Health Service

I may have overreacted with the "government take-over" thing. American Crossroads (Karl Rove) is spending millions in Colorado trumpeting about Obamacare as a total "government take-over" to elect a Dick Cheney fan running as a pretend Tea Partier to the Senate.

But as I said I don't know about a government takeover of health care, but I believe the basic premise of our health care (profit motive) has so screwed it up, that it needs to be revolutionized not reformed. There are things the government doesn't do well and can't do well. I happen to believe that the market doesn't do everything well and can't do well (wars fought by mercenaries).

 

we need to cut the insurance companies out of the equation and have the government work directly with the healthcare providers. then it would be as efficient as medicare. but the friar has a point, they get good care, but if you don't want to wait a few months, the well off can speed it up for a few extra quid.

 

this sounds like a bad idea to me. certainly you don't think medicare is efficient? it's hemmoraging money and costs a fortune, and from what I hear, 400 billion or so has been redirected to obamacare. i'm not sure how anyone can look at something like medicare or social security and think the government is doing a good job with them.

 

This is my main beef when it comes to talking points about allocations for the national budget. I think one middle ground would be to just balance it. That way, forecasts for when social security or such would be moot (as the government would no longer be borrowing against it). It would take sweeping reform in healthcare, military spending, and all the pork barrell stuff.....but the pessimest in me with politics see that each party is going to do too little too late. Each party inherits a government form the previous one, and can only do so much. Richard Nixon ran on conservative values, but his government spent more portions of social issues then Clinton or Obama can do. Unfortunately, since politics are getting more polarized, I think the chance of balancing the budget gets even more remote. People just respond to talking points: look at Christine O'Donnell...the Tea Party's favorite candidate. Apparently they're running on an issue of economic conservation, but she has no track record of such.

One thing about "Obamacare" is that it's not sweeping enough. Yes, I agree it would be good to reform medicare and medicade....just as I think we should do something about medical coverage for most the population.

 

No, that is NOT true. Health care in Canada is the domain of the Province, and every Province has their own scheme for providing health care.

Ontario has OHIP: Ontario Health Insurance Plan

Manitoba has Manitoba Health

Within the Province are administrative units called RHA - Regional Health Authority. It's up to the RHA Board, which is appointed not elected, to determine how funds are spent, level of care appropriate to Charter, etc

One interesting thing is that at the RHA level, health statistics are gathered and arbritarily forwarded to Health Canada, then to other organizations like WHO. Which is why the data is sometimes discarded and otherwise massaged

Let's not even discuss wait times, and how sometimes the best thing to do is to get the Ombudsman involved

Ombudsman Ontario — Welcome to the Ombudsman of Ontario Website

Or the OHIP "ehealth" cost over run scandal, pegged at over 1 billion dollars

Amir Attaran: Worse than eHealth - Full Comment

CTV Toronto - eHealth Ontario exec steps down amid contract scandal - CTV News

I do believe NIH has had similar scandals. These costs must be absorbed by the taxpayers, and they come out of patient care.

I really don't understand how difficult it is to set up an electronic record system. When I used to do a lot of contract work with Oracle DB, and SAP, I did it routinely.

But when the public purse is involved, that purse is assumed to be bottomless

 

Having two different systems nearby creates some ability to select the best of each, especially for those able to / needing to pay out of pocket. Along this border, this most commonly means faster specialized care to the south, more affordable drugs to the north.

I think there is also some capacity sharing happening, such as when a number of high risk pregnancies were Vancouver and Victoria to Seattle for birth.

 

Yep that's it here. You might have to wait 6 - 8 months on some non urgent operations but also have the option to pay into a private plan (or even pay privately) if you so wish and get it done earlier.

If I need a heart bypass operation tomorrow I know I'll be covered by the State and could have a plush room if I want to pay extra. I find it amazing that in the 21st century in other western countries you could actually die if you can't afford the operation.

Effectively we have a basic but adequate free health care offered by the state with private top up if required. Private medical is a perk with many employers over here just like in the US, but at least nobody dies just because they either can't afford the op or their insurer voids the policy due to some small print.

