Agreed.
That’s why I keep saying the US so-called “health insurance system” is jacked up. REALLY jacked up. FUBAR.
It’s cold, cruel, and callous.
I’m sorry - are you somehow under the the impression that hormone-based contraceptive pills are over the counter?
It’s not JUST the pill - there is also the required annual doctor’s visit.
And, contrary to your assumption, no, they are not one-size-fits all. Different formulations exist for actual medical reasons and not just marketing. Part of the rationale for the doctor’s visit is to help determine which pill is the correct one for a woman - and which one is correct might change over time.
Additionally - there’s more to contraception that just the pill (or the pill and condoms). Other forms may actually be more suitable for a particular woman (or couple) but, again, most of them require a doctor’s prescription. Not just here but pretty much everywhere.
So it’s not just a matter of taking tax money and dispensing pills - it’s also a matter of making sure women get the proper evaluations/monitoring/counseling to have safe and effective birth control.
But I expect many Americans, enamored of the “I’m paying for it therefore I should get whatever I desire at this moment” viewpoint, to think as you do.
Well, and also our current insurance system does not keep the price of contraception down via competition. Everything that requires a prescription goes through insurance bureaucracy, which now (for the last few years) for many insurance plans includes the additional bureaucracy of pharmacy benefit managers.
I’m beyond the age of needing contraception so may be out of date. What contraception is free? The closest I’m aware of is stuff women can get from Planned Parenthood… assuming they can get through the anti-abortion picket lines. Otherwise everything costs money.
Those are questions that confront every health care system, will continue to be debated if the USA moves towards UHC, and are certainly worth debating here
Generally speaking the USA fails on all three counts at present, but that is no reason not to consider how other systems compare to each other.
I think you have to start by understanding that all health care is rationed: we have an almost infinite capacity o accept the work of servants, including in the health care system. Secondly, any rationing system, including the one in place in the USA, inevitably creates inequity at some boundary. And thirdly, that (Australia) does have a different social ethic than the USA does, and the 3 criteria mentioned aren’t going to ensure that a particular UHC system will be a good fit for the USA.
An obvious hypothetical would be for the USA just to adopt that Canadian system. If you don’t like that, what don’t you like? What do you not like about the feature that you don’t like? Are your facts correct, and is your analysis correct?
I disagree with your premise. As far as I can tell, the French system is affordable and provides high quality healthcare without significant wait times. And I think it’s the same in Germany (not 100% sure), even though their system is pretty different. Italy has a very robust system too, even though there might be longer wait times in some cases, but I’m not even sure of that.
Canada is famous for its waiting lists, but I think it’s the exception rather than the norm. I suspect that Americans tend to have in mind that waiting lists are an unavoidable consequences of an UHC because the two countries they’re the most familiar with have this issue (and because of anti-UHC propaganda that of course will point at the worst possible issues), but it’s far from universal.
Any description of the American system at work that I can read here shows abundantly that ours is massively more straightforward.
You need tons of people to process claims because your system is incredibly complex with multiples actors, none of them applying the same rules. At your level, you have to spend your time reading the small characters, understanding what is reimbursed and what isn’t and where, and in which circumstances, etc… Your doctor needs staff just to take care of claims because he’s facing dozens of different companies, each with its own set of very complex rules (sorry…in fact, each with several sets of very complex rules, since a single company will offer a variety of different insurance schemes), and nobody knows what is covered or not. The insurance companies need a large staff because part of their job is denying claims, and checking them to see if someone is making a claim for something that isn’t covered.
None of this applies over here. Claims are processed essentially automatically. When I see my doctor, he pass my card in a machine, enters a code for whatever he has done, computers process that and I’m reimbursed later on my bank account. It’s extremely doubtful that any human being besides me and my doctors has been looking at anything related to my health coverage during the last years. And even my and my doctor involvement is minimal. Not everything is covered, or covered in the same way, but if for some reason I’m wondering about whether it is or not, I can look up online, or ask my doc who is likely to know, because the answer is going to be the same for everybody. I can even ask my coworkers or my friends, in fact, because what applies to them applies to me too. In any case I never need to call our Social Security, as it is called, to know whether something is covered or not. Let alone argue with somebody about a denied claim. Or for any other reason for that matter. I never call them, period. I’m not saying that it’s impossible that I could need to call them for some unusual problem, but it doesn’t normally happen.
And regarding fraud, I’m not sure what kind of fraud you’re expecting. I assume something like a doctor billing for things that haven’t been done??? Then yes, for this I guess the cost to prevent fraud will be the same here and in the USA, I would assume. But i would expect that to be a rather marginal cost (although I could be mistaken).
