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Hernia surgery shouldn't cost more than $50,000. His bill was $116,000.

T_R_Oglodyte

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Anyone see 60 Minutes interview of Jamie Dimon of JPMorgan Chase with Lesley Stahl Nov 10th?

''Compensation for executives, CEOs, grew 940%, 940%, in the last 40 years. Your average worker, so middle class, middle class, grew 12%.''
Per Benjamin Disreali - there are lies, damn lies, and statistics.

You can't really make that comparison without considering changes in the workforce and the influence of technology and changes in the workforce.

To give a microexample of how that skews. When I left college and went to work in 1974 as an Assistant Sanitary Engineer (entry level position in CA state government for someone with a MS in engineering and no work experience), I was making $1400/month (a competitive salary at the time). Meanwhile, a Clerk-Typist II (which was a basic office staff person, with five or more years of experience) was earning about $500/month.

Our business was doing inspections, reviewing reports and studies and data, and preparing permits, evaluations, and related correspondence. This is pre-Word processor days. C-Ts are banging away on IBM Selectrics and doing triplicate and quadruplicate carbon copies of final documents. The mode is to write documents out in long-hand, give it to a C-T to type, make hand-written edits to the typed documents, and hand it in for retyping. Repeat as needed until the document reaches final. Our rule of thumb was the we needed one Clerk-Typist for every three engineers in the office. If we skewed much from that we either had a highly efficient C-T or inefficient professional staff.

Move forward 25 years to 1990. I'm now working in consulting, but the nature of our work is very similar. What is different is the office environment. Everyone has a computer (PC or Mac), the office staff are using word processing software, and documents are being generated on printers. Staff now write reports on the computer instead of long-hand, do a fair amount of document cleanup before turning over the document to clerical staff.

We're still doing hand-written edits and markups, but that's happening after a document is nearing conclusion, and often when it's being edited by a work team. We now expect the word processing staff to manage document production - they handle document layout and organization, and have responsibility for document physical appeal - spacing, organization, headings, graphics layout, etc.

Our rule of thumb is now one document production person for every ten engineers. That same entry level engineer coming out of school with a MS is being hired at about $4000/month. That office staffer is earning $3000/month. So that central office staff person has gone from earning roughly 33% of the salary of an early career engineer to earning 75% of the engineers salary. And that's commensurate with the added technological requirements of the job. But we're also employing one-third as many as we did before.

******

In the old 1974 days, assume on office of ten engineers. Given the range of experience and that some engineers are in a supervisory position, the total base engineering salary burden might be $20,000/month. Admin would be three C-Ts and one office manager, so a direct admin salary burden of ~$1800/month. So office staff is about 8% to 10% of total salary.

In 1990, an office with ten engineers would likely have a base salary burden of ~ $60,000/month. There would be two clerical staff - one supervisory office person and one document production person. The supervisory person is document production plus other office coordination activities. Probably totaling to about $6500/month.

So during the time clerical support represents a bigger portion of base salary burden, but the work that is being performed is at a higher level. The people doing those jobs have seen a dramatic increase in pay, to a level where a single mother with a deadbeat ex-husband can actually support a family at more than poverty level. (I have a favorite performance review story related to that aspect.) But there were proportionally fewer of those jobs available.

********

Long story - but the point is that when you making comparisons across time is difficult because conditions change.
 

T_R_Oglodyte

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Anyone see 60 Minutes interview of Jamie Dimon of JPMorgan Chase with Lesley Stahl Nov 10th?

''Compensation for executives, CEOs, grew 940%, 940%, in the last 40 years. Your average worker, so middle class, middle class, grew 12%.''
IMHO - another item that is relevant in looking at CEO pay is what leverage is associated with that pay.

Using an example cited above, Pfizer had 92,000 employees and the CEO made $26 million. To me that's a lot more palatable than an investment banker heading a firm of 1000 people, and who takes home $26 million (but most heads of investment banking organizations take home well over $26 million.

