Someone by the name of Sarah Robinson who uses both the Canadian and U.S. health care system addresses some of the assertions about the Canadian system that are routinely raised by people who oppose a national health care system for the U.S.
Go read the whole thing, but, a very abbreviated version:
1. Socialized medicine? False. Doctors are not employees of the state. It’s more of a single-payer insurance system. Kind of like Medicare for everyone.
2. Doctors don’t make as much? True & False. They don’t take in as much revenue, but they don’t have as much overhead devoted to wrestling with insurance companies. As a result, they also tend to work fewer hours.
3. Wait times are bad? True & False. Mostly depends where in Canada you are. Rural areas tend to be worse than suburban areas.
4. You don’t get to choose your own doctor? False. You do.
5. Coverage is limited to basics? Mostly true. But it doesn’t end up being as big a deal because without big insurance premiums and the expensive basics mostly covered, the extras are more affordable.
6. Canadian drugs are not the same? False. They’re often made by the same companies in the same factories.
7. The taxes to support such a system are unsustainable? False. They’re less expensive than health insurance premiums.
[tags]health care[/tags]
Dude, you could say every last thing about HMOs back in the 1990s.
How did that work out for ya?
If you restrict medical care to Americans in any way, you will have another American Revolution on your hand. That’s my take away from the HMO experiment.
Google “Hansonian health care”. Robin Hanson is an economist who believes that half of all US healthcare spending is not only wasted, but actually results in WORSE health care outcomes than if nothing had been spent at all!
This is why these foreign countries that spend less than the US can have the same or better health as the US. Our health care system is not just bad, it literally kills people that are supposedly being helped.
And the worst thing is that socializing medicine, single payer, Medicare-for-all, etc. would do almost nothing to address this.
What would address it? Those pesky HMOs and their “managed care”!
What is it about American demands for medical care that are so much different than Canadian demands? Are Canadians just more rational than Americans or what?
You’re used to what you’re used to. We’ve had our system of healthcare since the 1940s. The Canadians have had their since the ’70s. So they’ve been used to being told “no”. Americans have not been told no, and thus feel entitled to anything and everything that their doctor recommends.
Also, don’t discount demographic factors. Even today, Canada is lilly white. There is no Candaian underclass. Canadians are not living with the after effects of slavery and Jim Crow. And the Canadian immigration system is a lot different than the American one. They don’t let in just anybody.
So… yes. Canadians are different than Americans. Maybe they are more logical. Maybe they’re smarter than us. Maybe they’re more civic minded.
In any case, their system is most properly described as a government run HMO. Do YOU think that that would fly here? I don’t. I think we tried HMOs, and they didn’t work (well, they DID work, but people hated them).
I think the the catch 22 above is that for an HMO to ‘serve the people ‘ the government,or the people, must step in to set rules and make sure they are enforced.Otherwise an HMO becomes a private profit machine for some investors,patients be hanged.But the government surely can’t provide health care on its own;that requires trained professional personnel.
Too often the HMO tells the medical profession what they will be ‘allowed’ to do,rather than the government mandating to the HMO what they ‘must’ provide.That’s when a HMO fails the patient in my, and my family’s experience.
Yeah, I remember when my wife’s company switched to an HMO. I went in with two of her prescriptions and the pharmacist changed them completely; without even consulting a doctor. Told me that the HMO wouldn’t pay for the other meds.
We moved six months later and our new doctor said that one of the meds my wife was switched to was “as good as pissing on a forest fire.” He switched her back to her original med and the condition cleared up in less than a month.
Until we have a system where it’s not acceptable for insurance companies to refuse to provide insurance for people because they are *gasp* sick, then we’re just chasing our tails.
Yeah, it’s really the gaps that we need to fill in; especially those who are denied coverage and those who have jobs that don’t offer benefits.
Amy,
It seems all of us have the wrong idea of the word “insurance”, myself included. Can you imagine paying car insurance coverage that would include oil changes, replacement tires, and windshield wiper solution? It would be extremely expensive!
Yet, that is what I and most other people do with our health “insurance”.
