obsceneOne American dies every twenty minutes for lack of health insurance: http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf

[jillian]

One American dies every twenty minutes for lack of health insurance: http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf

it boggles the mind that we can't do, or won't do, in this country, what is done in every civilized country on earth

[Chris]

And yet, all emotionalism aside, as this thread has demonstrated, the socialized public system you two advocate is failing and being replaced by a privatized system.

[Dr. Who]

And yet, all emotionalism aside, as this thread has demonstrated, the socialized public system you two advocate is failing and being replaced by a privatized system.Augmented, not replaced. There is a difference. Canadians are not dying every 20 minutes from lack of health insurance or from waiting times for that matter.

[jillian]

And yet, all emotionalism aside, as this thread has demonstrated, the socialized public system you two advocate is failing and being replaced by a privatized system.

emotionalism?

to think people shouldn't die?

you're right. we should all be just like you and ayn rand...

oh wait... she lived on social security

[Chris]

Augmented, not replaced. There is a difference. Canadians are not dying every 20 minutes from lack of health insurance or from waiting times for that matter.

Changing, Who, changing. Because the socialized system you advocate does not work.

[Chris]

emotionalism?

to think people shouldn't die?

you're right. we should all be just like you and ayn rand...

oh wait... she lived on social security

Yes, emotionalism, as opposed to arguing rationally.

And thanks for the made up ad hom.

[zelmo1234]

The ER addresses emergencies only. What about congenital deformities, hip replacement, knee replacement, cerebral palsy, prenatal care, chronic pain, annual exams, diabetes care, renal issues, arthritis treatment, diseases of the eye, anemia, crones disease, irritable bowel syndrome....

I think that President Obama has a plan for that!

http://www.youtube.com/watch?v=rin4h4cRs6Y

That should take care of it don't you think? And if you disagree, then why would you support obamacare

[zelmo1234]

not to mention oncological and neurological issues which require chronic care as well

of course, we can just let those people die if they can't pay or don't have insurance... right?

Again see Obama's plan for taking a pill!

[jillian]

Again see Obama's plan for taking a pill!

what are you talking about?

i understand insurane is your business and you want to maximize the ability of insurance companies to exclude people who pay for their services, but seriously.....

[zelmo1234]

Augmented, not replaced. There is a difference. Canadians are not dying every 20 minutes from lack of health insurance or from waiting times for that matter.

http://dailycaller.com/2012/07/11/report-thousands-fled-canada-for-health-care-in-2011/

Well maybe they are ?

[lynn]

Many people believe that the ACA is going to get all those people that show up in the E.R. for healthcare with no insurance are going to have coverage in 2014. People with no source of income, unemployed or just barely able to keep a roof over their head will not get Medicaid coverage unless they develop a chronic condition like diabetes.

Hospitals only have to stabilize you, give you a prescription if needed and refer you back to your physician. If it is more serious that that and they know it is going to be expensive, that person will have to fill out forms to apply for Medicaid before they leave the hospital.

[Dr. Who]

Changing, Who, changing. Because the socialized system you advocate does not work. Only according to a few disgruntled doctors. Most Canadians rate their healthcare system very well, in spite of wait times etc. Canadian opinion on healthcare in Canada: http://www.newswire.ca/en/story/884001/support-for-public-health-care-soars-94-of-canadians-including-conservatives-choose-public-over-for-profit-solutions Another article re out of control US healthcare costs:
http://www.forbes.com/sites/frederickallen/2013/03/05/the-reason-american-health-care-is-out-of-control/

[zelmo1234]

Many people believe that the ACA is going to get all those people that show up in the E.R. for healthcare with no insurance are going to have coverage in 2014. People with no source of income, unemployed or just barely able to keep a roof over their head will not get Medicaid coverage unless they develop a chronic condition like diabetes.

Hospitals only have to stabilize you, give you a prescription if needed and refer you back to your physician. If it is more serious that that and they know it is going to be expensive, that person will have to fill out forms to apply for Medicaid before they leave the hospital.

No developing properties and renting and selling them is my business. Insurance is one of my largest expenses, and Health Insurance under the new regulations, is not going to be affordable for my company!

there is enough about this program that is horrible and known, so that Republicans and Dems should be able to get togehter and either start over, or start to change the really horrible aspects of the law, But the Dems are not admittting realtiy!

