Canadian Health Care We So Envy Lies In Ruins

[Bruzilla]

What is your idea a "fair price"? From each according to his ability, to each according to his need?

Just because you think the government should own everything and set all the prices doesn't mean it's right. Go friggin' live in Cuba or China if you love government control so much. I can tell you right now that if you owned your own business, you wouldn't want the government dictating what you sell your product for and how much money you are allowed to make.

And something else you miss, dear, is that if there were no wealthy people, there would be no tax dollars going into your precious social programs. Where do you think the money for "free" health care is going to come from, anyway?

Vrai... you keep slipping further and further into the abyss. What's a for price for anything? A fair price for a typical mid-size, mid-grade, automobile is about $28,000. A fair price for a man's haircut is about $12. A fair price for a 20-oz bottle of Coke is $1.25. A fair price for a good pair of running shoes is $60. There's no government controls that mandate these prices, just the commonly accepted prices on the open market. Can you spend $100,000 on a Ford Taurus, $500 on a haircut at the Haircuttery, or $50 for a bottle of coke? Sure... if you're a friggin moron. But most people look at the prices of products and services, and buy the best product at the price that's best for them and not the provider of the good or service. That is... except for healthcare.

What's a fair price for healthcare? I don't know, nor do you. All we know is what our doctor charges us. If I take my car to a mechanic for a new alternator, and he charges me a fair labor rate of $60 an hour, and $1,000 for an alternator I know was a fair market price of $80, then I know he's ripping me off because that alternator has a fair price associated with it. But again, what is a fair price for an hour of a doctor's time? It's whatever they want it to be, AND they won't tell you what it is so you can compare it to what someone else charges.

Let me ask you this... would you ever just walk into a grocery store with no prices posted anywhere, buy whatever the store manager told you to buy, and then pay whatever the store manager told you to pay? F No you wouldn't, but that's exactly what you're doing when you go to the doctor. If that store manager wanted to charge you $50 for a gallon of milk, you would know you were getting robbed. But if your doctor charges you and your insurance $2,000 for a service you could get at another doctor for $200, you have no idea, nor do you care because most of that $2,000 is being paid by someone else.

 

[BadGirl]

Our government would learn from Canada's mistakes, they would do it right, and it will be perfect.

It would save money, your taxes wouldn't go up as you'd save all your medical insurance premiums.

Nobody will go without care, there wouldn't be waiting lines for surgery, and nobody will ever get...




DAMNIT couldn't keep a straight face.

 

[BadGirl]

Bru, my wife was HR Director of Southern Maryland Hospital for awhile. When she got cancer, she was HR Director for All American Ambulance, who had 17 medical billers. I have done network troubleshooting for both companies and several doctors over at Pembrooke Medical Center in Waldorf. I stand by my statement that fully one third of claims do NOT get paid. Check the Maryland Judiciary Case search and type in Civista if you think I'm kidding.

If a Nutrionist can charge $466 for a 1/2 hour consultation, 1/2 of their claims can go unpaid and they'd still make a crap load of money.

 

[Bruzilla]

Insurance premiums for health care are high. There's no doubt about that. Find a cheaper doctor. If everyone did that, the premiums would drop. Hospitals only charge an arm and a leg to people, not insurance groups. Read your statement one time, and you'll see things like "Charge, 3 gazzilion dollars. Allowed amount, 50 bucks. Provider accepts allowed amount". The insurance doesn't pay what's charged, they pay what they'll allow, and the vast majority of providers accept whatever is allowed - thus the insurance companies ARE setting the price, overall.

Oh brother are you off! The insurance allowed amount is the only way to keep providers in check, and those rates are negotiated each year with the providers. It says "provider accepts" but doesn;t mention that "Provider told insurer this is how much I want". And here's how the deal works: you receive a service that the provider has negotiated a set price for, and the insurer pays that amount. Unless you are on Medicare, providers can then use balance billing to bill you for any additional price they feel like charging. They can also order tests or supplies that they can overinflate the costs on to compensate for the reduced primary billing.

If you want to see an example of how healthcare should work, look at lazer eye surgery. This is a procedure that has never been covered by most insurers, meaning that almost all procedures are paid for out-of-pocket. These are also non-recurring services as most people get the treatment once in their lives and their are no health maintenance issues. A fair price for Lasik back in 1987 or so was about $3,000 per eye. Those with the means to pay that much got the procedure done, but once those patients were gone the providers had to make a choice: keep charging $3,000 and eye or go out of business. There was no health insurer to negotiate a higher fee with. So they began lowering their prices. Then they ran into the problem of most providers charging the same thing, and they had to advertise their prices to get people in, so they had to look for other ways to attract customers. They made huge investments in developing and deploying new equipment, procedures, and processes. So here we are in 2008 and the price of Lasik has gone down about 75% while improvements in quality have gone way up.

