I saw that! That’s why I didn’t make the claim that most Americans are unhappy with their healthcare. It is a surprising figure, given how incredibly cost-ineffective the American system is. I’m fundamentally suspicious of that figure, but I’m also not sure what better figure to use.
If the subsidies were stronger - they cut off too early in the income levels - we wouldn’t need a public option. The medicaid expansion is already good enough for increasing the “public” part of the ACA. Having said that, I’m not against giving some states the freedom to experiment with a public option. An idea that is being discussed is a “medicaid buy-in” option, that has a similar flavor to what you’re talking about. Speaking of medicaid expansions, see the link. This is the type of political sabotage that is occurring by Republicans in America, and it’s also why I don’t think anything to improve & build on the ACA is going to happen soon.
This Lepage guy is a nut. And he’s still trying to stonewall the Medicaid expansion even though the voters passed a law requiring it in a referendum. And this is after the legislature passed the expansion, and he vetoed it numerous times.
This is what we’re up against down here…and this is why single-payer is a pipe dream in the US.
The cut offs are very annoying. You literally cannot get out of poverty, if you are not allowed to get out of poverty.
I have had employees that I wanted to give raises and promotions and more hours, but couldn’t, because they were at the limits of what they could make without losing benefits, and I couldn’t give them enough of a raise to get them through that gap.
So, I have employees that have the skills and ability to make more money for themselves, make more money for me, and produce more services for the community, but cannot, due to the very stupid nature of our healthcare system.
As is, I only took the chance of starting my own business once I could buy an individual policy on the exchange. Prior to ACA, an individual policy cost nearly twice as what it did off the exchange, and would not cover anything to do with my joints or spine because I had had sciatica years earlier.
I’m very concerned about what will happen with the collapse of the exchange, and what I will do then. I really need to have insurance, as a medical bankruptcy on my part would destroy my business and ruin the careers of a dozen people.
They need to extend the subsidies to a higher income level, and then need to plug the holes caused by the states that don’t expand medicaid. If you don’t mind me asking, what state are you located in, and are you yourself a policyholder from the ACA exchange?
Ohio, and yes.
I used to buy it individually from insurance companies, and that was a pain in the ass. In order to get a quote, you had to call an agent, then wait for them to call you back a few days later, and if you didn’t take their offer right there and then, then they “couldn’t guarantee the same offer” if you wanted to wait to hear back from another agent before making a decision. They did not want you to be able to comparison shop based on service or price.
The exchanges changed that. Even without a subsidy (which I for the first year of the exchange qualified for a $5 a month subsidy), they were a massive improvement in the system. Actually being able to comparison shop on services and price was a totally new thing to the individual insurance purchaser. I also found a policy that had more coverage, cost a bit more than half of what I was paying, and didn’t have dis-qualifiers to coverage due to pre-existing conditions.
That’s where the real shore up on healthcare needs to be. Sure, there are lots of people with nice cushy jobs in big corporate environments who have great healthcare plans. They don’t realize just how much those plans actually cost, as a large portion is covered by their employer, and they don’t realize that their experience is not universal.
There are many companies out there, like my own, that are too small to effectively cover employees on a healthcare plan. I’d like to change that in the near future, but for now, it’s just something that is not doable. I’ve had a number of jobs in my life, and the jobs that gave me the greatest sense of fulfillment of doing something useful were always for small businesses that didn’t offer health insurance. The jobs I had at larger cooperate places that did have insurance were much less interesting, I was just another cog in the system.
And there are the places that offer medical coverage, but it was a terrible crappy coverage that really didn’t do anything for you if you actually needed it, it was really just another revenue stream for the insurance companies.
So yeah, having employer based coverage is great for your employers. It means that employees are terrified of losing their jobs, not due to the pay, but due to the health insurance. It means that employees are not willing to find jobs that are more fulfilling and productive, as those jobs are almost always in growing businesses that are still too small to get an affordable healthcare plan for their employees. It means that individuals are not willing to quit their jobs to take care of ailing family members, new family members, start a business, or just because they want to have more time to enjoy their lives. Like I said, great for established large employers.
Not so great for the employee who hates their job and only stays because if they leave, their child’s treatment for their diabetes will end and they will die.
