Apparently there were about 1.7 million bankruptcies between 2002-2003. Now a new tudy finds that about half of those were caused due to medical costs, and that furthermore, a large portion of those people had insurance. http://www.suntimes.com/output/news/cst-nws-bankrupt02.html
So what does this mean? That we as a society are willing to ignore systemic problems like this?
Posted by Jay (Member # 5786) on :
Wonder how much of this is the fault of frivolous law suits which has lead to higher malpractice insurance cost which has lead to higher insurance rates which has lead to less being able to get adequate insurance.
Posted by IdemosthenesI (Member # 862) on :
That's a great daisy chain, there. I'm willing to wager not as much as you think. My family was in this situation for a while (though we never had to file for bankruptcy because my father is really good at extracting services after week-long marathons of hours on the phone with insurance companies.) The point is that these people HAVE insurance. Our current sytem just doesn't work all that well.
[ February 02, 2005, 10:46 AM: Message edited by: IdemosthenesI ]
Posted by Icarus (Member # 3162) on :
Why on earth would a bankruptcy be caused by medical expenses? (Or do people not realize that, in a crunch, they should pay medical expenses last because almost no creditor holds late medical payments against you?)
(Not that I disagree with your basic premise, though.)
Posted by Belle (Member # 2314) on :
I didn't read the link, but are the bankruptcies due to the medical costs themselves, or because a medical condition made it impossible to keep working? There's a big difference between having medical insurance and disability insurance - you can get your hospital bills paid with medical insurance but if you've got a permanent disability due to accident or illness that prevents you from working and no disability insurance, then I can easily see how that might lead to bankruptcy.
Posted by ketchupqueen (Member # 6877) on :
Icarus, they may not, but when you're pregnant and your insurance decides not to cover you, and your doctor won't continute treatment until someone is paying, you pay. Then you shop around for a new doctor. *mutters*
Posted by Belle (Member # 2314) on :
Ok, curiosity got me and I read it.
quote:For people without much buffer between income and expenses, "a $3,000 or $5,000 loss can be a pretty catastrophic number," Morris said.
That astounds me.
Makes me extremely grateful that we've had to absorb a loss that large, and even larger, and that we've made it through okay.
I don't give thanks for my blessings nearly enough.
I have to say the article was an eye-opener, because I always figured bankruptcy due to medical costs would only be a problem with people without health insurance.
Posted by ketchupqueen (Member # 6877) on :
*snorts* $1000 could be catastrophic for us right now.
Posted by Elizabeth (Member # 5218) on :
Yes, Belle, that is what scared me about it.
And, Synesthesia, you are not alone. We have no padding, except what is on my bee-hind.
Posted by Amka (Member # 690) on :
I can see it. We have coverage, and we'll still be paying over a thousand dollars for this pregnancy. This is supposed to be good coverage, but even Wal-mart coverage was better than this. There was a level higher coverage, but it was $120 more a month. I ran the numbers and determined that we would need two other major medical incidents for it to be worth it. And then, we'd still be seriously screwed.
I'm a little irritated that our deductible gets to be deduced twice simply because of the timing. I'm a little irritated that a very routine mid pregnancy blood test is going to cost us 50 dollars when we never had to pay anything for it before. Before, we would not have been able to afford it at all. We'll absorb it all, sure. And braces too. But this year is going to be hard.
[ February 02, 2005, 12:20 PM: Message edited by: Amka ]
Posted by fugu13 (Member # 2859) on :
Jay, as malpractice lawsuits are one of the great tools of capitalist efficiency, I'd answer a negative number.
Posted by Belle (Member # 2314) on :
Praise God for the insurance provided from my husband's employer.
Man, Amka I'm sorry. that must be tough.
I never had to pay more than $100 for any of my three pregnancies.
They have raised our deductibles this year though, medications now cost $35 a prescription and doctor's visits are also $35, up from $25. That can get costly with four kids, and with me taking four different medications.
Posted by Nato (Member # 1448) on :
Yeah, braces are expensive. My brother is going through all that stuff right now. I hope by the time I have kids, there's a cheaper way to make their teeth grow straight.
Posted by IdemosthenesI (Member # 862) on :
((Amka))
My mother went through a huge health care crisis that lasted several years. What's more, it was mental health related, for which insurance companies are not known for their compassion. I truly believe that all insurance policies should be modified to include this line:
quote:Some procedures covered by this policy will initially be denied. This is normal, and is intended to weed out those policyholders who are not assertive enough to demand we keep our obligations. If your covered procedure, medication, or visit is denied coverage, please allow approximately two weeks of calls to the provider, the payer, the catastrophic coverage payer, and your employer in order to recieve coverage.
My dad said this was the first time he's ever voted based on a single issue, and that was health care.
At least we all have our health savings accounts, right?
Posted by Belle (Member # 2314) on :
Ugh don't remind me. My oldest had a dental appt. today, and while she had no cavities or any problems, the dentist does want an orthodontic evaluation for her. He said her alignment is fine but her bite is off.
Don't forget glasses - I need to get my oldest in for another eye exam too. And I have no vision coverage whatsoever, and my dental is a reimbursement plan at only 50% with a 1000 maximum for the year. So, if we do need braces, it's still going to cost me a good bit.
Posted by IdemosthenesI (Member # 862) on :
I just went in for new glasses. They ended up costing me about 250$ out of pocket, and I have insurance. I even had a coupon!
The insurance premiums my dad pays are astronomical. I am about to switch over to my own coverage through my employer, even though it's expensive, because I can only imagine the nightmare of trying to get care without insurance.
