If America adopts Canada's health care system

[muskrat89]

I seem to have heard that this IS the case in the US from different sources.

Well, I have LIVED here for well over 15 years. My family is currently a single-income family, and my wife has some very significant health issues. We're not experiencing any of these horror stories.

 

[a_majoor]

The arguments about not being able to afford health care after a car accident or in event of a serious illness are non sequiters; you could make the same arguments about replacing your car after a bus hits it or your house burns down, but most people would look at you and say "what about your insurance?"

Perhaps we need to ask ourselves what is different between accident and casualty insurance and health insurance? Since the basic principles are the same, there are obviously extraneous factors in the US system which distort the use of insurance. Government funding is one obvious reason, insurance companies wargame the system to extract as much from Medicare and Medicaid as possible. The truth of this can be seen where experiments in Medical Health Savings plans have demonstrated that consumers do make rational choices for less expensive care when they can see and control their own expenditures.

 

[Brad Sallows]

>I seem to have heard that this IS the case in the US from different sources.

Interesting.  When did the US provide free routine health care, and when did it stop?

 

[Brad Sallows]

>Tell me how long it would take to just live without any joy in life to save up the amount of money you would need to cover expenses incured in a car accident with the US system?

If you're foolish enough to not purchase any health insurance at all, probably a long time.  But even high-deductible insurance would cover that.

 

[Brad Sallows]

>First, how do you define routine?

We could beat this around for days and not achieve a concensus.  Leave it to the profession.  Dentists and dental service insurers seem to have figured out how to calibrate their system.

Whenever insurance includes routine care, you may be assured that on average people are paying more than the cost of the routine care.  The insurer doesn't pay part of those costs as charity.  Even a public insurer has overhead expenses to meet.  If you pay your dentist or doctor or other provider directly, you're not paying for insurer's profits or expenses.

Private insurers tend to insist on the same kind of "discounts" that government insurers do.  It may just mean that overcharging is done elsewhere to make up the difference.  I'm sure the egalitarians would be all over that if they got so much as a sniff it was going on - surely they wouldn't freeload on others.

 

[Blackadder1916]

>First, how do you define routine?

We could beat this around for days and not achieve a concensus.  Leave it to the profession.  Dentists and dental service insurers seem to have figured out how to calibrate their system.

The intent of my previous post was to point out that savings to the public purse would not be as great as some seem to imagine should individuals be responsible for "routine" or basic health services, however, since the cost of a "routine" visit would be borne by by us whether through public funding, private insurance, or personally, there is significant difference in routine care between the medical world and the dental world.

When I see a dentist for a routine visit, it is very clear what will be done and therefore it is relatively easy to forecast the cost.  It is not so easy when someone presents to the medical system, with what may be a routine problem.

I will use a personal example that involves both the American and Canadian system.  Several years ago, I was in Northern California (on business, and incidentally it involved a hospital).  Having concluded my business activities that day,  I was in my hotel when I started feeling particularly unwell.  I hadn't been feeling great during the day, either.  Among my symptoms was chest tightness and SOB, also there was some aching in my left arm.  Though not concerned that I was having an MI, I did feel that I should seek medical advice since I was flying in the morning.  The problem, however, was finding a doctor to see me.  The hotel wasn't able to provide me with a referral and DIAB (doc in a box) clinics are not common down there as they are here.  My only recourse was to visit the emergency dept at a local hospital (not the one where I had been on business).  After spending about 2 hours in the waiting room, another hour with the admission (finance) clerk & a screening nurse, an hour sitting in a hallway, I was put into an exam room where I finally met what I first took to be the doctor (turned out he was both nurse practitioner and physician assistant ex US Navy).  After my history and a physical exam, he suggested that that an EKG and some blood work was necessary.  Techs came in to do these and the NP/PA returned to discuss the EKG with me.  He said that he didn't see anything grossly abnormal  with it, but he wasn't that great with EKGs and it would officially be read by a doctor.  I had a look at it (recalling some of what I remembered from my MA days) and was able to point out a couple of things to him though they were not of any great clinical significance.  After having another listen to my chest, he asked me how I felt and then stated he wasn't sure what was wrong with me (also said that he had reviewed my case with the attending doctor in the ER), but that I should take it easy that evening and see my family doctor when I returned home the following day.  Before leaving the hospital I managed to get photocopies of all the records that had been generated on me so far and tried to get a bill for the services rendered.  I was told that a bill would be sent to me.  I knew that it would be more than for comparable service in Canada, but PSHCP (at that time) would cover three times the reimbursement rate from OHIP SOB.  This sticker shock is now lessened since PSHCP is now using an emergency travel assistance provider.

The next day I saw my GP who listened to my chest, said I had pneumonia, prescribed an antibiotic, ordered an XRay as a precaution and I started feeling better by the next day.