**************

And why are corporate CEOs raked over the coals about salary, while entertainers are given a pass?

George Clooney made $329 million in 2017. Did George Clooney keep even as many as 10,000 people employed in the entertainment business? What is the ratio of his salary to the average salary of the people working on his movies? How does that number compare with the BigPharma companies?
 

klpca

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Per Benjamin Disreali - there are lies, damn lies, and statistics.

You can't really make that comparison without considering changes in the workforce and the influence of technology and changes in the workforce.

To give a microexample of how that skews. When I left college and went to work in 1974 as an Assistant Sanitary Engineer (entry level position in CA state government for someone with a MS in engineering and no work experience), I was making $1400/month (a competitive salary at the time). Meanwhile, a Clerk-Typist II (which was a basic office staff person, with five or more years of experience) was earning about $500/month.

Our business was doing inspections, reviewing reports and studies and data, and preparing permits, evaluations, and related correspondence. This is pre-Word processor days. C-Ts are banging away on IBM Selectrics and doing triplicate and quadruplicate carbon copies of final documents. The mode is to write documents out in long-hand, give it to a C-T to type, make hand-written edits to the typed documents, and hand it in for retyping. Repeat as needed until the document reaches final. Our rule of thumb was the we needed one Clerk-Typist for every three engineers in the office. If we skewed much from that we either had a highly efficient C-T or inefficient professional staff.

Move forward 25 years to 1990. I'm now working in consulting, but the nature of our work is very similar. What is different is the office environment. Everyone has a computer (PC or Mac), the office staff are using word processing software, and documents are being generated on printers. Staff now write reports on the computer instead of long-hand, do a fair amount of document cleanup before turning over the document to clerical staff.

We're still doing hand-written edits and markups, but that's happening after a document is nearing conclusion, and often when it's being edited by a work team. We now expect the word processing staff to manage document production - they handle document layout and organization, and have responsibility for document physical appeal - spacing, organization, headings, graphics layout, etc.

Our rule of thumb is now one document production person for every ten engineers. That same entry level engineer coming out of school with a MS is being hired at about $4000/month. That office staffer is earning $3000/month. So that central office staff person has gone from earning roughly 33% of the salary of an early career engineer to earning 75% of the engineers salary. And that's commensurate with the added technological requirements of the job. But we're also employing one-third as many as we did before.

******

In the old 1974 days, assume on office of ten engineers. Given the range of experience and that some engineers are in a supervisory position, the total base engineering salary burden might be $20,000/month. Admin would be three C-Ts and one office manager, so a direct admin salary burden of ~$1800/month. So office staff is about 8% to 10% of total salary.

In 1990, an office with ten engineers would likely have a base salary burden of ~ $60,000/month. There would be two clerical staff - one supervisory office person and one document production person. The supervisory person is document production plus other office coordination activities. Probably totaling to about $6500/month.

So during the time clerical support represents a bigger portion of base salary burden, but the work that is being performed is at a higher level. The people doing those jobs have seen a dramatic increase in pay, to a level where a single mother with a deadbeat ex-husband can actually support a family at more than poverty level. (I have a favorite performance review story related to that aspect.) But there were proportionally fewer of those jobs available.

********

Long story - but the point is that when you making comparisons across time is difficult because conditions change.

Another data point. My boss and I run a small 2 person professional service office. It's just me and him. No secretary. No admin. No janitorial. No security. No IT. I think about that every once in awhile. It just wasn't possible in the past. Now it's fairly straightforward.

Btw, in your example above I am shocked that you have an engineer with a masters working for $50k/year. Why do they bother? They should just be a plumber or an electrician. My brother (HS only, unskilled job) makes close to that.

And as far as entertainers go, perfect example of the market at work. Clooney (and others) have a skill that few others possess. The market is apparently willing to pay him the big bucks. It's not worth it to me, but I am not the market.
 

