Fair enough. If your opinion is that most people will have a hard time changing insurance, that’s cool. You made some assertions earlier, and I just thought you might have more data than me.
Personally, I don’t have data which proves the reverse either. So I’m perfectly willing to be wrong.
About John Major, however, the facts are easy to look up. This site is a summary of his career. Including:"*Towards the end of his term, the economy was steadily emerging from recession. However, the Conservatives were defeated by Labour in the 1997 General Election, and John Major resigned as leader, having been Prime Minister for seven of the Conservatives eighteen consecutive years in power. *"
I cannot find a good cite to describe the history of NHS spending. But I remember from another thread that they had drastically underfunded it in the early nineties. Since Mr. Majors was not voted out until 1997, it seems that health care was not the major cause. And perhaps (I could be wrong especially because I could not find a cite) was not the major cause.
What I am suggesting is that removing prime ministers who do not fund health care to your satisfaction is not a simple matter. Changing insurance carriers may not be simple either, but I’d put money on the later being much easier than the former.
But let’s forget about how easy it is for a second. I’d like to make another point. IF you are going to remove politicians for underfunding health care, you will have to convince many people that they are doing that. In order to do that, the government will have to underfund health care to an extent that it makes a sizeable portion of the population unhappy. Meanwhile, if a particular insurance company is engaging in bad practices, this one company is the only thing you have to change. It only has to cause enough problems for its customers to become disattisfied. That is, central control of an industry tends to magnify problems. Market driven industries tend to lessen the impact of such problems.
Well, unless you want to make an argument that we should stop our health care professionals from leaving at gunpoint, I don’t see how it’s relevant that it’s easy for them to follow their desire to leave. The bottom line is, they desire to leave.
That could be an explanation if the percentage of health care workers leaving was proportional to percentages in other industries. But it’s not. The number of health care workers leaving Canada is way out of proportion compared to the total percentage of Canadians leaving Canada.
5 Cent said:
Sorry if I implied that money was the only reason, or even the main reason. It’s not. In fact, Nurses in Canada get paid very well. My wife makes about $70,000 a year as a senior nurse. Even nurses straight out of college are pulling in over $40K.
But our government-run health care system is incredibly frustrating for the people that work in it. My wife wants out, and the jobs she’s looking for won’t pay her anywhere near what she gets from nursing. I could tell you horrible stories about government mismanagement all day long.
One of the problems, for example, is that there is no way to reward the good nurses and punish the bad. They are treated like commodities. If you’ve been there for X years, you get $x dollars. Period. It’s almost impossible to fire bad nurses. As a result, you wind up with a system where a few bad apples game the system and the rest pay for it. One of my wife’s co-workers calls in sick probably twice a week. She’s not really sick - she’s a party animal. Every time there is a nursing party she’s face down on the floor drunk. Needless to say, this causes havoc. My wife often has to cancel suppers and stay at work because of last-minute sick calls. There’s officially a policy where people who abuse the incredibly generous sick time are supposed to be ‘reviewed’, but it’s so much hassle for the administrators that a ‘review’ is usually a meeting where some low-level manager calls this woman in and says, “Is there something we can do to help?” And the woman says, “No, I went through a bad spell, but I’m better now.” Then she does it again. She’s been at it for years.
Another co-worker wrangled straight night shifts, because she likes to read. So she shows up and reads all night, and the other nurses have to do her rounds. She’s been there 20 years.
This is the kind of gross abuse of the best by the worst that goes on in government employment. You see it everywhere - the post office, the DMV… The triumph of the lowest common denominator. In a hospital where the administrator has to make a profit or lose her job, nurses that don’t pull their weight are sent packing - as it should be. The nurses who improve the hospital the most get compensated accordingly - as it should be. The best and brightest thrive in environments like that. They want to be challenged. They want to see how far their ability can take them. That’s a big reason why they go to the U.S.