I would add that I read many times here about American dopers who are spending their free time fighting their insurer while they’re gravely ill or their spouse is dying, and I find the idea chilling. That’s yet another cost, human this time, of your system. Not even counting having to consider your risks of bankruptcy, or of leaving your family destitute after your death when you have cancer. If avoiding these things was the only single benefit of an UHC system, it would be well worth it for this reason alone in my not so humble opinion.
Actually, I don’t have my cites here, but from what I’ve seen Canada’s waiting times are perfectly fine; they have a bad reputation based on nothing but the fears of their southern neighbors. Kind of like “everybody” (in many countries, definitely not France) “knows butter is bad for you” thanks to the propaganda of margarine companies.
There’s no reason why you can’t design a UHC system without waits - if you can agree on an acceptable level of redundancy built into the system: baseline + x% to allow for demographic/demand variations. But it’s a permanent quandary to balance efficiency against efficacy, in any system - although marketisation is probably not the best way to do so in this case.
I’ve snipped that for brevity but they are all good points. In the UK it is much the same process. The concept of coverage is not even on most people’s radar.
If I have a medical issue I make an appointment at the doctors (the nearest one, it doesn’t matter where in the country I am ). I then get assessed and get medicine or further specialist treatment according to my medical needs.
That is it. That is the full extent of the bureaucracy I face.
I don’t show any documents or ID at all and I don’t pay anything (other than a nominal prescription charge which is a flat rate of £8.80 regardless of the actual cost of the medicine and even that is waived for the unemployed, the pregnant, children, OAP’s)
It’s actually even worse than that. For each insurance company there are thousands of different insurance plans. So nobody can easily look up what might be covered, except for the insurance company staff and then only if you give them your plan “group number” and member id number. (There are exceptions, like Kaiser Health, I guess. But most PPO plans work the way I describe.) So for example just because you and your neighbor both have Carefirst Blue Cross doesn’t mean you have the same insurance coverage.
I agree so much. We’re either spending time fighting the insurance or sometimes simply waiting weeks while going untreated to see whether the insurance will approve the proposed treatment or medication. We don’t talk about it much because the other issues are so much larger, but with the recent (last ten years or so) increase of the use of pharmacy benefit managers, a lot of people are now fighting to get the medication they need. This includes diabetics because in many cases the type of insulin they are prescribed has been placed on “tier II” or “tier III” lists, meaning the PBM and/or insurance companies do everything they can to discourage the use of those medications. Life saving medication like insulin should NEVER be on those lists. That’s unconscionable.
In the interests of strict accuracy, I should point out that, in the UK, if you’re not registered with the GP practice you visit, you’ll probably be asked why you’re not calling at the practice you are registered with; and if they think you’re visiting from overseas, recent government regulations require them to ask some pretty searching questions to determine your eligibility for NHS treatment. But I’d hope that most practices would defer the administrative requirements till after they’ve dealt with the problem, and temper them with a bit of common-sense, in relation to what they actually need to do by way of treatment (i.e., they won’t give you the Spanish Inquisition for lancing your boil, but they will if you present as having some longterm condition and needing all sorts of complicated treatment you could and should have settled with your own doctor, or in your own country).
But as long as you are dealing with your regular practice, yes, indeed it is as NoveltyBobble outlines. We find it hard to understand quite why the US makes such heavy weather of these issues.
Did you read the post you quoted and responded to? I argued specifically that contraceptives might be a good exception to a general principle about health insurance. You then defended your position on health insurance with a long post dealing specifically with … contraception!
At some point the subject under debate becomes less interesting to me than the cognitive models exhibited by the debaters! Did you sense any cognitive discord between the assumptions in the post you responded to and your response?
As a Canadian, I concur. The misinformation and fearmongering that American health insurance lobbyists and other propagandists direct against the Canadian single-payer system is appalling – and also against the UK system, although Canada, being closer, is a more obvious target. The question that should be asked is not whether wait times exist, since wait times always exist everywhere, but whether wait times or any other factors exist in a way that negatively impacts health care outcomes. And in my experience, they do not, largely because of the emphasis on quality in health care, since everyone, rich or poor, including the lawmakers themselves, all use the same system. One can certainly look up tables of typical wait times, which vary not only by province and region but by individual hospital, but these are always non-critical elective procedures where the wait has no impact on outcomes.
