# Canadian Tuggers / Healthcare in Canada



## gpurtz (Aug 2, 2009)

Hi,

This is not intended to invite political wrangling.  Unfortunately, with news what it is today, it's difficult to sort fact from opinion.  I'd really like to hear from Canadian Tuggers about their healthcare system...the good and the bad.  Thanks.


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## dioxide45 (Aug 2, 2009)

gpurtz said:


> Hi,
> 
> This is not intended to invite political wrangling.  Unfortunately, with news what it is today, it's difficult to sort fact from opinion.  I'd really like to hear from Canadian Tuggers about their healthcare system...the good and the bad.  Thanks.



I don't think you can discuss this topic without it becoming political.

I grew up in Canada but now live in Ohio. While those in Canada know their system is not perfect, I know many would not trade it for what we have here in the USA.

In fact several years ago they had a TV show in Canada called the Greatest Canadian, the founder of medicare in Canada, Tommy Douglas, was voted the greatest Canadian. This goes to show how much they do like their system even with the flaws it does have.


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## Sandy VDH (Aug 2, 2009)

I too am an Canadian living in Texas.  So I will venture a few observations from personal, friends and family experiences.  These are ONLY my opinions and my experiences and may not be reflective of every personal situation in Canada. Just wanted to give that warning.

There are good and bad things about the system.

For most routine issues it likely works just fine.  When I was a student I ended up with nodes on my vocal cords after having larengytis for about 3  months.  I saw the doctor, about month later I saw the specialist, made an appointment for surgery within about 3 weeks, then post surgery had speach therapy to learn to speak better and not stress my vocal cords.  From start to finish about 3 months.  Cost and paperwork ZERO. Now it was routine surgery with an ENT and I got lucky enough to pick up a cancellation.  

That was several years ago and I think that doctor levels have dropped and waiting times have increased.  But I am not there now, so I have no recent experiences.

It is when there are sudden symtoms and people want answer as quick as possible is when it becomes an issue.  My friend's husband had a seizure, never had one before.  They live in a smaller city which does not have every imaginable bells and whistle piece of medical equipment.  Why, because with a Managed Health care system you optimize the expensive equipment in locations with the highest usage.  Not every hospital or every city has every piece of hugely expensive equipment available.  So for instance they needed an MIR.  They had to travel a hour to a larger city to get an MIR done.  They also had to wait.  Too long, in my friend's opinion.  They know someone and got the MIR in about a week.  But as I said, it was too long for my friend who wanted an answer yesterday.  Which of course is a response I understand.  My family lives in a larger city that has a large concentation of medical facilities.  There wait times and frustration for most routine matters are far less than my friends.  But location is likely a major factor there.

In the US, nearly every hospital has EVERY piece of equipment, there is no waiting time for specialized tests or specialists.  But in Canada it is a managed system so there is no real duplication of services, everything is working together, optimized over the system.  In the US everyone is competing for business, and therefore has to match or beat the competition.

But at the same token, everything in the US is 3 - 4 times the cost of the same treatment in Canada.  At least this was the cost difference when I had to have an emergency treatment when I first arrived.  I did not yet have US healthcare, but my Canadian coverage was still in place.  My Canadian coverage would refund my US costs, but only up to their levels of reasonable and customary.  Their levels were 25% to 33% of what I actually paid in the US, so I was out of pocket 66 to 75% of what they charged me.  Luckily it was not an extremely serious situation. Why the differences in price, Malpractice insurance in the US, administration & all the paperwork that goes with it (and more and more and more paperwork), and the increased costs of creating a competition with profits for a publicly traded company, as most health care systems and insurance providers are.

Now on the other hand competition is good for patients.  It gives everyone everything they ever needed within minutes and at most within hours of when they need it.  So that is what many like about the US system.  However I think that also comes at a great increase in price.

I am sure others have horror situations, but my friends and family have not had that situation arise.

So how to create a system that has a pros of each, but at a balance of cost?  That is the Trillion dollar question.


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## BevL (Aug 2, 2009)

Well, here's a Canadian that lives in Canada.  

First off, this could become political, but as we Canucks are a fairly laid back crew, it will hopefully not go down that road.

There are pros and cons as there are with every system.  These are only my opinions and observations. 

The pros are that everyone will get the treatment they require, whether they could afford to pay for it or not.  

A few examples - when my dad was diagnosed with an aortic aneurism, he was booked for surgery within a few months.  Excellent care, and he's fit as a fiddle today.

When my husband's kidney function tanked in December, the care was superb.  When the decision was made that he needed to start on dialysis, he was in and had a required hernia repair and a catheter for peritoneal dialysis inserted within about eight weeks.  Every single thing related to his renal care is paid for by the government.

There's no way we could have afforded to pay for those surgeries and hubby's ongoing renal care.

The downside is that, even if you could afford it, you can't pay for many medically necessary procedures.  There are currently lawsuits launched by the government against some private clinics up here.  So my sister-in-law, whose knee is giving her huge problems cannot pay for a surgeon to do a knee replacement, even if she could afford it.  Her doctor is saying she's not bad enough to have it done through the public system.  If she wanted to jump the line, so to speak, she'd need to go outside the country to do it.  There are folks that do that.

I think for people who have good insurance, the U.S. system is better.  For many who couldn't afford good insurance, the Canadian system is better.

My own personal thought is that there should be some merging of the two - require doctors (especially specialists) to practice a certain percentage of their time within the public system, but allow some privatization to "clear the lines" a bit.  I also personally feel there should be a nominal charge of $20 per doctor's visit for those who can afford it to at least help somewhat alleviate the health care costs.

Again, I hope this doesn't get political, and again stress that these are strictly my observations and opinions.


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## Passepartout (Aug 2, 2009)

Thanks, Bev and Sandy and all who provide their observations. As one US citizen who retired early and is now paying for insurance coverage entirely out of pocket, I am observing the ongoing debate with more than a little personal interest. You did a great job of keeping the discussion on observations and not on pointing fingers and laying blame. 

May we all be granted Spock's wishes: "Live long and prosper".

Jim Ricks


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## Ironwood (Aug 2, 2009)

Here's a link to some discussion on the pros and cons of a national health care system.


http://www.canadaspace.com/crwb.php?q=Pros+and+Cons+of+National+Health+Care


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## Ubil (Aug 2, 2009)

*Canadian Healthcare for Visitor*

If I am visiting Canada on vacation and require unexpected and urgent healthcare, will it be free under the Canadian healthcare system, or do I need to make sure that my US-based insurance will cover it?  If I understand the posts above, private healthcare is not available (or of questionable legality) in Canada.


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## BevL (Aug 2, 2009)

Ubil said:


> If I am visiting Canada on vacation and require unexpected and urgent healthcare, will it be free under the Canadian healthcare system, or do I need to make sure that my US-based insurance will cover it?  If I understand the posts above, private healthcare is not available (or of questionable legality) in Canada.



As a Canadian, I buy private insurance to cover me for trips to the U.S.  It's actually included in private insurance that I buy that covers prescriptions, certain medical services not paid for by the government such as massage therapy and other things like that.

I also know that my brother had to have private insurance for his wife (a Brazilian national) until she was a landed immigrant here - the fact that he and his child had coverage under the government plan did not extend to her merely because she was in Canada.  

I would suggest that you would need private insurance.


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## Elan (Aug 2, 2009)

I also appreciate the input of the Canadian TUGgers on this sensitive issue.  Hopefully we can all learn some of the pro's and con's of the Canadian system without the thread getting out of hand with personal opinions.


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## dioxide45 (Aug 2, 2009)

Ubil said:


> If I am visiting Canada on vacation and require unexpected and urgent healthcare, will it be free under the Canadian healthcare system, or do I need to make sure that my US-based insurance will cover it?  If I understand the posts above, private healthcare is not available (or of questionable legality) in Canada.



The Canadian Healthcare system will not cover a non resident traveling in the country. You will need to make sure your US based insurance will cover you or you need to buy some type of travel insurance that will cover you while outside the US.


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## Chrisky (Aug 2, 2009)

gpurtz said:


> Hi,
> 
> This is not intended to invite political wrangling.  Unfortunately, with news what it is today, it's difficult to sort fact from opinion.  I'd really like to hear from Canadian Tuggers about their healthcare system...the good and the bad.  Thanks.


Hello, another Canadian here.  These are my experiences.  I have a chronic condition that requires continuing Dr. checks every 3 - 6 months, which also involves blood tests and an occasional ultrasound or x-ray, or scan.  All these appointments and tests are free (mind you we all contribute to our national health plan through our income tax).  If I move, or for some reason don't like my present Dr. I can change, without having to get approval from any insurance company or government agency.  Where some problems have come up is when patients need to be seen by a specialist, sometimes you might have to wait a few months for an appointment.  
Another example - close friend suffered what turned out to be a minor stroke.  He went to the local hospital emerg. was seen immediately and was given a variety of tests immediately.  He was diagnosed that day, was given some medication, and was seen by his family Dr. within a day with regular follow-ups now every 2 months.  
When we all reach 65, all of our medication is free, except for some newer ones, and even those, if the Dr. shows that the conventional medication has not helped, then we can get the newer ones.  
When we travel out of country we purchase medical insurance to cover any mishaps.
For anyone visiting Canada, they need to have their own medical insurance.  The hospitals and Drs. will expect payment and then the visitor will have to claim for payment from their own medical insurance.


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## Chrisky (Aug 2, 2009)

Ubil said:


> If I understand the posts above, private healthcare is not available (or of questionable legality) in Canada.


There are some private clinics in Canada and the Province of Ontario that are legal.  They have made some sort of agreement with the government.  In Ontario, we can go to this clinic, have required procedure done, and it is paid by the government, we or our insurance company have to pay for the semi-private room.


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## pgnewarkboy (Aug 2, 2009)

*No Single Payer Proposal FOR U.S*

I am glad there is interest in the canadian system.  It is very important to understand that THERE IS NO PROPOSAL FROM THE WHITE HOUSE, CONGRESS, DEMOCRAT, OR REPUBLICAN  for anything like the Canadian or european systems.  That has been deemed a dead issue from the very beginning.  It really doesn't matter what health care is like in canada or any other single payer system because the United States of America will not be getting that kind of system .  I guess it is good to know if you are travelling there.


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## Liz Wolf-Spada (Aug 2, 2009)

There are huge differences in the US between most HMO's and most PPO's. When I had an HMO and eventually needed back surgery, it was well over a year and to get an appt. with a neurosurgeon took 6 months. With my PPO, I find I can make appts. to see specialists much more rapidly doing it on my own rather than going through the referral process. My one experience with Canada is that in the last flu shot shortage I was not able to get a flu shot here. With some chronic health issues and being an elementary teacher that was a big, big concern. A friend and I flew to Vancouver on a cheap flight on Alaska Air and got our flu shot in the Vancouver Airport, no waiting and about $20 per shot.
Liz


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## Elli (Aug 2, 2009)

Chrisky said:


> Hello, another Canadian here.  These are my experiences.  I have a chronic condition that requires continuing Dr. checks every 3 - 6 months, which also involves blood tests and an occasional ultrasound or x-ray, or scan.  All these appointments and tests are free (mind you we all contribute to our national health plan through our income tax).  If I move, or for some reason don't like my present Dr. I can change, without having to get approval from any insurance company or government agency.  Where some problems have come up is when patients need to be seen by a specialist, sometimes you might have to wait a few months for an appointment.
> Another example - close friend suffered what turned out to be a minor stroke.  He went to the local hospital emerg. was seen immediately and was given a variety of tests immediately.  He was diagnosed that day, was given some medication, and was seen by his family Dr. within a day with regular follow-ups now every 2 months.
> When we all reach 65, all of our medication is free, except for some newer ones, and even those, if the Dr. shows that the conventional medication has not helped, then we can get the newer ones.
> When we travel out of country we purchase medical insurance to cover any mishaps.
> For anyone visiting Canada, they need to have their own medical insurance.  The hospitals and Drs. will expect payment and then the visitor will have to claim for payment from their own medical insurance.


Medication being free after you reach 65, does not apply to all provinces.  I know this is the case in Ontario, but not in B.C., not sure about the other provinces.


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## saf512 (Aug 2, 2009)

As a Canadian healthcare worker I can’t help but think that most of our waiting times could drastically be decreased with patient accountability.  If patients show up for their scheduled appointment, multiple appointments for same i.e. tests would not have to be booked.  If a patient misses their appointment I feel they should be charged.  Just my two sense.


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## Htoo0 (Aug 2, 2009)

Interesting. Guess I need to review my opinions of Canadian health care. My in-laws have several friends from Canada who have traveled to the States for care. (They can afford to.) My workplace has people come down from Canada as they built the equipment we operate. One present around last September was wearing a hernia belt and told us he was going to have to wait nearly a year for surgery. This was all before the latest debate about health care so I didn't really ask for details as to circumstances. But so far the above posts don't seem to indicate as severe a problem as I assumed.


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## happymum (Aug 2, 2009)

When diagnosed with breast cancer 7 years ago, I considered going to the US for evaluation and treatment. Of particular concern was the possible delay for surgery and chemo. My surgeon convinced me that a delay of a few weeks would be irrelevant in something that had probably been growing for years. (Not the case with all cancers, obviously). In the end I chose to stay in the country for all of my treatment. I feel that the quality of care was equivalent to what I would have received  elsewhere.
There are certainly times that I would choose to use an alternate (ie. quicker) system if available - but so far the occasion has not arisen.
As a side note it is interesting how many Canadian physicians now practise in the US and I have found it quite informative to hear their opinions on the relative systems.


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## TSchmidt (Aug 2, 2009)

What are your income and property taxes like in order to pay for your health care?   When we visited Quebec last year, we were told that your property taxes were 3%.   Those of us from California would have a hard time with that one.


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## Timeshare Von (Aug 2, 2009)

BevL said:


> <<SNIPPED>  A few examples - when my dad was diagnosed with an aortic aneurism, he was booked for surgery within a few months.  Excellent care, and he's fit as a fiddle today.



And I guess that is as good an example as any why I fear that type of medical system here in the USA.

My dad had them . . . thrice . . . and was on the operating table within hours for the one (emergency surgery) and 48 hours for the second & third (scheduled because it wasn't an emergency yet).

Those things can burst without any advance notice.  To way for "a few months" could be a death sentence for many.


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## swift (Aug 2, 2009)

Thank you for being careful with your answers.


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## spike (Aug 2, 2009)

*see this video*

http://www.youtube.com/watch?v=q2jijuj1ysw


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## AKE (Aug 2, 2009)

Also what is free in one province is not free in another AND if you even make a half decent wage you have to pay an extra tax in Ontario for health care every year (around $1000/person I think)...

Also, health care in Canada is not always transferrable between provinces.  I live in Ottawa, Ontario which borders the province of Quebec.  Because there is a shortage of doctors in the Quebec side, many residents of Quebec were coming to Ontario for treatment.  Initially their health card was accepted 'at par' but no longer because each province has their own fee schedule (i.e. the amount that a doctor is reimbursed for a particular procedure), and Quebec's fee reimbursement was less than Ontario, (i.e. the Ontario government only got x% back from the Quebec government for each procedure where 'x ' is less than 100).  As such, Quebec residents have to pay $$$ up front and then apply for reimbursement from their own provincial government and they will not get the full amount reimbursed.


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## Pit (Aug 2, 2009)

happymum said:


> As a side note it is interesting how many Canadian physicians now practise in the US and I have found it quite informative to hear their opinions on the relative systems.



Why are so many now practicing in the US? What type of comparisons do they make between the two systems?


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## BevL (Aug 2, 2009)

Pit said:


> Why are so many now practicing in the US? What type of comparisons do they make between the two systems?




Same as any other job, I would expect - private sector versus public sector = more dollars for the private practitioner.


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## BevL (Aug 2, 2009)

spike said:


> http://www.youtube.com/watch?v=q2jijuj1ysw



I honestly didn't watch the whole video but it was interesting that it seemed to be based mostly in Quebec.  Their health care system is somewhat different, from my limited understanding of the matter, than most of the other provinces.  I'm not offering that as a defence or attack of the portion of the video I saw, simply an observation.

I don't think any Canadian would deny that the healthcare system is overburdened and could use vast injections of cash to make it better.

But as a person who has always been self-employed (no company insurance) with a husband with a life threatening illness, I'm not complaining at all.


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## dioxide45 (Aug 2, 2009)

TSchmidt said:


> What are your income and property taxes like in order to pay for your health care?   When we visited Quebec last year, we were told that your property taxes were 3%.   Those of us from California would have a hard time with that one.



Don't anyone ever think for a second that health care in Canada is free to their residents. It is not. The tax rates all around are higher. From sales tax to income tax. Very little of property tax probably goes in to health care since it primarily pays for schools and local services such as snow removal and infrastructure.


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## BevL (Aug 2, 2009)

I am sincerely hoping that I can ask similar questions about the US healthcare system without it turning political as I know it's a bit of a hotbutton issue "down there" right now.  I'm really just turning the tables to get comments about questions I have about the American system.

I've heard of Medicaid but my impression is this really covers people pretty much in dire poverty and there are other restrictions - am I wrong?  

You don't hear of people dying in the streets from lack of medical care in the U.S.  so there must be some sort of safety net.

How do lower (but not lowest) income people who haven't worked at jobs that give them private insurance pay for required medical care?  

I sure hope I don't have to moderate a thread I've contributed to so please, keep it polite and non-partisan.


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## calgarygary (Aug 2, 2009)

A discussion of the health care systems of the 2 countries can find similarities and differences.  Certainly, runaway costs is an issue with both systems.  However, with the Canadian system, we are able to spend substantially less of our GDP on healthcare while providing coverage for all.  This year, one more Canadian per 1000 births will live then will in the U.S.  A Canadian is on average expected to live 2 years longer than an American.  Now it is not only the differences between the 2 healthcare systems that contribute to these stats, but that is the main contributing factor.  Having healthcare available to all translates to healthier pregnancies and longer lives.

The U.S. does have a great health care system if you can first afford it and then can retain it.  However, if there isn't substantive change in the U.S. system, it will not be long before the majority of Americans will either have no health care or coverage that will not meet the demands of anything other than an acute illness.  

Our system is not ideal - I don't think you would find many Canadians who think that we have the perfect health care system.  However, you would have true difficulty in finding a Canadian with average income that would prefer a profit based system that have accountants making medical decisions.  

Pit, doctors who will leave their country in search of a more lucrative payday are likely not the type of doctor you would want.


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## Liz Wolf-Spada (Aug 2, 2009)

Bev, Medicaid is for people very poor or disabled (where it works with Medicare for permanent disability). The states share the cost of Medicaid with the federal government. Medicare is paid for by a tax (2.5% split between employer and employee) but only covers people over 65 or people on Social Security disability for permanent disabilities. People without any insurance are really up a creek. Because they don't have insurance if they go to a doctor they don't even get the discounted rate that is negotiated by insurance companies, so they might pay twice as much or more than insurance reimburses a doctor for a patient with insurance. There are some free clinics in cities and mostly urban areas. The emergency rooms are obligated to treat everyone, so people without insurance usually don't get any care until the problem is very serious and then go to an emergency room where costs are probably a minimum of $500 to $1000 just to be seen. This cost then gets passed on in the cost of higher insurance premiums for everyone.
Liz


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## pgnewarkboy (Aug 3, 2009)

BevL said:


> I am sincerely hoping that I can ask similar questions about the US healthcare system without it turning political as I know it's a bit of a hotbutton issue "down there" right now.  I'm really just turning the tables to get comments about questions I have about the American system.
> 
> I've heard of Medicaid but my impression is this really covers people pretty much in dire poverty and there are other restrictions - am I wrong?
> 
> ...



People do actually die in the united states from a lack of health care.  I will give you a real example of someone I know who has a job and didn't qualify for healthcare insurance from the employer.  She was getting dizzy and fainting at work.  She went to the emergency room and after an extremely long wait was seen and diagnosed with extremely high blood pressure.  Emergency rooms do not provide follow up care or medicine.  She could not afford blood pressure medication.  She ended up back in the emergency room after several months.  She was diagnosed this time with having had several strokes from the high blood pressure.  She is now in jeopardy of losing her job because she cannot go back to work because of her condition.  

Other people end up dead because they cannot afford to see a doctor or get preventitive care.  There is no safety net for millions of people.  An emergency room is not a safety net.  Preventitive and ongoing care is not provided by an emergency room.  By the way, many people (such as the person I am discussing) work and earn too much money to get state assistance called Medicaid.  Their employers don't provide healthcare insurance or the premiums are so high they cannot afford to pay them.  These people have their lives in jeopardy.

Many hospitals in the United States cannot afford expensive diagnostic equipment and have a severe doctor shortage.  This is particularly true in rural areas.  Many specialists, even in urban areas, are so busy that it can take months to see them.  I have what would be considered good insurance but the premiums increase every year and the benefit coverage shrinks every year.

Another problem in the United States is the issue of "pre-existing conditions".  If you have a job that provides some form of health insurance and get sick your health insurance may pay for it.  Lets say you get cancer and your insurance pays for treatment.  If you lose your job or get laid off you will have no insurance and no treatment.  If you get a new job and that employer offers health insurance it is highly unlikely that the new health insurance will pay for your cancer treatment. It will be considered a pre-existing condition.  You will have to pay for that yourself.  If you have hundreds of thousands of dollars to pay for it yourself you may live.  If not, you may die.

Another problem in the United States is insurance companies setting dollar value limits on your insurance.  Lets say you have insurance and you get cancer.  The treatment is very expensive.  The treatment may be so expensive that your insurance coverage will be exhausted and you will have to pay for the rest of your treatment yourself.  If you have a job you will not likely qualify for state aid called medicaid.  Many people in such a situation go into debt, mortgage their homes, and eventually have to file for bankruptcy.

These are well known and documented facts.  There is not an american citizen with a TV that has not seen stories about people trying to raise money to pay for their childrens cancer treatment because their insurance has run out.

Another problem in the United States is that most often medical decisions are not ultimately made by your doctor.  The insurance company decides if a treatment or medicine is warranted and therefore covered by the insurance.  In other words, a doctor could order a test, medicine, or procedure and a clerk at the insurance company (following company guidelines) could deny payment for that treatment.  Medical treatment, diagnosis, and medicine is so expensive that most people cannot afford to pay for it themselves.  I have personally had my insurance company refuse to pay for medicine prescribed by my doctor.  And as I have said, I am considered to have good insurance.


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## BevL (Aug 3, 2009)

Thank you for those measured responses.

I have one more question.  What sort of premiums does one pay for health care insurance there?  I'm not talking about employers picking up some/all of the tab.  But for someone like me, I'm self employed, what sort of monthly bill would I be looking at for adequate health care?

I must say that the pre-existing condition thing would scare me silly.  I've been able to keep my private insurance that pays for out of country, prescriptions etc., which I had when I had my professional practice.  We would be hooped for anything like that now if we had to apply with Greg's renal disease - it wouldn't cover the thing that is most likely to cause a problem for him.  

That being said, here in Canada it's only the "extras" that I would have to worry about, out of country and such.  His dialysis supplies, drugs, everything is covered completely - and I can't imagine it's cheap.


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## Passepartout (Aug 3, 2009)

BevL said:


> I have one more question.  What sort of premiums does one pay for health care insurance there?  I'm not talking about employers picking up some/all of the tab.  But for someone like me, I'm self employed, what sort of monthly bill would I be looking at for adequate health care?



DW and I just went on private pay in the last month. I could continue my working coverage at $370USD/mo for myself and include DW for $830/mo. It provides $20 office visits, $10 generic scripts, we pay the first $800 a year. 

We opted for me to take the above single coverage for myself, and DW, in pretty much BevL's  situation, bought one with pretty much the same benefits, a $7500 deductible for $350/mo. with a Healthcare Savings Account wherein one puts pre-tax money in an account, then is able to pay for medical stuff with those pre-tax funds, and carry those unspent deposits and earned dividends/appreciation forward into future years. We are pretty healthy, and have never hit our deductible and have no pre-existing conditions to speak of.

We will have to provide our own coverage for 3 years until we reach age 65 and Medicare coverage will start. 

So for us, if one of us needed serious medical care, we'd pay about $15000 a year before we'd get much help from insurance. It's expensive, but without it, it is like playing Russian Roulette with at least half the chambers loaded.

Jim Ricks


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## jamstew (Aug 3, 2009)

I'm interested in hearing what the income and sales tax rates are in Canada if someone could answer that.


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## BevL (Aug 3, 2009)

From the Canada Revenue Agency website - Federal Income Tax rates:

15% on the first $40,726 of taxable income, + 
22% on the next $40,726 of taxable income (on the portion of taxable income between $40,726 and $81,452), +
26% on the next $44,812 of taxable income (on the portion of taxable income between $81,452 and $126,264), +
29% of taxable income over $126,264.

Provincial rates are different but here in B.C. they're:

5.06% on the first $35,716 of taxable income, +
7.7% on the next $35,717, +
10.5% on the next $10,581, +
12.29% on the next $17,574, +
14.7% on the amount over $99,588

We have federal sales tax of 5% - Goods and Services Tax (GST)

Here in B.C. our provincial sales tax is 7% - again that changes province to province.

Add on high user type taxes - which is why we always fly from Seattle instead of Vancouver- and we all know we pay high taxes up here compared to Americans.


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## jamstew (Aug 3, 2009)

Thank you


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## isisdave (Aug 3, 2009)

Bev, your Federal rates seem lower than ours, and not so steeply progressive, but the devil is always in the details ... what's "taxable income"?  In the US, we get to deduct most mortgage interest, medical expenses over $7500, charitable contributions, property tax and most state income tax.  Or, instead of itemizing these (for example, if you don't own a home with mortgage and tax), there's a "standard deduction" of about $5500 for an individual, twice that for a couple.

State taxes vary wildly, with rates from 2 to 12%, but applied to income at different levels depending on state.  Oregon has a tax of 9% on "taxable income" above $7300. In California, that income would be taxed at 2% and you wouldn't get to 8% until you hit $37,000. Oregon has no sales tax, and maybe they have more deductible items, but you can see the wide variation.


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## Icarus (Aug 3, 2009)

BevL said:


> I've heard of Medicaid but my impression is this really covers people pretty much in dire poverty and there are other restrictions - am I wrong?



Medicaid is free if you qualify. Everything is free if you have medicaid, including aspirin. I mean everything, including dental, podiatry, open heart surgery, vitamins, etc. I'm sure the coverage is different from state to state. I'm most familiar with the way the NY State program worked in the 1980s.

You have to use a provider that accepts medicaid. There's no shortage of them. In order to qualify for medicaid, I think you have to be on some form of public assistance (welfare or SSI), but according to the aricle below, it's not the only requirement.

http://en.wikipedia.org/wiki/Medicaid

And Liz, that tax we pay is for Medicare, the insurance plan for the elderly, not Medicaid. I think it's 1.45% of income, x2 (1.45% paid by employer, 1.45% paid by employee, on all income.) Medicaid is jointly funded by the federal and state govenments, I believe, from the general funds.



> You don't hear of people dying in the streets from lack of medical care in the U.S.  so there must be some sort of safety net.



They have some free clinics and things like that, but for the most part, public emergency rooms end up being where people that can't afford care get their care. ERs are required to take anybody, regardless of their ability to pay. (not all are required, but certainly publicly funded ERs are.)

That's part of what burdens the system in the US.



> How do lower (but not lowest) income people who haven't worked at jobs that give them private insurance pay for required medical care?



For the most part they don't, and that's a big part of the problem.

And the double whammy for them is that people without insurance who are least able to afford it, pay the highest rates for medical care. When I get care in my PPO plan, as long as I use providers that are part of the plan, the PPO has negotiated discounts with those providers. My copay is based on the discounted rate. The discounts are usually 40% - 50% or more off the amount the provider billed for the service. It's certainly a sham, because only the uninsured have to pay full price.

In Hawaii, the co-pay is only 10%. Hawaii already has employer medical care mandates for full time workers. The employee has to pay for it (unless the employer elects to pay for it), but it's always provided for any full-time employee.

Some states have their own insurance plans for the working poor. Everything here varies from state to state.

-David


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## pgnewarkboy (Aug 3, 2009)

My wife works in the health care industry.  Her place of work has relied in the past on medicaid patients.  Medicaid benefits in our state,  have been cut year after year.  It is extremely difficult to get Medicaid and most people (even with low paying jobs) cannot get on.  Furthermore, medicaid pays for less and less treatment because the state budget is in bad shape.  This situation with medicaid is growing worse all over the United States because the state governments do not have enough money to pay for the benefits.  My wife's employer is a non-profit with a heart and has tried not to kick these medicaid patients to the curb who have lost their benefits.  It is, however, a losing battle.  In order to keep themselves solvent, they are refusing to take new clients that are medicaid beneficiaries


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## dioxide45 (Aug 3, 2009)

pgnewarkboy said:


> Another problem in the United States is the issue of "pre-existing conditions".  If you have a job that provides some form of health insurance and get sick your health insurance may pay for it.  Lets say you get cancer and your insurance pays for treatment.  If you lose your job or get laid off you will have no insurance and no treatment.  If you get a new job and that employer offers health insurance it is highly unlikely that the new health insurance will pay for your cancer treatment. It will be considered a pre-existing condition.  You will have to pay for that yourself.  If you have hundreds of thousands of dollars to pay for it yourself you may live.  If not, you may die.



The problem I have with the pre-existing condition argument is that it is much like driving without insurance and then getting in to an accident. After the accident you call an insurance company and say you now want insurance to cover your accident. I think that most would agree that a policy that covered this type of situation would bankrupt almost any company.


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## Icarus (Aug 3, 2009)

dioxide45 said:


> The problem I have with the pre-existing condition argument is that it is much like driving without insurance and then getting in to an accident. After the accident you call an insurance company and say you now want insurance to cover your accident. I think that most would agree that a policy that covered this type of situation would bankrupt almost any company.



That's not a very good analogy. The person wanted insurance before they had the accident, but couldn't get coverage for that vehicle for a year while paying their premiums, because they once had an accident in the past. That would be a better analogy.

Anyway, here's the thing. If everybody has to have insurance, then you spread the risk of the not so healthy with healthy people. That's the entire idea. Right now insurance companies get to cherry pick. And when you lose your job, if you can't afford the Cobra plan or private coverage, then you have to wait another year for your pre-existing conditions to be covered by your health plan because you weren't financially able to maintain your coverage between jobs? Again, it's just another thing that hurts those least able to afford it more than anybody else. And for what?

-David


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## pgnewarkboy (Aug 3, 2009)

dioxide45 said:


> The problem I have with the pre-existing condition argument is that it is much like driving without insurance and then getting in to an accident. After the accident you call an insurance company and say you now want insurance to cover your accident. I think that most would agree that a policy that covered this type of situation would bankrupt almost any company.



With all due respect, the "pre-existing condition" situation is not an argument it is a fact.  When asking about health care in the United States, this fact is a very important part of the answer.  So far this is a discussion about "what is".  In order to keep the discussion going without getting political or controversial I think it would be adviseable to stick to the facts.


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## caribbeansun (Aug 3, 2009)

Taxable income varies by Province as well however, there is a standard deduction of approx $10k per person, we don't deduct mortgage interest but we don't pay tax on gains on principal residences.  Deduction of medical expenses are linked to taxable income via percentage, there are property tax credits/rebates again linked to income level.  There is no deduction for Provincial taxes.  There are considerably more line items so I restricted myself to a direct comparison of what you detailed.




isisdave said:


> Bev, your Federal rates seem lower than ours, and not so steeply progressive, but the devil is always in the details ... what's "taxable income"?  In the US, we get to deduct most mortgage interest, medical expenses over $7500, charitable contributions, property tax and most state income tax.  Or, instead of itemizing these (for example, if you don't own a home with mortgage and tax), there's a "standard deduction" of about $5500 for an individual, twice that for a couple.
> 
> State taxes vary wildly, with rates from 2 to 12%, but applied to income at different levels depending on state.  Oregon has a tax of 9% on "taxable income" above $7300. In California, that income would be taxed at 2% and you wouldn't get to 8% until you hit $37,000. Oregon has no sales tax, and maybe they have more deductible items, but you can see the wide variation.


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## caribbeansun (Aug 3, 2009)

Recent personal situation:

DW had a blood clot in the lungs - was transported to hospital after a three tiered response (police, fire department and ambulance).

Was taken into emerg immediately and was treated immediately.  Was administered a clot busting drug, required 3 surgeries, stayed in hospital for about a month, received physio, blood tests, consulted with no less than 5 specialists and has ongoing treatments, drugs and reviews with a vast number of additional specialists.

Costs: 
= $34 for ambulance not covered by insurance
= $9 dispensing fee each time she gets her drug Rx's refilled


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## BevL (Aug 3, 2009)

As well, I don't know how Americans fund government unemployment insurance and old age security, but here in Canada, on top of everything else we pay, an employee pays approximately 5% for CPP - Canadian Pension Plan and approximately 2% for EI - Employment Insurance - the latter is the rate for B.C.

The employer is required to pay the same for CPP and a little bit more for EI.  As a self-employed person I pay the full 10% CPP - I don't have to pay EI as I don't qualify for benefits.


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## Eli Mairs (Aug 3, 2009)

Another personal situation:

I recently had a total hip replacement after a six month wait. It was not an emergency. They were able to schedule the surgery between my vacations. I had a five day hospital stay followed by four weeks of in home physiotherapy. 

Total cost - 0


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## Icarus (Aug 3, 2009)

BevL said:


> As well, I don't know how Americans fund government unemployment insurance and old age security, but here in Canada, on top of everything else we pay, an employee pays approximately 5% for CPP - Canadian Pension Plan and approximately 2% for EI - Employment Insurance - the latter is the rate for B.C.
> 
> The employer is required to pay the same for CPP and a little bit more for EI.  As a self-employed person I pay the full 10% CPP - I don't have to pay EI as I don't qualify for benefits.



Both unemployment tax and social security taxes are payroll taxes, on top of the income taxes we pay in the US.

Depending on the state, the employee or employer or both pay unemployment insurance tax. Unemployment insurance benefits are very small if you ever have to collect them. I did once, for about a month or 2 in 1989. I think I got about $252 a week, which was a small fraction of my salary. IIRC, I paid unemployment insurance tax when I lived in NY State, but I don't recall paying it separately anywhere else, so the employer has to pay it, I guess.

Social Security tax is also a payroll tax on top of the income tax we pay. Both the employer and employee pay about 6.2% (each), but the income is capped on it. The cap goes up every year. This year, I think the cap is a little over $100k on your gross income. If you are self-employed, you pay both the employer and employee part of it.

We also have to pay for state disability income insurance through a payroll tax, but it's a relatively small deduction, with relatively small benefits. Again, the amount and type varies from state to state. I think I pay around $8 and change from each paycheck in Hawaii, and I get paid every 2 weeks. In Hawaii, the deduction never stops, but in other states, it's only collected as a small percentage on a capped amount weekly, and/or the deduction ends after you paid in so much in a year. Either way, it's a small tax. The state plans are only short term plans and generally only cover disability related to a job and the benefits are very small. Most large companies supplement that with both a short term and long term plan.

-David


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## easyrider (Aug 3, 2009)

In Washington State, if you have medical insurance you can buy any other medical insurance with pre-existing conditions covered. If you don't have medical insurance there is an elimination period befor pre existing conditions are covered.

Our deductable is $1000.00 per person with caps on different types of medical services. I can switch to a different provider and get different options should we get sick in slow motion. If something sudden happens this complicates this stratagy.

So, its in my best interest to not get sick or hurt. So far so good.


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## Icarus (Aug 3, 2009)

easyrider said:


> In Washington State, if you have medical insurance you can buy any other medical insurance with pre-existing conditions covered. If you don't have medical insurance there is an elimination period befor pre existing conditions are covered.



That's fairly standard everywhere in the US. If you already have coverage, pre-existing conditions are generally waived. But if you have a one day gap in your coverage, all bets are off with the current system.

So, today, it's really important to never let your medical insurance policy expire without replacing it.

-David


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## Icarus (Aug 3, 2009)

I looked up the SS tax amounts for 2009. It is 6.2% each for employer and employee. Like you, the self-employed have to pay both halves.

For 2009, the cap is $102,000 of income. For 2010, the cap goes up to $106,800. The cap goes up every year.

-David


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## calgarygary (Aug 3, 2009)

easyrider said:


> .....
> 
> So, its in my best interest to not get sick or hurt. So far so good.



With that strategy we could do away with both private and public insurance providers.