T_R_Oglodyte

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Btw, in your example above I am shocked that you have an engineer with a masters working for $50k/year. Why do they bother? They should just be a plumber or an electrician. My brother (HS only, unskilled job) makes close to that.
The salaries I was citing are from ca. 1989. Nowhere close to salaries now.
 

rickandcindy23

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George Clooney made $329 million in 2017. Did George Clooney keep even as many as 10,000 people employed in the entertainment business? What is the ratio of his salary to the average salary of the people working on his movies? How does that number compare with the BigPharma companies?

I love that example.
 

T_R_Oglodyte

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Another data point. My boss and I run a small 2 person professional service office. It's just me and him. No secretary. No admin. No janitorial. No security. No IT. I think about that every once in awhile. It just wasn't possible in the past. Now it's fairly straightforward.
Yeah - another example of how things have changed, and how it's difficult to make comparisons across eras.

I have been self-employed as a consulting engineer since 2002. My situation is all made possible by the internet. I work out of a spare room in my home. I have web-hosting. I have e-mail.

My fixed expenses run to about $30k/yr. Once I cross that threshold, about 80 cents of every dollar hits my bottom line.

I think I'm doing pretty good. Then I think of one of my kids, who like me got a BS and MS in engineering. Then he decided he liked finance more, went back to school and got an MBA in finance and now works for F500 company. He blends his engineering training with his financial training and provides company management with incredibly precise financial analysis. He makes me look like a piker.
 

T_R_Oglodyte

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And as far as entertainers go, perfect example of the market at work. Clooney (and others) have a skill that few others possess. The market is apparently willing to pay him the big bucks. It's not worth it to me, but I am not the market.
How is it different for the CEOs of large companies? Aren't their salaries an example of the market at work? Aren't their salaries set by a board of directors, that is selected by the shareholders? Aren't most of those shares held by funds that represent mutual funds or investment funds, whose managers are compensated based on the return on investment? Would those funds be paying those CEOs the salaries they receive if those salaries didn't represent the market at work?

******

I think that hypocrisy reigns when it comes to high income earners who aren't perceived as part of the evil capitalist empire. Non-corporate people, e.g., entertainers, such as Clooney, will rant about the inequities of the economic system and unjust enrichment of CEOs. But when it comes to their business affairs, it's a different story. Somehow it doesn't count for them.
 
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  • 17 of the highest-paid CEOs in healthcare
The annual Equilar 100 examines CEO compensation at some of the nation's largest companies by revenue for fiscal year 2017. The 100-company study includes businesses that filed annual proxy statements before March 31. Equilar is scheduled to release its annual Equilar 200 study in conjunction with The New York Times in May as more public companies file their executive compensation data during the month of April.

Here is how much 17 healthcare CEOs received in compensation during fiscal year 2017, according to Equilar.

6. Ian Read (Pfizer) — $26.17 million
9. Michael F. Neidorff (Centene) — $25.26 million
10. Alex Gorsky (Johnson & Johnson) — $22.84 million
20. Joseph M. Zubretsky (Molina Healthcare) — $19.74 million
22. Richard A. Gonzalez (AbbVie) — $19.13 million
24. Giovanni Caforio (Bristol Myers-Squibb) — $18.69 million
34. David M. Cordani (Cigna) — $17.55 million
47. Timothy Wentworth (Express Scripts) — $15.90 million
51. Miles D. White (Abbott Laboratories) — $15.62 million
53. John F. Milligan (Gilead Sciences) — $15.44 million
56. Bruce D. Broussard (Humana) — $14.87 million
62. Stefano Pessina (Walgreens) — $14.67 million
63. David A. Ricks (Eli Lilly) — $14.50 million
66. R. Milton Johnson (HCA Healthcare) — $13.71 million
83. George S. Barrett (Cardinal Health) — $10.99 million
86. Steven H. Collis (AmerisourceBergen) — $9.91 million
99. Ron A. Rittenmeyer (Tenet Healthcare) — $3.65 million

Want to see where your healthcare dollars go? These guys make 10's of thousands of dollars A DAY.

