That’s the key difference and problem - American health care is tied (generally) to the employer. The “welfare” class (whatever they call it in the USA these days) get health care paid for by the government (medicare, medicaid?) The working poor and the able-bodied unemployed get screwed by the system since they have jobs that do not include health care, and/or they can’t afford premiums.
Obamacare still tries to make the insurance be paid to the employer. It requires all larger employers to provide plans; it requires people to participate in those, or if they can’t afford them, join government-organized plans.
You can join government palns if your mployer’s plan costs too much of your income. Employers get dinged if too many employees end up on the government exchange plans (subsidized). However, that was defined as the employee-only plan cost; so the employer has to only offer a cheap employee plan, and if the family plan is horrendously expensive, well tough bananas for them. Also, it’s not clear what happens if you get a raise half-way through the year and your eligibility for the government subsidy changes. Most of these plans still have significant deductibles or co-pays, while Canadian provinces specifically do not charge anything.
The difference is that in Canada, your employment status, income, etc. are irrelevant. you are covered. The incentives to stay in a bad job due to the need for healthcare is gone. there’s no worry that changing employers means a major disruption in health plans because your provider changes. Employers do not have to worry about the additional cost of health care benefits or the risk that one employee with a cancer in the family does a serious number on the cost of the company’s health plan. Doctors do not have to know 100 diffferent health providers, approval procedures, billing procedures, and fee tables.
So much information, and so fast! And no incediary remarks!
Thank you especially to all you Canadians for explaining how your system works. It’s clear that the Affordable Care Act is very different from what you have. I fear it will be far less effective.
I intentionally tried to ask the question to get factual information. I have an opinion (every’s got 'em), I need real information to base my opinion on (or correct it if wrong). As to reading it - the PDF is 2.6MB! Probably written by lawyers! I remember when it was coming up for a vote hearing Nancy Pelosi saying something like “We’ll find out what’s in it after we pass it”. Even the people trying to pass it didn’t want to read it.
Thanks to all for the input. If anyone’s got more, don’t stop!
IMHO the ideal way for the USA to get to where we are would be to allow anyone without healthcare to join Medicare by paying a percent of income, and employers pay equivalent of plan in taxes if they don’t offer one (almost what ACA does now). Keep making it easier and easier and cheaper to be on medicare instead, pretty soon it’s almost universal. Then you could also tax doctors who don’t do medicare work for medicare fee schedule (to pay the ones that do…)
But f course, anything too good would not have passed the houses of congress. In fact, to get there, the ACA was passed using some procedural tricks. (IIRC the Democratic senate passed the flawed but better-than-nothing house bill, which was only passed because the Republicans expected the House bill to need adjustments in the senate and come back for another vote where it would be rejected).
Yes, that whole thing about lawmakers not reading the bill was a bunch of hooey. It’s very hard to understand legislation sometimes by just reading it. You have to have the context. A summary that tells you what the language does is alot more useful sometimes.
For instance, this might be bill language (I’m totally making this all up):
"Section 3, Paragraph J of U.S. Code Chapter 17 is amended by striking “7.3%” and adding “6.9%, except for a non-qualified retirement sub-account as defined in Section 9.”
What the heck is that?
A summary written by congressional staff would be much more informative. It might say something like:
“The bill amends the tax code to reduce the tax on retirement accounts held by individuals from 7.3% to 6.9%, except for certain accounts that are not taxed.”
This also resulted in a bunch of idiot amateur bill readers going out and completely misunderstanding what they were reading, and posting ridiculous claims on the Internet about the health care bill. The most stupid of many was the “death panel” thing.
Instead, read a (neutral, professionally written) summary. Here’s one:
That would seem reasonable enough to me provided that treatment could not be withheld due to the patient’s inability to pay, but there’s the rub, for the legislation does not deal with this possibility.
In addition to various public and private complementary plans, provinces subsidize some expensive medications. There are life-threatening issues, like insulin or anti-rejection drugs you mentioned, and public health issues, like tuberculosis and STDs.
If it were that simple, we’d have no problem. But the poor, including many working people who can’t get insurance from their employer, are far from fully covered by the government. That was something ACA is supposed to fix.