I’ve been looking into Health Savings Accounts. I think a solution like this might be the answer on the national scale. Maybe there is some what to de-couple “health care”, i.e. checkups and meds from “health insurance”, i.e. heart transplants and chemo?
I have no confusion about what insurance is and what it should cover. None whatsoever. Insurance should cover your emergency c-section to the tune of $9,153.50. It should cover the anesthesia for that emergency procedure, to the tune of $2,200. It should cover the pediatrician’s bill for taking care of the newborn immediately following the emergency c-section, for somewhere around $3000. It should at least help with the cost of nursery care at the hospital, $2500. That’s not even including the cost of prenatal care. Add it all up and you are looking at a $20,000 bill.
I should never have had to lay awake in my bed at night having anxiety attacks wondering how I’m going to pay for a procedure that my doctor deemed absolutely necessary for the well being of my baby. That’s not right. No one should do that.
I can take the bus. It won’t kill me. Not having health insurance might and does every day. You can’t compare car insurance and health insurance. I have a bike, I can get where I need to go. But heaven forbid I get hit by a car on the way!
And I HAVE insurance. I HAVE medical savings account. I am healthy so they will sell it to me. But what about the people who can’t buy it? That’s the problem. Insurance companies cherry pick their clients and refuse to pay for anyone who is sick or has a pre-existing condition. If you are buying your insurance privately, you can forget about maternity.
Am I supposed to sell my home-based business and go put my kids in daycare all day and get a job in a factory so that I can have health insurance?
If the right to lifers cared so much about life after birth, perhaps they’d do something about our abysmal infant mortality rate – which is a result of the fact that women can’t afford prenatal care because THEY CAN’T GET INSURANCE.
Saw those set of bills three different times. (One mergency and two plannded c-sections). We knew we were covered 100%-minus deductable.
Newborns make you lose enough sleep without worrying about the bill. Yes, this is a gap that needs to be closed.
Amy, I agree with what you are saying! 100%!
I’m saying that, in order to get rid of the notion that a national health insurance system would be abused, we should point out that stories like yours are what health insurance is for, and why it should be universial.
Taking care of your self, like normal doctor visits, are not something that should be under “insurance”. Yes, there should be a way for those that can not afford it to have some basic care in his area as well, but that is a seperate discussion from the one of insurance.
To me, that also helps dispel the whole “can’t choose your own doctor” rubbish.
The other point, to back up what you were saying (I did a poor job explaining before, but it made sense in my head), is that by making the focus of a national health insurance plan to be actual INSURANCE, we can make sure that there is always coverage, that the national one can’t turn anyone down.
If you seperate the two, the costs of the actual insurance are low on a national scale. Most people won’t need it in any given year, so the costs are spread out.
If you don’t seperate the two, people quickly add up what their own employeer pays for insurance, add in their own premium, and multiply that by the population of the country. That is what I did when first thinking of national health insurance, and it lead me to the wrong conclusion.
I’m sorry that my quick-fire post earlier dug up some bad memories!
Insurance companies take care of the basic things, because, in the long run, it’s cheaper for them then paying out for the big things. If people have to pay for basics themselves, they don’t… then it becomes an emergency where you are expecting the insurance to kick in.
You can’t really compare it to auto-insurance.. that’s an accidental/theft coverage – it doesn’t pay out when your engine conks out on you.
Perhaps a little off subject,but people are so caught up in the private enterprise vs the government socialism fear that they will argue away comprehensive health care in order to save the country from socialism( any govt oversight),which will lead us into complete government takeover ,the next step being totalitarian communism.The Bush administration more than any other has exploited this american fear of socialism to justify all the public money flowing to the private sector. Even that wouldn’t be so bad except there’s a feeling among us americans that the government should not interfere with private enterprise,so then everything should be carte blanche( Halliburton in Iraq ,ie,so they can ‘do their job’).People tolerate in the private sector what they would never tolerate from government.In health care the measuring stick for success cannot be the profit margin of the HMO. At what cost profit if the HMO won’t fill percriptions as written or pay for what the physician deems appropriate for the patient? When will we ever get back to good old American pragmatism: solve the problem with whatever works,and tailor the remedy to the situation.But first define the goals and make the rules and figure out how to accomplish them and then how to grade the process,with everyone at every level being graded.Hint: and if medical professionals with patients don’t have the final say,then probably we are already on the wrong track.