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## wayzer (Aug 3, 2009)

First let me say that I didn't not read all post before posting, but I did manage to read most before I saying something. 

First off, many of the posters are correct and I agree with all that I have read; so I just have a few comments. 

I do not care if I pay more taxes, I do not care if I have to wait longer, and I also do not care if I pay more than the guy down the street because he is less fortunate than I.

The most important thing to me is that if my unemployeed neighbour was to get cancer she would be taken care off. I don't care if she is not paying as much tax. I just care that she gets the same type of care that I would get. 

Yes, we do wait a little longer for some care, however there is nothing stopping us from driving down to the U.S. to get that care and pay for it out of our pockets like you would. 

I do believe there needs to be a blend of the two systems and then it needs to be tweaked as you go. It will not be right the first time, but what is? 

These are my thoughts.


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## donnaval (Aug 3, 2009)

> If you already have coverage, pre-existing conditions are generally waived. But if you have a one day gap in your coverage, all bets are off with the current system.



Not in PA. We're self-employed. We've always paid for health insurance and have never been uninsured for even one single day.  But when we tried several years ago to find some less expensive coverage (what we'd had for so long had simply become crushingly expensive), we were shocked to learn that what we had considered minor problems had turned into "pre existing conditions" that made us undesirable.  Several companies offered to insure us but refused to cover my feet (I have heel spurs) or my right arm, where I'd had a small muscle tear that responded to PT, no surgery required.  The arm could be covered after a THREE year waiting period, but the exclusion of my feet was forever and ever, and since anything that ever went wrong with my legs or hips could conceivably relate back to the problems with my feet, those insurances were no-go's for us.

We did find comprehensive coverage, with DH going with one company and me with another.  Over these three years the cost has crept up and up so we are almost back where we started cost-wise, and now I'm shopping again.

Between the two policies, we currently pay $1,000 per month for health coverage.  DH has a $3,000 annual deductible.  I have $1,500 deductible.  These rates are scheduled to go up about 11% in September.

I haven't had a bit of trouble with my feet or arm over these past years.

But so far, we haven't had any luck finding anything more affordable.


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## Icarus (Aug 3, 2009)

donnaval said:


> Not in PA.
> 
> ...



Yeah, I said generally. The pre-existing thing is generally waived if you change jobs and go with another employer. But I imagine that there might be some that don't waive them too.

Unfortunately, as you pointed out, it's a big problem with the current system.

-David


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## Larry6417 (Aug 3, 2009)

*My 2 cents*

I'm a physician, which gives me some perspective on Canadian healthcare. Take what I say with a grain of salt though (remember the story about the blind men and the elephant) . In some ways, comparing Canadian and US systems is understandable. We are close geographically, but our healtcare systems are very different. In the Canadian system private providers for medically insured services are prohibited, which is very rare among first world countries. In the US system the federal government plays a very small role in healthcare for average individuals, also rare among first world countries. Most countries have a combination of state + private healthcare. Countries we often consider as "socialist," like the Nordic and Western European countries, have private healthcare. Thus, Canada and the US have extreme models of healthcare compared to the rest of the world. We should remember this fact as we compare our respective systems.

Also, we should remember to compare apples to apples. The Canadian system is meant to provide the best possible coverage for all Canadians; in other words, sometimes compromises are made. The US system, as ranked by the WHO, came in first for "responsiveness." That is, if one has money then one can buy the latest, greatest medical treatment immediately. However, we need to consider some facts. The US system is responsive only if one has good insurance. If one has no insurance, then the system is considerably less responsive. Also, even middle-class Americans are finding it difficult to find or maintain good health insurance. Often in Canada we hear stories of how Canadians travel to the US to buy healthcare or surgery instead of staying on a waiting list. The story frequently ends with an unflattering comparison of Canadian wait lists vs US  ones. These stories aren't comparing apples to apples. They're comparing coverage for the average or poor person in Canada to healthcare available only to the relatively wealthy in the US. So when will wait times in Canada fall to levels in the US? Canadians won't like this, but the answer is likely...never. Wait lists in the US include those of the wealthy/ well-insured, which lower overall averages, while Canadian wait lists include everyone. There's an old joke among Canadian physicians. We can have healthcare that's quick, good, or universal, but not all three at once. Therefore, pick the two attributes that you want. 

Also, finances will increasingly constrain healthcare in both countries. I suspect the situation will worsen rapidly in both countries. In Canada, healthcare consumes about 10% of our GDP; in the US that number is greater than 15%, for lesser coverage of the population. Even before the credit crisis states and health insurance companies in the US were cutting expenses. That trend will only worsen. Also, the US federal debt, on a cash basis is about 11 trillion dollars; on an accrual basis, where one considers the present value of future obligations such as medicare and social security, the US debt is over 65 trillion dollars. The preceding figures don't include states' debt. The fiscal situation in Canada is better but still unsustainable. I don't know any physicians who consider the status quo in Canada sustainable.

In Canada we need a rational debate about healthcare delivery. Unfortunately, any attempts to consider parallel private healthcare are labelled as anti-Canadian. I believe multi-tiered healthcare already exists in Canada and will become more prominent with time. Most first world countries have a combination of private and public healthcare delivery. As a physician, I don't think it's unreasonable for people to buy faster healthcare delivery, and the supreme court of Canada agrees with me. I think it's acceptable to have both private and public delivery IF good, comprehensive care is available to everyone.


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## AKE (Aug 3, 2009)

The Ontario government website http://www.health.gov.on.ca/transformation/wait_times/providers/wt_pro_mn.html gives the average wait times for surgeries.


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## Icarus (Aug 3, 2009)

Larry6417 said:


> As a physician, I don't think it's unreasonable for people to buy faster healthcare delivery, and the supreme court of Canada agrees with me.



The Supreme Court of Canada thinks it isn't unreasonable, or that it's not prohibited by law or constitution?

There's a little difference there, Larry.

Thanks for sharing your perspective.

-David


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## Larry6417 (Aug 4, 2009)

*lawful*



Icarus said:


> The Supreme Court of Canada thinks it isn't unreasonable, or that it's not prohibited by law or constitution?
> 
> There's a little difference there, Larry.
> 
> ...



Thanks for your reply Icarus. I'm referring to a legal case, Chaoulli vs Quebec, which ruled that restrictions on the purchase of medically necessary services within Canada were unlawful. There is no specific clause within the constitution that outlaws purchase of medical services; however, the preceding case did rule that the restriction of services did violate Canada's constitution.


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## pgnewarkboy (Aug 4, 2009)

There can be a comparison between the U.S and Canadian Health care systems.  I would like to emphasize the words system and entitlement.The bottom line is that in Canada every living human that is a resident of Canada is entitled to get health care and in fact GETS health care.  In some cases it may be slow or not what someone might expect.   In canada, there IS a health care system. And let me emphasize that in Canada that health care is an ENTITLEMENT The bottom line is that in the United States Nobody is entitled to get health care and there is no health care system.  

Some people believe in the United States that Veterans are entitled to health care.  That is not true.  That is a different topic and I will not go into convoluted detail here.  Medicare is not an entitlement program in that it does not provide a health care as a right.  If you can get a doctor who will accept medicare payments you get treated.  If you can't find a doctor - you don't get treated.  The same goes for Medicaid.  

For the rest of the population only those with good jobs that have good insurance policies for their employees (also long lasting at the same employer) and good incomes get good health care.  Everyone else has nothing, or policies that are so expensive and with so many exclusions that people effectively get crappy health care.  People with policies which large deductibles are NOT going to the doctor and therefore are getting sicker because the deductibles will break them.  There is no system.  There is no entitlement.

Yes, it is quite easy to make a comparison between the Canadain and United States Health Care systems.


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## Gramma5 (Aug 4, 2009)

Just a couple of curious questions. In Canada are there any age limits for certain types of surgery? ie;  a person is 80 years old and needs heart surgery, or hip replacement or a kidney transplant or dialysis or any other type of expensive surgery or medical care. Also is abortion publically funded?


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## John Cummings (Aug 4, 2009)

Ubil said:


> If I am visiting Canada on vacation and require unexpected and urgent healthcare, will it be free under the Canadian healthcare system, or do I need to make sure that my US-based insurance will cover it?  If I understand the posts above, private healthcare is not available (or of questionable legality) in Canada.



No, you will NOT receive free healthcare in Canada unless you are a resident of Canada. My US insurance covers me world wide. Check and see what yours covers. If necessary you can get temporary trip insurance that covers medical for a reasonable price.


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## John Cummings (Aug 4, 2009)

BevL said:


> Thank you for those measured responses.
> 
> I have one more question.  What sort of premiums does one pay for health care insurance there?  I'm not talking about employers picking up some/all of the tab.  But for someone like me, I'm self employed, what sort of monthly bill would I be looking at for adequate health care?
> 
> ...



How much one pays for depends on what you want. My wife has her own medical insurance as she is under 65 and not employed by choice. She has a self directed PPO that is very good and it costs $340 /mo. A PPO allows her to see any doctor or specialist without needing a referral. Self directed means that she has a certain amount of money allocated every quarter to spend as she sees fit and covers anything she chooses 100% as long as the money lasts. It is accumulative so what she doesn't use in each quarter gets carried over. All other expenses are covered by the insurance with deductibles and co-pays. There is a maximum amount of out of pocket expenses after which the insurance will cover 100% of everything. Prescription drugs are covered. This is an excellent plan for people that are reasonably healthy and it also protects against any health catastrophe.

I am over 65 so I receive Medicare. I have a Medicare Advantage Plan that is private insurance but is paid for by the government. I do not pay any premiums nor co-pays of any kind. Medicare Advantage plans have approximately 10 million subscribers. Anybody that qualifies for Medicare can get a Medicare Advantage plan if offered in their locality. They are very strong in California. There are approximately 15 competing companies offering them where I live. They are not all the same. Some are better than others, some charge a small monthly premium and/or co-payments. Some are very good like mine is. The official US government Medicare web site lists all of the ones available in your locality and provides a comparison of them.

Before I was 65, I was self employed. My wife and I had group Medical Insurance through my own business. Actually I was the only one in the business but I included my wife. I chose what insurance I wanted. There are many, many choices at varying costs. There are no medical qualifications, in fact they do not ask any medical questions. You must meet the definition of being a business which is pretty easy no matter what your self employment is. The medical insurance premiums are tax deductible. You must get the small business group insurance through an insurance broker which is a good thing. It doesn't cost you anymore and a good broker will help a great deal in navigating through all the choices.


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## calgarygary (Aug 4, 2009)

Gramma5 said:


> Just a couple of curious questions. In Canada are there any age limits for certain types of surgery? ie;  a person is 80 years old and needs heart surgery, or hip replacement or a kidney transplant or dialysis or any other type of expensive surgery or medical care. Also is abortion publically funded?



I am not a doctor nor did I sleep in a Holiday Inn last night - so this is only from personal experience.  I believe that the determining factor in obtaining any of the procedures you listed is the patient's health.  In my father's case, he was deemed not healthy enough to survive a transplant procedure but did begin dialysis at the age of 82.


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## John Cummings (Aug 4, 2009)

isisdave said:


> Bev, your Federal rates seem lower than ours, and not so steeply progressive, but the devil is always in the details ... what's "taxable income"?  In the US, we get to deduct most mortgage interest, medical expenses over $7500, charitable contributions, property tax and most state income tax.  Or, instead of itemizing these (for example, if you don't own a home with mortgage and tax), there's a "standard deduction" of about $5500 for an individual, twice that for a couple.
> 
> State taxes vary wildly, with rates from 2 to 12%, but applied to income at different levels depending on state.  Oregon has a tax of 9% on "taxable income" above $7300. In California, that income would be taxed at 2% and you wouldn't get to 8% until you hit $37,000. Oregon has no sales tax, and maybe they have more deductible items, but you can see the wide variation.



You can't go just by the rates. One thing that makes the Canadian Income tax rates much higher than the US is you hit the top rates at a much lower income than in the US. Also they do not have all the deductions that we do. The biggest income tax hit in Canada is for the middle and upper middle income families.

My sister lives in British Columbia, Canada and is retired like I am. She pays as much as I do in income taxes yet my income is more than 4 times as high as hers.


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## John Cummings (Aug 4, 2009)

caribbeansun said:


> Taxable income varies by Province as well however, there is a standard deduction of approx $10k per person, we don't deduct mortgage interest but we don't pay tax on gains on principal residences.  Deduction of medical expenses are linked to taxable income via percentage, there are property tax credits/rebates again linked to income level.  There is no deduction for Provincial taxes.  There are considerably more line items so I restricted myself to a direct comparison of what you detailed.



A husband and wife that have lived in their principal residence for 2 years or more do NOT pay any taxes on the first $500,000 of capital gain. It is $250,000 for a single person. This pretty well covers just about everybody selling their home.


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## John Cummings (Aug 4, 2009)

Gramma5 said:


> Just a couple of curious questions. In Canada are there any age limits for certain types of surgery? ie;  a person is 80 years old and needs heart surgery, or hip replacement or a kidney transplant or dialysis or any other type of expensive surgery or medical care. Also is abortion publically funded?



My mother fits your question perfectly. She was a Canadian citizen living in California. She needed to have back surgery to relieve the extreme constant pain she had. She was 83 at the time. She was considering living with my sister in British Columbia at the time so she checked and had my sister investigate getting the operation done there. My sister was the head nurse at a hospital in BC. My mother was told that she would not be eligible to get an operation in Canada because of her age and it was deemed to be an elective surgery. My mother had Health Net Seniors Plus insurance in California. She was able to get the operation done in California within 2 weeks of requesting it and her insurance paid 100% of all costs.


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## John Cummings (Aug 4, 2009)

BevL said:


> As well, I don't know how Americans fund government unemployment insurance and old age security, but here in Canada, on top of everything else we pay, an employee pays approximately 5% for CPP - Canadian Pension Plan and approximately 2% for EI - Employment Insurance - the latter is the rate for B.C.
> 
> The employer is required to pay the same for CPP and a little bit more for EI.  As a self-employed person I pay the full 10% CPP - I don't have to pay EI as I don't qualify for benefits.



Employees do not pay for unemployment insurance. It is funded by the employers. Our Social Security, which is not only old age but also disability and child survivor insurance, is paid for by both the employee and employer with a 50/50 split between them. The rate is approximately 6% for the employee with a cap at approx. $110,000 /year income. A self employed person has to pay both parts or double that of an employee. Many call that the self employment tax.


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## John Cummings (Aug 4, 2009)

wayzer said:


> The most important thing to me is that if my unemployeed neighbour was to get cancer she would be taken care off. I don't care if she is not paying as much tax. I just care that she gets the same type of care that I would get. These are my thoughts.



Actually the statistics show that cancer is one area where medical care in the US excels compared to Canada and other countries in Europe. The statistics for both prevention and cure rates are considerably higher in the US.


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## itchyfeet (Aug 4, 2009)

John Cummings said:


> Actually the statistics show that cancer is one area where medical care in the US excels compared to Canada and other countries in Europe. The statistics for both prevention and cure rates are considerably higher in the US.



If you are lucky enough to have insurance.


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## Larry6417 (Aug 4, 2009)

John Cummings said:


> My mother fits your question perfectly. She was a Canadian citizen living in California. She needed to have back surgery to relieve the extreme constant pain she had. She was 83 at the time. She was considering living with my sister in British Columbia at the time so she checked and had my sister investigate getting the operation done there. My sister was the head nurse at a hospital in BC. My mother was told that she would not be eligible to get an operation in Canada because of her age and it was deemed to be an elective surgery. My mother had Health Net Seniors Plus insurance in California. She was able to get the operation done in California within 2 weeks of requesting it and her insurance paid 100% of all costs.



Actually, I'm not sure your mother fits the question perfectly. There are no formal age limits on surgery in Canada. I'm not sure what your mother was told; it's more likely that one particular surgeon turned her down because of her overall condition rather than her age. This comfort level varies from surgeon to surgeon. I've seen a 99 year-old get hip surgery.


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## falmouth3 (Aug 4, 2009)

Timeshare Von said:


> And I guess that is as good an example as any why I fear that type of medical system here in the USA.
> 
> My dad had them . . . thrice . . . and was on the operating table within hours for the one (emergency surgery) and 48 hours for the second & third (scheduled because it wasn't an emergency yet).
> 
> Those things can burst without any advance notice.  To way for "a few months" could be a death sentence for many.



I'm not a doctor, but I once worked at a company developing a AAA stent-graft.  It is my understanding that some cases require immediate treatment and some are watched, sometimes for years.


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## Larry6417 (Aug 4, 2009)

*Be careful interpreting statistics!*



John Cummings said:


> Actually the statistics show that cancer is one area where medical care in the US excels compared to Canada and other countries in Europe. The statistics for both prevention and cure rates are considerably higher in the US.



Interpreting medical statistics is fraught with traps for the unwary. It's very hard to directly compare cancer stats between Canada and the US. For example, demographics may cloud the interpretation. The US has a relatively high proportion of Hispanics while Canada has a relatively small proportion of Hispanics and a large number of Aboriginals. Hispanics tend to have a lower cancer rate while Aboriginals tend to have a higher cancer rate. Therefore, some of the difference between Canada and the US may be due to differential rates of cancer in different ethnic groups. Also, there's a strong relationship between survival and socioeconomic status (higher is better). In the US those with insurance i.e. eligible for treatment are likely to be of higher socioeconomic status while in Canada all income groups receive treatment. Therefore, US stats are skewed compared to Canadian stats. 

Also, some cancers like prostate cancer tend to be more heavily screened in the US and skew the results. Let me explain. Prostate cancer tends to be long and slow-growing, so early diagnosis doesn't necessarily mean that one is treated earlier. Let's say that patient "A" is screened early for prostate cancer and discovers he has it at age 55 while patient "B" has it at the same age but doesn't discover it until age 60. Both "A" and "B" live to the same age, 70. According to the "statistics" patient "A" has a longer survival period than patient "B." If one corrects for earlier screening for prostate cancer the difference between Canadian and American cancer survival rates drops to almost zero, with a slight benefit to the US.

I'm not an expert in cancer - far from it. I know just enough to avoid extrapolating from the data. My suspicion is this: if you're wealthy then treatment in the US is probably faster. If you're of average income, there's probably little difference. If your income is below average, then you're better off being treated in Canada. Just my opinion. Take it with a grain of salt.


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## Larry6417 (Aug 4, 2009)

falmouth3 said:


> I'm not a doctor, but I once worked at a company developing a AAA stent-graft.  It is my understanding that some cases require immediate treatment and some are watched, sometimes for years.



You're exactly right. Some aortic aneurysms (those involving the ascending aorta) require immediate attention while those involving the descending aorta, depending on the size, may not. The difference in treatment may be due to different types of aortic aneurysms. I can't believe that any surgeon would delay treatment for a high-risk aneurysm; the risk of malpractice is too high. I've seen patients with high-risk aneurysms come into the ER and receive surgery the next day.


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## John Cummings (Aug 4, 2009)

I was born in Canada and lived there until I was 19 when I moved to the US by myself. My wife and I did live in Vancouver for 18 months in 1968 - 1970. So any direct experience I have had with Medical care in Canada is not relevant at all. However, I am the only member of my family that does not live in Canada. My sister, cousins, etc., etc. live in British Columbia, Alberta and Ontario so I can relate some experiences that they have had. The first one was my aunt that lived in Ontario. She needed hip replacement surgery that she had to have done in Florida because she would have had to wait over 2 years to get it done in Ontario. My brother in law had to wait 9 months for heart bypass in British Columbia. There are other examples of long waits. And then there is the case of my mother's back surgery that I discussed in an earlier post. My sister and I have discussed the issues of healthcare to great extent and in fact did so yesterday. She is retired from being the head nurse at a hospital in British Columbia. She agrees that there are definite problems with Canada's system and I also believe that there are some badly needed reforms to the US system.

On the positive side, my sister recently had a very serious auto accident that required her to be hospitalized. She did receive very good care.

I am very concerned about long waits for people, especially seniors, requiring surgeries or treatments deemed elective such as hip/knee replacements. I personally have had very serious problems with my hips as I have both arthritis and AS ( Ankylosing Spondylitis ). The pain was so bad 7 months ago that I couldn't walk, sleep in my bed, or sit in most chairs. The only spot I was comfortable was in my reclining chair. I was offered the option of having hip replacement surgery which I could have had done in a matter of a couple weeks. However, I wanted to see if there was anything I could do first because I wasn't too keen on surgery. Through physical therapy and losing some weight it is now much better and I can walk with some limitations and I am back to sleeping in my bed. However, if I just make the slightest wrong move I get excruciating pain in my hips. That is because of the AS. The one good thing is I have a Handicap Placard from the DMV so I get the good parking spots. In any event I will probably have to get hip surgery sooner or later. The big problem I have with the Canadian healthcare is deeming it as elective and the long waits. I felt like I was in a living hell 7 months ago and waiting 1 week was intolerable so calling it elective is not true at all. The only thing stopping me from getting the surgery at the time was my fear of surgery and optimism that somehow I could get over it.

I have one suggestion to cut healthcare costs in the US that is totally non-political and would not reduce the care and in fact would probably improve it. That is automation of admin and health records. As a retired computer software engineer, this subject is dear to my heart. There is no reason for having to fill out all the paper work when going to another doctor or getting an X-ray, blood tests, or whatever. All that manual record keeping does is provide employment for a lot of people that have nothing to do with your healthcare. Some doctors, like mine are automated but others like my former doctor still uses paper records. It can all be automated to where you can just go from one provider to another and not have to fill out any forms. It may not work to well on a national basis but could certainly work on a statewide basis. This has already existed for many years in some Medical groups. When I lived in San Diego, Scripps was my medical provider. They have large clinics and hospitals throughout San Diego County. They are totally automated so that all admin and health records are available throughout the system. Kaiser was the same. On the other hand If I have to go to get an X-ray here, I have to fill out the same forms every time. Because my doctor is automated, she just hits the referral button and it prints out a referral with all the pertinent info including my insurance etc. I can then present that at some providers without filling out any forms. However many referrals from other doctors are hand written with no insurance info etc. so you fill out a form. All of this can be eliminated, saving costs and reducing the chance for errors.


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## calgarygary (Aug 4, 2009)

John although I agree that automation of records will indeed reduce costs, that reduction would be minimal compared to removing profit and obscene salaries from the U.S. system.  

Both systems have their issues, and I most certainly agree that an elective surgery wait in Canada is frustrating for all.  However, John you are coming from the position of being able to afford that surgery.  I would much sooner have a wait for the procedure than knowing that I could never afford the procedure and have to live with that pain for the rest of my life.


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## pgnewarkboy (Aug 4, 2009)

The United States does not have a health care system when compared to most western democracies.  What the united states has is "chaos" in comparison.  It is the wild west when it comes to health care.  A system implies by definition some sort of integration of various parts. In the U.S  Some people get health care, some don't, some get some procedures but others with the exact same condition get nothing.  It all depends on money.  If we have any system at all it is the "he who has the money gets the health care system".  This is a fact.


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## Larry6417 (Aug 4, 2009)

John Cummings said:


> I was born in Canada and lived there until I was 19 when I moved to the US by myself. My wife and I did live in Vancouver for 18 months in 1968 - 1970. So any direct experience I have had with Medical care in Canada is not relevant at all. However, I am the only member of my family that does not live in Canada. My sister, cousins, etc., etc. live in British Columbia, Alberta and Ontario so I can relate some experiences that they have had. The first one was my aunt that lived in Ontario. She needed hip replacement surgery that she had to have done in Florida because she would have had to wait over 2 years to get it done in Ontario. My brother in law had to wait 9 months for heart bypass in British Columbia. There are other examples of long waits. And then there is the case of my mother's back surgery that I discussed in an earlier post. My sister and I have discussed the issues of healthcare to great extent and in fact did so yesterday. She is retired from being the head nurse at a hospital in British Columbia. She agrees that there are definite problems with Canada's system and I also believe that there are some badly needed reforms to the US system.
> 
> On the positive side, my sister recently had a very serious auto accident that required her to be hospitalized. She did receive very good care.
> 
> ...



John, if you want to argue that both Canada and the US badly need healthcare reform, I would be the last to disagree. In a prior post I argued that Canadians should have a rational discussion about healthcare and design the system they want. 

My province, Alberta, is actually quite advanced in information technology. I can access the hospital records, consultations, diagnostic imaging, lab results, ER records, and personal statistics (e.g. phone #) of every patient I see, if they had these things done in Alberta. I suspect information technology will be adopted inconsistently in the US. I'll draw an analogy between cellphone providers and HMOs/insurance companies. In Canada we only recently gained the ability to change cellphone providers but keep the same cellphone # even though US customers had that right for several years. I suspect, but can't prove, that the cellphone providers didn't want us to move freely. I suspect, but can't prove, that some HMOs/insurance companies don't want to digitize their information because they don't want their patients to be able to take their information with them readily.

I'll draw another analogy to the airlines + internet technology and US patients + digitized health records. Airlines thought that the internet would be an enormous boon it allowed them to cut out the travel agencies and sell to customers directly. Unfortunately for the airlines, the internet also allowed customers to search for the lowest ticket prices, so selling airline tickets became a race to the bottom. Airlines now pine for the "good old days" when ticket prices were less transparent, and they dealt with travel agents. In other words, there's a law of unintended/ unforseen consequences. The internet has taken away more from the airlines than it has given back. I suspect the same may be true about digitizing medical records for US patients. Yes, digitizing information lowers administrative/secretarial costs, but those costs aren't the main ones. Providing medical care is far more expensive. Now imagine insurance companies/HMOs writing programs to pore over digitized records to look for "pre-existing" conditions. Now imagine thousands (millions?) of Americans being denied coverage on the flimsiest of "pre-existing" condition pretexts, i.e. the law of unintended consequences.

I agree that many waiting lists are too long. Some provinces are posting online the waiting times for different procedures at different hospitals. That way, patients can book themselves into the hospital with the shortest time. If your relatives live near major urban centres, the waiting lists tend to be longer.


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## John Cummings (Aug 4, 2009)

itchyfeet said:


> If you are lucky enough to have insurance.



Insurance has nothing to do with the statistics which are for the entire population, insured or not.


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## donnaval (Aug 4, 2009)

> Now imagine thousands (millions?) of Americans being denied coverage on the flimsiest of "pre-existing" condition pretexts, i.e. the law of unintended consequences.



I just ran into this TODAY!   I had been notified that my monthly premium was going up $68.  My insurance agent thought she'd found something that would save some money for me--a new type of policy just coming out for small business owners like me with a "group" of one.  Well, I have had no medical issues at all for several years.  The last time I went through underwriting, one company had problems with heel spurs and a muscle tear; the company that insured me did not.  I've been covered continuously by major insurance companies for all my adult life.

So anyway, last week she submitted my application and neither of us expected a problem.  To both our shock and dismay, the verdict came in a couple of hours ago:  DENIED.  The reasons?  Pre-existing conditions that have existed for more than three years!  1) BMI - I'm about 10# overweight, but I was much heavier three years ago when I last went through underwriting, 2)A benign kidney cyst - which my doctor assured me was very common in folks over the age of 50 and did not require treatment and was nothing to worry about, and 3)"unspecified chronic liver disease with no mention of alcohol."  

WTF?  I've never had any liver problems; nor have I ever been advised I had any liver problems.

I have had no medical treatment over the past three years.  None of these things were "pre-existing conditions" during my previous bout of underwriting.  The person who explained the denial to me was very vague about the rejection, particularly the liver.  She said something like "well it was probably noted in your records that the liver might need some testing or something."  

I have a call in to my doctor; the nurse went through my file and can't understand what was in there that would have prompted this rejection.  The doc is out but will call me tomorrow.

So basically, over the past three years, conditions that were not a problem and/or that I have not been aware of have suddenly become "pre-existing conditions" that are grounds for denying medical insurance.

I can appeal the decision, and I will, but this is very troubling.  I'm basically a pretty healthy 50-something who has no immediate medical issues, who takes no prescription drugs.  I can, of course, stay with my current plan but the costs are getting harder and harder to absorb.  If I can't get new coverage, how on earth are those in my age group who have some real serious issues ever supposed to get affordable coverage?

This system stinks.


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## John Cummings (Aug 4, 2009)

calgarygary said:


> John although I agree that automation of records will indeed reduce costs, that reduction would be minimal compared to removing profit and obscene salaries from the U.S. system.
> 
> Both systems have their issues, and I most certainly agree that an elective surgery wait in Canada is frustrating for all.  However, John you are coming from the position of being able to afford that surgery.  I would much sooner have a wait for the procedure than knowing that I could never afford the procedure and have to live with that pain for the rest of my life.



You are badly mistakened if you think that I have to pay for the surgery. It is completely covered by my health insurance. I do not pay any premiums at all for my insurance so it is available to everybody, regardless of their economic situation as long as they qualify for Medicare which virtually all senior US residents do at the age of 65.

Just like Americans don't know much about healthcare in Canada, it is obvious that most Canadians do know much about healthcare in the US. Both sides just get the horror stories. My kids, who are definitely not rich by any measure, have good medical care. Our son's wife is expecting their 3rd child next month. All of our friends have good medical care and don't pay a fortune for it. It does require some due diligence to select the best option available. I am not saying that healthcare is perfect in the US or even close to it but it is not nearly as bad as many of you think it is and it is not just available to the rich. Yes, reforms are needed but we have to be very careful that we don't throw out the baby with the bathwater.


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## calgarygary (Aug 4, 2009)

John Cummings said:


> You are badly mistakened if you think that I have to pay for the surgery. It is completely covered by my health insurance. I do not pay any premiums at all for my insurance so it is available to everybody, regardless of their economic situation as long as they qualify for Medicare which virtually all senior US residents do at the age of 65.
> 
> Just like Americans don't know much about healthcare in Canada, it is obvious that most Canadians do know much about healthcare in the US. Both sides just get the horror stories. My kids, who are definitely not rich by any measure, have good medical care. Our son's wife is expecting their 3rd child next month. All of our friends have good medical care and don't pay a fortune for it. It does require some due diligence to select the best option available. I am not saying that healthcare is perfect in the US or even close to it but it is not nearly as bad as many of you think it is and it is not just available to the rich. Yes, reforms are needed but we have to be very careful that we don't throw out the baby with the bathwater.



John I did not say you had to pay for your procedure.  Rather you are not taking a more global view (something that I think is endemic with Americans on this issue) that a large portion of your population could not get this procedure as they do not qualify for medicare and that the options available to them are not comparable to what is available to your family.  Your analogy was of the suffering that you would encounter if on a waiting list for this procedure in Canada.  Mine was of the millions (an easily verifiable statistic) of Americans that would have to suffer without a means to pay for the procedure.  

The most telling stat. in all of this discussion is that the U.S. pays such a large portion of their GDP on healthcare while at the same time leaving a large portion of the population out of the discussion.  However an even more telling thought (not a statistic) is why is it necessary for those supporting the status quo to make Canada or any other western nation for that matter, the socialistic boogie man when it comes to this discussion.  (ps - John this comment was not directed at you, just a commentary on the ads I see on tv)


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## John Cummings (Aug 4, 2009)

calgarygary said:


> John I did not say you had to pay for your procedure.  Rather you are not taking a more global view (something that I think is endemic with Americans on this issue) that a large portion of your population could not get this procedure as they do not qualify for medicare and that the options available to them are not comparable to what is available to your family.  Your analogy was of the suffering that you would encounter if on a waiting list for this procedure in Canada.  Mine was of the millions (an easily verifiable statistic) of Americans that would have to suffer without a means to pay for the procedure.
> 
> The most telling stat. in all of this discussion is that the U.S. pays such a large portion of their GDP on healthcare while at the same time leaving a large portion of the population out of the discussion.  However an even more telling thought (not a statistic) is why is it necessary for those supporting the status quo to make Canada or any other western nation for that matter, the socialistic boogie man when it comes to this discussion.  (ps - John this comment was not directed at you, just a commentary on the ads I see on tv)



I think we have to agree to disagree as carrying this any farther would turn it into a political discussion that is prohibited on TUG.


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## John Cummings (Aug 4, 2009)

Larry6417 said:


> John, if you want to argue that both Canada and the US badly need healthcare reform, I would be the last to disagree. In a prior post I argued that Canadians should have a rational discussion about healthcare and design the system they want.
> 
> My province, Alberta, is actually quite advanced in information technology. I can access the hospital records, consultations, diagnostic imaging, lab results, ER records, and personal statistics (e.g. phone #) of every patient I see, if they had these things done in Alberta. I suspect information technology will be adopted inconsistently in the US. I'll draw an analogy between cellphone providers and HMOs/insurance companies. In Canada we only recently gained the ability to change cellphone providers but keep the same cellphone # even though US customers had that right for several years. I suspect, but can't prove, that the cellphone providers didn't want us to move freely. I suspect, but can't prove, that some HMOs/insurance companies don't want to digitize their information because they don't want their patients to be able to take their information with them readily.
> 
> ...



First, I don't want to argue anything as that would require turning it into a political discussion which is a no no on TUG. I just report what I, and people I know personally, have experienced.

My insurance company does digitize everything and it is available to me and all the subscribers on the insurance company's web site. I can access all of my medical records, personal info etc. It is NOT the insurance companies I am referring to that need to automate. It is the providers like the doctors, labs, clinics, etc. Some do now like the ones I mentioned but many do not hence the need to fill out unnecessary forms. There is the necessity to abide by the HIPPA ( Health Insurance Portability and Accountability Act ) rules. Below is an overview of HIPPA and a link to 1 of the web sites about HIPPA.

*"The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) required the Department of Health and Human Services (HHS) to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. As the industry adopts these standards for the efficiency and effectiveness of the nation's health care system will improve the use of electronic data interchange. 

For more information and to view more categories of HIPAA Administrative Simplification, go to the "Related Links Inside CMS".*


http://www.cms.hhs.gov/hipaaGenInfo/

There are many web sites that allow one to compare all of the various health insurance options, prices, coverage, networks, quality of coverage and participating doctors, etc.


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## Htoo0 (Aug 4, 2009)

This talk of electronic records reminds me of my last hospital stay. I had a kidney stone causing  a full blockage. I can't recall the number of times in one day at the same hospital I was asked if I was allergic to any medications but it was numerous. Each time I would reply, "Neosporin eye ointment, although I don't think will be a problem for this." I couldn't resist when I was wheeled down for a CAT scan. I asked if there was going to be a problem as I am allergic to cats. 
Something I don't understand about U.S. insurance is the large price difference when in a group and buying it individually. After all, individuals are probably the largest group out there. One would think if the prices were similar for everyone then more people would be insured and the risk would be spread out. I know there are concerns about a greater amount of high risk people not working for a corporation but it's hard to imagine it would really be that big of a problem. (I guess they would be the individuals most wanting affordable insurance while healthy people would still decide to risk going without coverage.)


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## BarCol (Aug 4, 2009)

You are correct there are differences in each Province, but I know that if I need care - urgent or otherwise I will never be refused becausee I can't pay and have no insurance.  As another example - our son - the one that was in that horrible MVA in New Zealand is once again back in Ontario and sees our family doctor every 3 months for follow-up and specialists through a comprehensive pain program at a major hospital in Toronto every 2 months - the only that is not free (as in covered by our taxes) is the medication he receives, since he has no private health plan that covers his medications and dental. (I keep drilling into my kids that it's not just the salary of a job -its the BENEFITS that make the diference  in the package!!!!)

Is the system perfect - nope - but it's better than no health care system IMO
- just my $.02 CAD


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## Redrosesix (Aug 4, 2009)

Looks like I'll be the first poster from Nova Scotia -- I know quite a bit about our system, some about PEI, Quebec and Ontario.  And I'm just going to reiterate that health care is a provincial jurisdiction -- NS is doing some things differently from the other provinces (some good, some bad)



Chrisky said:


> There are some private clinics in Canada and the Province of Ontario that are legal.  They have made some sort of agreement with the government.  In Ontario, we can go to this clinic, have required procedure done, and it is paid by the government, we or our insurance company have to pay for the semi-private room.



In NS, so far we only have private diagnostic clinics, but if the referring doctor can deem a procedure necessary we can have it done at a private clinic in Ont. and have it covered.

I'll give an example of diagnostics -- when I had my DD, the ultrasound including a picture (we had to pay $10 for the print) and sex determination were covered.  5 years ago, the gov't decided these 2 things were no longer to be done during the ultrasound that they paid for -- it is only for health reasons, and it was taking up too much time to try to get the right shot.  So a private clinic started up to do these things.

