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cjc
Citizen
Username: Cjc
Post Number: 5267
Registered: 8-2003
| | Posted on Tuesday, February 28, 2006 - 9:51 pm: | 
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I ask this in all honesty. Canada has had problems that become known to us in the US when patients come down to the US to get care they can't at home, or doctors leave their practises in Canada. I've read reports of nurse shortages, massive strikes (though emergencies are still taken care of).
Norway is full of petro-dollars so I don't know if that's a fair comparison. Is Sweden's system affordable and working well and would that translate well to the US and the make-up of our population?
Canada's Private Clinics Surge as Public System Falters
http://www.nytimes.com/2006/02/28/international/americas/28canada.html?_r=1&page wanted=all&oref=slogin |
Montagnard
Citizen
Username: Montagnard
Post Number: 1895
Registered: 6-2003
| | Posted on Tuesday, February 28, 2006 - 11:21 pm: |
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Private health insurance has always existed in Canada, often to cover more elaborate procedures or more lengthy hospital stays than were covered by the public health system. Patients have always been able to pay extra for (say) a private room where the public health system or even the private plan would only pay for semi-private. Moreover, things like physiotherapy and psychological care have always been limited in scope.
It's also common for patients to be sent to the U.S. for treatments that the Canadian system has outsourced to U.S. providers (and which could one day be outsourced to Indian providers). This is essentially a business decision driven by the relative sizes of Canada and the U.S., since a rare and costly procedure in a smaller Canadian province may be common and cheap in a place like New York or L.A.
"Doctor shortages" in Canada are mainly felt in the remote regions of the country where it is hard to attract doctors and nurses. In the urban areas it's more a case of facility shortages, i.e. you can see a doctor but you can't get scheduled for an operating room or even an MRI scan without a long wait.
My impression from talking to people that have experienced both the Canadian and the U.S. system is that public health care works well in areas where the risks and costs are relatively predictable (pediatrics, motor vehicle accidents, etc.) and less well in areas where more elaborate and expensive treatments might improve the quality of a patient's life without being a matter of life and death (cosmetic surgery or gender reassignment). Even the relatively wealthy and generous Canadians have to draw the line somewhere, and with the rising cost of health care everywhere, it's being drawn a little closer to primary care. |
argon_smythe
Citizen
Username: Argon_smythe
Post Number: 768
Registered: 5-2001
| | Posted on Wednesday, March 1, 2006 - 12:45 am: |
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You know what works really well? Having large numbers of working families with no health insurance whatsoever. That works great.
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kendalbill
Citizen
Username: Kendalbill
Post Number: 119
Registered: 6-2002
| | Posted on Wednesday, March 1, 2006 - 9:39 am: |
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I guess you could answer with a question: where does health care work at all? Does that mean we don't come up with ways to insure? Seems to me that we have to make tough choices and not wait out till we come up with a perfect solution.
And if we were willing to create a laboratory here in the US that offers universal healthcare to a small group, we might want to do that. Wait-- we have. Its the VA system, and despite the problems it had in the past it actually gets high marks now. Or we could create allows market influence to control nearly every aspect of our health a develop a patchwork system of coverages tied to your employment. We've done that as well and its a mess. HMOs decide whether I'm covered based on their bottom line, employers are required to get into the insurance business, if I'm out of work my family loses coverage... I can go on but you know the story.
Look, there are problems with every system. But it seems like every time single payer is brought up it is dismissed out of hand based on problems that I would suggest are similar to problems we see in our existing system-- but at a much lower cost. I'm glad you asked the question-- I think we need to start talking bout this issue. |
cjc
Citizen
Username: Cjc
Post Number: 5269
Registered: 8-2003
| | Posted on Wednesday, March 1, 2006 - 11:57 am: |
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It seems that universal healthcare systems have their own bottom line when they refuse and ration some of their coverage as well, given they aren't immune to exploding costs. I guess it comes down to where you draw it, and who'd doing the drawing.