Jim
Jim - how about if you construct the same table, using the highest salaries for 2017 earned by individuals in the entertainment industry - production company executives, movie stars, musicians?

Then contrast that with the number of people employed and the average salary earned by people such as roadies?

I think you would find that the numbers paid to people in your table who are in the business of leading companies that provide actual healthcare are a pittance compared to what we give people who do nothing but keep us amused.
 

bluehende

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Jim - how about if you construct the same table, using the highest salaries for 2017 earned by individuals in the entertainment industry - production company executives, movie stars, musicians?

Then contrast that with the number of people employed and the average salary earned by people such as roadies?

I think you would find that the numbers paid to people in your table who are in the business of leading companies that provide actual healthcare are a pittance compared to what we give people who do nothing but keep us amused.

I think Stars be it in entertainment or sports make too much money. However at least that is an open free market with alternatives. In your other example Clooney is paid so much because some one who has the money think he is worth it. When it comes to CEO's their compensation is set by the compensation committee. At the company I worked for we were in a time of frozen wages. Our CEO got a 12% raise and stock options. When we looked at the compensation committee it comprised of 5 other CEO's and our CEO sat on the compensation committee of three of those people. Somehow that does not seem real fair and free market. I would have loved to set the compensation for someone that then sets mine. I bet my salary would be a lot higher.
 

T_R_Oglodyte

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I think Stars be it in entertainment or sports make too much money. However at least that is an open free market with alternatives. In your other example Clooney is paid so much because some one who has the money think he is worth it. When it comes to CEO's their compensation is set by the compensation committee. At the company I worked for we were in a time of frozen wages. Our CEO got a 12% raise and stock options. When we looked at the compensation committee it comprised of 5 other CEO's and our CEO sat on the compensation committee of three of those people. Somehow that does not seem real fair and free market. I would have loved to set the compensation for someone that then sets mine. I bet my salary would be a lot higher.
But those executive board members were voted in by shareholders.

If the corporate structure is such that it enables insider wheeling-dealing and cozy dealing, then smart money managers stay away. Or they sometimes do a takeover to replace the inbred management with an effective management (while the popular press decries them as corporate raiders). And if people make choices to place their savings and retirement money with organizations that do not demand corporate accountability - ???? Well, what do you do?
 

Passepartout

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Steve, people can choose whether or not to support entertainers. Consumers have no choice when it comes to healthcare. They can get it, and bay whatever price the Market can bear, or choose not to and suffer the consequences. Comparing entertainers to healthcare executives is not a good analogy. Imo, they both make what I feel to be obscene amounts of money- far above any reasonable expectation. But that's the way of the world.

Jim
 

klpca

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The salaries I was citing are from ca. 1989. Nowhere close to salaries now.
Thanks for the clarification. If you were paying that now, I wondered about the intelligence of the person with those qualifications who would work for those wages.

As far as CEO's - some are innovative and I assume, support their salary. Some, not so much (for yucks, look at Stephen Elop. I could have done just as poor of a job as he did, and I would have done it at half the price, lol). https://en.wikipedia.org/wiki/Stephen_Elop
 

T_R_Oglodyte

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Steve, people can choose whether or not to support entertainers. Consumers have no choice when it comes to healthcare. They can get it, and bay whatever price the Market can bear, or choose not to and suffer the consequences. Comparing entertainers to healthcare executives is not a good analogy. Imo, they both make what I feel to be obscene amounts of money- far above any reasonable expectation. But that's the way of the world.

Jim
And I think you are being too simplistic re healthcare. The reality is that the current system is broken. Health care providers are obligated to provide services to anyone who shows up, even if there is no chance of recouping payment. Meanwhile they are serving Medicare patients, where their compensation does not cover costs. Logically, they do what they can to try to minimize those obligations, but there are costs they need to eat. Again logically, they try to recoup those costs by soaking patients who have an ability to pay. So, going back to the OP, yes the cost might be unreasonable for that procedure in isolation. But services are not provided in isolation, and the charges that were incurred are simply the price to make our current health care system function.
 