The absence of any deep pockets forced the providers to price their services and advertise those prices in such a way as customers could make a value judgement as to how to spend their money. And if some provider wanted to grow their market share, they had to invest in better services, i.e., the way most any other business operates. If insurance had covered this procedure, the price of it would have gone up year after year just like any other service.

Ask what your insurance will allow, and you'll find out the reasonable amount.

That is an excellent point! But you know how many people do that? About 2%, and most of those are on Medicare and care more about copays and coinsurance than doctor preference.

Actually, yes, I have about the best plan I can afford, the best plan offered to me. And, it's worth it. - I pay for the best plan so that I can get the best service, in the manner I want. You get what you pay for.

You're contradicting yourself. First you say "I have about the best plan I can afford' then you say "I pay for the best plan so that I can get the best service." Those are not the same things. If you're like 97% of most health insurance members, you are paying the lowest premium for an adequate amount of service. You most likely have deductibles, limits on annual coverages, limits on how much the plan will pay certain providers, limits on drugs, co-pays, etc. You assessed your risk, your income, and potential for need, and bought the lowest-cost plan that met your needs. And why did you do this? Because you have to pay the bill. You could sign up for a plan that has no deductibles, covers every procedure regardless of where it is provided, covers every drug, etc., but these plans cost about five times what your plan costs. So if you want top service, why aren't you paying for it? Again, because at this point we're talking about your money. And then when folks like you get told that your plan doesn't cover some procedure, you get all upset and blame the insurer for not giving you what you paid for. If people want optimized healthcare, then pay for it. And if you're not willing to pay for it, don't whine when you don't get it.

 

[czygvtwkr]

Lasik isn't a very good example. In 1987 it was a fairly new procedure and few doctors could do it. It was also much more labor intensive then than now. Now it is almost like a conveyor belt assembly line.

The problem with health care lies in the way people view insurance. Most want insurance for every thing, if they need a $10 prescription they want insurance to cover it. A $75 checkup, they want insurance to cover it. I recently went through a search to find health insurance for my 59 year old mother. She had the mindset that she needed insurance that paid for prescriptions and glasses, and teeth cleaning since my fathers did before he passed away.

We ended up going through AARP. Insurance that covered the big stuff was less than half of what insurance that covered every little splinter was. Insurance can be fairly reasonable if people get the correct mindset. The Health Savings Accounts are a great idea for someone in their 20's and 30's to save some money on insurance plans and get a pretty fair discount through a tax deduction.

On another somewhat strange but related note...look at an unneeded procedure.....when the UK's universal health care no longer covered circumcisions the number of them dropped dramatically. It seems people only wanted it when it was free.

Strangely you can not get health insurance across state lines, if the barriers were broken down so that competition was fostered I'm sure that rates would drop some too.

 

[wintersprings]

Our government would learn from Canada's mistakes, they would do it right, and it will be perfect.

It would save money, your taxes wouldn't go up as you'd save all your medical insurance premiums.

Nobody will go without care, there wouldn't be waiting lines for surgery, and nobody will ever get...




DAMNIT couldn't keep a straight face.

This did not even pass the smell test....the government is just another way to slow down the line for health care, that we right now pass on to Insurance providers.

So who puts you in line, the Gov, who will put payees in line with everyone, or the iNSURANCE Agency wo will put the payee to the front of the same line.

I pay, so as payee, I want the front of the line. Free loaders and drunks to the back.

 

[Bruzilla]

Lasik isn't a very good example. In 1987 it was a fairly new procedure and few doctors could do it. It was also much more labor intensive then than now. Now it is almost like a conveyor belt assembly line.

I think you're missing the forest for the trees. Why is it like a conveyer belt assembly line now? Because providers have been forced to streamline and optimize their process to remain competitive... just like most any other business that agressively competes for market share. In other areas of the healthcare industry that are covered by insurance, there is progress but it is always coupled with huge price spikes that take years to decline (anyone price an MRI session lately?). Lasik has improved quality and points of service AND lower costs as a result of competition and an open market.

