Canadian health care - Small Cabin Forum (3)

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ICC Member	# Posted: 14 Feb 2020 21:27 Reply Quoting: spencerin Just be open to the fact that there could solutions to the problem other than socializing it. OK. What? And why are we in the US still stuck with a system that costs us more and still does not provide us all with superior care? Forget the s---- word. Canada, the UK, western European and Scandinavian countries are not socialist countries. They are capitalist countries with greater social consciousness.

bugs Member	# Posted: 15 Feb 2020 19:11 Reply I have a friend whose father was a family gp who practiced in both CA and USA. He mentioned that in the states the people he saw on average were sicker when they went to see an md than those he saw in CA. This he attributed to the direct costs of visiting a doctor in the states especially for those not lucky enough to have heath care through work or could afford their own private health insurance. This of course often resulted in more complications related to the illness/injury and longer recovery periods. Of course in CA we have the hypochondriacs who abuse the system and head to the dr's office at the first sign of a sniffle or to patch up a small "boo boo"... I was once at a medi clinic for a head x-ray (no comment from the wags in the peanut gallery ) and a person from the US hobbled in with a foot injury. I over heard the prices and list of things that had to be done to assess the injury... My x-ray and consultation cost me 0$ (and yes I appreciate that I already paid for it with my tax $'s) the person with the foot injury had to pay over $500 for their visit. I prefer the CA system. I don't mind the higher taxes nor mind paying for other people's care as I suspect down the road I will be using their tax $$$'s for my care soon enough.

silverwaterlady Member	# Posted: 15 Feb 2020 22:55 Reply Correct bugs. Big problem in the USA. People without health insurance do not maintain their health with annual checkups and bloodwork. They donâ€™t go to the doctor or hospital until they are very ill or they just drop dead at home. I know of many people including relatives where the above has been the outcome.

ICC Member	# Posted: 16 Feb 2020 00:20 - Edited by: ICC Reply Quoting: bugs I don't mind the higher taxes nor mind paying for other people's care as I suspect down the road I will be using their tax $$$'s for my care soon enough. Taxes might be higher, but at the same time the absence of insurance premiums, co-pays and deductibles help to compensate. In addition one need not feel trapped in a job they no longer enjoy just because they need to stay for the insurance benefits. There is nothing wrong with helping others in any manner, including helping to educate and to help pay for healthcare that in the end benefits everybody. At the same time you can be an entrepreneur, can be self employed at something you have a passion for.

jsahara24 Member	# Posted: 17 Feb 2020 20:24 Reply My situation is I was diagnosed with a disease that isn't fatal, but significantly decreased my quality of life and put me on a bunch of medication that didn't really work. My Dr recomended I try a newer drug that was getting great results, but warned that the cost was around 30k a year. We applied to my insurance company who approved it within days. I have been on the new drug for 4 weeks and seen great improvements. Once I was approved I joined a FB group of people with the same issue and I read about many Canadians and Europeans who can't get on the drug, or even get their Drs to consider it. As I read it I truly feel bad for them as it has changed my life. I'm not sure what my point is exactly, but I suppose I worry that the quality of healthcare will decrease if its government run.

toyota_mdt_tech Member	# Posted: 17 Feb 2020 21:04 Reply A socialist wants everything you have except your job.