T_R_Oglodyte

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As far as CEO's - some are innovative and I assume, support their salary. Some, not so much (for yucks, look at Stephen Elop. I could have done just as poor of a job as he did, and I would have done it at half the price, lol). https://en.wikipedia.org/wiki/Stephen_Elop
Jeff Bezos' salary is ~$100k/yr. He has gained his wealth by making other people wealthy, not by extracting money from Amazon via personal privilege. I think I like that model.
 

klpca

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Jeff Bezos' salary is ~$100k/yr. He has gained his wealth by making other people wealthy, not by extracting money from Amazon via personal privilege. I think I like that model.
Yeah, I was listening to a story about the (now former?) CEO of WeWorks and how much money he pulled out of the company. Simply unconscionable. 1.7bb. I don't care how smart and clever you are, that's absurd.
 

easyrider

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A couple of years ago I was for Universal Healthcare. Now, not so much because of my Seventh grand daughter. I'm pretty sure she wouldn't have been approved for the almost 1.5 million dollars of health care that was provided to get her where she is today. She is doing great. :D

Bill
 

bluehende

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But those executive board members were voted in by shareholders.

If the corporate structure is such that it enables insider wheeling-dealing and cozy dealing, then smart money managers stay away. Or they sometimes do a takeover to replace the inbred management with an effective management (while the popular press decries them as corporate raiders). And if people make choices to place their savings and retirement money with organizations that do not demand corporate accountability - ???? Well, what do you do?

Board members are nominated by the nominating committee. Want to guess who controls the nominating committee?? That's right the corporation or the board. Nominations can be made in person at the annual meeting but since the proxy's have been sent in getting a seat would be almost impossible. As for corporate raiders....many companies have provisions that make that impossible called poison pills. Also many runs at companies are for the greenmail to make them go away. While there certainly is some accountability with CEO's it usually revolves around removal and seldom salary. When a CEO is sent packing it rarely is a financial problem for the ex CEO. He leaves with an amazing package.
 

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A couple of years ago I was for Universal Healthcare. Now, not so much because of my Seventh grand daughter. I'm pretty sure she wouldn't have been approved for the almost 1.5 million dollars of health care that was provided to get her where she is today. She is doing great. :D

Bill

That is great to hear. You should remember that before Obamacare insurance policies had a lifetime maximum and would have exceeded ours by 500,000. Not only would that have been the bill but there would be no future coverage. I would love to hear from some our tuggers with national healthcare if they have ever heard of limits on care due to expense.
 

T_R_Oglodyte

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Board members are nominated by the nominating committee. Want to guess who controls the nominating committee?? That's right the corporation or the board. Nominations can be made in person at the annual meeting but since the proxy's have been sent in getting a seat would be almost impossible. As for corporate raiders....many companies have provisions that make that impossible called poison pills. Also many runs at companies are for the greenmail to make them go away. While there certainly is some accountability with CEO's it usually revolves around removal and seldom salary. When a CEO is sent packing it rarely is a financial problem for the ex CEO. He leaves with an amazing package.
Wrong.

Board members are elected by the stockholders. Except as noted below, if the board members are shills for management, that's only by consent of the shareholders. If it gets too insular, there are private investment funds that are more than willing to shake things up and install new management to unlock unrealized profits. Of course, in the popular press, those outfits are characterized as predatory vultures. So pick your poison - do you want to have an insular, unaccountable executive team, or do you want to have a vulture firm come in and shake things up?

The exception is if the corporate structure allows a minority of the shareholders to control the Board. In that case, the lower voting value shares typically trade at a discount. Frankly, that's not unlike a timeshare company that puts timeshare ownership into a trust that is firmly under its thumb.
 

bluehende

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Wrong.