Monty -- I'm confused that private healthcare was always available in Canada. Especially when the story says: "Accepting money from patients for operations they would otherwise receive free of charge in a public hospital is technically prohibited in this country, even in cases where patients would wait months or even years before receiving treatment."
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Bob K
Supporter
Username: Bobk
Post Number: 10845
Registered: 5-2001
| | Posted on Wednesday, March 1, 2006 - 12:08 pm: |
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We have a nice health insurance plan. We can see pretty much any doctor we want, when we want to for a $10 copay. Works great for us and I assume Cjc has something similar or better. Our anti-personnel manager complains about the costs all the time.
However, there are somewhere around 50 million people without any health care coverage and maybe the same number with inadequate coverage. To them I expect the Candadian system with all its issues looks pretty good.
If we had universal health care of some type, there is nothing to keep people from buying insurance and seeing other doctors.
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CageyD
Citizen
Username: Cageyd
Post Number: 622
Registered: 6-2003
| | Posted on Wednesday, March 1, 2006 - 1:01 pm: |
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cjc
Whatever its failings, at least Canada's public health provides some coverage for those out of work, those who freelance, those with pre-existing conditions, the rich to poor,etc. The real question to you is, how do you define "works" If you mean providing excellent, overpriced healthcare to the wealthiest and healthiest citizens while leaving the poorest, sickest and most vulnerable without any, then yea, our system works just great. |
kendalbill
Citizen
Username: Kendalbill
Post Number: 123
Registered: 6-2002
| | Posted on Wednesday, March 1, 2006 - 2:40 pm: |
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cjc, I agree that there are pluses and minuses with every program, but that doesn't negate the differences.
If the goal is to provide access to health care for all people at an adequate level, our system obviously fails.
If we wish to provide high levels of service to most people, I think we believe we are doing that-- but I seriously question that we are doing even that. I work for a large company that believes they provide excellent benefits. I have seen the costs of that coverage explode and the services narrow. When I talk to friends, they see the same thing. So I'm not sure I see an upside to those of us lucky enough to be covered at the expense of those who aren't covered. |
Tom Reingold
Supporter
Username: Noglider
Post Number: 12682
Registered: 1-2003
| | Posted on Wednesday, March 1, 2006 - 3:03 pm: |
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cjc said: It seems that universal healthcare systems have their own bottom line when they refuse and ration some of their coverage as well, given they aren't immune to exploding costs. I guess it comes down to where you draw it, and who'd doing the drawing.
Yes, that's right. We are facing some tough decisions all around the planet. Rationing will get more severe, because we are inventing new procedures and medicines that are very expensive but were previously unavailable. So you have someone in her 80's who is facing nearly certain death, but we have a new treatment that will either make her more comfortable or will keep her alive for a short time. And she's your mother, and you would be infuriated to hear that it's not worth paying the high price because it's her life, dammit, and how can we place a value on someone's life? Yet some huge percentage of healthcare costs over a person's life are spent in some tiny slice of time. I forgot the numbers, but I think it's something like 80% of the cost goes into the last few months of life. That sounds messed up, but so does letting someone die because she's already old.
I don't think anyone has the answers to this dilemma. And science and technology are furthering this problem, because their job is to figure out new treatments to improve life. And we can't blame them for trying!
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Tom Reingold
Supporter
Username: Noglider
Post Number: 12683
Registered: 1-2003
| | Posted on Wednesday, March 1, 2006 - 3:05 pm: |
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And universal coverage, compared with the USA's current so-called system, would increase the average guy's condition but would worsen the condition for the folks at the top of the economic food chain.
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cjc
Citizen
Username: Cjc
Post Number: 5271
Registered: 8-2003
| | Posted on Wednesday, March 1, 2006 - 3:31 pm: |
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Tom Reingold -- what makes you think the 'average' guy wouldn't be hurt by rising costs. It's not only the rich who are complaining about the healthcare situation in Canada. If that were the case, no one would care how much the rich complained and be prompted to act. |
Tom Reingold
Supporter
Username: Noglider
Post Number: 12685
Registered: 1-2003
| | Posted on Wednesday, March 1, 2006 - 3:34 pm: |
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Oh, I wasn't saying anything about that. I mean, if costs were fixed -- and they're not -- then changing from the US system to a Canadian system might result in improvement for the average guy, but it would surely improve things for the bottom guy and worsen things for the top guy.