Research funding is another, and that brings up another big factor - the profit motive drives huge amounts of medical research in the U.S. If you take that away (and socializing medicine WILL take that away - once the government starts picking up the cheque for medicine, you’ll see a host of new regulations controlling prices, just as in Canada).
I said, “for reasonable values, and especially as the baby boom retires.” Sure, I suppose that if you were willing to spend 30% of your GDP on health care, you could give people as much as they want (assuming that ‘what they want’ doesn’t change). But for the types of dollars we can afford, there will always be scarcity. Look at the U.S. - spending what, 15% of GDP on health? And you keep saying you have a crisis, because 30 million people aren’t covered by insurance? And the quality of care could be better for people in HMOs?
And wait until the baby boom retires. The elderly consume the lions’ share of health resources, and over the next 15 years they are going to become the largest demographic group. And they all get free health care under Medicare. And thanks to Bush’s pandering, they’ll also get 550 billion dollars worth of drugs over the next ten years.
And health care is getting more expensive over time, as doctors learn how to treat an ever-growing list of illnesses. This is the downside to improved cancer treatments, the improvement in heart surgery and transplant operations, the ballooning growth in new drugs that can treat things that were previously untreatable. These are all great things, but they cost money. Geriatric medicine is currently making great strides because the health care industry realizes that the baby boom is going to create a gigantic new market. So people will get ever-more intrusive care as they age, and stay alive a lot longer. That is going to cost even more money.
Well, then perhaps you can explain why it is that various European countries with socialized medicine have minimal waiting times while spending less than the US in terms of % of GDP (though more than we do)?
First of all, this isn’t true. Waiting lists in countries like Sweden and the U.K, where the state almost completely manages health care, have very long waiting lists. Worse than Canada. For example, in Sweden and the U.K, the waiting list for cataract surgery is almost 2 years. Both of these systems are now trying to reform - Sweden has deductible limits on insurance, and it has been increasing the deductible to help manage waiting lists and cut costs.
Other countries in Europe have varying levels of private health care, and they tend to do best. In the Netherlands, they leave the system largely alone, but provide government-funded insurance for people who make less than $30,000. If you make over that, you pay for your own coverage.
Other countries, like Germany (and Canada), are rationing health care in other ways. Demands on doctors are being lowered by offloading patients onto less qualified professionals such as nurses, midwives, etc.
Another common form of rationing is the restriction on availability of services for some people. According to the Brookings Institution, Britain denies kidney dialysis to 9,000 patients a year, and denies treatment to 15,000 cancer patients and 17,000 heart patients a year. Basically, to receive these treatments you have to qualify for them.
And almost every country with universal health care has waiting lists of some sort. Over 1 million people are on waiting lists for surgery in Britain. In New Zealand, with a population of 3 million, there are over 50,000 people on waiting lists for surgery.
SS:And almost every country with universal health care has waiting lists of some sort. Over 1 million people are on waiting lists for surgery in Britain. In New Zealand, with a population of 3 million, there are over 50,000 people on waiting lists for surgery.
Sam, again, could we get some cites for this barrage of claims? In particular, I’d like to be sure we all mean the same thing by “waiting list”. As the report I quoted earlier points out, some of these studies count all future medical appointments as being on a “waiting list”, which means that everybody everywhere who is scheduled for treatment but isn’t actually being treated right at this moment is on a waiting list.
*And you keep saying you have a crisis, because 30 million people aren’t covered by insurance? And the quality of care could be better for people in HMOs? *
And because uninsured people are often bankrupted to pay for medical treatments, or go untreated because they can’t afford care. And because those in high-risk groups or with pre-existing conditions have such difficulty getting insurance. And because even for those with insurance, premiums are rapidly increasing and benefits are being cut. And because of the gross inefficiencies and burdens involved in making hospital emergency rooms provide care to people who can’t afford to pay for routine care when they need it. Hell yes we have a crisis, and we’re going to keep on saying so.