Board members are elected by the stockholders. Except as noted below, if the board members are shills for management, that's only by consent of the shareholders. If it gets too insular, there are private investment funds that are more than willing to shake things up and install new management to unlock unrealized profits. Of course, in the popular press, those outfits are characterized as predatory vultures. So pick your poison - do you want to have an insular, unaccountable executive team, or do you want to have a vulture firm come in and shake things up?

The exception is if the corporate structure allows a minority of the shareholders to control the Board. In that case, the lower voting value shares typically trade at a discount. Frankly, that's not unlike a timeshare company that puts timeshare ownership into a trust that is firmly under its thumb.

Then how do the corporate raiders get guaranteed seats on the board if not through the nomination committee? If the board does not control that how can they offer it? How do those board members you can vote on get on that proxy? While you can vote for others it never happens. While boards do get replaced it is always through a very expensive proxy fight about how the company is run. I have never heard of a board being replaced over executive salaries.
 

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Then how do the corporate raiders get guaranteed seats on the board if not through the nomination committee? If the board does not control that how can they offer it? How do those board members you can vote on get on that proxy? While you can vote for others it never happens. While boards do get replaced it is always through a very expensive proxy fight about how the company is run. I have never heard of a board being replaced over executive salaries.
When a corporate raider comes in, there's usually a proxy fight as the two sides line up votes. Very similar to a presidential election.
 

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A couple of years ago I was for Universal Healthcare. Now, not so much because of my Seventh grand daughter. I'm pretty sure she wouldn't have been approved for the almost 1.5 million dollars of health care that was provided to get her where she is today. She is doing great. :D

That is great to hear. You should remember that before Obamacare insurance policies had a lifetime maximum and would have exceeded ours by 500,000. Not only would that have been the bill but there would be no future coverage. I would love to hear from some our tuggers with national healthcare if they have ever heard of limits on care due to expense.

Maybe I am misunderstanding the issue raised by easyrider, but in Canada, as in most national universal healthcare programmes, there is rarely a dollar limit on any qualified procedure, no lifetime maximum, nor any pre-existing condition limitations. You are simply covered, either from birth or from the time you become an eligible resident. No real fine print. I am not really familiar with all the nuances of the various US systems, so maybe I am missing the point?
 

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Maybe I am misunderstanding the issue raised by easyrider, but in Canada, as in most national universal healthcare programmes, there is rarely a dollar limit on any qualified procedure, no lifetime maximum, nor any pre-existing condition limitations. You are simply covered, either from birth or from the time you become an eligible resident. No real fine print. I am not really familiar with all the nuances of the various US systems, so maybe I am missing the point?

I guess there are some countries with a national plan where people have to be approved if the bill will be over a certain amount. England comes to mind but I could be wrong about that.

All we ever hear about here in the USA is how Canadians have huge waiting lists for procedures. Not sure if that is true. Also- I know the taxes are high, but are these income taxes? What about people that do not work? Does everyone else subsidize them in Canada? I am talking young and old and the like.

In the USA we do through taxes for Medicaid (for the very low income)- property taxes in NY are very high and this is one reason.

We pay taxes for Medicare (for the elderly- 65+) all our lives here but still have to pay a fortune in insurance premiums on top of it when we retire. Just crazy town.
 

bluehende

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Maybe I am misunderstanding the issue raised by easyrider, but in Canada, as in most national universal healthcare programmes, there is rarely a dollar limit on any qualified procedure, no lifetime maximum, nor any pre-existing condition limitations. You are simply covered, either from birth or from the time you become an eligible resident. No real fine print. I am not really familiar with all the nuances of the various US systems, so maybe I am missing the point?

I think the original worry was that a national health organization would not have gone to the measures used (1.5million) to save a child. I have no idea whether the total would have been known in advance.
 

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I guess there are some countries with a national plan where people have to be approved if the bill will be over a certain amount. England comes to mind but I could be wrong about that.

All we ever hear about here in the USA is how Canadians have huge waiting lists for procedures. Not sure if that is true. Also- I know the taxes are high, but are these income taxes? What about people that do not work? Does everyone else subsidize them in Canada? I am talking young and old and the like.

