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Country_Gal
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Philippines 2013 life expectancy 71.94
Does anyone know if medical costs were more reasonable before the government first got involved?
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JimG
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Yes, the whole system of medical coding and insurance billing, review and payment constitutes a whole second industry which is a large overhead cost to any medical office.
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Ridgerunner
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Some truth to it, but government very much does distort medical pricing. Every insurer’s “deal” with providers is based on Medicare rate. I used to negotiate those rates, and I know. Now, Medicare rate is a false “discount” from “reasonable and necessary” costs. So, “retail” medical is greatly higher than the actual cost of the care.
But few pay “reasonable and necessary” because insurers negotiate from Medicare rate, not the utterly bogus “reasonable and necessary” that is ginned up in order to give a false discount to Medicare. It’s a fraud in which all participants are knowingly engaged.
Another thing is that Medicare rate supposedly is a discount from the cost of care, but actually it allows providers to build all of their costs, including salaries, buildings, equipment, into their reimbursement rates on a “community” basis. This mightily encourages “gold plating” and “over-equipping”, particularly in low-cost areas like the one I live in. The “over-equipping” encourages “over-testing” because the providers don’t want all that expensive stuff lay idle.
Insurer rates are based on Medicare in another way. The codes and code combinations that are used in determining charges and the nature of “evidence based medicine” (itself based on financial considerations) are the codes medicare uses and are in universal use by providers, insurers, etc. So, the way medicare sequences treatment regimens is the the same one used by the insurers. That is often the reason why treatment sequences often seem so unresponsive and inappropriate to consumers and, sometimes, so stupid.
Providers, then, which are now concentrated horribly into massive organizations, are often driven by the “bean counters” considerations, not by the physicians’. If a physician or NP departs from “guidelines”, he/she has to explain it, not only to the bean counters all the way up the line, but to the jury if he/she is accused of malpractice. Organizations really do impress on physicians that they have to follow “guidelines” in treatment in order to keep malpractice claims down. Following “evidence based medicine guidelines” is a very good defense even if the outcome is bad. Independent medical judgment, even when correct, is harder to defend.
From what little one can glean from the exchange information, pricing of care and insurance has accelerated due to Obamacare. There’s little or nothing to stop it other than jiggering the “guidelines” to ration or avoid care altogether.
No one now living can tell what medical pricing would be like if government wasn’t so pervasive in the system. Looking back to the 1950s, for instance, doesn’t enlighten, because of technological change. But if one looks at the way the reimbursement system itself works, it is almost inescapable that it adds a great deal to what would otherwise be the costs.
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Ridgerunner
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Bible: Three score and ten (70)
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freeRadical
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You can’t compare Canada to the US, that’s like comparing apples to oranges. To study the effect of government intervention on the cost of medical care you would have to compare the costs before government got involved to the costs after the government got involved in a single country, while controlling for extraneous variables.
Regardless, many economists have said that government subsidization always leads to higher costs. Look at higher education, college was way less expensive, and more affordable, before government started subsidizing it.
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catholictiger
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in theory the free market should have a better control on medical costs then a government run system. A government run system won’t be controlled by free market and it can cost to much which leads to not many people having health care or to low of cost and the services are as good because people try and use health care to much for even simple issues.
A free market allows for competition in the health care market, and in theory allows there to be checks in this system. People won’t go to a health care organization that has bad practices if one with good practices is available.
But because this is just about cost I want to focus on why its more reasonable. Well in general the free market will usually set the correct market price on goods and services. There is a demand for health care and people are willing to pay a certain amount of money for certain types of health care. A government doesn’t have these controls as stated earlier so there is no guarantee that it will meet the market demand.
The only thing that must be added is that government must place minimal laws in place that will prevent private hospitals from refusing life saving treatment to patients. This does create a problem because some people may come and receive treatment without having to pay for it. But if you only allow the no rejection rule apply to immediate life threatening situations it will be better than what we have now.
Health care isn’t an easy issue but the less government the better.
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freeRadical
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I agree with you but you’re just spinning your wheels. The people of this country have decided, with a little prodding from government, that healthcare is a public good and, as such, they believe that it cannot be adequately supplied by a free market. Plus, their is growing belief in this country that the profit motive and rational self-interest are bad and do not belong in the healthcare industry.