Posted by Belle (Member # 2314) on :
Insurance premiums are the main reason my husband works two jobs instead of one. If he quit his job with the fire department and went to work full time with our business, we'd make enough in gross income, but we wouldn't be able to afford family coverage as an individual. None of our employees are full time so we can't qualify as a group plan.
Posted by Amka (Member # 690) on :
Four kids do make medical expenses a lot more, even under fairly healthy circumstances.
We can sing our tale of woe together, all us moms, eh?
Posted by ketchupqueen (Member # 6877) on :
Glasses prices are ridiculous. I'm wearing ones that came from $39 glasses.com. They actually cost me $20 extra because I have a high prescription, but it was better than paying $350 (I have no insurance) to replace the ones I lost.
Posted by Synesthesia (Member # 4774) on :
Padding? I have no insurance at all. But, if I worked for at my job for 2 more years I would have healh care but I hate my job and I don't want to work there for 2 more years.
Posted by Amka (Member # 690) on :
Dem,
How did they cost you that? I have a very high index prescription that more or less requires me to get the ultralight carbon lenses, and I'm still only paying about $100. Our insurance is covering $150, so mine total cost about $250.
Posted by Jay (Member # 5786) on :
I think it would help if doc worked 40 hours a week instead of 80 hours a week. Then they might not make as many mistakes. Of course this would mean they made half as much. But the less mistakes would also help the malpractice insurance go down.
Posted by IdemosthenesI (Member # 862) on :
My lenses alone cost me more than your glasses! I went with the polycarb lenses, but I may have splurged for the anti-reflective ones, because I don't anticipate buying glasses again for quite a while. I also needed new frames, so it was rather expensive.
Posted by Amka (Member # 690) on :
The braces will probably cost us considerably more than the pregnancy, actually, but we'll spread it out over 2 years. Not payments, but two big chunks from our flex plan, which is limited to $3000 a year. We anticipate using it all up both years.
Posted by Amka (Member # 690) on :
Well, my glasses are backups, but I can't wear contacts more than 10 hours a day. I also intend to use them for quite a few years... But even the most expensive lenses from my eye doctor are only $80 each and I believe that includes anti-reflective which really is only about $10 a lense. Where are you getting your glasses?
But once I stop nursing and my prescription is stable again, and we don't have so many extra medical (cross fingers, knock on wood, etc) we are planning on intra ocular implants. I'm too high risk for lasik.
Posted by IdemosthenesI (Member # 862) on :
Jay, malpractice suits are not the sole reason for the high cost of health care. There are many many factors, here, not just the one single factor Bush cited because he didn't have a health care plan. The pharmaceutical industry has one of the highest profit margins in all of business. The back end administrative costs in the health care industry are a sizable percentage of what gets paid. Collective bargaining for all but the largest corporations is practically nonexistent. The government has rejected the idea of price controls, and completely ruled out any drug importation based on problems that could be addressed, but would hurt big Pharma. Direct to consumer advertising raises the price of less popular, live preserving drugs while making Pharmaceutical companies money hand over fist on their big name stuff, usually for non-life threatening conditions.
It's a really complex issue, that's affecting real people. You do yourself no favors by oversimplifying it.
Posted by ketchupqueen (Member # 6877) on :
And you insult all the doctors who sacrifice their careers, in some instances, to give patients the attention they deserve.
Like my dad.
Posted by IdemosthenesI (Member # 862) on :
Ami,
Is the anti-reflective lense a coating on the lens (which tends to make it scratch easier), or the new Crizal Alize, which is a production method that actually makes the lens itself anti reflective. Also, I need astigmatism correction, as well, which might make a difference. Of course, I may just be going to an opportunistic optometrist. There are only two in town that are in network, and the other one I refuse to go to because the last time I was there I had his first appointment of the day, and I was sitting in the chair half an hour before he pulled into his parking spot.
Posted by Sopwith (Member # 4640) on :
Malpractice insurance isn't the biggest cause of skyrocketing health care costs.
For one, the administrative staffs of most hospitals equals their actual medical staff, if not exceeding it. Have you ever had to call and check on your medical bill? How many layers of administrative strata did you have to dig through to get information?
Also, as a society, we simply go to the hospital/doctor's office more than we used to. Every sniffle, ache or anxiety sends us to the hospital for treatment.
Think of all of the testing done today for even the slightest of reasons. Sometimes you can go in to have an old ailment treated at a new doctor's office and because of HIPA regulations have to go through a totally new battery of the same tests you went through before.
And how often does your doctor send you off to a specialist whereas ten years ago, the doctor would have nodded sagely and said, "Here take this for two weeks."
Now add in advertising budgets. Not for pharmaceuticals, but for actual hospitals. Billboards, radio, television, print ads. It all adds up, as does the public relations staff that produces the advertising.
But what it boils down to is this: the medical field is a business. Making money is the first order for those in charge of hospitals. And it costs money to make money. That money comes from you, the patient. Even your insurance is paid in by you.
And about insurance: if they weren't making a profit from the insurance, then the insurers wouldn't stay in business, would they?
Posted by Jay (Member # 5786) on :
I don’t see anywhere that I stated it is the “sole” reason for the problem. I didn’t say the single most either. I didn’t even say the most. I was talking about things that could be changed to reduce the cost of insurance so that it would become easier to insure everyone. But of course, instead of looking at good ideas let’s attack the conservative. Yeah! That’ll work. I think another thing that would help is if instead of having useless pre-med under grad degrees you make all med school people go through the 4 year nursing program. That way they’ll know more about what they’re getting into and also what the true workers do. If they flunk out of med school they still have a useful degree. They might get into nursing and see they don’t like it and can get into something else. It makes so much sense all around. Better more rounded experienced doctors who have an appreciation of the whole system.
