Health Care Costs

[royal_archer]

Health Care costs will be paid for by your employer, it will be full coverage and it will be transfered to your next employer when you change jobs, and you will not be uninsurable, all pre-existing conditions will be covered by all of the insurance plans, or they will not be able to sell insurance in America, During terms of unemployment, your insurance may be paid for by the government until you obtain new employment and are covered by your new employer. There will be some insurance plans in which you can buy, like abortion, face lifts, tummy tucks, health spas, ete…

And your pay/hours will be cut accordingly. And, many workers will be laid off and many buisnesses will be forced out of buisness.

 

[Bluegoat]

Governments raise costs and reduce benefits. There is no free lunch. Governments are only parasites; they cannot produce wealth.

People keep saying this, but there is no evidence in other nations with national health programs that it is so. Benefits are at a similar level, in some cases better - costs are less.

 

[Ridgerunner]

People keep saying this, but there is no evidence in other nations with national health programs that it is so. Benefits are at a similar level, in some cases better - costs are less.

If you look at the tax rates of those countries, you will see that their tax rates are higher. For example the average rate in France, which has government healthcare, is 40%, whereas it’s 25% here. And France’s defense budget is far smaller. A lot of foreign countries’ costs are “hidden” in other budgetary categories. Interestingly, in the case of France, almost all medical costs are not “direct pay” but are 'reimbursed". The patient has to pay in full at the point of service, then applies for government reimbursement. That is designed to prevent overutilization. Even after all that, about 30% of French healthcare is “private”, not government. In addition, French doctors in the government sector make about half what doctors here make. But the government also pays for their malpractice insurance, and malpractice cases are tried by judges only, and in special courts.

It’s extraordinarily difficult to have public healthcare on a large scale without doing all kinds of things to cut costs, including reduction in services. The Democrats’ approaches do none of the things that keep the costs down in places like France.

 

[Bluegoat]

If you look at the tax rates of those countries, you will see that their tax rates are higher. For example the average rate in France, which has government healthcare, is 40%, whereas it’s 25% here. And France’s defense budget is far smaller. A lot of foreign countries’ costs are “hidden” in other budgetary categories. Interestingly, in the case of France, almost all medical costs are not “direct pay” but are 'reimbursed". The patient has to pay in full at the point of service, then applies for government reimbursement. That is designed to prevent overutilization. Even after all that, about 30% of French healthcare is “private”, not government. In addition, French doctors in the government sector make about half what doctors here make. But the government also pays for their malpractice insurance, and malpractice cases are tried by judges only, and in special courts.

It’s extraordinarily difficult to have public healthcare on a large scale without doing all kinds of things to cut costs, including reduction in services. The Democrats’ approaches do none of the things that keep the costs down in places like France.

I was speaking of the general sentiment, which seems to be repeated like a mantra - public will cost more than private. Of couse, it may sometimes be true, but many seem to hold it as a principle. That is certianly not supported by the evidence.

But looking at tax rates does not tell you how much is being spent on health care. Yes, Canadians have higher taxes than Americans. There are a number of reasons, including a very large space with fewer people in it.

On the other hand, if you look at money spent on health care specifically, we spend less on health care per capita than the US does. Health of Canadians is comparable to that of Americans, better in some areas and worse in others, but not radically different.

 

[markomalley]

I was speaking of the general sentiment, which seems to be repeated like a mantra - public will cost more than private. Of couse, it may sometimes be true, but many seem to hold it as a principle. That is certianly not supported by the evidence.

Please tell me a few government programs that are more efficient (i.e., less administrative costs) than a corporate equivalent.

(Before answering, you might wish to consider Al Gore’s Reinventing Government initiative, which privatized a huge number of previously government functions…because industry could do it cheaper than government could. The DOD outsourced over 200,000 jobs between1993 and 2001 because they could be done cheaper and better by industry)

 

[royal_archer]

People keep saying this, but there is no evidence in other nations with national health programs that it is so. Benefits are at a similar level, in some cases better - costs are less.

Then why do we have such a problem with people wanting to risk their lives to get into our country instead of those other countries?

 

[royal_archer]

I was speaking of the general sentiment, which seems to be repeated like a mantra - public will cost more than private. Of couse, it may sometimes be true, but many seem to hold it as a principle. That is certianly not supported by the evidence.