bill_bly_ca Member	# Posted: 18 Feb 2020 15:52 Reply Many of these stories (of deficiencies of both systems) are anecdotal. My Own experience A) 1997 Cancer - Tests - 3 days - Results of tests 5 days - On the table in 4 days after that. CT scans and blood tests for the next 5 yrs at one of the top 5 Cancer hospitals in NA (Princess Margret) B) 2016 - Appendix - Diagnose at Dr office @ 3PM (I received an appointment 2 hrs after I called) - Given letter to bypass triage at hospital (Drove myself) in a ER bed by 4:30 - Operation by 11:30 PM (3 incession with maybe 12 stitches and sent home next day. The only cost to me was driving back and forth to Toronto every 6 months for 5 yrs for A and for B I had to pay $60 for parking Up here hospitals are given a working budget and funding but are independent entities that are paid by patient and procedure. Many of the larger items (CT, MRI physio etc etc) are funded by public drives or philanthropists. Dr's are private offices as well with a book rate for procedures that is paid to them by the single-payer system. Example I like was the city where I live (Kitchener Waterloo) with about 500,000 in our area and Buffalo NY with about the same population. At the time of my Cancer (A above) KW had two CT scanners. Buffalo area had 10 - Our 2 were run at 90% utilization 8AM to 10PM - Buffalo's 10 units were apparently only run at less than 20% each. Similar were the accounts payable and receivable departments between a leading Buffalo hospital and the Grand River Hospital (Where I go). If I recall correctly the Buffalo hospital had over 100 people for each. Grand river had 2 accounts payable people and one accounts receivable person. There is a problem with rural - our cabin will be a 40 min away from a regional hospital and almost an hour and a half from a full hospital. But Ontario does have one of the largest air ambulance services in NA.

ICC Member	# Posted: 18 Feb 2020 18:18 Reply Quoting: bill_bly_ca Similar were the accounts payable and receivable departments between a leading Buffalo hospital and the Grand River Hospital (Where I go). If I recall correctly the Buffalo hospital had over 100 people for each. Grand river had 2 accounts payable people and one accounts receivable person. Yep. Right there is where the US spends (wastes) a lot of money on administration costs. The US health care system has to deal with many different insurance companies and adjusters. The Canadians have one central system and cuts costs because of that. Quoting: bill_bly_ca Example I like was the city where I live (Kitchener Waterloo) with about 500,000 in our area and Buffalo NY with about the same population. At the time of my Cancer (A above) KW had two CT scanners. Buffalo area had 10 - Our 2 were run at 90% utilization 8AM to 10PM - Buffalo's 10 units were apparently only run at less than 20% each. Having fewer machines does sometimes mean there is a wait for some procedure in Canada. However, emergencies do receive a priority. Machines that sit un-used for hours every day in some places in the US means there is sometimes tests run that may not necessarily needed. An MRI or CT may be ordered by a doctor just because if the machine is not being used money is not being billed. Somebody has to pay for the machines. There are also rural areas in the US that have long distances between facilities. My state is one of them.

jsahara24 Member	# Posted: 19 Feb 2020 08:50 Reply Quoting: ICC Yep. Right there is where the US spends (wastes) a lot of money on administration costs. The US health care system has to deal with many different insurance companies and adjusters. The Canadians have one central system and cuts costs because of that. OK, I won't argue with the point that making it government run would make it cheaper. I am wondering what your stance is on the quality of service received from a public versus private system?

silverwaterlady Member	# Posted: 19 Feb 2020 09:21 - Edited by: silverwaterlady Reply In Canada the government pays for transportation and hotel stays if you have to travel far to hospital if you live in a rural area. I know from many Canadian relatives that certain medications are not covered because they are too expensive. Thatâ€™s not what they tell them. Itâ€™s always another reason. At least here in the States I can shop around for cheaper prices via my app. I see a huge difference in my Husbands medical bills Medicare versus the private insurance I have to pay for and the deductibles. I just donâ€™t understand why after working over thirty years and having enough credits to be eligible for social security I cannot have Medicare now. Iâ€™m 58 and healthy my Husband is 80 and has 3 different medical issues. His medical bills are half of mine. His medications are higher because he has to take Eliquis. BTW my Canadian SIL was shocked to find that there is a Medicare premium taken directly from your Social Security every month. It was her impression that once you hit age 65 Medicare was free. Also, my Husband has supplementary medical insurance to pay for his medications.

Thelar Member	# Posted: 19 Feb 2020 10:19 Reply There are 370,000,000 people in the 18 countries that have universal healthcare. The healthcare ranges from single payer to private health insurance companies. The cost to citizens in each of those countries varies. We here in the U.S. are looking for a system that will accommodate 330,000,000. 92% of them had coverage as of 2018. I think we need to look at all of those countries to see what works and why. I also think a one-size fits all solution is wrong for the U.S.

