She’s in Nova Scotia, here are the current wait times:
http://waittimes.novascotia.ca/procedure/knee-replacement
She had the first one done years ago, with what seemed like minimal delay. Now she needs the other done. I don’t know if the numbers on that site include weekends or not. But I do know that she’s not allowed to pay to have it done in Canada, even if she wanted to. That’s how you keep the numbers low.
Sure, but when you get old and sick you must pay more - and perhaps they won’t even sell you insurance.
So you can make broad generalizations about the entire economies and tax structures of two major countries based on one personal anecdote that you remember from many years ago. Good to know.
“Wrong”? It’s “wrong” to say that Canadian health care costs in total being half of US costs is a valid representation of the health care financial burden? And it’s “wrong” to say that Canada’s much greater spending on social programs other than health care, as I duly noted, is where a great many taxpayer dollars are going? The figures I quoted are from a working paper of the Economic and Fiscal Policy Branch of the federal Department of Finance, which appears to believe that you’re wrong. And I have no idea what a phrase like “you’re confusing costs” is even supposed to mean.
I’ll let you in on a little secret, too. Look at the costs chart I linked earlier. It’s not just Canada. US health care costs are a huge outlier compared to every country in the civilized world. And by many standards – life expectancy, infant mortality, quality of life in old age, risk of being uninsured, financial stress and bankruptcies from health care costs – it offers far less than other nations for the money spent. And it’s not hard to see, if one observes how the insurance system operates, its incredible overhead and its inability to control costs, where that waste comes from. So here’s the other part of the little secret I’ll let you in on: that Americans spend that much more on health care not because they want to, but because they have to.
You probably didn’t realize but my doctor and probably yours and most others are in private practice and make a profit. You probably didn’t realize but there are private clinics all over the place, private diagnostic imaging centers, private labs doing all manner of medical testing – all of them being “private for profit health care”. You probably didn’t realize but there are even major private for-profit hospitals like the Shouldice. You probably didn’t realize that centers like these are around and making serious money – if “you are not allowed to buy health care in Canada”, what are they selling?
You probably didn’t realize but the only thing with respect to health care that you are generally not allowed to do in Canada is use money to gain preferential treatment for medically necessary procedures, though that was mitigated somewhat in the province of Quebec by Chaoulli v Quebec (2005). If the limitation were not there, an influx of big money would threaten the integrity of the public system, and the big US insurers, whose asses were quite properly kicked out and sent back to their homelands, at least as far as medically necessary coverage is concerned, would come roaring back with a vengeance.
Looks like Nova Scotia is falling behind, all right. Ontario remains right on target. And I don’t see why anyone would spend all that money and take all that trouble to fly to the US rather than wait another few months for an elective procedure that is clearly related to a longstanding chronic condition. And why would she even go to the US instead of, say, just driving to Ontario, where around 85% of knee replacements, like those my friends had, were done within the provincial wait guidelines, and where it might well even be free due to reciprocal coverages? Is it because it wouldn’t make as sensational a story as “have to fly to the US to get health care”?
As a side note, according to the Canadian Institute for Health Information an aging population has been responsible for a major upsurge in demand for hip and knee replacements and surgeries. Provinces like Ontario have kept up with the increased demand; perhaps smaller provinces like Nova Scotia could not. I still don’t see it as a huge problem unless she is in bad condition, but if she were, at least in Ontario it would be triaged to a high priority.
[QUOTE=wolfpup]
I’ve not tried to address XT’s challenge because direct comparisons on any individual level are so difficult, and XT does seem to be conveniently avoiding the obvious point that the aggregate numbers tell the story – after all, if total health care costs are about half of those in Canada, then surely that is, on average, reflected in less individual burden, regardless of whether the burden is taxes or direct premiums.