But looking at tax rates does not tell you how much is being spent on health care. Yes, Canadians have higher taxes than Americans. There are a number of reasons, including a very large space with fewer people in it.

On the other hand, if you look at money spent on health care specifically, we spend less on health care per capita than the US does. Health of Canadians is comparable to that of Americans, better in some areas and worse in others, but not radically different.

But Canadians keep coming in Droves to America to get care that is not available in Canada. That drives up our costs and makes the costs in Canada look much lower than they actually are.

 

[Bluegoat]

Please tell me a few government programs that are more efficient (i.e., less administrative costs) than a corporate equivalent.

(Before answering, you might wish to consider Al Gore’s Reinventing Government initiative, which privatized a huge number of previously government functions…because industry could do it cheaper than government could. The DOD outsourced over 200,000 jobs between1993 and 2001 because they could be done cheaper and better by industry)

I think I gave the example in my post. This is also true of other nationalized health-care programs.

Then why do we have such a problem with people wanting to risk their lives to get into our country instead of those other countries?

There are droves of people trying to get into those countries too. None of them lack for applicants, they all turn people away.

Why people choose to immigrate to one place or another varies. However, I believe the biggest determinate is having family members in the new place, or failing that a community of other immigrants of the same nationality.

I have no idea how many consider how health care is administered in their decision.

But Canadians keep coming in Droves to America to get care that is not available in Canada. That drives up our costs and makes the costs in Canada look much lower than they actually are.

In droves, just like the people risking their lives to get into the US? That an exaggeration. It isn’t nearly enough to make our health costs look lower, and to say it drives up your costs is laughable - medical tourism is a money maker. Whoever is telling you this is fibbing or twisting the truth.

Canadians going to the US for care do so for a few possible reasons. Some are not willing to wait their turn for the procedure they need and prefer to pay out of pocket. Some want a procedure that is not covered in Canada. There are not a lot of standard treatments that aren’t - very new or experimental ones; some that might be considered extreme measures; and things like cosmetic stuff. And some need a procedure that is not available in Canada, so there provincial health plan pays for them to go to the US. This isn’t so much a reflection of a bad system as it is of a smaller population. Of course only the first group would affect Canadian health care costs at all.

 

[markomalley]

I think I gave the example in my post. This is also true of other nationalized health-care programs.

Nah, you didn’t. You said that the overall cost was less. You didn’t say a word about efficiency.

Please take a look at the United Health financial statement I copied up in post #17 of this thread. You will note that their administrative costs were 14,6% and that the 82.3% of the revenue went to delivery of medical services. (The other 3.1% went for depreciation and the “cost of goods sold”). In other words, for every dollar paid into the system 82.3 cents were delivered as medical care.

You are considering the fact that you can cut the amount physicians are paid for their services (and their only choice is to leave the country or go into another line of work). You can also put limits the quantity and type of services that can be delivered to the consumer. Their only choice is to leave the country as well (which might not be a viable choice for some of more modest means).

That can reduce the cost. But that doesn’t mean it’s more efficient.

 

[Bluegoat]

Nah, you didn’t. You said that the overall cost was less. You didn’t say a word about efficiency.

Please take a look at the United Health financial statement I copied up in post #17 of this thread. You will note that their administrative costs were 14,6% and that the 82.3% of the revenue went to delivery of medical services. (The other 3.1% went for depreciation and the “cost of goods sold”). In other words, for every dollar paid into the system 82.3 cents were delivered as medical care.

You are considering the fact that you can cut the amount physicians are paid for their services (and their only choice is to leave the country or go into another line of work). You can also put limits the quantity and type of services that can be delivered to the consumer. Their only choice is to leave the country as well (which might not be a viable choice for some of more modest means).

That can reduce the cost. But that doesn’t mean it’s more efficient.

Yes, you’re right, I didn’t notice that you’d said efficiency. I wasn’t able to find figures in the same format as you, though I had a limited time to look. I did find the per capita administration costs - $307 in Canada, and $1059 in the US. I am actually rather surprised it is that big, because we have quite a bit of expense providing health care in the North to isolated communities.

I’m not sure what you meant I was concidering in your second paragraph, so I may not address what you were getting at. It is true that in the Canadian system and many other nationalized systems doctors can only charge proscribed fees for services. THis is not unlimited of course - it has to cover costs, and it has to be enough that people will actually want to work as doctors, or other medical professionals. Doctors here make a good living.

