Canadian Tuggers / Healthcare in Canada

[Redrosesix]

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

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

 

[Zac495]

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.

 

[calgarygary]

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.

 

[donnaval]

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.

 

[BocaBum99]

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.

 

[Icarus]

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

 

[Redrosesix]

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.

 

[John Cummings]

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.

 

[Liz Wolf-Spada]

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

 

[donnaval]

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.

 

[John Cummings]

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.

 

[BocaBum99]

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.

 

[John Cummings]

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.

 

[John Cummings]

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.

 

[Icarus]

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

 

[BocaBum99]

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

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.

 

[Icarus]

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

 

[BocaBum99]

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.

 

[Icarus]

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

 

[pgnewarkboy]

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!

 

[Redrosesix]

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.

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!

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.

 

[John Cummings]

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.

 

[John Cummings]

...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.

 

[John Cummings]

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.

 

[Icarus]

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