But if there’s a perceived need to tempt doctors into a UHC system, how much would it cost to pay off all or part of their medical school loans in return for agreement to stick to a standard rational tariff (and maybe X years’ service in an under-doctored area )?
I agree with all of this, and you’re exactly right about the single payer price list. Literally. Here in Ontario there is a document called Schedule of Benefits: Physician Services Under the Health Insurance Act that sets out the procedure codes and exact fees for all medical procedures in the province. The one I have is a few years old, and contains 728 pages of detailed pricing information, setting out exactly what every doctor gets paid as full payment for every procedure. There’s no mystery about it.
And yes, the claim that Brooks is making there is absurd. So he thinks doctors will revolt if their gross income goes down by 30% while their overhead expenses including medical losses go down by 40%? Maybe, but only if they’re very bad at math. 
Of course in practice those relative percentages may be different; generally speaking medical fees are very much lower in Canada while doctors’ average net salaries are also lower than their US counterparts, but only moderately so. Most think it’s worth it to be able to devote their time to medical practice instead of insurance bureaucracy. I’ve met a number of excellent doctors here in Ontario who came from the US, including some leading specialists. They’re glad to be here and we’re glad to have them.
Yes! When (if) we devise single payer, we should make it a policy to never lose a talented potential health care professional because of personal affordability. The cost of the training tab would be peanuts relatively and the gain huge for all of us.
Your own experience is not dispositive of the questions. I have had good experience in the US healthcare system, and you don’t seem to be impressed by my very good experience in the system. So, why should I assume your experience is indicative of all of Canada, when other sources are describing problems that you don’t have in your own experience?
The article I provided was not behind a pay-wall. It required a sign-in, but it was free. Anyway, here’s another link. Home Health Care requires private funding, at least for some in Canada.
So again, there are holes in Canada’s healthcare system that have to be plugged by private dollars. I’m not saying that makes the system bad. But it’s not the panacea you make it out to be. There are sub-groups in Canada that have a hard time paying for their healthcare, and some sub-groups that don’t do well in health outcomes. You might not like me pointing it out. But that doesn’t make you right.
Because the claims that you were making are subjective judgments about your degree of satisfaction, whereas the things that I’m telling you – and that others are telling you – are objective evidence of full coverage for services that you claimed were not covered, that’s why. I even pointed you to a government website describing some of those covered services.
I wasn’t making a claim about all of Canada, as each province’s health system is different under the general requirements of the Canada Health Act. I only know firsthand what is covered in Ontario, and you are just flat-out wrong about home care. I also believe the most other provinces have similar services, though I’ve never looked at the details.
But you’re reading these generic reports and either through misinterpretation or inappropriate extrapolation reaching the wrong conclusions and spreading misinformation. With respect to Ontario, at the very least, you’re wrong, period.
I think part of the disconnect here is due to the following: “Home care services are not publicly insured through the Canada Health Act in the same way as hospital and physician services. In Canada, most home and community care services are delivered by provincial, territorial and some municipal governments.” Cite. Translation: Provincial governments are not obligated to provide home care under the CHA, but most or all of them do anyway. It’s like my drug coverage, which you also claimed I didn’t have – it’s covered by the same health card, but technically at some level in the upper echelons of the Ministry of Health comes out of a different program budget than primary health care. That doesn’t mean I don’t have it!
The other part of the disconnect in this conversation is that people who are sufficiently incapacitated to require home care services may have a wide array of needs, some of which they may indeed have to pay for themselves (hence, “private money”). For instance, if they’re bedridden and can’t prepare their own meals, but still insist on living at home, then there is either a real cost incurred in providing them, or an imputed cost ascribed to the services performed by someone like a family member. None of which has a damn thing to do with the fact that very extensive home care services are provided in Ontario, contrary to your claims. I didn’t just read about it, I lived it for many years. Please stop trying to tell me how my own health care works! You’re wrong. Give up, already.
I’m not telling you how your own healthcare works. But if I was, that would be no different from you telling me how mine has worked in multiple threads over multiple months, even though I keep telling you my experience is very different, as well as the experience of almost everyone I know.
What I’ve said is that Canada has problems in their healthcare, too. I’ve backed it up with links. Here’s another, this one focused on how some Canadians have issues with oral health:
Quoting from the link:
*An estimated 20-30 per cent of Canadians have great difficulty getting access to dental care.