One thing the gov't is doing right now is to allow patients to travel to other parts of the province to get procedures or diagnostics done ie. rather than stay on a long wait list in Halifax, you can opt to go to a rural area to have it done.  This helps out in lots of ways -- it reduces wait times in Halifax, but it also makes better use of facilities in rural areas, and gives specialists in rural areas more patients (thus helping to solve the issue of losing Dr's in those areas -- Dr's aren't all paid by salary, most of those not on hospital staff are still paid by their billings, they're just billing the gov't instead of the patient)



TSchmidt said:


> What are your income and property taxes like in order to pay for your health care?   When we visited Quebec last year, we were told that your property taxes were 3%.   Those of us from California would have a hard time with that one.



My property taxes are about 1%, but they're higher because I live in the capital city (but there are rebate programs for seniors and lower income families) -- we have a lot more infrastructure than the rural areas, and a plebiscite decided that we would pay additional funds to keep the school music program going (it provides optional band and orchestra instrument lessons to kids in the public schools, free of charge not incl. cost of instruments and books)  Hmmm, it's sort of like our health care system -- everybody is entitled to basic coverage, prescriptions are extra.



jamstew said:


> I'm interested in hearing what the income and sales tax rates are in Canada if someone could answer that.



In NS, our sales tax rate is 13 %.  There is also a rebate program for people making under a certain family income level, taking into consideration the number of kids in the family.



isisdave said:


> Bev, your Federal rates seem lower than ours, and not so steeply progressive, but the devil is always in the details ... what's "taxable income"?  In the US, we get to deduct most mortgage interest, medical expenses over $7500, charitable contributions, property tax and most state income tax.  Or, instead of itemizing these (for example, if you don't own a home with mortgage and tax), there's a "standard deduction" of about $5500 for an individual, twice that for a couple.
> 
> State taxes vary wildly, with rates from 2 to 12%, but applied to income at different levels depending on state.  Oregon has a tax of 9% on "taxable income" above $7300. In California, that income would be taxed at 2% and you wouldn't get to 8% until you hit $37,000. Oregon has no sales tax, and maybe they have more deductible items, but you can see the wide variation.



In NS, we deduct about $10K for the first person, about $7 for the 2nd (whether it is a spouse or the child of a single parent), can't deduct mortgage interest unless it is an income property, plus medical expenses (the floor is determined by the individual's income), also day care costs, tuition costs (for yourself or your child), as well as contributions to pension plans and unemployment insurance.  There are many more, but these are the big ones. Provincial tax is calculated after federal tax, but there is a rebate for individuals below a certain income level.



wayzer said:


> First let me say that I didn't not read all post before posting, but I did manage to read most before I saying something.
> 
> First off, many of the posters are correct and I agree with all that I have read; so I just have a few comments.
> 
> ...



I totally agree with this view.

Our biggest problem in NS is the cracks that people fall into between hospital care (everything covered including meds) versus nursing homes and at-home care (some things covered, others not)  Most people would agree that emergency care for serious acute problems is excellent, but wait times for other issues can be intolerably long.  Unfortunately, it depends sometimes on how serious your Dr. considers the problem to be.

Emergency health care in Halifax is a totally separate issue -- since the gov't closed all adult ER's except for one (in a part of the city that has approx. 200,000 people) there have been serious problems with wait times, etc. especially on weekends when most Dr's offices are closed. But I suppose that wouldn't have been possible for them to do if the gov't had less control of the health care system.  ER care for kids is still awesome!  



Gramma5 said:


> Just a couple of curious questions. In Canada are there any age limits for certain types of surgery? ie;  a person is 80 years old and needs heart surgery, or hip replacement or a kidney transplant or dialysis or any other type of expensive surgery or medical care. Also is abortion publically funded?



In NS, there are no age limits for any type of surgery -- it's based on the recommendation of the Dr.  There are a limited number of hospitals which perform certain procedures, like transplants ie. the gov't has determined which ones should invest in the personnel and equipment to do those procedures. There are no age limits for things like dialysis.

Re abortion -- not exactly sure, but I think most abortions are performed at a private clinic here in Halifax, but medically necessary ones are covered and are performed in hospital.


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## calgarygary (Aug 4, 2009)

Your comment about getting procedures done in rural areas reminded me of a dance mis-hap my daughter had in a dance competition in Banff.  She landed badly doing a jump and we had to take her to the emergency room in Banff on a Friday evening.  Had something like that happened here in Calgary, it likely would have been the middle of the night before everything was complete.  In Banff, there was only one other patient in the e.r. and she was examined promptly and we had x-rays and cast completed in just over an hour!  If my kids can handle the pain, I think future accidents may see me driving out to Banff for emergency care.

John didn't want to start a political debate as I agree, it doesn't belong here on TUG.


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## dioxide45 (Aug 4, 2009)

calgarygary said:


> John although I agree that automation of records will indeed reduce costs, that reduction would be minimal compared to removing profit and obscene salaries from the U.S. system.



If digitizing records was able to save money, why have many medical institutions not done so already? The drive of cost cutting and profit should make digitizing records a high priority in a healthcare environment like the US has, if it would actually save money. No one has instituted it to large degree, there must be something cost prohibitive there that is preventing that.


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## Redrosesix (Aug 4, 2009)

spike said:


> http://www.youtube.com/watch?v=q2jijuj1ysw



I agree with a previous poster -- Quebec is very different than the rest of Canada (they don't even have Mounties there -- they have the Surete de Quebec).  They have opted out of almost every federal program (hence the tax on tax issue) and there is very little federal control over anything they do.  There is another saying we use about health care there: don't get sick if you only speak English.

In NS, it is not impossible to get a family Dr.  Ours works in a group with other Dr's so there are on-call physicians available on evenings and weekends -- you still need to make an appt. but they always find a way to squeeze you in if it's something that shouldn't wait (if you just want to get a requisition for blood tests though, you may not be able to get an appt. the day you call) There are also drop-in clinics for those whose Dr.'s offices aren't open -- this is strongly supported by the gov't since it is the people who should be going to a GP, not the ER, that unnecessarily clog up the ER system.  There are no private clinics for family Dr's here.

If we do go to the ER, we make bloody well sure it's not something that should have been treated by the family Dr. or we might be waiting 9 hours.  Anybody arriving by ambulance jumps the line and goes straight to triage. If you arrive by car and obviously need care quickly, they can send you straight to triage.  If you have to take a number, the wait in most ER's is about 15 mins -- the receptionist puts together your paperwork and pulls up your hospital file using your health card number so that the triage nurse will have that info available to them ie. once your file is open, everybody is entering info on the same file.  Wait times to be seen by a Dr. depend on the severity of the problem and the number of people waiting -- the triage nurse can send you right to the Dr. or send you to wait.  As an example, a 1 yo here at the campground broke her arm and had to go to the local rural hospital -- total time including the cast hardening somewhat was 3.5 hours.  That would be about the same at the children's hospital in the city where I live, but it would likely take at least 4 hours for the adult ER.

We do have private blood testing clinics in NS -- yup, we pay $10 for faster service -- usually about 1 hr total time first thing in the am  The public clinics would take about 2 hr.  Either way you have to get a requisition from a Dr. since the results go back to them, not to the patient.

Re the prices of everything -- we do have our own currency in Canada.  Funny how they didn't calculate the exchange rate into the price difference for gas.


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## Redrosesix (Aug 4, 2009)

calgarygary said:


> Your comment about getting procedures done in rural areas reminded me of a dance mis-hap my daughter had in a dance competition in Banff.  She landed badly doing a jump and we had to take her to the emergency room in Banff on a Friday evening.  Had something like that happened here in Calgary, it likely would have been the middle of the night before everything was complete.  In Banff, there was only one other patient in the e.r. and she was examined promptly and we had x-rays and cast completed in just over an hour!  If my kids can handle the pain, I think future accidents may see me driving out to Banff for emergency care.
> 
> John didn't want to start a political debate as I agree, it doesn't belong here on TUG.



:hysterical: better they be in pain while driving in the car than waiting in the waiting room


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## Liz Wolf-Spada (Aug 4, 2009)

My doctor does have everything on computer, but I think she started out that way. I think it is very labor intensive, and thus expensive, to input all the paper records into a computer, after that, much cheaper and easier.

John, you probably do pay for your Medicare part B. I think my husband pays about $100 a month that comes out of his social security. Most people also pay for a supplement, unless they have a Medicare Advantage Program, which does get additional funds from the government.

Liz


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## pgnewarkboy (Aug 5, 2009)

Digitizing medical records is at first a daunting and costly task.  I have personal experience with the effort of trying to get the Department of Veterans AFFairs and Department of Defense medical records to be digitized and useable seemlessly by each system.  I am not saying it should not be done.  It will definitely cost a great deal of money at first to get an integrated national system of records between all part of the health industry.  Savings will come down the road in part because of fewer medical errors.  At present the U.S does not have a health care system.  There is no integration of its myriad parts.  The parts must act in concert using the same standards before there will be any savings from digitizing records.  It is of no value if my doctors and hospitals systems don't "talk to each other".


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## GadgetRick (Aug 5, 2009)

Haven't had a chance to read EVERY post but I get the jist of everything.

On the digitizing of records issue...

This is something which should have been done years ago (although it won't fix the many problems with our current healthcare, "system") at the expense of the healthcare/insurance providers. We do have a PRIVATE system afterall. Why should we foot the bill for something they should have paid for long ago? Sorry, might be too political but I don't understand it.

I have many Canadian friends as well as friends from England, France and other countries with a nationalized healthcare system. Like the OP, I wondered if their systems really are as bad as many (here in the states) would lead us to believe so I've conducted my own (admittedly non-technical) polls with them. The general consensus--as it seems to be here with the Canadians on TUG--seems to be the same...not perfect but seems to work well enough in most situations and they ALL wonder why we can't get our act together. 

I don't have first-hand experience with other systems but I have experience with our system and I've been wondering why our system is so bad for YEARS...

I certainly don't think the proposed system in the US (currently) is the answer, in fact, I feel it'll be worse for many people. More importantly, I don't know why they're forcing this EXPENSIVE issue NOW while we're (essentially) broke rather than when times are (financially better).

Sorry if I crossed the political line, not my intention to start a political debate, just agreeing with much of what's been typed here.


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## pgnewarkboy (Aug 5, 2009)

GadgetRick said:


> Haven't had a chance to read EVERY post but I get the jist of everything.
> 
> On the digitizing of records issue...
> 
> ...



  I am trying to get the point across that digitizing records must be done across the board using ONE seemless system.  The insurance companies, doctors, and hospitals are not capable of creating such a system.  Think of it like the national highway system.  The states and municipalities were not capable of creating a national highway system. The Federal Government had to do it.  Digitizing records is totally useless unless it is part of an integrated system of records from top to bottom throughout the entire health care industry.


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## Redrosesix (Aug 5, 2009)

pgnewarkboy said:


> I am trying to get the point across that digitizing records must be done across the board using ONE seemless system.  The insurance companies, doctors, and hospitals are not capable of creating such a system.  Think of it like the national highway system.  The states and municipalities were not capable of creating a national highway system. The Federal Government had to do it.  Digitizing records is totally useless unless it is part of an integrated system of records from top to bottom throughout the entire health care industry.



It would probably be a great cost-saving measure, and I think it would improve patient care since every Dr. would have access to your entire health history, as well as info about family health history.  And it would easily be doable here since every patient has a unique Health Card Number.  But with the exception of hospital records (where they can access info from every visit you've made to that hospital) we don't have it here either.

So I'm not sure that the issue of digitizing records has so much to do with whether you want to choose a user-pay system (as you now have in the US) or a gov't-pay system.  You could digitize records with either system, or not.


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## pgnewarkboy (Aug 5, 2009)

Redrosesix said:


> It would probably be a great cost-saving measure, and I think it would improve patient care since every Dr. would have access to your entire health history, as well as info about family health history.  And it would easily be doable here since every patient has a unique Health Card Number.  But with the exception of hospital records (where they can access info from every visit you've made to that hospital) we don't have it here either.
> 
> So I'm not sure that the issue of digitizing records has so much to do with whether you want to choose a user-pay system (as you now have in the US) or a gov't-pay system.  You could digitize records with either system, or not.



I think you can have it in the US only if the government mandates the standards, and requires every provider in the system to install the system.  I would be happy if the insurers would pay for it - but the reality is that they won't because it will "break them".


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## Redrosesix (Aug 5, 2009)

GadgetRick said:


> Haven't had a chance to read EVERY post but I get the jist of everything.
> 
> On the digitizing of records issue...
> 
> ...



It might make sense to put in a new system now since so many people are out of work and losing their health care coverage.  There is also a lot of evidence that universal medical care contributes to worker productivity and mobility of labour -- people don't refuse to take jobs that they're qualified for just because the health benefits aren't good -- certainly both issues are pertinent to economic recovery.


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## Larry6417 (Aug 5, 2009)

*Another 2 cents.*

I hope this post isn't considered too political, but here goes. I'm an outsider looking at the US healthcare, so take my opinion with a grain of salt . The present US model of healthcare exists because it benefits certain groups. It doesn't benefit poor or working-class Americans (or increasingly, middle-class Americans), but it does benefit those who profit from high-priced healthcare. This system persists because the groups that benefit from high-priced healthcare wield disproportionate power in Washington. 

I compare this situation to the credit crisis. The average American did not benefit enormously from financial deregulation. One might have benefited by owning rising financial stocks, but after counting market losses in the same stocks + bailouts, one likely lost money. But a small group - executives, traders, insiders - profited in good times and bad, often with taxpayer dollars. This was made possible because the financial industry lobbied the politicians to get what it wanted, and when the system imploded the same politicians who failed to oversee the banks postured phony outrage for the cameras while sending trillions in bailouts. 

Similarly, those who benefit from high-priced healthcare lobby Washington. Look at recent Medicare "reform" - it's going to cost the public more for less benefit. Meaningful healthcare reform is hindered, perhaps impossible, under a political system in which the wealthy minority speaks louder than the majority.


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## dioxide45 (Aug 5, 2009)

I understand that in the US there are some people who truly can not afford healthcare. I see no issue with helping these people, in fact there are already many programs out there for them to get healthcare. 

There are others who are uninsured and can't afford it yet they have a boat in the driveway, an RV parked beside it and a nice new big screen LCD television in the living room along with a $100 cable monthly cable bill to go along with it. They may even have a timeshare too.

There is a large percentage of uninsured who can afford it if they choose to make it a priority. They choose not to and I can understand why many people don't want to pay for their healthcare through a national system.

We are a have society, not a have not. We want all the fancy things and then want others to help us out when it comes to healthcare too. There is a lot to be said about personal responsibility.

Guess this is now boarding on a social issue discussion, so I will say no more.


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## grest (Aug 5, 2009)

Ubil said:


> If I am visiting Canada on vacation and require unexpected and urgent healthcare, will it be free under the Canadian healthcare system, or do I need to make sure that my US-based insurance will cover it?  If I understand the posts above, private healthcare is not available (or of questionable legality) in Canada.



This happened to us when visiting Quebec.  My husband was struck (as a pedestrian) by a tour bus that came too close to the sidewalk.  He was pushed to the ground, but it was not terribly serious, thank goodness.  An ambulance was called immediately, but before he could board, we had to pay up front.  Fortunately, we had some cash with us.  Also, we had to pay the hospital ER.  They were very attentive and there was no wait to be seen.  When we got home, we processed a claim with his insurance company, which reimbursed us.
Connie


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## grest (Aug 6, 2009)

dioxide45 said:


> I understand that in the US there are some people who truly can not afford healthcare. I see no issue with helping these people, in fact there are already many programs out there for them to get healthcare.
> 
> There are others who are uninsured and can't afford it yet they have a boat in the driveway, an RV parked beside it and a nice new big screen LCD television in the living room along with a $100 cable monthly cable bill to go along with it. They may even have a timeshare too.
> 
> ...



I agree that some are uninsured and can afford to be insured, but certainly most who do not, cannot, and most, by a very large margin, do not have boats in their driveway.


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## calgarygary (Aug 6, 2009)

dioxide45 said:


> I understand that in the US there are some people who truly can not afford healthcare. I see no issue with helping these people, in fact there are already many programs out there for them to get healthcare.
> 
> There are others who are uninsured and can't afford it yet they have a boat in the driveway, an RV parked beside it and a nice new big screen LCD television in the living room along with a $100 cable monthly cable bill to go along with it. They may even have a timeshare too.
> 
> ...



I came across a couple of interesting sites that report statistics on healthcare in the U.S.  Of course we all know that statistics can be manipulated but I still think that some of these are worth examining.  According to this site over 75 million Americans are covered by either Medicaid or Medicare.  So your system is reaching out to the elderly and those in financial need.  I don't quite understand why I see concerns about socialized health care or government intrusion where it already exists for a substantial portion of the population.  

That same site reports that over 46 million Americans did not have health care in 2007!  According to another site another 40+ million Americans spent some period of 2006/07 without healthcare - likely due to job transitions.  That is one heck of a lot of people who don't have their priorities right - or maybe they do and the system is failing them.

Maybe the stories that Canadians hear about Americans losing their homes to pay for hospital stays when they become ill are ficticious.  Hopefully the stories we hear about HMO's cutting off coverage aren't accurate.  Probably the need for hospitals to turn a profit of at least 10% doesn't impact on their duty to serve the community.  Or hopefully, after a frank and honest discussion, where maybe the representatives of all - the public, the health care providers, the insurers, and the government can develop a solution that would be the envy of the world.


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## GadgetRick (Aug 6, 2009)

Larry6417 said:


> This system persists because the groups that benefit from high-priced healthcare wield disproportionate power in Washington.



Nail has been hit squarely on head...


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## GadgetRick (Aug 6, 2009)

dioxide45 said:


> There are others who are uninsured and can't afford it yet they have a boat in the driveway, an RV parked beside it and a nice new big screen LCD television in the living room along with a $100 cable monthly cable bill to go along with it. They may even have a timeshare too.
> 
> There is a large percentage of uninsured who can afford it if they choose to make it a priority. They choose not to and I can understand why many people don't want to pay for their healthcare through a national system.


This is an exception rather than the rule.


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## pgnewarkboy (Aug 6, 2009)

People in Canada, France, Germany and elsewhere have LCD TV's and boats in their driveways too.  They have single payer insurance.  So I guess the situation in the US is that the cost of health care is so high and unreachable that people have to give up things to get it while in other countries they don't.  Of course too many people in the US have to choose between paying the rent, getting groceries, or paying for health care.

I don't know if and what kind of change is coming.  I do know that unless we as a nation get a grip on the situation the following things will happen:  Medicare will go bust due to uncontrolled increases in the cost of care, Medicaid will go bust for the same reason, more and more employers will not offer health insurance because of the cost, more and more individuals will not be able to afford the premiums because of the cost.  More and more people will die because they can't afford simple preventitive or maintenance care for high blood pressure and diabetes etc.

So maybe someone will tell me what can we do to prevent all this from happening?


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## Liz Wolf-Spada (Aug 6, 2009)

For some reason, Americans don't seem to realize that Medicare and Veteran's Health Administration and the Congressional Health Plan are all single payer government run systems. Other than VA, there are many choices within those single payer systems, various PPO's, HMO's, and traditional 80/20 pay for service. There is lots of choice of doctors, hospitals and plans, and everyone on those plans thinks well of them. But mention the idea of "single payer" and people go ballistic. Evidently one person at a demonstration was known to have said, "Leave your government hands off my medicare." 
Liz


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## calgarygary (Aug 6, 2009)

Liz Wolf-Spada said:


> For some reason, Americans don't seem to realize that Medicare and Veteran's Health Administration and the Congressional Health Plan are all single payer government run systems. Other than VA, there are many choices within those single payer systems, various PPO's, HMO's, and traditional 80/20 pay for service. There is lots of choice of doctors, hospitals and plans, and everyone on those plans thinks well of them. But mention the idea of "single payer" and people go ballistic. Evidently one person at a demonstration was known to have said, "Leave your government hands off my medicare." Liz



I love that.  I don't think you will find a better quote that exemplifies the misinformation that surrounds this topic.  Back in 1992 when this was again a very hot topic in the U.S., we ate out at King Henry's Feast in Orlando where you sat at large group tables.  The table conversation switched to this topic when our tablemates found out we were Canadians.  It was sad to us how many people believed that somehow the Canadian govt. dictated who our doctors were and what procedures we were allowed.  I suspect that it is this misinformation about change, any change, that keeps the current system alive.


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## pgnewarkboy (Aug 6, 2009)

Liz Wolf-Spada said:


> For some reason, Americans don't seem to realize that Medicare and Veteran's Health Administration and the Congressional Health Plan are all single payer government run systems. Other than VA, there are many choices within those single payer systems, various PPO's, HMO's, and traditional 80/20 pay for service. There is lots of choice of doctors, hospitals and plans, and everyone on those plans thinks well of them. But mention the idea of "single payer" and people go ballistic. Evidently one person at a demonstration was known to have said, "Leave your government hands off my medicare."
> Liz



The "Congressional Health Plan" is not a single payer plan.  It is the same as the Federal Employee Health Benefits Plan which is simply employer based health care.  The employer (the government) pays a portion of the premium and the employee (the federal employee or congress person) pays the remaining amount.  Premiums on these plans continue to rise and coverage continues to shrink.  You have a choice of various insurers in your area.  Rates and coverage vary from carrier to carrier.


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## pwrshift (Aug 6, 2009)

In 2005 I tripped over a parking curb and damaged my right knee to the point it was badly swollen and dark in colour. Decided to go to the ER in Laguna Beach and there wasn't one person waiting -- I was seen right away, showed my insurance card, and the doc ordered some pictures. The swelling was blood but had stopped, so they sent me back to my TS. The bill arrived about 2 weeks later for me to forward on to my insurance company -- $5700 and I couldn't have been there more than 3 hours. I was stunned and assumed that's why the ER was empty. About 3 years earlier I was in Williamsburg for 2 weeks and got what I thought was food poisoning -- went to the ER there and was admitted with a serious abdominal infection. They dripped antibiotic into me for a week's stay (some holiday) and sent specialist after specialist in to see me and used every machine in the building to check me out - quite impressive, but I can only imagine what that cost my out of country insurance company.

When I had a PE March08 I got immediate attention at a nearby hospital, primarily because I arrived by ambulance with shortness of breath. The CT scan showed 2 clots in my lungs and I was then given heparin injections twice a day to get the blood thin and that took a week. My insurance paid for semi private. Still on Coumadin and never had to pay for it, so my total costs were about $45 for the ambulance (which was there in 10 minutes btw). I have to get blood tests for INR every 2 weeks now but have a standing order and just go to a nearby blood clinic and it's done within 10 minutes - no charge. 

The lineup of people in the ER these days comes as a result of people going in with stomach aches, hangovers, etc. -- and they bring their kids and relatives! The triage nurse looks at each ER case quickly and decides the urgency ... those in need of fast treatment get preference. It ain't perfect, but it could be improved. If our politicians had to sit in the ER with everyone else in Canada the system would be fixed right away.

I love the USA like a second home and would have moved there if it wasn't for the fear of aging in country without universal healthcare. 

Brian


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## dioxide45 (Aug 6, 2009)

pwrshift said:


> If our politicians had to sit in the ER with everyone else in Canada the system would be fixed right away.



This is something that many here have issue with. It has been asked of the politicians in DC that if the plan they develop becomes law, will they all drop their congressional plans to pick up the new plan. If it is good enough for everyone else it should be good enough for them. I am not aware of any that have actually answered the question.


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## pgnewarkboy (Aug 7, 2009)

dioxide45 said:


> This is something that many here have issue with. It has been asked of the politicians in DC that if the plan they develop becomes law, will they all drop their congressional plans to pick up the new plan. If it is good enough for everyone else it should be good enough for them. I am not aware of any that have actually answered the question.




First, there will NOT be a new plan for every one.  The government option will be for those who want it or need it.  Nobody will be forced into the government option.  So, if nobody else would have to use the government option (which is just another insurance plan) why on earth would Congress be required to use it.?


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## Beverley (Aug 7, 2009)

England also has a National Health care plan.  My relatives think it is good but they also accept it for what it is, something they have to work within and cannot change.  

Just two observations:  

1. My cousin waited over a year for a knee replacement and finally got it.  He needs both knees done but the doctor did not recommend doing both at once (understandable) so he is now waiting another year for the second one.  The wait period would not begin until he was completely recovered from the first so it will be at best three (yes 3) years before he has both done.

2. My uncle lost 30 stone in approximately one month (not on a diet was thin to begin with)  Had to wait almost one month for an appointment.  Once at the appointment with the doctor the doctor needed some tests.  Had to wait two more months for the tests to be scheduled (others were ahead of him) and then a month to get back in to see the doctor.  Turned out to be cancer at the entrance to the stomach and it was now too late to do anything about it.  Yes, he died.    

All care is paid for, great no bills, but very long wait times.  If your situation is not life threatening ... great ... if it is... not so great.

Beverley


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## Beverley (Aug 7, 2009)

Oh, one more thing:  You may ask why my uncle did not leave the country to get treatment. He trusted and believed in his government and the health care system and he didn't get diagnosed until it was too late.  It was the long waiting period for the diagnosis that really did him the most harm.  Faster action then may have made the difference.  At least that is what the doctor thought.


Beverley


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## caribbeansun (Aug 7, 2009)

I hear and read about the wait times in Canada but have never personally experienced it.  Some of my relatives have had to wait for procedures but have never fared the worst for it.  Having said all of that I'm guessing there is a reason that critical illness insurance is offered - the pitch to me on that point was something along the lines of take the $150,000 and go to the US to get treatment.  Of course before they pay out you'd need a Dr. to indicate you actually had a critical illness so...


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## Beverley (Aug 7, 2009)

And there the wait begins ....


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## frenchieinme (Aug 7, 2009)

*Certain facts which need to be understood...*

First of all Medicare and Medicaid are not synonymous terms.  As mentioned in these posts Medicare is mainly for people over 65 or SSI (social security disabled people) while Medicaid is for people with relative low financial resources.  Medicaid will usually cover a reasonable amount for services rendered and not all doctors elect to participate while Medicare will usually cover 80% of covered medical costs with one's supplemental coverage covering the remaining 20%.  I happen to have excellent supplemental insurance which basically covers what Medicare usually will not cover.  However, that is not the case for everyone.  One needs to read carefully what is and is not covered in supplemental plans as that is in the end a large consideration in its cost.

What we have skirted around here without mentioning it is the fact when someone who goes to get medical assistance without insurance and can not pay for it, that cost is too often passed on to those that have inusrance. That is a large part of our ever increasing insurance costs.

Another fact not mentioned here is something which I believe is not allowed in Canada and is encouraged here in the US.  This is the cost of advertising one's product.  My Canadian relatives tell me advertising RX drugs in Canada like on prime time TV is not allowed while in the US it is prevalent especially on prime time at night.

Here in the US if you are poor you can get insurance thru Medicaid.  If you are rich, you can self insure.  If you are caught in the middle where one is too poor to be rich and too rich to be poor, that is our big donut hole of medical insurance coverage.   For the latter one needs to buy insurance which tends to be costly making it a prime feeding ground for the large amount of uninsured people.

Finally a fact on an individual's medical insurance costs.  I retired at the age of 58 which meant I had to buy my medical insurance for me and my wife for 8 years from 2001 thru 2009 at a cost of $12,000 per year.  Keep in mind that this after the fact my employer (the State of Maine) was covering 45% of my share. You can readily see why many people find the affordability of insurance very serious.

frenchieinme


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## pgnewarkboy (Aug 7, 2009)

There are long wait times in the United States to see any kind of specialist.  Quite often you cannot see a specialist for months.  In the United States many primary care physicians are closing their practices to new patients.  You can't see them at all.  Even with insurance.  The next part of the situation in the  US is that not every doctor accepts all insurance or even any insurance.  You cannot choose your own doctor in the US.  You choose the doctor that accepts your insurance.  People don't get to keep their personal doctors these days even if they have insurance because employers keep dropping plans and changing plans meaning that you must get a new doctor.  Further, you may keep the same insurance and lose your "personal" doctor because your doctor drops out of the plan.

In Canada you are lucky that you can get surgery - even with a wait.  In the US you will get nothing if you have no insurance or even with insurance if it is a pre-existing condition.  Of course your insurance may choose not to pay for any number of reasons.


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## dioxide45 (Aug 7, 2009)

pgnewarkboy said:


> First, there will NOT be a new plan for every one.  The government option will be for those who want it or need it.  Nobody will be forced into the government option.  So, if nobody else would have to use the government option (which is just another insurance plan) why on earth would Congress be required to use it.?



That is what is proposed, but what it will be in ten years may be far different. To discuss that becomes a political topic I will stay out of.


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## Carolinian (Aug 8, 2009)

Here is an account of how waiting times can kill you in Canada:

www.humanevents.com/article.php?id=32851

Here are some interesting comparisions on health care between the US and government-run medicine in Canada and the UK:

www.realclearpolitics.com/articles/..._medicine_should_horrify_americans_97810.html


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## GadgetRick (Aug 8, 2009)

pgnewarkboy said:


> First, there will NOT be a new plan for every one.  The government option will be for those who want it or need it.  Nobody will be forced into the government option.  So, if nobody else would have to use the government option (which is just another insurance plan) why on earth would Congress be required to use it.?



Not 100% accurate. Everyone will be forced into the, "ala carte," system when they change jobs or their employer-sponsored healthcare is renewed. So, in essence, there _will_ be a new plan for everyone...eventually.


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## BocaBum99 (Aug 8, 2009)

This is an interesting thread.  

I'll speak for myself when I say that I do not trust the US government to do anything better than what it is today.  They have proven time and time again that anything they do, they screw up.  That is my opinion and the opinion of many Americans who are against the healthcare bill as it stands today.

Rather than debate my above belief system, I would love nothing more than for them to prove me wrong on healthcare.  

The US is a different place than Canada, Europe and the rest of the world.  We need a solution that meets the USA's needs based on where we are at, our value system as a country and where we would like to go.  So, I doubt very much that solutions from other countries will work well in the USA.

What would make me more supportive of a massive change to our health care system, would be a successful trial of the system in a handful of states for 3 years.  If it works, then we consider making it a national model.  If it doesn't work, we scrap it.   Until that happens, I doubt we will reach a consensus on this issue.  When this cat is out of the bag, it's never going back in.


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## BocaBum99 (Aug 8, 2009)

My understanding is that Canada has very relaxed immigration policies.  Whenever I am in Toronto, I see lots of Eastern Europeans living there offering fantastic ethnic food.  It's one of the great things about that city. 

Question about heathcare to these immigrants.  Are they covered as well?  How does Canada administer healthcare as it relates to immigrants?  How does it prevent illegal immigrants from getting free coverage?


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## Liz Wolf-Spada (Aug 8, 2009)

I know many people say they don't trust the government to do anything right, but most of those same people believe Medicare is a good program for seniors and it's overhead is 4%, compared to Blue Shield, a non-profit 15%, and Blue Cross, for profit (at least in California) whose overhead is 30%. Medicare is not perfect and also has costs, but it has lots of choices of plans, plan types, doctors and supplementals. You can choose an HMO, PPO, traditional 80/20 fee for service. You pay for part B, about $100, and most supplementals except the Medicare Advantage, an HMO which gets additional money from the government, which gives it an unfair advantage over other plans and which is part of the problem with Medicare costs right now. 
Liz


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## BocaBum99 (Aug 8, 2009)

Liz Wolf-Spada said:


> I know many people say they don't trust the government to do anything right, but most of those same people believe Medicare is a good program for seniors and it's overhead is 4%, compared to Blue Shield, a non-profit 15%, and Blue Cross, for profit (at least in California) whose overhead is 30%. Medicare is not perfect and also has costs, but it has lots of choices of plans, plan types, doctors and supplementals. You can choose an HMO, PPO, traditional 80/20 fee for service. You pay for part B, about $100, and most supplementals except the Medicare Advantage, an HMO which gets additional money from the government, which gives it an unfair advantage over other plans and which is part of the problem with Medicare costs right now.
> Liz



Where do you get your data that more than 50% of people who mistrust the government's ability to execute believes Medicare is a good program?  That surprises me.  I've never heard that before.


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## Liz Wolf-Spada (Aug 8, 2009)

Boca, I didn't give any percentage of people as I have no idea about percentages. However, most seniors seem happy to have Medicare. My comment is that people seem to not realize that Medicare is a government run single payer system, with plenty of choices and high levels of satisfaction.
Liz


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## BocaBum99 (Aug 8, 2009)

Liz Wolf-Spada said:


> Boca, I didn't give any percentage of people as I have no idea about percentages. However, most seniors seem happy to have Medicare. My comment is that people seem to not realize that Medicare is a government run single payer system, with plenty of choices and high levels of satisfaction.
> Liz



Okay, I thought you found a silver bullet solution.  When I think about the population that mistrusts government most, I think of libertarians.  If most liberatarians thought that Medicare was a good solution, then surely so would everyone else.  I guess that's not what you were saying.


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## Carolinian (Aug 8, 2009)

Lets look at another government run health care system, the UK's NHS.  One of my staff got her graduate degree in the UK and she said you dared not get sick.  If you did not plan your heart attack six months in advance and make an appointment, you would not get treatment.

The EU puts out a European Health Consumer Index, and it is interesting to compare the UK's standing on health care with insurance-based systems on the continent.  Overall, the UK ranks lower than Estonia, which spends about a fourth of the money per capita on health care as the UK's government-run system.  Compared to the rest of Europe, the UK ranks at or near the bottom in such things cancer survival rate, waiting time, MRSA (superbug) infections, and access to new drugs.

Here is what a British journalist from one of the UK's leading newspapers has to say about the situation in the NHS:

www.humanevents.com/article.php?id=31173


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## dioxide45 (Aug 8, 2009)

---Deleted---


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## wilma (Aug 8, 2009)

Carolinian said:


> Lets look at another government run health care system, the UK's NHS.  One of my staff got her graduate degree in the UK and she said you dared not get sick.  If you did not plan your heart attack six months in advance and make an appointment, you would not get treatment.
> The EU puts out a European Health Consumer Index, and it is interesting to compare the UK's standing on health care with insurance-based systems on the continent.  Overall, the UK ranks lower than Estonia, which spends about a fourth of the money per capita on health care as the UK's government-run system.  Compared to the rest of Europe, the UK ranks at or near the bottom in such things cancer survival rate, waiting time, MRSA (superbug) infections, and access to new drugs.
> Here is what a British journalist from one of the UK's leading newspapers has to say about the situation in the NHS:
> www.humanevents.com/article.php?id=31173



I think it's important to remember that as the previous poster mentioned--no one is proposing a US nationalized healthcare system:


pgnewarkboy said:


> I am glad there is interest in the canadian system.  It is very important to understand that THERE IS NO PROPOSAL FROM THE WHITE HOUSE, CONGRESS, DEMOCRAT, OR REPUBLICAN  for anything like the Canadian or european systems.  That has been deemed a dead issue from the very beginning.  It really doesn't matter what health care is like in canada or any other single payer system because the United States of America will not be getting that kind of system .  I guess it is good to know if you are travelling there.


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## Carolinian (Aug 8, 2009)

wilma said:


> I think it's important to remember that as the previous poster mentioned--no one is proposing a US nationalized healthcare system:



So they claim. But the way this is designed, it will kill private insurance, and then you get to ''single payer'' by default.  Oh, except for the President, Congress, and some other favored elites in government.


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## Carolinian (Aug 8, 2009)

Remember the tragic death of British actress Natasha Richardson?  Serious deficiencies in the government-run medical system of Canada almost certainly played a major role in her unnecessary death.  Her family did finally get her to a US hospital, but by then it was too late.

A doctor explains how the Canadian health system contributed substantially to her death:

www.humanevents.com/article.php?id=31180


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## dioxide45 (Aug 8, 2009)

Carolinian said:


> Remember the tragic death of British actress Natasha Richardson?  Serious deficiencies in the government-run medical system of Canada almost certainly played a major role in her unnecessary death.  Her family did finally get her to a US hospital, but by then it was too late.
> 
> A doctor explains how the Canadian health system contributed substantially to her death:
> 
> www.humanevents.com/article.php?id=31180



While I sit mostly on the fence on this issue. You are looking at a one off case. This is not indicative of all situations in Canada. Had she gone to the hospital as soon as the accident happened, should would have been fine. There was no problem with the first response time at all. Medical assistance was at the initial scene, but the injury wasn't taken seriously enough. Don't blame the system when the people involved made judgment calls of their own. We don't know what the first responders advice was.

I am not saying the system wasn't at fault, it may have been. However, the result may have been the same at a ski resort in the US.