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Country_Gal
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United Kingdom 80.75 years (2011)Bible: Three score and ten (70)
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catholictiger
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so we need to convince them other wise
note: the free market still plays a role in our system of health care. Obama care takes that away.
also don’t think because we have passed Obamacare that we now support healthcare as a public good. there are still plenty of people who think that health care should be in the private sector.
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Ridgerunner
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Interesting. Did you know that life expectancy is higher in societies in which the population is older, as compared to one in which it’s younger?United Kingdom 80.75 years (2011)
That’s because everybody has a life expectancy, no matter how old. Because a child of ten has many years of hazards to go through (particularly males age 15-25) and a person of 80 has few, the life expectancy of an 80-year-old will always be higher than that of a 10-year-old, all other things being equal.
So, if the average life expectancy in the Philippines is 70 and that in the UK is 80 (and most by that age will be females, who live longer than males), it might mean people have better care in the UK. It might mean that Brits are longer-lived than Filipinos for genetic reasons. But it also might simply mean that the median age in the Philippines is lower than it is in the UK, and probably does.
Yes, looking it up, the median age in the UK (forty) is almost double the median age in the Philippines (twenty-two).
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Country_Gal
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Hmmm, just shows statistics are not the objective data that some would like to purport.
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rossum
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The statistics are generally correct and objective. The interpretation of those statics however…
My favourite example: “Statistically, tall people are more likely to be bald.”
This is correct, but not very useful:
- on average, men are more likely to be bald than women.
- on average, men are taller than women.
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hu324b
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As long as no-one claims its free in Canada - all though if you don’t work - pay taxes it is free. You should see the tax coming off my pay check every payday - I’m paying for my medical coverage - instead of paying a monthly premium to an insurance company its taken from your paycheck in the form of tax.
Big American pharmaceutical company s do patent their drugs here and lock up the market for how many years it is in the agreement
The problem here is we do not have enough doctors and nurses working creating long wait times - just like the Reps the Conservative governments like to cut back on health care and we suffer for it.We have what are called walk-in clinics where hundreds of people who don’t really need a doctor show -up with colds, minor things that can be taken care of by going o a drug store and waste the doctors time which is a drawback of the system.
We have the same supplies as Americans - were do you think we get it from? And almost everything in Canada that comes from the states no matter what our dollar is trading at is jacked up in price - free trade doesn’t work well on this side of the border - its actually cheaper to order online from the states for all sorts of goods.
As for the online drug companies it may be true they get drugs from India but it all set up for Americans - we go to the drug store to get our drugs not these flyby night online drug companies with some being illegal in Canada - it was all set up to sell Americans drugs because some patents don’t apply anymore on this side of the border and generics are available - they have nothing to do with how our drugs are distributed - they are not part of the system.
Big American pharmaceutical company s do patent their drugs here and lock up the market for how many years it is in the agreement
The problem here is we do not have enough doctors and nurses working creating long wait times - just like the Reps the Conservative governments like to cut back on health care and we suffer for it.We have what are called walk-in clinics where hundreds of people who don’t really need a doctor show -up with colds, minor things that can be taken care of by going o a drug store and waste the doctors time which is a drawback of the system.
We have the same supplies as Americans - were do you think we get it from? And almost everything in Canada that comes from the states no matter what our dollar is trading at is jacked up in price - free trade doesn’t work well on this side of the border - its actually cheaper to order online from the states for all sorts of goods.
As for the online drug companies it may be true they get drugs from India but it all set up for Americans - we go to the drug store to get our drugs not these flyby night online drug companies with some being illegal in Canada - it was all set up to sell Americans drugs because some patents don’t apply anymore on this side of the border and generics are available - they have nothing to do with how our drugs are distributed - they are not part of the system.
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Ridgerunner
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Is it separately identified on your paycheck? If so, what’s the percentage?
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Brendan
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My wife is Canadian, from Quebec, the family moved to Windsor, ONT when she was 12.
She has three friends from High School who are nurses. All three work in the States because the pay is better ( almost double). They cross border commute to the Detroit area.
