Canadians: tell us about your health care system

[Paul Ryan]

Paul,

Explain how in a capitalistic society you'd pay the folks who work there Paul.

Would you work at a Chevy dealer for free?

Ken,

I am a little confused as to what you are implying, or what your question is. I am not sure how it pertains to our health care system. My whole point is your care, my care, my neighbors heath care should not be determined by how much money each of us make. At this point in time it is. Many people that cannot afford insurance must pass up simple procedures that would make them heathier. And that is wrong. I have a close friend that lives in Brooklyn. He and his wife purchased a modest 800 sq foot apartment 3 years ago for the low low price of $480,000. They have 1 child that is 3. About 4 months ago his wife got laid of, her employer supplied a heath insurance option that they could afford. Since her lay off, they cannot afford the cobra payments, his employers insurance option runs $1700 per month. Private insurance for them for a basic policy with a high deductible runs $1100 per month. So at this point in time himself, his wife, and his 3 year old child are uninsured because they either pay for their dwelling, or their heath care insurance. So if that little girl comes down with flu like symptoms, they may for go the doctor visit an extra day or 2 days because they do not have insurace. Now if she comes down with very bad flu and double pneumonia. It may cost her, her life because they did not see the doctor as soon as some one with insurance. That is what is wrong. And that is capitalism at its best. To grow the economy and increase a countries wealth capiatalism is great. But to take care of us, wether it is through public saftey, elected officials, or heath care it is wrong and should be illegal. Insurance companies that are getting rich off of others heath is wrong. I have no problem with capitalism in insurance when it comes to property, and casualty, but not heath. It is not your right to determine what type of care a person should received by how much they can pay you. We need a system where everone receieves the same treatment regardless if they make 1 billion per year, or 1 dollar per year.

[Greg Peterson]

Last I heard they were operating on about a 2-3% profit margin.

Paying the CEO of United Health $753 million over five years is simply obscene. If he's getting that much, how much do the other executive bring in? How about the other big insurance companies?

Health insurance companies profits over the past ten years have skyrocketed, as well as have premiums.

Tort reform is a strawman argument. Malpractice accounts for such a small part of the pie (less than 1%), it isn't even worth going after. Besides, would you be willing to surrender your only avenue of recourse should you ever have the misfortune of crossing paths with a doctor that shouldn't be practicing in the first place.

If you want tort reform go after the ambulance chasers. Give 'em a three strikes your out rule. Three frivolous lawsuit filings and your out.

No one should have to surrender their freedom just because they got cancer or diabetes. People get locked into jobs they don't like or enjoy because they have a condition that would prevent them from getting a new policy elsewhere.

My brother is stuck at a job that is literally breaking his back. One day soon he will turn the wrong way and that's it, he won't be able to lift so much as a feather. His employer just won't give him a different job (and this company is an international company). He could take disability as it is with his other conditions, but he wants to work. I guess when the company finally breaks his back he'll have no other choice but to take disability. So much for the bottom line.

Praise the dollar and banish all else to the scrap heap. When did we start measuring worth by the god almighty dollar?

[Dan Lee]

Greg you said
"Tort reform is a strawman argument. Malpractice accounts for such a small part of the pie (less than 1%), it isn't even worth going after. "

Is that settled court case awards or does it include/exclude malpractice insurance the Drs have to pay.
In these cases good thing we have insurance companies that sell malpractice insurance and pay damages.

Greg you said
"If you want tort reform go after the ambulance chasers. Give 'em a three strikes your out rule. Three frivolous lawsuit filings and your out"

Now that sounds like a interesting and maybe good idea.Maybe 2 strikes

edit
Maybe take look at Texas medical tort reform. Varying opinions

[Wayne Watling]

No, I would like to see a single non working mum/dad with three kids pay the same as a single non working me, or a working mum/dad pay the same as a working me. I am not responsible for the fact that they have three kids, they are. If I wanted to pay for three kids I would have had three of my own.

If I'm reading you right Belinda you are advocating that everyone pay exactly the same rate no matter what their financial situation.