Ugh, this is too hard.
I’m going to work on peace in the middle east…
It’s hard to see how bad it is until you’ve been victimized by it. I’m lucky, because I’m married to Doug, he spent half an hour writing up an appeal with all his legal-speak and scared them into paying – not all of it, but at least we didn’t have to take out a second mortgage.
Not everyone has access to the resources that I do. I’m lucky. But I can see how something that should be joyful can bankrupt people. That’s not how it should be.
I have to admit I don’t know all of the demographics of Australia and how they compare with the demographics of Canada, the U.S., etc. but I remember a trip my mom took to Australia in 1994 soon after the “Hillarycare” debacle of the early 90’s. I remember my mom commenting on speaking with several Aussies during her trip there. Her observation was that the Australians were happy with their health care system. (From what I know about the Australian system is that it is similar to the Canadian system.) I’m not a Hillary fan but do appreciate her efforts back then to try to do something about the health care problem here in the states. In our firm we have went to an HSA plan to try to cut costs for health insurance, a problem many small businesses are trying to cope with. I am absolutely for free enterprise but it is asinine the premium increases that employers (and employees) are facing. There is something fundamentally wrong with a health care system that is seeing 30% annual increases in premiums. If we as Americans are going to be truly competitive in the world marketplace the insurance companies and politicians are going to need to pull their heads out of their asses and work on a solution to this. It is a complex problem to be sure, I am glad there are politicians out there who want to solve this problem.
Tying health care to employment is one of the stupider aspects of our system, in my humble opinion. The two go together like fish and bicycles.
When you take into account that employer paid healthcare coverage is in effect, a tax subsidy, and combine Medicare, Medicaid, Bureau of Indiana Affairs healthcare, VA hospitals, government employees and military personnel (what did I miss?), it appears that something in the order of 60-65% or more of the population is already on a taxpayer funded health system. Is it really so hard to go the rest of the way?
Furthermore, the Kaiser Foundation tabulates the cost to process the paperwork from the myriad of insurance companies to be around $250 billion if memory serves me right – it’s been a few years since I did the research. When I visit my doctor, I am paying towards the salaries of 4 people – the doctor and the 3 employees that manage the sea of paperwork.
As I understand it, the tie between employment and health insurance is an unfortunate legacy of WWII wage controls.
Since companies could not compete for workers by raising wages, they offered new benefits. And at the time, health care was a lot cheaper to provide (most of modern medicine has been invented since then – transplants were science fiction stuff in 1942, for instance).
I think the ‘car insurance’ model makes more economic sense – but we are used to the mess we’re in, and when you add in the fact that this can literally be a life and death issue, emotions run high.
At the end of the day, all health care has to be paid for, one way or another – and the economic forces in play are not greatly swayed by emotion.
As I’ve said before, I’d love to see an answer that truly makes this whole mess better – what I’m afraid of is that well-meaning and unconsidered mandates may make it even worse.
The life and death aspect of health care vastly reduces my confidence in a market model. In my mind, markets work a lot better when a potential buyer can rationally walk away from the potential purchase. If the clock is ticking and a life or death procedure is necessary, standard market forces probably aren’t going to allocate resources in the most efficient way.
Guys, here is the deal. Healthcare spending is out of control. We can get it under control. The process of getting it under control is called “managed care”.
When your HMO switched your perscription without consulting your doctor, that’s managed care.
Quite frankly, the doctor may have not given you the “right” perscription: the one that does the job at the lowest cost. He might have given you the name brand when the generic was available, for example.
He might have given you Vitorin, when studies show that Vitorin doesn’t do a g.d. thing to lower risk of heart attack.
These are just 2 example, and I really don’t want to get into an argument about the details of them. I just use them to make a point.