According to a 2014 report by the Canadian Academy of Health Sciences, about six million annually avoid the dentist because of the cost. *
Here’s one related to vision insurance:
https://www.sciencedirect.com/science/article/pii/S0008418217306087
Quoting from the link:
Significant disparities exist in eyeglass insurance coverage in Canada. Individuals with low levels of income and education, and the self-employed, seniors, immigrants, nonwhites, and residents of Quebec had less coverage. Studies are needed to understand whether these disparities contribute to the visual impairment burden in Canada.
I think you paint a misleading rosy picture of Canadian healthcare.
Then why do medical professionals put up with this abhorrent behavior? Why don’t they refuse to accept insurance from companies that play games? I own a business. If I have a client that plays games with paying me, I simply stop doing business with them. One would think the free market would be begging and providing a business arrangement in the private sector that was cost efficient and hassle free.
It seems that if you get hammered on false or misleading claims on one topic, you just bounce over to a completely different topic. I believe this is the classic definition of the Gish gallop.
I didn’t claim the health care systems in Canada are “rosy”. I don’t think that’s a recognized term in health care economics, anyway. I claim that, on balance, for the vast majority of people, the health care system in any province is orders of magnitude superior to the clusterfuck in the US. I claim that the majority of Canadians recognize this fact, to the extent that any hint of moving toward a more “American style” of coverage would be political suicide for any party including conservatives. People would revolt. And I think there’s an important lesson to be learned from that.
With regard to the latest off-track trot in your current Gish gallop, dental care is in my view a genuine gap in our UHC coverage, although it’s only a gap in terms of ordinary dental care and not certain dental surgery procedures. I think we need to close this gap, which is just a matter of putting the appropriate amount of additional money into the system, and that will probably eventually happen.
The interesting thing about this is that since I’ve had supplemental private insurance to cover dental during most of my working life, except the years that I was a freelance consultant, I have personal experience dealing with private insurance, even up here in “rosy” Canada! And I will be delighted to tell you just how it worked:
The cost of every dental procedure involved about 20% or 25% co-pay, sometimes as much as 50%. My dentist sometimes had to apply for pre-approvals. I once had a claim denied for a crown because the insurance company claimed that according to the submitted X-rays, “patient already has one”. The dentist had to refile the claim with a note to the effect that “Listen, morons: that thing in the X-ray was the temporary that I put in!” Later on, a friend of mine, dealing with that same dentist, eventually left him because the dentist became so negligent about doing his paperwork that my friend never got compensated for his claims. So let me say this: **I thank God that I don’t have to deal with my primary health care the way I had to deal with my dental insurance! **
In aggregate, we know that doctors will get paid less in single-payer than they are currently. That’s actually one of the “selling points” that M4A advocates have.
Well, all the insurance companies play games. Wolfpup and I have both mentioned several times in this thread that any one service provider needs to be able to deal with tens of insurance companies and thousands of insurance plans (since each insurance company offers many thousands of different plans that all have different coverage). It’s not really that they’re playing games. It’s just that their reason for being in business is to make a profit which is counter to the doctor’s reason for being in business (to care for people).
I have heard of a few doctors who have switched to cash-only services but I don’t know any personally. I think they’re rare. My guess is that if you don’t take insurance, the only other option available is to accept only cash and the majority of patients can’t afford to pay cash. In other words, our awful system has everything so locked down that individual providers can’t even escape it.
One possible explanation - the people dying younger are the ones that can’t afford health care, so the ones that are living are the ones who can afford to get it, thus they have the same survival rates as the countries where it is provided gratis.
survinga, it’s doubly interesting that the problems with Canadian health care you list are with vision and dental coverage. First, because those are items that in the U.S. are typically covered separate from general health care, so it’s not like we have it any better.
And second, because the problems you list come from those being covered by private health plans, not the public health service. So if Canada actually covered them like they do general health, they would have fewer problems. That doesn’t make a strong case for keeping private health insurance in the U.S.
That’s not quite true.A study published by the NIH examined 150 years’ worth of Canadian academic studies, government reports, census data, tax stats, and surveys and found that physicians’ net income actually increased as a result of medicare. Bolding is mine.
To sum up: you’re wrong.