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## "Roger" (Aug 8, 2009)

Here is one survey concerning medical errors:

http://www.consumeraffairs.com/news04/2005/medical_errors.html


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## Liz Wolf-Spada (Aug 8, 2009)

Boca, I would imagine that most libertarians over 65 accept Medicare as their right to a government paid for insurance program (of course, paid for by our taxes, but that is how government is funded). Unfortunately medical mistakes are rampant in the US system also. I don't have the numbers, but I have read articles with very high numbers on mistakes in hospitals, wrong diagnosis, wrong medicine, wrong person for operation etc. A friend of mine on Kaiser kept telling them she was concerned about a lump on her neck and she's a nurse! They told her it was nothing until over a year later it hurt so much she couldn't sleep on her back. Turns out it was advanced cancer and she is undergoing very extensive treatment now that could have been avoided if they had paid attention earlier and she may lose her life due to their negligence.
Liz


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## ricoba (Aug 8, 2009)

Liz your story about your friend from Kaiser is interesting in that I think it may point out to some of the challenges of health care reform.

My understanding is that if we go to a national system - it will be very much like a Kaiser based model, which is in some effects similar to a Canadian model of delivery.

Under a Kaiser like system, health care will be rationed or controlled.  Most procedures will be available and some procedures and medicines will not be available.  For medicines for example Kaiser uses a formulary. If a drug is not on the formulary, then Kaiser doctors cannot prescribe it and it will not be offered in a Kaiser pharmacy. For the most part the latest and fanciest or newest or most advanced procedures will not be offered or available, though they may be in some circumstances.

To some this system or model is attractive and provides what they are looking for in a health care system.  To others this is the antitheses of what they want in their health care delivery.

I have lived in Canada and have experienced the positives and the negatives of the Canadian system.

As you are perhaps aware - I live here in CA and my wife is a Kaiser RN, and we have Kaiser as our health care provider, so I have experience with the pluses and minuses of the Kaiser system as well.

My experience has shown me there is quite a bit of similarity between the two models.

For those of us who live in California, we have probably all heard Kaiser horror stories and also heard stories about the good of the Kaiser system, since Kaiser is the largest insurer in the state (I believe).

Again, some will love a Kaiser like model here in the US and others will hate it. This is where the debate and difference of opinion comes into play.


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## pgnewarkboy (Aug 8, 2009)

Carolinian said:


> So they claim. But the way this is designed, it will kill private insurance, and then you get to ''single payer'' by default.  Oh, except for the President, Congress, and some other favored elites in government.



There are currently publicly owned hospitals in the U.S.  Have they killed privately owned hospitals?  No.   The Tennesse Valley Authority is a government run and owned utility that provided needed electrification for part of the nation.  Did that kill privately owned utilities? No.  Has the Post Office killed off Fed Ex or UPS?  No.  The National Pubic Broadcasting system is a government entity.   Has that killed NBC, CBS, etc.? No.  Medicare is a government run insurance program.  Has that killed private health insurance?  No.  Has Social Security killed off the huge retirement investment industry.?  No.

Who are the elites?  Is the head of Blue Cross or Humana or Aetna and elite?  Does making hundreds of millions of dollars in salaries and billions of dollars in profits make the insurance companies and their executives elites?  Aren't they making that money by denying and RATIONING care?  

Isn't the provision of medical care to our friends, families, and fellow countrymen a moral issue?  Or is it ok to let the elite go to their expensive clubs, drive their expensive cars, live in their expensive mansions, send their children to expensive schools, while denying care to people whenever they find an excuse in their policy such as pre-exisiting condition, innacurate application for the insurance, failure to get a timely referral, exhaustion of benefits, experimental treatment, treatment not deemed necessary by the clerk at the insurance company?  Is this all Okey Dokey?


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## dioxide45 (Aug 8, 2009)

pgnewarkboy said:


> Medicare is a government run insurance program.  Has that killed private health insurance?  No.



This is different than Medicare. Not everyone qualifies for Medicare so people have to seek other options. If everyone can qualify for the new plan, then it likely will kill private healthcare.

Say my employer offers private health care insurance and it costs them $5000 a year to do so. The public plan may require my employer to offer me healthcare or pay a $3000 fine. My employer in order to be competitive in it's industry may drop my healthcare insurance and just pay the fine. It is cheaper to pay the fine than offer me healthcare.

They know that I will qualify for the new government plan. I won't be able to afford private individual coverage and will need to pick up the new government option. If enough employers do this the big insurers have no customers, how do they stay in business? They can't compete against a government plan that doesn't have to earn a profit to stay in business. In this scenario the government plan will only run in parallel with private insurance for a short period of time.


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## calgarygary (Aug 8, 2009)

Carolinian said:


> Here is an account of how waiting times can kill you in Canada:
> 
> www.humanevents.com/article.php?id=32851
> 
> ...



Regarding your real clear politics article - odd that they forgot to mention that Canadians live 2 years longer than Americans.  Surprisingly they did not mention that Americans have among the highest infant mortality rates in the western world.  Or maybe they are just cherry picking?

Regarding human events link, of course in every system there will be stories of tragedy, error, etc.  However, no Canadian, whether a citizen or a landed immigrant will die from a denial of service.  Yes pain, suffering and sometimes death will occur from delays in service.  

It really is time that these scare tactics be put to rest.  What fear is there in providing those that do not have coverage in the U.S. (currently over 50 million) healthcare.  

Carolinian, your use of the Richardson case is not germaine to the issue.  Even a government run system does not "force" healthcare on those that refuse it.  I don't know if she would be alive today had she accepted assistance right away but she initially refused care and time is critical in these situations.


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## Karen G (Aug 8, 2009)

If only a certain percentage (much less than half) of Americans have no health insurance and the majority of people are happy with the insurance and healthcare they have, why not just provide some kind of insurance for the ones who don't have it.  Why destroy healthcare as we know it for everyone?


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## dioxide45 (Aug 8, 2009)

calgarygary said:


> It really is time that these scare tactics be put to rest.  What fear is there in providing those that do not have coverage in the U.S. (currently over 50 million) healthcare.



This is a much contested number. People have no problem with people who need healthcare getting it. The 50MM number you provided consists of people who can get healthcare with their employer but choose not to, people who can afford healthcare but are young and healthy and choose not to pay for it, people transitioning from one job to another and some have suggested even illegal immigrants. The true number of uninsured that really need a government option is only about 20MM. Paying what the bill would cost over 10 years is far more than it should to only cover less than 10% of the US population.


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## Liz Wolf-Spada (Aug 8, 2009)

I think the goal is to provide health care for those that need it and help people pay for it, as many employers do now.  To me, a logical extension of our current health care system would be to require all employers to pay for good health care for employees (the number of employers who do that used to be much higher than it is now, thus helping precipitate the problem). Then the only people who didn't have health care would be unemployed  and could be covered by an expanded version of Medicaid and Medicare. The money for that would have to come from somewhere though, still raising some issues, but fewer. Unfortunately, more large and small employers are no longer offering health care, or paying less and less and so it doesn't cover as many people as it did. There also needs to be insurance reform so that all would be covered, including those with pre-existing conditions. Right now, people truly don't leave their jobs to start their own small businesses because they can't give up their health care and the cost of health care is impacting US business competitiveness when competing against companies, such as Japan, that provide health care for workers.
Liz


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## dioxide45 (Aug 8, 2009)

Liz Wolf-Spada said:


> I think the goal is to provide health care for those that need it and help people pay for it, as many employers do now.  To me, a logical extension of our current health care system would be to require all employers to pay for good health care for employees (the number of employers who do that used to be much higher than it is now, thus helping precipitate the problem). Then the only people who didn't have health care would be unemployed  and could be covered by an expanded version of Medicaid and Medicare. The money for that would have to come from somewhere though, still raising some issues, but fewer. Unfortunately, more large and small employers are no longer offering health care, or paying less and less and so it doesn't cover as many people as it did. There also needs to be insurance reform so that all would be covered, including those with pre-existing conditions. Right now, people truly don't leave their jobs to start their own small businesses because they can't give up their health care and the cost of health care is impacting US business competitiveness when competing against companies, such as Japan, that provide health care for workers.
> Liz



People still won't leave their jobs to start small businesses because it will be much more expensive to do so since they would have to provide healthcare to their employees. Mandating something like this kills jobs or drives companies to send jobs offshore. I don't think this is something we really want to do.


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## Chrisky (Aug 8, 2009)

Carolinian said:


> Remember the tragic death of British actress Natasha Richardson?  Serious deficiencies in the government-run medical system of Canada almost certainly played a major role in her unnecessary death.  Her family did finally get her to a US hospital, but by then it was too late.
> 
> A doctor explains how the Canadian health system contributed substantially to her death:
> 
> www.humanevents.com/article.php?id=31180



There may have been a problem, but it disturbs me when only one view is presented about this tragic death, and that view is of an orthopaedic surgeon, not a trauma specialist.  
Immediately after she fell, and mentioned her fall to a ski instructor, 2 ski patrollers came to her aid, and an ambulance was summoned.  This potentially life-saving ambulance was turned away, because she said she was fine.  She was conscience and alert after her fall and was walking without any difficulty.  The problems started to happen one hour later when she complained of a headache and was transported to a hospital in Ste-Agathe and then transferred to Sacre-Coeur Hospital in Montreal.  There are a lot of 'should haves' in this story, like should have worn a helmet, should have gone to a hospital immediately, But that didn't happen.  This could also have been not a trauma to the brain but to the surrounding area, which could have caused a blood clot and swelling.  
So to blame this on the Canadian health system is not totally accurate.


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## Elan (Aug 8, 2009)

Carolinian said:


> So they claim. But the way this is designed, it will kill private insurance, and then you get to ''single payer'' by default.  Oh, except for the President, Congress, and some other favored elites in government.



  I'm sorry, but I get sick of these far fetched extrapolations that have no basis in fact.  Similar paranoia resulted in claims that banning assault weapons was supposed to be the first step toward removing all firearms from private citizens.  Did that ultimately happen?  No.  Let's just stick to the facts here without paranoid fear mongering based on "what might be".  

  Also, it's senseless to try to form an argument on either side based on anecdotal accounts.  I'm sure there have been long waits for health care in Canada, just as I'm sure there have been long waits for the uninsured in the US.  Just because my cousins boyfriend's mother had to wait 3 months for an operation doesn't mean it's significant, particularly without knowing the particulars of the case.

  Obviously, the Canadian system is not perfect.  But on the other hand, the consensus of Canadians that are responding here seem to not be that disenchanted with their health care system.  Admittedly, it's a very small sample size, but it's still more telling than these random one-off, non-personal accounts.


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## GregGH (Aug 8, 2009)

Elan said:


> ...snip ......
> Obviously, the Canadian system is not perfect.  But on the other hand, the consensus of Canadians that are responding here seem to not be that disenchanted with their health care system.  Admittedly, it's a very small sample size, but it's still more telling than these random one-off, non-personal accounts.



Add one more vote from a Cdn that likes his health care.   It takes the discussion in USA to remind us how good we have it.   It is not perfect.  And we continue to need smart people to make changes that are often resisted.

TOO BAD we can't run a poll and see the summary on what Cdn's think.

I really do NOT APPRECIATE how some American's spin our health care for their political gain - enough of the fear mongers!

Greg
Kingsville, ON


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## vacationhopeful (Aug 8, 2009)

Because health care as we know it, has people who keep paying budget choking increases in their premiums because they are not willing to walk away with nothing IF they become sick and are underinsured.  There truly is a limit within a family budget and eventually, the private or employer assisted health insurance bill will be downsized (eliminated).

The system is failing, as hospitals are bankrupt with "charity care" bills for unpaid for services.  State and federal governments have forecasted even larger increases in future years as higher percentage of their budgets go to health care services. Adding to this problem is the legions of persons who say "it not our/their fault if we/they needed health care, got our/their care, but now don't want to pay any of the bills (even reduced bills)".

Do I want a nationalized health care system?  Not any more than I want state or federal governments which can't pay for schools or police or highways or national security.

I feel that HARD CHOICES are going to have to be made by many individuals, companies and layers of government.  The USA is part of a global economy, not a wealthy country which has unlimited resources who can continue to PRINT money without a deflation of our currency against other world currencies.


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## dioxide45 (Aug 8, 2009)

GregGH said:


> Add one more vote from a Cdn that likes his health care.   It takes the discussion in USA to remind us how good we have it.   It is not perfect.  And we continue to need smart people to make changes that are often resisted.
> 
> TOO BAD we can't run a poll and see the summary on what Cdn's think.
> 
> ...



Being Canadian and my parents still living there, I know quite well that Canadians love their universal healthcare system and would not want the current. US system no matter what. 

I think though that people in the US are actually paying for healthcare around the world. In many cases healthcare in other countries is price controlled by legislation. Take prescription medicine in Canada. There are price controls in place. This keeps costs down for the people there. However those companies still have to make money, they do so by charging those in the US very high prices. 

Americans pay more in health costs than any other country. The US market must pay for the shortfalls companies end up with when marketing their products to other countries. Price controls stiffen innovation, when was the last time a big new innovative drug or technique invented in Canada? The reason for this is because there is little money to be made in healthcare in Canada. If the US was to add price controls to medicine, you would see an almost halt in new drugs being developed. 

Some doctors leave Canada to work in the US market because that is where they can make money. Some say that they wouldn’t want a doctor who was only in it for the money anyway. That is not a good attitude to have as these could still be some of the best doctors around. What is wrong with the free market deciding what something is worth?


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## pgnewarkboy (Aug 8, 2009)

dioxide45 said:


> This is different than Medicare. Not everyone qualifies for Medicare so people have to seek other options. If everyone can qualify for the new plan, then it likely will kill private healthcare.
> 
> Say my employer offers private health care insurance and it costs them $5000 a year to do so. The public plan may require my employer to offer me healthcare or pay a $3000 fine. My employer in order to be competitive in it's industry may drop my healthcare insurance and just pay the fine. It is cheaper to pay the fine than offer me healthcare.
> 
> They know that I will qualify for the new government plan. I won't be able to afford private individual coverage and will need to pick up the new government option. If enough employers do this the big insurers have no customers, how do they stay in business? They can't compete against a government plan that doesn't have to earn a profit to stay in business. In this scenario the government plan will only run in parallel with private insurance for a short period of time.



First, people on Medicare do buy insurance.  It is called supplemental insurance.  Second, in most countries with true universal healthcare(excluding Canada which prohibits private insurance as I understand it) people can and do buy insurance.   Its just like a pollice department.  It provides protection to all but people still hire private security and burglar alarms.  

Second, isn't it more important to protect the health of our nation then the profits of insurance companies?  It seems to me there is alot of moral outrage by people about a government option but NO moral outrage by the same people about people who can't get health care in this country, the rationing of health care by insurance companies, and the huge profits these companies make at the expense of others.  Some people are very outraged that in some fantasy the congress and the president would get better healthcare then they get but could care less that right now they have health insurance and health care and others don't.


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## Elan (Aug 8, 2009)

dioxide45 said:


> Americans pay more in health costs than any other country. The US market must pay for the shortfalls companies end up with when marketing their products to other countries. Price controls stiffen innovation, when was the last time a big new innovative drug or technique invented in Canada? The reason for this is because there is little money to be made in healthcare in Canada. If the US was to add price controls to medicine, you would see an almost halt in new drugs being developed.



  If you're suggesting that drugs are only developed profitably here in the US, you may want to reconsider.  3 of the 5 or 6 largest pharmaceutical companies in the world (Novartis of Switzerland, Bayer of Germany, and GSK of the UK) are non-US entities.


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## dioxide45 (Aug 8, 2009)

pgnewarkboy said:


> First, people on Medicare do buy insurance.  It is called supplemental insurance.  Second, in most countries with true universal healthcare(excluding Canada which prohibits private insurance as I understand it) people can and do buy insurance.   Its just like a pollice department.  It provides protection to all but people still hire private security and burglar alarms.



It seemed I confused medicare with medicaid. However medicare is not a single payer system. With medicare there are two or three payers involved. Medicare, a suplimental insurance company and the user. What is being proposed appears to be a single payer medical option. There is rationing in medicare with tests only being allowed at certain intervals as being determined by the system.


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## dioxide45 (Aug 8, 2009)

Elan said:


> If you're suggesting that drugs are only developed profitably here in the US, you may want to reconsider.  3 of the 5 or 6 largest pharmaceutical companies in the world (Novartis of Switzerland, Bayer of Germany, and GSK of the UK) are non-US entities.



These are all three companies that have their roots that started long before many universal health programs around the world. Their primary profit center is still the US market and other countries without price controls on pharmaceuticals in place. Price controls help no one.


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## Elan (Aug 8, 2009)

dioxide45 said:


> Their primary profit center is still the US market and other countries without price controls on pharmaceuticals in place.



  If true, perhaps that's because unnecessary drugs and procedures are prescribed more often in a system that rewards such behavior?????


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## calgarygary (Aug 8, 2009)

pgnewarkboy said:


> First, people on Medicare do buy insurance.  It is called supplemental insurance.  Second, in most countries with true universal healthcare(excluding Canada which prohibits private insurance as I understand it) people can and do buy insurance.   Its just like a pollice department.  It provides protection to all but people still hire private security and burglar alarms.
> 
> Second, isn't it more important to protect the health of our nation then the profits of insurance companies?  It seems to me there is alot of moral outrage by people about a government option but NO moral outrage by the same people about people who can't get health care in this country, the rationing of health care by insurance companies, and the huge profits these companies make at the expense of others.  Some people are very outraged that in some fantasy the congress and the president would get better healthcare then they get but could care less that right now they have health insurance and health care and others don't.



Unfortunately your information regarding health insurance in Canada is incorrect.  There is a large for profit segment in our market selling secondary insurance.  They are very similar to the various insurance providers in the U.S. but because they are not insuring hospital procedures, doctor visits, etc. their costs, and the overall costs in Canada are significantly lower than the U.S.  For profit insurers still provide prescription plans, vision care, dental care, etc. in Canada.


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## calgarygary (Aug 8, 2009)

dioxide45 said:


> These are all three companies that have their roots that started long before many universal health programs around the world. Their primary profit center is still the US market and other countries without price controls on pharmaceuticals in place. Price controls help no one.



Unfortunately, I don't believe the facts reported by these companies in their filings support your claim.  Although the U.S. is an important profit center it is substantially smaller than Europe for Bayer and GSK but closer to Europe's profit for Novartis. 

I state this not to be argumentative but to point out that these are large, global companies that have succeeded in regulated health care systems and achieved substantial profits even in those systems perceived as "socialized".  They have managed to be world leaders and developers of pharmaceuticals even while achieving most of their profits from regulated systems.


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## calgarygary (Aug 8, 2009)

dioxide45 said:


> This is a much contested number. People have no problem with people who need healthcare getting it. The 50MM number you provided consists of people who can get healthcare with their employer but choose not to, people who can afford healthcare but are young and healthy and choose not to pay for it, people transitioning from one job to another and some have suggested even illegal immigrants. The true number of uninsured that really need a government option is only about 20MM. Paying what the bill would cost over 10 years is far more than it should to only cover less than 10% of the US population.



As I have said before, statistics can be manipulated and I certainly believe that they might have been by the site that provided the 50million uninsured number as I also believe that they may have been by whichever site reported the 20 million number.  I think that this highlights the fundamental difference between many Americans and most Canadians on this issue.  Here in Canada, we find it completely unacceptable that any Canadian is without healthcare.   To ask Canadians to accept that 2-5 million of our population would be without care, whether by choice or not, would be unthinkable.


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## Liz Wolf-Spada (Aug 8, 2009)

Perhaps I don't understand the concept of single payer, but to me Medicare is essentially that. You can get Medicare part A with no additional cost, (single payer the government), you can add part B (still single payer the government, but you the user have a $100 co-pay, that I'm sure does not cover the cost) and it is in the supplemental insurance market, which is optional, that you see competition and private insurers. Maybe if the government could guarantee the big costs of hospitalization and catastrophic insurance, the insurance polices for doctors, lab, prescriptions etc. would cost less for the user.
Liz


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## BevL (Aug 8, 2009)

calgarygary said:


> As I have said before, statistics can be manipulated and I certainly believe that they might have been by the site that provided the 50million uninsured number as I also believe that they may have been by whichever site reported the 20 million number.  I think that this highlights the fundamental difference between many Americans and most Canadians on this issue.  Here in Canada, we find it completely unacceptable that any Canadian is without healthcare.   To ask Canadians to accept that 2-5 million of our population would be without care, whether by choice or not, would be unthinkable.



That pretty much sums it up.  

Again, an anecdotal situation - I posted at the beginning about our experiences with the healthcare system here.

My son was experiencing odd symptoms, some swelling of the glands in his throat, neck, headache.  Went to the doctor Wednesday, a walk in clinic.  Sent him for some blood tests.  Maybe mumpss, maybe some sort of infection.  No charge.

He goes back Thursday, not an infection, viral, probably mumps.  No charge.

He phones this morning in a panic.  He got up and his eye is swollen shut, along with most of the left side of his face, and shooting pain along the side of his head.  I roar down to his place and trundle him into emergency.  It took three hours, but he left with a diagnosis of shingles, some medication to "tide him over" and a prescription.  No charge other than the for the medication at the pharmacy later.

He has to see an opthamologist first thing Monday morning to make sure his eye will not be affected.  WOuld I have preferred today?  Yep, but he's under strict orders that if certain symptoms start, get back into ER with the instructions that were written out and he'll be attended to immediately  No charge for his appointment Monday.

A follow up appointment next Thursday to see how he's doing.  No charge.

I realize there's a cost, so when I say no charge, I hope it's clear what my meaning is.  It's not all coming out of my pocket directly.

My son is 24 years old.  He works part time, goes to school part time.  His jobs are such that he would not, I'm sure, have any sort of included medical if he lived in the States.  He's a part-time student but doesn't have a large enough class load that he could be covered on our private insurance - I'm not sure what the rules would be in the States but I'm guessing similar.  However, there was absolutely no hesitation this morning.  No, "How are we going to pay for this?  What if there's tests, maybe a hospital stay?"

The thought that everyone in Canada has that kind of coverage makes it worth the taxes we pay.  It's not a perfect system, but when the chips are down, it does okay.

Again, I'm sorry for the long post but this subject hits close to home today.


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## pgnewarkboy (Aug 9, 2009)

BevL said:


> That pretty much sums it up.
> 
> The thought that everyone in Canada has that kind of coverage makes it worth the taxes we pay.  It's not a perfect system, but when the chips are down, it does okay.
> 
> ...


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## itchyfeet (Aug 9, 2009)

pgnewarkboy said:


> BevL said:
> 
> 
> > That pretty much sums it up.
> ...


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## ricoba (Aug 9, 2009)

How have these last few posts not crossed the line of political statements?


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## Carolinian (Aug 9, 2009)

pgnewarkboy said:


> There are currently publicly owned hospitals in the U.S.  Have they killed privately owned hospitals?  No.   The Tennesse Valley Authority is a government run and owned utility that provided needed electrification for part of the nation.  Did that kill privately owned utilities? No.  Has the Post Office killed off Fed Ex or UPS?  No.  The National Pubic Broadcasting system is a government entity.   Has that killed NBC, CBS, etc.? No.  Medicare is a government run insurance program.  Has that killed private health insurance?  No.  Has Social Security killed off the huge retirement investment industry.?  No.
> 
> Who are the elites?  Is the head of Blue Cross or Humana or Aetna and elite?  Does making hundreds of millions of dollars in salaries and billions of dollars in profits make the insurance companies and their executives elites?  Aren't they making that money by denying and RATIONING care?
> 
> Isn't the provision of medical care to our friends, families, and fellow countrymen a moral issue?  Or is it ok to let the elite go to their expensive clubs, drive their expensive cars, live in their expensive mansions, send their children to expensive schools, while denying care to people whenever they find an excuse in their policy such as pre-exisiting condition, innacurate application for the insurance, failure to get a timely referral, exhaustion of benefits, experimental treatment, treatment not deemed necessary by the clerk at the insurance company?  Is this all Okey Dokey?



''From those according to their ability; to those according to their need'' - Karl Marx


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## Carolinian (Aug 9, 2009)

ricoba said:


> How have these last few posts not crossed the line of political statements?



This whole thread has been political from the ''get go''.


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## Carolinian (Aug 9, 2009)

Oh and the lack of proper staffing by specialists, the lack of proper medevac, the lack of proper diagnostic machines is Natasha Richardson's fault?  Aren't you trying to blame the victim?

And what about this case?  www.humanevents.com/article.php?id=32851  Are you going to blame the victim in that one, too?  Fortunately the victim lived in that case, but no thanks to Canadian medicine!  If she had not come south of the border, she would have ended up like Richardson.




dioxide45 said:


> While I sit mostly on the fence on this issue. You are looking at a one off case. This is not indicative of all situations in Canada. Had she gone to the hospital as soon as the accident happened, should would have been fine. There was no problem with the first response time at all. Medical assistance was at the initial scene, but the injury wasn't taken seriously enough. Don't blame the system when the people involved made judgment calls of their own. We don't know what the first responders advice was.
> 
> I am not saying the system wasn't at fault, it may have been. However, the result may have been the same at a ski resort in the US.


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## John Cummings (Aug 9, 2009)

Liz Wolf-Spada said:


> Perhaps I don't understand the concept of single payer, but to me Medicare is essentially that. You can get Medicare part A with no additional cost, (single payer the government), you can add part B (still single payer the government, but you the user have a $100 co-pay, that I'm sure does not cover the cost) and it is in the supplemental insurance market, which is optional, that you see competition and private insurers. Maybe if the government could guarantee the big costs of hospitalization and catastrophic insurance, the insurance polices for doctors, lab, prescriptions etc. would cost less for the user.
> Liz



Liz,

You are basically correct. Both traditional Medicare and Medicare Advantage Plans are financed by the Medicare tax on both employees and employers. Medicare Part A ( hospitalization, etc. ) is free to the subscriber and the optional Medicare Part B ( doctor visits, etc. ) costs $96 /month. Medicare Advantage Plans are run by private organizations and are funded by Medicare and some may charge a small additional monthly premium. I have a Medicare Advantage Plan from Health Net that is extremely good. I do not pay any premium to Health Net and ZERO co-pays for any doctor's visits, labs, etc, and I also get prescription drug coverage. It even pays for me to belong to a gym if I wish to. There is no need for any supplemental insurance if you have a Medicare Advantage Plan. Approximately 15 different companies offer Medicare Advantage Plans in my area with some being insurance companies and other non-profit organizations and all competing with each other. If you have the traditional Medicare then most people buy a private supplemental insurance that fills the gaps not covered and typically costs between $100-200 /month.


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## Carolinian (Aug 9, 2009)

Medicare is a hybrid that is really not comparable to the Canadian or British system.  The government-run system in the US that is most comparable to the Canadian or British system would be the VA, but even that is not the best comparision given the finite and known number of veterans.  Ask a veteran about wait times and whether the care at the VA is as good as in the private system.


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## Carolinian (Aug 9, 2009)

*Prominent UK journalist describes government-run healthcare in UK*

Britain's National Healthcare Looks Like Medieval Medicine 
by  James Delingpole 

03/24/2009 


Victims left for hours covered in blood, denied pain relief; elderly cancer patients lying in their own filth; dirty, chaotic wards akin  to "war zones"; a shortage of basic equipment, including trolleys and thermometers; shouting nurses; ill-trained, badly supervised medics;  disease outbreaks; starvation and dehydration; mounting piles of dead…

Scenes from a hospital in war torn Chechnya, perhaps? Mugabe's Zimbabwe? Romania in the days of Ceaucescu? The aftermath of Antietam? The Middle Ages?

Why, no. This was an English hospital the day before yesterday. And the day after tomorrow -- if President Obama gets his way -- it could well be an American hospital too.


All too often when I tell my U.S. friends just how dire the state of our nationalized health care system is in Britain, they assume I must be exaggerating for effect. "But we've English friends who tell us that it's the Envy of The World," some of them say (of which more later). "Come on, it can't be that bad. At least it's fair, and at least it's for free," say others.

Then consider, my friends, Exhibit A. The foul sub-third-world conditions I've just described came not from my overactive imagination but from a newly-published official report into the parlous state of affairs at two state-run hospitals in the central English district of Mid Staffordshire.

According to the report by the Healthcare Commission, standards of care were so "appalling" that between 2005 and 2008 as many as 1,200 patients may have died unnecessarily.


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## pgnewarkboy (Aug 9, 2009)

Carolinian said:


> Britain's National Healthcare Looks Like Medieval Medicine
> by  James Delingpole
> 
> 03/24/2009
> ...




You are not scaring anybody here with this rubbish and your Karl Marx quotes!  We have been having an intelligent factual discussion.


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## Carolinian (Aug 9, 2009)

pgnewarkboy said:


> You are not scaring anybody here with this rubbish and your Karl Marx quotes!  We have been having an intelligent factual discussion.




While I would agree that the government-run health care systems of Canada and the UK are rubbish, maybe you ought to look at the facts of what happened to Shona Holmes in Canada's system:   


 Shona's Health Care Nightmare 
by  Connie Hair 

07/25/2009 


Shona Holmes is a Canadian citizen. She came to the United States to warn lawmakers at the Republican Health Care Solutions Group hearing last Thursday about the dangers of government-run healthcare. Shona survived a brain tumor, having surgery performed at the Mayo Clinic in Scottsdale, Ariz. The subject of a national ad campaign for Patients United Now, she is also warning the American people. 

Shona sat down with HUMAN EVENTS this week for an interview.

After seeing her primary care physician in Canada, Shona was given a wait time of four to six months to see a specialist. She was experiencing serious problems with her vision; she rapidly gained weight and began exhibiting other strong indications of an aggressive brain tumor.


“The most worrisome problem to me was my vision,” Shona said. “There were a lot of physical changes but my vision started to go. So my family doctor set up an appointment with a neurologist and an endocrinologist and, from the onset of my symptoms, it was four to six months to see a specialist. They were in two different hospitals in two different cities.”

After talking with friends in the United States, they urged her to see a specialist here. After making calls to try to get a specialist in Canada to at least give her a diagnosis, she began calling America.

“I have a lot of American friends and they were ranting and raving at me saying don’t be crazy, go see another doctor,” Shona said. “And I said it just doesn’t work like that in Canada. I can’t. So I tried to move those appointments up. You can’t. They don’t even have wait lists. They don’t even take your name. They don’t even ask what’s wrong.”

“So I called a couple of hospitals in the U.S. and was told to go immediately to the Mayo Clinic in Arizona,” Shona continued. “I spent a week there and got a full diagnosis.”

The doctors she happened to see at Mayo were Canadian. Shona said that made her feel more comfortable. Everyone in Canada had told her that American doctors were only after money. The doctors told her to go home and get the surgery she required since she had coverage there. They said they would make some calls and inform the doctors in Canada of the urgency. The tumor was pressing on her optic nerve. She was three to four weeks from permanently losing her eyesight, at best. The outlook was grim.

Diagnosis in hand, she still could not get in to see the specialists. And to make matters worse, once back in Canada, she and her husband got a call from doctors at the Mayo clinic informing them further tests showed she had another tumor. Even with that information, Canadian doctors refused to take her out of the scheduled order, the first of her two appointments at this point still being over a month away, the second over two months away.

Shona and her husband made the decision, borrowed money from every friend and family member, took a second mortgage on their house and paid for the surgery in Arizona. She was sure she could get reimbursed by the Canadian government, as she found out they had already sent 36 patients that month to America for brain surgery.

“They admitted there’s a shortage of neurosurgeons, they’ve admitted that the wait times are too dangerous but because I went without that pre-approval, they wouldn’t pay for it,” Shona said.

She said she’s still had issues with the health care system at home. Getting a diagnosis on adrenal issues from two more tumors was a struggle.

“There was one test that could diagnose my problems,” Shona said. “It’s an 8 a.m. blood draw and an 11 p.m. blood draw. Our labs are only open 7 a.m. to 5 p.m. on a normal day, sometimes 7 a.m. to 7 p.m. I’m not allowed to go into a hospital and have a blood draw done at 11 o’clock at night. It’s illegal. So I couldn’t get that test.”

“I’ve actually had to fly to Los Angeles,” Shona continued. “Had my blood done in the morning in Canada and flew to Los Angeles, had a blood test done and they diagnosed me [snapping fingers] like that.”

Shona said it took three years in the Canadian health care system before she finally had surgery to remove the adrenal tumors. But she says her life and her eyesight were saved thanks to the American health care system.

[sentence deleted - political] She’s even been the brunt of harsh attacks by her own hometown newspaper for daring to speak out about the perils of government-run health care.

“The people who are supposed to care about sick people, the backlash I’ve experienced since I’ve spoken out, I’m shocked,” Shona said. “I’m really shocked.”

[sentence deleted - political] What is becoming abundantly clear here these days is if America surrenders to government-run health care, it’s going to kill a lot of Canadians, too.


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## pgnewarkboy (Aug 9, 2009)

Carolinian said:


> Medicare is a hybrid that is really not comparable to the Canadian or British system.  The government-run system in the US that is most comparable to the Canadian or British system would be the VA, but even that is not the best comparision given the finite and known number of veterans.  Ask a veteran about wait times and whether the care at the VA is as good as in the private system.



I know alot more about the VA then the average person.  Care at the VA has been rated excellent and better then many private hospitals by independent studies.  I know many veterans who have received great medical care at VA hospitals and would only go to a VA hospital although they have other choices.  Yes, veterans have other choices besides the VA and the VA is still the choice of many.  Mistakes at the VA are highly publicized because of their public nature and because of the fact that the VA is constantly monitored internally and externally.  The mistakes at private hospitals are generally buried with their patients.  Unlike the private sector, care is not rationed at the VA.  A veteran gets all the tests and treatment that the doctors think are necessary without filling out one piece of paper work.  The VA medical system is a key part of spectacular medical research and breakthroughs.  In fact, it is part of the VA mission.  Many of the doctors in the U.S. received their residency training at the VA. VA has lead the way in computerized medical records and the efficient delivery of pharmaceuticals through their computerized mail out system.  Veterans Groups throughout the nation recognize the great care that Veterans receive at VA hospitals and become outraged at proposals that are sometimes floated to throw the veterans into the private health care system by giving them health care vouchers.  

Fear tactics, distortions, and misrepresenations will not fly here!


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## pgnewarkboy (Aug 9, 2009)

Carolinian said:


> While I would agree that the government-run health care systems of Canada and the UK are rubbish, maybe you ought to look at the facts of what happened to Shona Holmes in Canada's system:
> 
> 
> .




Don't misquote me. BTW we have actual canadians posting about health care in Canada.  You can read their posts to learn about the quality of care and ask them about it. It is first person information as to opposed to so called " real stories" you are posting.


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## pgnewarkboy (Aug 9, 2009)

Carolinian said:


> Shona has suffered vicious attacks at the hands of the Obama-bot bloggers who hate anyone who doesn’t worship at the Big O. She’s even been the brunt of harsh attacks by her own hometown newspaper for daring to speak out about the perils of government-run health care.
> 
> 
> 
> Welcome to the Obamination. What is becoming abundantly clear here these days is if America surrenders to government-run health care, it’s going to kill a lot of Canadians, too.




Carolinian is the only one to make blatant political attacks.  It is being done with the full knowledge that it will eventually shut down this otherwise intelligent and important discussion that has been ongoing.   It seems clear to me that is the ultimate goal of Carolinian.


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## Carolinian (Aug 9, 2009)

pgnewarkboy said:


> Carolinian is the only one to make blatant political attacks.  It is being done with the full knowledge that it will eventually shut down this otherwise intelligent and important discussion that has been ongoing.   It seems clear to me that is the ultimate goal of Carolinian.



Those are not my words.  They are quoted from the article.  It it offends you, I will edit Connie Hair's words.  Her comment is not what is important in the article.  What is important is what happened to that real Canadian Shona Holmes.

OK, I have gone back and deleted the two sentences that make references to Obama, and noted their deletion.


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## Carolinian (Aug 9, 2009)

pgnewarkboy said:


> Don't misquote me. BTW we have actual canadians posting about health care in Canada.  You can read their posts to learn about the quality of care and ask them about it. It is first person information as to opposed to so called " real stories" you are posting.



OK, so you were calling the report of the UK's Healthcare Commission, a government entity, ''rubbish'' simply because it does not track with your beliefs.  Did you go to these two government-run hospitals in Mid-Staffordshre to be able to dispute the facts they found, or is yours just an armchair opinion?  You say you want a factual discussion, but I do not see that you have possession of any facts to dispute those that the Commission found in their own investigation on the ground in Mid-Staffordshire.