Posted by IdemosthenesI (Member # 862) on :
You may not have stated it's the sole reason for the problem, but it's the only one you mentioned. If it's not the most important factor... if it is, in fact, one of the lesser factors, why focus on it instead of the myriad costlier aspects of health care, like the administrative back end?
I'll tell you why it's been proposed. Because tort reform would help the big Business of medicine (like insurers), who we would then just have to trust to "pass on the savings" to me and you. The Pharmaceutical companies have a lot more money for lobbyists than patient advocacy groups, Jay.
Now I'm not saying that frivolous malpractice suits are not a problem. I'm saying that going after those suits to decrease the general cost to consumers of health care is a fairly ineffective response that helps the corporations far more than the consumers.
Posted by IdemosthenesI (Member # 862) on :
Without passing judgement on the sense behind the idea, how exactly would all doctors having nursing degrees decrease health care costs?
Posted by Bob the Lawyer (Member # 3278) on :
I'll pass judgement on the sense behind the idea. As it stands one can transfer into medicine after finishing any degree (you don't actually have to finish that first degree if your marks are high enough). By locking all would be doctors into the same premed course you aren't going to make more well rounded doctors, it just doesn't follow.
Posted by Icarus (Member # 3162) on :
quote:We can sing our tale of woe together, all us moms, eh?
You know, there are other parents of medically needy kids here who aren't moms. Posted by Jay (Member # 5786) on :
I’m not sure I’d even call it a lesser problem. It would for sure make the top ten and most likely be in the top 5. And the benefits of helping tort reform would ripple across so many areas that the other problems would be greatly reduced.
I mentioned the doctors having nurse’s degrees in the whole sense of having better doctors so that fewer mistakes would be made. More caring doctors who are in it for the patient instead of the money is what would be best for everyone. Uh oh….. I said best. Great. Do I have to clarify. Let’s see…. What would be the most best. Or is that bestest? Better? Great? Maybe I should say good. Oh who cares. Oh wait… The silly English teachers that read this do! Oh what do I care, they can’t flunk me anymore!
Posted by IdemosthenesI (Member # 862) on :
Wait... So the problem is avaricious doctors? All the doctors I know care most about helping their patients. Yes, they get paid a lot, but they sacrifice a lot for what they do. The huge excess of expense in the health care industry ain't going to the doctors, Jay. It's going to the businessmen, the insurance companies, and the Pharmaceutical companies. Besides, your whole premise is that a lot of the malpractice suits are frivolous. In that respect, having higher quality doctors wouldn't help at all. I frankly think we have pretty good physicians in this country, even if they didn't get their nursing degree first.
What we also have is a system that maximizes profit to the health care industry by maximizing cost and minimizing benefit to consumers. Tort reform isn't going to change that.
Posted by Amka (Member # 690) on :
Dem,
On glasses: Ahh, probably it is a combination of the new fangled lense and your doctor. Our doctor has a lot of competition in the area, even in network.
On health care:
I think you make many good points. Our problem, much like the SS reform problem, is what, exactly, should we do about it?
It actually benefits all of humanity to give our pharmacuetical companies enough incentive and profit that they spend lots of money on R & D. If we take away those incentives, by limiting patents or allowing the companies from outside our nation that didn't spend a dime creating the new drug to compete with our companies, our companies are less likely to spend so much effort themselves. Unfortunately it isn't the researchers we rely on, but the stock holders who will sell the company stock should it cease to become profitable. R & D will become one of the first things to get cut.
If we put pricing restraints on medical services, we have the same thing happening to therapeutical procedures. All those medical miracles that go on in the high end medical facilities eventually trickles down to everyone.
What we really need to attack is insurance, I believe. I am somewhat hesitant to put this in the hands of government. It is simply too huge and hard to manuever. Programs under it fail, often quite miserably, to serve a few in the interest of being able to serve the majority.
The impact might be less though, if it really were only insurance we were dealing with and not any interference with providers.
But I propose we can do something else, as well.
We have credit unions, non profit banking institutions that compete with banks.
Why non privately owned by the insurees, non-profit insurance companies? It wouldn't suprise me if such things exist already...
Posted by Jay (Member # 5786) on :
I didn’t say not let them transfer in. I said do away with useless pre-med and have them go through nursing. And how having them be nurses first would that not make them more well rounded in their field? I worked at a hospital for 6 years and there is a huge disconnect between the doc and nurses. The whole better then thou thing and what not. Doing it this way could help and make that gap less with more appreciation of them.
Posted by IdemosthenesI (Member # 862) on :
Sort of like extending the idea of a flex plan to the entire system? That could work. The problem there is that such a collective would necessarily be too small to exert much of a collective bargaining power. Thus, the procedures the insurance companies pay less for, the health union would have to pay more for.
As to R&D. This is, I think, where a lot of misconception is placed. A lot of the Research and Development of drugs that are necessary to our survival, like vaccines and chemotherapy, and antibiotics and really vital stuff is financed by Federal grant money! In other words, we are already paying for it through the HHS department. The pharmaceutical companies cite R&D as their big expense, but in fact they spend vast amounts of money developing things like Viagra, and then spent a significant percentage (I think it was more than ten last time I checked) of their revenue marketing these drugs direct to consumers, who then specifically request a drug that may not be right for them from their doctor. Then, if the doctor wants to keep the patient, he prescribes it (else the patient will find someone else that will.)
Cerainly R&D is important, but there seems to be an inverse relationship between the R&D money spent by Pharmaceutical companies and the severity of the condition treated by the drug. Naturally, if I come up with yet another arthritis drug, I get more customers than if I come up with something to treat a debilitating but rare disease like... scleroderma, for example. When I get home, I'll dig for an article I read recently in the New Yorker about Pharma R&D and vaccines for diseases prevalent only in developing countries.