 

i'm not sure there's rampant dying going on. you could be financially ruined, but they can't let you die on the operating table if you're insurance lapses.

it's really a conundrum because a private system allows for better, faster, stronger care and meds. but there are people falling through the cracks. i have always supported a way to prevent that. i don't think that enrolling the whole country into government health care is the answer, especially against their will. that's why i have always said reform is great, but take-over is wrong.

for the people who would ask specifics, one of the things i would do is create a program from young people who aren't covered by insurance when they are in college and the time period after college until they find a job with insurance. if a 22 year old breaks his leg after he graduates college and is dropped from his parents' insurance, he's out of luck right now in most cases.

another would be to fund a program for the unemployed. make it a short term (12-24 months) plan that people can buy into for cheap so that they are covered in that down time of unemployment.

of course you should not be punished for a pre-existing condition, so that needs to be changed.

and there needs to be competition in the insurance market so i support being able to buy insurance across state lines.

this kinds of things haven't even been tried yet before jumping into socialized medicine. i don't understand why improvements couldn't be made to our current system which provides some of the best health care on the planet.

 

No, he is not out of luck. One of the pieces of health care reform was to extend eligibility of young adults for precisely this reason. This piece of reform has already taken effect.

A system exists for unemployed persons, COBRA. As part of the stimulus plan, COBRA premiums were subsidized up to 65% for 15 months. As part of the reform bill, unemployed persons would be allowed to enroll in programs offered through exchanges (see below).

This was part of the reform, and has already taken effect.

Part of health reform requires states to setup exchanges to facilitate competition. Exchanges can also be setup by a group of states. This is the biggest unknown in the reform, imo. It's unclear how these exchanges will shake out, or if any states will band together to create larger exchanges.

See above. All of your ideas have generally been implemented, and most of them were part of the recent legislation. The reform bill did not fundamentally alter the current system.

 

I should point out that alone among all the nations offering "free" public health care, Canada makes it ILLEGAL to offer private medical care.

 

As expected, this thread has drifted about. Getting back to the OP's questions, here are some direct answers and a few comments:

Q1: What happens when you can no longer pay?

A1: This gets back to my original comment about emergency services. Some hospitals are required by law to provide emergency services regardless of insurance or ability to pay. The patient is billed for the service and is obligated to pay, but if the patient goes bankrupt or has no assets, the hospital ends up eating the cost. Essentially this means that insured patients and those paying out of pocket pick up the cost. People paying out of pocket also subsidize insured patients and Medicaid patients. Insurance companies and Medicaid set fees for services. Paying patients have no such protection, and as a result often pay much higher fees for the same service.

Very poor people are often covered by government aid (Medicaid and such). The ones who suffer the most are those who can't afford to buy insurance or pay medical costs out of pocket. These people often go bankrupt, or forgo treatment.

A different problem presents itself for non-emergency services. Most medical facilities will refuse treatment if the patient is not insured, covered by a government aid program, of able to pay out of pocket. These people tend to use the emergency system instead, which is not an efficient use of resources or a good way to treat chronic problems.

Q2: Why are the opinions on this thread so varied?

A2: This mostly depends on whether you have employer paid health insurance. Health insurance in the U.S. is generally too expensive for most people to buy out of pocket. If you are lucky enough to have a job that pays for most of your health insurance, you will find the U.S. medical system pretty good. If you are uninsured, it is a financial disaster waiting to happen.

Likewise the U.S. system is good for healthy people. People with chronic problems are likely to be dropped by their insurers, and find themselves unable to pay. New laws have been enacted to limit this sort of hostile behavior, but the new laws remain contested and unpopular in many parts of the country. Only time will tell if the new laws are embraced and extended, or repealed outright.

Some comments:

1) The OP mentions prescription medicine being expensive in the U.K., and mentions that many prescriptions cost $10 (or was it 10 pounds). Many prescriptions in the U.S. cost hundreds of dollars. Most insurance programs do not cover the cost of medication. Many of us have supplemental insurance for prescription medication. I am one of the lucky ones that do. Each of my prescriptions requires a $40 co-pay, then the insurance pays the rest. On the plus side, many generic older medications have become inexpensive. Many of these can be had for about $10 a month.

2) Employer paid medical insurance is key in the U.S. Without it, everything relating to medical treatment is hideously expensive. Unfortunately, medical insurance gets more and more expensive, getting to the point where many companies can no longer afford to offer it as a benefit.

Individuals lucky enough to have employer paid medical insurance often feel indentured to their employer. If they lose their job, they lose their family's health insurance. Once you lose your health insurance, you can't get re-insured with an existing condition. Fortunately, some of the pre-existing condition problem has been removed with the new health laws.

Even the doctors are hamstrung by private insurance. Our local doctor's office, with two doctors, employs a full time person to do nothing but call insurance companies on the phone. One full time person for two doctors. It's crazy.