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## pgnewarkboy (Aug 9, 2009)

Carolinian said:


> This whole thread has been political from the ''get go''.



A discussion of health care is not by its nature political. This thread has not been political from the "get go".  You, Carolinian, have made it political and intentionally so.  

Your irresponsible and intentionally inflammatory use of "Karl Marx" quotes when discussing the moral responsibility of humans to help each other says much about you and those who share your sad view of the world.  

Your[deleted by BevL] and [deleted by Bev L] was designed to shut down this discussion because you didn't like all the really good information being discussed.


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## pgnewarkboy (Aug 9, 2009)

Carolinian said:


> OK, so you were calling the report of the UK's Healthcare Commission, a government entity, ''rubbish'' simply because it does not track with your beliefs.  Did you go to these two government-run hospitals in Mid-Staffordshre to be able to dispute the facts they found, or is yours just an armchair opinion?  You say you want a factual discussion, but I do not see that you have possession of any facts to dispute those that the Commission found in their own investigation on the ground in Mid-Staffordshire.



You quoted somebody named "Delingpole" which included a vicious political attack on Obama.  I don't have a clue what some British Commission said or didn't say and I don't give any credence by a second hand report written by someone with an obvious political agenda.  Once again  there is NO committee releasing a bill that calls for true universal health care.  So you have set up a bogey man solely for the purpose of obfuscating the real issues.

Even if this commission existed and Delingpole didn't misrepresent their finding how does it help the people in the U.S ?  Maybe we could say that we will learn from the mistakes of the Brits and do it better.  We surely need to provide health care in a better way then we are doing it now. In our "system"  Infectious disease is a tremendous problem , people are dying waiting to be seen in emergency rooms,  people are laying in their own feces and catheters are not being changed because of lack of nurses, people have the wrong organs removed, pharmaceutical errors are killing tens of thousands of patients, insurance companies are denying and rationing care, doctors are forced to see too many patients because the insurance pays too little, children are dying because they can't get cancer and other treatment, our infant death rates are the highest in the West.  What is your answer for that?  Its okay?


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## Chrisky (Aug 9, 2009)

pgnewarkboy said:


> Don't misquote me. BTW we have actual canadians posting about health care in Canada.  You can read their posts to learn about the quality of care and ask them about it. It is first person information as to opposed to so called " real stories" you are posting.



I totally agree.  It's very easy to pick a few cases, as many in the media do, and then say that the Canadian system is terrible and doesn't work.  But I know, first hand, of 10 people, who had serious health conditions and have had to deal with our system, and not one of them would ever have anything to complain about.  Yes, it's only 10, but how many more are out there that get excellent care.  At least here regardless of your financial standing, we can all get good medical care.
We do have private insurance companies here.  Some of us that work don't get medical insurance with our employers, or are self-employed, or retired so we pay for our own insurance to cover prescriptions, vision care, dental care etc.


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## Icarus (Aug 9, 2009)

Carolinian said:


> [Deroy Murdock is a columnist with the Scripps Howard News Service and a media fellow with the Hoover Institution on War, Revolution and Peace at Stanford University.]



that's an "article"?

Why don't you knock it off already? You made your point.

-David


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## pgnewarkboy (Aug 9, 2009)

"Collectivist notions"?  What in the heck are "Collectivist notions"?  Are you saying that having a moral responsibility to help other humans is a collectivist notion?   If so, I am guilty as charged and have collectivist notions.  

I think the "article" you just posted is drivel.  Even if it was absolutely true, what would it tell us except that we should do something better.  Are you saying that the Brits represent the zenith of human evolution and that their brains are so huge that we couldn't possibly come up with a better way?

And once again, the U.S. bills do not, not, absolutely not, propose a universal health care system as in britain, canada, france, germany, etc.  Once again you continue to obfuscate the issue of lousy healhcare in the US.


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## GadgetRick (Aug 9, 2009)

Always interesting to see how many Americans pooh pooh other universal systems when the bulk of the people living in those systems seem quite happy. This thread is an example of this as you can see with the number of Canadians talking about how happy they are with their system while some Americans try to convince them their system doesn't work.

I always scratch my head at this....

I don't know what system is the best but I do know our system is not working terribly well...


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## BevL (Aug 9, 2009)

Please, let's just tone it down.  I've contributed to and enjoyed this thread and have been amazed at how civilized it has remained.  But the namecalling has got to stop.


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## Carolinian (Aug 9, 2009)

GadgetRick said:


> Always interesting to see how many Americans pooh pooh other universal systems when the bulk of the people living in those systems seem quite happy. This thread is an example of this as you can see with the number of Canadians talking about how happy they are with their system while some Americans try to convince them their system doesn't work.
> 
> I always scratch my head at this....
> 
> I don't know what system is the best but I do know our system is not working terribly well...



Shona Holmes happens to be a Canadian.  Did you happen to overlook her?  Thanks to US medical care, she is still here to point out the poor service she received from Canada's medical system.  If she had relied on Canada's system, she would have been 6 feet under and not in a position to complain.

Or then there is James Delingpole, who is not only British himself but a prominent journalist with one of the UK's leading newspapers.

And it is not just what I read.  I hear it first hand.  One of my staff members got her graduate degree in the UK and learned all about their National Health Service.  Even coming from an eastern European system that is a strange mix of public, private, and insurance and behind on a lot of medical advances, she still found the British system very substandard.  The waiting lists were a particular problem.  Her favorite remark about the NHS is that if you are going to have a heart attack in the UK, you had better plan it six months in advance and make an appointment as otherwise you will not get treatment.  She likes most things British and has worked for both their embassy and the BBC, but she is not fond at all of their health service.


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## BevL (Aug 9, 2009)

I guess the part that I found troubling in the example about the woman with the brain tumour was:

"Shona and her husband made the decision, borrowed money from every friend and family member, took a second mortgage on their house and paid for the surgery in Arizona."

She had the means to do that and could raise enough money to have the surgery immediately.  But there are many, many Canadians - and by extension I can only assume many, many Americans - who don't have those assets and probably wouldn't have that option. 

I don't think, and I stand to be corrected, that there is one Canadian that has posted on this thread that has said our medical system is perfect.  I don't think there is one Canadian anywhere that would deny that yeah, there are wait times and the consequence of that is that people suffer harm or yes, could die.  But I strongly believe that the overwhelming majority of Canadians would not want to trade our system for yours and that's really what the original poster on this thread was asking, I think.


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## Liz Wolf-Spada (Aug 9, 2009)

I tried to get a link in here from an article today I saw on yahoo about the importance of the consumer protections included in the proposed health care bills, how they will protect small businesses and individuals especially by not allowing insurance companies to deny or raise costs for preexisting conditions. I have been paying $200 a month for my son since he stopped being a student. That is a Blue Cross Tonik plan aimed at the 20-30 year old group. He is going to school now for 2 years for a master's and included in his fees is a good health plan. However, I don't want to drop his other plan because I worry he could go in for something that seems minor and it could either be more serious or even something minor could cause him to be denied coverage as an individual later. If we had the kind of consumer protections included in these bills, that would save me paying for a policy he doesn't even need for two years, just to make sure he has insurance later. Unfortunately, the article said that doesn't start until 2013, so I still need to cover him now.
Liz
This is an important discussion, let's try to keep it civil.


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## itchyfeet (Aug 9, 2009)

Check out Deroy Murdoch and James Delingpole (authors of cited articles), on Wikipedia.  Also check out Connie Hair's credentials.  Then come to your own conclusion whether their articles are unbiased.


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## swift (Aug 9, 2009)

It is too bad that a few have to ruin this for others. This thread is coming close to being closed.


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## Liz Wolf-Spada (Aug 9, 2009)

This started out comparing different systems from the viewpoints of members who experience those systems. Maybe if we keep it on track we can avoid the name calling and continue to discuss what is a very important issue.
Liz


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## Carolinian (Aug 9, 2009)

itchyfeet said:


> Check out Deroy Murdoch and James Delingpole (authors of cited articles), on Wikipedia.  Also check out Connie Hair's credentials.  Then come to your own conclusion whether their articles are unbiased.



These articles cite facts.  Those facts are what is important.  Delingpole is a highly respected journalist with one of the UK's leading newspapers and most of the portion of the article that I posted in taken from a report by a British government commission. Murdoch is a media fellow at one of America's most prestigious universities.  Most of the content of Hair's piece consists of direct quotes from Shona Holmes.  Holmes has gone on a national tour on this subject, and if you don't like Hair's interview with her, I am sure you can find others.

As to the bias of Wikipedia on controversial matters such as this, the following article from the CBS News website tells the tale:

www.cbsnews.com/stories/2008/07/08/opinion/main4241293.shtml?source=search_story

And you offer nothing to refute the facts they present, only try to discredit them personally.


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## Carolinian (Aug 9, 2009)

Maybe someone could share the statistics on how many Canadians have to come to the US every year in order to get treatment within a reasonable time.  What will those Canadians do if the US system becomes just like theirs?

As to people dying from delays in Canada, a Canadian Supreme Court Justice wrote in the majority opinoin in _Chaoulli v. Quebec_ that ''This case shows that delays in the public health care system are widespread and that in some cases, patients die as a result of waiting lists for public health care'' Do you contend that this finding is not accurate?




BevL said:


> I guess the part that I found troubling in the example about the woman with the brain tumour was:
> 
> "Shona and her husband made the decision, borrowed money from every friend and family member, took a second mortgage on their house and paid for the surgery in Arizona."
> 
> ...


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## caribbeansun (Aug 9, 2009)

If you choose to believe "the drive by media" (to borrow one of PerryM's sayings) reports over first hand accounts including some excellent posts from a Canadian Dr. that's your choice - it wouldn't be my own.

I have found this to be a very interesting discussion for people on both sides of the 49th parallel sans the last page of inflammatory postings.


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## BevL (Aug 9, 2009)

Carolinian said:


> Maybe someone could share the statistics on how many Canadians have to come to the US every year in order to get treatment within a reasonable time.  What will those Canadians do if the US system becomes just like theirs?
> 
> As to people dying from delays in Canada, a Canadian Supreme Court Justice wrote in the majority opinoin in _Chaoulli v. Quebec_ that ''This case shows that delays in the public health care system are widespread and that in some cases, patients die as a result of waiting lists for public health care'' Do you contend that this finding is not accurate?



I am not contending that that finding is not accurate.  Since you've chosen to quote my post, I will respond to your question by quoting my post as well:

"I don't think there is one Canadian anywhere that would deny that yeah, there are wait times and the consequence of that is that people suffer harm or yes, could die."

Yes, people die in Canada on waitlists.  It happens.  And as I said, I don't think you will find one person on Canada who would deny that happens.

However, while there are Canadians that go "across the line" for medical care, I am not one that could.  I might be able to sell my and my husband's home, I suppose, for medical care in the U.S. but I would not jeopardize his wellbeing for my sake.  That's my personal circumstance.  

COuld it be better?  Of course.  HEre's what I wrote in my very first post on this thread:

"I think for people who have good insurance, the U.S. system is better. For many who couldn't afford good insurance, the Canadian system is better.

My own personal thought is that there should be some merging of the two - require doctors (especially specialists) to practice a certain percentage of their time within the public system, but allow some privatization to "clear the lines" a bit. I also personally feel there should be a nominal charge of $20 per doctor's visit for those who can afford it to at least help somewhat alleviate the health care costs."

Believe me, our healthcare system generates much debate here in Canada, as it does in the U.S.  WHere it will go from here, I don't know.  But as a Canadian, I'm glad to have the system we do.  You think it's an undesirable system.  C'est la vie - we'll agree to disagree, I guess.


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## calgarygary (Aug 9, 2009)

Carolinian said:


> This whole thread has been political from the ''get go''.



All do respect, the Canadians posting have not been posting from a political point of view.  Those in Canada that believe in universal health care are right wing, left wing, centerist, federalist, and probably separatist.  Trying to paint Canadians as somehow Marxist is however inaccurate.


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## donnaval (Aug 9, 2009)

> ''This case shows that delays in the public health care system are widespread and that in some cases, patients die as a result of waiting lists for public health care''



I'm simply astounded at the attacks against the Canadian system.  Good grief--does anyone seriously believe we don't have long waiting lists and indifferent treatment here?  I don't know a lot of Canadians personally but the few I do know are much, much happier with their system than I am with mine.

For every sad case quoted, I could also recount first-hand experience with friends and family here who endured long wait lists and misdiagnoses and just plain lousy treatment in our health system.  Canada and Britain may not be perfect, but news flash--neither are we.  

It's not just the uninsured who don't get treatment here.  There's also a significant number of folks who can only afford catastrophic health care with such high deductibles that they simply never go to the doctor--they can't afford the astronomical monthly premiums, let alone doctor and prescription fees on top of it.  They are technically not among the uninsured by whoever calculates those things--but they might as well be.

Nobody should have to sell their home, strip themselves of all assets, beg for money from friends and family for health care, but that happens on a regular basis here, in the good ole USA.  For more often, I would venture to say, than it happens in Canada.

Good grief.


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## Carolinian (Aug 9, 2009)

calgarygary said:


> All do respect, the Canadians posting have not been posting from a political point of view.  Those in Canada that believe in universal health care are right wing, left wing, centerist, federalist, and probably separatist.  Trying to paint Canadians as somehow Marxist is however inaccurate.



And trying to paint me as painting Canadians as Marxist is also inaccurate.

The opinion of that Canadian Supreme Court Justice was also not political, justing finding the facts as to the withspread delays in the Canadian medical system and their consequences.


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## Carolinian (Aug 9, 2009)

Instead of anecdotal opinions, look at health care statistics.  The US outperforms Canada, and even more so the UK.  That is particularly true for major illnesses.  That will change if our system changes, and it will not be for the better.




donnaval said:


> I'm simply astounded at the attacks against the Canadian system.  Good grief--does anyone seriously believe we don't have long waiting lists and indifferent treatment here?  I don't know a lot of Canadians personally but the few I do know are much, much happier with their system than I am with mine.
> 
> For every sad case quoted, I could also recount first-hand experience with friends and family here who endured long wait lists and misdiagnoses and just plain lousy treatment in our health system.  Canada and Britain may not be perfect, but news flash--neither are we.
> 
> ...


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## calgarygary (Aug 9, 2009)

pgnewarkboy said:


> Don't misquote me. BTW we have actual canadians posting about health care in Canada.  You can read their posts to learn about the quality of care and ask them about it. It is first person information as to opposed to so called " real stories" you are posting.



Seeing as how carolinian wants to cherry pick her nightmare stories (and believe me I can find many more documented nightmares originating out of the U.S. system) I will relay a very personal story that would have crushed our family had we lived in the U.S.  

A number of years ago, I lost my business.  Had we lived in the U.S. that would have resulted in the loss of healthcare.  We would have had sufficient income from the first half of the year to not qualify for any subsidized healthcare had we lived in the States.  Four months afterwards, before finding any employment, one of my daughters became ill.  She was initially tracking on the same type of infection that her older sister had and was being treated similarly.  However, she wasn't improving and repeated doctor's visits was not providing relief.  Finally, after describing her symptoms to our family doctor and our desire not to go the weekend without her seeing him again, we were advised to not wait for an appt. but to bring her in and he would see her immediately.  That visit resulted in her being sent to the closest hospital.  It is a very scary feeling for a parent to visit an e.r. and have their child seen immediately - no delay, when there is a room of waiting patients.  They started tests there while holding her in the e.r. until a ICU room opened at the Children's Hospital.  A viral infection that in most people displays as cold like symptoms attacked my daughter and every major organ.  A lengthy ICU stay with follow up care by many, many specialists would have economically devistated our family had we lived in the U.S.  Our cost in Canada - $7/day for parking at the hospital and assorted out of pocket expenses for our meals while giving our daughter around the clock companionship.

Carolinian, the people falling through the cracks in the U.S. system are likely very similar to us.  They are not marxists or anti-American.  They deserve the same quality of care that Canadians receive - which is comparable to the care that Americans with insurance receive and of course much superior to the millions that you feel are somehow not worth healthcare.


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## calgarygary (Aug 9, 2009)

Carolinian said:


> Instead of anecdotal opinions, look at health care statistics.  The US outperforms Canada, and even more so the UK.  That is particularly true for major illnesses.  That will change if our system changes, and it will not be for the better.



How long does the average American live?  What is the infant mortality rate of the U.S.  These are key statistics in determining the *overall* effectiveness of a system.


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## calgarygary (Aug 9, 2009)

Carolinian said:


> And trying to paint me as painting Canadians as Marxist is also inaccurate.
> 
> The opinion of that Canadian Supreme Court Justice was also not political, justing finding the facts as to the withspread delays in the Canadian medical system and their consequences.



Carolinian if your quoting marx and other socialist statements in a discussion of the Canadian healthcare system misled me into believing that you were trying to associate the two then I stand corrected.  However, I do not believe those quotes were accidental and I do believe that my conclusion was intended.

The Supreme Court in Canada at least had the resolve to deal with this issue.  Maybe in time, the U.S. will have a Court that develops the same resolve.


----------



## Eli Mairs (Aug 9, 2009)

Since Shona Holmes has been referred to several times in this thread, it is important to note that there appears to be more to the story than meets the eye. The following is an excerpt from an article by:

Author: Tim Pelzer 
People's Weekly World Newspaper, 08/05/09 11:40 

Holme’s is also misleading people about her so called life threatening ordeal. She was diagnosed with a Rathkes cleft in 1998, not a life threatening brain tumor. According to the John Wayne Cancer Center, “Rathkes cleft cysts are not true tumors or neoplasms; instead they are benign cysts. Dr. Roland del Maestro, Director of the Montreal Neurological Institute’s Brain Research Department believes that Holmes exaggerated her condition. He told the Canadian Broadcasting Corporation (CBC) that Holme’s lesion was benign, slow growing and did not require urgent attention. 

Michael Schwartz, a neurosurgeon at Toronto’s Sunnybrook Hospital has never seen or heard of a death from Rathkes cleft, he told the CBC. He added that vision improves if a cyst is drained or removed. 

Holmes admits that she had a Rathkes cleft, but said that it was the same as having a brain tumor and that American doctors told her that she would quickly die if it was not removed. In contrast, her Canadian doctors told her that her condition was not serious and monitored her condition. 

In 2005, she suffered a 50% vision loss which was temporary and reversible, according to Schwartz. She was placed on a waiting list of 6 to 4 months to see an endocrinologist and neurologist, respectively, in Ontario. Holmes decided not to see the specialists, determined her own treatment and flew to the Mayo Clinic in the US for surgery, paying $97,000. 

While she had a medical problem, it was a far cry from a life-death situation.


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## John Cummings (Aug 9, 2009)

BevL said:


> I don't think there is one Canadian anywhere that would deny that yeah, there are wait times and the consequence of that is that people suffer harm or yes, could die.  But I strongly believe that the overwhelming majority of Canadians would not want to trade our system for yours and that's really what the original poster on this thread was asking, I think.



Having experienced both systems personally, as well as having many relatives living in Canada, I am definitely happy to have my US medical care. I can live in Canada or just about any country I wish to. Apart from many other reasons, health care is an important reason why I choose to live in the US. I am not going to go any farther with this as I am trying to keep it non-political which is not easy. I am simply stating that I do have a choice and have very happily chosen what I have.

One of the big problems in discussing this subject is that so few people really understand the realities of health care in the US or Canada. Many Canadian's opinions on health care in the US is based on being constantly told how evil it is. Well it is not all evil. There are many good features. The simple fact is that the vast majority of Americans ( 83% ) are happy with their own medical care. The US system involves making personal choices of what is best. Most employer's offer at least 3 different choices of medical care. It is up to individual to educate themselves so they can make intelligent decisions. Many Americans don't know how all the options available. Yes, there are instances where people don't have any choice and do not receive good care. These are a small percentage but receive a lot of publicity. There are also many instances where people simply made a poor decision or didn't bother to make the effort to learn what is available. NOT all insurance companies are bad. In fact the majority are pretty good but there are some bad ones. It is very easy to determine which are the good ones and which are bad. I would much rather live in a country where I have the freedom to choose what health care I feel is best for me and my family. Most Canadians think it is all about having lots of money in order to get good quality care in the US. That is simply not true. I am not rich, my kids are not rich, but they have excellent medical care.


----------



## John Cummings (Aug 9, 2009)

calgarygary said:


> ...Had we lived in the U.S. that would have resulted in the loss of healthcare.



Where did you get that idea from? Losing your job does not result in automatically losing your medical insurance. Under the law, you have the choice of continuing your medical insurance for 18 months under COBRA. Yes, you will have to pay the premiums but you will still retain your insurance. the choice is up to you. I have done that myself.


----------



## Carolinian (Aug 9, 2009)

Maybe you ought to google your source before you post.

The People's Weekly World Newspaper is the official publication of the Communist Party of the United States!



Eli Mairs said:


> Since Shona Holmes has been referred to several times in this thread, it is important to note that there appears to be more to the story than meets the eye. The following is an excerpt from an article by:
> 
> Author: Tim Pelzer
> People's Weekly World Newspaper, 08/05/09 11:40
> ...


----------



## pgnewarkboy (Aug 9, 2009)

John Cummings said:


> Having experienced both systems personally, as well as having many relatives living in Canada, I am definitely happy to have my US medical care. I can live in Canada or just about any country I wish to. Apart from many other reasons, health care is an important reason why I choose to live in the US. I am not going to go any farther with this as I am trying to keep it non-political which is not easy. I am simply stating that I do have a choice and have very happily chosen what I have.
> 
> One of the big problems in discussing this subject is that so few people really understand the realities of health care in the US or Canada. Many Canadian's opinions on health care in the US is based on being constantly told how evil it is. Well it is not all evil. There are many good features. The simple fact is that the vast majority of Americans ( 83% ) are happy with their own medical care. The US system involves making personal choices of what is best. Most employer's offer at least 3 different choices of medical care. It is up to individual to educate themselves so they can make intelligent decisions. Many Americans don't know how all the options available. Yes, there are instances where people don't have any choice and do not receive good care. These are a small percentage but receive a lot of publicity. There are also many instances where people simply made a poor decision or didn't bother to make the effort to learn what is available. NOT all insurance companies are bad. In fact the majority are pretty good but there are some bad ones. It is very easy to determine which are the good ones and which are bad. I would much rather live in a country where I have the freedom to choose what health care I feel is best for me and my family. Most Canadians think it is all about having lots of money in order to get good quality care in the US. That is simply not true. I am not rich, my kids are not rich, but they have excellent medical care.



I am glad that you are an american that gets to choose what health care is good for you. I don't care what insurance company you have (and by the way most employers do not offer 3 plans) your employer decides what insurance to offer based on cost.  It is your employer's decision - not yours.  Then you get to choose one.  After you choose one the insurance company decides what kind of health care you get. Period. Whatever plan you choose your health care is rationed by the insuranace company.  Decisions about your health are made by the insurance companies - not your doctors.  Your doctor gets to recommend what should be done, the insurance company gets to decide if they will pay for it.


And what will happen if you lose your job?  what health care will you choose then? What kind of freedom of choice will you have then?  

Well, I won't dispute that you are happy.  I can hardly dispute a personal fact but I ask you this:  Don't you think every single american should have it as good as you?  Every single person.  Your answer is critical to this discussion.  

A famous person on the health care issue was and is Ted Kennedy.  He comes from a wealthy family and has always had great insurance.  Ted Kennedy's son got cancer and lost a leg.  Ted Kennedy said he got great health care for himself and his family. Ted Kennedy said in a speech (which I saw) that every single american should get healthcare that was as good as his.  What do you think?


----------



## pgnewarkboy (Aug 9, 2009)

I am going to answer the question I posited above about health care in the United States.  I have good health care insurance.  It is too expensive but it is good.  I think every single american should have health care as good as mine.  I believe in our country and our people.  I think that where there is a will there is a way.  I think we can provide healthcare that is good for every single american.  We are smart enough to do that and resourceful enough to do it - all we need is the desire.  We can provide better healthcare for all, better then Canada or the UK or any other nation on earth.  We were and are the only nation to send men to the moon.  We saved the world from fascism in WW2.  While other nations are continually bogged down in ethnic strife, we have managed to abolish some of our worst evils such as slavery and segregation.  

I don't believe for a moment that our great nation cannot provide the best healthcare in the world to all of its citizens.


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## Karen G (Aug 9, 2009)

donnaval said:


> Nobody should have to sell their home, strip themselves of all assets, beg for money from friends and family for health care


Why not? 

Why does anyone think he is "entitled" to the very best healthcare available and that someone other than himself, his family, or his friends should provide it for him?

One of the primary objections to all the proposals being put forward for overhauling our health care system is that it will cost too much.  There is no need to throw out the perfectly good care that most people in the U.S. now receive just to provide insurance to people who don't have it now. I think it would be cheaper and less destructive to our country to just buy uninsured people some insurance.


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## ricoba (Aug 9, 2009)

John Cummings said:


> Having experienced both systems personally, as well as having many relatives living in Canada, I am definitely happy to have my US medical care. I can live in Canada or just about any country I wish to. Apart from many other reasons, health care is an important reason why I choose to live in the US. I am not going to go any farther with this as I am trying to keep it non-political which is not easy. I am simply stating that I do have a choice and have very happily chosen what I have.
> 
> One of the big problems in discussing this subject is that so few people really understand the realities of health care in the US or Canada. Many Canadian's opinions on health care in the US is based on being constantly told how evil it is. Well it is not all evil. There are many good features. The simple fact is that the vast majority of Americans ( 83% ) are happy with their own medical care. The US system involves making personal choices of what is best. Most employer's offer at least 3 different choices of medical care. It is up to individual to educate themselves so they can make intelligent decisions. Many Americans don't know how all the options available. Yes, there are instances where people don't have any choice and do not receive good care. These are a small percentage but receive a lot of publicity. There are also many instances where people simply made a poor decision or didn't bother to make the effort to learn what is available. NOT all insurance companies are bad. In fact the majority are pretty good but there are some bad ones. It is very easy to determine which are the good ones and which are bad. I would much rather live in a country where I have the freedom to choose what health care I feel is best for me and my family. Most Canadians think it is all about having lots of money in order to get good quality care in the US. That is simply not true. I am not rich, my kids are not rich, but they have excellent medical care.



John this is in an excellent response and having lived on both sides of the border under both systems I can tell you it is right on.


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## ricoba (Aug 9, 2009)

pgnewarkboy said:


> ....What do you think?



I think you have shared your political opinions enough....that's what I think


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## calgarygary (Aug 9, 2009)

John Cummings said:


> Where did you get that idea from? Losing your job does not result in automatically losing your medical insurance. Under the law, you have the choice of continuing your medical insurance for 18 months under COBRA. Yes, you will have to pay the premiums but you will still retain your insurance. the choice is up to you. I have done that myself.



John, I lost my business and therefore would have lost the ability to pay the premiums.  Where do you get the idea that someone that has lost 100% of their income with no employment insurance would have had the ability to pay the premiums.  My situation is as was described and I believe that someone in the same economic situation in the U.S. would have been forced to choose food and shelter over healthcare.

Also, as a Canadian I do not see the U.S. system as evil I just question people dismissing the needs of millions so casually - as though their needs are not important.  It is obvious from the postings that not every American shares such a view but unfortunately enough fear change to the status quo.


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## Eli Mairs (Aug 9, 2009)

Carolinian said:


> Maybe you ought to google your source before you post.
> 
> The People's Weekly World Newspaper is the official publication of the Communist Party of the United States!



The same story is all over the internet, including this one from the CBC -

http://www.cbc.ca/health/story/2009/07/31/medicare-ad-exaggeration523.html


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## calgarygary (Aug 9, 2009)

As some seem to be focused on the death of celebrities due to poor healthcare, maybe we should discuss how a profit based system contributed to the death of Michael Jackson.   Or possibly we could talk about the misdiagnosis of John Ritter.  Personally I don’t think the deaths of these people are terribly germane to the conversation as in any system, people will die.  They will die from waits in the U.S., Canada and elsewhere.  They will receive quality care in each system and they will receive poor care in each system.   

However, a poster here wants to focus on individual cases so maybe the discussion should include:

http://willtoexist.com/universal-health-care_1202/

http://www.washblade.com/thelatest/thelatest.cfm?blog_id=19742

http://findarticles.com/p/articles/mi_m0CYZ/is_1_30/ai_99018717/

http://www.washingtonpost.com/wp-dy.../AR2009080503331.html?nav=rss_opinion/columns

I can assure you that I can find many more stories of neglect or abuse in U.S. hospitals than can be found regarding the Canadian system.  These links and the names I mentioned above are not meant as a condemnation of the U.S. system.  Rather, I would like to point out to readers (or maybe just one reader) that every system has its failures.


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## John Cummings (Aug 9, 2009)

calgarygary said:


> John, I lost my business and therefore would have lost the ability to pay the premiums.  Where do you get the idea that someone that has lost 100% of their income with no employment insurance would have had the ability to pay the premiums.  My situation is as was described and I believe that someone in the same economic situation in the U.S. would have been forced to choose food and shelter over healthcare.
> 
> Also, as a Canadian I do not see the U.S. system as evil I just question people dismissing the needs of millions so casually - as though their needs are not important.  It is obvious from the postings that not every American shares such a view but unfortunately enough fear change to the status quo.



I owned my own business for several years. I always kept a money market account with enough in it to cover such emergencies and living expenses for a year. That is part of taking personal responsibility.

By the way, if you were that poor, you would automatically get free medical care in the US.

You are very wrong about the attitudes of the majority of Americans. The ones posting on TUG do NOT reflect the general population. All polls indicate that the majority of Americans do NOT want Universal Government medical care period.


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## Liz Wolf-Spada (Aug 9, 2009)

John, what I was hearing on the Sunday talk shows is that polls show 75% of people actually do want a public option as one choice. It is predicated that most people would not necessarily use that option, but there is a good chance that it would add a non-profit competitive edge to the market. Most people do not want government interference in health care decisions, but as pointed out earlier, the interference most of us has is now insurance company based. Remember the 15 year old girl who was turned down for a medical procedure by one of the HMO's in LA and when they got bad publicity they reversed the decision, but it was too late and she died. This was a big story in the LA area, maybe 3 or so years ago. That was the profit margin of the insurance company making a decision that disagreed with what her doctor recommended.
Liz


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## calgarygary (Aug 9, 2009)

John Cummings said:


> I owned my own business for several years. I always kept a money market account with enough in it to cover such emergencies and living expenses for a year. That is part of taking personal responsibility.
> 
> By the way, if you were that poor, you would automatically get free medical care in the US.
> 
> You are very wrong about the attitudes of the majority of Americans. The ones posting on TUG do NOT reflect the general population. All polls indicate that the majority of Americans do NOT want Universal Government medical care period.



John the loss of income occurred at the end of a year and in Canada, at least at the time of this event, ytd income determines elegibility for the social net and I assume that a similar situation might exist in the states.  In my case, everything but our home went into trying to keep the business solvent and meet payroll.  Maybe if I went through a business failure in the U.S. I would be more callous about the payroll obligations and "stashed" away $ for personal needs.   However, I believe that there are sufficient stories of people losing homes in the U.S. to meet their healthcare needs to assume that something very similar would have happened in my situation.  To clarify about my personal obligations, in the case of establishing my business it was necessary to sign a personal guarantee with the franchisor.

Maybe you are right about the opinions of a majority of Americans.  Maybe the majority do not care about the millions of uninsured.  Maybe the majority do not care about the run away escalations in healthcare costs.  Maybe the majority do not care that the U.S. is getting the least for their GDP spending on healthcare.  Or maybe the majority do care and the pollsters haven't phrased the questions to get an accurate answer as to what people care about.


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## GadgetRick (Aug 9, 2009)

Carolinian said:


> Shona Holmes happens to be a Canadian.  Did you happen to overlook her?  Thanks to US medical care, she is still here to point out the poor service she received from Canada's medical system.  If she had relied on Canada's system, she would have been 6 feet under and not in a position to complain.
> 
> Or then there is James Delingpole, who is not only British himself but a prominent journalist with one of the UK's leading newspapers.
> 
> And it is not just what I read.  I hear it first hand.  One of my staff members got her graduate degree in the UK and learned all about their National Health Service.  Even coming from an eastern European system that is a strange mix of public, private, and insurance and behind on a lot of medical advances, she still found the British system very substandard.  The waiting lists were a particular problem.  Her favorite remark about the NHS is that if you are going to have a heart attack in the UK, you had better plan it six months in advance and make an appointment as otherwise you will not get treatment.  She likes most things British and has worked for both their embassy and the BBC, but she is not fond at all of their health service.


Not overlooking anyone. I don't know any of the people you cite. I have no idea what their story is. You can find exceptions to every rule. There are plenty of people who are happy with our system. Does that make it perfect? There are also many of us unhappy with our system. My point is, out of the people I know who live in these systems, I find a very low percentage (don't know the exact numbers as I didn't take a scientific poll) seem to hate their system and complain about it the way our media would have us believe. This thread here on TUG is a microcosm of what I've seen and heard from others. Doesn't seem these other systems are as bad as we're led to believe...

I'm always told of the long wait times, the horrible care, etc. of these systems but, quite honestly, I've not heard that from people I know who live in these systems. I can attest to long wait times, horrible care, screwed up billing (something they don't have in their systems, btw) in our very own system here in the US.

I've also said I don't know what the answer is, all I know is our current system sucks if you look at it objectively from the whole group's (i.e. the US population) point of view. It's broken and needs to be fixed. How? I don't really know and I'm not so sure it's a thing which we should be tackling during these tough economic times but that's another discussion.

I just get tired of people here in the US screaming how bad they have it in Canada or the UK or France when they really don't know since they've not lived in those systems. I really don't know if they're good/bad either as I've also not lived in them. All I know is the vast majority of the people I know who DO/HAVE lived in these systems seem more than satisfied with them but they do have some (relatively) minor complaints. So they aren't perfect either, however, EVERYONE is covered and that, to me, is one of the most important things. We are one of the richest nations in the world yet everyone is NOT covered. I just don't get it...


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## GadgetRick (Aug 9, 2009)

John Cummings said:


> By the way, if you were that poor, you would automatically get free medical care in the US.


The most basic care, no pre-natal care, etc. I'd hardly consider that being covered. Everyone always cites this but it's not the same as having real coverage.



> You are very wrong about the attitudes of the majority of Americans. The ones posting on TUG do NOT reflect the general population. All polls indicate that the majority of Americans do NOT want Universal Government medical care period.


I supposed you didn't see the most recent CNN poll indicating 50% of Americans favor the currently proposed plan? I don't favor the currently proposed plan but I do favor some sort of universal healthcare coverage. I think maybe most of the people around you don't favor it but you'd be surprised at how many of us do want it. Many more than you think. Is it the majority? I have no idea but I wouldn't make it seem as if hardly anyone does...


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## pgnewarkboy (Aug 9, 2009)

ricoba said:


> I think you have shared your political opinions enough....that's what I think



You have not heard my political views.  You don't have to be nasty.


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## pgnewarkboy (Aug 9, 2009)

Karen G said:


> Why not?
> 
> Why does anyone think he is "entitled" to the very best healthcare available and that someone other than himself, his family, or his friends should provide it for him?
> 
> One of the primary objections to all the proposals being put forward for overhauling our health care system is that it will cost too much.  There is no need to throw out the perfectly good care that most people in the U.S. now receive just to provide insurance to people who don't have it now. I think it would be cheaper and less destructive to our country to just buy uninsured people some insurance.



Much of the world thinks they are entitled to health care.  It is part of the United Nations Bill of Rights.  You are certainly free to disagree.  There are, however, many reasons for everyone to have healthcare. There is the issue of world wide diseases.  No country is or person in the world is immune from the spread of infectious diseases.  We can see that from the swine flu.  we here in the U.S may very well die from an infectious disease started in some part of our country or the rest of the world that could have been contained or prevented if healthcare was available to all.


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## susieq (Aug 9, 2009)

John Cummings said:


> I owned my own business for several years. I always kept a money market account with enough in it to cover such emergencies and living expenses for a year. That is part of taking personal responsibility.
> 
> By the way, if you were that poor, you would automatically get free medical care in the US.
> 
> You are very wrong about the attitudes of the majority of Americans. The ones posting on TUG do NOT reflect the general population. All polls indicate that the majority of Americans do NOT want Universal Government medical care period.