As well, as you pointed out, limiting types of care is a possibility, although our federal law states that the provincially run systems must provide all medically necessary care. Decisions on what is covered are also not made directly by government - normally it is by recommendation of a committee of people with medical expertise. We very occasionally have controversies about a particular procedure, but it is uncommon. (Also, it doesn’t always mean the patient has to leave the country - many kinds of extra services can be paid for. Wart removal, nose job…) But of course this happens with private insurance plans too, and people complain about real inadequacies a lot - the insurance company decides what is covered, and if you want more coverage you have to pay more, and often they can’t. But the difference is, in the latter case the process for deciding what is covered is not transparent, and you can’t vote out the people that implemented it.

 

[royal_archer]

There are droves of people trying to get into those countries too. None of them lack for applicants, they all turn people away.

Why people choose to immigrate to one place or another varies. However, I believe the biggest determinate is having family members in the new place, or failing that a community of other immigrants of the same nationality.

I have no idea how many consider how health care is administered in their decision.

Health care is part of a bigger issue it is a matter of freedom vs socialism. People have overwhelmingly choosen freedom. Now Maybe Canada and those other nations need to be forced to take their fair share of immigrants.

In droves, just like the people risking their lives to get into the US? That an exaggeration. It isn’t nearly enough to make our health costs look lower, and to say it drives up your costs is laughable - medical tourism is a money maker. Whoever is telling you this is fibbing or twisting the truth.

Canadians going to the US for care do so for a few possible reasons. Some are not willing to wait their turn for the procedure they need and prefer to pay out of pocket. Some want a procedure that is not covered in Canada. There are not a lot of standard treatments that aren’t - very new or experimental ones; some that might be considered extreme measures; and things like cosmetic stuff. And some need a procedure that is not available in Canada, so there provincial health plan pays for them to go to the US. This isn’t so much a reflection of a bad system as it is of a smaller population. Of course only the first group would affect Canadian health care costs at all.

So It appears that you agree that Canada has an innadequate health care system and you all are relying on the US system to make up for the failures of your system.

By the way people are not comming down here for cheep procedures, they are coming down here for the important stuff. If Americans were put on long waiting lists or denyed coverage like they do in countries with socialized medicine Our total costs would go down also.

 

[Ridgerunner]

I was speaking of the general sentiment, which seems to be repeated like a mantra - public will cost more than private. Of couse, it may sometimes be true, but many seem to hold it as a principle. That is certianly not supported by the evidence.

But looking at tax rates does not tell you how much is being spent on health care. Yes, Canadians have higher taxes than Americans. There are a number of reasons, including a very large space with fewer people in it.

On the other hand, if you look at money spent on health care specifically, we spend less on health care per capita than the US does. Health of Canadians is comparable to that of Americans, better in some areas and worse in others, but not radically different.

It’s actually very difficult to know the actual cost of healthcare in other countries that have socialized medicine to a significant degree, because a lot of the cost is not registered that way. I don’t know about Canada, but I did rn across considerable information on the
french system which, by the way, seems better than what the Democrats in the U.S. are passing. Medical education, for example, is paid for by the government, but it’s in the education budget. Malpractice insurance is paid for by the government, but that’s not a “medical expense”. The French government buys virtually all drugs (excluding a lot that are used here. It pays zero for illegal residents. Nothing at all. Not ER, nothing. About a third of French medicine is in the private sector. The government will pay its “allowance” to those physicians and hospitals, but the rest is paid privately and the government does not keep track of it or even know how much it is. Interestingly, there are co pays on just about everything, which discourages overutilization.

I very much doubt what the Dems are gonig to pass will be anything other than a massive money pit. I do think, though, that if we’re going to have socialized medicine, which I now consider inevitable, unfortunately, we would do worse (and will) than to have something like the French system.

 

[markomalley]

Yes, you’re right, I didn’t notice that you’d said efficiency. I wasn’t able to find figures in the same format as you, though I had a limited time to look. I did find the per capita administration costs - $307 in Canada, and $1059 in the US. I am actually rather surprised it is that big, because we have quite a bit of expense providing health care in the North to isolated communities.

The other thing to consider is that there is some (not much) competition between health insurers in this country. Companies that contract with insurers seek to get the best bang for the buck. If an insurance company’s administrative costs become too excessive, the companies that contract with them will simply switch insurers at the end of their contract. That is, by nature, not the case with government.