[/QUOTE]
I did address the aggregate numbers…I conceded that you were correct, and have conceded that we’d most likely do better with a more efficient system, whether that be single payer or some sort of UHC. My point, though, was that one reason most Americans don’t see this is because a lot of this is masked by other things, and wrt actual, real world take home pay it’s not obvious. What started all of this was a hyperbolic response you made earlier in the thread, and this was my round about way of explaining why it was hyperbole from the perspective of most Americans. We don’t notice the large aggregate costs (and you wouldn’t either unless you dug into this more and untangled how it all works and where the hidden costs are) because they are masked by so many other things. We also, for the majority, have a perfectly fine and serviceable health care system that provides for the majority of our needs in at least as good a fashion as any other system, including Canada’s. As long as you aren’t poor and have a job that provides health care it’s good care, and your earlier response ignores that. What we don’t have is an efficient system that is able to cover the large gaps we have, to cover those who aren’t getting the best out of our current system (millions of Americans) and that wastes a lot of money to cover millions fewer people at a larger aggregate cost. Like I said earlier in this thread, I think this is something that just about everyone agrees on. The rub is what we do about it, and how we get from where we are to something else, and how we agree on what that something else will be. Simply pointing at, say, Canada and saying ‘well, they did it, so we can too’ doesn’t really do much, nor does providing endless cites showing how much greater their system is than ours.
I didn’t read the rest of the thread, but my understanding was that this was exactly what catastrophic health insurance is supposed to cover. I use an HSA for things like doctor visits, prescriptions, contraception, and minor surgeries or illnesses. I use catastrophic insurance for what we traditionally use other forms of insurance.
IOW, we will all need doctor visits, medication, and contraception. It is inefficient to pay these things through a third party payer. One might as well have food insurance, electricity insurance, or “insure” against the possibility I might need gasoline for my car next week. These are costs that everyone needs to pay and the idea that they should be “insured” is absurd. Insurance is about paying for unforeseen, but possible risks of life. If the event is certain to occur, one doesn’t insure against them, he or she simply budgets and pays for them. Enter HSAs. When I’m a strapping 20 year old more money goes in than comes out. When I’m older, more money starts coming out than going in.
However, I might get cancer or heart disease later in life. Or I might get in a devastating car wreck at age 23. That’s not a certainty, so we pool money against that risk in the same way that not everyone’s house burns down so we buy home owners insurance. Enter catastrophic insurance.
The fact that we have to use the term “catastrophic” in front of health insurance shows the absurd lengths that we have stretched health insurance. ALL insurance should be for events that are catastrophic. Apart from health insurance, I have life, auto, CGL, professional malpractice, and home owners insurance. If I use any of the last five, some really bad shit has happened. If I use health insurance, then that means I went to the doctor or refilled my prescriptions.
IMO, that is what needs to change. It is horribly inefficient for the doctor to have to involve a third party in what is a customary and routine transaction for everyone. Same with the pharmacist. Imagine if every time I bought coffee for my business or refilled the water cooler, I ran it through the CGL policy; would that make things more efficient?
TLDR version: the insurance model works for things that are possibly but unlikely to happen to a given person but likely to affect the population in general. It also must be something that if it would happen to an individual, he or she is unlikely to be able to afford to pay for that event. In that case, we each pool our risk by paying our share of “in case that happens to me” and the people who are unlucky get the pool so that they do not go bankrupt.
It costs money to administer this system, so it is unwise and inefficient to do this for things that are likely to happen to a person or for such things that a typical person can afford.
One could make the case for requiring everyone to carry catastrophic health insurance and nothing more. But you’d run into the same old resistance about liberty and all that crap. I think I’d have more respect for opponents of ACA if they would say “yeah, everyone should be required to at least have catastrophic insurance so when they wreck their cars we all don’t pay for it.” But no, the reaction is typically “how DARE you make me possibly take MY MONEY and give it to some of THEM?”
But the trouble with catastrophic only is that little things are allowed to become catastrophes. That untreated blood pressure turns into a heart attack which is either treated at the ER at taxpayer expense or by catastrophic insurance. In the long run, it’s cheaper for everyone to have full coverage.
By this we have confirmed the worst fears of the anti-New Dealers in the 1930s: social welfare will lead to restrictions on personal freedom. You use the phrase “liberty and all that crap” but our nation was founded on the idea of liberty and individual responsibility.
Can we really be free if our personal choices are subject to “others will have to pay for your foolish choices, therefore you can only make government approved choices”? I agree that people should have catastrophic health insurance. People should also not drink too much, have unprotected casual sex, should wear their seat belts and motorcycle helmets, cut down on foods that are high in fat, and not have second trimester abortions.
Where do the restrictions on freedom stop and what principled reason is there to not take the next step since it saves the taxpayers money on social welfare programs? Almost anything can lead to high blood pressure which leads to heart attacks which leads to ER visits. Once we say single-payer health insurance, can we then say no more cheeseburgers or male to male anal sex? Remember, we are all paying.