Just wanted to throw my 2 cents in here.  Another option, my husband has been out of work for over a year now, as soon as he lost his job, *I * carry the insurance .  We do have options, and frankly, I like having a choice.


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## pgnewarkboy (Aug 9, 2009)

susieq said:


> Just wanted to throw my 2 cents in here.  Another option, my husband has been out of work for over a year now, as soon as he lost his job, *I * carry the insurance .  We do have options, and frankly, I like having a choice.





Do you have a job?  Does your employer have an insurance plan?  What are you choosing?


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## susieq (Aug 9, 2009)

pgnewarkboy said:


> Do you have a job?  Does your employer have an insurance plan?  What are you choosing?



I've worked at the same job for 15 years, yes my employer offers insurance, and I chose to participate.


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## Karen G (Aug 9, 2009)

pgnewarkboy said:


> Much of the world thinks they are entitled to health care.


So what?  Much of the world might think they are "entitled" to a lot of
free stuff.  That doesn't mean we have to buy it for them.


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## Karen G (Aug 9, 2009)

pgnewarkboy said:


> It is part of the *United Nations Bill of Rights. * You are certainly free to disagree.


Give me a break!  You can be absolutely certain that I DO disagree.


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## Tia (Aug 9, 2009)

http://www.businessweek.com/bwdaily...top+news+index+-+temp_policy++amp;+government

June 4, 2009,

"Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance "


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## pgnewarkboy (Aug 9, 2009)

Karen G said:


> So what?  Much of the world might think they are "entitled" to a lot of
> free stuff.  That doesn't mean we have to buy it for them.




Many would argue that there is a difference between "alot of stuff" and health care.  I wouldn't buy a tv for someone because they thought they were entitled to it.


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## ace2000 (Aug 9, 2009)

Tia said:


> http://www.businessweek.com/bwdaily...top+news+index+-+temp_policy++amp;+government
> 
> June 4, 2009,
> 
> "Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance "


 
Thank you for sharing this reference...


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## Karen G (Aug 9, 2009)

pgnewarkboy said:


> I wouldn't buy a tv for someone because they thought they were entitled to it.


Why would you balk at a tv?  Shouldn't everyone have a working tv? Shouldn't everyone keep up with the latest news or have access to the best tv programming available? I'm sure there are great programs about having better health or whatever. Earlier you stated that everyone should have the same health care as Ted Kennedy.  Perhaps everyone should also have a nice house or a nice car so that everyone would have the same good life as Ted Kennedy.


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## Redrosesix (Aug 9, 2009)

Wow. I was away from the internet for just a few days and this thread has doubled in length.  I simply can't get over the inaccurate statements that some have posted about my health care system.



grest said:


> This happened to us when visiting Quebec.  My husband was struck (as a pedestrian) by a tour bus that came too close to the sidewalk.  He was pushed to the ground, but it was not terribly serious, thank goodness.  An ambulance was called immediately, but before he could board, we had to pay up front.  Fortunately, we had some cash with us.  Also, we had to pay the hospital ER.  They were very attentive and there was no wait to be seen.  When we got home, we processed a claim with his insurance company, which reimbursed us.
> Connie



Again, this is the Quebec system -- in Nova Scotia, nobody pays for ambulance up front.  What would they do if the patient was unconscious? Leave them lying in the road? Patients are billed later, but they can just send the invoice on to their insurance company or pay it if/when they have the funds.  The exception is medevac, which is covered since it is prescribed by the hospital.



Carolinian said:


> Here is an account of how waiting times can kill you in Canada:
> 
> www.humanevents.com/article.php?id=32851
> 
> ...



My mother spent a month in the neurosurgery ward a couple of years ago and a friend is recovering from a near-fatal aneurism.  I can assure you that in Nova Scotia, the wait times listed for neurosurgery for serious issues are completely incorrect.

BTW, a real Canadian would identify the province they come from -- all Canadians know that their health care system is provincial, not federal.



BocaBum99 said:


> My understanding is that Canada has very relaxed immigration policies.  Whenever I am in Toronto, I see lots of Eastern Europeans living there offering fantastic ethnic food.  It's one of the great things about that city.
> 
> Question about heathcare to these immigrants.  Are they covered as well?  How does Canada administer healthcare as it relates to immigrants?  How does it prevent illegal immigrants from getting free coverage?



I love Toronto!  My favourite area is Kensington Market and Chinatown -- lots of great restaurants around there.

No, we don't have relaxed immigration policies -- it's a lot harder to get into Canada than the US.  Refugees have to meet certain political criteria to be granted entrance and  are covered by government health care.  Immigrants have to meet certain financial criteria to be allowed in the country -- they are covered after they are in Canada for 90 days.



Carolinian said:


> Remember the tragic death of British actress Natasha Richardson?  Serious deficiencies in the government-run medical system of Canada almost certainly played a major role in her unnecessary death.  Her family did finally get her to a US hospital, but by then it was too late.
> 
> A doctor explains how the Canadian health system contributed substantially to her death:
> 
> www.humanevents.com/article.php?id=31180



Again, the Quebec health care system -- Quebec is NOT Canada.  Almost 50 percent of Quebecers don't even think they're a part of Canada.

And since my mother actually suffered a similar brain injury, I can tell you that the outcome was at least partially a result of the family's choices, unfortunately .  I see no reason to believe that the same outcome would not have occurred in the US. 



ricoba said:


> Liz your story about your friend from Kaiser is interesting in that I think it may point out to some of the challenges of health care reform.
> 
> My understanding is that if we go to a national system - it will be very much like a Kaiser based model, which is in some effects similar to a Canadian model of delivery.
> 
> ...



The model you are talking about is nothing like the system we have here.  Case in point, my daughter was prescribed an asthma medication that was still not finished licensing in Canada -- it had passed all of the trials in Europe, and was the only one proven to not have the side-effects that prevented her from taking other meds.

You make it sound like we don't even do heart transplants in this country.  I can assure you that is not true.  Doctors can prescribe any medication or procedure that they want to.  But the most serious cases always take priority in scheduling.  



GregGH said:


> Add one more vote from a Cdn that likes his health care.   It takes the discussion in USA to remind us how good we have it.   It is not perfect.  And we continue to need smart people to make changes that are often resisted.
> 
> TOO BAD we can't run a poll and see the summary on what Cdn's think.
> 
> ...



EXACTLY!  I myself have felt a little insulted by the statements from some posters.  If you don't live where I do, you don't know what our health care system is like.  I suppose you also think we have snow 12 months of the year.  



calgarygary said:


> As I have said before, statistics can be manipulated and I certainly believe that they might have been by the site that provided the 50million uninsured number as I also believe that they may have been by whichever site reported the 20 million number.  I think that this highlights the fundamental difference between many Americans and most Canadians on this issue.  Here in Canada, we find it completely unacceptable that any Canadian is without healthcare.   To ask Canadians to accept that 2-5 million of our population would be without care, whether by choice or not, would be unthinkable.



ITA!  This is the real difference between the US and Canadian health care systems -- it's way people think about them.


----------



## BevL (Aug 9, 2009)

Karen G said:


> Why would you balk at a tv?  Shouldn't everyone have a working tv? Shouldn't everyone keep up with the latest news or have access to the best tv programming available? I'm sure there are great programs about having better health or whatever. Earlier you stated that everyone should have the same health care as Ted Kennedy.  Perhaps everyone should also have a nice house or a nice car so that everyone would have the same good life as Ted Kennedy.



To equate a television with care that could save someone's life denigrates the discussion, don't you think?  Really, no matter what side of the issue, you're on, you can't honestly think that's helpful if you step back and reread it, can you?  And please, don't respond by saying you were just playing off another comment - that post obviously was making the point that trying to equate something as trivial as a TV to something as important as healthcare is, well, silly, and again, that's on both sides of the issue.  

And I remind everyone that this thread didn't start out as an "issue," it started out asking about comments on Canadian healthcare.  It's unfortunate it's turned into an "issue" today.

I'm checking out for tonight and expect I won't be back to this thread - it's mired down to nothing but trying to convince others that "I'm right and you're not."  It was a lively, relevant, level headed discussion for quite a while and I thank those that rationally answered my questions about the American healthcare system.  It was really very informative and I probably learned a lot more that's useful to me than reading and listening to lots of American media.


----------



## Karen G (Aug 9, 2009)

BevL said:


> To equate a television with care that could save someone's life denigrates the discussion, don't you think?


I disagree.  I think whether or not a government is supposed to provide health care is key to any discussion of healthcare. It's not central to what this thread started out as--a comparison of the Canadian & U.S. health care systems, but a lot of the posts to this thread have strayed off that topic.

My point about the television is this:  If someone thinks that it is the duty of government to provide healthcare, why does it stop there? Why doesn't the government provide other things that would enhance one's life, too? 

I don't believe our Constitution has any provision for the government to even be providing health care.  That is my point--not that a tv equates to healthcare.


----------



## Redrosesix (Aug 10, 2009)

Karen G said:


> I disagree.  I think whether or not a government is supposed to provide health care is key to any discussion of healthcare. It's not central to what this thread started out as--a comparison of the Canadian & U.S. health care systems, but a lot of the posts to this thread have strayed off that topic.
> 
> My point about the television is this:  If someone thinks that it is the duty of government to provide healthcare, why does it stop there? Why doesn't the government provide other things that would enhance one's life, too?
> 
> I don't believe our Constitution has any provision for the government to even be providing health care.  That is my point--not that a tv equates to healthcare.



Hmm...the government might not provide TV's, but might decide that everyone is entitled to be informed and provide television coverage of important events and decisions.  Hey, they already do that, don't they? I'm pretty sure I've seen your State of the Union address on TV.  And I'm pretty sure it's the same information regardless of whether you watch it on the largest flat screen TV, or an old b/w that you buy for $2 at a flea market -- I think the message is more important than the medium in this case.


----------



## ricoba (Aug 10, 2009)

Redrosesix said:


> Wow. I was away from the internet for just a few days and this thread has doubled in length.  I simply can't get over the inaccurate statements that some have posted about my health care system.
> 
> 
> The model you are talking about is nothing like the system we have here.  Case in point, my daughter was prescribed an asthma medication that was still not finished licensing in Canada -- it had passed all of the trials in Europe, and was the only one proven to not have the side-effects that prevented her from taking other meds.
> ...




You have no idea about the Kaiser system - yet you judge others for having no idea about your system - this is the height of smugness and hypocrisy that I grew very tired of in my 12 plus years of living in Canada....

I have lived in Manitoba, Saskatchewan and BC, and the Kaiser system that I have now is very similar to the systems that I lived under in those provinces.

So, what system besides the Canadian system have you lived under since you obviously think you are an expert on the US system???  

Talk about insulting, your very post insulted me, by assuming that I didn't know what I was talking about....


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## Icarus (Aug 10, 2009)

Karen G said:


> If someone thinks that it is the duty of government to provide healthcare, why does it stop there? Why doesn't the government provide other things that would enhance one's life, too?



I think they should give everybody besides you at least one flat panel television and health care.

-David


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## pgnewarkboy (Aug 10, 2009)

Karen G said:


> I disagree.  I think whether or not a government is supposed to provide health care is key to any discussion of healthcare. It's not central to what this thread started out as--a comparison of the Canadian & U.S. health care systems, but a lot of the posts to this thread have strayed off that topic.
> 
> My point about the television is this:  If someone thinks that it is the duty of government to provide healthcare, why does it stop there? Why doesn't the government provide other things that would enhance one's life, too?
> 
> I don't believe our Constitution has any provision for the government to even be providing health care.  That is my point--not that a tv equates to healthcare.



I agree with Karen G that the role of government in health care is essential to the discussion of health care.  I would go a step further, however, and say it is essential to comparing the Canadian system and health care in the U.S. because in Canada health care is a right.  In the United States it is not a right.  From that starting point all else follows when comparing health care in each place.

I certainly did not and do not mean to denigrate anyone's view in this discussion.  The reference to the TV was just to point out that what people are entitled to can be viewed on a spectrum.  I pointed out an extreme end of the spectrum to make a debate point - not to denigrate.

I think, however, that even those who do not see health care as a right (leaving the constitution out of this - I can find support in the constitution) might see that there is a general benefit to society whether or not it is a right.  The general benefits would include things like preventing or limiting the spread of contagion, increased productivity at work, more people physically capable of working (meaning less people on disability), less crime (some people take illegal drugs to curb pain), more financial stability for families (helping them to stay together).  There are many other benefits.


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## Icarus (Aug 10, 2009)

Fine, no tv for you either.

-David


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## GadgetRick (Aug 10, 2009)

Karen G said:


> My point about the television is this:  If someone thinks that it is the duty of government to provide healthcare, why does it stop there? Why doesn't the government provide other things that would enhance one's life, too?



You mean like schools? Or roadways? Or someone to come put a fire out in your home? Or someone to come when you push three numbers on your phone because someone broke into your home? Or parks?


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## pgnewarkboy (Aug 10, 2009)

Icarus said:


> Fine, no tv for you either.
> 
> -David



OK. You are pretty tough.  I'll take the healthcare and give up the TV.


----------



## caribbeansun (Aug 10, 2009)

I would agree with this 100% which is why I was finding the banter in this thread so interesting.

While I think most of us Canadians know that Michael Moore isn't the definitive word on health care in the US we do unfortunately often know one or more people that have needed care in the US while traveling and we see the $ of the bill.  Now it might cost the same here at home BUT we don't see the bill - that alone makes for a different perspective on things.



John Cummings said:


> One of the big problems in discussing this subject is that so few people really understand the realities of health care in the US or Canada.


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## Karen G (Aug 10, 2009)

GadgetRick said:


> You mean like schools? Or roadways? Or someone to come put a fire out in your home? Or someone to come when you push three numbers on your phone because someone broke into your home? Or parks?


All these services can be best provided by state and local governments, not the federal government.  And the services you mention are functions of government.


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## Icarus (Aug 10, 2009)

Karen G said:


> All these services can be best provided by state and local governments, not the federal government.  And the services you mention are functions of government.



You are so misinformed about the health care bill it's almost sad, Karen. Yes, I understand it. But that doesn't make it good.

You should really go find out the facts about it. There's a ton of misinformation and redirection out there.

The only government run healthcare program will continue to be medicare. Medicaid isn't run by the federal government, it's run by the states. Yes, there will be an optional government health insurance plan, but nobody will be forced into it. The government is not planning on providing any medical services/plans other than medicare and this new fully optional insurance plan. Nobody that doesn't already tell you what doctor you can go to or what procedure you can have is going to tell you that under the proposed bills. There are no plans for the government to get between you and your doctors or your private insurance company.

Seriously, you should get the facts.

-David


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## Liz Wolf-Spada (Aug 10, 2009)

"Life, liberty and the pursuit of happiness" surely people die without health care, and happiness is extremely elusive if one is ill without help or one looses one's home and is homeless due to large medical expenses.
Liz


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## calgarygary (Aug 10, 2009)

Karen G said:


> All these services can be best provided by state and local governments, not the federal government.  And the services you mention are functions of government.



Absolutely, that is why the right to healthcare in Canada is federal but the provision of healthcare is provincial (and I do believe that Quebec is part of Canada).  I believe that the ultimate solution for the U.S. will be a similarly legislated solution where the federal government is not involved in the delivery of the system.  That is not to say that I believe the U.S. should have the Canadian system, but I do see healthcare as a right protected by the federal government.

Karen, I do recognize that your constitution does not have healthcare as a right but the U.S. constitution (like those in most countries) is a work in progress and therefore has many amendments.  I think an amendment on healthcare would be much more important to the lives of Americans then say the 18th was (granted it was later appealed) and I struggle to understand the importance of the 27th amendment to your constitution. I recognize that the idea of a healthcare amendment to the constitution would be an incredibly difficult path to approval but I think that if the question was raised, that most Americans would agree that Healthcare is more important then say the 3rd amendment.  Finally Karen, it is very difficult to promote the General Welfare of your citizens when so many are left out.


----------



## Icarus (Aug 10, 2009)

calgarygary said:


> I believe that the ultimate solution for the U.S. will be a similarly legislated solution where the federal government is not involved in the delivery of the system.



ok, so we should scrap Medicare now too?

wow.

Except for medicare and the new optional government insurance plan (yes, it's optional), there are no plans before congress that will put the US federal government in charge of health care delivery.

-David


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## calgarygary (Aug 10, 2009)

Icarus said:


> ok, so we should scrap Medicare now too?
> 
> wow.
> 
> ...



If the global solution is a scrapping of a system that only provides partial service maybe at sometime that question will be on the table.  Obviously, I am an outsider sharing my thoughts, as was requested in the op.  I have not seen or heard nor propose anything that suggests the scrapping of medicare but maybe you have.  Nor have I seen/heard any discussion of healthcare being an amendment. 

I agree that I haven't seen anything that suggests the U.S. federal government will be in charge of delivery.  However, news reports I have seen suggest that there is a large element, seemingly under the influence of hysteria, that believe that to be so.  Please understand that I do not believe all those who want the status quo or want change, just not this change, to be hysterical.  That was just an observation from the news reports and online reports I have followed on the topic.  Hopefully, an intelligent discourse will rule the day and not emotions.


----------



## pgnewarkboy (Aug 10, 2009)

There is no bar in the U.S contitution against universal health care.  Just like there is no bar against Social Security or Medicare. No amendment is required to the U.S constitution to provide universal healthcare.


----------



## John Cummings (Aug 10, 2009)

ricoba said:


> You have no idea about the Kaiser system - yet you judge others for having no idea about your system - this is the height of smugness and hypocrisy that I grew very tired of in my 12 plus years of living in Canada....
> 
> * I agree 100%. That is one of the reasons why I would never live in Canada and I was born there and lived there.*
> 
> ...



I have received many e-mails in the last few days from Canadians that live in the US. They didn't want to post replies but they all agreed with you and me.


----------



## GadgetRick (Aug 10, 2009)

Karen G said:


> All these services can be best provided by state and local governments, not the federal government.  And the services you mention are functions of government.



And your point would be? Whether it's state or federal government, it's still government. I could care less who runs healthcare as long as it's a good (enough) system.


----------



## Beverley (Aug 10, 2009)

I, for one, do not want to be forced to drop my current health care plan.  We pay for it and its coverage is good.  I want to continue to pay for it and use it.  Some parts of at least the first version ( I have been vacationing ... sorry ... and have not kept totally up on whether anything has been added or dropped since the first pass at it) forced people like me and my hubby out of our current system and into the government run plan.  Not for me! 

My hubby was diagnosed with lymphoma just after New Year's and finished 6 months of chemo three weeks ago.  No wait except for 2 weeks for the lab results to come back.  I think this is excellent and want to be afforded the same if I am ever sick.

Hopefully what ever is done does not undo the good in what is out there today.


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## Htoo0 (Aug 10, 2009)

I apologize if this is too political, it is not my intent. I'm reading an article by a well-known Senator who envisions everyone in the U.S. having the same quality of health care he has enjoyed. There within lies the problem-that simply isn't going to happen. I wish I was wrong and I certainly don't have any 'facts' to back that up but I believe it's obvious such a high level of care simply can not be made affordable to everyone. Is it right that some should have great care while others have very little? No, but then life isn't fair nor do I think it ever will be. So what's the answer? Reduce health care to a level affordable to all? (Of course we know high-ranking government officials and the very wealthy individuals will not be so limited or we wouldn't even be having this debate.) Leave everything the way it is and if you can't afford health care, too bad? I know I don't have those answers and can't imagine anyone who does. I just hope there's some way to put the genie back in the bottle if the magic doesn't work as expected.


----------



## Icarus (Aug 10, 2009)

Beverley said:


> I, for one, do not want to be forced to drop my current health care plan.  We pay for it and its coverage is good.  I want to continue to pay for it and use it.  Some parts of at least the first version ( I have been vacationing ... sorry ... and have not kept totally up on whether anything has been added or dropped since the first pass at it) forced people like me and my hubby out of our current system and into the government run plan.  Not for me!



There is no such proposal in the bills before congress. Please please educate yourself. You have been misinformed. You can keep your current plan if you like it. You can keep your current doctors. Nobody is proposing to change any of that.



Htoo0 said:


> I apologize if this is too political, it is not my intent. I'm reading an article by a well-known Senator who envisions everyone in the U.S. having the same quality of health care he has enjoyed.



What they are talking about is the ability to choose from a variety of different healthcare providers and insurance companies, including a new optional government plan, offered through an insurance exchange, with no limits on pre-existing conditions and no coverage caps. Since virtually everybody will be required to have health insurance (or they pay a penalty), even the insurance companies support it, since the risk is spread to the entire population. Yes, there will still be age-based premiums. But no risk-based premiums. If you have diabetes, high blood pressure, or any pre-existing condition, you will be able to get insurance that covers your pre-existing conditions without exception. The coverage caps that hit people with an expensive illness will be eliminated.

Please, please, please, educate yourself on what the bills before congress actually do.

Don't base your opinions about this important topic based on one-liner sound bites.

-David


----------



## calgarygary (Aug 10, 2009)

John Cummings said:


> I have received many e-mails in the last few days from Canadians that live in the US. They didn't want to post replies but they all agreed with you and me.



John I don't dispute the emails you have seen but they are certainly not a scientific sampling.  Every poll in Canada shows overwhelmingly that Canadians prefer the Canadian system vs. the U.S. system.  So those arguements that not even Canadians support their own system just aren't accurate.  For every story that  Carolinian or yourself mention about Canadians disliking our system, I can find a thousand about Canadians who think that the greatest Canadian in history is Kiefer Sutherland's grandfather!  Think of this in U.S. terms, imagine a modern politician held in greater esteem than the greatest sports heroes, George Washington, Abraham Lincoln, etc.  That is how the majority of Canadians feel about Tommy Douglas.  It is all the more amazing in that very few Canadians share his political views.  We are an odd lot up here north of you, we are prepared to accept great ideas even when they come from political parties we can't stomache.


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## Htoo0 (Aug 10, 2009)

The article I read wasn't a one-liner soundbite. The Senator basically said he envisions a system where everyone would have the same care he, as a Senator, has enjoyed throughout his career. He also seemed to imply he is willing to compromise for now as a way to to get there step by step. I don't believe he is the only one willing to take it one step at a time until achieving the final goal of a one payer system. Nor am I taking an iron-clad position at this time as I haven't seen a final bill. I understand the current system is flawed but I am concerned the new system may lead to one just as flawed if not worse. For instance, I was very happy with my POS plan but DW convinced me to switch to an HMO. All was fine until I experienced a real problem. Now that I'm getting a taste of insurance controlled care vs doctor controlled care I can assure you I've suffered needlessly through waiting for authorizations, paid co-pays for services which should not have been necessary, and spent most of this past Saturday in an ER in much pain when before things would have all ready been resolved. Still, I know I'm getting better treatment than someone without insurance. So what's fair? Perhaps someone else should decide for me. I may be too biased.


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## Redrosesix (Aug 10, 2009)

ricoba said:


> You have no idea about the Kaiser system - yet you judge others for having no idea about your system - this is the height of smugness and hypocrisy that I grew very tired of in my 12 plus years of living in Canada....
> 
> I have lived in Manitoba, Saskatchewan and BC, and the Kaiser system that I have now is very similar to the systems that I lived under in those provinces.
> 
> ...



What?!!!!!!

I was responding to a post that said that the Canadian system was like the Kaiser system, and the post then went on to say that all procedures were rationed, some were not available, and that medications would not be allowed to be prescribed.  And my response was that that has not been my experience in the Nova Scotia system (or any family members, or anybody that I know)

I never said I was an expert in the US system -- I never actually commented on the US system -- You must have me confused with somebody else.  With the exception of pointing out that the Quebec socio-political systems cannot be used as an example of anything for the rest of Canada, I haven't even posted any information about the systems in other provinces even though my uncle is a leading physician in this country and once headed a major hospital in Calgary, I have many family members in Ontario, and have spent a great deal of time in Montreal. 

You're insulted? I did in fact go back an re-read all of my posts in this thread and could find nothing that should bring about the post that you directed at me.  I only got involved in this thread because the OP asked for Canadians to respond to questions about their health care system.  Obviously that was a HUGE mistake.


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## Icarus (Aug 10, 2009)

Htoo0 said:


> The article I read wasn't a one-liner soundbite. The Senator basically said he envisions a system where everyone would have the same care he, as a Senator, has enjoyed throughout his career. He also seemed to imply he is willing to compromise for now as a way to to get there step by step. I don't believe he is the only one willing to take it one step at a time until achieving the final goal of a one payer system.



The congressional health plan is not a single payer system. I explained what it is in my previous reply. It's not even close to that. It's an exchange system where participants can select from one of many private insurance plans.

Please get the facts straight and stop spreading more misinformation.

Your decision to switch to an HMO was your personal choice. The bills before congress don't even mandate managed care, in fact, those bills will make it much easier for you to switch back to a traditional insurance plan anytime you want since pre-existing conditions can't be used for denial of claims or for getting the policy.

-David


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## Elan (Aug 10, 2009)

calgarygary said:


> John I don't dispute the emails you have seen but they are certainly not a scientific sampling.  Every poll in Canada shows overwhelmingly that Canadians prefer the Canadian system vs. the U.S. system.  So those arguements that not even Canadians support their own system just aren't accurate.  For every story that  Carolinian or yourself mention about Canadians disliking our system, I can find a thousand about Canadians who think that the greatest Canadian in history is Kiefer Sutherland's grandfather!  Think of this in U.S. terms, imagine a modern politician held in greater esteem than the greatest sports heroes, George Washington, Abraham Lincoln, etc.  That is how the majority of Canadians feel about Tommy Douglas.  It is all the more amazing in that very few Canadians share his political views.  We are an odd lot up here north of you, we are prepared to accept great ideas even when they come from political parties we can't stomache.



  Wait a minute.  You're not implying that you find your own personal experience and polling of the populace more compelling than real live emails from real live people, are you?  If so, you're right, you Canadians are an odd lot.........


----------



## Htoo0 (Aug 11, 2009)

Icarus said:


> The congressional health plan is not a single payer system. I explained what it is in my previous reply. It's not even close to that. It's an exchange system where participants can select from one of many private insurance plans.
> 
> Please get the facts straight and stop spreading more misinformation.
> 
> ...



I'm well aware the HMO was a personal choice. Where did I imply anything different? I did say it was insurance controlled care and I believe it is. 
Nor did I say the current proposed plan was a single payer system. I did say I believe there are some who see the current proposed change as a step toward a final goal of a single payer system. If that's misinformation I'd say I'm in good company. Glad you know all the "facts". I certainly don't and don't pretend that I do.


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## Icarus (Aug 11, 2009)

Htoo0 said:


> I'm well aware the HMO was a personal choice. Where did I imply anything different?



You didn't and I didn't say otherwise. But you used that as an example of a system that you don't want, right? And I replied with it because there is no proposal in the current bill to force anybody into that system. So, yeah, I thought it was pertinent to our conversation.



> Glad you know all the "facts". I certainly don't and don't pretend that I do.



yeah. very nice.

hahaha.

You are more than implying that any change in the US system is just a step towards the ultimate goal of a single payer system, and trying to use that as a fact in an argument based on an unnamed source, aren't you?

Whatever. When facts don't work, attack the person arguing with you, I guess.

-David


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## calgarygary (Aug 11, 2009)

Elan said:


> Wait a minute.  You're not implying that you find your own personal experience and polling of the populace more compelling than real live emails from real live people, are you?  If so, you're right, you Canadians are an odd lot.........



Elan, I am saying that a poll involving millions of Canadians is much more compelling than a handful of emails.  After all, whether in a poll or an email, we are all real live people - such an odd concept so yes we are an odd lot.

Now if only I knew in what context you meant the wink.


----------



## Elan (Aug 11, 2009)

calgarygary said:


> Elan, I am saying that a poll involving millions of Canadians is much more compelling than a handful of emails.  After all, whether in a poll or an email, we are all real live people - such an odd concept so yes we are an odd lot.
> 
> Now if only I knew in what context you meant the wink.



  I understood your point, one which seems to have been lost on so many posting here.   My comment was made completely in jest.  The wink was in lieu of a "dripping with sarcasm" emoticon.


----------



## pgnewarkboy (Aug 11, 2009)

Htoo0 said:


> I believe it's obvious such a high level of care simply can not be made affordable to everyone. Is it right that some should have great care while others have very little? No, but then life isn't fair nor do I think it ever will be. So what's the answer? Reduce health care to a level affordable to all? (Of course we know high-ranking government officials and the very wealthy individuals will not be so limited or we wouldn't even be having this debate.) Leave everything the way it is and if you can't afford health care, too bad? I know I don't have those answers and can't imagine anyone who does. I just hope there's some way to put the genie back in the bottle if the magic doesn't work as expected.



The above statement reflects two related major assumptions about health care in the U.S.   The first assumption (based on the facts and accepted by most) is that good health care in the U.S. is very expensive and is therefore available to only the well-off (people with money and or access to good insurance plans they can afford )and or powerful.  The second assumption is that because it is so expensive it cannot be provided to everyone without lowering the quality of health care to some and increasing taxes or the deficit. I think this is a fear that in large part drives those opposed to reform.  

I assert that as a matter of fact we in the U.S have the opportunity and ability to design reform that will provide high quality health care to all, and that we can afford to do so without raising the deficit. It is simply a matter of desire and making choices about how we spend our collective money.


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## GadgetRick (Aug 11, 2009)

pgnewarkboy said:


> I assert that as a matter of fact we in the U.S have the opportunity and ability to design reform that will provide high quality health care to all, and that we can afford to do so without raising the deficit. It is simply a matter of desire and making choices about how we spend our collective money.


Exactly. And I don't know why they're trying to ram the currently proposed solution down everyone's throat without allowing anyone the time to think about whether it's the right solution at the right time...


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## Icarus (Aug 11, 2009)

GadgetRick said:


> Exactly. And I don't know why they're trying to ram the currently proposed solution down everyone's throat without allowing anyone the time to think about whether it's the right solution at the right time...



lol, sure, let's wait another 12 years.

It was part of Obama's platform, discussed for well over a year during the campaign, and they've been working on it for how long now? And they aren't done yet. When would be the right time for you, Rick? Do you have your calendar handy?

-David


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## pgnewarkboy (Aug 11, 2009)

GadgetRick said:


> Exactly. And I don't know why they're trying to ram the currently proposed solution down everyone's throat without allowing anyone the time to think about whether it's the right solution at the right time...



One of the problems is that we don't know what the proposed solution is.  I believe there are three bills that made it out of house committees and one or two bills that made it out of senate committees.  Once all the bills make it out of the required committees they will have to be debated and reconciled before anything is put to a vote.  Before anything in the house or senate is put to an actual vote there will be numerous amendments.  If anything actually ends up being passed by either the House or Senate the two bills will go to a committee for reconciliation.  The proposed reconciled bills would then have to go through the amendment process again and then a vote.

I have personally experienced this process.  It is grueling for even the most minor legislation.  The only "bills" that usually go through easily are nothing but resolutions honoring mom and apple pie.  Everything else is excruciating. With the notable exception of the bills that were passed in response to 9/11.  I am not a happy camper with those results.

So far, no bill of any kind has been put to a vote outside of a few committees.  Personally, I am not interested in stock boiler plate arguments from ANY side in this whole matter.  I firmly believe that universal care is the right thing to do and is needed for economic well being of our society.  I also believe that costs must be contained and the quality of care must be high and any program paid for.  I also believe that medical decisions should be made by doctor and patient based upon solid evidence of what works. 

I don't want a half fast solution that caters to special interests to the detriment of the people.  As a supporter of universal health care, I will not support "anything".  In my view "anything" is not better then "nothing".  So, the bottom line is that this is a big agenda item.  As we have already seen, there is no chance of anything being rushed through.  

I am a supporter in theory who could become an opponent in fact if the product stinks.  I hope that something good will come out of this process but suspend judgement until there is actually something to judge.


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## Karen G (Aug 11, 2009)

Icarus said:


> Please get the facts straight and stop spreading more misinformation.


One of the big problems with all this is that we aren't being given the facts. Politicians say whatever they think will help them stay in power; the President urges them to quickly vote on bills before they've had time to read them; and when anyone does actually read these bills, they are so confusing no one really knows what is in them. Fortunately, the voting has been delayed so that people can actually study the bills before Congress and have these debates.

Since I'm planning to enjoy my vacation here in Cabo I doubt that I'll post any more to this thread. But just because I don't post doesn't mean I'm not still very alarmed about the proposed changes to our country.


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## calgarygary (Aug 11, 2009)

Elan said:


> I understood your point, one which seems to have been lost on so many posting here.   My comment was made completely in jest.  The wink was in lieu of a "dripping with sarcasm" emoticon.



I thought that might be the case but I didn't want to assume. 



pgnewarkboy said:


> I firmly believe that universal care is the right thing to do and is needed for economic well being of our society.  I also believe that costs must be contained and the quality of care must be high and any program paid for.  I also believe that medical decisions should be made by doctor and patient based upon solid evidence of what works.


 Possibly one of the very best thoughts shared in this thread. IMHOP


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## Redrosesix (Aug 11, 2009)

Since we're now discussing the US system, maybe it might be a good time to go back to the original intent of this thread.  Canadians are not here to say that the US should adopt our system.  I can easily say that most Canadians see universal health care as an apolitical issue, and the way it works is fundamentally based on our constitution, the BNA Act (1867) which created the country, and was later reafirmed as an individual right in the Charter of Rights and Freedoms.

I don't know if the same types of issues would come into play with the US health care system, but just the statements I have heard from people in the media re their concerns that health care legislation could grow into much more far-reaching socio-political changes make me realize just how contentious this issue is going to be in the days to come.  I'm not sure that is even possible, but I know that in Canada, that would not be possible because of the constitutional framework within which health care legislation exists.


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## BocaBum99 (Aug 11, 2009)

I think it's fantastic that Canadians love their system.  They can keep it.  I am American and I like the quality of our healthcare and I don't want that destroyed.  I would bet that a poll of Americans that asks if they would like to have our current system or Canada's that they would vote to keep the current system we have despite all its flaws.  

I don't believe in idealistic solutions.   They don't exist except in fantasyland.  There is only better or worse.  Given the nature of the beast, whenever government gets involved in anything, it gets worse, not better.  As soon as I see some proof that any government healthcare program is better than what we currently have, I'll support it.  Until then, I'll be very skeptical.  I'd like to see a trial program run in a few states with the before and after picture clearly in view for all to see before we risk our entire healthcare system on a theory in an irreversible way.

The bottom line is that any system where 40M people will create additional demands on the doctors without a commensurate increase in supply of doctors will result in long lines, denied care and bureaucrats making choices on who gets the care vs. who doesn't.  They may like that in Canada, but Americans don't like that idea at all.


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## calgarygary (Aug 11, 2009)

BocaBum, I appreciate your feelings and have never stated that the U.S. should adopt the Canadian system.  I agree that in a poll, most Americans would likely chooe the existing U.S. system over Canada's.  However in those same polls, I believe that they are now showing that most Americans now want some form of a universal system - in all liklihood a hybrid.  I have attempted to correct some misconceptions about our system, as have others, and in doing so, it may be misconstrued that we think the U.S. should copy the Canadian system.  One statement you made though exemplifies the misinformation that is out there.  Bureaucrats do not make choices about who gets care - so implying that Canadians may like that is inaccurate.   I can not be clearer, there is no government involvement in health decisions regarding my family.

It is unfortunate that you are prepared to dismiss the health needs of 40 million people because of its possible impact upon you.  I personally feel that approach is short sighted because those 40 Million (or whatever substantial number it is) will cause a tremendous drain on your system moving forward as they turn to emergency care instead of seeking treatment through the family physician.  That care is incredibly expensive and that cost is bourne by all.


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## Liz Wolf-Spada (Aug 11, 2009)

Boca, you bring up an interesting point about longer delays with more people, that hasn't been discussed. I don't believe it is a reason to not insure everyone, but it is a reason to consider maybe a "doc for America" program, like Teach for America, where new medical professionals could work at a reasonable, but reduced salary, in exchange for some government loan forgiveness. (yes, I know, the government would have to get involved and many of you don't like that idea). Anyway, I think everyone should have access to health care and you have added an important point in the discussion as to how to increase the supply of doctors.
Liz


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## Redrosesix (Aug 11, 2009)

BocaBum99 said:


> I think it's fantastic that Canadians love their system.  They can keep it.  I am American and I like the quality of our healthcare and I don't want that destroyed.  I would bet that a poll of Americans that asks if they would like to have our current system or Canada's that they would vote to keep the current system we have despite all its flaws.
> 
> I don't believe in idealistic solutions.   They don't exist except in fantasyland.  There is only better or worse.  Given the nature of the beast, whenever government gets involved in anything, it gets worse, not better.  As soon as I see some proof that any government healthcare program is better than what we currently have, I'll support it.  Until then, I'll be very skeptical.  I'd like to see a trial program run in a few states with the before and after picture clearly in view for all to see before we risk our entire healthcare system on a theory in an irreversible way.
> 
> The bottom line is that any system where 40M people will create additional demands on the doctors without a commensurate increase in supply of doctors will result in long lines, denied care and bureaucrats making choices on who gets the care vs. who doesn't.  They may like that in Canada, but Americans don't like that idea at all.