Now the fun began as I started receiving the bills from my American adventure.  By the time they were all in (from the hospital, the ER subcontractor, the ER doctor, the lab/EKG subcontractor) they totaled in excess of $5500(US).  Ahh, the free enterprise system at work.  As this was somewhat just up my alley,  I first checked what would be reimbursed by PSHCP, around $2100(Cdn).  By the time negotiations finished with the Americans, I was out of pocket about $100 and they had not "waived" one charge but they were not able to "justify" all.

Two "routine" visits.  Both for the same problem.  Significant difference in outcome and costs.

PS:  The amount that was paid by PSHCP (reimbursed to me) was also significantly lowered.

edited to include the PS

 

[Flip]

Well, I have LIVED here for well over 15 years. My family is currently a single-income family, and my wife has some very significant health issues. We're not experiencing any of these horror stories.

I am very pleased to hear that you have no horror stories .

I could mention that Dad did his residency in Cleveland. - It wouldn't matter anyway....

My wife's grandmother is a pretty telling example.
She found herself in hospital. when she was in her early sixties. Had to move from a private hospital
to a public hospital when her insurance ran out.  She languished there until things started looking desperate.
She had someone call her son - My father in law.
When she was transported to Edmonton she had double pneumonia and she was in dreadful shape.
It was pretty clear that she would not have survived that American hospital where she spent most
her time just getting sicker in the hallway.  Grandma almost didn't survive being put on the plane in
the condition she was in. Personal care had not been provided in weeks. It was grim.

After a stay at the UofA Hospital she went on to live another 40 years here.

Still we go round and round.

I would rather have a system with a healthcare motive than a profit motive.

 

[observor 69]

"Still we go round and round.
I would rather have a system with a healthcare motive than a profit motive."

Ain't it the truth.

 

[Brad Sallows]

>When I see a dentist for a routine visit, it is very clear what will be done and therefore it is relatively easy to forecast the cost.  It is not so easy when someone presents to the medical system, with what may be a routine problem.

When I see a dentist for a routine visit, there is no way until the "clear what will be done" procedures are complete to know whether there will be non-routine work required.  Same-same doctor: the examination and a basic workup of other tests (at whatever intervals, ranging from semi-annual to every N years) can be forecast.

 

[Roy Harding]

...
But I frequently encounter the objection: if routine health care were not free, people would stop going to see doctors.  Bullshit.  Most people are not that foolish.  Of the people I know who would not see a doctor if it cost $150 out of pocket (or on an extended health care plan, or out of a pre-tax health spending account, etc), most do not go to see a doctor right now when it costs nothing.  Apathy and indifference are the dominant factors, not finances.

My experience tells me that you are right. 

Using myself as an example, I contracted a skin infection in mid-September.  I didn't see a Doctor until mid-October (after both my father and wife gave me hell for not doing so).  By the time I saw the Dr, it had become a very serious matter.  I lost six weeks of work because of it.  (And the visit to the Dr cost me nothing up front - my taxes paid for it - and the prescriptions are covered by my medical plan, so they cost me little).  Why are we like that?

Perversely, I think I would be MORE apt to see a Doctor for "minor" complaints if I were paying for it up front.  The present system makes me feel like I shouldn't be "bothering" the Doc for minor stuff.  If I were PAYING (up front - I know that I'm paying for it through my taxes) for the visit, I'd feel more "entitled" to the visit - maybe that's just me.

 

[Flip]

If I were PAYING (up front - I know that I'm paying for it through my taxes) for the visit, I'd feel more "entitled" to the visit - maybe that's just me.

Yup, It's just you 

In Alberta, that visit cost the tax payer $35 the lab work we can guess at $100
A user pay system would create a range of costs above those numbers. ( I think )
maybe $55 to $105 and the lab work might go to $150 ??
I suggest an increase because of what happened when King Ralph allowed extra billing.
Line item 57......paper clip on attached bill.  ;D

Ever go to the vet and find out that it's $60 bucks for the exam the labs
can run from $100 to $200 and you leave with the feeling that you might
try to "wing it" at home with leftover meds or a home remedy?

People do the same.......

My Dad once knew a farmer who injected himself with veterinary antibiotics
and the same needle he used for the cows.  He died of course, but not before
a bunch of his farmer friends came into the hospital and made fun of him.
Covering theselves with bedsheets and making ghostie noises was what
they regretted most.
(This story was usually told with a rather vivid ethnic slur attached.)
This was before I'd ever heard of the Darwin awards.

 

[Blackadder1916]

When I see a dentist for a routine visit, there is no way until the "clear what will be done" procedures are complete to know whether there will be non-routine work required.  Same-same doctor: the examination and a basic workup of other tests (at whatever intervals, ranging from semi-annual to every N years) can be forecast.