[zelmo1234]

Sorry Lynn, this was to be a quote on Jillian's Post assusing me of being involved in the insurance industry!

[Dr. Who]

http://dailycaller.com/2012/07/11/report-thousands-fled-canada-for-health-care-in-2011/

Well maybe they are ?
Well that's about 0.0013987575757576 of the Canadian population, less than a small town's worth and they were probably compensated by their provincial health insurance.

[zelmo1234]

I wonder if 50K americans are going to other contries to get treatment they can't get in the USA?

They may be, I know that I have friends and family that are a lot happier not that they are involved in a private health organization, rather than trying to depend on their Provincial coverage and the red tape and ristrictions

[jillian]

No developing properties and renting and selling them is my business. Insurance is one of my largest expenses, and Health Insurance under the new regulations, is not going to be affordable for my company!

there is enough about this program that is horrible and known, so that Republicans and Dems should be able to get togehter and either start over, or start to change the really horrible aspects of the law, But the Dems are not admittting realtiy!

my bad. i thought you said you were in insurance.

if insurance is one of your largest expenses, it's because we have one of the stupidest medical systems in the world

[Dr. Who]

I wonder if 50K americans are going to other contries to get treatment they can't get in the USA?

They may be, I know that I have friends and family that are a lot happier not that they are involved in a private health organization, rather than trying to depend on their Provincial coverage and the red tape and ristrictions Actually at least 750,000 per year do. http://www.cdc.gov/Features/MedicalTourism/ The US system is so much better with one person dying every 20 minutes for lack of health care. That is 72 people per day and 26,280 people dying every year. Whereas less than 50K Canadians seek treatment in the US for which they receive compensation from their Provincial health care provider. Wow. The Canadians are really hard up.

[lynn]

Employers can gain some leverage when shopping for health coverage for their employees by demanding a copy of their fee schedule. When you get a better picture of what they are actually paying for services and what your employees out of pocket costs is you are in a much better position to negotiate rates.

Since most people's insurance now comes with high deductibles, they also have a right to a copy of the fee schedule of who they are contracted with for health coverage. Shopping around to find providers of care that charge different rates is a complete waste of time if you are insured. It doesn't matter what they charge, it matters what they paid for each service item and what you are going to be responsible for in medical costs.

The new trend these days with commercial, Medicaid, Medicare Advantage, Tri-Care is they are becoming capitated risk plans whereby a specific amount is paid per member per month to providers of care whether you see a provider of care or not. My experience with capitated risk plans is they are evil and it can limit your healthcare needs without you being aware that it is being done since we don't have a choice but to trust our physician orders of treatment or specifically lack of.

Capitated plans are designed for providers of care is they make a profit if the individual never or seldom has to use their services. A primary Care Physician is paid per member per month that is anywhere from $9 to $29 for each member assigned to the provider of care. The higher the number of members assigned to the PCP puts them in a better position to cover the costs for those members that do need healthcare services for each month.

At the end of the year the provider of care may earn a bonus for limiting the number of referrals to specialists, limiting the number of tests, etc on those members that need care. In other words, if providers of care can get away with prescribing medication only, they will come out ahead in profit. The winners are the pharm companies and the contracted health plan while the provider of care may be biting their nails in hopes of not getting sued some day.

[Chris]

Only according to a few disgruntled doctors. Most Canadians rate their healthcare system very well, in spite of wait times etc. Canadian opinion on healthcare in Canada: http://www.newswire.ca/en/story/884001/support-for-public-health-care-soars-94-of-canadians-including-conservatives-choose-public-over-for-profit-solutions Another article re out of control US healthcare costs:
http://www.forbes.com/sites/frederickallen/2013/03/05/the-reason-american-health-care-is-out-of-control/

I'm surprised, who, you usually don't stoop to ad hom.

How Canadians rate their system depends on whether government is asking or some independent group is. The government finds everything fine, others see problems--but of course they're just disgruntled doctors.

Ever wonder why the CA doctors are so disgruntled? It's related to the doctor shortages up there.

Healthcare costs are out of control everywhere.

[Chris]

Sorry Lynn, this was to be a quote on Jillian's Post assusing me of being involved in the insurance industry!

Making assumptions is fine, assuming further that they're true gets you in trouble.