ICC Member	# Posted: 19 Feb 2020 10:28 - Edited by: ICC Reply Quoting: jsahara24 I am wondering what your stance is on the quality of service received from a public versus private system? Many Americans participate in and receive heathcare from one of the worlds largest "socialized" healthcare systems. The Veterans Administration (VA). They just don't think of it as a "social" program because they they "earned" the right by serving in the armed forces. Yes, there are reports of grave deficiencies but that can also be found in the private sector. There can be, and are, big differences between facilities in different parts of the country. Same thing can be found with private care hospitals. Similarly the native American population receives "socialized" care via the BIA. There are also some issues with that bureaucracy, but the native Americans (known as the First Nations in Canada) have always been treated poorly, or worse, by the American white invaders. A few years ago the Rand Corporation did a study on the VA healthcare system. Among their findings; " "Quality of care delivered by VA is generally equal to or better than care delivered in the private sector, though there is considerable variation across centers and types of care." One of my friends who served in the army has a cancer diagnoses. He seems to be receiving good care at the VA. He does not complain about his care and he does complain vocally about some other things. I have family and extended family living and working in Canada. From traveling there I have met many Canadians. Except for one particular couple everyone I have talked to would not trade their Canadian system for the private sector system in the US. There are people here in the US who stick with a job they detest solely because they cannot afford to leave the health insurance benefit. One in particular that I think of wanted to open his own business about 15 years ago. But a daughter had been born with health issues and obtaining private insurance on his own was cost prohibitive. A person in Canada would not have had to worry about that.

ICC Member	# Posted: 19 Feb 2020 10:45 Reply So to directly answer the question, yes I would prefer a change to a healthcare system that provided care to everybody who is a citizen or legal resident.

bill_bly_ca Member	# Posted: 19 Feb 2020 11:46 Reply Quoting: jsahara24 OK, I won't argue with the point that making it government run would make it cheaper. I think this is the biggest misconception of the Canadian model. The Federal government set care standards. The provincial and Federal government provides the funds to the private entities that provide the services. The Federal Government provides matching funds that the province collects and dispurses. Test labs are private firms that deliver services for a fee/service. XRay and ultrasound labs are private firms that deliver services for a fee/service. Walk-in clinics are private firms that deliver services for a fee/service. Dr. offices are private firms that deliver services for a fee/service. Hospitals are private not for profit entities are also private firms that deliver services for a fee/service. Rarely does a gov bureaucrat gets involved other than what one poster alluded to above, where a certain treatment or drug is not prescribed because of cost or the fee for the above services are set. It is a "Rationed" system in the end - But one could argue so is the US system where you are unloaded from the HMO or regular plan when you are too sick or fired from your job, to then go on the limited public plan where you may or may not get better.

ICC Member	# Posted: 19 Feb 2020 18:47 - Edited by: ICC Reply Absurd. Put people in jail because they can't pay a medical bill.... https://www.cbsnews.com/news/coffeyville-kansas-medical-debt-county-in-rural-kansas-i s-jailing-people-over-unpaid-medical-debt/

Thelar Member	# Posted: 20 Feb 2020 08:16 Reply It sure looks like they are put in jail for missing court dates. Two court dates according to the link. It still seems kinda slimy to make them appear in court quarterly to simply state they can't pay the bill.

silverwaterlady Member	# Posted: 20 Feb 2020 08:46 Reply This is awful. He should have showed up for his court date. He knew about it far enough in advance so he could take a entire day off from his TWO JOBS. Probably unpaid leave for the day. So he could sit in court all day while they had the other 60 poor people stand before the judge and over and over again tell the same thing. Itâ€™s either eat, pay rent or my mortgage or pay my overinflated medical bills. In the meantime there are attorneys and others reaping the benefits. Sickening.