But costs are rising everywhere, which will require new types of rationing. One question, among the others you raised, is who should be making new sacrifices. I don't have any satisfactory answers, and I don't think anyone else does, either.
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themp
Supporter
Username: Themp
Post Number: 2626
Registered: 12-2001
| | Posted on Wednesday, March 1, 2006 - 4:32 pm: |
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A friend of mine moved to Italy. When he was back visiting, he pointed out to me that if you get sick and don't have a lot of money "you might as well be in Cuba". Imagine recovering from surgery in a public hospital with no air-conditioning during a heat wave? |
dave23
Citizen
Username: Dave23
Post Number: 1397
Registered: 5-2001
| | Posted on Wednesday, March 1, 2006 - 4:42 pm: |
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Here's the crux: We are the wealthiest nation in the history of the world with the best doctors, medicines and medical technology in the history of the world, yet tens of millions of us don't get to be a part of it.
And insurance companies and HMOs have managed to build multibillion-dollar industries based entirely on paperwork. |
Elgato
Citizen
Username: Elgato
Post Number: 33
Registered: 2-2004
| | Posted on Wednesday, March 1, 2006 - 8:15 pm: |
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themp. If I had no insurance I'd take a hospital with no air-conditioning over no hospital at all! |
cjc
Citizen
Username: Cjc
Post Number: 5276
Registered: 8-2003
| | Posted on Wednesday, March 1, 2006 - 10:32 pm: |
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dave23 -- yes, we are the wealthiest nation in the world. Given the unfunded liabilities of both Social Security and Medicare -- with Medicare recently expanded -- do you think that the country should raise taxes on those who pay them to fund those programs and then extend it to even more people after that? And what will that do to our economy and standard of living if we continue on with this. At some level, this is faced by private healthcare systems and now universal systems.
The argument is "well, at least everyone is covered at less of a cost." But the same problems eventually creep up, and then you're paying Ontario tax rates of 39% on income of 72K, or 46% on income at the $118K level plus sales taxes. It will go even higher if you have to maintain a military.
And their system needs even more money.
It's just insane.
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Lester Jacobs
Citizen
Username: Lester
Post Number: 88
Registered: 10-2005
| | Posted on Thursday, March 2, 2006 - 10:56 am: |
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Our healthcare system is the gold standard for the world in terms of quality of care. Also depsite the hype very few are without some form of coverage for very long. An alternative to big government might be funding of the gap through charities, faith based organizations, etc. Also returning to a fee for service model in the primary care setting may also temper spiraling costs. |
dave23
Citizen
Username: Dave23
Post Number: 1403
Registered: 5-2001
| | Posted on Thursday, March 2, 2006 - 11:10 am: |
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cjc,
I'm not going to pretend to be an expert on this. The only solution I've heard that appeals to me is single-payer for all levels of care. |
cjc
Citizen
Username: Cjc
Post Number: 5277
Registered: 8-2003
| | Posted on Thursday, March 2, 2006 - 11:14 am: |
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And why does that appeal to you? |
dave23
Citizen
Username: Dave23
Post Number: 1406
Registered: 5-2001
| | Posted on Thursday, March 2, 2006 - 12:14 pm: |
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For one, I have a deep-rooted dislike of insurance companies (and HMOs). This would largely take them out of the eqation. And, believe it or not, if it's done right (unlikely, of course), it would greatly reduce the bureaucracy and administrative waste on all sides. |
kendalbill
Citizen
Username: Kendalbill
Post Number: 128
Registered: 6-2002
| | Posted on Thursday, March 2, 2006 - 12:15 pm: |
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First, right now many Americans that are provided healthcare for the employees are paying for the cost of that care anyway. It is not unusual for an employee that makes 72K to pay 5-10% out of pocket in addition to what the company is paying to get the healthcare they need. So, if my taxes go up but I don't have to pay and my employer can make business decisions about their employees that don't neccesarily have to include their healthcare, I don't see the big problem.