I was going to post a very snarky response to this post, but I'll just agree with you and say Yes, an additional 40 million people suddenly having access to health care is going to cause some issues.

If anyone ever needed proof that Canadians and Americans are fundamentally different, I think we may have found it.


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## GadgetRick (Aug 11, 2009)

Icarus said:


> lol, sure, let's wait another 12 years.
> 
> It was part of Obama's platform, discussed for well over a year during the campaign, and they've been working on it for how long now? And they aren't done yet. When would be the right time for you, Rick? Do you have your calendar handy?
> 
> -David



Hmm, it's been the part of platforms for years and nothing has been done. So, because it's been discussed (not in detail), we should just ram something down everyone's throat before anyone has the time to actually look at the details? Yes, you're right, the heck with the people, let's just give them something they don't understand....

Maybe the right time would be when everyone has had time to digest what's being proposed. Heck, the people in Congress haven't even had the time to look into this. I'm all for change but it shouldn't be rushed through. If they're gonna spend these kinds of dollars, maybe they should ensure it makes sense and, more importantly, it's what the PEOPLE want...

Thanks for the sarcarsm...


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## Redrosesix (Aug 11, 2009)

Liz Wolf-Spada said:


> Boca, you bring up an interesting point about longer delays with more people, that hasn't been discussed. I don't believe it is a reason to not insure everyone, but it is a reason to consider maybe a "doc for America" program, like Teach for America, where new medical professionals could work at a reasonable, but reduced salary, in exchange for some government loan forgiveness. (yes, I know, the government would have to get involved and many of you don't like that idea). Anyway, I think everyone should have access to health care and you have added an important point in the discussion as to how to increase the supply of doctors.
> Liz



This incentive was tried in a few Canadian provinces to deal with critical shortages of doctors in rural areas, especially General Surgeons.  Apparently, there was some success.  Nova Scotia has also tried some other methods, but has apparently had the most success with fast-tracking certification of immigrant doctors ie. they don't have to retake their entire medical degree if the schools they were trained at were equivalent to ours.  In some cases, they had to retake only certain parts of the curriculum.  I think these types of programs might be necessary under any health care system, however, especially wrt rural areas.  Unfortunately, in many areas there just is not sufficient population for a Dr. to have a full case load, and would otherwise be unable to afford to repay loans along with the financial obligations of a medical practice.


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## GadgetRick (Aug 11, 2009)

BocaBum99 said:


> I think it's fantastic that Canadians love their system.  They can keep it.  I am American and I like the quality of our healthcare and I don't want that destroyed.  I would bet that a poll of Americans that asks if they would like to have our current system or Canada's that they would vote to keep the current system we have despite all its flaws.



I think you underestimate the hatred many Americans have for our system. I, for one, would take Canada's system (pick a province, any province) over what we have here. And, yes, I have good coverage. This is not saying we should adopt their system, I just feel their system is better than ours. I feel we have a lot to learn from them and the challenges they have with their system as well as other systems sponsored by governments. We should take advantage of the fact there are many government-sponsored programs up and running (for a number of years) in other countries. We can learn from their mistakes and implement fixes BEFORE they become problems...

Of course, you'll never keep everyone happy so someone will be unhappy regardless of the program someone is living under.


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## Carolinian (Aug 11, 2009)

Here are some interesting concerns from former New York Mayor Ed Koch.  Particularly look at some of the criteria for determining who gets care about the middle of the article:

www.realclearpolitics.com/articles/2009/08/11/falling_out_of_love_with_barack_obama_97843.html

And here are some other concerns about this bill from a supporter of universal health care, particularly as to euthanasia:

www.thedailybeast.com/blogs-and-stories/2009-08-11/obamas-euthanasia-mistake/?cid=bsa:archive4


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## Redrosesix (Aug 11, 2009)

Just a few more random points re the NS system:
* some people asked about the tax rates to finance our system.  In NS, a large portion of it is paid for through additional taxes on alcohol and tobacco (the latter especially), which are known here as the sin-taxes.  The rationale for taxing tobacco so much is that the use of tobacco contributes so much to ill-health and increased health care costs.  There is also the corollary that if cigarattes, etc. are made more expensive, less people will use them (or people will use them less) and this will reduce health care costs on the whole.
* in NS, dentistry is not covered except for children (and they have been gradually reducing the cut-off age).  At one time, extractions of infected teeth were covered and IMO I still think they should be.
* one of the biggest controversies in the NS health care system is that it has not kept pace with advances in medicine re use of prescription medicines.  Many ailments could only be cured by surgery but now they are more efficiently dealt with by prescription drugs (which are not covered for most people, unless they have private medical insurance).  The last few years, there have been more steps to provide prescription med coverage to more people, including seniors and families.
* the biggest crises in understaffing, etc. have been precipitated by economic causes, ie. migration of workers from one part of the country to another to find work or take advantage of increasing business opportunities.  But that could occur in any system at least on a temporary basis.  This has had a direct effect on the NS system because the coverage for transplanted Nova Scotians continues for a year, despite the fact that they are no longer paying taxes here -- it takes some time for things to get sorted out when there is a major economic crisis, as there was here when many of the fisheries were closed.

And finally, I don't even know anyone who has travelled to the US for health care.  Perhaps that's because we don't live right across the border from the US, but I feel like every time I watch the American news, somebody makes a statement to the effect that we're all traveling to the US for medical care.  That simply isn't the case.


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## TUGBrian (Aug 11, 2009)

It is a shame that this thread has turned into what many predicted it would from the start.  I was extremely impressed and interested to read the first few pages of the thread, however now its just turned into your average run of the mill disagreement/argument.

only and final warning, no snide comments, no insults, no more political/govnt reference to incompetence (or vice versa you being incompetent for not agreeing with it).

posts following this warning that fall into the above categories will be deleted with no further warning.


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## Zac495 (Aug 11, 2009)

Everyone deserves health care.Period. I am very lucky to have great health care (I'm a US citizen). But not everyone is so lucky.
It is a right - how can anyone compare it to a TV? Sometimes we forget that it's not all about ME.


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## Redrosesix (Aug 11, 2009)

Carolinian said:


> Here are some interesting concerns from former New York Mayor Ed Koch.  Particularly look at some of the criteria for determining who gets care about the middle of the article:
> 
> www.realclearpolitics.com/articles/2009/08/11/falling_out_of_love_with_barack_obama_97843.html
> 
> ...



I read both of these articles in their entirety, but I really don't see how either one applies to the Canadian health care system


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## Zac495 (Aug 11, 2009)

pgnewarkboy said:


> Another problem in the United States is that most often medical decisions are not ultimately made by your doctor.  The insurance company decides if a treatment or medicine is warranted and therefore covered by the insurance.  In other words, a doctor could order a test, medicine, or procedure and a clerk at the insurance company (following company guidelines) could deny payment for that treatment.  Medical treatment, diagnosis, and medicine is so expensive that most people cannot afford to pay for it themselves.  I have personally had my insurance company refuse to pay for medicine prescribed by my doctor.  And as I have said, I am considered to have good insurance.



This is the reason I had to wait until my pacemaker ran completely out of batteries to get fixed. I was actually told by the doctor that the insurance company wouldn't pay until the pacemaker completely stopped - and I was very sick (true) because I'm young and they want to get as  few pacemakers in my body over my lifetime as possible.


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## calgarygary (Aug 11, 2009)

I am not certain that a discussion of euthanasia is germaine to the topic but let's discuss it as it exists in Canada.  There is no euthanasia policy.  Like the U.S., loved ones across the country are inevitably faced with difficult decisions.  Those decisions involve no bureaucrats, accountants, or administrators.  The decision is made by family with the consultation of physicians but it never involves euthanasia (which is a crime in Canada) but rather whether to continue care.  The topic of euthanasia received widespread coverage and discussion in Canada with the Robert Latimer case which resulted in his conviction. 

I am not sure why those links were provided in a Canadian Healthcare thread, but if it is to imply that changes to a universal healthcare system would result in euthanasia, then that is inaccurate.  Maybe if the thread was a discussion of the Dutch healthcare system it would be relevant.  I would only support Canada copying the Dutch system if we also had their cafes.  There might even be some support for that idea in the U.S.


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## donnaval (Aug 11, 2009)

> but I feel like every time I watch the American news, somebody makes a statement to the effect that we're all traveling to the US for medical care. That simply isn't the case.



I realized I never reported that I personally traveled from the US to Canada for care!  About 7 years ago, my husband and I decided we'd like to have  laser surgery for our eyes.  US prices ranged from $8000 to $12,000 total each for the surgery, and in several cases the surgery was not recommended due to the severity of my near-sightedness or for my husband because of astigmatisms.  I heard from a friend who worked for an opthamologist(sp?) that Canadian docs were using a newer-generation laser machine and at a much lower cost, so we traveled to Toronto for an exam.  Turns out my degree of myopia and my husband's astigmatisms were no problem at all for this up-to-date laser, and to make it even sweeter for us, the doctor was opening a new office in Niagara Falls which was closer for us.  Long story short, our state-of-the-art eye laser surgery cost $800 US per person done in Canada--one-tenth of the best price I could have had it done for here.  The only downside was we had to take two short vacations in Niagara Falls for the surgery and follow-up exams 

I also know several folks who travel to Canada for prescription drugs which they can buy much less expensively there than here.

I really appreciate the input from the Canadian folks here.  It is very illuminating.


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## BocaBum99 (Aug 11, 2009)

calgarygary said:


> It is unfortunate that you are prepared to dismiss the health needs of 40 million people because of its possible impact upon you.  I personally feel that approach is short sighted because those 40 Million (or whatever substantial number it is) will cause a tremendous drain on your system moving forward as they turn to emergency care instead of seeking treatment through the family physician.  That care is incredibly expensive and that cost is bourne by all.



I am not dismissing the needs of 40M people.  And, I am far for short sighted.  I have seen other ideas that I believe are far superior to the ones on the table for solving the problem.  I've posted those ideas on other boards.  

I am saying that any plan that adds demand to a system must add supply as well or the system will fail or severely degrade.  In such a situation, everyone suffers for a noble theory that isn't executed properly.  If any plan does not have a credible plan to increase capacity, then the law of economics suggests that many people will be denied care or experience severe delays in receiving it.  This is FACT.

Recent polls that I have seen suggest that a super majority of Americans like their healthcare and they don't want to see it destroyed without some level of comfort that a new plan will work.  I am not against change or reform.  I am against untested theories supported only with good intentions.


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## Icarus (Aug 11, 2009)

Carolinian said:


> And here are some other concerns about this bill from a supporter of universal health care, particularly as to euthanasia:
> 
> www.thedailybeast.com/blogs-and-stories/2009-08-11/obamas-euthanasia-mistake/?cid=bsa:archive4



More dis-information and misdirection. But that's par for the course.

There is a new proposed medicare benefit that offers counseling to people near the end of their life, and it's supposed to be for helping them creating living wills and things like that. Some people, in order to spread fear, have turned that into something it isn't. I can't imagine why.

-David


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## Redrosesix (Aug 11, 2009)

Icarus said:


> More dis-information and misdirection. But that's par for the course.
> 
> There is a new proposed medicare benefit that offers counseling to people near the end of their life, and it's supposed to be for helping them creating living wills and things like that. Some people, in order to spread fear, have turned that into something it isn't.
> 
> -David



Thanks for the clarification on that issue.

And I have to back up Calgarygary here -- the issue of euthanasia is not pertinent to a discussion of the Canadian health care system since it is against the law (everywhere in Canada, since criminal law is a federal jurisdiction).  However, I will add that I chose to sign a Do Not Resuscitate order for both of my parents (my mother actually pulled through) since their condition at the time did not warrant doing everything to try to revive them if their heart stopped -- which the hospital would have had to do, by law, if those papers had not been signed.


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## John Cummings (Aug 11, 2009)

donnaval said:


> About 7 years ago, my husband and I decided we'd like to have  laser surgery for our eyes.  US prices ranged from $8000 to $12,000 total each for the surgery, and in several cases the surgery was not recommended due to the severity of my near-sightedness or for my husband because of astigmatisms.



Those US prices are hard to believe. My wife and I both had Lasik eye surgery in the San Francisco Bay area in 2000 and 2001. We had it done at the best Lasik eye center in the area with the latest technology. I had extreme astigmatism. It went so well that after the surgery I had better than 20/20 vision and absolutely no side effects like haloing etc. The cost was $3300 but our insurance paid most of it so it only cost us $500.00. That included all pre-care and post-care for a year plus free touch-up if necessary. There were many Lasik Eye centers that charged a lot less but we wanted the best.


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## Liz Wolf-Spada (Aug 11, 2009)

John, you're unusual in that your insurance paid for lasik. I have had a lot of different policies from work, Blue Shield HMO and PPO, Health Net POS, Blue Cross POS and PPO and none of them covered lasik. I, however, am scared to do this anyway, so ....
I have gone to Canada for a flu shot, as I mentioned before, and it was so easy and definitely not rationed as it was at the time in the US.
Boca, adding more doctors or FNP's would be beneficial for adding more jobs also.
Liz


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## donnaval (Aug 11, 2009)

John--I sure wish I could get the deals you do for health care.

Yes, back when we were checking out things, lasik surgery cost from $4,000 to $7,500 PER EYE in the Pittsburgh area.  Our insurance would not pay anything toward it.  Prices have dropped some since then, but not all that much--my best friend had her eyes lasered earlier this year and paid $6,800.  Not one penny of it was covered by her insurance.


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## John Cummings (Aug 11, 2009)

Liz Wolf-Spada said:


> John, you're unusual in that your insurance paid for lasik. I have had a lot of different policies from work, Blue Shield HMO and PPO, Health Net POS, Blue Cross POS and PPO and none of them covered lasik. I, however, am scared to do this anyway, so ....
> I have gone to Canada for a flu shot, as I mentioned before, and it was so easy and definitely not rationed as it was at the time in the US.
> Boca, adding more doctors or FNP's would be beneficial for adding more jobs also.
> Liz



I have had several different insurance plans and providers but that one was the best. I was working at a small startup high tech company in Livermore that had great benefits. It was the smorgasbord plan where the company gives you a set amount of money per month and you choose whatever benefits you want. If you don't spend it all then you keep what is left which was always the case for me and everybody else I knew. I had vision insurance which did cover Lasik up to a certain amount. All other vision services, like glasses, contacts, tests, etc. were covered 100%. My health insurance was the best in that it was a PPO but had many of the advantages of a HMO.

Both my wife and I have had flu shots every year with no problem and they have been 100% free.


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## BocaBum99 (Aug 11, 2009)

Liz Wolf-Spada said:


> Boca, you bring up an interesting point about longer delays with more people, that hasn't been discussed. I don't believe it is a reason to not insure everyone, but it is a reason to consider maybe a "doc for America" program, like Teach for America, where new medical professionals could work at a reasonable, but reduced salary, in exchange for some government loan forgiveness. (yes, I know, the government would have to get involved and many of you don't like that idea). Anyway, I think everyone should have access to health care and you have added an important point in the discussion as to how to increase the supply of doctors.
> Liz



I don't think this solves the problem.  It's the same pool of doctors you are tapping.  I think there has to be a new class of medical professional with a reduced requirement for certification that supports certain type of ailments and are paid less than ordinary doctors.  In this way, the supply of health care professionals is actually increased.  Have those professionals work in clinics and have private insurance policies that allow those citizens to get healthcare at those clinics.

I don't have all the answers about how this would be funded and/or subsidized by the government, if at all.  I'd leave it to the people who understand that business.  But, I do know basic supply and demand and without increasing supply, someone, if not everyone will be harmed.


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## John Cummings (Aug 11, 2009)

donnaval said:


> John--I sure wish I could get the deals you do for health care.
> 
> Yes, back when we were checking out things, lasik surgery cost from $4,000 to $7,500 PER EYE in the Pittsburgh area.  Our insurance would not pay anything toward it.  Prices have dropped some since then, but not all that much--my best friend had her eyes lasered earlier this year and paid $6,800.  Not one penny of it was covered by her insurance.



I can only say two things. First, I do a lot of research, checking everything etc. and choosing the best options. I ask my health insurance broker, doctors, friends, etc. and do a lot of research on the Internet. I have worked for 15 different companies from very small startups to mid-size to very large in Oregon, California, Arizona, and Florida. Every company had good medical insurance with most of them offering your choice of at least 3 different plans. My son in law works for Raytheon in Los Angeles and he has his choice of 6 different insurance providers. He pays a whopping $12.00 /mo for his insurance through Health Net. I was self employed for many years and incorporated so I had to get insurance for my wife and I. I used a very good insurance broker in San Diego that helped me a lot. There is no charge for using a broker and it was required for getting group insurance through my own business. When I was eligible for Medicare, I dissolved the corporation and switched to a very good Medicare Advantage plan. This made it necessary that my wife has her own medical insurance as she is under 65. My broker in San Diego got a very good policy for her at a reasonable premium. We have always had very good service. My wife and I have had several surgeries and hospital stays that were covered 100%.

Second, all I can say about the Lasik is that your prices in PA are out of sight. The prices I quoted were the total for both eyes. Prices have come down since we had it done. Several of our friends and relatives in California have had the Lasik surgery with very good results.


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## John Cummings (Aug 11, 2009)

BocaBum99 said:


> I don't think this solves the problem.  It's the same pool of doctors you are tapping.  I think there has to be a new class of medical professional with a reduced requirement for certification that supports certain type of ailments and are paid less than ordinary doctors.  In this way, the supply of health care professionals is actually increased.  Have those professionals work in clinics and have private insurance policies that allow those citizens to get healthcare at those clinics.
> 
> I don't have all the answers about how this would be funded and/or subsidized by the government, if at all.  I'd leave it to the people who understand that business.  But, I do know basic supply and demand and without increasing supply, someone, if not everyone will be harmed.



That has existed for many years with nurse practitioners and physician assistants. They are allowed to treat the common stuff like colds, flu, etc. They can prescribe drugs. They are quite common in many group practices and at Kaiser, etc.


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## Icarus (Aug 11, 2009)

BocaBum99 said:


> I don't think this solves the problem.  It's the same pool of doctors you are tapping.  I think there has to be a new class of medical professional with a reduced requirement for certification that supports certain type of ailments and are paid less than ordinary doctors.  In this way, the supply of health care professionals is actually increased.  Have those professionals work in clinics and have private insurance policies that allow those citizens to get healthcare at those clinics.



They have that already. They are called PAs (Physicians Assistants). I'm not a nurse, so I don't know the training requirements to be a PA, but it's a higher form of certification than RN, as far as I know. They can do basic treatment, follow-up, and write prescriptions.

You know, John, I think the cheapest plans are still going to be those plans that have very high deductibles and copays and don't cover preventative care, which are basically catastrophic illness policies. Which is sort of like what you have, but you have ability to use and fund a tax-free spending account to cover your deductibles and copays at negotiated rates.

Plans that cover everything are still going to be expensive and people that can't afford those plans, I imagine, are not going to opt into them.

So I'm not sure I see a huge influx of new patients being seen on a daily basis at your doctors office because of these plans.

What it does mean is that somebody who needs to be hospitalized or has a serious illness will now have insurance to cover those things. They are already being seen, and the insured and those that can afford it are subsidizing the system to pay for their care today.

-David


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## BocaBum99 (Aug 12, 2009)

Icarus said:


> They have that already. They are called PAs (Physicians Assistants). I'm not a nurse, so I don't know the training requirements to be a PA, but it's a higher form of certification than RN, as far as I know. They can do basic treatment, follow-up, and write prescriptions.
> 
> You know, John, I think the cheapest plans are still going to be those plans that have very high deductibles and copays and don't cover preventative care, which are basically catastrophic illness policies. Which is sort of like what you have, but you have ability to use and fund a tax-free spending account to cover your deductibles and copays at negotiated rates.
> 
> ...



Okay, if there is already a class of licensed practitioner to meet the need, then there needs to be an incentive for more people to go into the profession en masse.   Something needs to be done to increase supply at the same rate as demand increases.  Or, the system will break down and everyone's worst nightmare will come true.

I don't agree with the concept that people are already getting care today, they are just uninsured.  Sure, the emergency rooms are getting hammered, but if people now have insurance and there is a limited number of doctors, simple math suggests long waits for appointments of all types as those who wouldn't normally get health care except when they had to go to the emergency rooms flood the system with appointments.

I agree with high deductible plans with healthcare savings accounts.  I have that now and it works brilliantly.  I get pre-negotiated PPO rates and I choose what we think we need.  Plus, we get cash discounts since there is no fighting with insurance companies for the provider to get paid.  They run the credit card and then cash is in their accounts the next day.

Lastly, whatever the ultimate healthcare bill becomes, I want to see it tested in a few states for a few years with clear statistics that shows the before and after state of healthcare delivery.  Like any business initiative, it should target 10x improvement in a set of key metrics.  If it is substantially better than it was before, then we can apply that math to the other states to accurately assess the overall impact to the economy and healthcare delivery.  At this point, if this market test of the new system isn't done, the plan is sure to fail and to overrun costs and underdeliver on promises.   This plan would include metrics to watch the overall demand for services and its relation to the supply of healthcare professionals.

I hope someone brings this up somewhere.  If they don't, I don't see how it can become successful.


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## Icarus (Aug 12, 2009)

BocaBum99 said:


> I don't agree with the concept that people are already getting care today, they are just uninsured.



That it isn't an accurate characterization of what I said.

I don't personally know if the current system is overutilized today or not. It's not an unreasonable concern, but I don't think it's going to be a huge problem. That's just my personal opinion. The system will adjust to the demand.

-David


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## BocaBum99 (Aug 12, 2009)

Icarus said:


> That it isn't an accurate characterization of what I said.
> 
> -David



How else can one interpret this statement?



> What it does mean is that somebody who needs to be hospitalized or has a serious illness will now have insurance to cover those things. They are already being seen, and the insured and those that can afford it are subsidizing the system to pay for their care today.



This statement says that today, the insured are subsidizing the care of the uninsured who are getting care anyway.


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## Icarus (Aug 12, 2009)

BocaBum99 said:


> How else can one interpret this statement?
> 
> 
> 
> This statement says that today, the insured are subsidizing the care of the uninsured who are getting care anyway.



That is true. For critical emergency care and for people that succumb to expensive, life threatening diseases and end up on public assistance and medicaid after running through any savings or assets they might have, plus the unreimbursed hospital, lab, pharmacy, nursing, doctors, etc fees that have to be recouped somehow.

But not for preventative care so much. But my point was that the vast majority of the uninsured are not likely to elect expensive insurance plans that cover lots of doctors visits and have low copays.

Take a look at how Kaiser prices their plans in Hawaii. The cheapest plans only allow for a few included doctors visits per year and have high copays and very high prescription drug copays. The most expensive plans cost 4x the cheapest plans allow for unlimited doctors visits, low copays and very low prescription drug copays. But both cover catastrophic illness and both kick in 100% once your annual out of pocket max has been reached. There are intermediate choices between the low end and high end plans.

There's more to it than that.

I just don't think our system is fully utilized to the point where droves of people are going to overburden it with any of these new plans. The system will adjust.

-David


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## pgnewarkboy (Aug 12, 2009)

The way insurance companies pay doctors has created doctor shortages - particularly in primary care.  I have seen several in depth reports on the crisis in primary care on NBC and CBS (it could have been ABC).

Primary care doctors are paid far less money for their services  then specialists by insurance companies.  Consequently, medical school graduates do not want to go into primary care.  That is the simplest explanation but there is far more to it.

Every medical office today must have people who can handle health insurance claims.  These people are a specialty unto themselves.  They call it "medical billing" but it is really "insurance billing".  Doctors will not get paid by insurance companies for their services to you as a patient unless they get approval for payment by the insurance bureaucracy.  This is no simple matter.  First, whatever the doctor does must fit into a diagnosis or treatment code.  When billing the insurance company the doctors office must use the correct code or they will not get paid.  Billing specialists must be fluent in understanding and applying these codes.  It is not a simple matter. Having the correct code is just the start of the process. The paper work must be submitted on the proper forms (different for each company), in a timely manner (different for each company), and often with referrals (different for each company).  After submitting the bill the insurance company is free to deny it based upon your individual coverage as a patient.  If it is denied, the patient is responsible for the bill in its entirety.

Here is a typical scenario.  Doctor submits bill.  Bill denied (insurance company uses their own weird code for denial).  Doctor sends patient bill for payment in full. Patient screams bloody murder and calls doctor asking why the insurance company didn't pay.  Doctor says call your insurance company.  Patient calls the insurance company and eventually says (after numerous calls) code used by doctor inappropriate, bill submitted late, there was no referral, pre-existing condition etc.  Patient calls doctor back and says please fix this matter - I can't afford to pay you.  The doctors billing person calls back the insurance company (numerous times) to see if the problem is fixable.  They re-submit the claim.  Sometimes numerous times.  Eventually the bill gets paid by the insurance or it doesn't.  If it doesn't the doctor must collect from you.  They eventually hire a collection agency to get their money who typically takes one-third of the proceeds for the collection.

All of the above costs the doctors office a great deal of time, effort, and MONEY. This goes on every single day in every single doctors office that takes insurance.  It is the same time, effort, and money if you are a specialist or a primary care physician.  The primary care doctor has the same overhead as the specialist for billing insurance but gets paid less and therefore must see more patients to make any kind of money.  No wonder people don't want to go into primary care!


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## Redrosesix (Aug 12, 2009)

BocaBum99 said:


> Lastly, whatever the ultimate healthcare bill becomes, *I want to see it tested in a few states for a few years *with clear statistics that shows the before and after state of healthcare delivery.  Like any business initiative, it should target 10x improvement in a set of key metrics.  If it is substantially better than it was before, then we can apply that math to the other states to accurately assess the overall impact to the economy and healthcare delivery.  At this point, if this market test of the new system isn't done, the plan is sure to fail and to overrun costs and underdeliver on promises.   This plan would include metrics to watch the overall demand for services and its relation to the supply of healthcare professionals.
> 
> I hope someone brings this up somewhere.  If they don't, I don't see how it can become successful.



When universal health care was first introduced in Canada, it was only in Saskatchewan, Alberta followed and within 10 years the federal government had negotiated with the other provinces to have it across the country ie. once Canadians saw how the Saskatchewan system worked, everybody wanted it.  But it happened this way because of the constitutional framework -- Saskatchewan had the power to unilaterally introduce the system.

From the way I read your post, I'm understanding that your federal government has the power to choose where to introduce a new program with or without the cooperation of the state or municipal government.  If that is the case, then a pilot program could be run in a city ie. a place where all of the health care needs of that sample population could be met.  JMHO, I think keeping the sample area smaller would allow them to test the program without running into peripheral issues such as urban/rural disparities, transportation issues (especially ambulances) and income related issues eg. if universal health care was introduced in some areas of Appalachia, where currently many towns have no doctor because nobody has insurance or money, the results of the study would inevitably be skewed.  Sure, having coverage for everybody might fix some of these problems, but that is not really what you want to test -- you just want to test how the new program works within the context of the resources that already exist.

I also think that if a city of at least 500,000 people was tested, you would have sufficient data to do the appropriate studies after only 1 year.



pgnewarkboy said:


> The way insurance companies pay doctors has created doctor shortages - particularly in primary care.  I have seen several in depth reports on the crisis in primary care on NBC and CBS (it could have been ABC).
> 
> Primary care doctors are paid far less money for their services  then specialists by insurance companies.  Consequently, medical school graduates do not want to go into primary care.  That is the simplest explanation but there is far more to it.
> 
> ...



I think this is where the cost savings exist for us. 

But there are obviously other areas where more money can be saved in Nova Scotia.  We don't have anything like physician's assistants -- the public health nurses used to do something like this many years ago, especially when families had to be quarantined for whooping cough, etc. I remember thinking how ridiculous it was to have to take my DD to her first Dr's appt when she was 1 week old in the middle of flu season.  Either she could have been visited at home, or all those coughing people could have seen somebody other than a Dr. to get a sick note for their workplace.


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## John Cummings (Aug 12, 2009)

Icarus said:


> You know, John, I think the cheapest plans are still going to be those plans that have very high deductibles and copays and don't cover preventative care, which are basically catastrophic illness policies. Which is sort of like what you have, but you have ability to use and fund a tax-free spending account to cover your deductibles and copays at negotiated rates.-David



Obviously the plans with the higher deductibles are going to be cheaper. It doesn't take a rocket scientist to figure that one out. However, you are absolutely wrong in assuming that is what I have. I do NOT have a health spending account and never have as I don't need one. I have said repeatedly that I have a Medicare Advantage plan from Health Net. I do NOT pay any premiums for it and there are ZERO co-pays for doctors, specialists, labs, x-rays, physical therapy etc. My wife has her own individual Self Directed Health Plan that pays her up front money that covers co-pays and deductibles. I have explained all of this earlier in this thread.


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## John Cummings (Aug 12, 2009)

BocaBum99 said:


> ...Lastly, whatever the ultimate healthcare bill becomes, I want to see it tested in a few states for a few years with clear statistics that shows the before and after state of healthcare delivery.  Like any business initiative, it should target 10x improvement in a set of key metrics.  If it is substantially better than it was before, then we can apply that math to the other states to accurately assess the overall impact to the economy and healthcare delivery.  At this point, if this market test of the new system isn't done, the plan is sure to fail and to overrun costs and underdeliver on promises.   This plan would include metrics to watch the overall demand for services and its relation to the supply of healthcare professionals.
> 
> I hope someone brings this up somewhere.  If they don't, I don't see how it can become successful.



It has been tested to some extent in Massachusetts and doesn't appear to be working very well.


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## John Cummings (Aug 12, 2009)

BocaBum99 said:


> How else can one interpret this statement?
> 
> 
> 
> This statement says that today, the insured are subsidizing the care of the uninsured who are getting care anyway.



That is a very true statement especially in states like California which have millions of illegal aliens burdening the system. One of my wife's nieces lives in Tucson, AZ. All of her nieces family including her, her husband, and 3 kids are illegal aliens. They receive 100% free medical care with the taxpayers picking up most of the tab and the insured folks picking up the rest. This is not just ER care but also regular preventative care for the children.


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## Icarus (Aug 12, 2009)

John Cummings said:


> However, you are absolutely wrong in assuming that is what I have. I do NOT have a health spending account and never have as I don't need one.



I attributed somebody elses post to you. Sorry about that.

It must be nice to have free healthcare paid for by the government.

-David


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## ricoba (Aug 12, 2009)

I thought today's column by Steve Lopez in the LA Times offered some interesting alternatives from a Doctors point of view.


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## John Cummings (Aug 12, 2009)

ricoba said:


> I thought today's column by Steve Lopez in the LA Times offered some interesting alternatives from a Doctors point of view.



Very interesting. I need some more time to digest it but I see a couple flaws. The idea of using teaching schools would work in areas like Southern California but what happens in rural areas hundreds of miles away from a teaching school?

I do agree very strongly with employers NOT providing health insurance. It is not an employer's responsibility to do that. It is another fringe benefit that adds to the employee's compensation. Employer's could increase the cash compensation instead.


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## ricoba (Aug 12, 2009)

I agree the teaching university idea only works in cities/urban areas.

I was interested in the idea of allowing nationwide insurance competition and the cap on medical malpractice.


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## pgnewarkboy (Aug 12, 2009)

I read the article.  It has major flaws that are basically unworkable.  First, employers provide insurance because they are bargained for as part of negotiating with labor or to obtain and retain employees.  Is the good doctor going to guarantee that employees will get paid more if they don't get health benefits? And how much more will that be?  Enough to get insurance?  Will the federal government require employees to get paid more?  This is nothing but flawed wishful thinking without a shred of evidence to back it up.  It solves nothing except to create more people without healhcare.

Everyone knows who has studied the issue that "groups" get lower rates then individuals from insurance companies.  It is simple economics.  When an employer comes to an insurance company to buy a plan, the bigger the group the bigger the leverage when it comes to setting rates.  Further, insurance companies can determine how health the entire group is and therefore will be able to spread risk.

He proposes that the "some government" , he doesn't know which one, pays teaching hospitals to take care of the uninsured.  He has no estimates of what that would cost, what would be provided, where all the doctors would come from etc, etc.  Right now there are 40 million uninsured. Under his plan there will be many many more.  Where will all the money come from to pay to take care of these people.  Raise taxes? What?


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## easyrider (Aug 12, 2009)

The way Medicare is working for my inlaws, age 80 +, is very confusing and time consuming.The way their long term care insurance works is very time consuming and frustating. The insurance for long term care has so many rules as does Medicare that it creates many problems for folks that can no longer think for them selves because of their age or health issue. With out long term care insurance their estate would get wiped out in 4 - 5 years and then they would recieve a lesser care with Medicade. 

How does this work in Canada ? Does the heath care system take the assets of elderly for long term care ?

Thanks


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## Redrosesix (Aug 12, 2009)

John Cummings said:


> Very interesting. I need some more time to digest it but I see a couple flaws. The idea of using teaching schools would work in areas like Southern California but what happens in rural areas hundreds of miles away from a teaching school?
> 
> I do agree very strongly with employers NOT providing health insurance. It is not an employer's responsibility to do that. It is another fringe benefit that adds to the employee's compensation. Employer's could increase the cash compensation instead.



I agree with both of your points.  RE the employer providing insurance -- a lot of people in NS get additional coverage through their work (dental, prescription, etc) but many would just love the ability to opt out (most plans won't allow this) -- the result is that if both spouses are covered through their workplace, they are each paying larger premiums than would be necessary, even if both workplaces use the same insurer for their group plan.  Yes, they'd rather have more cash.

In fact, I think a lot of the ideas from that article could be implemented here to save us even more money.  Which brings me to my final point -- obviously, no matter what type of health care system you have, it should always be considered a work-in-progress.  It's never going to be perfect, and needs to be able to change with the times and advances in medicine.


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## Redrosesix (Aug 12, 2009)

easyrider said:


> The way Medicare is working for my inlaws, age 80 +, is very confusing and time consuming.The way their long term care insurance works is very time consuming and frustating. The insurance for long term care has so many rules as does Medicare that it creates many problems for folks that can no longer think for them selves because of their age or health issue. With out long term care insurance their estate would get wiped out in 4 - 5 years and then they would recieve a lesser care with Medicade.
> 
> How does this work in Canada ? Does the heath care system take the assets of elderly for long term care ?
> 
> Thanks



I can only speak for Nova Scotia, because this is another area that is under provincial jurisdiction.  Nursing home care, assisted living apartments and home care are in a grey area outside of the health care system (hence the current controversy here over whether prescription medicines for people in nursing homes should be covered the same as they would be in hospitals) and are more affiliated with the welfare system (which becomes the payer for these services if/when a person runs out of funds)  A certain amount of assets can be exempted eg. the family home, but all other assets must be used to pay for care before the province will take over.  The family is never expected to pay for any of this care.  

Everybody is still covered 100 % for medical care and diagnostics, people over the age of 65 are covered under the Pharmacare program for prescriptions and vision care (but there is a 20 % copay) but may have to pay the deductible to belong to the program (income tested).  Disabled persons who must live in a nursing home would also be eligible for a prescription drug program for low income individuals.

For example, my MIL had a stroke at age 64, one year before retiring and never had enough funds to pay for her own care (didn't even own a house).  Despite the fact that she has 5 children, none of them were expected to contribute to her care.  Once she turned 65 and her pensions kicked in, the nursing home took these towards her care.  However, whether she was paying for part of her care or the province was, a certain amount of money was given to her every month to pay for hairdressers, etc (in fact, they have a beauty salon right in her nursing home).  She was given a private room when it became available, at no additional charge, since there was nobody on a wait list for a private room at that time.  

On the other hand, my grandmother stayed in her own home for a number of years before having to move to a nursing home, and the cost of having help come in was subsidized by the government.  She later spent all of her savings on nursing home care until the province took over, but her children split the proceeds from the family home.