Having said that, if the Canadian government (or the corresponding provincial scheme) is more effective than the US government with providing services, my hat’s off to them. But that doesn’t change how the US government works.

I’m not sure what you meant I was concidering in your second paragraph, so I may not address what you were getting at. It is true that in the Canadian system and many other nationalized systems doctors can only charge proscribed fees for services. THis is not unlimited of course - it has to cover costs, and it has to be enough that people will actually want to work as doctors, or other medical professionals. Doctors here make a good living.

What concerns a lot of physicians I’ve spoken with is that the government-run plans (medicare, and particularly medicaid) do not reimburse them enough to pay their bills and, in fact, their patients with commercial insurance actually end up subsidizing those who depend upon government run insurance. There are a number of practices that will only accept a certain number of medicare patients and a certain number of medicaid patients for that reason. There are other practices that will simply not accept government insurance.

If the government gets control of all insurance, many have expressed concern that all their patients will be stuck with the reimbursement rates they receive from the government schemes…making it virtually impossible for them to stay in business.

As well, as you pointed out, limiting types of care is a possibility, although our federal law states that the provincially run systems must provide all medically necessary care. Decisions on what is covered are also not made directly by government - normally it is by recommendation of a committee of people with medical expertise. We very occasionally have controversies about a particular procedure, but it is uncommon.

The scheme that is being proposed over here is that a panel of experts (appointed by the President, with no requirement for confirmation by the Senate) will make recommendations…but the final approver of what is and is not medically appropriate and for what populations it is appropriate is the Secretary of Health and Human Services. There is no mechanism to appeal those decisions either.

The concern is that some treatments may not be deemed cost-effective for some populations. For example, joint prostheses may not be deemed to be cost-effective for people over a certain age.

The difference is that if your commercial insurer does not provide the coverage you like, you will be able to switch to a different insurer with different policies (or switch employers to one that contracts for insurance with the correct kind of coverage). However, if the government determines, for all insurers what is and is not cost effective (as is being proposed), it won’t really matter which insurer one selects.

(Also, it doesn’t always mean the patient has to leave the country - many kinds of extra services can be paid for. Wart removal, nose job…) But of course this happens with private insurance plans too, and people complain about real inadequacies a lot - the insurance company decides what is covered, and if you want more coverage you have to pay more, and often they can’t. But the difference is, in the latter case the process for deciding what is covered is not transparent, and you can’t vote out the people that implemented it.

The key factor with insurers is what the employers are willing to cover. If **employers **wished to have comprehensive coverage for their employees, the insurance companies would be more than willing to accommodate them. But **employers **are not willing to do that (as the premiums would likely be cost-prohibitive). If one wished better coverage, he/she might need to change **employers **to one that provided better coverage (or select a different plan offered by the same employer). I know when I switch jobs (which, in my industry, I do every three to five years or so), one consideration I have is the quality of the benefits package, which includes medical insurance.

The above is not something considered most of the time by folks, and it sure isn’t discussed much in the media.

 

[Bluegoat]

Health care is part of a bigger issue it is a matter of freedom vs socialism. People have overwhelmingly choosen freedom. Now Maybe Canada and those other nations need to be forced to take their fair share of immigrants.

THis isn’t what was being discussed, it is a totally different argument.

So, how many immigrants do you think other countries should allow? What makes you think there are more being allowed, proportionally, into the US? Do you actually know anything about the immigration rules in other countries? Many have sizable immigrant populations.

So It appears that you agree that Canada has an innadequate health care system and you all are relying on the US system to make up for the failures of your system.

THat is rather the pot calling the kettle black! We provide generally good service, though just as in the US, there are challenges. People will be treated. If some prefer to go where health care is a commodity, than we cannot stop them, nor do we really want to. That doesn’t mean they will not get care here if they need it.

You seem to be forgetting the many people in the US who get inadequate care - a far greater proportion of your population. Look at access to specialists for seniors. In the US, it is correlated to income. In Canada, it is not - it is correlated to condition. Or consider a person who waits a long time in an emergency room in Canada. In the US, one person may not wait at all who is well insured, but five others don’t go at all because they cannot afford it.

By the way people are not comming down here for cheep procedures, they are coming down here for the important stuff. If Americans were put on long waiting lists or denyed coverage like they do in countries with socialized medicine Our total costs would go down also.