The problem with health care lies in the way people view insurance. Most want insurance for every thing, if they need a $10 prescription they want insurance to cover it. A $75 checkup, they want insurance to cover it. I recently went through a search to find health insurance for my 59 year old mother. She had the mindset that she needed insurance that paid for prescriptions and glasses, and teeth cleaning since my fathers did before he passed away.

We ended up going through AARP. Insurance that covered the big stuff was less than half of what insurance that covered every little splinter was.

And you did things right, but there are a lot of folks out there who want to pay the low premium for "covers the big stuff", but when the insurer declines to pay for every thing under the sun, they yell "how dare in the insurance company put a price on my heathcare!" when it was they who decided how much their health was worth when they bought the cheapest plan available.

Insurance can be fairly reasonable if people get the correct mindset. The Health Savings Accounts are a great idea for someone in their 20's and 30's to save some money on insurance plans and get a pretty fair discount through a tax deduction.

HSAs are the way of the future and the best way to correct lots of problems with healthcare. Unfortunately they are so different from traditional plans that many people shy away from them. My wife and I have an HSA, and all my kids have their own HSAs.

On another somewhat strange but related note...look at an unneeded procedure.....when the UK's universal health care no longer covered circumcisions the number of them dropped dramatically. It seems people only wanted it when it was free.

That' not a great example to use. Circumscisions have been falling out of favor for years now, and the number of them occuring, paid or free, has been going steadilly down for about the past decade.

Strangely you can not get health insurance across state lines, if the barriers were broken down so that competition was fostered I'm sure that rates would drop some too.

That is because every state regulates it's own insurance requirements. There was a recent change to the Medicare rules that implemented a new product that would support retirees across state lines. For example, Winn Dixie is a big employer in FL, but a lot of WD retirees live in GA, AL, LA, etc., and under the old rules if their plan was based in FL, their services provided by out of state physicians either weren't covered or were reimbursed under FL requirements. This new product was supposed to change that, but so far it's been a disaster at every BCBS that's tried to implement it. If I live in AL and see a doctor, that claim has to be submitted under the rules in AL, then it gets sent to FL which has it's own rules. All of this drives up costs as each claim is using up resources in two states. And customer service is a nightmare because now CSRs have to not only be able to address local issues, but issues across all 50 states!

Folks like Newt Gingrich are singing the praises of buying insurance across state lines because all they see is that some states have lower cost insurance than others, but all that will change once the controls are taken off. The higher price insurers won't lower their prices, the lower cost insurers will raise their prices, and they'll have to to cover the expenses incurred with operating across state lines. Plus a lot of the smaller insurers that can compete on a state level will fold up tent as they can't afford to compete nationwide without massive investments in infrastructure, and before you know it you'll have one or two megainsurers running everything and that'll be a recipe for disaster.

 

[cwo_ghwebb]

Looks like they learned the core truth about healthcare, that being that providers costs (salaries) and not insurance is the biggest cost associated with providing care. Once you've tapped as many tax dollars as you can, you have to start cutting back on salaries, and when you do you quickly learn all that high-minded talk about "I just want to help people" is a lot of hooey, and the providers bail out of the system.

FTA as it appears you didn't read it:

What would drive a man like Castonguay to reconsider his long-held beliefs? Try a health care system so overburdened that hundreds of thousands in need of medical attention wait for care, any care; a system where people in towns like Norwalk, Ontario, participate in lotteries to win appointments with the local family doctor.

It's not the doctors bailing. Since you want to place the blame on doctors, just how does a medical hospital helo, with no doctor aboard, justify a charge of $4,600 for transport from Calvert Memorial to Washington Hospital Center?

My wife needed a cortisone shot for her torn rotator cuff. Couldn't be administered by the GP because, you guessed it, insurance requires a orthopedic doctor to administer the shot. The kicker is one can't call the orthopedic doctor directly either. One has to make an appointment with the GP ($80), and get a referral. All required by insurance, who have to cya due to frivolous lawsuits by trial lawyers.

Doctors charge what the insurance carriers have determined is the going rate. It's like a plumber who doesn't get paid directly but by a third party. That third party determines prices for a service based on their costs including the cost of frivolous lawsuits brought to court by ambulance chasers. As that one advertisement by some scumbag attorney says "It's all about the money!"


Polls show Americans are desperately unhappy with their system and a government solution grows in popularity. Neither Sen. Obama nor Sen. McCain is explicitly pushing for single-payer health care, as the Canadian system is known in America.