Posted by Amka (Member # 690) on :
Very true, Icarus. Okay, all of us parents can sing the woes of everyday health crises. And some of us have a bit more woe.
Jay,
I disagree. That wouldn't lessen any of the 'better than thou' attitudes. It might make it even worse. I can really see them saying "I went through what you did, but I didn't quit like you did."
If it is doctor/nurse relations you are worried about, then perhaps what needs to happen are classes on intrapersonal relations between patients and coworkers. Talking about how a nurse in the hospital, simply by attending the patient regularly, may have some insight that a doctor who can only spend a few minutes with the patient can't have. How a doctor can get more out of his nurses by treating them with respect rather than disdain. This may sound silly, but weekly 'talk about it' meetings specifically meant to air out grievances between nursing staff and doctors might be useful if conducted properly.
Do we want to complain about how much the doctor's visit costs? Around 60 dollars a typical visit. If it is more, it is because there is more time involved. It all pays for nursing staff, renting the office, adminstrative staff, supplies, and medical malpractice insurance.
Jay, I forget how old you are. Do you have kids? Are you the one taking them into the doctor? Or calling them in the middle of the night? Doctors give up a LOT of personal freedom just to be doctors. They always have a pager on them. If a crisis develops with a patient while they are at their kid's play, they may very well have to leave no matter how much they promised to be there.
Compare this to the business men who make more than those doctors do.
Posted by Amka (Member # 690) on :
True, about the viagra. And about silly people who go to their doctor just to get a drug they saw on TV.
I'll rant a bit about that. A while ago, I heard a radio advertisement about the purple pill. It really helped everyone. The purple pill changed their lives and made them livable again. The purple pill, apparently, was a medical miracle. But the commercial never said what the purple pill actually was. It just told you to go to purplepill.com or call some number for more information.
Perhaps we should simply ban all broadcast advertisements for prescription drugs. And limit patents to about a year when they are placed OTC.
Posted by IdemosthenesI (Member # 862) on :
Actually, direct to consumer advertising is a fairly recent phenomenon. Nevertheless, it's made so many people so much money that I doubt you could get rid of it. My dad introduced a resolution at the district Democratic convention to limit direct to consumer advertising, but nobody understood it. Posted by TomDavidson (Member # 124) on :
Jay, I know quite a few doctors and quite a few nurses. And I'm confident that the cultural gap between them is not a primary healthcare cost. Nor, for that matter, do I believe that requiring all doctors to be nurses first would a) increase the quality of doctors b) make doctors and nurses get along better and c) reduce the current shortage of qualified doctors.
Nor do I believe that malpractice costs are the fundamental reason behind skyrocketing medical costs. In fact, I think the problem is more insidious: it's insurance. Because costs are hidden from the consumer, and those consumers unable to pay are subsidized by those who are, hospitals and pharmaceutical companies are able to conceal the true cost of their treatments from consumers. There is, in other words, not only no real competition but no real price awareness. This introduces a number of inefficiencies into the market which, sadly, are not eliminated by tort "reform."
Unfortunately, given the way modern health care is set up, I can't think of any way to introduce a freer market without seriously risking the lives of people relying on our existing controls. So my gut feeling is that, in the short term, we're better served by moving to a nationalized healthcare system where costs become a matter of standardized public record. (On the downside, this would probably prove very disadvantageous to private practicioners. But, hey, I suspect they'll go the way of the American farmer in a few years, anyway.)
Posted by Jay (Member # 5786) on :
I never said I thought that doctors and nurse relations were a cause for more expensive health care. I said doctors having nurse’s degrees in the whole sense of having better doctors so that fewer mistakes would be made. And after watching med students and first year residents for 6 years I know it is a fact that they are lost most of the time. So…. To go through something like nursing could do nothing but help in all aspects. What does pre med do? Nothing. What can you do with it? Nothing. It would probably be helpful to have first year nursing students be nursing assistants. Nothing to make someone more humble then to have to wipe a bunch of butts. Why is insurance so high? Well you can’t say malpractice doesn’t affect it. I do agree with the price awareness but disagree with nationalized health care. Canada has that and sounds like a horror story to me. I do like the idea of the ban on prescription advertising. I have a pharmacist friend who tells me about all the people who come in and want the pill that lets you run through the fields and how they want to run through the filed too. Oh well. Oops. I shouldn’t have agreed with something. That’s bad. Can’t have a conservative agree with it so now they’ll be against it.
Edit: Ok, before some numb skull says you can go to med school with it, I mean what can anyone else do with it.
[ February 02, 2005, 02:34 PM: Message edited by: Jay ]
Posted by ClaudiaTherese (Member # 923) on :
quote: I do agree with the price awareness but disagree with nationalized health care. Canada has that and sounds like a horror story to me.
Posted by ClaudiaTherese (Member # 923) on :
quote:What does pre med do? Nothing. What can you do with it? Nothing.
BTW, at nearly all (if not all) universities, there is no "pre-med" major or "pre-med" degree. It just doesn't exist.
Often students who want to go to medical school will get a BS in chemistry and/or biology, since you have to essentially take most all those classes anyway to score well on the MCAT (medical college admissions test).
What can you do with a bachelor's degree in biology? In chemistry? Well, actually, a lot.
On the other hand, my BA in philosophy wasn't likely to further my gainful employment on its own.
[ February 02, 2005, 02:43 PM: Message edited by: ClaudiaTherese ]
Posted by TomDavidson (Member # 124) on :
"Canada has that and sounds like a horror story to me."
Jay. most people who say this don't really know much about Canadian health care. It's actually pretty good.
Posted by IdemosthenesI (Member # 862) on :
Yeah. Surveys show that general satisfaction with the system is actually higher than in the U.S.