And by the way, that number of uninsured is over 40 million now—some 7–8% of the entire population. I’m not denying that there are problems with publicly-funded health care, nor that it can be good to have public and private insurance systems operating together—in fact, I believe I was among the first in this thread to point out that strategy. I’m just saying that overall, the problems of our system are worse, and they cost more too.
Let’s fact it, most Americans would rather be on a waiting list for non-emergency surgery than to have to do without the surgery altogether because they’re uninsured and can’t afford it. So would pretty much anybody else, which is why the other developed countries are going to retain universal publicly-funded healthcare (though that doesn’t mean they won’t reform their systems somewhat) and the US is eventually going to adopt it.
SS:In the Netherlands, they leave the system largely alone, but provide government-funded insurance for people who make less than $30,000. If you make over that, you pay for your own coverage.
“Leave the system largely alone”? Not only do they have a national insurance benefit for medical expenses not otherwise covered (mostly relating to chronic illness), but fully 60% [pdf] of the population is eligible for the means-tested publicly-funded insurance that you mentioned. The private insurance that covers the other 40% is heavily regulated, and in fact the private providers form a common organization with the public health care funds. The private premiums are extremely reasonable compared with those for any comparable US system; I’m applying for a fellowship in the Netherlands now, and I’m told by the organization that I’d have to pay about 35 euros/month for insurance, which contrasts very favorably with the $300/month that my US plan costs me.
So I don’t think the Dutch system is really much of a poster child for laissez-faire. Mind you, it seems to work quite well and to exemplify many of the advantages of combining public and private health insurance, but we ain’t talking no libertarian triumph of market-managed free enterprise here.
SS: *Don’t get me wrong - I’m not opposed to changes in health care. […]
Rather, my position would be that any attempts to improve access to health care must retain the fundamental market-driven nature of the industry. So I could be talked into expanded insurance for the working poor, or medical liability reform, or other plans to correct some of the worst problems.*
On re-reading and reflection, Sam, I think maybe we’re ultimately not so far apart on this issue, in terms of what we think are desirable outcomes. It’s just that you’re focused primarily on correcting the chief problem of your system—inaccessibility and inefficiencies due to lack of market incentives—and I’m focused on correcting the chief problem of ours—inaccessibility and inefficiencies due to market failures.
Some kind of move towards the middle is probably going to turn out to be the best solution to both cases. In addition, we are all just going to have to accept the fact that some sorts of care are inevitably going to be rationed to the point of (hopefully no more than slight) inconvenience—whether because of funding constraints in the public system or high prices in the private system, or both.
But single-payer is not the way to go. Because once the government sets the fee schedules, all the rules change. All of the problems, excesses, and shortages in our system can be traced back to that one simple fact.
I doubt it, partly because we have many of the same problems, excesses, and shortages without government setting the fee schedules. From what I can make out abuot the Dutch system, their rates are negotiated in a three-way among the government, the healthcare providers’ associations, and the public/private insurance groups. They seem to have come up with reasonable solutions even without letting free markets do the price-setting.
For many services, wait lists are not inherently bad, and they can add to the efficiency of the system. If you want no wait list for, say, MRI, that means you have to have enough MRI machines to cover peak instantaneous usage. If you do that, these machines will sit idle much of the time because average load isn’t going to be as high as peak. Waiting lists let you smooth out the peaks.
For some other services, you just have to build out to meet the peaks. Examples of this would include emergency services and labor/delivery/maternity.
Having said this, the 5 month wait for non-emergency MRI in Ottawa is ridiculous. So is next-morning non-emergency MRI in Cleveland. 5 months shows undercapacity, next morning overcapacity. Neither is good. What is a good wait list for MRI? You’d have to look at usage stats and the urgency of conditions diagnosed by the technology, but I’d hazard a guess that between 2 weeks and a month would be about right.