The problem with relying on Medicaid as a public option is that it’s completely the wrong model for it. First of all access to Medicaid is subject to a means test. It’s not intended to be universal, yet everyone – regardless of means – should be entitled to affordable health coverage without being forced to rely on private insurance, with all its costs and arbitrary denials. Secondly, as if that wasn’t problematic enough, Medicaid is subject to pretty barbaric estate recovery actions on the death of a beneficiary in order to get the money back, and in some cases the state may even place a lien on the home of a living beneficiary. This is the kind of bullshit that needs to be abolished, not expanded. But it exists in part because of soaring costs due to the incredible inefficiencies of the health care system it has to function in.
Having just watched the Trumpists and Republican crackpots in Congress try to kill what little there is of the ACA – and the rejection purely on ideological grounds of Medicaid expansion – I think most of us are well aware of the political obstacles to single-payer. However, it’s important not to conflate “politically difficult” with “can never work”. Those are two different things.
Far too often I hear some argument along the lines of “it can never work in the US because …”. No, the issue is that single-payer can’t realistically be implemented right now because there are too many far-right lunatics running around, and too many people have been misled by insurance industry propaganda. One should at least recognize that as being a different issue. The strength of single-payer is that it can and demonstrably does work, that it’s arguably the most effective way of providing universality while managing costs, and it has thrived in other places precisely by gaining a foothold and proving its merits. I think the insurance industry saw the public option proposal as just such a potential foothold for single-payer, and that’s why its demise was absolutely non-negotiable – it had to be killed.
For your info, the “Medicaid buy-in” isn’t just for low income people. That’s why I mentioned it. Nevada actually voted on it, but their governor vetoed it. I think you will see some other states try it. This is a de facto public option that some states are looking at, and not just for poor people. I’m not against some states experimenting with it, to see how it works.
And I’m not conflating the politics of getting single-payer with the underlying theory of single-payer. At the same time, I don’t think we can talk about single-payer in the US without talking about the politics. As I mentioned in an earlier post, it’s like talking about being at the top of Mt Everest without discussing the dangers of high-altitude hiking. That’s not the only reason I don’t want single-payer. But it is a damn good one, and shouldn’t be shrugged off by the hard-left single-payer advocates.
I’ve already mentioned that I like the private health insurance that I have, and don’t want to replace it with something else. About half the country has something similar to what I have. And most who have it like their healthcare. We don’t need to be “saved” from the evils of private health insurance.
And then there’s the Trump factor. Once you get single-payer, then you have to hope you don’t get a demagogue like Trump who would target it, the way he’s targeting the ACA and Medicaid currently.
All of the above is why we don’t need single-payer in the US. All we need is to strengthen the ACA, get to approximate UHC. Then, maybe all the social justice warriors will leave us alone.
Throw in a public option, and we could make it work.
Without a public option, without having a base level of service and coverage that can be had by anyone, the for profit industries will never control costs.
You talk about fearing trump messing with the ACA, then say that the ACA should just be tweaked, and it’ll be just fine.
We do need to have a system that is not beholden to the whims of the executive, and that system is probably best administered at the state level, but by legislation that removes the executive’s ability to meddle in it. Right now, trump is messing with the insurance by refusing to pay out the pool that insurance companies paid into, that the executive is only supposed to administer, not control.
Link: From referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 9.4 weeks in 2016 to 10.2 weeks this year. This wait time is 177% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Ontario (6.7 weeks) while the longest occur in New Brunswick (26.6 weeks).
Where to start. If my doctor isn’t available we have after hours medical facilities that you can walk into without an appointment. As for your surgery, you didn’t have a choice of surgeons and you lucked out on the ER visit. You should have had that diagnosed ages ago. Instead you stumbled in with a serious condition. The issue of wait time for treatment is addressed in the same rticle:
From the consultation with a specialist to the point at which the patient receives treatment. The waiting time in this segment increased from 10.6 weeks in 2016 to 10.9 weeks this year. This wait time is 95% longer than in 1993 when it was 5.6 weeks, and more than three weeks longer than what physicians consider to be clinically “reasonable” (7.2 weeks). The shortest specialist-to-treatment waits are found in Ontario (8.6 weeks), while the longest are in Manitoba (16.3 weeks).
I had open heart surgery which is a lot different than stents or bypass. They just did a stent on a friend of mine in a similar example to yours. Completely different comparison to what I had.