Posted by ClaudiaTherese (Member # 923) on :
Do physicians tend to be arrogant pricks? I would have to say "yes."
Are they more a hinderance than a help in their first years on the wards? Again, "yes."
Do the physicians I know who were previously nurses (3) make for some of the most practical, knowlegable, patient-oriented healthcare providers? Yes, absolutely.
Are nurses undervalued, underpaid, and treated like crap as they work pretty much tirelessly for the good of their patients? Yes. Yes, a thousand times, "yes."
Do you need to have a whole lot of additional hard science training to understand physiology, pathology, and pharmacology in order to assume primary responsibility for a patient? Yes.
[Can nurses do that? Yes. They are called Nurse Practitioners, and they can be fearsomely good at what they do. ]
Does Canada's healthcare system suck, when assessed in terms of the standard ways of comparing healthcare systems? No, it does not.
There are sad and distressing anecdotes of how the system failed for particular individuals in every healthcare system. But when you look at the system as a whole, the US does not fare better than Canada in terms of healthcare. And Canadian individuals express more satisfaction with their personal experience of their own system than do Americans. (Same for Kiwis, Brits, and Aussies.)
This is likely to be in part due to a generally healthier population. However, the investment in preventive medicine and continuity of care and records has a lot to do with that aspect, regardless. And certainly it is not a given that the US system would rank better on standard assessment scores even if there was a healthier baseline population to start with. You'd have to argue long and hard to establish that -- you don't get to just assume it.
[ February 02, 2005, 03:06 PM: Message edited by: ClaudiaTherese ]
Posted by Jay (Member # 5786) on :
Considering the hassles of dealing with insurance in the US, this does not suprise me very much.
Sara,
Have you been a doctor in both Canada and the US? What are the doctor's experiences? Do they express the same satisfaction? I know that there are things such as paperwork and getting payment from government/insurance to deal with. Better, worse?
See, one of my beefs is that there is a range of people that simply don't qualify for medicaid because they make too much, but don't make enough to take care of basic medical needs. And if something catastrophic happens, well... like the first post indicated: it leads to bankruptcy. In my experience, with my parents, their biggest financial hurdle was and is their medical obligations.
Posted by ketchupqueen (Member # 6877) on :
Jay, when you say things like "Thought this was the cure all", you sound irritatingly self-righteous.
Posted by ClaudiaTherese (Member # 923) on :
Jay, links do not an argument make. If you want to make a case, you'll have to ... well, make a case.
Your links are rife with problematic interpretations. E.g., from the first, re: Canada:
quote:US Patients Have Greater Access to Advanced Medical Technology Than Do Canadians [graph]
Shame it doesn't translate into lower disease and mortality rates. Because, you know, it doesn't. And you'd have to argue to convince me that having access to a CT scan is helpful if it doesn't affect medical outcomes in a positive way.
quote:According to a national poll, four out of five Canadians are unhappy with their socialized health care system.
Which poll? Where is the citation?
Jay, you can do this. You can make a much better case than this! Of course some people in Canada are dissatisfied -- for a systems comparison, though, than needs to be placed in context of how many more (or fewer) people are dissatisfied under the other systems.
Posted by ClaudiaTherese (Member # 923) on :
quote: Have you been a doctor in both Canada and the US?
I spent four months as a med student in international electives there (pediatrics, pediatric endocrinology (2 mo), and pediatric surgery). I have not worked there as a licensed physician, although I did work with both hospital-based and clinic-based physicians while I was there.
[I am in the process of obtaining my Canadian license, though. I have to go back through the whole battery of tests from the beginning.]
Additionally, my husband (a PhD sociologist, not an MD), who is a Canadian, did contract work for the Manitoba (province) and Canadian Federal Government in assessing health outcomes data. He also headed the research center of the Addictions Foundation of Manitoba.
quote: What are the doctor's experiences? Do they express the same satisfaction? I know that there are things such as paperwork and getting payment from government/insurance to deal with. Better, worse?
In my personal experience, it's better. There are studies to back this up, too (e.g., an average of 44% of work time spent on paperwork here as opposed to 5-10% there).
Many doctors have their own private practices. Street corners, in the malls, wherever patients will go, you can find a physician. If you have a license, you can put up a shingle. There is no time wasted on trying to convince a bureaucrat that a particular procedure is really needed or should be covered. No wrangling back and forth. You see the patient, do what needs to be done, and send the bill to the national insurance system, along with that patient's ID number.
Most people don't get this. You make private practice more feasible in a single-payer insurance system, not less.
All the provinces recognize each other's patient ID numbers, so if you are (say) a British Columbia physician who sees a vacationer from Quebec, the system is just as streamlined. All you need is the patient's number.
Of the five Canadian physicians I know who came to work in the States, all of them have returned to Canada. There is scuttlebut about a "brain drain" south of the border, but the numbers do not support this in the long run. Yes, Canadian physicians do make less money overall than do their American counterparts. But they can practice medicine.
quote:See, one of my beefs is that there is a range of people that simply don't qualify for medicaid because they make too much, but don't make enough to take care of basic medical needs. And if something catastrophic happens, well... like the first post indicated: it leads to bankruptcy. In my experience, with my parents, their biggest financial hurdle was and is their medical obligations.
I understand completely. It troubles me, too.
[ February 02, 2005, 03:34 PM: Message edited by: ClaudiaTherese ]
Posted by Icarus (Member # 3162) on :
I think access to a CT scan is verrry helpful!
You know, I have no idea what the hell that means, but it sounded funny to me, so . . .
Posted by ClaudiaTherese (Member # 923) on :
Canada is undergoing a healthcare crisis, due in large part to cuts in funding.