Those foreign healthcar systems that everyone is so enamored with are HMOs. They tell your doctor how to practice medicine. The coordinate care, just like HMOs do. That’s how they get the cost savings. And because the US healthcare system is “Hansonian” (again, google that to get the definition), they can spend less and get the same or better results.
But are you ready for a government run HMO? I am, but are you? I don’t think ANY of the commenters here are being realistic if they say that they are.
You guys think that we’re going to get some kind of “Medicare for all” system, and its just not viable. We can’t afford it. And anybody who says that it is is a crackpot, or is delusional, or ignorant of the facts.
Insurance used to be for catastrophic things. When we’re getting down to things like C-sections, which are very routine and very expensive, then it can be a challenge. C-section rates approach 40% in some places, and most women will have 2-4 children in their lifetimes. At $20,000 per, that’s a lot of money when most of the recipients of that care have paid in nowhere near that much in premiums. Again, we’re not talking about a catastrophic accidental head injury or something like that. We’re talking about a very common, routine procedure that a large percentage of American women on average will have at some point. Getting rid of some of the layers of beaurocracy will trim costs some. But any system will cost a lot and people will have to make some choices.
I should note that I am a physician and hate having to fight insurers. I also should not I was more than relieved that our insurance picked up the $100,000+ bill when our child was delivered and had catastrophic problems at birth and a month in the NICU.
Just need to share an experience…
In ’95 I was in a car accident in Italy (a bus hit our car, everyone ok). In the police station, while we were doing paperwork and attempting to get a replacement car rented (which the police were helping with) my ankle started puffing up. The police became concerned and insisted on driving me to the local hospital where it was x-rayed. It ended up being just a severe sprain (no fractura) and they taped it up. On the way out, they asked for my passport and wrote my name down in a book. I asked what it cost and they looked at me like I was from another planet – just shaking their heads “no cost, no cost.” Then they sent me on my way and that was the end of it.
It was… surreal.
Interesting points, T.
My wife is pregnant now, this will be our fourth. The first two were completely natural (no epidural, we followed the Bradley method, second kid was a water birth). The third was an emergency C-section (cord was wrapped around her neck).
So what do we do for the next baby? The doctors are totally against VBAC. But are they doing what’s right, or what is expedient, or what is least likely to result in a lawsuit?
It is a problem.
With #2, I learned way more about VBACs than I ever thought I would. (#1 was a C-section after the water broke but the labor failed to progress.)
Our OB/Gyn was one of the few who was o.k. with attempting VBACs. But, after a long labor with slow progression, #2 started having fetal tachycardia (high heart rate for longer than normal). That could be a sign of an infection. If it was an infection, the docs could deal with it a lot better on the outside. So, they (understandably) exerted a lot of pressure with the C-section recommendation.
Turns out there was no infection; which is why the insurer wanted to deny it. But, it was fear of infection that caused the C-section. Sepsis (infection) was covered as a complication of child birth. I successfully argued to the insurer that sepsis was, in fact, the reason for the C-section. Had there been no legitimate fear of infection, no C-section would have occurred. I wrote an insurance decision appeal that would have put some of my appellate court briefs to shame. Fortunately, the insurer changed its mind.
I have no idea what people do when they don’t understand the opaque insurance policies and aren’t used to writing legal briefs. I guess they just get cheated out of the value of their insurance contract.
Yikes Doug, that is just scary that an insurance company would decide to trump the medical decision of the doctors “on the scene.” There are all those rumors & John Grisham plots about insurance claims departments existing for the sole purpose of increasing profits by denying claims; and even if the claim is ultimately paid after an appeal process, they have at least enjoyed interest on the funds they refused to pay in the first place. Not sure that’s purely fictional.
And as for the medical questions involved, VBACs are very tricky! My wife had a C with our first daughter in 1995. With our first son in 2000, VBACs were all the rage, and she tried one, but ended up with another C. By 2002 and our second son, VBACs had suddenly become very passe and she was scheduled for a C, but the darn kid came one day early anyway! But the point is, medical opinion on the “necessity” of various procedures change all the time, and insurance companies if they are so inclined can find plenty of loopholes to justify denying claims.