In summary, the U.S. has excellent emergency services and state of the art medical equipment and personnel. Primary care is failing as family doctors now find it impossible to make a living in many areas. Medical treatment is generally good if you have insurance or can pay out of pocket. Mortality rates are not as good as you would expect, probably because many people forgo routine medical exams and treatment for chronic conditions.

In short, the system works if you have the means, otherwise it's not so good. As I said before: I've got mine, screw you.

Tom

 

Thanks jayman and fuzzy for your inside and on the scene information. I couldn't help notice that toaster and robby were not responding to this.

What you mentioned reflects what I heard while attending college in Fairbanks (AK) where there were many Canadian students (most of our hockey team). Health-care was mediocre at best and just plain dangerous in cases. Long wait times. General lack of enthusiasm (take a number, next...).

That to me sounded pretty systematic of government involvement into well anything.

Yes it sucks that people fall through our system and we pay such a high costs. But I don't think a government run system is the answer. I suspect something in the middle might be. Anyway, I just haven't sat on the can thinking about this subject so I don't have any real answers either. AGW has been taking up all my time...

 

It would help if you actually became educated on both, since you have such a strong opinion, I have insurance and I know lots of Canadians, they suffer the same problems we do, if you are in rural areas, you get what you get, if you are in cities, you get decent care, wait times are really not much different then here.

 

I am guessing you are referring to me... your point really is nonsensical. How much education do I need? Enough to come to your point of view? I have insurance too... I had Canadian friends as indicated. Plus I spent some time in CA as I often drove the AK Highway to school and back.
If as you indicated that the CA Healthcare is not much different than here, why buy into it?

 

They probably just treat jayman that way because they know him

I guess I cant just wait to respond in a thread... Geeze. Anyways, the good cases and bad cases get blown out of proportion on any side.

I could just as easily make the argument that American doctors have a lack of enthusiasm with horribly trained doctors. I could base the argument on numerous stories in the news.

Here's one: Local News | Baby sent home from Tacoma hospital dies | Seattle Times Newspaper

Parents take baby to US hosptial, the release it saying it will be fine, then it dies. This never happens in the US now does it?

People make mistakes, and doctors are people. They do what they do to save lives. If they have a lack of enthusiasm, they shouldnt be in practice.

I have used the Ontario Healthcare System and it is wonderful. I have not needed a major operation, but the wait times are not long if you need it. My uncle had brain cancer, and everyime they found a tumour, it was within a day he was under the knife. Until he refused treatment to die in peace. The government did not kill him, and nobody forced him to do anything.

I have never had to use any services in rural areas of Canada, I am always in a major metro area, so I cannot comment on that. But is that not the stereotype throughout the world? The "country" doctors routinely send their patients to the "big city" doctors when there is something they dont understand or just because their practice wasnt setup to support whatever dire situation it is.

The situation in Canada in the GTA is utopia compared to any services I have experienced in Metro Washington DC (same hospital Cheney had his heart surgery), Metro Denver, CO, and wanna-be metro Colorado Springs, CO.

In DC, my sister fell "up" an escalator on vacation. Don't ask how... We spent almost a full day (9am to close to 4pm) for them to stitch it up and send us on our way. It was past lunchtime when we saw the first doctor. Once inside, we went through the security detectors, then waited in the wait room for about 30minutes. Then we had a RN (I would hope) take all the information, and send us into the waiting room again. I dont remember the time, but I do remember myself walking a block or two to get some food and bring it back to the waiting room for lunch, so it was afternoon. We ate everything, and shortly thereafter we went to the back where we got a shared room and waited a few more hours before a doctor came in poked her with a needle, then it was within 20 minutes that she was sewed up and sent out the door. That was embarassingly long, for a simple procedure. But the doctors probably had better things to do, like gunshots or whatnot. Sounds familiar, patient priority based on health status and not time of arrival...


The most recent fiasco was a rather serious health problem I had while down here. It happened in 2008, and I am still not done with the insurance nightmare. I was admitted to a hospital in Colorado Springs. They said I was dehydrated, gave me an IV and sent me home. Two days later, I was still not better so I went to another hospital. I told them about the other day, and they agreed I was still dehydrated despite me saying I already had an IV was drinking normally. They gave me another IV, as well as some potassium and sent me home. Each time it was $125 out of pocket, because we have the cadillac of health insurance when we are down in the states. We pay dearly for it too... A few days later, same difference so my family drove me to Denver (state capital) where I was admitted for 2 weeks. The care was fine, but I would never say anyone other than my doctor cared. The RNs, the blood work people, the room cleaners, the food bringers, nobody cared. There were times I had bubbles appearing in my IV line (I was on a constant line) and I would have to call the nurse. After waiting a minute or two and seeing this bubble slowly make its way down the line closer and closer to the needle and no help available... well it wasn't fun. Needless to say once they finally arrived, they almost immediately disconnected the IV, bled the system and put it back in. But if I had done nothing, I would have had air in my system multiple times. The machinery was faulty apparently, because after the 4th time they switched out the machine and it didnt happen again.