"I happen to be a proponent of a single-payer health care program," Obama said back in the 1990s. Last year, Obama told the New Yorker that "if you're starting from scratch, then a single-payer system probably makes sense."

As for the Republicans, simply criticizing Democratic health care proposals will not suffice — it's not 1994 anymore. And, while McCain's health care proposals hold promise of putting families in charge of their health care and perhaps even taming costs, McCain, at least so far, doesn't seem terribly interested in discussing health care on the campaign trail.

However the candidates choose to proceed, Americans should know that one of the founding fathers of Canada's government-run health care system has turned against his own creation. If Claude Castonguay is abandoning ship, why should Americans bother climbing on board?


I like the HSAs myself but the socialists in this country want to go to a single-payer system, which has failed in Canada and England. We have quite a few problems with our system. Bru thinks the problems lay with doctors making too much money. I think the problems are with trial attorneys. I believe tort reform is a good first step. It works.


In Texas. (H/t Puggymom)

Proposition 12 Produces Healthy Benefits
A Recap: Five Years After Its Passage

Physicians' liability insurance premiums have continued to drop since the passage of Proposition 12 and the state's landmark 2003 health care liability reforms. All major physician liability carriers in Texas have cut their rates since the passage of the reforms, most by double-digits. Texas physicians have seen their liability rates cut, on average, 24.9 percent. Roughly half of Texas doctors have seen their rates slashed a quarter or more. Cumulative liability cost savings since January 2004: $322.94 million. Texas has added new admitted, rate-regulated carriers, more risk retention groups, captives, surplus lines and other unregulated insurers. Meanwhile, lawsuit filings in most Texas counties have been cut in half since the passage of the 2003 reforms and access to health care has improved.

Professional Liability Insurance Reform



And let's guess who is trying to get this overturned? Trial lawyers!

 

[Bann]

...quit being so envious of those that have busted their butts to get where they are.

Therein lies the majority of his problem, it sounds like.

 

[cwo_ghwebb]

Therein lies the majority of his problem, it sounds like.

I believe we disagree on the source of the problem. I do apologize for getting hot fingered there for a second.

 

[Bann]

I have had an HSA for 3 years. (I planned ahead. Once my military dependency ended through divorce, I knew I would no longer be covered by the military health care. I had 60 days (I think) to find something or go through COBRA) My first insurance co. was Mega Life and they thoroughly stunk. I paid insurance premiums of 300. a month in addition to having a higher deductible (1,850?) than I do now. (1,700) I didn't have a prescription plan or vision plan through them. I do not recommend Mega life - they also had stinky claims filing procedures, etc., I was really unhappy with them.

Anyhoo - NOW my high deductible insurance plan is thru Carefirst BC/BS and I pay very low monthly premiums. (122. including a vision "discount plan" & a prescription discount plan). My dr. bills Carefirst and they pay an allowed amount (my doctor is in their "network", so they agree to accept that amount) but I can go to whomever I choose) and I pay the balance out of my pocket. It's usually about 1/3 of the total billed. I also pay for my prescriptions out of pocket, after the discount - which is not too much, really. (Or I take it out of my HSA, which is allowed) Another thing I like about BC/BS is a lot of the same stuff I go to the Dr. for is allowed towards my deductible, which was not the case with ML. (don't get that - but it's the difference between the companies)

 

[cwo_ghwebb]

I have had an HSA for 3 years. (I planned ahead. Once my military dependency ended through divorce, I knew I would no longer be covered by the military health care. I had 60 days (I think) to find something or go through COBRA) My first insurance co. was Mega Life and they thoroughly stunk. I paid insurance premiums of 300. a month in addition to having a higher deductible (1,850?) than I do now. (1,700) I didn't have a prescription plan or vision plan through them. I do not recommend Mega life - they also had stinky claims filing procedures, etc., I was really unhappy with them.

Anyhoo - NOW my high deductible insurance plan is thru Carefirst BC/BS and I pay very low monthly premiums. (122. including a vision "discount plan" & a prescription discount plan). My dr. bills Carefirst and they pay an allowed amount (my doctor is in their "network", so they agree to accept that amount) but I can go to whomever I choose) and I pay the balance out of my pocket. It's usually about 1/3 of the total billed. I also pay for my prescriptions out of pocket, after the discount - which is not too much, really. (Or I take it out of my HSA, which is allowed) Another thing I like about BC/BS is a lot of the same stuff I go to the Dr. for is allowed towards my deductible, which was not the case with ML. (don't get that - but it's the difference between the companies)

We got Tricare Prime which is hard to beat. Funny thing is that Medicare (which my wife got after being classified disabled by Social Security), takes precedence over Tricare. Just weird.