Going back to my blood clot issue it was the immediacy of diagnostics that saved my leg. I had already seen my doctor once, a specialist twice and had 2 diagnostic tests. All within weeks of each other. I didn’t think the medical conclusions matched my symptoms so I voiced my concern with my doctor over the phone and had a 3rd diagnostic test that day. It was scheduled after work at an after-hours diagnostic facility. Any delay in this would have cost me my leg.
your anecdotal story doesn’t match what Canadians are experiencing.
It’s not a function of perfection. It’s a function of choice and time. You get what you pay for and it’s not a linear ROI. It’s like you’re trying to justify the number of lifeboats on the Titanic.
I’ve provided a cite showing the delays and have tried over and over again to explain that this is how serious conditions get overlooked. You don’t know how serious a lot of conditions are until diagnosed.
No, wait times refer to the time waiting to see a doctor, specialist, diagnostic equipment, and treatment.
This is a plan that I freely admit I don’t know anything about, but I’d have some serious reservations about it. From a quick read, it appears that the “means test” would be eliminated. But doesn’t that mean that already soaring costs would increase tremendously faster, and would become absolutely astronomical if “Medicaid buy-in” came close to being universal without changing anything else? And therefore wouldn’t the barbaric aggressiveness of the Medicaid Estate Recovery Program have to get even worse? And how would people feel about being limited to only those providers willing to accept about two-thirds of their normal fees?
You’ve mentioned both the political difficulties and also things like how different the US is from Saskatchewan (and, presumably, from the rest of Canada, where single-payer now thrives), which I perceive (perhaps unfairly) as talking about political difficulties and operational feasibility all in the same breath. The difference is crucial, especially when those political difficulties are largely based on ideologically motivated falsehoods being promoted in the service of special interests.
With all respect, I don’t think most Americans know enough about the difference between private insurance and single-payer or its close equivalents as practiced throughout the civilized world to be able to make that evaluation objectively. Why would anyone NOT want their insurance to cost half as much while having unconditionally guaranteed coverage for everything that was medically necessary? Unless they believe the bullshit that AHIP and the other lobbyists are constantly spewing.
Everyone loves their private health insurance until the first time a claim is denied or the first time they’re hit with enormous out-of-pocket costs, like the various cites I’ve already provided. Some people die because of those factors. I wonder how much they liked their insurance? I’m reminded of lengthy discussions I had with someone on a different board a long time ago, who was a staunch defender of US private insurance. According to him, it could do no wrong, and served his needs with consummate perfection. Then I found a different thread in which this same person was complaining bitterly about the out-of-pocket costs that a hospital was charging him, and which required him to put down a huge deposit on his credit card before they would even treat his child, and asking if that was even legal.
And it’s not just the big stories that make the news about claims denials that are relevant – they happens thousands of times every day across America. My own brother who lives in the US and has an excellent executive-level health care plan has had claims denied. Nothing especially major, but frustrating as hell. One time the insurer refused to pay for a prescribed medication because there was a cheaper alternative, which made his doctor absolutely furious because while the other stuff was cheaper, alright, it was also less effective. And the insurer turned down home care when he was home with an injury, for reasons that were inconsistent the several times that he called them about it. Meantime my elderly mother here in Ontario has had the home services of a nurse, a personal care worker, a dietician, and a hospital technician providing oxygen devices including a portable mobile oxygen system – all at no cost under the public insurance system. So yeah, I tend to be a cheerleader for single-payer, because experience is a powerful teacher.
And as I’ve said before, in a democracy you can’t kill a system that has overwhelming popular support. That’s why single-payer was never at risk in Canada, and the NHS was never at risk in the UK. Even the new ACA, with its many limitations and limited support, managed to mostly survive Trump and Republican lunatics anxious to kill it, because the impacts to those who depended on it were obvious even to some of the more dull-witted voters.
Which is why it would be better if we have more people covered. People without insurance, or without insurance that provides affordable coverage, don’t go to the doctor until they are able to self diagnose that they have a serious problem, by which time, it is too late for treatment that will be both effective and affordable.
Take your issues, and take away your insurance, or give yourself the type of insurance that many have, that doesn’t cover co-pays, that really doesn’t even kick in until you’ve spent several thousand, and tell me how long you would have gone before getting your leg diagnosed. If you had not had the excellent employer sponsored insurance that you do, what are the chances that you would have lost your leg?
Do you feel more beholden to your employer, now that you are aware of how devastating it would have been had you not had their insurance? If someone comes by with a job offer that is the absolute dream for you, but doesn’t have as good health benefits as your current employer does, will you take your dream job, or stay with the one that lets you keep your leg?
