Canadian Tuggers / Healthcare in Canada

[ricoba]

I thought today's column by Steve Lopez in the LA Times offered some interesting alternatives from a Doctors point of view.

 

[John Cummings]

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.

 

[ricoba]

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.

 

[pgnewarkboy]

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?

 

[easyrider]

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

 

[Redrosesix]

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.

 

[Redrosesix]

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.

 

[John Cummings]

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.

 

[easyrider]

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

 

[pgnewarkboy]

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 ?

 

[John Cummings]

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.

 

[John Cummings]

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.

 

[Redrosesix]

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.

 

[easyrider]

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.

 

[John Cummings]

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

 

[pgnewarkboy]

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.

 

[barndweller]

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.

 

[John Cummings]

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.

 

[John Cummings]

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.

 

[Icarus]

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

 

[Redrosesix]

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.

 

[John Cummings]

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

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.

 

[charford]

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.

 

[pgnewarkboy]

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.

 

[Liz Wolf-Spada]

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