Yes, but only because even Medicare conforms to the fundamentally broken system of treating health care funding as “insurance”. In single-payer in Canada, a claim cannot be denied because at the patient level, there’s no such thing as a “claim” – the patient simply receives a service and goes home. There are no forms, claims, or financial transactions of any kind involved.
If the denied claim was for a medically necessary procedure, it absolutely makes them evil. And if it causes the patient to die, as has indeed happened, then it also makes them murderers.
There’s also the issue of “who cares”. If somebody decides to kill you for their own profit then really, why the heck does it matter if they are “evil” or not? If they don’t count as evil are people going to just shrug and say “Well, all right then, go ahead and kill me that’s fine.”
Or, they stay on a waitlist for months or years and then die. 17k and possibly up to 31k people died while waiting for procedures in Canada in 2022-23:
Every time a doctor triages a patient as requiring immediate attention, it means that another patient is denied the procedure. The doctor may not know the name of that other patient, but morally it’s the same as an insurance company denying coverage to that other patient. There are only so many resources to go around and those have to be prioritized somehow.
Medicare loses billions of dollars each year due to fraud, errors, and abuse. Estimates place these losses at approximately $60 billion annually , though the exact figure is impossible to measure.
[quote=“wolfpup, post:181, topic:1011177”]
If the denied claim was for a medically necessary procedure, it absolutely makes them evil.
[/quote]How about if the claim was fraudulant?
Most fraud is from providers, not patients. Providers (doctors, equipment sellers, therapists…) are paid by Medicare, and benefit from getting more money. Patients get medical care, and while there’s a range of how much care people want, it’s just not true that “more is better”, like it is with money.
This. When I am in an ambulance, going into shock, my number one priority is speed; what emergency room is quickest. I do not have time to comparison shop, even if I am coherent.
Even longer term: I had cancer. When caught and treated early, it was completely survivable. I simply did not have time to look into other options.
Wrong. My Medicare Supplemental coverage is run by UHC (no complaints) and Plan D drug coverage is run by private insurance companies. These are more tightly regulated, it seems, so there seem to be fewer issues.
I wrote about the history of triage in our book. The modern system began during the Napoleonic Wars, led by the French surgeon Dominique Jean Larrey. He began prioritizing treatment based on need. Before enemy troops were ignored, and officers and nobility were treated before common soldiers.
Which is part of the way the American system works in the broadest sense. Each ER might treat patients in order of need, but you are going to wait longer in a crowded hospital serving lots of poor people with inadequate resources versus a suburban hospital.
If you want to give all cases reasonably fast turnaround time, you need to put money into the system to make it possible. If you don’t, you don’t get to say the system is a failure due to long wait times.
Supplemental and advantage are two different programs. But private insurance companies administer Parts A&B. See (What's a MAC | CMS*
A Medicare Administrative Contractor (MAC) is a private health care insurer that has
been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment
Whenever I see stuff like this, which makes my eyes glaze over, I am once again amazed at the unfathomable complexity of the US health care funding system.
Here’s how it works in Canada from the patient’s standpoint. Fill out a simple form and provide proof of citizenship or legal residency the first time and get a health card. Renew every five years just by showing that you still live in a particular province. Present the health card when needing any kind of medical service. That’s the end of any patient’s concern about any medical costs.
That question should actually be reworded to “why do 2/3 of Canadians have supplemental health insurance?”
The answer is that it’s a benefit provided by employers that has traditionally covered relatively minor expenses like prescription drugs, some dental, and sometimes miscellaneous stuff like a private rather than semi-private hospital room, and a few other fairly low-ticket items.
A hugely major philosophical difference between single-payer in Canada and private insurance is that the former tends to nickel-and-dime on minor stuff but unconditionally covers all major medically necessary procedures regardless of cost, while private insurance is sensitive to high costs even if that threatens the patient’s well-being and even their life.
But even those items traditionally not covered by single-payer in Canada are changing. A dental care program separate from Medicare is now being rolled out, and seniors are fully covered for prescription drugs.
Some Canadians may indeed choose to buy supplemental insurance, but I believe the numbers are very small. It almost all comes as an employment benefit. Ever since I retired I’ve never had supplemental insurance and never felt the need for it. Meanwhile the primary Medicare system has literally saved my life, and it didn’t cost me a penny.
Prescription drugs can be very expensive, and can address life-threatening health issues. I’m kinda shocked they are excluded from your health insurance.
No it shouldn’t, because every benefit that an employer pays for ultimately comes out of the employee paycheck. Canadians are buying that insurance whether they explicitly choose to or not. Same as American health insurance.
I don’t think it’s a great mystery why, if (retired) seniors are already covered for prescription drugs, and most people with jobs have supplemental coverage, the number of people explicitly buying extra coverage is small. I think I can predict that if you look at, say, the early-retirement population, the numbers would be fairly high.
The super-expensive ones tend to be covered under special programs, or administered in hospitals where they’re automatically covered. The other point to note is that prescription drug prices are federally regulated in Canada, so that what might be “very expensive” in the US may only be a minor nuisance in Canada even if you have to pay out of pocket.
And yet a third point to note is that many of those needing such drugs are the over-65-ers who are automatically covered anyway. And then finally, if the cost of a needed drug is prohibitively expensive because of lack of financial means, funding will be provided in other ways. Those receiving social assistance are covered for most of the things associated with supplemental insurance.
Your prediction would be wrong, at least taking my case as typical. I retired early and never had the slightest interest in supplemental insurance. I looked at it the same way as pet insurance for my dog – it was statistically calculated to be profitable for the insurer. The only reason to have that insurance is for catastrophic expenses that you wouldn’t be able to cover out of pocket, but that insurance would cover and not find a reason to deny. The probability of both being true seemed vanishingly small.
The most expensive drug I’ve ever had to take for a while was the anti-platelet medication Brilinta. It was covered for me by the public drug plan for seniors, but if it had not been, it would have cost me around a thousand dollars. That would not have been fun, but it also would not have been the five or ten thousand it would have cost in the US.
That’s a very reasonable take, but the existence of pet insurance should remind you that your case may not be typical.
The US should do something about high prescription prices, in any case. Though if we do so I anticipate prices will rise everywhere else. We currently subsidize the world with our pharmaceutical spending.
And actually we went on a tangent that largely missed my point. These annoying lists of medical expenses that are or aren’t covered for esoteric reasons exist in Canada as well. Maybe you personally aren’t so exposed to them, but others are. And it varies province by province! This page makes my eyes glaze over just as much as US Medicare nonsense:
Quite a lot of medical work in the US is exactly as easy as in Canada if you have health insurance. You give them your insurance card, a bunch of behind the scenes stuff happens, and you eventually get a “bill” for $0.00. The trouble is when you’re on the margins.
The major difference – and I can’t emphasize enough how huge this difference is – is that in the system in Canada you might sometimes be surprised by an unexpected fee of a few bucks for some miscellaneous crap, although that’s really quite rare. The last time I encountered it was the previous time I was fitted with a Holter monitor for heart rate and blood pressure, and I had to pay them for the cost of the non-recharcheable alkaline batteries.
In the US system, you may wind up owing hundreds of thousands of dollars or wind up dead if you don’t have the money.
Does that ever actually happen? Or is it only after deductibles, co-pays (and “co-insurance” – whatever that means) have been satisfied? No such things exist in the universal health care system in Canada. My one and only major hospital visit and cardiac procedure cost me literally nothing – exactly zero dollars.