The majority of Americans have less access to health care than Canadians do. Your costs have nothing to do with having better access, because quite frankly, it’s worse. Your costs are higher because the same things cost far more - a day in hospital, a doctors’s office visit, a PAP smear, all cost more. There are extra costs at every level - profit, medical practice insurance, administrative costs, and so on.

And you need to forget this idea that our costs are substantially lower than yours because of people leaving Canada to get things done. The vast majority cannot afford to pay American costs, and most of those that can, don’t anyway. It also would not make your costs go down. As I said before - medical tourism makes money, like all tourism does. It does not count as funds spent by Americans, but still injects money into the system.

 

[Bluegoat]

It’s actually very difficult to know the actual cost of healthcare in other countries that have socialized medicine to a significant degree, because a lot of the cost is not registered that way. I don’t know about Canada, but I did rn across considerable information on the
french system which, by the way, seems better than what the Democrats in the U.S. are passing. Medical education, for example, is paid for by the government, but it’s in the education budget. Malpractice insurance is paid for by the government, but that’s not a “medical expense”. The French government buys virtually all drugs (excluding a lot that are used here. It pays zero for illegal residents. Nothing at all. Not ER, nothing. About a third of French medicine is in the private sector. The government will pay its “allowance” to those physicians and hospitals, but the rest is paid privately and the government does not keep track of it or even know how much it is. Interestingly, there are co pays on just about everything, which discourages overutilization.

I very much doubt what the Dems are gonig to pass will be anything other than a massive money pit. I do think, though, that if we’re going to have socialized medicine, which I now consider inevitable, unfortunately, we would do worse (and will) than to have something like the French system.

I believe when such comparisons are done, it has to be set out what will be considered a medical expense. So for example, we also subsidize doctor’s educations, as we do all university students. But that isn’t considered part of health care in most comparisons. But I do agree, that figuring out things like costs, and especially efficiency, is very difficult. Are Americans more likely to get diabetes because they are more likely to be overweight, or because they neglect basic preventative heath care? Or both?

I agree that the bill that has been passed seems to have a lot of problems. I don’t think it is at all reasonable to lay that on the Democrats - it would likely have been impossible to pass a really good bill without some major changes to the entirety of American political culture, and that isn’t about just them I suppose people hope that with it passed, over the next 50 years or so it may be possible to make changes that will really make it effective. My husband says, “Hope is not a method” but sometimes there isn’t much else to do.

It seems to me there are two basic views represented in the US. One is that health care is a commodity, and should be treated as such, and one that it is something that we as a society ought to give for all. I tend to think of the latter as a more Christian position, but obviously that’s my personal view. What is too bad is that it does not seem possible for a real dialoge on this to happen, because lobbyists and those with vested interests, or seem to just want to prove their political power, get in the way. I can’t help but wonder if one day the poor in America may not rise up and wipe these groups out, and probably lots of others too. But I may be getting a bit far-fetched there.

I really do object though to the assertion that a good (not perfect) universal health system must cost more, and be less effective, than what the US has now. There are tons of examples that show this is not the case. I find it disingenuous that people whose disagreement is essentially idealistic use this argument. They are lying to get people to support their stance, controlling knowledge to gain political advantage, which is the opposite of supporting freedom.

 

[Ridgerunner]

I believe when such comparisons are done, it has to be set out what will be considered a medical expense. So for example, we also subsidize doctor’s educations, as we do all university students. But that isn’t considered part of health care in most comparisons. But I do agree, that figuring out things like costs, and especially efficiency, is very difficult. Are Americans more likely to get diabetes because they are more likely to be overweight, or because they neglect basic preventative heath care? Or both?

I agree that the bill that has been passed seems to have a lot of problems. I don’t think it is at all reasonable to lay that on the Democrats - it would likely have been impossible to pass a really good bill without some major changes to the entirety of American political culture, and that isn’t about just them I suppose people hope that with it passed, over the next 50 years or so it may be possible to make changes that will really make it effective. My husband says, “Hope is not a method” but sometimes there isn’t much else to do.