If your employer ever decides that it no longer needs to offer high end health insurance to its employees, and decides to reduce it down to the coverage equivalent of a bronze plan, do you get any say in that? If your employer decides to no longer subsidize your insurance premium, and instead, have you pay the whole thing, would you be able to afford it?
This is neither responsive to what I wrote nor is it medically accurate. You claimed you had no significant wait times after a series of events and procedures. I can make the same claim. I didn’t “stumble in”, I felt perfectly fine except for minor pains that I thought should be looked at out of an abundance of caution. There is absolutely no medical basis for you to declare that “You should have had that diagnosed ages ago”. I have regular doctor visits and had a full checkup not long prior to that. Sometimes the onset of cardiac conditions is just unpredictable. And furthermore, insurance is not likely to pay for many of the precautionary screenings – Cigna says they’re applicable only “when a personal history or physical exam points to risk for a heart problem”; Consumer Reports suggests that CT angiography is pointless and overutilized, and the Mayo Clinic recommends full-fledged catheter angiograms only when indicated by specific symptoms.
Nor did I in any way “luck out” on the ER visit. To me it was a perfect example of the system working exactly as it should, prioritizing urgency and treatment options based only on the balance of medical need and patient preference, not insurance company edicts about what they’re willing to pay for. The whole thing to me was a very positive experience, if frightening. My only complaint, to be honest, was just being poked and tested all weekend (I came in late on a Friday afternoon) with no apparent indication of when I could go home. I even complained to the attending cardiologist about it, and he said, yeah, things get slow around here on a weekend, but they’re really going to speed up for you on Monday. And they sure did.
ETA: I should mention for what it’s worth that your link is from the Fraser Institute, which is a conservative think-tank generally opposed to single-payer and all things liberal. Their actual numbers quoted may not be wrong, but the context and presentation, and information omitted, is often extremely right-wing biased.
No, you’re medically incorrect here. Cardiac bypass surgery (more fully, coronary artery bypass grafting (CABG)) is open-heart surgery. The heart is stopped while arteries from other parts of the body are transplanted.
You’re quite correct that stenting (PCI) is a much different and much less invasive kind of operation, which is why I was so glad that I was a viable candidate for it. But if I had opted for bypass it would have been done within a day or two. How do I know this? Because I spoke with the bypass surgeon immediately after the angiogram, and because my neighbor in the hospital was taken for his bypass within two days of his arrival, which I think was mostly diagnosis and prep time. In fact he got his bypass before I got my stents, because I went through more diagnostics and decision-making.
A lifetime of experience isn’t an “anecdote”.
I should emphasize that this was in response to my comment “The other obvious point that’s often misunderstood is that “wait times” refer to procedures scheduled for outpatients. Once you’re admitted to hospital, wait times are generally pretty much how long it takes them to wheel you over to where the procedure is done.”
And as a response to that, this is just flat-out wrong, and seems to reveal your deep misunderstanding of how health care works in Canada. For MRIs, for example, outpatient wait times range from one day to some number of weeks depending on urgency. But when one patient I was accompanying was in the hospital and was about to be discharged, a nurse came by and said the doctor wanted an MRI done just as a precaution before they left to ensure that some condition wasn’t present, the details of which I can no longer remember. I asked when that could happen, and she said someone would come by in about ten minutes and take them down for the MRI. Yeah, quite the wait.
Personally, I doubt that “Medicaid buy-in” will work. I don’t want it in my state, for instance. I think a lot of doctors don’t like Medicaid, and that’s why only 70% take Medicaid patients. But I’m willing to sit back and see how that experiment goes if certain states want to try it. That’s one good thing about our system. It’s not efficient, but not everything is continent-wide. So, if a mistake is made in one state, it only affects that state. I’m not aware of their estate recovery program, so I can’t comment. I know there’s some kind of “spend down” of assets required for nursing home care, which I definitely don’t like about Medicaid. Is that what you’re referring to? I think if Medicaid buy-in was available for all, then people who became age 65 would then move over to Medicare, and maybe not be affected by an estate recovery thing? Not sure, but I will read up on it.