Lets leave childen out of the picture for a moment. Even in so called civilized western societies such as the US and Canada you get folks who are born into povety like circumstances, obviously not by choice. Under your system these folks would simply not get health care. This is but one example, there are many others where folks through no fault of their own would get no health care due to their financial position.
You can't have this going on if you want your country to stay civilized. The whole medical industry is a very different beast to other areas of a society in that it very directly relates to the raw necessity for humans to stay healthy and alive, we can't leave this to capitalism to sort out otherwise the whole things turns into an animalistic jungle.

[Neal Clayton]

Canada believes that it is in the best interest of their country to promote healthcare of everyone from conception…through birth…in life…until death. The US approaches it as it’s an individual responsibility.

whereas the US has the approach of "how can i make the most money from this".

i honestly don't pay much attention to the constant debate about this in the congress, and the news, etc.

because no one will stand in front of a camera in this country and plainly state that "there is no room for third party administrative profit in health care. this is now a public service, and as such, the profit motive is gone, hope you enjoyed it while it lasted"

and that's the bottom line. paying for it all is rather simple. you eliminate the insurance company overhead, use that to cover the care of the poor, and tell the insurance companies to get bent.

when you see that, come join me while i toss snowballs in hell .

[Greg Peterson]

Because no one will stand in front of a camera in this country and plainly state that "there is no room for third party administrative profit in health care. this is now a public service, and as such, the profit motive is gone, hope you enjoyed it while it lasted"

We worship at the altar of the all mighty dollar and quarterly reports. The United Kingdom has their royal family, and we have our corporate elite. Not much difference between the two.

In the most powerful nation the world has ever seen, and the envy of the world, that there is even a debate as to whether health care is a right or a privilege for the citizens of this country indicates to me that perhaps we still have some growing up to do as a nation. A lot of growing up to do.

[Greg Cuetara]

I think we have the best health care in the world...hands down. Why does everyone in the world come to this country for their treatment? Why do we have the highest survival rates when it comes to cancer?

There needs to be a break between health insurance and health care. If you can't afford it you go into an emergency room and you will be treated. Yes there are problems with the way in which insurance companies handle things but realistically do you think the gov't is going to handle them any better. The gov't this week came out with recommendations to postpone mamograms 10 years until woman are 50....how crazy is that when a lot of women get breast cancer in their 40's. Along with postponing the mamograms they are also recommending to not do self-exams hoping that woman won't go to the doctor. Is that a good gov't recommendation?

Do we need reform? Yes we do. Are there things we can do which will simplify everything and not have a single payer system? Yes.

Another item which has been broached here but is more important than health insurance is the cost of the actual treatments. Health insurance companys actually reduce the costs of all the treatments compared to what hospitals charge. Why shouldn't we be looking at the charges to begin with. Insurance companys just pay a bill. If you do not look at where the charges are coming from then there is no way to reduce the costs. Even if we have a single payer system the big evil hospital managment personel will still be making big profits.

[Rick Moyer]

And how many decades would you like to study it? Or do we just wait until a government that is more in line with your ideology is in place?

We as a nation are about as useful as the Judean People's Front from Life of Brian:




We've talked long enough. A good plan put into place today is far better than a perfect plan put into place 10 years from now. And most of America agrees with that.

I had to quote your post Eric, just to bring up the pic of the Judean People's Front again. Thanks for the laugh!

On a more serious note, I am rather conservative idealogically and politically. However, I am in favor of major health care reform in this country, despite my misgivings about the government's ability to run anything better than the private sector. I fear the big government approach many others do, but "desperate times call for desperate measures". My wife and I are both self-employed. We work hard and pay our own health insurance. Our health insurance costs eat up a larger portion of my wife and my incomes than anything else, including mortgage, and we are healthy. I liked the analogy of the fire departments, etc. Shouldn't public health be as important as public safety? We pay a lot of taxes for things that are way less important to me than my health. I don't want much from my government, save for them to keep me safe. Shouldn't that include preventing my premature demise even though I could no longer afford to pay the high costs of insurance run health care?

I wonder how many on the side of capitalistic health care are paying the bulk of their own health care premiums.

[Mike Henderson]

I'm a big believer in capitalism, but I also have a lot (waaay too much) experience with the medical system.

For capitalism, consumers have to be able to compare prices, quality, and any other factors that are important to them (like how close the facility is to them). For many of those factors, that's rarely possible with health care. When you're sick, you are not in a position to make those kind of choices or shop for doctors or services, even if the quality and cost information was available to you (which it's not).