It seems to me there are two basic views represented in the US. One is that health care is a commodity, and should be treated as such, and one that it is something that we as a society ought to give for all. I tend to think of the latter as a more Christian position, but obviously that’s my personal view. What is too bad is that it does not seem possible for a real dialoge on this to happen, because lobbyists and those with vested interests, or seem to just want to prove their political power, get in the way. I can’t help but wonder if one day the poor in America may not rise up and wipe these groups out, and probably lots of others too. But I may be getting a bit far-fetched there.

I really do object though to the assertion that a good (not perfect) universal health system must cost more, and be less effective, than what the US has now. There are tons of examples that show this is not the case. I find it disingenuous that people whose disagreement is essentially idealistic use this argument. They are lying to get people to support their stance, controlling knowledge to gain political advantage, which is the opposite of supporting freedom.

First of all, we don’t really subsidize “all university students”. Some courses of study (like law) are profitable. Some, (like medicine) are not. Not many university students are subsidized in any way, other than the government guarantee on student loans.

Let’s talk about idealism, if that’s how you want to approach it. Of all the uninsureds in the U.S., the minority are actually involuntarily insured. Now, as to them, what do we really feel morally compelled to cover? Catastrophic care? Sure. Viagra? I wouldn’t think so. Contraceptives? Again, hard to justify that. Abortion? Harder still. What about Wellbutrin prescribed by a GP because his patient says he’s depressed? What about covering an ongoing prescription you can buy at Walmart for $4? And what if you’re employed? Is it idealistic to think others should pay for that $4 prescription if the taker makes, let’s say, $60,000/year? Under this bill, others will pay it at least in part.

Meanwhile, there are a substantial number of people in this country whose benefits for a number of things are extremely inadequate. Nothing is being done for them. I have previously on here mentioned speaking to a woman with MS who is trying to take care of her husband, who has Alzheimer’s. Both of them have to “spend down” to “poverty level” in order to get him long-term care. Nothing for them.

My problem with this bill is that it’s a broad-brush middle class welfare scheme, in which people with significant incomes are going to be subsidized by people whose incomes are only marginally better, and in which the overall financial condition of neither is considered.

In order to provide that scheme, which is fundamentally a “vote buying” measure, huge resources have to be collected and spent, and an entire industry has to be turned on its head with potential consequences no one knows. And, as anyone with an ounce of foresight realizes, elective abortions will be funded as well.

This is not a charitable measure. It’s a political measure.

 

[Bluegoat]

What concerns a lot of physicians I’ve spoken with is that the government-run plans (medicare, and particularly medicaid) do not reimburse them enough to pay their bills and, in fact, their patients with commercial insurance actually end up subsidizing those who depend upon government run insurance. There are a number of practices that will only accept a certain number of medicare patients and a certain number of medicaid patients for that reason. There are other practices that will simply not accept government insurance.

 

[markomalley]

markomalley;6427691:

In the long term, this would have to sort itself out. Obviously a system that had no doctors in it would have to be addressed by government. In the short term it would be a difficult situation.

One thing I would say is that in many places, national health care was not supported by doctors when it began, but that does not seem to last. Canadian doctors were against it, but now they feel as the rest of the population does - most consider it a basic component of our society. Though I come from a medical family and I know that the negotiations for fees for service between doctors and government can get quite heated.

Interesting. Two of my wife’s surgeons in recent years (her neurosurgeon and a reconstructive surgeon…both at Hopkins) moved to the States because of the issues with the Canadian system. I am told (by those two) that there are a lot of Canadian doctors who have moved to the States for that reason. Please note: they are doctors at Johns Hopkins…so they get paid a salary, not fee for service (in other words, it’s not like they moved here to get rich).

Our federal legislation about access to health care addresses some of this, and it could easily become a human rights issue as well under some circumstances. “medically necessary” is the bar, rather than cost effective, and there are parts about access as well. There are questions about efficiency of course, but in general the focus seems to be putting the balance where it ought to be. People become very angry if government seems to be undervaluing individuals, and it occasionally comes out. (Although here our national health care does not cover drugs or devices, or dentistry, except for the poor, elderly, or children. Many people have private insurance for these things.)

That may well work out here…but the USA is not Canada. And the mindset is quite a bit different. (After all, how many $3M lawsuits have you had from people who have spilled hot coffee in their laps after going through a drive-through window??)

But this must only work well when one’s skills are under demand? In a static or really bad economy, employers incentive to provide good coverage would be pretty limited.