The biggest difference is we’re not running a ‘for profit’ system. Our hospitals/ ambulances aren’t trying to turn a profit, just not go into the red. Same goes for our health insurance, no profit is in the system, or in the fees. Much like police and fire services elsewhere. Access to services is largely triaged by need. So an aging cohort produces high demand for things like knee replacements. If ibruprophen handles your pain, and you can still get around, you’re probably going to wait. But cranky old people want what they want and complain bitterly when put off.
The provinces negotiate with the drug companies and secure very low prices by doing so as one large group.
Having everyone covered means issues get addressed immediately, instead of festering into more expensive treatments. People go to the doctor so more things get caught earlier. Covering everyone also focuses health care on prevention wherever applicable savings are to be had. Society as a whole benefits from this, costs for some things continue to come down, as a result.
Also, it’s a lot cheaper to cover the insurance premiums for the poor, than their actual health care costs. (This just seems so self evident to me.)
A few comments. In Montreal, there are just not enough doctors. This is no accident. The province has limited the number of doctors who can practice in Montreal. This began as a way to get doctors to move to remote northern communities, but the result is an oversupply of doctors in the ring around Montreal (the 450 area code). It is, in my cynical opinion, because the 450 area is a swing area in elections, while the 514 area (Montreal island) isn’t. When my GP retires (which he is obviously planning to do; he has not taken a new patient in 20 years and increasingly has a geriatric practice), I will be reduced to walk-in clinics and no regular doctor.
That said, I am very happy with the care I’ve gotten–so far.
One other comment. Tomorrow I will get a NY Times and the magazine section will have three or four full page ads for hospitals! When I was growing up (in the US), my doctor advised me not to got to med school because there’d be socialized medicine in the US within ten years. If only… He said then bureaucrats would be running the system. Well my physician DIL spends a lot of time arguing with bureaucrats all right, but from the for-profit insurance companies. It is clear that the whole system is profit-driven, not health driven.
Just becasue it’s so commonly referred to, I just wanted to mention that in that coffee case, the person was actually pretty seriously injured:
The person tried to settle out of court for about $20,000 (her hospital cost were over $10,000 and she wasn’t done at that point) but McDonald’s only offered $800, and that’s when it went into the full blown case.
Obviously, lots of questions about negligence, responsibility, etc., but I feel like the myth around this story it “ow, that’s hot give me a million dollars,” when the truth was “holy crap that burned the living hell out of me, please help cover the actual costs.”
From my standpoint (as a doc practising in Canada), this is worth emphasizing.
Doctors in the US spend a huge amount of resources dealing with the various payers - there are scores and scores of them, each with different processes, different criteria for reimbursement, different degrees of required documentation, etc. As I understand it, American physicians almost always require staff (singular or plural) whose only job is to deal with the multitude of payers (all the various insurance companies, etc.). Bottom line is that it is expensive, frustrating, and time consuming.
On the other hand, here in Canada (I’ve practised in more than one province), all my bills, for all my patients, regardless of diagnosis, are submitted in a straightforward manner (electronically) to a central processing department at the Ministry of Health (OHIP - Ontario Health Insurance Plan). It couldn’t be simpler; takes me, personally, about two minutes per day (literally) and my assistant about ten minutes a week (literally). And, best of all - 99% of my bills (again, literally) are paid to me quickly, in full, and with no further documentation required or requested.
Right - because here in Canada we have all those unhealthy fast food places: McDonald’s, DQ, A&W, Wendy’s, KFC, Taco Bell, plus calorie-laden chains like Red Lobster and Olive Garden. And we have all those high calorie soft drinks, like Coke and 7-Up.
You guys down south don’t have anything like that in your diet.
Oh, wait …
Seriously, what cultural diversity are you talking about? And, since this is GQ rather than IMHO, cite, please?
Again, cite please, for these social standards of the working poor in the US. Or are you just making up “facts” to support your own prejudices and opinions?
I concur with my learned friend Gorsnak - what demographic differences are you talking about?
And again, cite, please. If you’re relying on demographic differences to rebut the factual information provided by Muffin, you should be able to bring some facts in support - otherwise, it’s just your speculation.