And private insurance is a serious problem. The insurance companies would like to make each person "a group of one", meaning that each person would pay for insurance based on their medical history and condition. But that eliminates the reason for health insurance. If you're going to to a "group of one", you'd just as well pay your own health costs.

One way to reform the health system is to require everyone to carry health insurance, and to allow them to change carriers without penalty for past health experiences. Even without a "single payer system" the insurance companies can figure out how to price under those rules. But the costs would be based on the entire group (all US citizens) and not some small group, or a "group of one".

I'm now on Medicare. Medicare is a WONDERFUL system for the patient - maybe too wonderful. Much better than any private policy I ever had. The only bad thing I have to say about Medicare is that if you have Medicare and a supplemental policy, you generally don't pay a penny, which is the wrong incentive.

For all health care, there should be some cost to the patient. We should probably limit the "out of pocket" cost in each year, but there has to be some disincentive for utilization. If you make health care completely free (not based on usage) people will use as much as possible. The co-pay should be based on a sliding scale but everyone, even the poorest, should pay something, even if it's only a dollar.

People will object because applying some cost will cause some people to delay or not seek care, but it's the only way to "ration" care that reasonable. At least the individual makes the decision - not some committee.

How would I do it? I'd reform Medicare to apply a cost to each doctor's visit, or test, or whatever, with an annual max out of pocket. Then, I'd start lowering the age for Medicare, until after some number of years, everyone would be covered by the equivalent of Medicare. Payment is still not decided (by me). Either some tax, or each person pays an annual fee for their "policy", or some other funding source. I'm not particular about the way we fund it.

Anyway, that's my $0.02

Mike

[Mike Henderson]

My husband and I pay 978.00 per month for health care, 11,736.00 per year, when COBRA runs out my husband will be uninsurable, he has a tremor. He had an upper and lower GI a few months back, cost about a 1000,00 out of pocket, took about 25 minutes. The health care system in this country needs to change, I was raped as a small child, it hurt less than what is happening now.

Heather

Look into what's called a HIPAA policy. They aren't cheap, but you can get a policy without any consideration of pre-existing conditions, as long as you get the policy within some time (60 days???) of the expiration of your COBRA policy.

Do some research on the web on HIPAA.

Mike

[Dan Lee]

This has been a very good discussion thread with out being over come by politics.

[Greg Peterson]

Mike - In the This American Life episode I recently listened to they spent the entire hour telling stories about the health insurance industry.

I guess EMT's could carry a price list of the various ER's and let the patient decide what they want.

As for using the ER as a primary care provider, that doesn't work to well if you have a chronic or long term disease that requires continuous care and medication (cancer, diabetes, high cholesterol, Parkinson's, MS....).


I find the way Japan manages their system to be very elegant. The fact that half of their hospitals are running at a deficit is a relatively minor problem compared to the matters we need to correct here.

[Dan Friedrichs]

I am not responsible for the fact that they have three kids, they are. If I wanted to pay for three kids I would have had three of my own.

+1.

Ultimately what we need is a system that spreads the risk of unforseen illness EQUALLY amongst everyone. Then we need some way to discourage people from visting the doctor everytime they cough, but not to the point that they don't seek attention in serious cases. Mike's analysis is right-on.

Also, I personally think there should be some financial penalties for doing things that hurt your health and cost the system (either private or public) more money. Smoke? Your premium should be 10x the normal premium. Think you need 23 children? You should be paying 23 premiums. Obese? Higher premium. I'll gladly share the unforseen risks with you, and frankly, even if you have a preexisting condition, I think it's my moral obligation to help relieve you of that burden. But if you're choosing to do things that cost the system more money - you should be the one paying for it.

[Darius Ferlas]

One thing that always gets me are meaningless slogans. One that almost always comes up in any health care debate is "socialized" medicine. What does it mean? Why is it even considered wrong, even derogatory. After all, aren't Americans proud of their "socialized" military? "Socialized" court system? How about the "socialized" national highways system? I'm not sure how the word became derogatory. It isn't and the way it is presented it is designed to scare people away.

Now a few thoughts on some responses in this very interesting and clearly civil thread.

Why should a single mum with three kids pay any less for health care that a single woman, or anyone else?