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## John Cummings (Aug 12, 2009)

pgnewarkboy said:


> I read the article.  It has major flaws that are basically unworkable.  First, employers provide insurance because they are bargained for as part of negotiating with labor or to obtain and retain employees.  Is the good doctor going to guarantee that employees will get paid more if they don't get health benefits? And how much more will that be?  Enough to get insurance?  Will the federal government require employees to get paid more?  This is nothing but flawed wishful thinking without a shred of evidence to back it up.  It solves nothing except to create more people without healhcare.
> 
> Everyone knows who has studied the issue that "groups" get lower rates then individuals from insurance companies.  It is simple economics.  When an employer comes to an insurance company to buy a plan, the bigger the group the bigger the leverage when it comes to setting rates.  Further, insurance companies can determine how health the entire group is and therefore will be able to spread risk.
> 
> He proposes that the "some government" , he doesn't know which one, pays teaching hospitals to take care of the uninsured.  He has no estimates of what that would cost, what would be provided, where all the doctors would come from etc, etc.  Right now there are 40 million uninsured. Under his plan there will be many many more.  Where will all the money come from to pay to take care of these people.  Raise taxes? What?



There are some major flaws in your arguments. Companies providing health insurance is no more guaranteed than their employees getting paid more. Both are market driven as they should be. It is all part of an employees compensation, be it in cash or fringe benefits. There are other ways to spread the risk than through an employer group.


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## easyrider (Aug 12, 2009)

Redrosesix said:


> On the other hand, my grandmother stayed in her own home for a number of years before having to move to a nursing home, and the cost of having help come in was subsidized by the government.  She later spent all of her savings on nursing home care until the province took over, but her children split the proceeds from the family home.



My understanding of property in the USA is it can be put in a trust with trustees named and after 5 years it is protected from Medicade. 

So did the children in your case have to put the house in a trust or is property exempt from medical expences in Canada ?

Thanks


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## pgnewarkboy (Aug 12, 2009)

John Cummings said:


> There are some major flaws in your arguments. Companies providing health insurance is no more guaranteed than their employees getting paid more. Both are market driven as they should be. It is all part of an employees compensation, be it in cash or fringe benefits. There are other ways to spread the risk than through an employer group.



You are correct there is no guarantee that anybody gets insurance. That doesn't make the doctors prescription any better.  That is one reason people are discussing reform. All insurance be it life, health, disability, long term care, auto, home, etc. is based on spreading the risk.  The risk is that a group of x size there will be more people who don't need the insurance at any given time then people who need it.  That is how insurance companies make money.  What other way is there to spread the risk ?


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## John Cummings (Aug 12, 2009)

Redrosesix said:


> I agree with both of your points.  RE the employer providing insurance -- a lot of people in NS get additional coverage through their work (dental, prescription, etc) but many would just love the ability to opt out (most plans won't allow this) -- the result is that if both spouses are covered through their workplace, they are each paying larger premiums than would be necessary, even if both workplaces use the same insurer for their group plan.  Yes, they'd rather have more cash....



Are you saying that it is mandatory that you take the insurance being offered by your employer? That seems very strange to me. Who says that you can't opt of it, the employer, or whom?

A very common practice in the US where both spouses work is for one or the other to take their employer's insurance depending which has the best. The one getting the insurance includes the other spouse under their insurance. Sometimes it is advantageous that both have their own but not always. The point is it is up to the employee to decide what is best for their circumstance.


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## John Cummings (Aug 12, 2009)

easyrider said:


> The way Medicare is working for my inlaws, age 80 +, is very confusing and time consuming.The way their long term care insurance works is very time consuming and frustating. The insurance for long term care has so many rules as does Medicare that it creates many problems for folks that can no longer think for them selves because of their age or health issue. With out long term care insurance their estate would get wiped out in 4 - 5 years and then they would recieve a lesser care with Medicade.
> 
> How does this work in Canada ? Does the heath care system take the assets of elderly for long term care ?
> 
> Thanks



I am curious why your in-laws are finding Medicare to be very confusing and time consuming. I have had Medicare for almost 5 years now and it is neither confusing nor time consuming. If they don't understand their options, could you or somebody else assist them? If you go on the Medicare web site, you will find a wealth of information including a list of all the options available in their local area. You will be able to see all the Medicare Advantage plans, if any are available in their area, with the benefits, costs if any, quality rating, etc. They can go to a Medicare office and talk to someone in person. Somebody could go with them. I did that with my mother.


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## Redrosesix (Aug 12, 2009)

John Cummings said:


> Are you saying that it is mandatory that you take the insurance being offered by your employer? That seems very strange to me. Who says that you can't opt of it, the employer, or whom?
> 
> A very common practice in the US where both spouses work is for one or the other to take their employer's insurance depending which has the best. The one getting the insurance includes the other spouse under their insurance. Sometimes it is advantageous that both have their own but not always. The point is it is up to the employee to decide what is best for their circumstance.



Yes, in many cases where the group plan is offered it is mandatory -- there is no possibility of opting out.  And to purchase the optional family coverage, they must include their spouse even if the spouse has their own insurance through their own employer.  It's the insurance company that sets these rules ie. they cover all of the employees or none at all.  

It makes much more sense for it to be offered the way you state is done in the US.  My thinking is that since the group insurance offered is really only partial coverage, we have less bargaining power here.  Plus, there are only a million people in total in this province -- even the gov't groups would be smaller than many of those in the US.

Like I stated before, there are a lot of ways to cut down on health care costs, regardless of the system.


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## easyrider (Aug 12, 2009)

John Cummings said:


> I am curious why your in-laws are finding Medicare to be very confusing and time consuming. I have had Medicare for almost 5 years now and it is neither confusing nor time consuming. If they don't understand their options, could you or somebody else assist them? If you go on the Medicare web site, you will find a wealth of information including a list of all the options available in their local area. You will be able to see all the Medicare Advantage plans, if any are available in their area, with the benefits, costs if any, quality rating, etc. They can go to a Medicare office and talk to someone in person. Somebody could go with them. I did that with my mother.



Hi John
While the in laws health and mental capacities diminished they were very much under the opinion that they were fine. This has been going on since 2005 with both of them taking turns going in and out of the hospital and nursing home. This year they both ended up in the nursing home with only one of them able to go home. They both have private long term care insurance that provides benifits for assited and full time care. This care reumburses the some of the cost after its been paid. Full time nursing home care over here is around $250.00 per day or around $15,000.00 per month for two of them. This is out of pocket until some one turns in paper work according to the guidelines set in the policy. Before you can do anything with the policy you need to be authorized by the policy holder. All of this paper work takes time and before you know it the debt becomes more than whats available in the savings accounts. The insurance company also has to approve the skilled nursing facility and review doctors orders which takes time. Just when everything seems signed and approved you find that one piece of info is missing or turned in at the wrong time.

With Medicare are experience has been horible as we needed the same authorization to speak to a medicare rep. Every call involved a 30 minute wait at least. At the hospital with a broken back was covered by medicare but the nursing home stay wasn't covered because there was no surgery involved. The guidelines for phyisical therapy seem subjective to the therapist. Different levels of theraphy with different parts of medicare coverage and costs. 

Im a newbe at Medicare and really don't understand it. My involvement has been this year only as my wife is POA with her parents.


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## John Cummings (Aug 12, 2009)

easyrider said:


> Hi John
> With Medicare are experience has been horible as we needed the same authorization to speak to a medicare rep. Every call involved a 30 minute wait at least. At the hospital with a broken back was covered by medicare but the nursing home stay wasn't covered because there was no surgery involved. The guidelines for phyisical therapy seem subjective to the therapist. Different levels of theraphy with different parts of medicare coverage and costs.
> 
> Im a newbe at Medicare and really don't understand it. My involvement has been this year only as my wife is POA with her parents.



I have a Medicare Advantage Plan from Health Net so I don't deal with Medicare. I have explained the plan in earlier posts. You may want to look at this as an option for them if they are available in their locale. I never have to worry about paying any bills up front or filing any forms. There are no premiums nor co-pays for doctors, specialists, physical therapy, etc. I went to physical therapy 3 times a week for 6 months last year and it was 100% covered by insurance.

The following Medicare web site will allow you to find out what is available in your area:

http://www.medicare.gov/MPPF/Includ...COUNTY&ExternalSourceID=&MPPF_PDP_Integrate=N


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## pgnewarkboy (Aug 12, 2009)

John Cummings said:


> I have a Medicare Advantage Plan from Health Net so I don't deal with Medicare. I have explained the plan in earlier posts. You may want to look at this as an option for them if they are available in their locale. I never have to worry about paying any bills up front or filing any forms. There are no premiums nor co-pays for doctors, specialists, physical therapy, etc. I went to physical therapy 3 times a week for 6 months last year and it was 100% covered by insurance.
> 
> QUOTE]
> 
> Now there is a government program that really works!  Perhaps medicare should be expanded to cover everyone.


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## barndweller (Aug 12, 2009)

In the US, heath plans are available by not only states but by counties as well. When John talks about his excellent Medicare coverage, he fails to note that he lives in an urban area with 64 insurance plans available to him to suppliment his coverage provided by the Federal Government. Many are very highly rated and costs are low because there are so many to choose from. I live in a rural  county of California with a tiny population. The choices available to me are extremely limited and have either poor ratings or no information provided at the Medicare website. The highly regarded system of free enterprise and competition only works in high population areas. I guess if we all move to a major city when we turn 65, we could all be very happy with our healthcare in the US. Maybe the only solution to the healthcare crisis is for everyone to move to Southern California where John lives. Or take that extra $50,000 we have lying around and set up a Health Savings Plan.


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## John Cummings (Aug 12, 2009)

pgnewarkboy said:


> Now there is a government program that really works!  Perhaps medicare should be expanded to cover everyone.



The Medicare advantage plans are provided by insurance companies and non-profit organizations. Medicare pays them for each subscriber or in other words pay the premium. There are about 10 million seniors that belong to them. However, there are a couple of problems. First, they are not offered in all localities in the country. They operate very well where there is a large population and health providers base. That is why they are very strong in Southern California and work well in some other areas. There are 52 plans available to choose from in my ZIP code. They do not work so well in rural areas that aren't close to a larger population base and/or do not have many service providers.

The second problem is that the government wants to drastically cut the funding for them rather than expand them.


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## John Cummings (Aug 12, 2009)

barndweller said:


> In the US, heath plans are available by not only states but by counties as well. When John talks about his excellent Medicare coverage, he fails to note that he lives in an urban area with 64 insurance plans available to him to suppliment his coverage provided by the Federal Government. Many are very highly rated and costs are low because there are so many to choose from. I live in a rural  county of California with a tiny population. The choices available to me are extremely limited and have either poor ratings or no information provided at the Medicare website. The highly regarded system of free enterprise and competition only works in high population areas. I guess if we all move to a major city when we turn 65, we could all be very happy with our healthcare in the US. Maybe the only solution to the healthcare crisis is for everyone to move to Southern California where John lives. Or take that extra $50,000 we have lying around and set up a Health Savings Plan.



I explained that they don't work well in some localities such as where you live. I have also constantly said that they are NOT available in all areas. Perhaps if you had read the posts you would have seen that.

Another option is to get a medigap policy that fills in the holes that traditional Medicare doesn't cover. There are many of those at very reasonable rates. AARP is a good place to check for those.


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## Icarus (Aug 12, 2009)

John Cummings said:


> I am curious why your in-laws are finding Medicare to be very confusing and time consuming. I have had Medicare for almost 5 years now and it is neither confusing nor time consuming.



I think it's fairly complicated at sign-up time to figure out and understand all the options available, which depend on where you live, etc. Also, the rules about switching from one plan to another are very complicated.

I spent some time looking at it last week, and I thought it was very confusing.

With the regular medicare plan, there's holes in the coverage and there's a hole in the prescription benefit. If you want to opt into a private plan, you must do it at the right time, or there could be problems. If you decide you don't like the plan you took and want to change there's all sorts of rules about it too. Then there's the medigap policies which add an entirely different level of complication to it, for those that want it, but at least those policies are standardized.

-David


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## Redrosesix (Aug 12, 2009)

easyrider said:


> My understanding of property in the USA is it can be put in a trust with trustees named and after 5 years it is protected from Medicade.
> 
> So did the children in your case have to put the house in a trust or is property exempt from medical expences in Canada ?
> 
> Thanks



In Nova Scotia, the house is exempt as well as a set amount of other assets -- much more if there is a surviving spouse or dependent children.  Trusts can be used as well to protect more of the estate.

Again, nursing home care is completely separate from medical expenses here -- the costs of nursing home care are basically food, lodging and personal care.


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## John Cummings (Aug 13, 2009)

Icarus said:


> I think it's fairly complicated at sign-up time to figure out and understand all the options available, which depend on where you live, etc. Also, the rules about switching from one plan to another are very complicated.
> 
> I spent some time looking at it last week, and I thought it was very confusing.
> 
> ...



You may think it is complicated but I have actually done it and it was not complicated at all. I not only signed up, checked out the options, but I have also switched plans. The various providers have free seminars with free lunch where they explain it all and help you. I am thankful that we have all the choices available.


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## charford (Aug 13, 2009)

I'm a dual Canadian-American citizen.

After living in the U.S. for 14 years, I moved back to Canada just a couple of weeks ago. Health care costs in the U.S. played a big part in my decision. In the U.S., for a family of 4, I pay about $12800/year in health coverage. This is comprised of $5400 in monthly insurance premiums plus a yearly deductible of $7400. This is before the insurance company pays anything for my healthcare. There is a lifetime maximum of $6 million dollars for all 4 of us. This may sound like a lot, but really isn't. 

My dh died about 4 years ago. His medical bills totaled $700,000 for the 4 months of care that he received before he died. At the time, the lifetime max on our insurance was $2 million. I was concerned that he would outlive our insurance. 

I could go on and on about my experiences in both systems, but I won't. Suffice to say, that I am very happy to be back in a system where I don't have to worry about paying for my health insurance or worrying about whether something will be covered or worrying about whether my doctor will order a $2000 CT scan because the pain I felt 3 weeks ago might indicate something serious. I think the lack of the stress of worrying about health care coverage will let me live longer.


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## pgnewarkboy (Aug 13, 2009)

John Cummings said:


> The Medicare advantage plans are provided by insurance companies and non-profit organizations. Medicare pays them for each subscriber or in other words pay the premium. There are about 10 million seniors that belong to them. However, there are a couple of problems. First, they are not offered in all localities in the country. They operate very well where there is a large population and health providers base. That is why they are very strong in Southern California and work well in some other areas. There are 52 plans available to choose from in my ZIP code. They do not work so well in rural areas that aren't close to a larger population base and/or do not have many service providers.
> 
> The second problem is that the government wants to drastically cut the funding for them rather than expand them.



The Medicare HMO plans are provided by the federal government who authorize these plans to participate after proper certification, requiring certain benefit packages, and meeting other regulations.  The use of HMOs in Medicare was a policy decision made by government officials.  It was hoped that the use of HMO's would help to control costs.  I have read that it might not be working as well as hoped for in terms of saving costs.

I pay for your participation in this plan as do millions of other americans.  I am happy to do it.  I think it is the right thing to do and so did the rest of america 45 years ago when Medicare was instituted.  I pay for your health care and millions of other seniors through my taxes.  In order to provide health care under the government run program called Medicare, the american people must pay for it.  Medicare has run into increasingly high costs because the cost of health care has been rising dramatically higher then every other cost of living index in the nation.  The cost of administering healthcare by the government is only 3% as opposed to the average 25% in the private healthcare industry.  The increase in cost is being driven by the providers themselves including the HMO's.  

The government cannot afford to expand the HMO's without having the money to do it.  That means either the HMO's charge less or the government raises taxes.  That is how it works.  If we want a service we have to pay for it.  If the cost of the service is out of hand we have to find a way to reduce the cost or raise taxes.  

That is why the issue of controlling health care cost is so important to the discussion of health care reform.


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## Liz Wolf-Spada (Aug 13, 2009)

http://www.cnn.com/2009/POLITICS/08/12/health.industry.whistleblower/index.html

This is a link to a story today on CNN about an insurance industry whistleblower.
Liz


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## calgarygary (Aug 13, 2009)

I came across an interesting report that deals with healthcare increases between 2000 - 2007.  I appreciate that the report was produced by a group that is supporting change.  My question to our U.S. posters, do the statistics for your state resemble your experience?  

Warning!  This is a pdf file so if you have a slow connection, I wouldn't click on the link.
http://hcfan.3cdn.net/dadd15782e627e5b75_g9m6isltl.pdf


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## donnaval (Aug 13, 2009)

Gary--that report seems pretty accurate to me.

In the late 1990s, my husband and I were paying $226 per month for both of us to be covered under an excellent policy.  This month, we are paying a bit more than $1100 per month for far less coverage--we have downgraded our coverage and increased our deductibles every couple of years in a vain attempt to keep costs "affordable."

Our monthly income has not gone up more than 400% over these years.

Our financial exposure has gone from $1,000 family deductible per year, with that being the total out-of-pocket, to $8,000 deductible ($3k for me, $5k for DH), and additional co-insurance up to a maximum OOP of $15k per year ($5k for me, $10k for DH)

I am currently attempting to secure less-expensive coverage for myself since my premium is going up another $68/mo. with higher annual and total OOP deductibles.  My husband's policy will renew in January and we have no idea yet as to what type of increase to expect.  As of yesterday, I have been denied by two different insurers, citing "pre-existing conditions" that were part of my medical history the last time I sought new coverage. So anyone who thinks that pre-existing conditions only matter for the previous 12 months--think again.  One of my "conditions" was diagnosed more than five years ago.  The other "condition" is the underwriter's interpretation that a condition might exist that has not been diagnosed--huh?  

One of the companies denying new coverage to me is the company that currently insures me!  I will of course retain this coverage but it has gone up 40% over the past three years and I foresee no end in sight.  (Needless to say my income has not gone up 40% over the past three years.  I wish!)  My health has not changed, these "conditions" were present the last time I was approved, and these "conditions" were dismissed by my doctor years ago as "nothing serious."  No treatment has ever been recommended or required.  The only thing that has changed is I'm a couple of years older.

There is very little competition in our area, given the size of the market.  BC/BS is the biggie here, followed by UPMC and HealthAmerica.  After that you're dealing with Aetna and a handful of online companies.  I have spent (conservatively) more than 100 hours over these past few weeks doing research, making applications, and speaking to representatives about insurance.  I'm not just sitting back complaining about the high costs.  I'm trying to do something about it, but I keep hitting  

I'm healthier than most friends in my age group, take no prescription medications, and have not required any medical treatment other than routine check-ups (all of which said I'm in great health albeit a few pounds too heavy) for the past four years.  But so far, two out of three of my best options have refused to give me new coverage.  

I'm very happy for those who have had success with our current system.  I have not, and foresee only more difficulties if it continues this way.  I don't know the answers, but this system is screwy.


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## ricoba (Aug 13, 2009)

You know it was suggested that this thread turn away from politics...yet politics keeps getting thrown in via links....


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## calgarygary (Aug 13, 2009)

ricoba said:


> You know it was suggested that this thread turn away from politics...yet politics keeps getting thrown in via links....



If you are referring to the link I provided, I did so to find out if the financial numbers being used there are accurate which I think is a valid discussion in this thread.  The site claims increases in insurance costs by state of 40 - 70% from 2000 to 2007.  As in the case of almost every report viewable online, it comes from a group with a vested interest - if I or you can find reports on the cost increases from "neutral" parties, I would be happy to replace the link.


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## John Cummings (Aug 13, 2009)

It is virtually impossible to keep politics out of this type of discussion because it involves the role of government in our lives. That is a major difference between most Canadians and Americans. The majority of Americans favor a very limited government role whereas Canadians accept a larger government role. I am not arguing which is right but simply stating a fact and as such these type of threads always take on a political slant. I am going to bow out of this because I have nothing more to discuss and it should be obvious to all what I believe the role of government should be.


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## Icarus (Aug 14, 2009)

The only thing that's obvious to me is that you're a real character, John.

You personally benefit from the biggest socialized medical program in the US, and are proud of the fact that it costs you nothing, so, no, I don't think it's obvious at all.

But I'm glad you're able to speak for a "majority of Americans".

-David


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## Elan (Aug 14, 2009)

Icarus said:


> The only thing that's obvious to me is that you're a real character, John.
> 
> You personally benefit from the biggest socialized medical program in the US, and are proud of the fact that it costs you nothing, so, no, I don't think it's obvious at all.
> 
> ...



  Could not have said it better!


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## Liz Wolf-Spada (Aug 14, 2009)

I think this is an important topic to discuss. If we can stay focused on the issues and not on our agreements or disagreements our wonderful moderators will, I'm sure, let's this thread continue. 
Liz


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## Carolinian (Aug 14, 2009)

Here is an interesting insight as to government decisions on health care policy, from today's _Daily Telegraph_ of London,

The British NHS (National Health Service) has said that neither children nor the elderly are high on its priority list for swine flu vacine.

Children are considered ten times more likely to contract the disease, and are considered ''superspreaders''.  Moreover, children represent 17% of swine flu deaths so far in the UK.

The elderly tend to be more at risk of death if they contract the disease, but then in any government run system tend to be viewed as expendable.

Welcome to the Brave New World of government-run medicine.


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## Laurie (Aug 14, 2009)

Liz Wolf-Spada said:


> http://www.cnn.com/2009/POLITICS/08/12/health.industry.whistleblower/index.html
> 
> This is a link to a story today on CNN about an insurance industry whistleblower.
> Liz


Liz, this man Wendell Potter was interviewed more extensively by Bill Moyers on PBS a while back, very interesting - I hit the record button on TIVO halfway thru the show which I rarely do - here's the link:

http://www.pbs.org/moyers/journal/07102009/watch2.html


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## "Roger" (Aug 14, 2009)

Carolinian said:


> Here is an interesting insight as to government decisions on health care policy, from today's _Daily Telegraph_ of London,
> 
> The British NHS (National Health Service) has said that neither children nor the elderly are high on its priority list for swine flu vacine.
> 
> ...


While it is true that the UK tends to discriminate against the elderly, this is NOT a government vs. non-government issue.  

It is the CDC (a US government agency) which sets the priorities for flu shots in the United States.  Furthermore, it is Medicare (another government program) which guarantees the seniors will have the ability to pay for the shots.

If it weren't for the government (in the US) and it were left to private enterprise (in other words, there were no government involvement), my bet is priorities would be based upon ability to pay (code for who has medical insurance).

The bottom line is that as far as flu shots go, if you endorse US priorities, you need to give thanks to government intervention.  If it were not for that, it would be otherwise.

[An addedum about UK priorities.  Discrimination against the elderly is also apparent with regard to transplants.  They set strick age limits.  In the US, priorities are set up by UNOS - a government created enterprise supposedly independent from the government, but not always.  They too have age limits, but more liberal.  Age, however, is one of the factors considered when there are competing claims for the same organ.]


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## Icarus (Aug 14, 2009)

Carolinian said:


> The elderly tend to be more at risk of death if they contract the disease, but then in any government run system tend to be viewed as expendable.



More disinformation being spread by the same person.

That's the exact opposite of what I've read. Older people that are otherwise healthy tend to get a mild case of the disease, and are not considered a priority for the swine flu vaccine. That's the exact opposite of the normal flu vaccine.

-David


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## "Roger" (Aug 14, 2009)

Carolinian said:


> ...The British NHS (National Health Service) has said that neither children nor the elderly are high on its priority list for swine flu vacine...


Actually that turns out not to be quite true either.  The priority list for Britain is 


Those between 6 mo. and 65 with underlying conditions (the most vulnerable to die)
Pregnant women (very vulnerable)
Those living with the above (given that they might infect to above groups)
Senior citizens
Note, that while senior citizens are the lowest among what the government has identified as priority groups (nless, of course, they have an underlying condition), they were still given priority over the general population.

For a full discussion of the effect of swine flu upon the elderly and a suggested list of priorities offered by swine flu experts in America,

go here


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## Carolinian (Aug 14, 2009)

The UK has had a startling percentage of ''otherwise healthy'' people among those who have died of swine flu, particularly recently, as the _Daily Telegraph_ has pointed out.  So the ''underlying conditions'' have less relevence. And one would think that all in a group that is considered ''superspreaders'' of a disease and ten times more likely to contract it would be immunized.  The Senior Citiizens as reported in the _Telegraph_ is also highly conditional, rather than all senior citizens.




"Roger" said:


> Actually that turns out not to be quite true either.  The priority list for Britain is
> 
> 
> Those between 6 mo. and 65 with underlying conditions (the most vulnerable to die)
> ...


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## donnaval (Aug 14, 2009)

> startling percentage of ''otherwise healthy'' people among those who have died of swine flu, particularly recently



I'm a little confused (constant state of mind lately)--I heard on the news last night that the swine flu vaccine wouldn't be available until October, so how can deaths occurring now, pre-vaccine, be blamed on any sort of rationing system?  

And once the vaccine is available, what difference does having or not having a "priority list" make if you can't get the shot anyway due to not having insurance or not being able to afford the shot after paying huge monthly premiums?


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## Passepartout (Aug 14, 2009)

donnaval said:


> And once the vaccine is available, what difference does having or not having a "priority list" make if you can't get the shot anyway due to not having insurance or not being able to afford the shot after paying huge monthly premiums?



Furthermore, if it weren't for 'government involvement' via Centers for Disease Control, and pressure on drugmakers, and a guarantee that the aforementioned government would buy (X) quantity of doses sight unseen or untested,  there wouldn't be a vaccine until the drugmakers see a profit potential.

Jim Ricks


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## Clemson Fan (Aug 14, 2009)

pgnewarkboy said:


> I am glad there is interest in the canadian system. It is very important to understand that THERE IS NO PROPOSAL FROM THE WHITE HOUSE, CONGRESS, DEMOCRAT, OR REPUBLICAN for anything like the Canadian or european systems. That has been deemed a dead issue from the very beginning. It really doesn't matter what health care is like in canada or any other single payer system because the United States of America will not be getting that kind of system . I guess it is good to know if you are travelling there.


 
That's a very good point.  I'm a physician in the US and there are many days I envy a single payer system b/c I really have no love for the insurance companies.  However, you cannot have a single payer system unless you have significant tort reform in the US which is not currently on the table.  In places like Canada and Britian where there is a single payer system, there are very significant indemnification provisions in place for the physicians that are not in place here in the US.

There actually really isn't a current proposal on the table from the president.  There's just a hodgepodge of ideas.  Some are good and some are bad.  Some are realistic and some are fantasy.  IMO, one party is pro single payer but in the back pocket of the trial lawyer lobby and thus will not address that side of the equation while the other party wants to address tort reform but is in the back pocket of major insurance companies and thus not in favor of a single payer system.  This leaves us with a potential hodgepodge patchworked bill that is difficult to understand.


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## Carolinian (Aug 14, 2009)

Single payer is a euphemism for government control. Soviet medicine was probably the largest example of a single payer system ever put in place, and the medicine it provided to the average citizen was dismal.  If you have ever visited a former Soviet hospital, as I have, you would think it third world medicine.  But for the elite there were special hospitals with the best qualified doctors, decent equipment, and better conditions.  Even for the average Ivan, if they did not give their doctor, and others involved in treatment ''tips'', errors might occur, so everyone paid up.  Whether it is the Soviet, British, or Canadian version of ''single payer'', it is not something I want for my care.




Clemson Fan said:


> That's a very good point.  I'm a physician in the US and there are many days I envy a single payer system b/c I really have no love for the insurance companies.  However, you cannot have a single payer system unless you have significant tort reform in the US which is not currently on the table.  In places like Canada and Britian where there is a single payer system, there are very significant indemnification provisions in place for the physicians that are not in place here in the US.
> 
> There actually really isn't a current proposal on the table from the president.  There's just a hodgepodge of ideas.  Some are good and some are bad.  Some are realistic and some are fantasy.  IMO, one party is pro single payer but in the back pocket of the trial lawyer lobby and thus will not address that side of the equation while the other party wants to address tort reform but is in the back pocket of major insurance companies and thus not in favor of a single payer system.  This leaves us with a potential hodgepodge patchworked bill that is difficult to understand.


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## Carolinian (Aug 14, 2009)

donnaval said:


> I'm a little confused (constant state of mind lately)--I heard on the news last night that the swine flu vaccine wouldn't be available until October, so how can deaths occurring now, pre-vaccine, be blamed on any sort of rationing system?
> 
> And once the vaccine is available, what difference does having or not having a "priority list" make if you can't get the shot anyway due to not having insurance or not being able to afford the shot after paying huge monthly premiums?



Victims are not waiting for the vacine to arrive to die of swine flu.  Looking at patterns of deaths from the disease now helps determine how priorities should be set up for vaccination when the vacine arrives.

How expensive can a shot, or in this case series of two shots be?


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## Carolinian (Aug 14, 2009)

Laser eye surgery is not something covered by most insurance in the US, and therefore not something whose price is impacted by third party payors (insurance).  It is thus one of the few areas of medicine in the US where the price has actually come down.  I have no idea if it is free market in this area of medicine in Canada or not.  But this is one area that at least on the US side may not offer a good comparision, and that may be the case on the Canadian side.

I have personally had a root canal and crown done in Hungary, where the price was a fraction of what it would have cost in the US and did that before I started working on this side of the pond.  It was high quality, and many of the patients there were German, Austrian, or British ''dental tourists''.  Poland also has a lot of dental tourism, drawn by the price.  I have also had experience with continental European medicine when I needed examination of a condition to determine if it was merely cosmetic or something serious.  I was not comfortable with the examination done in the country where I work, but the doctor only charged about $5 for the visit.  I went to Switzerland for a second opinion where a specialist said he was confident that it was merely cosmetic but would have an ultrasound done if  I wanted, which I did.  The charge was so low that I did not even bother with the paperwork to turn it in to the US-based insurance company I have through my employer.  Prior to that, a colleague had set up an appointment with another specialist in Romania for me, who was  a medical school professor.  I decided to go as another opinion would not hurt.  Again a number of tests were done, with the same result.  I do not know how much that would have cost as the doctor said because of who had sent me to him, he would not even think of charging me a fee.  I was quite pleased with what I saw of Swiss and Romanian medicine.  I don't know the basis of Swiss medicine, but I do know that the Romanian system has moved from a single payor government run system which was inherited from Communist days toward an insurance based system.  I think the govenment still has some involvement in paying some costs but is decreasing its involvement.

I know generally among expats here that most would not want anything serious or even slightly serious done locally, and no one, even the local Brits I know, would use the British NHS if they could help it.  The German, Swiss, Austrian, and Dutch medical systems seem to be given the best marks for quality.  The two I know who have had experience with the Romanian system also have confidence in it.  Interestingly, when I was in Veliko Turnovo, Bulgaria, there was quite a British expat community there, and I shared a table for dinner with two expat British couples who had retired to Bulgaria.  They told me that not only did their British retirement money buy a better life in Bulgaria than it would back home, but the Bulgarian medical system was better than the NHS.  I did not ask if Bulgaria had done as Romania had and move toward an insurance based system.





donnaval said:


> I realized I never reported that I personally traveled from the US to Canada for care!  About 7 years ago, my husband and I decided we'd like to have  laser surgery for our eyes.  US prices ranged from $8000 to $12,000 total each for the surgery, and in several cases the surgery was not recommended due to the severity of my near-sightedness or for my husband because of astigmatisms.  I heard from a friend who worked for an opthamologist(sp?) that Canadian docs were using a newer-generation laser machine and at a much lower cost, so we traveled to Toronto for an exam.  Turns out my degree of myopia and my husband's astigmatisms were no problem at all for this up-to-date laser, and to make it even sweeter for us, the doctor was opening a new office in Niagara Falls which was closer for us.  Long story short, our state-of-the-art eye laser surgery cost $800 US per person done in Canada--one-tenth of the best price I could have had it done for here.  The only downside was we had to take two short vacations in Niagara Falls for the surgery and follow-up exams
> 
> I also know several folks who travel to Canada for prescription drugs which they can buy much less expensively there than here.
> 
> I really appreciate the input from the Canadian folks here.  It is very illuminating.


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## Carolinian (Aug 14, 2009)

deleted --------------


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## Carolinian (Aug 14, 2009)

John, there have been times when you and I have not agreed on timeshare issues, but you are right on the money on this one.

And there is no way that a thread about the far and away biggest political issue in the country today could *ever* be or have been anything but political.  It is sort of like having a ''non-political'' discussion of abortion or Iraq policy.




John Cummings said:


> It is virtually impossible to keep politics out of this type of discussion because it involves the role of government in our lives. That is a major difference between most Canadians and Americans. The majority of Americans favor a very limited government role whereas Canadians accept a larger government role. I am not arguing which is right but simply stating a fact and as such these type of threads always take on a political slant. I am going to bow out of this because I have nothing more to discuss and it should be obvious to all what I believe the role of government should be.


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## calgarygary (Aug 14, 2009)

Carolinian said:


> Single payer is a euphemism for government control. Soviet medicine was probably the largest example of a single payer system ever put in place, and the medicine it provided to the average citizen was dismal.  If you have ever visited a former Soviet hospital, as I have, you would think it third world medicine.  But for the elite there were special hospitals with the best qualified doctors, decent equipment, and better conditions.  Even for the average Ivan, if they did not give their doctor, and others involved in treatment ''tips'', errors might occur, so everyone paid up.  Whether it is the Soviet, British, or Canadian version of ''single payer'', it is not something I want for my care.



I can not believe the misinformation that is being pushed by you.  First you blame the Canadian system for the death of Natasha Richardson - which of course is far from the facts.  I noticed you wouldn't reply about John Ritter's death which based upon the settlement, was a result of U.S. healthcare.  So Carolinian, can you explain how one death exemplifies an entire system but the other does not?  Just so there is no confusion, I do not believe that any single death or case represents an entire system.  Nor do I believe that prudent use of a vaccine is wrong.  

Now to directly suggest that Canadian healthcare is comparable to what existed or still exists in the Soviet Union is nothing more than propaganda. This is representative of the scare tactics that one sees in the news and makes one wonder why there can not be an intelligent debate of the topic without hysteria.  Maybe the U.S. should do away with the whole concept of insurance because after all, isn't that the "collective" paying for the individual?


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## Carolinian (Aug 14, 2009)

It is not me who blamed the deficiencies of the Canadian medical system for the death of Natasha Richardson, but an American doctor who was knowledgable in those deficiencies and the differences betweent the systems.  If you have a beef with her analysis, I suggest you take it up with her rather than me.  I am not a medical expert. She is.  Ditto the John Ritter situation.  I do not know the details of the Ritter death, but an error by one doctor, if that is what happened would be a very different thing than the systematic deficiencies in the system described by the doctor who wrote the piece on Natasha Richardson.  Are you a doctor?  If not, do you have the background to challenge that doctor's assesement of the systematic deficiencies that led to Richardson's death any more than I would to comment on Ritter's.  You may not like that I posted that expert opinion that challenges your own opinion, but I really am not an expert myself to add to what she had to say.  If you are not an expert, why should your challenge have any credibility?

I am not saying that the British or Canadian or Soviet medical system are identical.  They are however, all single payor, and seeing some of the residue of the Soviet system just happens to be the one that I have the most personal knowledge of.  My information on the British or Canadian systems comes from other experts or people who have used them.  One interesting similarity between the Soviet and proposed US system is that both involve a seperate and better system for the elite in government.  Why should they not have to deal with the same care as every citizen?  And I cannot imagine that a member of the government elite of the UK or Canada would have to put up with the same waiting lists as the average Joe for health care.

And lastly, something that does not agree with your own personal opinion does not make it ''misinformation''.  I suspect that the doctor whom you disagree with over Natasha Richardson's death has a whole lot more professional crredentials to discuss that matter than you do.




calgarygary said:


> I can not believe the misinformation that is being pushed by you.  First you blame the Canadian system for the death of Natasha Richardson - which of course is far from the facts.  I noticed you wouldn't reply about John Ritter's death which based upon the settlement, was a result of U.S. healthcare.  So Carolinian, can you explain how one death exemplifies an entire system but the other does not?  Just so there is no confusion, I do not believe that any single death or case represents an entire system.  Nor do I believe that prudent use of a vaccine is wrong.
> 
> Now to directly suggest that Canadian healthcare is comparable to what existed or still exists in the Soviet Union is nothing more than propaganda. This is representative of the scare tactics that one sees in the news and makes one wonder why there can not be an intelligent debate of the topic without hysteria.  Maybe the U.S. should do away with the whole concept of insurance because after all, isn't that the "collective" paying for the individual?


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