[Chris]

my bad. i thought you said you were in insurance.

if insurance is one of your largest expenses, it's because we have one of the stupidest medical systems in the world

Why is it "stupid", jill. Begin by defining what you even mean by "stupid".

[Chris]

Actually at least 750,000 per year do. http://www.cdc.gov/Features/MedicalTourism/ The US system is so much better with one person dying every 20 minutes for lack of health care. That is 72 people per day and 26,280 people dying every year. Whereas less than 50K Canadians seek treatment in the US for which they receive compensation from their Provincial health care provider. Wow. The Canadians are really hard up.

And yet their system is changing from public to private.

[Dr. Who]

I'm surprised, who, you usually don't stoop to ad hom.

How Canadians rate their system depends on whether government is asking or some independent group is. The government finds everything fine, others see problems--but of course they're just disgruntled doctors.

Ever wonder why the CA doctors are so disgruntled? It's related to the doctor shortages up there.

Healthcare costs are out of control everywhere.It's not ad hom to suggest that doctors that don't like the status quo are disgruntled. They are in fact disgruntled. They are also the minority opinion. Who doesn't complain about health care at some point? I could also suggest by what people post on this site, and things written in the media that the American health care system of private insurance is fairly unworkable for a large number of people. High deductibles, like $1,000 would seem to make the insurance illusory, if you don't have any major diseases. Paying upward of $25K per year for family coverage is completely out of reach for anyone not receiving employer provided insurance. Just an FYI: http://www.cmaj.ca/content/183/8/E437.full

[Chris]

It's not ad hom to suggest that doctors that don't like the status quo are disgruntled. They are in fact disgruntled. They are also the minority opinion. Who doesn't complain about health care at some point? I could also suggest by what people post on this site, and things written in the media that the American health care system of private insurance is fairly unworkable for a large number of people. High deductibles, like $1,000 would seem to make the insurance illusory, if you don't have any major diseases. Paying upward of $25K per year for family coverage is completely out of reach for anyone not receiving employer provided insurance. Just an FYI: http://www.cmaj.ca/content/183/8/E437.full

But it has nothing to do with the facts the socialized public healthcare system is not working and Canadian's are shifting to a private system.

[Dr. Who]

But it has nothing to do with the facts the socialized public healthcare system is not working and Canadian's are shifting to a private system.Like Europe it is allowing private providers. Universal Health Care is a sacred cow in Canada - much like gun ownership in the US. The finances of Canada would have to collapse before people allowed Universal Health Care to be replaced by private insurance.

[Chris]

Like Europe it is allowing private providers. Universal Health Care is a sacred cow in Canada - much like gun ownership in the US. The finances of Canada would have to collapse before people allowed Universal Health Care to be replaced by private insurance.

Ah, so it's happening in Europe too. I didn't know that.

[Dr. Who]

Ah, so it's happening in Europe too. I didn't know that. Sure, people with lots of money don't like to wait in line. They feel that with money comes privilege, so clinics have sprung up everywhere to accommodate the wealthy.

[Peter1469]

Sure, people with lots of money don't like to wait in line. They feel that with money comes privilege, so clinics have sprung up everywhere to accommodate the wealthy.

If the future is universal coverage, I only wish that there is an option for people with cash.

[Chris]

Sure, people with lots of money don't like to wait in line. They feel that with money comes privilege, so clinics have sprung up everywhere to accommodate the wealthy.

I would imagine poor people don't like to wait either. How account for that? Entitlement?

[Chris]

If the future is universal coverage, I only wish that there is an option for people with cash.

Universal can only work if it is, well, universal, no choice.

[Peter1469]

Universal can only work if it is, well, universal, no choice.

How many counties no longer offer private insurance on the side of the universal LCD plan?

[jillian]

Universal can only work if it is, well, universal, no choice.

in every country where there is universal health care, people have the right to hire their own private physicians.

i think the problem is us thinking in terms of health "coverage" and not health "care"

[Dr. Who]

I would imagine poor people don't like to wait either. How account for that? Entitlement? When I suggest the wealthy don't want to wait, I mean they want immediate treatment for whatever bothers them. The less wealthy might well have to wait several weeks or months for elective treatment, but at least they get treated. No deductibles, no bill at the end.

[zelmo1234]

If the future is universal coverage, I only wish that there is an option for people with cash.