The Dermatologist she had in Windsor also has an office in the States. He sees enough patients in Windsor to reach his OHIP maximum, and sees other patients in the States to fill out his schedule.
That is part of the problem, at least with OHIP. To reduce costs, they cut salaries. There is no place else for a nurse to go in Ontario that does not get it’s funding from OHIP. So there is not much incentive for a person to go into nursing.
And, again to cut costs, a doctor has a maximum amount he\she can bill OHIP. So if they reach that amount, they cannot bill for any new patients. This is especially true for in demand specialists. So likewise, there is little incentive for a physician to go into anything other than general practice.
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Peter_Plato
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Generally, Canadian taxes, are about 36% (26% federal, 10% provincial [Alberta]) of total family income around $100k. There are lower rates for lower income earners and basic exemptions as well as the opportunity to claim deductions for retirement plans, education savings plans and additional private medical coverage which could lower those amounts significantly.
Source: cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html
The federal government pays only about 8.5% of federal taxes raised as transfer payments to provincial governments for health care ($2.2k from the federal taxes paid by the $100k family.)
Source: fin.gc.ca/taxdollar06/text/html/taxdollar06_-eng.asp
Add to that the provincial government contributions of about 45% of provincial spending ($4.5k from the 10% provincial taxes paid by the $100k earning family, you get a total of $6.7k ($4.5k provincial tax + $2.2k federal tax) that it costs the family for health care via taxation.
Source: health.alberta.ca/about/health-funding.html
From what I have read on this forum Obamacare will cost about $20k for a family in a similar situation (earning $100k) in the US. That amounts to $12.3k more than what a typical Canadian family in Alberta pays for basic health care.
The question remains, “Why will Obamacare be so expensive?”
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Peter_Plato
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The impression given by your post is that nurses, for example, are underpaid in Ontario. It is not clear to me that a wage range between $29 and $40 per hour with benefits and additional shift premiums constitutes hardship.
Source: lhsc.on.ca/Careers/LHSC/Nursing/Salary_Benefits.htm
Compare that to the $24 to $42 paid in Michigan (Source: salaries-by-city.findthedata.org/q/68584/135/How-much-do-Registered-Nurses-make-in-Detroit-Livonia-Dearborn-Michigan, it is not clear to me that nurses do, in fact, make double the salary.
Furthermore, given that Detroit is in bankruptcy it is not clear to me that that situation is anywhere as rosy as your post implies.
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BobCatholic
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Let’s take a look.
1946 delivery of a baby, plus about a week’s stay for both. $89.25
flickr.com/photos/mccradyfam/73615208/
About two week’s pay at minimum wage.
1946 hospital stay 11 days, a bunch of x-rays: $209.81
flickr.com/photos/hadesigns/3968188912/
About four week’s pay at minimum wage.
These were cash bills, no insurance. Health insurance as we know it was not common back then.
Imagine how much those same bills for similar services would cost today. And imagine how long a minimum wage worker would have to pay.
It won’t be two or four weeks pay. Probably years worth.
Third party payers, government or private, messed up the prices.
1946 delivery of a baby, plus about a week’s stay for both. $89.25
flickr.com/photos/mccradyfam/73615208/
About two week’s pay at minimum wage.
1946 hospital stay 11 days, a bunch of x-rays: $209.81
flickr.com/photos/hadesigns/3968188912/
About four week’s pay at minimum wage.
These were cash bills, no insurance. Health insurance as we know it was not common back then.
Imagine how much those same bills for similar services would cost today. And imagine how long a minimum wage worker would have to pay.
It won’t be two or four weeks pay. Probably years worth.
Third party payers, government or private, messed up the prices.
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oldcelt
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You hit the nail right on the head, but nobody wants to talk about this…they’ll be accused of supporting “Death Panels.”
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Country_Gal
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Sounds like Canadian nurses make equivalent to American ones, starting at higher wages than American, but with less disparity for years served. And they are making more, it looks like, than places like the South, where wages are significantly lower.
I currently, as a nurse of 20 years experience, make $40 an hour, plus differentials for nights and weekends. It goes up to, I think, $45 an hour in my hospital, which is on a union scale. Nurses outside the hospital setting make less. Nurses in non-union facilities make less as well, but don’t have to pay union dues.
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