In contrast, the US a) is undergoing a yet more extreme crisis, and b) still pays more per capita to subsidize about 25% of its citizenry (via VAs, Public Health Districts, State Labs of Hygiene, Medicare, and Medicaid) than Canada pays per capita to subsidize 100% of its citizenry.
Icarus, it is funny. But seriously, that's a major flaw in an assessment. You can't publish an article in JAMA that asserts X program is better because more people have access to medical technology. You'd be laughed out of town. To be meaningful at all, it has to be cashed out in terms of benefits in actual medical outcomes for patients.
[ February 02, 2005, 03:35 PM: Message edited by: ClaudiaTherese ]
Posted by Derrell (Member # 6062) on :
I'm living proof that there's a health care crisis in the United States. I work at a job that doesn't offer health insurance and can't afford it on my own. The last time I applied for AHCCCS(Arizona's health insurance plan for people who can't afford insurance), they said I made too much money. I make $5.60 an hour and work 20 hours a week. How is it that I make too much to qualify? Posted by ClaudiaTherese (Member # 923) on :
Derrell, I'm so sorry.
Just to clarify: the Canadian system isn't perfect -- far from it. It certainly could and should be improved.
However, the US system is in worse straits as a system. And yes, this translates into a greater percentage of individuals with significant problems under that system.
[ February 02, 2005, 03:47 PM: Message edited by: ClaudiaTherese ]
Posted by Derrell (Member # 6062) on :
I need to find a job that offers health insurance or move to Canada.
Unfortunately the job hunt isn't going so well.
With my limited job skills, I think the only way the Candian goverment would let me in is as a student. The problem with that is I don't have the money.
Oh well, I guess I'll just keep up the job search.
Posted by ketchupqueen (Member # 6877) on :
You could marry a Canadian. Posted by Derrell (Member # 6062) on :
This is true, but I'd have to find one that could put up with my Hatrack addiction. Either that or get her addicted too. By the way, are there any single female Hatrackers in Canada? *ponders the possibilities*
Posted by BannaOj (Member # 3206) on :
I realize that most people value human life more than animal life, and that ethically it probably should be, unless you are an extreme philisophical vegan. But what if we limited human costs to twice (or even possibly 3x) the standard veterinary cost? Veterinarians run both sucessful businesses and provide high quality care in most parts of the country, even if they aren't drawing in huge profits.
In the US it is more difficult to get into Veterinary school than it is medical school as far as academic credentials go. It is possible that this gives the animals the higher standard of care because the people that get in have to be even more outstanding than those in the human profession.
The point was really driven home to me recently. I paid $60 for an office visit and ultrasound for my dog. The inexpensiveness of the procedure flabbergasted many of my human friends who have had children. While a person with insurance would only generally see their $35 co-pay, the insurance company is often billed for $200-$300. Then there is the practice where the doctors normally only get reimbursed a percentage of what they are billed, and if you are lucky you don't have to make up the difference.
But should a human pregnancy ultrasound really 4-5 times more than a canine one? In dogs the vet has to check out 6+ fetuses for correct development instead of one or two.
AJ
Posted by ketchupqueen (Member # 6877) on :
When my insurance didn't cover the pregnancy, I was stuck with a $600 sonogram bill.
Posted by ClaudiaTherese (Member # 923) on :
I am sympathetic to the query. On the other hand, there is much that goes into the pricing of a procedure.
In Canada, I paid $145 (Canadian) out of pocket for a trans-esophageal echocardiogram when I needed one to rule out endocarditis. It is essentially an ultrasound of the chest cavity done via a swallowed probe. My insurance in Illinois was billed >$800 (US) for the same procedure at another time.
[Incidentally, I showed up at a family medicine physician's office in Canada with complaints of recurrent waxing and waning fever, chills, and history of both a tooth abscess and a replaced heart valve. I got the appropriate lab test that day (an ESR to measure general inflammation), was referred to a cardioloist (appointment in 2 days), and then the cardiologist ordered the echocardiogram (happened the next day).]
[ February 02, 2005, 04:10 PM: Message edited by: ClaudiaTherese ]
Posted by BannaOj (Member # 3206) on :
I *think* ultrasound= sonogram. In which case I underestimated the cost of the human ones and it's more like 10x the cost of the animal ones.
Also from personal experience, after I had my Gallbladder surgery I owed the hospital a little over $1000. I called them and asked if I could work out a payment plan. On the spot, they offered to drop the cost to $600, if I could pay it then. It was tight but we managed to swing it.
But hospitals do sell their unpaid bills to collection agencies who then hound their customers. (I had an accidental bill from that episode that never actually got sent to me that this happened to) It doesn't effect your credit report, and the collection agencies have no right to hound you to begin with, legally they have to stop if you ask them to, regardless of whether the debt is medical related or not. But most people don't know their own rights.
Also people run up credit cards while trying to pay their medical bills (talks about that in the article) another self defeating stragegy that only education could cure. But the credit companies don't really want you to have that education do they? Congress had to force them to let you see your credit reports for free once a year as it is.
AJ
Posted by ClaudiaTherese (Member # 923) on :
(ultrasound does = sonogram)
Posted by BannaOj (Member # 3206) on :
But CT the insurance industry already has list of gradations of extensiveness of the procedure and how much "value" it is worth to begin with, and how much they are willing to pay. There are at least 3 different sets of numbers that value these procedures. Correllating it to similar procedures in veterinary pracitices wouldn't be that difficult (an ordinary pregnancy ultrasoound with no complications vs more extensive one with a high risk pregnancy would obviously cost different amounts both in animals and humans.)