KinAlberta Member	# Posted: 24 Feb 2020 23:24 - Edited by: KinAlberta Reply Quoting: bill_bly_ca I think this is the biggest misconception of the Canadian model. The Federal government set care standards. The provincial and Federal government provides the funds to the private entities that provide the services. The Federal Government provides matching funds that the province collects and dispurses. Test labs are private firms that deliver services for a fee/service. XRay and ultrasound labs are private firms that deliver services for a fee/service. Walk-in clinics are private firms that deliver services for a fee/service. Dr. offices are private firms that deliver services for a fee/service. Hospitals are private not for profit entities are also private firms that deliver services for a fee/service. Rarely does a gov bureaucrat gets involved other than what one poster alluded to above, where a certain treatment or drug is not prescribed because of cost or the fee for the above services are set. It is a "Rationed" system in the end - But one could argue so is the US system where you are unloaded from the HMO or regular plan when you are too sick or fired from your job, to then go on the limited public plan where you may or may not get better. Great post thanks. Last week I went to my private doctor then to a private lab to get blood work done. Today I went to another private lab for an ultrasound. Basically the only direct bill I will have for any of the visits is my income tax bill. My purchases at restaurants, gas stations, etc. will include a 5% federal sales tax that also pays for the services. Company insurance not the government pays most of our prescription drug costs. Canada very much has private health care outside of the hospitals. Far from all hospitals are government owned hospitals as other organizations operate many hospitals. Itâ€™s the health care insurance system thatâ€™s public.

ICC Member	# Posted: 24 Feb 2020 23:57 Reply Am I correct in stating that the Canadians reading or commenting on this topic are satisfied with the Canadian system, at least satisfied enough to NOT want to change to a US type of health insurance and care?

KinAlberta Member	# Posted: 25 Feb 2020 00:18 - Edited by: KinAlberta Reply Quoting: ICC Am I correct in stating that the Canadians reading or commenting on this topic are satisfied with the Canadian system, at least satisfied enough to NOT want to change to a US type of health insurance and care? In 80 years my father had never spent a night in a hospital until he fell and broke his neck and ended up in a wheelchair in a 24/7 care facility. Life can change in a moment and I donâ€™t know how one would choose the right private insurance policy at the right time and place to cover the risks. Also I canâ€™t imagine the horrible amount of stress the US system puts on families when the unexpected happens and they seem to be essentially left on their own to deal with it. The paperwork alone must rob thousands of precious last moments with loved ones. So yes I feel that our insurance system is much much simpler fairer and so is more cost effective and no where near as oppositional as a private insurer system.

jsahara24 Member	# Posted: 25 Feb 2020 12:30 Reply So what is wrong with giving people the choice to choose a privately run insurance company in lieu of utilizing a government program? I believe that people who work hard and have made a good living deserve the ability to choose something better than the government can provide. Seems to me the US government is never able to do anything as good as the private world can while making a profit. As I stated earlier, if I was living in Canada my current condition would be generally untreated. With my insurance I am able to get on the latest medicine and my quality of life has increased by more than I can describe. Frankly I feel sorry for those in government run programs who are unable to get the medicine that could change their lives. I do acknowledge that someone can get hit with a life changing disease that they had no control over and we need to take care of these people. I may be in this position at some point in my life.

Ontario lakeside Member	# Posted: 25 Feb 2020 12:55 - Edited by: Ontario lakeside Reply The lack or coverage for your drug in Canada and Europe may be due to regulations approval more that cost. Some jurisdictions are slower to approve new treatments and a private system of payment wouldn't change that. That being said, no system is perfect and I agree governments are notoriously bad at managing these things.

Kamn Member	# Posted: 25 Feb 2020 12:57 Reply Quoting: ICC Am I correct in stating that the Canadians reading or commenting on this topic are satisfied with the Canadian system, at least satisfied enough to NOT want to change to a US type of health insurance and care? Im not satisfied and would rather have a US style where I can get my own health insurance.....it is my belief that government healthcare (or any government service) is a lesser quality than private/free market. We have been raised to believe that our Canadian system is top notch and to rely on government, its mediocre at best, and government doesn't know what is best for me or my family. For everyone that has a good anecdotal experience with our health care system, there are at least 3 bad. I agree with Jsahara24 Watch how our "health care" system will handle the eventual Covid19 meltdown that has China crumbling, its coming for us as well since the governments response here is to allow you to "self quarantine".......we are screwed

jsahara24 Member	# Posted: 25 Feb 2020 13:04 Reply Quoting: Ontario lakeside The lack or coverage for your drug in Canada and Europe may be due to regulations approval more that cost. Some jurisdictions are slower to approve new treatments and a private system of payment wouldn't change that. That certainly could be part of it, however the Canadian and European residents also complain that they can't even get seen by a Dr. who has any real knowledge of our issue. They are traveling 4+ hours and waiting 6+ months, and still not getting what they need. I will try to pull some screenshots from my group to show you their complaints. It just seems that the quality of health care provided is behind the US, at least in my circumstance.