After two weeks, I finally went home. Then the real battle began. I get a bill from the hospital for almost $350,000 USD. Immediately call the insurance company, and they tell us "yes you are covered, it is a billing mistake. We'll deal with it". Well after a good 2 years, hundred of letters FedEx Express'd to the main office, at least 20 drives to the hospital personally for meetings about this, it is still not resolved. The insurance company maintains that we are not responsible, and we are insured, and the hospital should bill them. The hospital maintains that they do not want to bill the insurance company, they want to bill me. They have even started collections proceedings twice for different amounts each time. Both times I have had to call the debt collector, three way the insurance company, and explain to them what is going on. Then the insurance company does its magic and they get an "extension" on the debt before it actually goes to collections and ruins my perfect (high 700's for a 22 year old) credit score for life. I just got another letter in the mail yesterday saying I am "eligable for a payment plan of only $4,000 USD per month for 9 years" to pay back my "debt". It is rediculous.

So I am fully aware of the healthcare system in Ontario, and fully aware of the healthcare system in Colorado. I would rather be the family dog in National Lampoon's Vacation when they tied it to the bumper and drove down the interstate then ever visit an American hospital again. It is cheaper and easier for me to fly back to Toronto, get what I need, and fly back if the situation arrises. By the time I get off the plane and am admitted to a good hospital in Toronto, I will probably still be sitting in a waiting room in the states waiting for any doctor to show up.

And if I dont response within 5 minutes of a post being made, it may be due to my full time job...

 

$350,000? Blimey you don't want that hanging over you at your age!

Isn't there some reciprocal agreement between the US and Canada? In Europe we have an insurance card that covers you in virtually all European countries including Iceland as well as Australia and New Zealand.

This card doesn't cover certain extras such as ambulances and private top up travel cover is recommended.

 

No, there is no reciprocal agreement. The U.S. is private pay only. If you don't want to pay out of pocket, you better have insurance. Even then, be prepared for years of billing controversy. I wish I could say the above $350,000 nightmare is unusual, but after dealing with insurance companies for years I can say it is more common than not. It took us two years to settle all of the medical billing after the death of my mother-in-law. She was completely insured, so it wasn't for lack of coverage. It comes down to an inefficient billing system and greedy insurance companies.

Tom

 

Thank you for defending OHIP, including the $1 billion overrun for its ehealth system.

There is the GTA (Greater Toronto Area, where many voting and taxpaying people live), and there is The Rest Of Ontario.

No matter what system, there are good outcomes and horror stories. Like the homeless Native guy in a wheelchair - Brian Sinclair - who was allowed to croak in the St Boniface emergency room here in Winnipeg.

CTV Winnipeg- Man dies after 34 hours in ER without getting treatment - CTV News

The initial story had him "walking" in. Not quite

Man dies during 34-hour wait in ER - thestar.com

They ignored him for almost two days. I guess they finally noticed him when he started to smell really bad. "Do you smell rotten meat? Yeah, I do."

Now we can trade good outcomes and horror stories of Canadian vs American hospitals

 

(The part in bold is what I am commenting on first)

That is exactly my point. There are some truly horrible stories on both sides, and some truly great stories about doctors diagnosing rare fatal diseases on a hunch and the like. But when it comes down to it, the healthcare in major metropolitan areas in Canada is on average far superior to the healthcare in major metropolitan areas in the United States on average.

Sure the OHIP spent $1billion CDN in wasteful efforts. The collective health insurance lobby in the states has spent that this year lobbying against healthcare. Seems wasteful to me too.

The grass is always greener on the other side of the hill. But not only is it greener in Canada, it is more civilized.

 

A portion of the Canadians coming to the US for healthcare is simply this. Need a MRI, and the closest machine is across the border, then cross the border. In cases of required care, the Canadian health system will cover the cost.

Canadians crossing the border is brought up as a sign that their system is failing. They share hundreds of miles of easily crossed border with the US. They also have a much smaller population. Canadians coming here for health care could easily be the Canadian system providing efficient and timely care to their customers.