AJ
[ February 02, 2005, 04:15 PM: Message edited by: BannaOj ]
Posted by ketchupqueen (Member # 6877) on :
AJ, we did put most of that sonogram on the cc. Bad, and we knew it, but as I said, I needed desperately to continue treatment, which was not going to happen without payment. (I was two months pregnant and bleeding.)
Posted by BannaOj (Member # 3206) on :
Aren't doctors leagally obligated to continue treatment in life threatening situations, regardless of the patients ability to pay or am I horribly naieve?
AJ
Posted by ClaudiaTherese (Member # 923) on :
I'm not disagreeing with you, AJ. Not at all. I am under the impression that this is a money-making business, and providers will charge in order to maximize what they will be paid. I'm pretty (cynically) sure that if vet procedure providers could charge more, they probably (in general) would.
I'd also claim that you likely have more altruists in that field anyway, though. Just a gut feeling, no data.
When providing healthcare is not seen as primarily a for-profit enterprise, I think the prices become more reflective of the actual costs.
Posted by Amka (Member # 690) on :
I think the swallowed probe ultrasound is a different procedure than a prenatal ultrasound. Just from what Sara described, I'm sure it would cost more for a dog too. My prenatal ultrasounds cost around $200, I believe.
Doctors have a lot more expenses than vets, and it wouldn't suprise me if it turned out to be considerably more that 3X the price of a vet's service. Medical malpractice insurance alone is going to bump up fees. I suspect nurses get paid more than vet assistants, as well. At our vet, the girl at the desk is also often the same person who helps the vet, if he needs it.
I suspect they are also a lot more likely to be consulted after hours than doctors.
Posted by ClaudiaTherese (Member # 923) on :
quote:Aren't doctors leagally obligated to continue treatment in life threatening situations, regardless of the patients ability to pay or am I horribly naieve?
We are legally required to stabilize a patient in critical condition. That doesn't guarantee you much as a patient overall, though. There is no general legal requirement to provide non-emergent care (emergent = loss of life and/or limb is immanent, as in now).
As to whether there is an ethical requirement, you can guess what I'd say. But that isn't the law.
[ February 02, 2005, 04:28 PM: Message edited by: ClaudiaTherese ]
Posted by ClaudiaTherese (Member # 923) on :
I'm sure Amka is correct in her assessment above, as well.
The TEE did cost a lot more than a standard echo (ultrasound of the heart) would. However, the same procedure cost much much less under a non-profit system. I don't quite know how to interpret that, but I find it interesting. How much of that was due to less bureaucratic cost passed on? I don't really know.
[ February 02, 2005, 04:25 PM: Message edited by: ClaudiaTherese ]
Posted by BannaOj (Member # 3206) on :
Note: I'm just throwing out something I've been musing on, a "wouldn't it be nice" I'm not saying it is actually feasible with the current american healthcare behemoth.
AJ
Posted by ClaudiaTherese (Member # 923) on :
I have issues with the current american healthcare behemoth.
I'm glad and grateful that I've had good care myself, but I want to make the care here better. I want it to be the best, really and truly the best, not just pretend.
Posted by Bob the Lawyer (Member # 3278) on :
I always wonder about average ER waiting time stats. I was in the hospital for about 6 hours when I dislocated my shoulder (even though I was pretty sure it was properly back in the socket). I met someone who arrived before me complaining about a migraine who wasn't seen until I was leaving, so she was there for about 7 hours. A man came in complaining of chest pains and had a waiting time of about a minute and a girl came in with a head wound who had a waiting time equal to the time it took to cross the waiting room. The average waiting period for each of us was 3.25 hours, but that is by no means a measure of the quality of care.
And what did I get for my 6 hours? 7 X-Rays, a shot of an anti inflammatory (didn't think to ask what), a sling, a referral at 1 week and 3 weeks which will not have any waits involved and, if necessary, physio. Total cost? 20$ for the sling. I feel it was worth my time.
Edit: Wrong number of X-Rays.
[ February 02, 2005, 04:31 PM: Message edited by: Bob the Lawyer ]
Posted by dread pirate romany (Member # 6869) on :
quote: AJ, we did put most of that sonogram on the cc. Bad, and we knew it, but as I said, I needed desperately to continue treatment, which was not going to happen without payment. (I was two months pregnant and bleeding.)
I think it reprehensible you could be denied treatment in that circumstance! If you had gone to an ER, would they have not been required to treat you?
We also fall into the category of, we have insurance, but all it would take would be one major accident or illness to put us in dire straits. Although our vision and dental are good- we pay nothing for preventative dental, we only paid $104 for Matthew's two fillings (Brian thought that was as lot, until the dentist's receptionist broke it down for him). We have a $35 co-pay for a full eye exam and glasses ( though two years ago it was $19, and we are pretty sure all the kids will need them someday).
But we are so lucky. My freind is a single mom. She works two jobs, PT, and has no insurance. Her boys are covered but she makes too much for state coverage. And she has recurrent kidney stones with bloody urine. Every spare cent she could be using to get her education, etc, goes to paying a doctor out of pocket.
Posted by ClaudiaTherese (Member # 923) on :
(I have to stop posting soon, as I still have work to do. But this topic is my obsession. No surprise to anyone who knows me, I realize.)
BtL, it varies. There isn't a lot of sitting around that goes on behind the scenes in any of the ERs I've worked at. However, when unstable patients come in, they are bumped to the head of the line. Sometimes a lot of them come in at once, as when there is a multiple-vehicle crash.
At the UW ER in Madison, we keep a close eye on time from check-in. there is a computerized board that starts flashing any given name that is on there for a set period of time, and the ER physicians and other staff are answerable for keeping the average numbers down. Results are posted in either the breakroom or other private area. Similarly for Meriter Hospital in Madison.
Posted by Amka (Member # 690) on :
I think you've pretty well stated how it would change in the non-profit system, Sara.