Making health care a civil right is pandering to those who believe in human rights.
If one does not support the idea of human rights, or considers human rights law unsustainable, then one may consider universal health care undesirable, offensive, or wrong-headed.
And of course, a nationalist or bigot may think that only “his kind” should enjoy such privilege.
It’s very easy to get the Malthusian pessimists and the racists on board with opposition to a universal right to health care, whatever marketist or Tenther nonsense is being argued as the ostensible reason.
I don’t really disagree with most things in that whole post, except some things here. I think most people do realize at least what the costs are, if not necessarily what causes them, because directly or indirectly they bloody well have to pay them. And I do acknowledge that the system works to a degree for many people, but I don’t believe that the intrinsic problems are fixable without going to some type of public system as the underlying infrastructure and relegating the present insurers to a tightly regulated supplementary role.
I don’t see the problem as simply a quantitative one of tweaking costs and efficiency. I see it as a fundamental philosophical divide between two completely different concepts of what health care really is. Our friend Bone illustrates this well when he demands to know why, under single-payer, he shouldn’t have the opportunity to reduce his taxes in return for having to co-pay, or to opt-out entirely, or otherwise tailor health care to his particular whims and desired costs. One may as well ask why one shouldn’t, if one doesn’t like war, just refuse to pay taxes to fund the military, or, being an owner of an arsenal of guns, refuse to fund police services because you don’t feel you need them. Or refuse to fund public services like schools, parks, or street lighting or road maintenance because you, personally, don’t care about those things.
To understand the philosophical divide we have to understand the side that believes that medically necessary health care – the essential process of helping the sick and curing disease – is a basic human right. It’s not like buying a washing machine or a TV or a car, where you buy whatever you can afford, or buy nothing at all. Single-payer is not like the government decreeing that everyone gets the same washing machine regardless of what they want or need. It isn’t a freaking appliance! That implied analogy with a washing machine is the conservative canard, the talking points of the insurance industry. Guranteed universal health care, is, instead, the most fundamental expression of the guarantee of basic human rights, a universal value that should be indisputable, as expressed in Article 25 of the United Nations Universal Declaration of Human Rights.
Industry whistleblower Wendell Potter, in the book he wrote after leaving the industry and a salary deep into six figures, said that he “could no longer serve in good conscience as a spokesman for an industry whose routine practices amount to a death sentence for thousands of Americans every year.” The last straw for Potter was the case of Nataline Sarkisyan, a 17-year-old girl diagnosed with leukemia and a case that began when CIGNA refused to pay for a liver transplant, stalling with excuses and, when her condition deteriorated further, they deemed that the operation at that point would be “experimental” and an even better reason for denying the preapproval. Responding to public outrage and protests even from the medical community itself, CIGNA eventually relented and agreed to pay. They need not have bothered. All the delays and bureaucracy had taken their toll. Nataline died that night. The tragedy is that this situation wasn’t unique, and it represents the intrinsic nature of how a business has to handle claims, though fortunately most of the screw-ups don’t have fatal outcomes, but some do. Having seen more of these situations than his conscience could stand, Potter left the company, wrote a book, testified before Congress, and now devotes himself to exposing the inside operations of this sordid industry.
It’s an industry with one of the most powerful lobby front groups in existence, AHIP, and its president, Karen Ignagi, is one of the most powerful and effective lobbyists in Washington. It’s an industry the routinely employs PR firms specializing in stealth PR, spin and deception, like APCO Worldwide and Porter Novelli. And this is why private insurance for medically necessary procedures is fraught with peril. Business interests and the imperatives of human life are in direct opposition. I wonder how many are aware that Remote Area Medical, an organization like Doctors Without Borders that provides free health clinics in the desperate backwaters of the world, also operates extensively in the USA. That this should be necessary in the richest country in the world is a travesty. My view is that the business of profiting through the provision of medically necessary health care as it’s presently implemented is an abhorrent affront to human rights. If it should exist at all, it should only exist as a strictly regulated option on top of a bedrock system of guaranteed universal health care.
I get what you’re saying. And I see some major problems. One is that “paying your own way” really means having no health care coverage, so many will still not be able to afford the routine stuff and many more will scrimp and delay and threaten their health and that of their kids by risking making things worse. You can try to help those who can’t afford it but then you get into the complicated quagmire of means testing and variable benefits.