Right now in this economy, you’d have a point, but normally that’s not the case. Benefits are pretty well standard across the board in given industries; there may be differences along the fringes, but not all that significant. (One thing I didn’t point out is that union contracts may mandate employer coverage in many cases)

I remember one time when my wife and I both had coverage from the same company (she was a teacher and I was, and am, working in private industry). Her policy had different coverage rules, deductibles, and cost-shares than mine…keep in mind, same company. When I filed a claim, my policy was primary while hers was secondary…when she filed, it was the other way around. Again, keep in mind the same company.

The point I was getting at is that insurance companies are working according to their contracts with employers…and if…hypothetically…the employer wanted to change the contract, the insurance company would be more than happy to go along.

This is not to say I like insurance companies (I don’t), but they’re not the bogeyman.

 

[Bluegoat]

Bluegoat;6429642:

Interesting. Two of my wife’s surgeons in recent years (her neurosurgeon and a reconstructive surgeon…both at Hopkins) moved to the States because of the issues with the Canadian system. I am told (by those two) that there are a lot

of Canadian doctors who have moved to the States for that reason. Please note: they are doctors at Johns Hopkins…so they get paid a salary, not fee for service (in other words, it’s not like they moved here to get rich).

This is something I always find a bit puzzleing. But first I’ll say this is much less common than it used to be, and many who left have actually returned. Some don’t like working in that environment, some just don’t like other aspects of life - the weather or whatever, some find the money isn’t that much better overall…

I’ll say, the reason I find it a bit puzzleing is that doctors really do quite well here. Now, they are rarely rich, but say upper-middle class.

As an example - My step-father is a GP, so among the lowest paid type, although he works hard and has another administrative position which is salaried. So he makes more than the average GP, but perhaps not as much as some specialists. We are in a province where doctors don’t make the most money, but COL is also reasonable here.

My parents have only one income. Their house get listed in the top 100 most expensive homes in our smallish city. They have two nice newish cars, they live on a lake, they eat nice food. They have a daughter they are partially funding through university, and paid for their other kids weddings. They can give generous gifts to family members who are less well off and they give substantially to charity. They don’t travel a lot but they like to spend on landscaping and furniture and so on. My mom buys nice clothes and shoes. They also pay horrendous taxes. They have plans for retirement income. They are sensible about money but not financial whizzes.

So when doctors say they can’t make enough, I am a bit skeptical. The other doctors I know also do alright, with a similar standard of living. Those in the hole would be anywhere, because they don’t work hard, or they spend immoderately. Nurses also do alright - they earn a living wage and get as much overtime as they want.

So I am not sure how much people think that doctors should be making.

 

[royal_archer]

THis isn’t what was being discussed, it is a totally different argument.

So, how many immigrants do you think other countries should allow? What makes you think there are more being allowed, proportionally, into the US? Do you actually know anything about the immigration rules in other countries? Many have sizable immigrant populations.

THat is rather the pot calling the kettle black! We provide generally good service, though just as in the US, there are challenges. People will be treated. If some prefer to go where health care is a commodity, than we cannot stop them, nor do we really want to. That doesn’t mean they will not get care here if they need it.

You seem to be forgetting the many people in the US who get inadequate care - a far greater proportion of your population. Look at access to specialists for seniors. In the US, it is correlated to income. In Canada, it is not - it is correlated to condition. Or consider a person who waits a long time in an emergency room in Canada. In the US, one person may not wait at all who is well insured, but five others don’t go at all because they cannot afford it.

The majority of Americans have less access to health care than Canadians do. Your costs have nothing to do with having better access, because quite frankly, it’s worse. Your costs are higher because the same things cost far more - a day in hospital, a doctors’s office visit, a PAP smear, all cost more. There are extra costs at every level - profit, medical practice insurance, administrative costs, and so on.

And you need to forget this idea that our costs are substantially lower than yours because of people leaving Canada to get things done. The vast majority cannot afford to pay American costs, and most of those that can, don’t anyway. It also would not make your costs go down. As I said before - medical tourism makes money, like all tourism does. It does not count as funds spent by Americans, but still injects money into the system.

No one in America is denied medical care, even those who did not earn it. Unfortunately that has driven up costs in part because of millions of aliens who were not admitted into Canada. When people complain about not having free health care, I often suggest they move to Canada, The consistent response is that Canada rejects them. Seems like Canadians have a thing against pre existing conditions.

And why shouldn’t wealth by better access?