Medical malpractice would be pooled with every doctor under the system. I suspect, were that the case, there might be a better ability to track such suits and make better laws to avoid frivolous cases or outrageous monetary claims.
Less time doing paperwork = more time to schedule appointments and less administrative costs.
Plus, I do think some things in a profit oriented system cost considerably more not because the procedure is considerably more difficult, but because it happens less commonly and is typically associated with more severe problems. It may be less optional in treatement.
For instance, in most cases, prenatal ultrasounds are not necessary at all. They are, for the most part, considered optional. A mom can refuse it if she wants and has very little to fear. But your procedure, Sara, was absolutely necessary to diagnosis. You wouldn't likely pass it up because it was too expesnive. But in Oregon, where insurance didn't pay for them unless there were health concerns, I did opt not to have an ultrasound because of expense.
Just like when the price of water at a fair can be $3.00 a bottle and you'll pay for it because you are very thirsty.
Posted by Bob the Lawyer (Member # 3278) on :
CT, that's my point
You always here about how ER rooms are clogged to the ceiling in Canada with people who don't necessarily have to be there so the waits are many, many hours. Which is true, the people who don't really have to be there do have to wait many hours, but the real emergencies don't have to wait at all. And yet I always hear ER waiting times as a black mark against the Canadian system.
Posted by ClaudiaTherese (Member # 923) on :
BtL: Ah. Yeah, I'm on the same page as you.
Amka: This is the stuff that keeps me up at nights. The trick is how to balance day-to-day (and very real responsibilities) with an eye on the bigger picture. With that in mind, I'll bid y'all adieu for awhile, as my data calls.
But gee whiz, I hope things stay smooth for you, Amka. Hard stuff.
[ February 02, 2005, 04:43 PM: Message edited by: ClaudiaTherese ]
Posted by ketchupqueen (Member # 6877) on :
(My sonogram was medically necessary to determine what further treatment should be.)
Waiting rooms: I have no problem with the triage system. I've waited a long time with my brother for a broken bone, and yes, it got long, but no one who went ahead of him didn't really need to. And when I was pregnant and needed a breathing treatment now, waiting time was less than the time it took my husband to say "she's pregnant and asthmatic and needs a breathing treatment".
Posted by mackillian (Member # 586) on :
Now I'm waiting for CT to unload her vast knowledge on the subject of the Canadian healthcare system. Posted by ClaudiaTherese (Member # 923) on :
Get thee behind me ...
[ ]
[ February 02, 2005, 04:45 PM: Message edited by: ClaudiaTherese ]
Posted by Derrell (Member # 6062) on :
So, what am I supposed to do? It's beginning to sound like marrying a Canadian is my best option. Serioyusly, what do you do when your job doesn't offer health insurance, you can't find a better job, the state's healthcare system for the poor and working poor is so screwed up that they think you earn too much to qualify, and you need medical care?
I'm sorry for the long, rambling sentence, but i'm really frustrated.
On top of everything else, I now have a serious headache from bashing my head against the wall so much. Posted by Telperion the Silver (Member # 6074) on :
Mmmmmmm... it's nice to see the middle-class give away their wealth to the ruling upper-class. Posted by mackillian (Member # 586) on :
You go into bankruptcy.
Posted by Black Fox (Member # 1986) on :
Well one reason that they send you to that specialist and will do more than what might actually be required for your condition is malpractice suits. If he tells you hey go buy some robatussum and you actually do have something seriously wrong with you and something bad happens then you go around and blame the doctor etc. Its safer for him just to have you go out and buy the prescription meds. That and people have a big thing now a days with getting everything checked up. As a society we have lots of spare time doctors, you know the sort that can come up with dozens of problems because your back is a little sore. I'm not saying you sholdn't go see the doctor when you're hurt etc. Simply that maybe as people we should take a realistic view on our ailments.
Posted by mothertree (Member # 4999) on :
Self pay for a baby in 2000 and a baby in 2003 and tell me malpractice insurance isn't driving up the cost of obstetrics. Don't post me your links. Send me cash.
I can also say, getting back to the original issue, that when whining to your creditors "medical emergency" sounds a hecuva lot better than "we needed a new computer".
Also, the creditors will prompt you. "Do you have an excuse such as a medical situation that you can blame your late payment on?" "Well now that you mention it, yes we do." When their accounts that are in trouble have sound reasons for late pays, it helps them hide the fact that their aggressive marketing to bad credit risks is cutting into their profitability.
Posted by Icarus (Member # 3162) on :
quote:You always here about how ER rooms are clogged to the ceiling in Canada with people who don't necessarily have to be there so the waits are many, many hours. Which is true, the people who don't really have to be there do have to wait many hours, but the real emergencies don't have to wait at all. And yet I always hear ER waiting times as a black mark against the Canadian system.
The wait you described, in my experience, would not be atypical in the states. (By which I mean--in case it's not clear--that I agree with your point, assuming your experience is typical of Canadian ERs.) Granted my own experience is anecdotal, but given the health histories of my wife and two daughters, it's pretty darned extensive anecdotal experience.
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I went with the polycarb lenses, but I may have splurged for the anti-reflective ones, because I don't anticipate buying glasses again for quite a while. I also needed new frames, so it was rather expensive.
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Nor, for that matter, do I believe that requiring all doctors to be nurses first would a) increase the quality of doctors b) make doctors and nurses get along better and c) reduce the current shortage of qualified doctors.![[ROFL]](graemlins/rofl.gif)
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I make $5.60 an hour and work 20 hours a week. How is it that I make too much to qualify? ![[Frown]](frown.gif)
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By the way, are there any single female Hatrackers in Canada? ![[Kiss]](graemlins/kiss.gif)
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