But the worst problem is, how do you define “catastrophic”? Medical care is a complicated continuum. What if I need some type of minor surgery like a hernia operation, or even just an MRI? Any of those things can run into thousands of dollars, and even minor surgeries can run to tens of thousands, or even more. Sure you can draw an arbitrary line at a dollar amount or procedure type, but what is an annoying expense for you might be a financial disaster for me. Do you propose having complicated tiers of different types of insurance at different costs, and maybe means-tested public assistance? You’re basically recreating the present mess. And none of it addresses the public interest inherent in the human rights issue, or the cost savings inherent in a simple universal streamlined system that supports this public interest.
Incidentally, I forgot to add that “definitiveness” is a proper word in the English lexicon. So is “definiteness”. They mean different things. “Definitiveness”, the word I used, best represents the meaning I intended. Just thought you should know. So… [sic] yourself! 
The operative principle is that it is incumbent on a civilized society to provide medically necessary health care for its citizens as a matter of its most basic moral values and respect for human rights. This principle explicitly requires that single-payer coverage must always be universal and unconditional. There is neither a practical or legal mechanism nor a moral basis for making exclusions. That’s just not how it works.
But, tragically and perversely, making exclusions and making judgments on individual circumstances is the very foundation of private insurance. Denying health care for reasons of cost and justified by contractual legalese is the singular most distinguishing feature of private health insurance and its profit-making objectives. That’s precisely how it works.
Won’t somebody think of the insurance companies?
What I think of the insurance companies can’t be printed in a family magazine. Especially the one which initially preapproved my daughter’s TMJ surgery, then tried for over a year to weasel out of it.
I don’t necessarily disagree with the basic premise, but I have to wonder what the source of this right is and what it entails. It’s not in the Constitution, for instance. Further, what type of medical care are we entitled? The very latest procedure that is very expensive?
But my overall point is with this type of social program, lawmakers can now take away other freedoms. Since we are paying for your health care, no more cheeseburgers or skydiving. You must surrender your freedoms to the greater good of society. I don’t like that at all.
I like the consumer protection aspects of the ACA. If I buy health insurance, I shouldn’t have to read the adhesion contract. I should get real health insurance that is what I am expecting.
The restrictions come in when that “freedom” is costing us around twice the % gdp of other nations for similar or worse overall outcomes while not even covering everyone. If that is what freedom in the healthcare arena means, then drop or. Like I always say to the libertarian anti government bigots, if you want perfect freedom, go live on an island. This is the price of civilization, you have constraints placed on your perfect freedom to allow the better functioning of a society. It does not mean you have zero freedom, just not TOTAL freedom in all spheres of life. I’m ok with giving up some freedom on how healthcare dollars are spent after seeing the disaster that is American healthcare, paying so much for so little is a sign that something is wrong.
stop worrying so much about absolute principles that pervade all time and space, practical considerations often mean having a hodge podge of different attitudes depending on the situation. Be flexible and get better results… or be a libertarian and stay a brittle ideological zealot.
[QUOTE=jtgain]
But my overall point is with this type of social program, lawmakers can now take away other freedoms. Since we are paying for your health care, no more cheeseburgers or skydiving. You must surrender your freedoms to the greater good of society. I don’t like that at all.
[/QUOTE]
I really think that comes within the “no straw men” prohibition in the OP.
I can assure you that cheeseburgers and sky diving are alive and well in Canada.
Two of FDR’s Four Freedoms were freedom from want and freedom from fear. ACA advances the causes of both. Allowing people to leave jobs without fear of losing medical coverage increases their freedom, as well. The only freedom that is impaired is the “freedom” to make the rest of us pay your share when you get cancer from being hit by a bus or something.
So how is UHC in *opposition *to the cause of freedom? That needs explanation, not gesticulation. Some discussion of how the rest of the civilized world is less free since adopting it would be very helpful to fighting our ignorance, hmm?
Do you really not know the answer to this question? As I pointed out earlier, Canadians are not free to buy and sell medical care the way they can in the US. Until recently, if you wanted an MRI you waited. If you were pregnant and needed an ultrasound you were allotted the minimal amount of time medically necessary. What I’ve noticed is this represents a huge cultural divide between Americans and Canadians. As a Canadian than moved to the US it was weird to have choice and control over my healthcare. Now that I’ve been here a while it’s something I prefer. I now get frustrated when I hear about someone in Canada waiting for imaging. On the other side of things, if you are a doctor you get paid what the province decides you’re worth. Right now doctors in Ontario are pissed that their pay is being cut back.