Ontario lakeside Member	# Posted: 25 Feb 2020 13:05 Reply Canadian here. Cancer survivor, two kids born in hospital, multiple broken bones. Lots of experience with family in the system. I am %100 happy with our public system. The only note is that I live in a very large city with some of the top hospitals in the world. Some of rural Canada does not get the same easy access.

Houska Member	# Posted: 27 Feb 2020 08:29 Reply I've lived in 5 countries to date, including the U.S., and (now and for more time than any of the others) Canada. The U.S. system is at the same time 2nd worst and best of the 5. It's 2nd worst (after a shambolic 3rd world country I won't name and shame), since the administrative inefficiencies and resultant stress on individuals are incredible. And if you fall through the cracks or just mis-step in the insurance minefield, your care can be awful. The U.S. system is best, if you are rich, and/or benefit from a gold-plated health plan, like my employer provided when I was there. That's both for the care options available, and the speed at which you can get them, if someone is willing to pay. And more broadly, due to the R&D and innovation that this chaotic, dollars-count Wild West system encourages, which by the way the rest of the world piggy-backs on. It's also weirdly hypocritical, in that the US trumpets individual choices and entrepreneurship, and yet for most individuals, it's someone else calling the shots on their care (the insurance company) and the fear of "losing healthcare" is a huge disincentive for someone to quit a job and do something entrepreneurial! The Canadian system is pretty good. While there are exceptions, by and large health outcomes are good (better than the U.S. on a societal level). Care quality is generally good, costs are low (to individuals as well as to society overall), access for urgent care is good. The single-payer, multiple independent provider model we have works pretty well. Yet there are limitations. In some areas of the country, it's hard to get a primary care physician. In others, emergency room wait times are insane, ditto time to wait for a nonurgent specialist appointment. The mix of public-private makes it harder to optimize the system versus a more centrally-run system (as I've experienced in Europe) OR a (nearly) fully private, market-fills-any-niche approach like the U.S. or Singapore. While there is no "rationing" or "death panels" in Canada as some fake news from south of the border has yelled, it can feel like rationing when you're waiting 9 months for a specialist appointment, and some treatment that might work is not available since some bureaucrats have said it's "only experimental". (Not that the U.S. is that different, with treatment choices too often constrained by what you and your doctor get approved by the insurance company.) Or when you're worried (maybe overly anxious) about something, and want to be tested Right Now and The System says "evidence-based effectiveness analysis" means you'll only be eligible for that test in 3 years since you have only 2 and not 3 of 5 risk factors so you're not in the high-risk group. And while Canadians are fond of saying they have "universal" care, that excludes -- for historical and now financial reasons -- all sorts of categories of care. Hospital and doctor care are covered, but (with some exceptions) dental care, eyeglasses, and prescription medicine are not. At-home care is a dog's breakfast. Many of these can be covered by supplementary employer benefits, so the line with the U.S. system then becomes a bit blurry. I personally think some European countries do this better - a universal basic level of care on all categories, but self-paid upgrades available in (nearly) all of them. Bottom line is I wouldn't exchange the Canadian system for the U.S. one in a million years, but let's not pretend it's perfect.