You’re right that when something has wide support, it’s hard to kill (not impossible, but it would be very hard). However, one of the selling points of the ACA is that once it was implemented, support would be enough to where Republicans wouldn’t attack it. And that ended up being wrong. Medicaid has also been well accepted for 50 years, and yet Republicans are now attacking it. I think we have more extremes in our politics in the US than Canada, and that’s why I don’t think a single-payer in the US would be safe from Trumpist shenanigans. I’m glad that our healthcare system has different insurance targeted for different populations & states. This limits the damage that can come from a nitwit like Trump.
As for private insurance, I’ve never had issues in my family, and we’ve had to deal with Type 1 Diabetes and epileptic-like seizures. We’ve had hospitalizations, and various referrals to different types of doctors. No problems, no hassle. Yeah, we fill out paperwork…but so what. And come to think of it, I’m not aware of anyone in my extended family with issues in their insurance either, except when my brother had issues with Medicaid eligibility…(damn govt bureaucrats).
Anyway, by now I hope you realize that I’m serious in what I’m saying and that I’ve done research on this topic. I think America needs to improve. I just hope we don’t do single-payer.
Are you saying my cite of delays in Canada is not accurate?
I missed this. No, the heart is not generally stopped for bypass surgery.
Cite: Approximately every 10 minutes, someone has beating heart or “off-pump” bypass surgery1. Beating heart bypass surgery is — in simple terms — bypass surgery that is performed on your heart while it is beating. Your heart will not be stopped during surgery. You will not need a heart-lung machine. Your heart and lungs will continue to perform during your surgery.
Your numbers are fine, but significantly devoid of context in a very complex matter where context is critical to understanding. In terms of my experience for myself and loved ones over a lifetime, yes, your cite of delays is deceptive and therefore not accurate. Your argument doesn’t accurately represent any meaningful reality. Because if someone like me has chest pains, they are dealt with competently and immediately. If someone breaks a hip, they are dealt with competently and immediately. And if someone has slowly growing pains in his knee because he’s getting older and heavier, then he can make an appointment and may have to wait a few months. My friend was shocked with how quickly he got his knee replacement appointment – he was hoping to avoid the damn thing for at least a year, he really hated the thought of having his knee smashed up in the hospital.
What all of us had in common was full coverage for the best possible quality of medical care* without spending a dime out of pocket.
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- It’s hard to judge quality, obviously, but when my mother got a pacemaker implanted years ago, as a techie nerd I looked up all possible information about it. It turned out to be one of the most sophisticated Medtronic units available, the procedure performed at a world-class Toronto hospital. Total cost: $0.
Yes, it is generally stopped – according to your own cite: “More than 70% of all bypass surgeries are performed on a stopped heart … Your heart will usually be stopped for about 30-90 minutes of the 3-6 hour surgery.”
I would say that “more than 70%” qualifies as “generally”.
But that wasn’t even my main point. My main point is that it was it was major open-heart surgery, which indeed it was. Maybe you don’t understand what “open heart surgery” is.
But perhaps your point is that in Canada, what with single-payer and all the ice and Eskimos and stuff, they don’t know about this advanced stuff and so I would naturally have had this more primitive kind of surgery.
Well, no, the reason I didn’t have this major surgery at all was the hospital’s catheter lab experience with advanced PCI techniques like fractional flow reserve as a means of optimizing stenting as a viable alternative to life-threatening and major debilitating surgery.
…and I almost forgot to respond to the pointless shot taken at Americans…
Look, almost anyone in the world you talk to in any country isn’t going to be able to analyze the nuance and differences between this or that type of healthcare system. People don’t understand macrosystems, whether it be healthcare, or central banks and monetary policy, or military, or, well, any other topic.
But people know if they’re getting good healthcare in their own lives. Their own situation is something where we should take their opinion seriously, even if they’re not experts in the “field”. I think 3 out of 4 is a lot of consensus. I think you’re trying to sluff off that with your bias against non-single-payer systems.
I understand delays just fine. They’re not complex unless you’re trying to spin them.
The United States has almost4 times as many MRI’s per person as Canada. As I cited earlier, the delays are increasing rather than decreasing. It’s not a function of UHC, it’s a function of throttling that occurs in all methods of insurance. Your system has X dollars to spend And it’s divided up. What you get is what you get. The same occurs with insurance in the US. We have faster service because we pay more. It’s a pretty easy concept to understand.
Bypass (CABG) is open heart surgery. There are also open heart surgeries that are not CABG, like valve replacement, but CABG is the most common type of open heart surgery and, in my experience, it’s the one people mean.