The other aspect to choice is what insurance plan is right for me. In Canada there is just one plan, that everyone gets, and it’s price is based on your income and spending habits (income tax and sales tax). In the US I can look through the variety of plans that are available and decide how much I think is necessary, that same way I do with all my insurance. Like I noted earlier, while young and healthy I could choose a lower cost plan. I should also point out that most Canadians will have supplemental health insurance through their employer to cover what the province won’t.
Keep in mind, neither of those points support the US system, and keep in mind that few countries follow a system as rigid as Canada’s. Because my insurance is through my wife’s employer we choose the plans they pick. And because there is so much money going through insurance companies, individual consumers don’t really factor into the medical system. My insurance company gets a huge discount that I can’t get.
Point being, conservative arguments against single payer don’t necessarily support the current US system.
But you always got them, no questions asked, no bills to pay, no effect on your employment or career prospects, no risk of bankruptcy or destitution. That sounds pretty damn free to me. And you’ve always had to wait for non-emergency procedures in the US too, btw.
Don’t you see how illusory much of that was, and still is for that matter?
The system has been in place for generations, and Canada still has no systemwide shortage of doctors, does it?
For most employers, that is not the case. There is only one plan provided at most companies.
Know what? Under ACA, that’s still the case. The ratio is now limited to something reasonable, though.
That’s also true for Medicare in the US.
I hope she gets to keep her job, then. Otherwise you’ll be glad we got ACA in place just in time for you. In Canada, you’d be free from that worry and the possibility of devastation for something out of your control.
Point being, conservative arguments against single payer don’t necessarily support the current US system.
[/QUOTE]
The point isn’t that the Canadian system is perfect, because no real-world system is. Only that you aren’t less “free”, whatever is meant by that from the US RW ideologues with their delusions of having control over all aspects of their lives, for having it, in fact pretty much just the opposite. The things you’re trying to describe as losses of freedom are better described as First World problems or even simple whining, frankly.
And as I pointed out earlier, profiting from the sale of medically necessary health insurance is fundamentally immoral, and the standard industry practice of trying to limit and block access to it for financially motivated reasons should be a criminal offense along the same lines as loan sharking and extortion.
Yes, like when my mother was in hospital and needed a precautionary MRI. She waited … about 20 minutes. Point is, wait times depend on circumstances and are triaged according to urgency. If no one ever has to wait, even for very routine procedures, then clearly there are wasted idle resources that someone has to pay for. Guess who that is?
Bullshit. The ultrasound rules provide all necessary imaging while preventing clinical profiteering – and most importantly, if the doctor – and I emphasize,*** the doctor***, believes the pregnancy is high risk, then the amount and frequency of imaging is determined solely by the doctor. The “huge cultural divide” with the US is that in the US, you get to substitute “insurance company bureaucrat” for “the doctor”, and believe me, the insurance company bureaucrat is not your friend. He is the friend of the CEO, the board of directors, and the stockholders.
Well as a Canadian than [sic] moved to the US, the family member I mentioned previously feels just the opposite. As a professor and director of a research center at a major university, I’m sure his health plan is at least as good as yours. And his critical observations are informed by direct personal experience on both sides of the border.
Bullshit again. You get paid according to a fee schedule that is negotiated with the provincial medical association. This is a fundamental method of cost control exercised in one way or another in all countries that have a handle on health care costs, which is to say, all countries in the world except the US. If it’s really bad they can leave the province, or leave the country. Do they? Both my doctor and my mother’s cardiologist came to Canada from the US. And both are excellent physicians. Do you suppose they just have a very bad sense of direction?
Don’t know about you, but the “insurance plan that’s right for me” is the one that pays the bill when I get sick. It’s not complicated. And “it’s price” [sic] bloody well should be tied to income, as it is in all civilized countries.
Are you saying that a civilized society has a moral obligation to provide necessary health care, and that it must be single payer? I’m trying to parse what you are actually claiming.
Why do you think that providing health care if a human right, as you put it? When did it become so, as an estimate? Are there other things that should be provided as a human right as well? I’m trying to flesh out the limiting principle that includes government provided/funded health care that would not also include, food, shelter, employment, etc. Do you believe there is such a limiting principle?