KinAlberta Member	# Posted: 27 Feb 2020 09:19 - Edited by: KinAlberta Reply Another great post above. I like the idea of a mixed system. One that evolves and improves as it tries to hit the moving target of providing great health care. Itâ€™s total misguided nonsense to blindly believe that anything public is inefficient or low quality. In addition itâ€™s total nonsense to think anything private is efficient or high quality. The thing is, that a system could be sliced and diced in many different ways. Instead of the crazy ideological stupidity the world always faces Id love to see redesigns based on obtaining the best outcomes for the dollars but without the pursuit of low costs at the expense of sacrificing innocent and even misguided lives (like smokers, drinkers of alcohol, etc that get cancers through their own actions). Also, for decades Iâ€™ve owned shares in private insurance companies. As an investor they have been my friend as they can be exceedingly profitable. That said, their profits come from their customers. So: Duhhh! As an aside: Iâ€™ve also owned bank shares for decades for the same reason. Therefore Iâ€™ve tried to do most of my banking at a credit union. Another mostly no-brainer. As a customer donâ€™t bank with the guy trying his hardest to take ALL your money while providing as little as possible in return - because thatâ€™s the definition of: profit margin.

KinAlberta Member	# Posted: 27 Feb 2020 09:47 - Edited by: KinAlberta Reply Having worked in finance/economics/investments/pensions for decades (though mostly with 10-figure investment amounts) one view Iâ€™ve adopted is that Iâ€™d like to see a ban on companies offering most pensions and benefits. Iâ€™d rather see companies sticking to their knitting and just paying higher salaries and workers compensation for work related injuries. Then Iâ€™d have mandatory requirements that every single worker pay into both private and public pension schemes. Same for health care and disability insurance. Let workers choose what they need above basic universal health care insurance. Get your employer out of the picture. They have divided loyalties. Government would dictate and likely offer coverage for the minimum acceptable standards but individuals could top up anything they wanted to focus on. Stuff for another thread but as Warren Buffett pointed out in the early 1970s, many companies inflate their expected pension earnings to game their reported earnings numbers. It rewards the execs and shareholders of the day but ultimately it thoroughly screws-over all the long term loyal employees.

KinAlberta Member	# Posted: 27 Feb 2020 10:05 Reply Iâ€™m a fan of Warren Buffett. Owned shares in his company for decades. I think what he says here (link below) is rational and logical. This is part of it: We Love What Warren Buffett Says About Life, Luck, And Winning The 'Ovarian Lottery' ... â€œA student asked him what shaped his political views (Buffett is a Democrat). The famous investor offered a great thought experiment, which helped him think through the kind of world he wants to live in. In it he characterizes something he calls the "Ovarian Lottery": [quote] My political views were formed by this process. Just imagine that it is 24 hours before you are born. A genie comes and says to you in the womb, â€œYou look like an extraordinarily responsible, intelligent, potential human being. [You're] going to emerge in 24 hours and it is an enormous responsibility I am going to assign to you â€” determination of the political, economic and social system into which you are going to emerge. You set the rules, any political system, democracy, parliamentary, anything you wish â€” you can set the economic structure, communistic, capitalistic, set anything in motion and I guarantee you that when you emerge this world will exist for you, your children and grandchildren. Whatâ€™s the catch? One catch â€” just before you emerge you have to go through a huge bucket with 7 billion slips, one for each human. Dip your hand in and that is what you get â€” you could be born intelligent or not intelligent, born healthy or disabled, born black or white, born in the US or in Bangladesh, etc. You have no idea which slip you will get. Not knowing which slip you are going to get, how would you design the world? Do you want men to push around females? Itâ€™s a 50/50 chance you get female. If you think about the political world, you want a system that gets what people want. You want more and more output because youâ€™ll have more wealth to share around. The US is a great system, turns out ... You also donâ€™t want fear in peopleâ€™s minds â€” fear of lack of money in old age, fear of cost of health care. I call this the â€œOvarian Lottery.â€ My sisters didnâ€™t get the same ticket. Expectations for them were that they would... . https://www.businessinsider.com/warren-buffett-on-the-ovarian-lottery-2013-12?op=1 [/quote] Bolding mine

ICC Member	# Posted: 27 Feb 2020 10:49 Reply Quoting: Houska Bottom line is I wouldn't exchange the Canadian system for the U.S. one in a million years, but let's not pretend it's perfect. Thank you for your comments, they pretty much express the thoughts and feelings of virtually all Canadians I have spoken with on this. Some related to me but mostly just ordinary people I have met in all the provinces.

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