My only really major health care event a couple of years ago was handled just as one would expect in a first-class health care system – I showed up at the nearest hospital, without any concern for ridiculous concepts like whether it was “in network” or whether I had coverage or whether I could afford the co-pay, and it was promptly treated. Yes, wait times exist for non-critical procedures, but they exist according to targeted maxima determined by triaged priorities, and in most cases hospitals tend to outperform the targets. For instance, the target wait time for Priority 1 and 2 non-emergency angiography in Ontario is 7 days and actual average waits were 1 day 99% of the time. Moreover, for patients already in hospital, there are essentially no wait times. When I had a similar procedure done, the “wait time” was about an hour. The propaganda would have one believe that wait times in Canadian health care constitute some sort of rampant chaos where patients with urgent needs are left untreated, and that couldn’t be further from the truth.
Ironically, factors that negatively impact health care outcomes are abundant under the present US system, even with the ACA reforms. These are primarily issues of money – whether or not one has insurance in the first place, and even if one does, whether one can afford the deductibles and co-pays, whether the insurance company will be kind enough to actually agree to pay for a medical service, whether the provider is part of the insurer’s network, or whether the insurer’s preferred specialist is as competent as the one your own doctor recommends but who unfortunately is not part of the insurer’s network. And even then you may have to wait, potentially a long time if the only provider(s) the insurance will cover is/are booked up.
No health care system is perfect, but here is perhaps the most important observation. The recurring theme here is that in other first-world countries, access to health care is patient-centric, governed and prioritized by the medical profession for the benefit of the patient. It’s crucially central to this model that the insurer strictly stays out of clinical decision-making. In the US the model is insurance-centric and essentially mercenary, governed and prioritized by the insurance industry for their financial benefit, even if it’s to the detriment of the patient.
Bolding the most important part
If the lawmakers would be forced to follow along with the rest of us plebs, we would have a good, dare I say even great system.
Nailed it! Canada is huge, with many, many remote and very remote communities. And, like every nation faces pressure from a huge aging cohort of baby boomers. But the greatest driver of this fear mongering is mostly by the very ‘for profit’ players that are continuously trying to find a way into the Canadian market. The politicians they pay in US never stop with this and Death panels ! And they pay right wing politicians in THIS country to attempt changes to our system that would give them an entry. (One of which is currently premier of Ontario!)
Recognizing we could be too easily dominated by US players, we refused a two tier system. A very wise choice for us, but also under pressure to change from American healthcare Titans.
All true, but I was more suggesting that, if you are a UK citizen visiting relatives or on holiday and an issue came up, you could pop into a local surgery to get it dealt with without jumping through hoops.
Which is one of the worries here in the UK about them using the investor-state dispute resolution process in prospective post-Brexit trade agreements to shoehorn their way into dismantling the NHS.
Exactly. The US health insurance industry along with certain highly profitable service providers is to Canada a lot like a massive wall of water being held back by a creaking dam that keeps popping leaks here and there. These are the same clowns that insinuated themselves into the early health care debates in Saskatchewan in the 60s, fearmongering like crazy, and encouraging the doctors to go on strike in protest to the proposed single-payer system, and suggesting that if single-payer were enacted in Saskatchewan, all the doctors would leave the province if not the country and no one would have any health care at all. Long story short: nothing like that ever happened, and today we actually get American doctors, sick of constantly fighting insurance companies, coming to Canada so they can practice medicine in peace. Just like enacting Medicare in the US did not, in fact, lead to “the end of freedom as we know it” and the onset of communism, as had been predicted in the early 60s by Saint Reagan, praised be His name. :rolleyes:
As for your reference to the current premier of Ontario, I agree that he’s a right-wing dumbass. However I think it will be instructive to watch how his reforms unfold. I have long maintained that single-payer public health coverage is so entrenched and popular in Canada (and has been for half a century!) that no politician would dare to do anything to seriously undermine it, contrary to the suggestions by some in this thread that single-payer is risky because a Republican Congress might destroy it. Premier Ford is a dangerous moron but I can confidently predict he won’t change anything truly fundamental in the health care system.
So far the major thing that’s been announced is the elimination of the LHINs – the local health integration networks – in favour of a province-wide super-agency. (For non-Ontarians, LHINs have nothing to do with health care coverage which comes from the Ministry of Health; their purpose was supposed to be to decentralize the planning of local health care facilities and the allocation of things like capital funding.) I confess that I haven’t yet looked at the details of the plan, but in principle it’s not necessarily a bad idea. LHINs have been much criticized and considered relatively ineffective in their core organizational missions.
A very important point, beautifully put.