For the same reason that same woman pays less for police protection, fire protection and prevention, military defense and a host of other "socialized" services provided to all citizens. If that is not enough of the reason then it would logically follow that those who make more money (and therefore pay more in taxes) should have access to more effective policing or fire protection. In case of war the richer should be protected by the military while the poor should not.

Another reason is that Americans are a nation of people who are supportive of one another and full of compassion, aren't they?

While certainly not a an argument to be considered by all, but rather by those who profess certain beliefs and values, yet another reason to support "socialized" medicine could be summed up in the old adage: "what would Jesus do?". Some of us may remember He treated the poor (for free) and didn't have a whole lot of sympathy for the rich.

However, no one seems to bother to check the statistic itself . Statistics like this that are measured across nations are notoriously unreliable, as individual nations may have different definitions or methods for gathering the data.
The main factors affecting early infant survival are birth weight and prematurity. The way that these factors are reported — and how such babies are treated statistically — tells a different story than what the numbers reveal. Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing less than 500 kg [sic; typo--read 500g] is not considered a living child.

So I checked the statistics and the document you link to. It turns out that some of the fundamental arguments in your statements are not true. Of The three countries named both in Germany and Austria ALL LIVE births are reported, regardless of the child's weight or term. (source, page 2)
I have no relevant information for Canada, but from friend's personal experience I know that serious care takes place even before birth, including pre-natal surgeries. (a side note, just last year I didn't know they could do a heart surgery on an unborn baby)

But when the main determinant of mortality — weight at birth — is factored in, Norway has no better survival rates than the United States....

The same source, on the same pages states:

since no live births occur before 12 weeks of gestation, the requirement for Norway that all live births at 12 weeks of gestation or more be reported is substantially the same as for countries where all live births are required to be reported.

So Norway can still be considered as a country with better survival rates.

Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States.
Page 30 or so of this interesting kind of dated but addressing international differences is still http://www.cbo.gov/ftpdocs/62xx/doc6219/doc05b.pdf

Again, the same source (page 6) indicates that there is indeed better survival ratio in the US for children born prematurely (before 37 weeks), but much worse for children born after that. But then, the US seems to have a greater ratio for premature to full term births than any of the countries analyzed. That, I'd say, is a medical indicator too, and not such a good one for the US.

The conclusion in the source I quoted are (emphasis mine):

However, it appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking. In 2005, 22 countries had infant mortality rates of 5.0 or below. One would have to assume that these countries did not report more than one-third of their infant deaths for their infant mortality rates to equal or exceed the U.S. rate. This level of underreporting appears unlikely for most developed countries.


Now, the report I am referring to is dated November 2009. The one you refer to is over 17 years older (dated February 1992. That report states that it was commissioned by Representative Willis D. Gradison Jr. (Rep.) A year after that report's purpose (whatever that purpose might have been we can only speculate) Mr Gradison took the position of ... SURPRIZE! SURPRIZE! - president of the Health Insurance Association of America! He held the position for 6 years.

But even if the Gradison report is seriously oudated (and perhaps biased?), it does reveal some interesting numbers where there can be no question about discrepancies in gathering and reporting data as all that data refers to the US.

Page 35 talks about Native American mothers, page 34 about Hispanic and page 33 about black ones. The conclusions are consistent with the numbers shown in Table1 (page 9, comparing IMR for white and black Americans) and they are also consistent with the material status of various ethnicities within the US. Given the current medical system in the US it would be hard to hide correlation between affordability of medical care and medical outcomes. I can't see how similar correlation would not be valid between the US and other developed countries where medical care is free and universally available.

There is no question that "socialized" health care system is less expensive to run. Yes, per capita a bus is much cheaper than a Golf. The rest of the debate is philosophical and political. In the US the wealthier and the luckier are given a better shot at obtaining medical care (although often at a risk of bankrupcy). In countries with "socialized" medical system every body is given a fair shot at surviving what God/Fate throws at them.

Your premium should be 10x the normal premium.

In Canada, taxes paid by smokers cover more than twice the cost of all cases deemed smoking related, whether they indeed are or not. The government needs the cigarette tax and I'd be surprised if the US was any different.

[Greg Peterson]

Darius - Well stated.

17 year old report being passed off as relevant data? Why do I not find this surprising? Sounds FOXy to me.