The majority of (adult) patients present to a dentist on a scheduled basis (usually annually, though business savvy dentists would like you in as often as your insurance will cover it) for a "routine" check and cleaning.  If problems are discovered during such a check (or if the patient is one who presents with a problem), the dentist will (or should) be able to provide at that time a reasonably accurate estimate of the work involved and the cost. 
From the Pensioners' Dental Services Plan (the one available to us retired old farts) Members Booklet

It is strongly recommended that you send Sun Life an estimate, before the work begins, for any major treatment or procedure that will cost more than $300.  You should send a completed dental claim form that shows the treatment the dental practitioner is planning along with the associated cost to Sun Life.  Both you and the dental practitioner will have to complete parts of the claim form.  Sun Life will tell you how much of the planned treatment is covered under the PDSP, and how much of the cost you will be responsible forbefore proceeding with the services.

The majority of (adult) patients present to a medical practitioner or encounter the health system when they have a medical problem.  Most physicians of my acquaintance, while they acknowledge some benefit of annual physical check-ups, note that it is the exception rather than the norm when a medical condition is discovered during such an exam.  While in many cases the problem can be diagnosed and appropriate treatment (of the symptoms at least) initiated by visiting a general practitioner, often (especially as technology increases) it requires additional encounters for specialized diagnostic services or consultations.  From my experience (not as a patient) few medical practitioners would (or even could) give a prognosis until all diagnostic steps have been completed.

 

[observor 69]

From my experience (not as a patient) few medical practitioners would (or even could) give a prognosis until all diagnostic steps have been completed.

Well from my experience as a patient, and as an old fart, receiving an annual medical checkup from my medical practitioner a digital diagnosis is possible.  ;D

 

[Blackadder1916]

Well from my experience as a patient, and as an old fart, receiving an annual medical checkup from my medical practitioner a digital diagnosis is possible.   ;D

I won't comment on the possibility that you are starting to look forward to that annual digital encounter and are developing a  "special" relationship with your physician.  It is, though, a very important routine procedure for us old farts to have on a regular basis.  Always look for a doctor with long, slender fingers (and well trimmed nails).

 

[Edward Campbell]

Just to help this thread drift waaaaaaay off topic, I, another old fart, will contribute my doctor's opinion (she's a Chinese lady with small fingers): digital rectal exams are only necessary if there are some other indications. They are invasive and rarely useful. But, we are to have the full colonoscopy (two days of fasting plus that horrible series of enemas) every five years, beginning at age 60. So say, she says, the medical gods.

 

[Blackadder1916]

Okay, it is getting off topic but does bring to mind when Generals had to be admitted to NDMC annually for their medical (is it still as comprehensive?).  It was always amusing (sometimes hilarious) to assist the MO performing the mandatory rigid sigmoidoscopy (referred to as the General Officer's brain scan).

 

[geo]

My experience tells me that you are right. 

Using myself as an example, I contracted a skin infection in mid-September.  I didn't see a Doctor until mid-October (after both my father and wife gave me hell for not doing so).  By the time I saw the Dr, it had become a very serious matter.  I lost six weeks of work because of it.  (And the visit to the Dr cost me nothing up front - my taxes paid for it - and the prescriptions are covered by my medical plan, so they cost me little).  Why are we like that?

Interesting,
In Holland, dental services are covered by their national health care system BUT, if you have been naughty & have skipped your cleanings & routine visits, then your 1st return visit is going to be on your nickle.  Once you have been certified "top shape", then you get back on the national healthcare bandwagon.... Preventive medicine is always better.

 

[Roy Harding]

Interesting,
In Holland, dental services are covered by their national health care system BUT, if you have been naughty & have skipped your cleanings & routine visits, then your 1st return visit is going to be on your nickle.  Once you have been certified "top shape", then you get back on the national healthcare bandwagon.... Preventive medicine is always better.

Interesting concept - perhaps worth pursuing here, both Dental and Medical??

 

[geo]

Not sure about the medical... friend of mine had dental problems .... and that's how the subject came up...

I am a fervent believer in the mandatory you do your part & we'll do ours... so long as everyone is pulling his own share, then everything is okie dokie.  The minute someone starts to expect being carried - with little or no effort on his part.... the buck stops here.

 

[Roy Harding]

Not sure about the medical... friend of mine had dental problems .... and that's how the subject came up...

I am a fervent believer in the mandatory you do your part & we'll do ours... so long as everyone is pulling his own share, then everything is okie dokie.  The minute someone starts to expect being carried - with little or no effort on his part.... the buck stops here.

I've got to admit that as an "old school" soldier I hesitate to attend the "MIR" - but I stand by my contention that a nominal fee would actually prompt me to attend MORE - perverse, I admit - but true - at least in my case.

I like the Dutch example as you posted it.  Do your bit, and you'll be taken care of - DON'T do your bit, and it'll cost you.