Second, we do not have a world class health care system. A world class health care system figures out how to distribute a resouce equitably. Our infant mortality rate is something to be ashamed of, below Cubas as well as 40 other countries.
The way I see it, we are paying a high price for a runaway bureacracy that gives us little or no choice. I don't think that critics of a single payer are realistic of the costs we are facing now. |
Lester Jacobs
Citizen
Username: Lester
Post Number: 89
Registered: 10-2005
| | Posted on Thursday, March 2, 2006 - 12:46 pm: |
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Thinking in terms of economics, typically competition and innovation drive down costs and improve quality of a product or service. How does a single payer system encourage competition and innovation in healthcare? Shouldn't the debate shift towards profitably serving the needs of the uninsured/underinsured population? |
Tom Reingold
Supporter
Username: Noglider
Post Number: 12700
Registered: 1-2003
| | Posted on Thursday, March 2, 2006 - 2:15 pm: |
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There isn't really competition when the employer pays the premiums. If my insurance company serves me badly, I don't have the option of telling my employer to choose a different provider. That's because I'm not really the customer. I'm dissatisfied, but my employer isn't, except in a very indirect way, if large numbers of employers are similarly dissatisfied about the same aspects of the service.
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kendalbill
Citizen
Username: Kendalbill
Post Number: 131
Registered: 6-2002
| | Posted on Thursday, March 2, 2006 - 2:19 pm: |
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I'd say if the goal is to create a system that develops the most profitable companies in the health care field, our system has the potential to do that for its shareholders. If the system is to provide efficency and overall health as its own value and not a means to an end, I think it fails. The free market does not have the power to fix every problem indiscrimanately.
And your question of how a single payer system and its relationship to competition only matters to me if competition is the goal.
I do like your premise, however. Is there a way to PROFITABLY insure the health of the underinsured? Any ethical ideas? I know there might be some, but I can't think of any at all. |
dave23
Citizen
Username: Dave23
Post Number: 1408
Registered: 5-2001
| | Posted on Thursday, March 2, 2006 - 2:52 pm: |
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Lester,
If competition drives down costs, why are costs spiraling out of control?
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Lester Jacobs
Citizen
Username: Lester
Post Number: 90
Registered: 10-2005
| | Posted on Thursday, March 2, 2006 - 4:13 pm: |
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Tom, I do agree with you on the disturbing trend of employers only offering one healthcare plan. This in some ways is similar to a single payer system. Ideally it would be nice if you could take the dollars allocated to you and choose the plan that best meets your needs.
Sadly our healthcare system is way behind the times in terms of productivity technology. For example it seems like it would be easy to market a blood test device that plugs into your computer so that the results could be sent to a physician (perhaps in a low-cost country like India) for diagnosis. The physician could then electronically write the prescription to be filled at your local pharmacy. Think about how much this would save in both dollars and lost time (getting to and waiting in the physician's office). |
dave23
Citizen
Username: Dave23
Post Number: 1411
Registered: 5-2001
| | Posted on Thursday, March 2, 2006 - 4:16 pm: |
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Lester,
A lot of devices like that do exist or are being developed right now. It's not always easy for inventors to find funding, though. |
Eponymous
Citizen
Username: Eponymous
Post Number: 124
Registered: 6-2004
| | Posted on Thursday, March 2, 2006 - 4:29 pm: |
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Lester,
Krugman is good on way competition doesn't work here. Insurers compete to be profitable. How do they do that? By not spending. How do they not spend? Have healthy customers and not paying claims.
In short, their economic interests are not those of their customers.
Let me reverse the thread topic: Does the existing US healthcare system work? |
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