Please note that all of these waiting times are for elective procedures. A relative of mine had a flesh-eating infection and he got the attention of 3 excellent surgeons immediately. This in Ottawa, home of long wait lists. The orthopedic surgeon who treated him had a 2 year wait list for elective surgery, but then again, most orthopedic surgery is not elective, and if it is, 2 years isn’t going to kill you. I’m not saying this is a suitable wait, but next-week elective orthopedic surgery (which you can get in Cleveland) isn’t optimal either.
I agree with most of this. Both my parents are doctors. One does research and one works at a large university hospital. The one that does research has state of the art equipment, while the non-medical equipment (computers for billing, email, etc, networking equipment) at the hospital the other works at is antiquated and the software is just as you describe. As far as I know, patient charts are still done the old fashioned way and the main things done electronically are the patient billing and possibly insurance billing. Billing systems are rebuilt regularly in the business world.
As I said, the insurance company wants this conflict to happen. The longer the claim goes back and forth, the longer they hold on to the money. Efficiency is their enemy in cases like this. It is not merely that the insurance company is trying to guard against fraud or prevent paying out money they are not obligated to pay out. It is a strategy to keep things so complex that even the money they have agreed to pay is difficult to collect in a timely manner.
There is no doubt that health care expenses are a problem. But, these expenses are independent of whether you have a free market health care system or not. In a free market system, health care is still expensive and is still rationed, just differently. And, some of the same failures occur under the current market system … e.g., the overuse of care because people don’t pay the full costs occur within the private insurance system too.
And note that not all that you talk about represent as large increases in expenses as you might think. For example, the uninsured (who can’t pay their medical bills) still cost the system now because they will still receive emergency care…They just won’t receive particularly good care and won’t receive preventative care. It is not clear to me how the numbers work out in terms of costs to insure them. Yes, there would be additional government spending involved but then there would be savings elsewhere in the system.
As kimstu says, there is no magic bullet here and every country is struggling with issues. However, there are better and worse systems, more and less equitable systems, and so on. And, I think kimstu is right that the reason why most developed countries have moved toward at least some sort of guaranteed health care system is because of the problems that occur otherwise. Here in the U.S., we have made some fortunate moves in that direction that do help us. For example, the COBRA law that allows you to buy into your former health care plan for up to 18 months after you leave the job is a God-send as far as I am concerned…Otherwise, for example, making a career change that involves any time off or going to a fellowship program or something that doesn’t offer insurance becomes a royal pain-in-the-ass if not infeasible if you have pre-existing conditions. My only wish is that you could continue it beyond 18 months. And, of course, this rule was generally opposed by those who want the free market to rule our health care.
If your doctor ratio is correct why is there a long wait for medical services in Canada and England? Canadians come across the border for surgery. I see a doctor the same day I call and if I need surgery it is at my convenience. How many months would it take to get a deviated septum fixed in Canada? The cost is probably higher because the service is available.
Although I agree with most of what is on this page, this little statistic is meaningless. I say this as a Canadian who “defected” to the US 10 years ago. The problem I have with this statistic is that a very large percentage of Canadians have either no experience with US health care, or at most have visited an emergency room while on vacation.
Think of Canadian health care as giant HMOs (one per province), with better distribution of primary care physicians (so you can find one or two in the little town you live in), $0 deductable, $0 office visits and cheap drugs. It’s pretty good, and better what a large percentage of Americans get. Some provinces (BC, Alberta) are better than others (Quebec).
However, if you are one of those lucky Americans (like me) that have great health insurance (PPO) and live somewhere well-endowed with medical facilities, then American health care absolutely kicks ass when compared to Canadian health care.
5cents: However, if you are one of those lucky Americans (like me) that have great health insurance (PPO) and live somewhere well-endowed with medical facilities, then American health care absolutely kicks ass when compared to Canadian health care.
Except it still costs us more as a nation and is a complicated mess when you need to file a reimbursement claim. But yeah, nobody’s denying that for the best-quality-coverage elite, American health care is probably the best in the world.