It really depends on exactly what you mean by “cash only” - Doe it means the doctor isn’t part of any networks, or that the patient pays upfront and waits to be reimbursed* or does it mean the doctor won’t even fill out a claim form? These articles are interesting. He says his overhead is so low because he doesn’t have to deal with insurance at all- and some of his patients have insurance. Sure, costs have gone up since he wrote the articles- but that just changes some of the specific numbers. It doesn’t change the fact that his office had two physicians , a nurse practitioner, one full time and two part-time assistants. While my doctor’s office has a doctor , an NP , 4 medical assistants, three people at the front desk , two in billing an office manager and a practice manager. Plus an outside billing agency.
- Which is how my dental insurance always worked since my dentist was not a participating provider. I paid him whatever he charged, he completed my claim form and eventually the insurance paid me the standard payment for xrays or whatever.
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Hit submit accidentally *
It really depends on exactly what you mean by “cash only” - Doe it means the doctor isn’t part of any networks, or that the patient pays upfront and waits to be reimbursed* or does it mean the doctor won’t even fill out a claim form? These articles are interesting. He says his overhead is so low because he doesn’t have to deal with insurance at all- and some of his patients have insurance. Sure, costs have gone up since he wrote the articles- but that just changes some of the specific numbers. It doesn’t change the fact that his office had two physicians , a nurse practitioner, and one full time and two part-time assistants. While my doctor’s office has a doctor , an NP , 4 medical assistants, three people at the front desk , two in billing , an office manager and a practice manager. Plus an outside billing agency. Dr Forrest can see 16 patients per day ( not sure if that’s per provider or total) while my doctor sees about 30 patients a day himself and I assume the NP does about the same. -
Which is how my dental insurance always worked since my dentist was not a participating provider. I paid him whatever he charged, he completed my claim form and eventually the insurance paid me the standard payment for xrays or whatever.
No, I’m sticking to the topic. And why are you talking about Canada switching to the US system and discussing how people would react? I’m not talking about changing Canada’s system. I don’t want to change your system. You just changed the topic yourself into something I’m not even talking about.
But for some reason, you are HELLBENT on wanting to change our system. You repeatedly, over and over and over, criticize US healthcare system, and flippantly dismiss anything I bring up from my 50+ years of experience with it, and talk about how great Canada is. So, I decided to look a little harder at Canada, and it’s clear that it’s not as good as you’ve said in the past.
Everything that I’ve said, I’ve backed up with links. You may or may not like it. But what I’ve said about Canada and healthcare is true.
I don’t care about any studies of Canada and their doctor’s pay. That’s not relevant to what will happen in the future in the US, and our doctors post-M4A. I’m talking about single-payer in the US. Doctors will get less pay if we switch to single-payer. How much less is still a question. Some will be fine with it. Others will not. Many will support single-payer, and some will not. But it’s well agreed that doctor pay, in aggregate, will come down in single-payer.
https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557
To do this effectively, they would need to act collectively and en masse. Indeed, I can’t help thinking that that would be the key to developing a workable UHC system in the US: get the clinical professionals to design it.
I think we know nothing like that actually.
The highest wages for doctors are in UHC countries. Switzerland and Luxembourg. Ireland is only slightly behind the US. Transitions to UHC systems historically have yielded great leaps in revenue for doctors, who have had their mouths stuffed with gold, as the man said.
Any adequate UHC setup should also free up funds about equal to the economy of about the 12th biggest economy in the world or so, so there should be surplus resources.
So no, I think indications lean heavily the other way.
Questions:
Could Medicare sell policies? Has anyone proposed lowering the eligibility age gradually?
And yet, thanks to cost, I do not have dental insurance. I have to say my escape hatch is that I travel to the old country for that and to also get affordable lab work now even with the regular health care from ACA and the health care of the workplace of my wife will not be offered until a year has passed. What you said implies a better dental and health care in America, but that is not quite the case.
While you say that 20-30% have difficulty getting dental care in Canada in the USA 23% (out of 77%) do not have dental care even with ACA added (before ACA it was worse, and worsening now thanks to the sabotage the Republicans are doing with the ACA now)
I think you are ignoring furiously that **wolfpup **has already reported that Canada is not perfect, and even the British system that looks better has flaws too, but they are very good compared to the irrational health care that we have in the USA. Dental care? Sure, there are similar problems in Canada as in the USA but the latest from Canada are proposals for the government to take care of the issue by expanding coverage for dental care, meaning that in the near future the USA will be once again pondering why in developed nations like in Canada they can do it better, and in dental care too.