If it were that simple, we should nationalize everything. That hasn’t worked out so well for those countries that have done that. So, I’m going to go out on a limb and say you’re oversimplifying and missing something.
Anyway, I’m asking for data, not speculation.
Because in America the people who make the profit determine the price. Our costs outstrip inflation every year.
Of course I am oversimplifying. However, still it sure seems like a factor to me.
Raygun99, yes, I know, but Canada is not the USA. Look at the Defence budget for each, for example.
Personal experience of healthcare in the UK.
I have a serious chronic (since birth) condition, that has required more than 25 surgeries in my 31 years. I have been treated at only NHS hospitals.
My last surgery (ileocystoplasty) was in august 2006, I spent a day in intensive care afterwards, and then 2 weeks in a high dependency unit bed. I was then discharged and had regular home visits from a nurse to change dressings and make sure that the supra-pubic catheter site and surgical wounds were clean. Six weeks post-surgery I was admitted as a day case for removal of the catheter.
In total I was off work for 4.5 months, during which I received full pay. There was no deadline for my return, I just visited my GP once a month to get him to sign me off for further sick leave.
When I returned to work I went back on a schedule that eased me back in, starting 2 days a week and then building up to fulltime over the course of a month. I was also seen by occupational health to see if there was anything my employer could do for me to make my transition easier, or if there was anything that needed to be changed about my working conditions (there wasn’t, besides the return to work schedule).
I also have all my prescription charges waived (because of the chronic condition), which means I recieve all the catheters (I go through 10-12/week), painkillers, surgical dressings, surgical tape, saline and syringes free of charge and I would also recieve any further prescriptions (e.g. antibiotics etc) free as required.
For all this, I currently pay £155/month ($310) in national insurance contributions, which covers healthcare, pension and employment insurance and works out as roughly 8% of my gross salary.
A lot of people here are saying that part of the difference in price is because government agencies pay companies less for healthcare products. Given that the companies make less money under that system, wouldn’t that give them less money to play around with R&D? Is there any evidence that a free-market US results in more drug research? (The large number of European pharmaceuticals is not a sufficient response; the drug market is highly globalized and those companies can easily sell their products at a large profit at the US.)
Some part of the problem must be the fact that US consumers pay much more for pharmaceuticals than consumers in other nations. The pharma companies justify this because, while other nations have price controls on medicine, the US does not. And someone needs to supply the capital to do the extremely expensive research and development of new therapies.
In essence, US consumers are subsidizing pharmaceutical R&D for the whole world. This is an unfair and unstable arrangement, and I’m not sure what the solution is.
(On preview, I see athelas is thinking along similar lines.)
Szlater, is this because of the NHS or British labor laws or just the policy of your own employer?
In the UK pharmaceutical companies are not allowed to market directly to the public (although they’ve started to maneuver around this by starting “patient support groups” for various afflictions). So whilst the UK market will bring them less profits through sales (because of the negotiated discounts for bulk purchasing), it also costs them a lot less as they don’t have to buy TV, radio and print ads (except medical journals) to advertise their products. The other effect of this is that the public in the UK is generally happy to receive generics where available and won’t insist on brand names which keeps costs down for the NHS.
The US isn’t a free market when it comes to drug development, it has the some of the strictest regulations on drug licencing in the world. Also thanks to your government’s religious bent, more and more biomedical research is leaving the US through lack of funding. The blue skies thinking (the cure developing) is largely done with government or charity funding. Drug companies really only spend large sums of money on registration, licencing and clinical trials.
After a little research, it turns out that my employer recieves ~£70/week statutory sick pay for each week I’m off, and offsets an equal amount of my salary (so my employer pays me £70 less, and the SSP makes up the difference) . This money comes from my national insurance contributions.
But would you do like the Canucks and outlaw private insurance? You’d really, really, want a complete government monopoly on something this critical? Maybe an available single-payer if you can’t get something better. Yeah, if you can afford to, why shouldn’t you get better treatment? After all, we don’t all have to drive Hyundais, right?
Ah, but universal coverage and single-payer are two entirely different things. If you don’t outlaw private insurance above and beyond the government’s wasteful, inefficient system, then we can keep our private doctors. If you’re stuck in universal healthcare, then you have no right to complain about who your doctor is (to a point). Kind of like private schools versus public schools. Everyone pays for public schools, even those that go to private schools. You wouldn’t close down private schools, would you?
Maybe we’re talking about different things, but I have private supplemental health insurance, for prescriptions, dental, optical, physiotherapy, etc. etc.
You don’t have to outlaw private care. It’s available in the UK, if you want it… you just can’t opt out of contributing your fair share to the universal system just as it is with private education and private pensions.
That’s a big assumption, and a discussion killer. If you’re going to attempt to kill any discussion by making these sorts of unsupported claims then what’s the point?
What rot.
At present you have massive repetition of administration, which costs a lot of money. Reducing the system to a single administrative process would cut costs considerably. In a system where profit is the major motivation (and it is by law where there are shareholders) the drive will always be to cut expenditure and increase profits rather than provide healthcare.
It’s perfectly possible to have a system where everyone is covered no matter what. You just can’t do it and expect to turn a profit.