I think that you guys are missing the point. “Medical opinion” is just that. You have no idea what motivates your doctor to do the things that he does. You have no idea if he is motivated by medical necessity, or just what’s easier and less risky for herself.
Doctors are notoriously ignorant of basic probablity as well. They are NOT good at balancing risk.
The HMO is in a different situation. They employ doctors. They know what the latest research says, and they can and do set their policies based on that research. They have statisticians that can quantify risk.
That’s why Doug’s situation was the way it was. If there is no CLEAR medical reason for a C section, they’re not going to pay for it. Seems like a great policy to me.
I was actually in an HMO once that had its own hospital, medical clinics, pharmacy, doctors, etc. I think that that was the best situation. Then there was no pissing match between the insurance company and the doctor. Of course, I’m pretty healthy and only used the facilities for routine sicknesses, so maybe I’m just ignorant of what really went on there. But it seemed like the ideal system to me.
I’m not a doctor – couldn’t provide a medical opinion. I am a lawyer, and I can read a contract. Their opinion of the contract doesn’t overturn what the contract itself says.
Preventing complications from sepsis was the clear reason for the C-section even though the sepsis didn’t turn out to be present in my daughter, thankfully.
I can only conclude they were hoping to avoid their obligations. When I called their bluff, they paid the bill.
Wait–I’m confused. Doctors are notoriously ignorant of basic probability? But HMO’s aren’t, because they hire doctors, statisticians, etc.? Well, sure, whatever.
In reality, they have their actuarial tables that tell them how many people they can deny a test for before their denials will kill someone. It’s a cost-benefit question for them, not a “this guy came to me to get well or avoid dying” question.
I don’t have those actuarial tables at my disposal. I do, however, have one patient in my office who I deem needs the test. If they deny the test, who do you think dies? The patient. Who gets sued? Me.
Now we’re not talking some dumbass stuff like me ordering a CT scan for strep throat or something. I was trained in the era where evidence-based medicine has been stressed above all. I was trained in VBAC’s for instance, and the entire thinking changed once there was enough statistical evidence that VBAC’s lead to an unacceptable risk of uterine rupture. You’re having someone contract their already-previously-cut uterus trying to push baby out of an opening that was in many cased inadequate the first time around, which led to more bad outcomes. We didn’t stop doing them because it was easier or more convenient. We stopped because the risk was unacceptably high for the benefit (the benefit mostly being less cost, had outcomes been equal).
Getting back to the HMO’s employing doctors, I’ll give you an average conversation:
Me: Why are you denying my cardiolite stress test for this patient with history of a father and brother with MI (heart attack), lifelong smoker with hypertension who has exertional chest pain?
Them: In our opinion it isn’t medically indicated. He can do a treadmill stress test.
Me: B.S. The treadmill test is for screening. My patient is having signs and symptoms with strong family history and risk factors that I took the time to note on the order. This is straight out of the medical textbook. Are you trying to get my patient (your customer) killed? Who is this? I need to speak to a doctor.
Them: OK. Please hold.
20 minutes pass…
HMO Doctor: We’ll go ahead and approve that.
My experience with managed care is they approve a lot of things, and deny a lot of things. Some (many) of the denials by these “knowledgable” HMO’s with their employed physicians are so dimwitted that they would have gotten the perpetrator sued had that HMO actually been the practitioner. Some days, it’s just a high-stakes game of “Simon Says”.
The problem is that all these practical arguments either way miss the point: the issue of socialized or single-payer health care is fundamentally a MORAL one.
And, frankly, it is patently immoral to enslave the individual to the collective.
One thing that this article does not cover correctly. Wait times in Canada. Sure you get to choose your doctor but guess what if you need a specialist you will wait. 16-24 months for a hip replacement surgery, medical breast reductions – 14 -16 months. I am 32 and have just started suffering from chest pains, they booked me an appointment for an EKG treadmill test 4 weeks later because there was a cancellation available, otherwise it was 9 weeks waiting time. If I could pay $1000 I would gladly pay it and have the test done immediately but there is no option in Canada for that. Now I could always fly down to the USA and walk in and have it done that day which is what I am know considering.