Does that make up for having one in 12–15 people (and that percentage is growing) totally without coverage? For skyrocketing coverage costs and dwindling benefits for many others? For the hassles involved in switching between plans or dealing with insurance claim paperwork? For losing your health care if you lose your job? For not being able to get any coverage at all if you’ve already got severe (or even quite moderate) medical problems? For the financial crises that strike the families of the uninsured when they have a serious medical problem? For critical shortages of health-care personnel in non-affluent areas? Most of us don’t think so.
I’m sure most Canadians would prefer the US health care system if they could get a guarantee that they would always be among the lucky ones with comprehensive, affordable insurance and access to high-quality care. But since nobody’s offering any such guarantee, I’m inclined to suspect that the fact that 96% of Canadians prefer their health-care system to ours is indicative not of their ignorance of our system, but rather of their basic good sense.
Sorry, I don’t concur. 96% sounds like the “election” results of a dictatorship, where you have limited to no information on alternatives. (Note: Don’t read that the wrong way, I’m not implying that Canada is a dictatorship. Far from it, I consider Canada more democratic than the US).
I think that percentage would go down if Canadians had real experience with the US healthcare system. Those with PPO coverage would say “it’s great”, those with HMO coverage would say “about the same”, and those with no or poor coverage would say “it stinks”. I’d hazard a guess the percentage would go down to about 70%.
I agree that the US health care system is broken and needs to be fixed. I agree that it’s terrible that we spend so much on health care and still can’t treat everybody. I agree that access to adequate health care should be universal, just as education, police, fire protection, roads, etc are universal. However…
We’d love to move to Montreal. It’s a beautiful city, pretty cheap, good culture, food, schools, etc. Language isn’t much of a problem for us. But health care in Quebec absolutely stinks. It’s probably the worst in Canada. It has been underfunded for a long time, and it shows. If I had never lived in the US and had elite US health care, and I were to consider moving from, say, Toronto to Montreal, would health care be an issue? Most likely not. However moving from Cleveland to Montreal, health care is an issue, and by itself it is big enough to rule out any move. Is that selfish, or just good sense? Does this mean I prefer American Health Care to Canadian Health Care?
I know that if I had never lived in the US I’d be part of that 96%, but today I’d answer “it depends…”.
I am reminded here of my doctor and my dentist, who are on the same floor of the same building. I live in Canada. As I am sure most Americans know, in Canada basic health care is universally insured, but DENTAL care is a wide open free market served by private interests, and there are any number of insurance companies around.
My doctor has two administrative assistants - and shares them with two other doctors.
My DENTIST has three administrative assistants, and shares them with one other dentist.
Everywhere I have gone, my doctor has shared administrative assistants with other doctors such that there were always as many or more doctors around as there were admin people. But my dentists have ALWAYS been outnumbered by the admin staff. Hmmmm.
5cents, I know of direct examples that contradict your claim. I have quite a few friends who have moved to the U.S. and every one of them bitches non-stop about the American system(s), even the ones who don’t like the Canadian system. My best friend, whose parents have been seriously screwed over by the Canadian system so he has no reason to think its wonderful, claims the American system is worse - and he has a very good job with a comprehensive health care plan. The tales he tells of his HMO ordering him to drive two hours to see a doctor they’ll approve of (he lives in a giant city with many doctors) are truly amazing.
I’m sure the 96% figure is mostly national pride and little else, but I know of more than one person whose experience with both systems have led them to believe Canada’s system is, at least, less difficult to negotiate. I am sure that IF you are lucky enough to have a really kickass plan in the USA, it’s better, but that’s kind of a different point.
Ah, yes, dentists in Canada. In terms of billing, its basically the same as dentists or doctors in the US. Dental billing seems to be a bit simpler than medical, though.
There are good HMOs and bad HMOs. Sounds like your friend had a bad one. As for what coverage you have making a difference, people generally vote out of self-interest. If you’ve got it better, you’ll vote to keep things the way they are. If you’ve got it worse, you’ll vote for change (unless those who have it better are able to convince you otherwise, which happens often enough).