There will be, that is what is happening in Canada where the best hospitals and Doc's have de cided not to play the governements game, they have set up private healthcare co-ops.

the masses can have the worst doc's and hospitals the wealthy get the best of the best!

Soon they will be back to telling us how Cuba's system is the worlds best! But like all socialized systems they go broke and have to start cutting back!

[Dr. Who]

Universal can only work if it is, well, universal, no choice.Canada was trying to keep it that way, but there were inevitable Court challenges.

[Chris]

in every country where there is universal health care, people have the right to hire their own private physicians.

i think the problem is us thinking in terms of health "coverage" and not health "care"

I agree, too many seem to think universal coverage means universal health.

But "in every country where there is universal health care, people have the right to hire their own private physicians" may be true not that the doctor in the OP has prevailed.

[Chris]

Canada was trying to keep it that way, but there were inevitable Court challenges.

And failures of socialized systems.

[jillian]

And failures of socialized systems.

what failures, specifically?

every civilized nation provides health care.

how is it more of a failure than having millions of people uninsured, having 50% of our bankruptcies be because of unanticipated medical costs and an employer based system that means if you lose your job, you are not only in trouble financially, but medically

how is that a success?

[Cigar]

what failures, specifically?

every civilized nation provides health care.

how is it more of a failure than having millions of people uninsured, having 50% of our bankruptcies be because of unanticipated medical costs and an employer based system that means if you lose your job, you are not only in trouble financially, but medically

how is that a success?

This should be fun ... :laugh:

[Chris]

what failures, specifically?

every civilized nation provides health care.

how is it more of a failure than having millions of people uninsured, having 50% of our bankruptcies be because of unanticipated medical costs and an employer based system that means if you lose your job, you are not only in trouble financially, but medically

how is that a success?

WHat, you haven't read the OP and other articles I've posted. Go back to Start, no $200.

[Chris]

This should be fun ... :laugh:

It wasn't, depressing really, that after 145 or more posts someone hasn't bothered to read the OP.

[Dr. Who]

It wasn't, depressing really, that after 145 or more posts someone hasn't bothered to read the OP.Of course I read the OP, but it doesn't contain anything I didn't know already. The Canadian debate over two tier health care is decades old. It is not that those same doctors want Universal Health Care to disappear, they simply want to be able to provide private for profit health care as well. For many years that was completely impossible, until it was challenged in the Courts. It's not like Canada didn't have US style health care in the past. It did. Too many people had to live without health care, so Universal Health Care was introduced in Saskatchewan and the concept spread across Canada and was ultimately incorporated in the Canada Health Care Act. The debate continues on an ideological basis. What two tiers of health providers represents in Canada is preferential treatment for those who can pay. That is the main objection.

[lynn]

Does Canada not have enough providers of medical care that meets the needs of that population for that area? What is Canada lacking in benefits that people want available to them?

[Dr. Who]

Does Canada not have enough providers of medical care that meets the needs of that population for that area? What is Canada lacking in benefits that people want available to them?
Most people don't quibble about the available health care, but some doctors don't care for the fee schedule and some wealthy people feel that if they have the money they should be able to jump the queue. Canada does not always have the most cutting edge treatments right away. It may take a while until doctors are schooled in the treatments and where new equipment is required, budgets must be available as Canadian hospitals are all Provincially owned (except for a few small private hospitals). Overall however Canada's healthcare outcomes are basically the same as in the US, despite not always having the latest equipment or techniques, but this may be because Canada graduates more diagnosticians than specialists, so earlier diagnoses are made. Because Canada has fewer specialists, there are longer wait times for some elective procedures. Nevertheless, no one is without health care for lack of insurance and no one goes bankrupt as a result of a prolonged illness and hospital stay.

[Chris]

Of course I read the OP, but it doesn't contain anything I didn't know already. The Canadian debate over two tier health care is decades old. It is not that those same doctors want Universal Health Care to disappear, they simply want to be able to provide private for profit health care as well. For many years that was completely impossible, until it was challenged in the Courts. It's not like Canada didn't have US style health care in the past. It did. Too many people had to live without health care, so Universal Health Care was introduced in Saskatchewan and the concept spread across Canada and was ultimately incorporated in the Canada Health Care Act. The debate continues on an ideological basis. What two tiers of health providers represents in Canada is preferential treatment for those who can pay. That is the main objection.