In the USA we do through taxes for Medicaid (for the very low income)- property taxes in NY are very high and this is one reason.

We pay taxes for Medicare (for the elderly- 65+) all our lives here but still have to pay a fortune in insurance premiums on top of it when we retire. Just crazy town.

I will to answer as best I can as an everyday Canadian. In travelling in the USA, I have found most Americans have little knowledge of how our health system actually works, including Bernie Sanders. Most Canadians and Europeans view health care, like education, as a basic tenet of our national values. So yes, everyone is covered, whether they work or not. It is not considered a subsidy of some people by other people, but a basic human right. And yes we get to pick our own doctor and have an input into our treatment options.

And overall we pay significantly lower overall costs per capita than in the USA, with longer life expectancy and better quality of life in general, according to most indices that measure these things. There is a chart earlier in this thread that illustrates the costs and outcomes and National Geographic magazine had a good article a few months ago on the same issue that reinforced this point. Early preventative care is almost always less expensive than acute care.

First there is no monolithic "Canadian" health care system. In Canada, there is an overall federal health act, which sets minimum standards for each province in order to be eligible for federal health grants. Each province has its own health system. They have their differences, but they are all very similar because of the Canada Health Act. The system is not normally funded by sources such as property taxes or direct charges, but through our income tax system and out of overall federal and provincial general revenues.

The physicians and hospitals bill the province for their procedures, at rates set out in each provincial plan. This means they are paid quickly and do not have to worry about receivables nor bad debt. If a doctor or hospital participates in the government programme (and almost all do), they cannot do any direct billing to a client for that procedure. While our doctors make lower gross incomes generally than doctors in the USA, they also tend to have lower overhead costs and they also do not face the huge liability insurance premiums that most doctors in the USA pay. Also, drug costs are regulated in consultation with the drug companies, if they wish to sell their drug in Canada, and generic drugs are encouraged once the patent protection period is past.

Most of the funding for these plans comes from income taxes, and therefore general government revenue, although there are some differences by province. With the exception of the province of Quebec, we file a single combined federal/provincial income tax form each year. The federal tax rates are consistent across the country, but each province sets its own provincial portion of the tax rate. The federal government administers the whole tax system through the Canada Revenue Agency (our version of the IRS) and remits the provincial income taxes collected to each province.

Our combined general personal income tax rates are higher to compensate for the fact that they are the primary source to fund our medical system. However, there may also be direct health tax surcharges on the income tax returns, but it varies by province. For instance in Ontario, there is a direct health levy on employers when filing their corporate tax returns. It only applies where the payroll is in excess of $400,000 per year, so smaller businesses are exempt. Also, there is a personal health care surcharge on the personal income tax return in Ontario, that increases with income, but also has a low-level initial exemption.

Is the system perfect? No system is and ours is no exception. But overall it works extremely well. Waiting lists are a standard threat trotted out by the vested interests in the US health care industry trying to protect their significant profit margins. Don't believe everything you hear. Since we have access here to both our own media broadcasts, but also those from across the border, we see the often less-than-truthful stories and information provided by the US health care industry in its denigration of universal health care.

Are there waiting lists? Sometimes...but they vary by procedure and by province, depending upon priorities. But if you have a stroke or a heart attack or anything else that is immediately life-threatening, no one is putting you on a waiting list!! Waiting lists were more common a few years ago, but with an aging population we have made larger investments in health care to help eliminate or reduce such bottle necks where possible, but they do still exist.

Most waiting lists are for non-urgent, non-emergency care. If you need new knees, you don't just get them on demand. Cases are triaged, with those most in need going to the head of the line and the rest wait their turn. It is a necessary compromise to make the system work, but overall most of us not only accept it, but think it is generally fairer as well. Hope this helps give everyone a better understanding, although I am certainly no expert, except as I have experienced it myself and with friends and family.
 
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