 

[Bann]

We got Tricare Prime which is hard to beat. Funny thing is that Medicare (which my wife got after being classified disabled by Social Security), takes precedence over Tricare. Just weird.

It's a tangled web, it is.

But the reason is - Tricare is the secondary payer. That's because both programs are essentially "subsidized" by the government, if that's the right word. In other words, Tricare (in your case, Prime) is (for military members, retirees, and their family, etc) is obtained through the federal government and your premiums (460/year for family, last I checked) are a lot less than with private health care insurance companies. Medicare is (for the elderly but sometimes other people who are disabled) through the federal government, also.

When I first got my HSA, one of the regulations were that you couldn't have and HSA if you were under Tricare or Medicare. (because they are essentially subsidized health care insurance plans)

 

[Bann]

We got Tricare Prime which is hard to beat. Funny thing is that Medicare (which my wife got after being classified disabled by Social Security), takes precedence over Tricare. Just weird.

My kids are covered through Tricare Prime, which their father pays for. I pay the co-pays. That's by choice, though, because by the time I take off from work to drive to a base 40 mins. away and then the gas, etc. etc. I'd just as soon pay the co-pay to go to a Dr. within 5 miles of my home!

 

[cwo_ghwebb]

It's a tangled web, it is.

But the reason is - Tricare is the secondary payer. That's because both programs are essentially "subsidized" by the government, if that's the right word. In other words, Tricare (in your case, Prime) is (for military members, retirees, and their family, etc) is obtained through the federal government and your premiums (460/year for family, last I checked) are a lot less than with private health care insurance companies. Medicare is (for the elderly but sometimes other people who are disabled) through the federal government, also.

When I first got my HSA, one of the regulations were that you couldn't have and HSA if you were under Tricare or Medicare. (because they are essentially subsidized health care insurance plans)

I never looked into HSAs as we didn't need one. I didn't know that about not being able to get into one of them if you were covered elsewhere. Prime went up to almost $800 last year, still very reasonable. $460 was a steal.

 

[Bann]

I never looked into HSAs as we didn't need one. I didn't know that about not being able to get into one of them if you were covered elsewhere. Prime went up to almost $800 last year, still very reasonable. $460 was a steal.

I have to amend my other post. I thought the reason you couldn't get an HSA if you had Tricare was due to it's being subsidized by the gov't. That actually only applies with regard to Medicare. But if you're in another plan (which, at the time I was when I was covered by Tricare) you can't have an HSA unless it's a HD plan.

HSAcenter - Health Savings Accounts - Health Care and Savings for You and Your Family_


I didn't know Tricare Prime went up! Yes, it's still very reasonable.

 

[wintersprings]

My Grandma in England at the age of 80 needed a new knee. The Nanny State said no, over 80 you don't get anything, here is a wheelchair. So those of us in the Evil USA pooled 10K and she had a new Knee on the open market system (Why does one exist in england?)

Anyway she lived for 10 more years and walked the entire time.

Thanks nanny State, you diverted her knee to someone else.

 

[This_person]

Oh brother are you off! The insurance allowed amount is the only way to keep providers in check, and those rates are negotiated each year with the providers.

I see...the insurance has nothing to do with the costs, just what they'll pay as negotiated with the providers. Makes sense. You're proving my point, BTW.

That is an excellent point! But you know how many people do that? About 2%, and most of those are on Medicare and care more about copays and coinsurance than doctor preference.

And?

You're contradicting yourself. First you say "I have about the best plan I can afford' then you say "I pay for the best plan so that I can get the best service."

That's not a contradiction - I pay for the best plan, I can afford the best plan. Therefore, I pay for the best plan I can afford - the best plan.

If people want optimized healthcare, then pay for it. And if you're not willing to pay for it, don't whine when you don't get it.

I do. I pay for the best plan available, because I want the best insurance available. And, others pay for less, and are willing to take the risk of less. Still others pay for more than what they need, because they can afford it. More don't get what they want, because they can't afford it. Kind of like houses, cars, clothes, plumbers, exterminators, food, etc., etc., etc. And, as I said before, it works. Just because people complain does not mean it doesn't work.