I think what you’re referring to is different. You have private coverage for supplementary things that (in your case, being in Calgary) Alberta Health does not cover: dentist visits, optical exams, prescription drugs, etc.
Alberta Health does cover you for medical procedures, doctor’s visits and so on. But no insurer is allowed to compete with Alberta Health for procedures covered by Alberta Health. For example, GreatWest Life (a private insurer) cannot cover you for a doctor’s exam or surgical procedure, since those are covered by Alberta Health. GreatWest can cover you for dental work, though, since dentistry is not covered by Alberta Health. Basically, GreatWest is legally prevented from competing with Alberta Health.
I think this is what Balthisar is getting at: private insurance to cover what the government insurer covers is outlawed. Alberta Health, and its equivalents in other provinces, essentially hold a monopoly on health insurance: if they cover it, no private insurer is allowed to. Only if the government insurer does not offer coverage of a procedure etc., then private insurers can compete to offer coverage.
I would be fine with dudes buying their own healthcare, as long as they don’t want a kickback or subsidy. I’d go for a tax deduction, much like today.
Sorry… I meant in terms of a proposed American system… not the Canadian system. (It says enough that affluent Canadians are prone to pay cash for instant service in the US rather than stay on waiting lists for certain procedures, though. A co-worker’s wife’s hip surgery is a personal example, but it’s publicized enough on its own.)
Oops, again in terms of a proposed American system with supplemental private insurance available. It was mentioned that Americans will never go for single-payer because we want to choose our own doctors. All I meant was that if we’re not prohibited from having private coverage (you don’t have that freedom/right there fully re-established), we could continue to to have our own doctors without much in the way of doctor quotas. All the people on the single-payer plan can do whatever the government says. If it means not having their choice of doctor, so be it – they’d have the choice of paying for something better (in any case, it’s not been established that we’d lose that option in the first place – you guys go where you want if there’s room). It’s like social security (social insurance). If that’s all you count on for retirement and you’re not happy, tough luck. Do something for yourself.
Exactly. Presumably the private insurance would be supplemental and the government (or single-payer) would still pay its fair share of the baseline treatment or meds, so one would be expected to contribute towards that.
Raygun99, that’s what Spoons means. Your federal/provincial system doesn’t cover any of the items that you mentioned. That’s why Americans like me are so surprised to see Tim Horton’s recruitment commercials that mention insurance coverage. Why would they need insurance coverage? Well, for all of the things that you mentioned (I’m told dental is covered in Ontario up to 14 years of age, though).
DrDeth, thanks for the clarification. I wouldn’t terribly be opposed to a basic single-payer system as long as I didn’t lose the right to carry my own supplemental coverage.
Over half the world’s drug research is done in the US. Even European companies perform much of their research here. If the US went to a government-controlled system, in all likelyhood most of that research simply wouldn’t get done, because there would be no way to make any money from it.
Drug companies pay more for marketing than they do on research.
Cite?
The American system is weighted by being for profit. It’s much more an on demand thing. If you have the insurance and want a hip replaced you can purchase it just like any retail transaction.
In Canada it’s managed like triage. Your doctor decides if you need a new hip. And your access to what you need is never affected by your insurance coverage. That’s why you hear so much about wait times. There are a lot of people, just like any emerg waiting room, thinking they should be a priority. They’ve been waiting all day! In fact, there are people with greater needs going ahead of them. Lots of old people think they should get a knee or hip long before the doctor feels it’s actually required.
Private insurance is an issue as we are trying to prevent a two tier system wherein people who can pay get access while others end up waiting for resources. Most Canadians understand this. At the same time, it’s sometimes cheaper for us to ship people off for immediate access to resources in the US than to wait out a back log or build new facilities.
I can go to any doctor I wish, switch as often as I please, and I rest well knowing me and my family will always have access to whatever care we need.
In addition the provincial government provides a seniors drug benefit which insures that seniors never spend more than $100 on drugs, once they hit that ceiling they only pay a $6 dispensing fee regardless of the drug or number of prescriptions.
Lots of pharmacists just over the border? Just 10 yrs ago the C$ was at an all time low. Pharmacology is a pretty easily transportable talent (no pesky licensing issues like doctors or nurses). If you’re just setting out in life it would sure be tempting. Work just over the border make big hard US $'s and still be close to home. There was a definite migration of Canadian talent during those years, not just in pharmacology. But the dollar is climbing high again so it’s likely slowed to a trickle.
Do you really think another insurance company would be able to offer a competitive insurance premium compared to Alberta Health? I pay $44 per month in Alberta Health care premiums. So does everyone else. Couples pay $88 per month, and there’s no additional premium for children. From the anecdotes I’ve heard from the American system, I’d find it unbelievable that another insurance company would be able to offer a lower premium than that.
Also, Alberta citizens are allowed to opt out of the publicly funded system. They are then responsible for paying for all of their medical costs, until/unless they chose to opt back into the system. Doctors are allowed to charge people directly for services that aren’t insured by Alberta Health, and they’re also allowed to directly charge people who don’t have insurance. But it seems like most people don’t mind having to use Alberta Health - last year only 255 people opted out - from a population of about 3,306,359. Note that’s the total number of people who are opted out, not just new ones from last year, as you have to re-opt out every year.