Go back, that comment was directed to the non-contributing peanut gallery.

Socialize healthcare in Canada is changing because, despite what the government thinks they need, it's what the people want that counts.

[Chris]

Does Canada not have enough providers of medical care that meets the needs of that population for that area? What is Canada lacking in benefits that people want available to them?

Last I read, CA is in the midst of a doctor shortage. That's the result of price controls.

[lynn]

Most people don't quibble about the available health care, but some doctors don't care for the fee schedule and some wealthy people feel that if they have the money they should be able to jump the queue. Canada does not always have the most cutting edge treatments right away. It may take a while until doctors are schooled in the treatments and where new equipment is required, budgets must be available as Canadian hospitals are all Provincially owned (except for a few small private hospitals). Overall however Canada's healthcare outcomes are basically the same as in the US, despite not always having the latest equipment or techniques, but this may be because Canada graduates more diagnosticians than specialists, so earlier diagnoses are made. Because Canada has fewer specialists, there are longer wait times for some elective procedures. Nevertheless, no one is without health care for lack of insurance and no one goes bankrupt as a result of a prolonged illness and hospital stay.

Well that explains the influx of Canadians that the Cardiologists that I worked for in 1999 came in for heart catherizations and stent placements. I like the idea that no one goes bankrupt over medical costs.

[Dr. Who]

Last I read, CA is in the midst of a doctor shortage. That's the result of price controls.There is not really a doctor shortage per se. There is a doctor shortage in rural areas where the government has to provide special incentives to attract doctors - the Canadian Federal government has offered $8,000 student loan forgiveness per annum, on top of the various amounts of money offered by the Provincial governments i.e. somewhere between $50,000 to $117,600 with guarantees that the doctor will practice there for up to 5 years. This of course only really attracts relatively newly minted doctors and as might be expected, many would rather work in major cities where there are large hospitals and more patients. In rural communities, Canadian doctors tend to be paid a salary because fee for service may not pay the doctor enough to warrant being there. Keep in mind Canada has a lot of square miles but the population density is concentrated in and around the larger cities. Many rural communities are very remote from each other.

[Chris]

Think again: http://www.fraserinstitute.org/publicationdisplay.aspx?id=17360

[Dr. Who]

Think again: http://www.fraserinstitute.org/publicationdisplay.aspx?id=17360 Well that was actually a piece objecting to the Canadian Medical Association's old boys network attitude about admitting foreign trained physicians. They have a point. There are thousands of foreign trained physicians in Canada who are not allowed to practice, without basically retaking their training. That really should change.

[Chris]

Well that was actually a piece objecting to the Canadian Medical Association's old boys network attitude about admitting foreign trained physicians. They have a point. There are thousands of foreign trained physicians in Canada who are not allowed to practice, without basically retaking their training. That really should change.

Who it was a piece on CA's doctor shortage. Importing foreigners a small part of the whole problem.

[Dr. Who]

Who it was a piece on CA's doctor shortage. Importing foreigners a small part of the whole problem.The Universities have been graduating more of late.

[Common]

Doctor shortage? What doctor shortage?Is this article true ? I dont have a clue, read it and judge for yourselves

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/15/doctor-shortage-what-doctor-shortage/

[Chris]

Doctor shortage? What doctor shortage?Is this article true ? I dont have a clue, read it and judge for yourselves

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/15/doctor-shortage-what-doctor-shortage/

I think that's about the US, which may or may not according to projections. The shortage under discussion is in Canada.

[Dr. Who]

I think that's about the US, which may or may not according to projections. The shortage under discussion is in Canada.I have seen similar debates vis-à-vis the Canadian doctor shortage. Similar to the US, Canadian doctors are also pooling resources, thus are able to handle higher patient loads.

[Chris]

Yet there is a shortage cause by public healthcare price fixing.

[Dr. Who]

Yet there is a shortage cause by public healthcare price fixing.

http://www.huffingtonpost.ca/2011/12/15/doctors-all-time-high-canada_n_1151828.html http://meds.queensu.ca/blog/?p=2072

[Chris]

Population is going up as well.

http://www.thebigwait.com/doctor-shortage-canada/doctor-shortage-getting-worse/